192. More low-hanging fruit: antibiotic chelation drug interactions
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions Leveraging the Electronic Health Record
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • MoreLowHangingFruit_IDWeek2018FINAL.pdf (177.1 kB)
  • Background: Attainable, low-resource antimicrobial stewardship (AMS) interventions, “low-hanging fruit” can be facilitated by electronic medical record (EMR) enhancements. Oral (PO) fluoroquinolone (FQ) or tetracycline (TCN) coadministration with di- and tri-valent cations reduces antibiotic absorption by up to 75%, is common, and may represent low-hanging fruit. We evaluated concomitant administration and outcomes in a 5 hospital system before and after an EMR medication safety improvement.

    Methods: IRB approved quasi-experiment, emergency (ED) visits and hospital admissions 09/16–02/17 and 09/17–02/18. Standard of Care: cations were scheduled 0900 and 2100; FQ and TCN administration instructions stated: “Administer at least 2 hours before or 6 hours after (cations)”. Intervention: April 2017 EMR change in the default timing of FQ and TCN to 0630 and 1530 with pharmacy and nurse education. Primary endpoint: Coadministration, defined as administration of PO product containing calcium, magnesium, iron, or phosphate binder 2 hours before or 6 hours after PO doxycycline, ciprofloxacin or moxifloxacin.

    Results: 4414 and 5231 patients, representing 4887 and 5781 encounters received PO FQ or TCN pre and post intervention, respectively. Average age (years) pre: 62.1, post: 61.3. Respiratory infection most common (25% pre, 27% post) followed by genitourinary (13% pre, 12% post). Concomitant administration: 3629/17702, 20.5% pre vs. 2184/20524, 10.6% post (p<0.001), see table 1. Median hospital length of stay: 3 (0.3, 6) pre, 2.9 (0.3, 5.8) post. 30 day all-cause readmission: 28% pre and 27.2% post.

    Conclusion: A system based change to the EMR was effective to reduce the frequency of FQ and TCN chelation interactions by half, and represents a low-hanging fruit strategy for AMS programs. Our institution has subsequently employed this strategy to reduce chelation interactions with HIV integrase inhibitors.

    Table 1. Coadministration by antibiotic

     

    Pre-group

    Post-group

    Drug

    # of administrations

    # (%)  of coadministrations

    # of administrations

    # (%)  of coadministrations

    Ciprofloxacin

    6,209

    1,394 (22.5%)

    6,721

    787 (11.7%)

    Moxifloxacin

    1,689

    392 (23.2%)

    1,378

    168 (12.2%)

    Doxycycline

    9,804

    1,843 (18.8%)

    12,425

    1,229 (9.9%)

     

    Rachel M Kenney, PharmD1, Charles T Makowski, PharmD1, Brian Church, PharmD2 and Susan L Davis, PharmD3, (1)Henry Ford Hospital, Detroit, MI, (2)Henry Ford Health System, Detroit, MI, (3)Pharmacy Practice, Wayne State University, Detroit, MI

    Disclosures:

    R. M. Kenney, None

    C. T. Makowski, None

    B. Church, None

    S. L. Davis, Achaogen: Scientific Advisor , Consulting fee . Allergan: Scientific Advisor , Consulting fee . Melinta: Scientific Advisor , Consulting fee . Nabriva: Scientific Advisor , Consulting fee . Zavante: Scientific Advisor , Consulting fee .

    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.