Cargando…

143. Modification of Linezolid Restriction Criteria Reduces ICU Gram-positive Antibiotic Consumption

BACKGROUND: Antibiotic time out (ATO) policies have been proposed by the Centers for Disease Control and Prevention to limit unnecessary use of antibiotics. Critically ill patients are often treated empirically with MRSA-active agents for a prolonged duration. The objective of this study was to asse...

Descripción completa

Detalles Bibliográficos
Autores principales: Boulos, John M, DeSear, Kathryn, Shoulders, Bethany, Venugopalan, Veena, Voils, Stacy A, Vu, Catherine, Logan, Megan, Santevecchi, Barbara A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778099/
http://dx.doi.org/10.1093/ofid/ofaa439.453
_version_ 1783631058529419264
author Boulos, John M
DeSear, Kathryn
Shoulders, Bethany
Venugopalan, Veena
Voils, Stacy A
Vu, Catherine
Logan, Megan
Santevecchi, Barbara A
author_facet Boulos, John M
DeSear, Kathryn
Shoulders, Bethany
Venugopalan, Veena
Voils, Stacy A
Vu, Catherine
Logan, Megan
Santevecchi, Barbara A
author_sort Boulos, John M
collection PubMed
description BACKGROUND: Antibiotic time out (ATO) policies have been proposed by the Centers for Disease Control and Prevention to limit unnecessary use of antibiotics. Critically ill patients are often treated empirically with MRSA-active agents for a prolonged duration. The objective of this study was to assess the impact of an ATO policy by targeting empiric gram-positive coverage. METHODS: Before this intervention, linezolid required pre-approval by the antimicrobial stewardship program or infectious diseases (ID) consult service before dispensing, and no automatic ATO policy was in place for any agent. In 2018, restriction of linezolid was modified to allow 72 hours of empiric use in the intensive care unit (ICU). This retrospective, single-center, pre- post-intervention study looked at eight ICUs at our institution from two equal periods. Adults (age ≥ 18 years) were included who received an IV gram-positive antibiotic (IVGP-AB), specifically linezolid or vancomycin, used for empiric therapy and were admitted to the ICU. The primary outcome was antimicrobial consumption of IVGP-AB defined as days of therapy (DOT) per patient. Secondary outcomes included in-hospital length of stay (LOS), ICU LOS, in-hospital mortality, 30-day readmission, and incidence of acute kidney injury (AKI). Figure 1. Flowchart of patient inclusion into the study [Image: see text] RESULTS: 2718 patients met criteria for inclusion in the study. 1091 patients were included in the pre-intervention group and 1627 patients were included in the post-intervention group. Baseline characteristics between the two groups were similar, with ID consults being higher in the pre-intervention group. Total mean DOT of IVGP-AB in pre- and- post-intervention groups was 4.97 days vs. 4.36 days, p< 0.01. Secondary outcomes of in-hospital LOS, ICU LOS, and in-hospital mortality did not vary significantly between groups. Thirty-day readmission was lower in the post-intervention group (12.9% vs. 3.9%, p< 0.01). AKI did not differ significantly between groups, however the need for renal replacement therapy was higher in the pre-intervention group (1.2% vs. 0.2%, p< 0.01). [Image: see text] [Image: see text] [Image: see text] CONCLUSION: This study assessed the impact of an ATO policy allowing 72 hours of empiric linezolid in the ICU. We found a statistically significant reduction in days of therapy of IVGP-AB without increases in LOS, mortality, readmission, and AKI. DISCLOSURES: All Authors: No reported disclosures
format Online
Article
Text
id pubmed-7778099
