1020. Out of Sight – Out of Mind: Impact of Cascade Reporting on Escherichia spp and Klebsiella Infections
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall

Targeted use of narrower spectrum antibiotics (ATB) as a key strategy for antimicrobial stewardship can reduce emergence of drug resistance, unnecessary drug toxicities, super-infection and costs. The goal of this study is to evaluate the effect of cascade reporting (CR) on ATB prescribing and outcomes in patients with Escherichia and Klebsiella infections.


A retrospective analysis of all patients with Escherichia and Klebsiella infections at a tertiary care academic medical center comparing pre-CR (July 2013 – June 2014) to post-CR (July 2014 to June 2015) was performed assessing the impact of the following CR: “If ceftriaxone is susceptible (S), then cefepime and meropenem will be suppressed. If ceftriaxone is resistant (R), then cefepime and meropenem will be reported. If ampicillin/sulbactam (AS) is S, then piperacillin/tazobactam (PT) will be suppressed. If AS is R, then PT will be reported.” ATB started within 7 days of culture collection were analyzed. The primary endpoint was the difference in mean days of therapy (DOT) of cefepime in pre-CR and post-CR. Secondary endpoints included DOT of individual ATBs, incidence of Clostridium difficile, length of stay (LOS), 3-month readmission and mortality. Continuous data was compared using student’s t-test and rank sum test, as appropriate. Categorical and discrete variable comparisons were done using chi-square.

Results: 1522 patients had positive cultures for Escherichia spp and Klebsiella spp (612 pre-suppression and 901 post-suppression). There is significant decrease in cefepime DOT in post-CR vs pre-CR (5.6±5.0 vs 3.88±2.60 days, p<0.001) with no significant difference in mean DOT in fluoroquinolones (FQN), AS, cefazolin, ceftriaxone, PT and carbapenem, C. difficile, 3-month readmission and mortality rates. There was a significant decrease in LOS after CR implementation (12.9±12.6 vs 10.9±11.1 days, p<0.001).

Conclusion: CR was effective in significantly reducing the overall usage of cefepime without increasing FQN, PT or carbapenem usage. In addition LOS was significantly decreased in this patient population since implementation of CR. It is an effective strategy to guide clinicians towards using appropriate narrower-spectrum ATB therapy.

Siyun Liao, Pharm.D., PhD, BCPS, UC Health - University of Cincinnati Medical Center, Cincinnati, OH, Judith Rhodes, Ph.D., DABMM, Microbiology and Molecular Diagnostics, UC health, Cincinnati, OH and Madhuri Sopirala, MD, MPH, Infectious Diseases/Internal Medicine, University of Cincinnati, Cincinnati, OH


S. Liao, None

J. Rhodes, None

M. Sopirala, None

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