Preauthorization of restricted antibiotics is a core component of antibiotic stewardship programs (ASP). Historically, a list of restricted antibiotics was maintained and prescribers were contacted and informed of the policy to obtain Infectious Disease (ID) approval; however, the initial treatment was provided without delay. On day 3, information about culture results and clinical status is typically available. We hypothesized that requiring reapproval on day 3 might improve the appropriateness of directed. antibiotic therapy. The main study objective is to compare an ASP that requires initial approval alone to one requiring initial and reapproval on day 3 of therapy.
A single center retrospective, quasi-experimental study was conducted. Randomly selected adults were eligible if receiving a restricted antibiotic ≥3 days during April to June in 2012 (preintervention) and during the same months in 2013 (postintervention). The target sample size was 163 patients with 83 in each group. The intervention required pharmacists to refer restricted antibiotics that were continuing on day 3 to the ID Service for reapproval with continued initial approval. The outcome variables included: days of therapy (DOT) of restricted antibiotics and length of hospital stay (LOS). Outcome variables were compared between pre- and post-intervention periods using a two-tailed Mann-Whitney U test for continuous variables and Fisher’s exact or chi-square test for categorical variables.
There were no significant differences in patient characteristics. The ASP intervention resulted in a decrease in median DOT from 5 (4-9) to 4 (3-5) days (P < .001) for all restricted agents, from 5 (3-6) to 3 (3-5) days for broad-spectrum Gram-negative agents (P < .001), and from 6.5 (6-7) to 3.0 (3-4.5) days for oral vancomycin. The proportion of subjects receiving restricted agents ≥3 days decreased from 63% to 41% (P < .001). LOS decreased from 8 (5-17) to 6 (5-9) days (P=.005) without a significant change in hospital mortality (9.6% and 2.4%, respectively).
Requiring reapproval of restricted antibiotic on day 3 of therapy reduced the overall consumption of restricted antibiotics and decreased LOS without adversely affecting hospital mortality.
S. Alshehri, None
D. Nix, None
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