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202. Implementation and Three-Year Results of Antimicrobial Stewardship Program in a Three Hospital Community Health System

BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been shown to reduce hospital-onset Clostridium difficile infection (HO-CDI) rates and antimicrobial utilization (AU). The purpose of this study was to evaluate the implementation of multidisciplinary ASP targeted toward finding a direct cor...

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Autores principales: Vyas, Nikunj, Hou, Cindy, Kraemer, Marianne, Condoluci, David, Cunningham, Deborah, Kim, Sungwook
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253654/
http://dx.doi.org/10.1093/ofid/ofy210.215
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author Vyas, Nikunj
Hou, Cindy
Kraemer, Marianne
Condoluci, David
Cunningham, Deborah
Kim, Sungwook
author_facet Vyas, Nikunj
Hou, Cindy
Kraemer, Marianne
Condoluci, David
Cunningham, Deborah
Kim, Sungwook
author_sort Vyas, Nikunj
collection PubMed
description BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been shown to reduce hospital-onset Clostridium difficile infection (HO-CDI) rates and antimicrobial utilization (AU). The purpose of this study was to evaluate the implementation of multidisciplinary ASP targeted toward finding a direct correlation between AU and HO-CDI. METHODS: This is a 3-year review of implementation of ASP in late 2014 Q4 in three hospital health system. Multidisciplinary ASP committee was established with representation from infectious diseases, clinical pharmacy, infection control, nursing, microbiology, and informatics. Each of the three hospital implemented targeted stewardship efforts with an initial focus on monthly advanced education, daily audit and feedback for targeted antibiotics, and infectious diseases approved restricted antibiotics. We created a monthly checklist of CDC Core Elements for committee review. The primary objective of this initiative was to evaluate changes in total and targeted AU and HO-CDI within a program over a 3-year period. Subgroup analysis evaluated annual antimicrobial cost/patient day. The secondary objective was Spearman’s rank correlation analysis between AU and HO-CDI. RESULTS: Baseline overall AU analysis was based on 2014 and the intervention period included 2015, 2016, and 2017. Baseline overall AU in 2014 was 850 DOT/1,000PD. We observed a consistent decline in overall AU in 2015, 2016, and 2017 (740, 572, and 550 DOT/1,000PD, respectively). Targeted analysis revealed consistent decline from 2014 to 2017 in fluroquinolones (FQ) (140 vs. 35 DOT/1,000PD) and ceftriaxone (CTX) (85 vs. 65 DOT/1,000PD). Overall decline was also noted in rates of HO-CDI from 2014 to 2017 (5.75 vs. 3.38 per 10,000PD). Consistent decline in overall antimicrobial cost/patient day was noted from 2014 to 2017 ($13.76 vs. $13.41/patient day). Spearman’s rank correlation analysis showed positive correlation between decline in AU and HO-CDI in overall antibiotics (r = 0.58, P = 0.022), CTX (r = 0.61, P = 0.016), and FQ (r = 0.54, P = 0.038). CONCLUSION: We present implementation of an effective health system-wide multi-disciplinary ASP. With ASP efforts over 3 years, we were able to show decline and positive correlation in overall as well as targeted AU and HO-CDI. We also noticed a consistent decline in cost/patient day in this timeframe. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62536542018-11-28 202. Implementation and Three-Year Results of Antimicrobial Stewardship Program in a Three Hospital Community Health System Vyas, Nikunj Hou, Cindy Kraemer, Marianne Condoluci, David Cunningham, Deborah Kim, Sungwook Open Forum Infect Dis Abstracts BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been shown to reduce hospital-onset Clostridium difficile infection (HO-CDI) rates and antimicrobial utilization (AU). The purpose of this study was to evaluate the implementation of multidisciplinary ASP targeted toward finding a direct correlation between AU and HO-CDI. METHODS: This is a 3-year review of implementation of ASP in late 2014 Q4 in three hospital health system. Multidisciplinary ASP committee was established with representation from infectious diseases, clinical pharmacy, infection control, nursing, microbiology, and informatics. Each of the three hospital implemented targeted stewardship efforts with an initial focus on monthly advanced education, daily audit and feedback for targeted antibiotics, and infectious diseases approved restricted antibiotics. We created a monthly checklist of CDC Core Elements for committee review. The primary objective of this initiative was to evaluate changes in total and targeted AU and HO-CDI within a program over a 3-year period. Subgroup analysis evaluated annual antimicrobial cost/patient day. The secondary objective was Spearman’s rank correlation analysis between AU and HO-CDI. RESULTS: Baseline overall AU analysis was based on 2014 and the intervention period included 2015, 2016, and 2017. Baseline overall AU in 2014 was 850 DOT/1,000PD. We observed a consistent decline in overall AU in 2015, 2016, and 2017 (740, 572, and 550 DOT/1,000PD, respectively). Targeted analysis revealed consistent decline from 2014 to 2017 in fluroquinolones (FQ) (140 vs. 35 DOT/1,000PD) and ceftriaxone (CTX) (85 vs. 65 DOT/1,000PD). Overall decline was also noted in rates of HO-CDI from 2014 to 2017 (5.75 vs. 3.38 per 10,000PD). Consistent decline in overall antimicrobial cost/patient day was noted from 2014 to 2017 ($13.76 vs. $13.41/patient day). Spearman’s rank correlation analysis showed positive correlation between decline in AU and HO-CDI in overall antibiotics (r = 0.58, P = 0.022), CTX (r = 0.61, P = 0.016), and FQ (r = 0.54, P = 0.038). CONCLUSION: We present implementation of an effective health system-wide multi-disciplinary ASP. With ASP efforts over 3 years, we were able to show decline and positive correlation in overall as well as targeted AU and HO-CDI. We also noticed a consistent decline in cost/patient day in this timeframe. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6253654/ http://dx.doi.org/10.1093/ofid/ofy210.215 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Vyas, Nikunj
Hou, Cindy
Kraemer, Marianne
Condoluci, David
Cunningham, Deborah
Kim, Sungwook
202. Implementation and Three-Year Results of Antimicrobial Stewardship Program in a Three Hospital Community Health System
title 202. Implementation and Three-Year Results of Antimicrobial Stewardship Program in a Three Hospital Community Health System
title_full 202. Implementation and Three-Year Results of Antimicrobial Stewardship Program in a Three Hospital Community Health System
title_fullStr 202. Implementation and Three-Year Results of Antimicrobial Stewardship Program in a Three Hospital Community Health System
title_full_unstemmed 202. Implementation and Three-Year Results of Antimicrobial Stewardship Program in a Three Hospital Community Health System
title_short 202. Implementation and Three-Year Results of Antimicrobial Stewardship Program in a Three Hospital Community Health System
title_sort 202. implementation and three-year results of antimicrobial stewardship program in a three hospital community health system
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253654/
http://dx.doi.org/10.1093/ofid/ofy210.215
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