1541. An Offer You Can’t Refuse: Clinical Impact of Accepting or Rejecting a Recommendation from an Antibiotic Stewardship Program
Session: Poster Abstract Session: Stewardship: Improving Outcomes
Friday, October 6, 2017
Room: Poster Hall CD
Posters
  • 1541_IDWPOSTER.pdf (814.4 kB)
  • Background:

    The outcomes associated with the acceptance or refusal of a recommendation from an antimicrobial stewardship program (ASP) on an individual level have not been studied yet. Our objective was to compare the clinical characteristics and mortality of patients for whom a recommendation from an ASP, based on prospective audit and feedback and triggered by a computerized decision support system, was accepted or refused.

    Methods:

    We performed a retrospective cohort study of all hospitalized adult patients who received intravenous or oral antimicrobials in two tertiary care hospitals in Canada between 2014 and 2016, and for whom a recommendation was issued by an ASP.

    Results:

    We identified 1251 recommendations throughout the study period. Among the recommendations made by the pharmacist to prescribers, 1144 (91.5%) were accepted. The most frequent interventions were immediate scheduling end of treatment (n=364, 29%), dosing/frequency adjustments (n=321, 26%), streamlining (n=251, 20%), and switching from intravenous to oral therapy (n=247, 20%). The antimicrobials most frequently targeted by recommendations were piperacillin/tazobactam (n=273, 22%) and fluroquinolones (n=267, 21). Overall, the length of the antimicrobial targeted by the recommendation was significantly shorter when a recommendation was accepted (0.37 days vs 2.11 days; P<.001). In the multiple logistic regression analysis, the independent risk factors associated with in-hospital mortality were the Charlson score, issuance of a recommendation for a patient in the intensive care unit, the duration between admission and the recommendation, issuance of a recommendation in 2016 (compared to 2014), and age of the patient. A recommendation issued on a fluoroquinolone or oral penicillin/1st generation cephalosporin was associated with lower odds of mortality. After adjustment, refusal of a recommendation by the attending physician was associated with a higher, albeit nonsignificant, risk of mortality (AOR, 1.81; 95% CI, 0.89–3.68; P=.10).

    Conclusion:

    The duration of the antimicrobial treatment was significantly shorter when a recommendation triggered by an ASP program was accepted. This decrease in antimicrobial duration was not associated with increased mortality.

    Alex Carignan, MD, MSc, FRCPC1, Adam Mercier, MD1, Julie Perron, B.Pharm., M.Sc.2, Vincent Nault, M.Sc.1, Isabelle Alarie, MD1, Cybele Bergeron, MD1, Mathieu Beaudoin, Ph.D.3 and Louis Valiquette, MD, MSc, FRCPC4, (1)Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, QC, Canada, (2)Department of Pharmacy, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada, (3)Department of Computer Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada, (4)Microbiology and Infectious Disease, Université de Sherbrooke, Sherbrooke, QC, Canada

    Disclosures:

    A. Carignan, None

    A. Mercier, None

    J. Perron, Lumed Inc., the company that commercializes APSS: Shareholder , Shareholder

    V. Nault, Lumed Inc., the company that commercializes APSS: Shareholder , Shareholder

    I. Alarie, None

    C. Bergeron, None

    M. Beaudoin, Lumed Inc., the company that commercializes APSS: Shareholder , Shareholder

    L. Valiquette, Lumed Inc., the company that commercializes APSS: Shareholder , Shareholder

    Previous Abstract | Next Abstract >>

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.