Impact of a sustained, collaborative antimicrobial stewardship programme in spinal cord injury patients

BACKGROUND: In patients with spinal cord injuries (SCIs), infections continue to be a leading cause of morbidity, mortality and hospital admission. OBJECTIVES: This study evaluated the long-term impact of a weekly, multidisciplinary Spinal/Antimicrobial Stewardship (AMS) meeting for acute-care SCI inpatients, on antimicrobial prescribing over 3 years. METHODS: A retrospective, longitudinal, pre-post comparison of antimicrobial prescribing was conducted at our tertiary hospital in Melbourne. Antimicrobial prescribing was audited in 6 month blocks pre- (25 April 2017 to 24 October 2017), immediately post- (27 March 2018 to 25 September 2018) and 3 years post-implementation (2 March 2021 to 31 August 2021). Antimicrobial orders for patients admitted under the spinal unit at the meeting time were included. RESULTS: The number of SCI patients prescribed an antimicrobial at the time of the weekly meeting decreased by 40% at 3 years post-implementation [incidence rate ratio (IRR) 0.63; 95% CI 0.51–0.79; P ≤ 0.001]. The overall number of antimicrobial orders decreased by over 22% at 3 years post-implementation (IRR 0.78; 95% CI 0.61–1.00; P = 0.052). A shorter antimicrobial order duration in the 3 year post-implementation period was observed (−28%; 95% CI −39% to −15%; P ≤ 0.001). This was most noticeable in IV orders at 3 years (−36%; 95% CI −51% to −16%; P = 0.001), and was also observed for oral orders at 3 years (−25%; 95% CI −38% to −10%; P = 0.003). Antimicrobial course duration (days) decreased for multiple indications: skin and soft tissue infections (−43%; 95% CI −67% to −1%; P = 0.045), pulmonary infections (−45%; 95% CI −67% to −9%; P = 0.022) and urinary infections (−31%; 95% CI −47% to −9%; P = 0.009). Ninety-day mortality rates were not impacted. CONCLUSIONS: This study showed that consistent, collaborative meetings between the Spinal and AMS teams can reduce antimicrobial exposure for acute-care SCI patients without adversely impacting 90 day mortality.