202. Implementation and Three-Year Results of Antimicrobial Stewardship Program in a Three Hospital Community Health System
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions to Improve Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
  • ID Week ASP Poster 2018.pdf (709.6 kB)
  • Background: Antimicrobial Stewardship Programs (ASPs) have been shown to reduce hospital-onset Clostridium difficile infection (HO-CDI) rates and antimicrobial utilization (AU). The purpose of this study was to evaluate the implementation of multi-disciplinary ASP targeted towards finding a direct correlation between AU and HO-CDI.

    Methods: This is a 3 year review of implementation of ASP in late 2014 Q4 in three hospital health system. Multi-disciplinary ASP committee was established with representation from infectious diseases, clinical pharmacy, infection control, nursing, microbiology and informatics. Each of the three hospital implemented targeted stewardship efforts with initial focus on monthly advanced education, daily audit and feedback for targeted antibiotics, and infectious diseases approved restricted antibiotics. We created a monthly checklist of CDC Core Elements for committee review. The primary objective of this initiative was to evaluate changes in total and targeted AU and HO-CDI within a program over 3 year period. Subgroup analysis evaluated annual antimicrobial cost/patient day. The secondary objective was Spearman's rank correlation analysis between AU and HO-CDI.

    Results: Baseline overall AU analysis was based on 2014 and the intervention period included 2015, 2016 and 2017. Baseline overall AU in 2014 was 850 DOT/1000PD. We observed a consistent decline in overall AU in 2015, 2016 and 2017 (740, 572, and 550 DOT/1000PD respectively). Targeted analysis revealed consistent decline from 2014 to 2017 in fluroquinolones (FQ) (140 vs 35 DOT/1000PD) and ceftriaxone (CTX) (85 vs 65 DOT/1000PD). Overall decline was also noted in rates of HO-CDI from 2014 to 2017 (5.75 vs 3.38 per 10000PD). Consistent decline in overall antimicrobial cost/patient day was noted from 2014-2017 ($13.76 vs $13.41/patient day). Spearman's rank correlation analysis showed positive correlation between decline in AU and HO-CDI in overall antibiotics (r=0.58, P=0.022), CTX (r=0.61, P=0.016), and FQ (r=0.54, P=0.038).

    Conclusion: We present implementation of an effective health system wide multi-disciplinary ASP. With ASP efforts over 3 years, we were able to show decline and positive correlation in overall as well as targeted AU and HO-CDI. We also noticed a consistent decline in cost/patient day in this timeframe.

    Nikunj Vyas, PharmD, BCPS1, Cindy Hou, DO, MA, MBA, FACOI2, Marianne Kraemer, RN, MPA, ED.M., CENP, CCRN3, David Condoluci, DO, MACOI3, Deborah Cunningham, MT HHS, BA4 and Sungwook Kim, Ph.D.5, (1)Pharmacy, Jefferson Health - New Jersey, Stratford, NJ, (2)Jefferson Health - New Jersey, Cherry Hill, NJ, (3)Jefferson Health - New Jersey, Stratford, NJ, (4)Microbiology/Laboratory, Jefferson Health - New Jersey, Cherry HIll, NJ, (5)Department of Mathematics, Physics, and Statistics, University of Sciences, Philadelphia, NJ


    N. Vyas, None

    C. Hou, None

    M. Kraemer, None

    D. Condoluci, None

    D. Cunningham, None

    S. Kim, 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.