242. Evaluating the Effectiveness of Antimicrobial Restriction at an Academic Medical Center
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions to Improve Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Abx Stewardship Poster IDWeek 2018 FINAL_9.14.2018.jpg (1.5 MB)
  • Background:

    Antimicrobial Stewardship Programs (ASPs) promote the optimal use of antimicrobial agents with the goal of preserving the effectiveness of existing drugs. One core ASP strategy is formulary restriction and preauthorization (PA). We evaluated restricted antimicrobial use at an academic medical center in Virginia; our program has a comprehensive restriction program that applies to adults only.

    Methods:

    Data from August 2012 to June 2017 were evaluated at the hospital unit level by month in days of therapy (DOT) per 1,000 patient-days. Ordinary least squares regression was used to compare the time trend of restricted use with that of non-restricted agents within the same unit.

    Results:

    Across the study period significant decreases in restricted antibiotic use were detected for medical and pediatric units with no significant increases in use. However, significant increases were identified for surgical units.

    Restricted

    TYPE

    UNIT

    Time Trend

    p

    Medical

    Oncology

    0.64

    0.0924

    Acute Care Medicine

    0.39

    0.4058

    Cardiac ICU

    -0.37

    0.1057

    Medical ICU

    -2.06

    0.0002

    Bone Marrow Transplant

    0.52

    0.5002

    Digestive Health

    -0.14

    0.3004

    Progressive Care

    -0.93

    0.0002

    Pediatric

    General Pediatrics

    -0.36

    0.1363

    Neonatal ICU

    -0.29

    0.0007

    Pediatric ICU

    -0.12

    0.7849

    Progressive Care

    -0.29

    0.0993

    Surgical

    Acute Care Surgery

    -0.30

    0.1574

    Burn ICU

    0.84

    0.0021

    Cardiac Surgery ICU

    -0.50

    0.2766

    Surgical Trauma ICU

    -0.52

    0.1019

    Table 1 – Results of Time Trend Analysis by Unit for Restricted Drugs.

    Unit Type

    Restricted

    Increase

    Decrease

    Medical

    0/7 (0%)

    2/7 (29%)

    Pediatric

    0/4 (0%)

    1/4 (25%)

    Surgical

    1/4 (25%)

    0/4 (0%)

    Table 2 – Significant Increases/ Decreases in Restricted Antimicrobials by Unit Type

    Conclusion:

    These data suggest the PA strategy for medical wards was effective across the time period whereas the PA strategy for surgical wards was suboptimal. However, it is unclear why pediatric wards (that were not subject to PA activities) also saw reductions in use; more research into this is needed.  These data will help us refine our PA strategy by targeting use on surgical wards. We believe this type of analysis may be useful for other ASPs utilizing the PA strategy.

    Andrew Kirk, BS1, Kimberly Lee, PharmD2, John Markley, DO3, Amy Pakyz, PharmD, MS, PhD4, Gonzalo Bearman, MD, MPH, FSHEA5, Michelle Doll, MD, MPH6 and Michael Stevens, MD, MPH3, (1)Virginia Commonwealth University, Richmond, VA, (2)Virginia Commonwealth University Health System, Richmond, VA, (3)Infectious Diseases, Virginia Commonwealth University Health System, Richmond, VA, (4)Dept. of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond, VA, (5)Infectious Diseases, VCU Medical Center, Richmond, VA, (6)Division of Infectious Diseases, Virginia Commonwealth University Medical Center, Richmond, VA

    Disclosures:

    A. Kirk, None

    K. Lee, None

    J. Markley, None

    A. Pakyz, None

    G. Bearman, None

    M. Doll, None

    M. Stevens, None

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