Impact of an Unsolicited, Simple Standardized Form Based Antimicrobial Stewardship Intervention to Improve Guideline Adherence in the Management of Staphylococcus aureus Bacteremia

BACKGROUND: Staphylococcus aureusbacteremia (SAB) is associated with poor outcomes. The objective was to assess the impact of a pharmacist driven antimicrobial stewardship intervention on SAB management. METHODS: A multicenter, pre-post quasi-experimental design was used to compare pre-intervention (Oct 2014 – Sep 2015) and intervention (Oct 2015 – Sep 2016) periods in hospitalized SAB patients. The antimicrobial stewardship program (ASP) developed an evidence based SAB management bundle that included: Infectious Diseases (ID) consult, blood culture clearance, appropriate empiric and definitive antibiotics, echocardiography, adequate treatment duration, and infectious source removal if applicable. ASP pharmacists performed prospective audit and feedback (PAF) using a standardized form after review with the ASP medical director. The primary outcome was bundle component adherence. Secondary outcomes were length of stay, 30 day readmission, in-hospital mortality, and 30 day mortality. RESULTS: 127 patients were included (pre-intervention = 62, intervention = 65). The two groups had similar patient demographics. The intervention group had a higher rate of complicated SAB at diagnosis. Bundle implementation with PAF resulted in significant improvements in ID consultation (56.5% vs. 92.3%, P < 0.001), appropriate definitive antibiotic dosing (83.9% vs. 100%, P = 0.001), ordering echocardiography (72.6% vs. 93.8%, P = 0.001), and adequate treatment duration (87% vs. 100%, P = 0.009). Overall bundle adherence increased by 43.3% (P < 0.001). Readmission and 30 day mortality decreased but did not reach statistical significance. During the intervention, ASP pharmacists made 81 recommendations (93.8% accepted). A post hoc analysis was conducted due to the 35.8% increase in ID consults with the intervention. A significant decrease of 18.5% in in-hospital mortality (P = 0.041) and 21.7% in 30 day mortality (P = 0.009) with ID involvement was seen. CONCLUSION: SAB management bundle development with PAF by ASP pharmacists significantly improved adherence rates to evidence based recommendations in SAB inpatients. This simple yet effective ASP intervention can ensure consistent management of a highly morbid infection. DISCLOSURES: C. Cervera, Sunovion: Scientific Advisor, Consulting fee