685. Working Together to Define Antibiotic Appropriateness: Point Prevalence Survey in 47 Intensive Care Units from 12 US Hospitals, Partnership for Quality Care, March 2017
Session: Poster Abstract Session: Stewardship: Data and Program Planning
Thursday, October 5, 2017
Room: Poster Hall CD

Background: 

A national assessment of antibiotic appropriateness in intensive care units (ICUs) with benchmarking was performed to assist antibiotic stewardship programs (ASPs) identify improvement opportunities. 

Methods:

A Centers for Disease Control and Prevention tool was adapted by an expert panel from the Partnership for Quality Care (PQC), a coalition dedicated to high quality care in US hospitals, to validate appropriate antibiotic use measurement via a point prevalence survey on a single day. Data was collected by ASP personnel at each hospital, de-identified and submitted in aggregate to PQC for benchmarking. Hospitals identified reasons for inappropriate antibiotic use by category and antibiotics misused. 

Results:   

Forty-seven ICUs from 12 PQC hospitals participated:  California (2), Florida (2), Massachusetts (3), Minnesota (1), and New York (4).  Most hospitals identified as teaching (83%) with 252-1550 bed size (median: 563) and 20-270 licensed ICU beds (median: 70).  All hospitals reported a formal ASP.  On March 1, 2017, 362 (54%) of 667 patients in participating ICUs were on antibiotics (range: 8-81 patients); 1 patient was not assessed. Of the remaining 361 antibiotic regimens, 112 (31%) were identified as inappropriate from among all 12 hospitals (range: 9-82%) (figure).  The table displays inappropriate antibiotic use by ICU type.  Reasons for inappropriate use included unnecessarily broad spectrum of activity (29%), duration longer than necessary (21%), and treatment of a non-infectious syndrome (19%).  The antibiotic most commonly misused was vancomycin in 7 (58%) hospitals.

Conclusion:

Up to 80% of antibiotic use in some ICUs is inappropriate, underscoring the need for ASP interventions, standardized assessment tools and benchmarking. Strategies should focus on de-escalation of broad spectrum antibiotics and reducing duration of therapy.   

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Kavita K. Trivedi, MD1, Belinda Ostrowsky, MD, MPH, FIDSA, FSHEA2, Lilian M. Abbo, MD3, Arjun Srinivasan, MD, FSHEA4, Rachel Bartash, MD2, Fred Cassera, RPh5, Jorge Fleisher, MD6, David W. Kubiak, PharmD, BCPS {AQ ID}7, Alyssa R. Letourneau, MD, MPH8, Priya Nori, MD2, Stephen Parodi, MD, FIDSA9, Laura Aragon, PharmD, BCPS-AQ ID10, Eliza Dollard, PharmD10, Christina Gagliardo, MD11, Monica Ghitan, MD, FIDSA12, Amber Giles, PharmD10, Suri Mayer, PharmD5, Jennifer Quevedo, PharmD13, Gunter Rieg, MD14, Galina Shteyman, PharmD, BCPS15, Jaclyn Vargas, MD16, Shannon Kelley, MPA17 and Phyllis Silver, MEd17, (1)Trivedi Consults, LLC, Berkeley, CA, (2)Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, (3)Infectious Disease, University of Miami-Jackson Health System, Miami, FL, (4)Centers for Disease Control and Prevention, Atlanta, GA, (5)Maimonides Medical Center, Brooklyn, NY, (6)Infectious Diseases, Saint Elizabeth's Medical Center/ Tufts University, Brighton, MA, (7)Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, (8)Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, (9)The Permanente Medical Group, Vallejo, CA, (10)Pharmacy, Jackson Memorial Hospital, Miami, FL, (11)Pediatrics, Maimonides Infants & Children's Hospital of Brooklyn, Brooklyn, NY, (12)Division of Infectious Diseases, Maimonides Medical Center, Brooklyn, NY, (13)University of Miami Hospital, Miami, FL, (14)Kaiser Permanente, Harbor City, CA, (15)Park Nicollet Methodist Hospital, Health Partners, St. Louis Park, MN, (16)Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, (17)Partnership for Quality Care, New York City, NY

Disclosures:

K. K. Trivedi, None

B. Ostrowsky, None

L. M. Abbo, None

A. Srinivasan, None

R. Bartash, None

F. Cassera, None

J. Fleisher, None

D. W. Kubiak, Shionogi: Consultant , Consulting fee
Astellas Pharma: Consultant , Consulting fee

A. R. Letourneau, None

P. Nori, None

S. Parodi, None

L. Aragon, None

E. Dollard, None

C. Gagliardo, None

M. Ghitan, None

A. Giles, None

S. Mayer, None

J. Quevedo, None

G. Rieg, None

G. Shteyman, None

J. Vargas, None

S. Kelley, None

P. Silver, None

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