1003. Mining the Power of a “Power Plan”: Antimicrobial Stewardship Program-led Intervention for Improvement of the Management of Staphylococcus aureus bacteremia through the use of an Electronic Order Set
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
Posters
  • SAB_pp_IDW16_poster.pdf (935.7 kB)
  • Background: Outcomes of patients with Staphylococcus aureusbacteremia (SAB) can be improved by adherence to evidence based processes of care (POC). Antimicrobial Stewardship Programs (ASPs) can guide targeted interventions towards these goals.

    Methods: Quasi-experimental pre-post study, to evaluate the impact on compliance with POC in the management of SAB through an intervention led by the ASP. An order set containing evidenced based recommendations for management of S. aureus was created in the computerized physician order entry system (Cerner) (Figure 1). The ASP was notified in real time via email by the microbiology surveillance system (Vigilanz) of all positive blood cultures with S. aureus, and immediately contacted treating physicians, who were advised to use the order set and consult infectious diseases specialist. Comparisons between periods were done using X2, Fisher exact or Mann-Whitney U test. Relative risks for associations with 14 and 30-day mortality were calculated.

    Results: 251 patients were included, 133 (pre-intervention), 118 (post-intervention period). Demographic characteristics are shown in Table 1. A significant increase in percentage of compliance to obtaining follow-up blood cultures, infectious diseases consultation, transesophageal echocardiogram, and use of beta-lactams in MSSA bacteremia was seen (Figure 2). Intervention period did not impact crude 14 or 30-day mortality.

    Conclusion:An ASP-led intervention combining real-time feedback and use of an electronic order set resulted in improvement in the management of SAB by increasing adherence to POC.

    Table 1. Select demographic characteristics

    Variable

    All

    N=251(%)

    Pre-Intervention

    N=133(%)

    Post-Intervention

    N=118(%)

    P-value

    Age (median, IQR)

    55(43-65)

    55(43-67)

    54(42-60)

    0.32

    Male sex

    164(65)

    87(65)

    (65)

    0.98

    MRSA

    129(51)

    62(47)

    67(57)

    0.11

    Renal replacement therapy

    35(14)

    17(13)

    18(15)

    0.57

    Intravenous drug use

    14(6)

    9(7)

    5(4)

    0.38

    Endocarditis/Septic thrombophlebitis

    31(12)

    20(15)

    15(13)

    0.73

    Type of infection

    0.82

    Community-acquired

    66(26)

    36(27)

    30(25)

    Hospital-acquired

    86(34)

    47(35)

    39(33)

    Health-care associated

    99(40)

    50(38)

    49(42)

    Pitt score ³ 4

    63(25)

    27(20)

    36(30)

    0.06

    Charlson Score ³2

    164(65)

    87(65)

    77(65)

    0.98

    Rossana Rosa, MD, Department of Medicine, Jackson Memorial Hospital-University of Miami Miller School of Medicine, Miami, FL, Bruno Zavala, MD, Medicine, Jackson Memorial Hospital, Miami, FL, Natalie Cain, BA, University of Miami Miller School of Medicine, Miami, FL, Shweta Anjan, MD, Jackson Memorial Hospital-University of Miami Miller School of Medicine, Miami, FL and Lilian M. Abbo, MD, UNIVERSITY OF MIAMI. DIVISION OF INFECTIOUS DISEASES, MIAMI, FL

    Disclosures:

    R. Rosa, None

    B. Zavala, None

    N. Cain, None

    S. Anjan, None

    L. M. Abbo, 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.