Cargando…
160. A Pre- and Post-intervention Study to Implement a Successful Antimicrobial Stewardship Program in Palliative Care
BACKGROUND: In patients receiving palliative care, medical interventions are transitioned away from aggressive and curative attempts to less invasive and more comfort measures. Antimicrobial usage remains a challenging subject in palliative care decisions, where many physicians focus interventions o...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777952/ http://dx.doi.org/10.1093/ofid/ofaa439.205 |
_version_ | 1783631023768076288 |
---|---|
author | McCracken, James A Nakeshbandi, Mohamed Sainvil, Carline Porosnicu, Eduard Sharma, Roopali |
author_facet | McCracken, James A Nakeshbandi, Mohamed Sainvil, Carline Porosnicu, Eduard Sharma, Roopali |
author_sort | McCracken, James A |
collection | PubMed |
description | BACKGROUND: In patients receiving palliative care, medical interventions are transitioned away from aggressive and curative attempts to less invasive and more comfort measures. Antimicrobial usage remains a challenging subject in palliative care decisions, where many physicians focus interventions on reduction of patient pain and discomfort, without consideration for adverse effects such as the development of antimicrobial resistance or patient-specific adverse drug events. With limited data on the comfort benefit, we aimed to assess antimicrobial use in patients at the end of life in our institution as well as the success of targeted stewardship interventions in palliative care patients. METHODS: Patients who expired between November 2018 and August 2019 were assessed retrospectively for antimicrobial use during their last 14 days of life. In January 2020, a prospective stewardship initiative began in collaboration with our institution’s palliative care team to focus antimicrobial interventions on patients involved in goals of care discussions. RESULTS: In our retrospective review of 200 patients, 139 (69.5%) of patients received antimicrobials in their last two weeks of life, with 50% having formal palliative care consultations. The most commonly used antimicrobials were piperacillin-tazobactam (64.7%) and vancomycin (60.4%), with primary indications being pneumonia (34.5%) and empiric coverage/sepsis (24.5%). Of note, 46% of antimicrobial regimens were eligible for optimization through stewardship initiatives. From January through February 2020, sixteen stewardship interventions were made on thirteen palliative care patients, with an 81.3% acceptance rate. Duration of therapy based on indication and discontinuation of antibiotics following transition to comfort measures only were the most frequent interventions made. Table 1. Baseline Characteristics [Image: see text] Table 2. Antimicrobial Usage - Pre-intervention [Image: see text] Table 3. Prospective Intervention Data [Image: see text] CONCLUSION: Close of half of patients receiving antimicrobials at the end of life are eligible for interventions to improve antibiotic regimens. These patients are often overlooked in antimicrobial stewardship, and, despite small sample size, our study shows the benefit of targeted stewardship in palliative care populations with an intervention acceptance rate of over 80%. DISCLOSURES: All Authors: No reported disclosures |
format | Online Article Text |
id | pubmed-7777952 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-77779522021-01-07 160. A Pre- and Post-intervention Study to Implement a Successful Antimicrobial Stewardship Program in Palliative Care McCracken, James A Nakeshbandi, Mohamed Sainvil, Carline Porosnicu, Eduard Sharma, Roopali Open Forum Infect Dis Poster Abstracts BACKGROUND: In patients receiving palliative care, medical interventions are transitioned away from aggressive and curative attempts to less invasive and more comfort measures. Antimicrobial usage remains a challenging subject in palliative care decisions, where many physicians focus interventions on reduction of patient pain and discomfort, without consideration for adverse effects such as the development of antimicrobial resistance or patient-specific adverse drug events. With limited data on the comfort benefit, we aimed to assess antimicrobial use in patients at the end of life in our institution as well as the success of targeted stewardship interventions in palliative care patients. METHODS: Patients who expired between November 2018 and August 2019 were assessed retrospectively for antimicrobial use during their last 14 days of life. In January 2020, a prospective stewardship initiative began in collaboration with our institution’s palliative care team to focus antimicrobial interventions on patients involved in goals of care discussions. RESULTS: In our retrospective review of 200 patients, 139 (69.5%) of patients received antimicrobials in their last two weeks of life, with 50% having formal palliative care consultations. The most commonly used antimicrobials were piperacillin-tazobactam (64.7%) and vancomycin (60.4%), with primary indications being pneumonia (34.5%) and empiric coverage/sepsis (24.5%). Of note, 46% of antimicrobial regimens were eligible for optimization through stewardship initiatives. From January through February 2020, sixteen stewardship interventions were made on thirteen palliative care patients, with an 81.3% acceptance rate. Duration of therapy based on indication and discontinuation of antibiotics following transition to comfort measures only were the most frequent interventions made. Table 1. Baseline Characteristics [Image: see text] Table 2. Antimicrobial Usage - Pre-intervention [Image: see text] Table 3. Prospective Intervention Data [Image: see text] CONCLUSION: Close of half of patients receiving antimicrobials at the end of life are eligible for interventions to improve antibiotic regimens. These patients are often overlooked in antimicrobial stewardship, and, despite small sample size, our study shows the benefit of targeted stewardship in palliative care populations with an intervention acceptance rate of over 80%. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2020-12-31 /pmc/articles/PMC7777952/ http://dx.doi.org/10.1093/ofid/ofaa439.205 Text en © The Author 2020. 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 | Poster Abstracts McCracken, James A Nakeshbandi, Mohamed Sainvil, Carline Porosnicu, Eduard Sharma, Roopali 160. A Pre- and Post-intervention Study to Implement a Successful Antimicrobial Stewardship Program in Palliative Care |
title | 160. A Pre- and Post-intervention Study to Implement a Successful Antimicrobial Stewardship Program in Palliative Care |
title_full | 160. A Pre- and Post-intervention Study to Implement a Successful Antimicrobial Stewardship Program in Palliative Care |
title_fullStr | 160. A Pre- and Post-intervention Study to Implement a Successful Antimicrobial Stewardship Program in Palliative Care |
title_full_unstemmed | 160. A Pre- and Post-intervention Study to Implement a Successful Antimicrobial Stewardship Program in Palliative Care |
title_short | 160. A Pre- and Post-intervention Study to Implement a Successful Antimicrobial Stewardship Program in Palliative Care |
title_sort | 160. a pre- and post-intervention study to implement a successful antimicrobial stewardship program in palliative care |
topic | Poster Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777952/ http://dx.doi.org/10.1093/ofid/ofaa439.205 |
work_keys_str_mv | AT mccrackenjamesa 160apreandpostinterventionstudytoimplementasuccessfulantimicrobialstewardshipprograminpalliativecare AT nakeshbandimohamed 160apreandpostinterventionstudytoimplementasuccessfulantimicrobialstewardshipprograminpalliativecare AT sainvilcarline 160apreandpostinterventionstudytoimplementasuccessfulantimicrobialstewardshipprograminpalliativecare AT porosnicueduard 160apreandpostinterventionstudytoimplementasuccessfulantimicrobialstewardshipprograminpalliativecare AT sharmaroopali 160apreandpostinterventionstudytoimplementasuccessfulantimicrobialstewardshipprograminpalliativecare |