214. Antimicrobial Usage and Outcomes following Laboratory Suppression of Antimicrobial Susceptibility Results for Pseudomonas aeruginosa in Sputum Cultures
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions to Improve Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • PSEUDOMONAS.pdf (66.9 kB)
  • Background:

    Pseudomonas aeruginosa isolates from sputum cultures do not always require treatment, often representing chronic airways colonization. By releasing sputum P. aeruginosa antimicrobial susceptibility results, only after specific phone request by treating doctors, we aimed to reduce use of ciprofloxacin without compromising clinical outcomes.

    Methods:

    From 26 February 2015, antimicrobial susceptibility results for P. aeruginosa in sputum were routinely suppressed except for immunosuppressed, Intensive Care Unit, cystic fibrosis or bronchiectasis patients. A database search of the Wollongong Hospital Microbiology laboratory information system identified 108 patients with susceptibility results suppressed (26 Feb 2015 - 25 Feb 2017), compared with 108 patients where antimicrobial susceptibility results were routinely reported (26 Feb 2013 - 25 Feb 2015). Data collected included age, sex, residency, admission date and diagnosis, comorbidities, allergy, empirical and definitive antibiotic treatment, date of sputum culture, resistance patterns of P. aeruginosa, ciprofloxacin usage, Antimicrobial Stewardship interventions, length of stay, inpatient mortality and readmission within 30 days.

    Results:

    The prevalence of P. aeruginosa in sputum cultures was 11% (1252/11388). Patient characteristics were comparable in the two groups. Ciprofloxacin use was significantly reduced post-intervention [26.9% (29/108) versus 39.8% (43/108); p= 0.043] as well as Guidance MS approvals [9.03% (87/963) versus 17.72% (188/1061); p=0.000001].  Interrupted time series analysis of this intervention was not associated with a significant change in the rates of ciprofloxacin use.

    Rates of ciprofloxacin resistance were lower post-intervention [2.8% (3/108) versus 16.7% (18/108); p= 0.0006], reaffirmed by SQL database search of the OMNI-Client [9.30% (32/343) versus 15.00% (60/399); p= 0.0187].

     

    Ciprofloxacin usage against resistance over time

     

    There was no difference in length of stay, 30-day readmission and mortality.

    Conclusion:

    This study offers a successful model of collaboration between the microbiology laboratory and antimicrobial stewardship activity. It showed a reduction in use of ciprofloxacin with possible influence on P. aeruginosa resistance rates, without affecting patient outcomes.

     

    Kwee Chin Liew, MBBS / Bachelor of Medical Sciences (1st Class Honors)1, Oliver Evans, MBBS1, Erica Wales, MD2, Stuart Bond, PhD2,3, Peter Newton, MBBS, FRCPA4 and Spiros Miyakis, MD, PhD, FRACP1,3,5, (1)Department of Infectious Diseases, Wollongong Hospital, New South Wales, Australia, (2)Department of Pharmacy, Wollongong Hospital, New South Wales, Australia, (3)School of Medicine, University of Wollongong, New South Wales, Australia, (4)NSW Health Pathology, Microbiology, Wollongong Hospital, Wollongong, New South Wales, Australia, (5)Illawara Health and Medical Research Institute, Wollongong, New South Wales, Australia

    Disclosures:

    K. C. Liew, None

    O. Evans, None

    E. Wales, None

    S. Bond, None

    P. Newton, None

    S. Miyakis, 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.