Methods: A retrospective chart review was performed to compare the rates of 30-day readmissions of patients 65 years and older who received ASP interventions between January and June 2017 with a control sample who received antibiotics between January and June 2015 (pre-ASP). Patients were included if they received antibiotics for pneumonia (PNA), urinary tract infection (UTI), acute bacterial skin and skin structure infection (ABSSSI) and complicated intra-abdominal infection (cIAI). The ASP team met daily to review patients identified by the clinical pharmacist. ASP interventions consisted of de-escalation of empiric or definitive therapy, change in duration of therapy or discontinuation of therapy. Treatment failure was defined as readmission due to re-infection or a new infection (e.g. Clostridium difficile).
Results: Overall, 461 patients (150 control; 311 intervention) were included. The 30-day readmission rate for all infections decreased during the intervention period (10.7% vs 3.9%, p=.004). There was a statistically significant decrease in 30-day readmissions in the PNA subgroup (9.8% vs. 2.9%, p=.038), a marginally significant decrease among UTI patients (12.5% vs. 4.7%, p=.097), and no statistically significant change in the ABSSSI (5.6% vs. 8.6%, p=.694) and cIAI (20.8% vs 6.7%, p=.233, CI) subgroups. The total APD was 16,267 (control) and 15,487 (intervention). Total antimicrobial expenditure during the control period was $379,643 ($23.33/APD) vs. $67,721 ($4.37/APD) during the intervention period.
Conclusion: ASP efforts did not lead to an increase rate of 30-day readmissions due to treatment failure. Furthermore, there was a statistically significant decrease in readmission rates in the intervention group as well as a large decrease in antimicrobial expenditure per APD.
R. Tuma, None
D. Livert, None