A Longitudinal Four-year Pre-Post Intervention Study Evaluating the Use of an Antimicrobial Stewardship Application

BACKGROUND: Clinical decision support via the electronic health record (EHR) is a vital component of many antimicrobial stewardship initiatives. However, many developed and developing countries lack the necessary infrastructure to perform such tasks. We hypothesized that an antimicrobial stewardship application (app) targeted towards empiric antimicrobial therapy, along with local clinical guidelines/pathways would decrease utilization of our two most commonly over-used antibiotics, piperacillin-tazobactam (PTZ) and vancomycin (VAN). METHODS: A four-year pre-post study was performed following the implementation of our antimicrobial stewardship web-based app. The app was introduced to those on medical services/wards and not to users on surgical services/wards. Comparative utilization of PTZ and VAN were subsequently measured among medical and surgical wards in the form of days of therapy (DOT) per 1,000 patient-days. RESULTS: Following the intervention period, annual VAN utilization among medical wards decreased from 171 DOT per 1,000 patient-days to 139 DOT per 1,000 patient-days, while increasing from 106 DOT per 1,000 patient-days to 126 DOT per 1,000 patient-days among surgical wards (Figure 1). Similarly, PTZ utilization decreased from 141 DOT per 1,000 patient-days to 80 DOT per 1,000 patient-days among medical wards, while increasing from 128 DOT per 1,000 patient-days to 132 DOT per 1,000 patient days among surgical wards (Figure 2). App analytics demonstrated an average user time of 2.68 minutes per session with the respiratory and urinary tract sections being the most commonly visited. CONCLUSION: In settings where EHR clinical decision support is not available, an antimicrobial stewardship app targeting empiric therapy can be used successfully to decrease utilization of inappropriate antibiotics. Future work will look at incorporating more comprehensive guidelines to help with clinical decision-making. DISCLOSURES: All authors: No reported disclosures.