Background: Required indication/duration and a 48 hour antimicrobial time out are an integral part of antimicrobial stewardship standards; however, limited data are available to demonstrate an effect on antimicrobial use and stewardship practice. We evaluated the impact of mandatory declared indications/durations along with a 48 hour time out on antimicrobial utilization and antimicrobial stewardship program (ASP) interventions.
Methods: We performed a retrospective evaluation of ASP interventions and antimicrobial use following implementation of mandatory indication/duration at the point of order entry. A 48 hour antimicrobial time out was introduced on the same date. This study was conducted at Childrens Mercy Kansas City, a freestanding pediatric hospital located in Kansas City, Missouri. Data were collected from February 1, 2016 to January 31, 2018. A pre- and post-comparison was performed; interventions were implemented hospital-wide on February 14, 2017. ASP intervention rates were measured. Days of therapy (DOT) per 1000 patient days of antibiotics were evaluated. Poisson models were utilized to compare DOT rates pre- and post-implementation, and seasonal decomposition analyses were performed to account for seasonal variability.
Results: A significant decrease in DOT rates was observed in non-ASP monitored antibiotics post-implementation, including cefazolin (39.7 to 36.9; p<0.001), ampicillin (39.9 to 35.7; p<0.001), and clindamycin (38.2 to 35.9; p<0.001). Additionally, a decrease also occurred in ASP monitored antibiotics including ceftriaxone (46.5 to 43.4; p<0.001) and meropenem (8.7 to 6.6; p<0.001). Vancomycin usage was unchanged. Cefepime and piperacillin/tazobactam were excluded due to the impact of drug shortages. ASP intervention rates did not decrease (16.9% vs. 16.8%, p=0.94).
Conclusion: Implementation of additional stewardship practices, including mandatory antimicrobial indication/ duration and a 48 hour time out, decreased the use of antimicrobials, including those not monitored by our ASP. These efforts augmented, but did not replace existing stewardship efforts. These results support initiatives highlighted by national organizations to minimize unnecessary antimicrobial use through ASP.
B. R. Lee, None
T. Frank, None
L. Fitzmaurice, None
R. Ogden, None
B. O'Neal, None
J. Goldman, None
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