857. A Tele-Antibiotic Stewardship Program Influences Antibiotic Use at 2 Rural Veterans Affairs Medical Centers
Session: Oral Abstract Session: Antimicrobial Stewardship: Better Prescribing, Better Outcomes
Thursday, October 4, 2018: 2:45 PM
Room: S 156


Telehealth offers the possibility of supporting antibiotic stewardship in settings with limited access to people with infectious diseases (ID) expertise. Previously, we described preliminary results from a pilot project that used the Veterans Affairs (VA) telehealth system to facilitate a Videoconference Antimicrobial Stewardship Team (VAST) which connected a multidisciplinary team from a rural VA medical center (VAMC) with ID physicians at a remote site to support antibiotic stewardship. Here, we present 3 distinct metrics to assess the influence of the VAST on antibiotic use at 2 intervention sites.


Outcomes assessed antibiotic use in the hospital and long-term care units of 2 rural VAMCs in the year before and after VAST implementation, allowing for a 1-month wash-in period in the first month of the VAST. Using VA databases, we determined 3 metrics: the rate of antibiotic use (days of therapy per 1000 bed days of care); the mean length of therapy (days); and the mean patient antibiotic spectrum index (ASI), a measure of antibiotic spectrum increasing from narrow to broad. Using segmented regression on monthly measures of each metric with a knot at the wash-in month (grey square), we calculated predicted values (solid lines) and confidence intervals (dashed lines) to examine trends before (black squares) and after (white squares) implementing the VAST.


The rate of antibiotic use, mean length of therapy, and ASI decreased at Site A. As indicated in the Figure, the effect was more pronounced in long-term care compared to the hospital, where the VAST sustained but did not accelerate downward trends. At Site B, the most notable influence of the VAST was on the ASI for the hospital and long-term care units


The VAST is a feasible, sustainable program that is effective at inducing change in antibiotic use at 2 VAMCs. The influence of the VAST differed between the two sites and, at Site A had a more pronounced effect on the long-term care compared to hospital units. These distinct metrics capture changes in overall antibiotic use, length of therapy and agent selection. Tele-antibiotic stewardship programs hold potential to improve antibiotic use at facilities with limited access to people with antibiotic stewardship expertise.

Brigid Wilson, PhD1, Richard Banks, BS2, Christopher Crnich, MD, PhD3, Emma Ide, BS4, Roberto Viau, MD5, Nadim G. El Chakhtoura, MD, MPH6, Yvonne Jones, RN, MSN7, Jason Cherry, RN, BSN7, Brett Anderson, B Pharm8, Andrew Urban, MD9 and Robin Jump, M.D., Ph.D.10, (1)Geriatric Research, Education, and Clinical Center, Cleveland VA Medical Center, Cleveland, OH, (2)Geriatric Research Center Clinical Center (GRECC), Louis Stokes Cleveland VA Medical Center, Cleveland, OH, (3)University of Wisconsin School of Medicine and Public Health, Madison, WI, (4)Infectious Disease, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, (5)Jacobi Medical Center, Guatemala, Guatemala, (6)Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, (7)Chillicothe Veterans Affairs Medical Center, Chillicothe, OH, (8)Tomah Veterans Affairs Medical Center, Tomah, WI, (9)William S. Middleton VA Hospital, Madison, WI, (10)Case Western Reserve University School of Medicine, Cleveland, OH


B. Wilson, None

R. Banks, None

C. Crnich, None

E. Ide, None

R. Viau, None

N. G. El Chakhtoura, None

Y. Jones, None

J. Cherry, None

B. Anderson, None

A. Urban, None

R. Jump, None

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