Antimicrobial Stewardship Program Interventions Targeting Intravenous Vancomycin Use at a Community Hospital Improves Prescribing and Safety
Intravenous vancomycin (VAN) continues to be a workhorse for suspected or documented methicillin-resistant Staphylococcus aureus (MRSA) infections. VAN over-prescribing, and suboptimal dosing or monitoring can be detrimental to efficacy, safety, and resource utilization. A local antimicrobial stewardship program (ASP) was implemented in September 2015 as an expansion of a pre-existing health-system ASP. The local ASP included an infectious diseases (ID) pharmacist, partial FTE ID physician, ASP software, and a goal to decrease inappropriate vancomycin use and improve safety.
We performed a serial cross-sectional study assessing the impact of ASP interventions on VAN consumption and AKI incidence at a single-center community hospital from October 2015 through March 2018. ASP interventions included a revised vancomycin dosing and monitoring guideline, education, and prospective audit and feedback by clinical pharmacists working under the guidance of ID pharmacist and physician. Antibiotic days of therapy (DOT) were tracked and reported quarterly with Theradoc® software. Acute kidney injury was defined as an increase of ≥ 0.5 mg/dL or 50% in serum creatinine from baseline in all hospitalized patients with baseline <2 mg/dL.
Figure 1 demonstrates MRSA antibiotic utilization and AKI over time. VAN use declined from a peak quarterly use of 119 DOT/1000 PD to a minimum of 74 DOT/1000 PD (37.8% decrease). During the same timeframe AKI/1000 PD decreased over 50%. R-squared values of the trends are 76.5% and 83.1%, respectively. The use of VAN alternatives daptomycin (DAP), linezolid (LNZ), and ceftaroline (CPT) remained stable. There were 809 ASP recommendations made regarding VAN over-prescribing (primarily to de-escalate or discontinue VAN therapy) and 340 ID pharmacist interventions to improve VAN dosing and monitoring.
ASP initiatives, education, and interventions were associated with reduced VAN use and reduction in AKI at a community hospital.
See more of: Poster Abstract Session