Background: Inpatient antibiotics are estimated 30-50% inappropriate and novel antimicrobial stewardship (AS) strategies to engage prescribers are needed. The objective of this study was to describe the implementation of a customized antibiotic use and outcome report with family medicine (FAM) providers and the impact on prescribing behaviors for routine infections in hospitalized adults.
Methods: Single-center quasiexperiment before and after AS/FAM collaborative intervention. Jan-Mar 2017 Standard of Care: routine audit and feedback. FAM leadership worked with AS pharmacists to design reporting process. Jan-Mar 2018 Monthly Interventions: reports of antimicrobial use, appropriateness, harms; positive-deviance cases highlighting successful stewardship; education and survey of rotating FAM providers; handheld prescribing tools/guidelines. Consecutive admissions to the adult FAM ward with respiratory, urinary, and skin infections were evaluated. Primary endpoint: duration of optimal prescribing. Each day of therapy (DOT) was classified as optimal, suboptimal, unnecessary, or inappropriate. Antimicrobials were stratified by spectrum and propensity to cause harm. Secondary endpoints: use of broad-spectrum agents, appropriate duration of therapy, and safety.
Results: Adults (n=150, 76 pre, 74 post) were similar in age, comorbid conditions, and antimicrobial indications (Figure 1). Following intervention, unnecessary antimicrobial days decreased from 2 to 0 days (p<0.001) per patient, optimal therapy selection increased from 25% to 58% (p<0.001). Narrow-spectrum agents increased from 41% to 59% (p=0.05) while use of broader (52 vs 48%) and extended spectrum agents (57 vs 44%) were not significantly different in the cohort. Guideline concordant duration of therapy improved from 37 to 57% (p=0.015). Concurrent unit-wide DOTs of broad and extended agents decreased (Figure 2).
Conclusion: Reporting unit-specific antimicrobial use, harms and successes, without change in standard audit and feedback, improved antimicrobial prescribing and quality of care. These findings support the need to engage front-line providers like FAM in stewardship interventions and reporting.
N. J. Mercuro,
R. Vemulapalli, None
M. Costandi, None
B. Rezik, None
C. T. Makowski, 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 .
See more of: Poster Abstract Session