Methods: An ASP was established at Amrita Hospital in Feb 2016 consisting of an administrative champion, hospitalist, microbiologist, intensivist and 5 pharmacists. Institutional guidelines for polymyxins were established and disseminated. The ASP team performed daily post-prescriptive reviews, evaluated and tracked appropriateness of PB and PE use, including administration of a loading dose (LD), maintenance dose (MD), frequency, route & duration of therapy. ASP recommendations & compliance were recorded.
Results: During the 12-month study period (Feb ‘16-Jan ‘17), 348 patients received 295 PE and 94 PB courses. Mean age was 50 yrs & 73% were male. Patients on Medicine and Hematology/Oncology teams accounted for 42% of all prescriptions. The most common infections were bacteremia (34%), pneumonia (29%) and UTI (23%). Pathogens were recovered in 69% (269/389) of cases, Klebsiella pneumoniae 23% (90/389) & Acinetobacter baumanii11 % (45/389) were most common. 290 (75%) of polymyxin course were judged to be inappropriate (78% of PE & 22% of PB). The most frequent reasons for inappropriate therapy included incorrect frequency of administration (64% for PB & 58% for PE), inappropriate MD (60% for PB & 48% for PE) and wrong duration of therapy (54% for PE & 48% for PB). 95% of incorrect MD for both PE and PB were too low. The reasons for inappropriateness were similar for both polymyxins.While all inappropriate LD episodes for PB (n=22 %) were due to lack of a LD, errors for PE (n= 34%) involved either omission of LD or administration of LD that was too low.ASP recommendations were made in 190 instances with 58% provider compliance.
Conclusion: Review of PB and PE use in our hospital indicates a high percentage of inappropriate use & highlights stewardship opportunities for improving care of patients with resistant infections.
V. Nampoothiri, None
A. Kumar, None
Z. U. Mohamed, None
S. Sudhir, None
J. Pogue, None
S. Singh, None
K. S. Kaye, Xellia: Consultant , Consulting fee
Merck: Consultant and Grant Investigator , Consulting fee and Research support
The Medicines Company: Consultant and Grant Investigator , Consulting fee and Research support