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-77780992021-01-07 143. Modification of Linezolid Restriction Criteria Reduces ICU Gram-positive Antibiotic Consumption Boulos, John M DeSear, Kathryn Shoulders, Bethany Venugopalan, Veena Voils, Stacy A Vu, Catherine Logan, Megan Santevecchi, Barbara A Open Forum Infect Dis Poster Abstracts BACKGROUND: Antibiotic time out (ATO) policies have been proposed by the Centers for Disease Control and Prevention to limit unnecessary use of antibiotics. Critically ill patients are often treated empirically with MRSA-active agents for a prolonged duration. The objective of this study was to assess the impact of an ATO policy by targeting empiric gram-positive coverage. METHODS: Before this intervention, linezolid required pre-approval by the antimicrobial stewardship program or infectious diseases (ID) consult service before dispensing, and no automatic ATO policy was in place for any agent. In 2018, restriction of linezolid was modified to allow 72 hours of empiric use in the intensive care unit (ICU). This retrospective, single-center, pre- post-intervention study looked at eight ICUs at our institution from two equal periods. Adults (age ≥ 18 years) were included who received an IV gram-positive antibiotic (IVGP-AB), specifically linezolid or vancomycin, used for empiric therapy and were admitted to the ICU. The primary outcome was antimicrobial consumption of IVGP-AB defined as days of therapy (DOT) per patient. Secondary outcomes included in-hospital length of stay (LOS), ICU LOS, in-hospital mortality, 30-day readmission, and incidence of acute kidney injury (AKI). Figure 1. Flowchart of patient inclusion into the study [Image: see text] RESULTS: 2718 patients met criteria for inclusion in the study. 1091 patients were included in the pre-intervention group and 1627 patients were included in the post-intervention group. Baseline characteristics between the two groups were similar, with ID consults being higher in the pre-intervention group. Total mean DOT of IVGP-AB in pre- and- post-intervention groups was 4.97 days vs. 4.36 days, p< 0.01. Secondary outcomes of in-hospital LOS, ICU LOS, and in-hospital mortality did not vary significantly between groups. Thirty-day readmission was lower in the post-intervention group (12.9% vs. 3.9%, p< 0.01). AKI did not differ significantly between groups, however the need for renal replacement therapy was higher in the pre-intervention group (1.2% vs. 0.2%, p< 0.01). [Image: see text] [Image: see text] [Image: see text] CONCLUSION: This study assessed the impact of an ATO policy allowing 72 hours of empiric linezolid in the ICU. We found a statistically significant reduction in days of therapy of IVGP-AB without increases in LOS, mortality, readmission, and AKI. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2020-12-31 /pmc/articles/PMC7778099/ http://dx.doi.org/10.1093/ofid/ofaa439.453 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
Boulos, John M
DeSear, Kathryn
Shoulders, Bethany
Venugopalan, Veena
Voils, Stacy A
Vu, Catherine
Logan, Megan
Santevecchi, Barbara A
143. Modification of Linezolid Restriction Criteria Reduces ICU Gram-positive Antibiotic Consumption
title 143. Modification of Linezolid Restriction Criteria Reduces ICU Gram-positive Antibiotic Consumption
title_full 143. Modification of Linezolid Restriction Criteria Reduces ICU Gram-positive Antibiotic Consumption
title_fullStr 143. Modification of Linezolid Restriction Criteria Reduces ICU Gram-positive Antibiotic Consumption
title_full_unstemmed 143. Modification of Linezolid Restriction Criteria Reduces ICU Gram-positive Antibiotic Consumption
title_short 143. Modification of Linezolid Restriction Criteria Reduces ICU Gram-positive Antibiotic Consumption
title_sort 143. modification of linezolid restriction criteria reduces icu gram-positive antibiotic consumption
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778099/
http://dx.doi.org/10.1093/ofid/ofaa439.453
work_keys_str_mv AT boulosjohnm 143modificationoflinezolidrestrictioncriteriareducesicugrampositiveantibioticconsumption
AT desearkathryn 143modificationoflinezolidrestrictioncriteriareducesicugrampositiveantibioticconsumption
AT shouldersbethany 143modificationoflinezolidrestrictioncriteriareducesicugrampositiveantibioticconsumption
AT venugopalanveena 143modificationoflinezolidrestrictioncriteriareducesicugrampositiveantibioticconsumption
AT voilsstacya 143modificationoflinezolidrestrictioncriteriareducesicugrampositiveantibioticconsumption
AT vucatherine 143modificationoflinezolidrestrictioncriteriareducesicugrampositiveantibioticconsumption
AT loganmegan 143modificationoflinezolidrestrictioncriteriareducesicugrampositiveantibioticconsumption
AT santevecchibarbaraa 143modificationoflinezolidrestrictioncriteriareducesicugrampositiveantibioticconsumption