209. Impact of a risk-based CAP prescribing guideline paired with antimicrobial stewardship to improve antibiotic prescribing for patients at low risk for drug resistant pathogens
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions to Improve Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
  • CCruce IDWeek Poster 2018_CC_09212018.pdf (616.6 kB)
  • Background: Antimicrobial stewardship programs (ASPs) reduce the burden of multidrug-resistant organisms & improve antibiotic prescribing. Concerns about drug-resistant pathogens (DRPs) in community-acquired pneumonia (CAP) lead to over-prescribing of broad-spectrum antibiotics, & ASP interventions to improve CAP prescribing are not well defined. In 2017, our hospital implemented a CAP guideline for patients at low risk for DRPs along with ASP support. The purpose of this study was to evaluate the impact of the guideline with ASP support on CAP-specific antibiotic prescribing.

    Methods: This was a pragmatic two-phase quasi-experimental analysis of CAP-specific antibiotic consumption before & after implementation of a CAP guideline evaluated according to each phase of implementation. The guideline provided Gram-positive & Gram-negative risk factors & guidance on oral fluoroquinolone (FQs) alternatives. ASP interventions were implemented in two phases: A) prospective audit & feedback in 7/2016, & B) publication of guideline with education in 3/2017.  Impact of each intervention was evaluated by interrupted time series segmented-regression analysis. Univariate statistics were calculated using EpiInfo 7. Least-squares segmented regressions were completed in Microsoft Excel.

    Results: CAP-specific antibiotic administrations were 782 over the entire study period, with 764, 771, & 928 administrations observed before phase A, after A, & after B, respectively. Macrolide consumption increased after the guideline (p=0.029). We observed a significant step change decrease in FQ consumption was observed after phase A) (p=0.039) and a positive upward trend in oral alternatives agents after phase B (p=0.090), as shown (Figure). Consumption of broad Gram-negative agents & vancomycin/linezolid were not significantly different after the guideline.

    Conclusion: Implementation of a CAP guideline with patient-specific & DRP risk factors was associated with significant changes in CAP-specific prescribing. Changes in prescribing were temporally associated with ASP interventions. Additional studies into the impact of this guideline on correct classification of Gram-negative resistance & clinical outcomes are needed.


    Caroline Cruce, PharmD1, Michael Postelnick, RPh BCPS AQ ID2, David Martin, PharmD, BCPS2, Sarah Sutton, MD3, Richard G. Wunderink, MD4, Teresa Zembower, MD, MPH, FIDSA3, Marc H. Scheetz, PharmD, MSc, BCPS AQ-ID2 and Nathaniel J. Rhodes, PharmD, MSc, BCPS5, (1)Midwestern University Chicago College of Pharmacy, Downers Grove, IL, (2)Department of Pharmacy, Northwestern Medicine, Chicago, IL, (3)Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, (4)Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, (5)Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, IL


    C. Cruce, None

    M. Postelnick, None

    D. Martin, GlaxoSmithKline: Independent Contractor , Salary . Syneos Health: Employee , Salary .

    S. Sutton, None

    R. G. Wunderink, Achaogen: Consultant , Consulting fee . Arsanis: Consultant , Consulting fee . Bayer: Consultant , Consulting fee . GlaxoSmithKline: Consultant , Consulting fee . KBP Biosciences: Consultant , Consulting fee . Meiji-Seiko: Consultant , Consulting fee . Merck: Consultant , Consulting fee . Nabriva: Consultant , Consulting fee . Polyphor: Consultant , Consulting fee . Roche/Genetech: Consultant , Consulting fee . Shionogi: Consultant , Consulting fee . The Medicines Company: Consultant , Consulting fee . Accelerate Diagnostics: Consultant , Consulting fee . Curetis: Consultant , Consulting fee . bioMerieux: Consultant , Consulting fee .

    T. Zembower, None

    M. H. Scheetz, Merck & Co., Inc.: Grant Investigator , Grant recipient . Bayer: Consultant , Consulting fee .

    N. J. Rhodes, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.