1818. Characteristics of a Cohort of Patients on Broad-Spectrum Antibiotics Targeted for Prospective Audit and Feedback.”
Session: Poster Abstract Session: Antimicrobial Stewardship: New Methods and Metrics
Saturday, October 6, 2018
Room: S Poster Hall
Background: Prospective audit and feedback (PAF) is a cornerstone of antibiotic stewardship (AS). PAF reduces inappropriate antibiotic use, decreases resistance, and improves outcomes. A major drawback of PAF is the significant time commitment required to determine which patients are on inappropriate antibiotics. The aim of this study was to describe features of a cohort of patients targeted for PAF and to identify factors associated with PAF intervention.

Methods: Retrospective cohort of all inpatients at UCSF Medical Center, who received a broad-spectrum antibiotic targeted by the AS program for PAF. Data was extracted from the electronic medical record. The outcome of interest was whether the AS team documented a recommendation (“rec”) on any given day. Univariate analyses were performed using Chi-squared tests for categorical data and t-tests for continuous data to compare variables

Results: Between December 15, 2015 and August 1, 2017, 9651 adult patients received at least one “targeted” antibiotic with a total of 62,095 days of therapy comprising 18,275 antibiotic courses (mean 1.9 courses/pt x 3.4 days) with 684 AS interventions made. Time to AS intervention was 4.6 days (±4.3). Table 1 shows factors associated with PAF intervention.

Conclusion: Factors associated with PAF intervention can help to prioritize patients for review by the AS team. These factors will be used to develop predictive models to improve the efficiency and effectiveness of PAF.

Table 1.

Overall

Rec

No Rec

P value

By course

n = 18,275

n = 684

n = 17,591

Female

7,922(43.4%)

288(42.1%)

7,634(43.4%)

NS

Age (years)

56.8

57.5

56.8

NS

Service

Medical

9,087(49.7%)

339(49.6%)

8,748(49.7%)

Surgical

4,694(25.7%)

157(23.0%)

4,537(25.8%)

Transplant

4,494(24.6%)

188(27.5%)

4,306(24.5%)

NS

# of Abx

1.8

2.3

1.7

<0.05

+ BCx

1,373(7.5%)

130(19.0%)

1,243(7.0%)

<0.05

ICU

4,504(24.7%)

285(41.7%)

4,219(24.0%)

<0.05

Prior ID consult

2,491(13.6%)

45(6.7%)

2,446(13.9%)

<0.05

By day

n = 62,095

n = 684

n = 61,411

WBC Count

10.1

10.2

10.1

NS

Tmax

37.3

37.4

37.3

0.07

Abx

Meropenem

5,611(9.0%)

152(22.2%)

5,459(8.9%)

<0.05

Piperacillin-Tazobactam

18,334(29.5%)

303(44.3%)

18,031(29.4%)

<0.05

Cefepime

7,184(11.6%)

76(11.1%)

7,108(11.6%)

NS

Vancomycin

27,106(43.7%)

414(60.5%)

26,692(43.5%)

<0.05

Rachel Bystritsky, MD1, Albert T Young, BA2, Andrew Wong, BA2, Alexandra Hilts-Horeczko, PharmD3, Conan Macdougall, PharmD, MAS, BCPS4, Henry F. Chambers, MD5 and Sarah B. Doernberg, MD6, (1)Infectious Diseases, University of California San Francisco, San Francisco, CA, (2)University of California, San Francisco, San Francisco, CA, (3)University of California San Francisco Medical Center, San Francisco, CA, (4)Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA, (5)Clinical Research Services, University of California San Francisco, Clinical and Translational Sciences Institute, San Francisco, CA, (6)Division of Infectious Diseases, University of California San Francisco, San Francisco, CA

Disclosures:

R. Bystritsky, None

A. T. Young, None

A. Wong, None

A. Hilts-Horeczko, None

C. Macdougall, None

H. F. Chambers, None

S. B. Doernberg, Genentech: Consultant , Consulting fee . Actelion: Consultant , Consulting fee .

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