188. A Novel inpatient Antibiotic Stewardship Assistance Program (ASAP) using Real-Time Electronic Health Record Data, Prediction Modeling and Epidemiologic Data to Provide Personalized Empiric Antibiotic Recommendations
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions Leveraging the Electronic Health Record
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • ASAP Poster for IDweek 2018 FINAL.pdf (377.8 kB)
  • Background: Antibiotic prescribing varies amongst clinicians, which can result in inappropriate or overuse. Inappropriate antibiotics can increase the risk of adverse drug events and multi drug resistant organisms (MDRO). Decreasing variability and increasing alignment with guideline based therapy may improve antimicrobial stewardship and outcomes.

    Methods: We developed a point of care stewardship tool embedded in the electronic health record (EHR) that provides empiric antibiotic recommendations for four syndromes, urinary tract infection (UTI), abdominal biliary infection (ABI), pneumonia and cellulitis. We identified key variables that alter antibiotic selection or need for infectious disease (ID) consultation such as allergy history, immunosuppression and risk factors for MDRO and mortality. We created algorithms of preferred empiric antibiotic choices based on national and hospital guidelines using these risk factors. We used a weighted incidence syndromic combined antibiogram (WISCA) prediction model to recommend ID consultation when likelihood of coverage was below a defined threshold. We also incorporated a home-grown epidemiologic tool that takes real-time data from outpatient clinics on incidence of influenza-like-illness (ILI) to recommend influenza PCR testing during periods of high ILI risk. Data on risk factors and WISCA variables including demographics, allergy history, ICD10 codes, vitals, labs, and microbiology results were extracted in real-time from the EHR and sent via URL into a web server which has an embedded Windows ASP.NET C# web site and a SQL server database. The web server was then embedded back into the EHR. This tool stores recommendations into the database for stewardship auditing.

    Results: 13 key and 20 WISCA variables are extracted from the EHR in real-time. There are 8 distinct antibiotic recommendations for UTI and ABI, 12 for cellulitis and 40 for pneumonia. An illustration of the ASAP tool is shown in Figure 1.

    Conclusion: ASAP is an EHR embedded platform that provides clinicians access to personalized antibiotic prescribing tied to best practices and optimal stewardship initiatives. Future work will look into the tool’s effect on variation in care, antibiotic prescribing and outcomes.

    Figure1

    Nirav Shah, MD1, Mary Ellen Acree, MD2, Clayton Patros, PharmD, BCPS2, Mira Suseno, PharmD3, Jennifer Grant, MD4, Gary Fleming, BE1, Bryce Hadsell, BS2, Jeffery Semel, MD, FIDSA, FSHEA5, Courtney Hebert, MD, MS6, Kamaljit Singh, MD7 and Lance Peterson, MD2, (1)NorthShore University HealthSystem, Chicago, IL, (2)NorthShore University HealthSystem, Evanston, IL, (3)Rosalind Franklin University of Medicine & Sciences College of Pharmacy., North Chicago, IL, (4)Infectious Disease, NorthShore University HealthSystem, Evanston, IL, (5)Infectious Diseases, Northshore University HealthSystem, Evanston, IL, (6)University of Chicago, Chicago, IL, (7)Department of Pathology, NorthShore University HealthSystem, Evanston, IL

    Disclosures:

    N. Shah, None

    M. E. Acree, None

    C. Patros, None

    M. Suseno, None

    J. Grant, None

    G. Fleming, None

    B. Hadsell, None

    J. Semel, None

    C. Hebert, None

    K. Singh, None

    L. Peterson, 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.