683. ASP Strategies and Appropriate Antibiotic Use
Session: Poster Abstract Session: Stewardship: Data and Program Planning
Thursday, October 5, 2017
Room: Poster Hall CD

Background: The Infectious Diseases Society of America (IDSA) recommends hospitals implement antimicrobial stewardship programs (ASP) in order to decrease inappropriate antibiotic use due to the rise in antibiotic resistant infections. Data are limited on the extent to which different ASP strategies influence appropriate antibiotic use.

Methods: We conducted an online survey in 2016 of U. S. Children’s Hospitals to collect hospital-level information on dedicated ASP effort, ASP monitoring activities, use of audit-feedback, formulary restrictions, rapid diagnostics, etc.  During the same period the ASP teams at these hospitals completed 3 point prevalence surveys that documented details on all admitted patients 0-17 years receiving any antibiotics, determined what ASP modifications could be made, and if the antibiotic was appropriate. We employed hierarchical, multivariable logit models to examine which ASP-related, hospital-level strategies were associated with appropriate antibiotic use.

Results:  Thirty hospitals participated. A total of 6,921 patients were included, representing 10,068 total antibiotics. Of these orders, 8,554 (85.0%) were categorized as appropriate, though this varied across sites (range: 68-92%). Additionally, 78.2% of antibiotics did not have recommended modifications. Appropriate antibiotic use was significantly higher for hospitals that relied on rapid diagnostics (aOR: 1.6; p <.001) or monitored their days of therapy (DOT) rate (aOR: 1.4; p<.001), whereas the presence of either audit-feedback (aOR: 1.04; p=.75) or formulary restrictions (aOR: 0.83; p=.059) were not associated.  Having annual education for all prescribers had increased likelihood of antibiotics having no modification recommendations (aOR: 1.45; p=.037).  Total ASP FTE was not correlated with hospital-level percent appropriate use (corr: -.05; p=.79) or antibiotic modification recommendations (corr: -.08; p=.67).

Conclusion: Routine monitoring of DOT rates and utilization of rapid diagnostics were associated with appropriate antibiotic use. Additional analysis is needed to understand additional factors that can aid hospitals in developing and maintaining ASPs to reduce inappropriate antibiotic use.    

Brian R. Lee, MPH, PhD, Children's Mercy Hospital, Kansas City, MO, Alison Tribble, MD, Department of Pediatrics and Communicable Diseases, Division of Infectious Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, Lori Handy, MD, MSCE, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, Jeffrey S. Gerber, MD, PhD, Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, Adam L. Hersh, MD, PhD, University of Utah School of Medicine, Salt Lake City, UT, Matthew Kronman, MD, MSCE, Pediatrics, University of Washington, Seattle, WA, Cindy Terrill, BS, Division of Pediatric Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO and Jason Newland, MD, MEd, FPIDS, Washington University S, Kansas City, MO


B. R. Lee, Merck: Grant Investigator , Grant recipient
PCORI: Grant Investigator , Grant recipient

A. Tribble, None

L. Handy, None

J. S. Gerber, None

A. L. Hersh, None

M. Kronman, None

C. Terrill, Merck: Grant Investigator , Research grant
Allergan: Grant Investigator , Research grant

J. Newland, Merck: Grant Investigator , Research grant
Allergan: Grant Investigator , Research grant

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.