1872. Antimicrobial utilization variability among training services at an academic medical center
Session: Poster Abstract Session: Antimicrobial Stewardship: Potpourri
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • AU between teaching services at AMC (IDWeek 2018 POSTER) FINAL.pdf (956.4 kB)
  • Background: The general medicine (GMed) and hospitalist (Hosp) services use antimicrobials at a relatively high rate among our teaching services. It is currently unknown if there is a difference in antimicrobial prescribing between various learner levels or attending type at our institution.

    Methods: We measured antimicrobial utilization between 1/1/2016 to 4/22/2018 (2.25 years) in our GMed services. Services are divided by resident-led and hospitalist only services. The GMed1 service is staffed by outpatient internists, the GMed2 service is split between geriatricians and hospitalists, and the GMed3 service is only hospitalists. The “A” service is junior residents while “B” is senior residents. We measured utilization using the WHO defined Days of Therapy (DOT) definition normalized per 1000 patient days (PD). Secondary analysis based on antibiotic breadth and route were analyzed by average DOT/1000 patient days.

    Results: GMed services prescribed at a higher rate of DOT than hospitalist services over the study timeframe (809 vs 645, p<0.0001). Junior resident-led services (A) used more antimicrobials than senior resident-led services (B) (894 vs 606, p<0.0001). There were no significant prescribing differences between the 1,2 and 3 services by different attending roles (840 vs 775 vs 797). Similar trends continue in secondary analysis with hospitalists prescribing a lower average DOT/1000PD of broad spectrum antibiotics and A services prescribing higher rates of broad-spectrum, anti-MRSA, and anti-Pseudomonal therapy compared with B services (Table 1).

    Table 1: Secondary analysis of antimicrobial breadth by service (mean Days of Therapy/1000 PD)

    Hospitalist

    Gen Med (All)

    Gen Med 1

    Gen Med 2

    Gen Med 3

    Gen Med A

    Gen Med B

    Broad Spectrum

    10.9

    11.5

    13.4

    13.0

    12.0

    13.5

    9.8

    Narrow Spectrum

    10.1

    11.7

    11.9

    12.2

    11.5

    11.8

    8.8

    Anti-MRSA therapy

    9.7

    12.7

    13.2

    12.0

    14.9

    14.9

    9.4

    Conclusion: Antimicrobials were prescribed at a significantly higher rate in services associated with trainees than those without. Junior resident-led services prescribed at a significantly higher rate than services-led by a senior resident. Interventions to reduce unnecessary antimicrobial exposure should be targeted towards learners, especially junior trainees.

    Lucas T Schulz, PharmD, BCPS (AQ-ID), University of Wisconsin Health, Madison, WI, Edward Lalik, MD, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, WI, Ann Sheehy, MD, University of Wisconsin Hospitals and Clinics, Madison, WI and Barry Fox, MD, FIDSA, FSHEA, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI

    Disclosures:

    L. T. Schulz, None

    E. Lalik, None

    A. Sheehy, None

    B. Fox, None

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