977. The Impact of Incorporating Infectious Diseases Led Antimicrobial Stewardship into Multidisciplinary Rounds in the Intensive Care Unit
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
  • PHC-DASON FINAL Poster.pdf (351.1 kB)
  • Background: The availability of infectious diseases (ID) expertise at the point of care has the potential to impact antimicrobial stewardship (AS). Multidisciplinary AS-focused rounds serve to improve knowledge of AS principles among front-line staff, make patient-focused interventions, and promote a collaborative, team approach to patient care. This study evaluated the impact of AS rounds on antibiotic utilization and C. difficile in the intensive care unit (ICU) setting.

    Methods: Two medical/surgical critical care units of a 488–bed community hospital were targeted for AS rounds. AS rounds were led by ID physicians, who rotated rounding duties among three members of a private practice group, assisted by an ID-trained pharmacist, and accompanied by the ICU team. AS rounds occurred two times a week, included chart review of all patients on antimicrobials, group discussion, and verbal feedback of AS recommendations to ICU providers. Staggered implementation occurred at two time points: December 2014 in ICU A and March 2015 in ICU B. The study period of January 2014 to February 2016 included a minimum 11-month pre- and 12-month post-period for both units. The effect of ICU rounds on antibiotic use (AU) in days of therapy per 1,000 patient days and rate of hospital-onset LabID C. difficile events were evaluated by time-segmented Poisson regression adjusted for clustering by unit and first-order autocorrelation.

    Results: Monthly recommendation acceptance rates from AS rounds ranged from 73% to 94%. Reduction in AU was observed among all antibiotics from the pre- to post-period 1499 vs. 1280 DOT/1,000 patient days (Adjusted Rate Ratio 0.84, 95% Confidence Interval 0.70-1.00, p=0.05). Reductions were observed in both anti-pseudomonal beta-lactam antibiotics (0.88, 0.77-1.00, p=0.06), and anti-MRSA antibiotics (0.70, 0.62-0.81, p<.001). C. difficile rates significantly decreased during the post-intervention period (0.14, 0.06-0.37, p<.001). Slope in the post-intervention period was numerically positive for AU outcomes, indicating a need to maintain enthusiasm over time.

    Conclusion: Leadership by ID experts during multidisciplinary, AS-focused rounds in the ICU reduced antibiotic exposures and C. difficile rates in a large community hospital.

    Angelina Davis, PharmD, MS1, Christine Zurawski, MD2, Jesse Couk, MD2, Todd Parker, PharmD3, Daniel Sexton, MD4 and Rebekah W. Moehring, MD, MPH5, (1)Duke Antimicrobial Stewardship Outreach Network (DASON), Durham, NC, (2)Atlanta ID Group, Atlanta, GA, (3)Pharmacy, Piedmont Healthcare, Atlanta, GA, (4)Duke Antimicrobial Stewardship Outreach Network, Durham, NC, (5)Division of Infectious Diseases, Duke University Medical Center, Durham, NC


    A. Davis, None

    C. Zurawski, None

    J. Couk, None

    T. Parker, None

    D. Sexton, None

    R. W. Moehring, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.