A Review of Antibiotic Prophylaxis for Interventional Radiology Procedures and Identification of Antimicrobial Stewardship Opportunities

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BackgroundAntibiotics used for peri-procedural prophylaxis are dispensed by providers or nurses from automated dispensing machines in the interventional radiology (IR) suites. These antibiotics are administered without pharmacist review which skips a critical point in time for antimicrobial stewardship intervention. The purpose of this study was to evaluate antibiotic prophylaxis for IR procedures and identify opportunities for antimicrobial stewardship.MethodsAll patients who underwent an IR procedure and received antibiotic prophylaxis from April 2016 to April 2017 were identified. We performed a manual chart review to determine procedure type, antibiotic prophylaxis, concomitant systemic antibiotics, and antibiotic concordance with the Society of Interventional Radiology (SIR) guidelines.ResultsThere were 410 IR procedures where the patient received a single prophylactic antibiotic dose; 261 were inpatient procedures. See Table 1 for procedure and antibiotic data. There were 74 patients (18%) who concomitantly received systemic antibiotics. There were 126 cases (31%) discordant with the SIR guidelines. Reasons for discordance include prophylaxis not recommended, inappropriate antibiotic selection, or patient already receiving an antibiotic with similar spectrum of coverage.ConclusionAntibiotics are frequently administered as prophylaxis for IR procedures. For many IR procedures, data to support prophylaxis is limited; however, there are opportunities for antimicrobial stewardship intervention which include optimizing antibiotic selection and withholding prophylaxis when not indicated or when patients are receiving systemic antibiotics.Table 1ProcedureNo. of procedures, n = 410Routine prophylaxis recommended (y/n), antibioticAntibiotic dosesTunneled line or port placement181No consensusCFZ 162 VAN 8 LVX 6 CRO 5Genitourinary59Yes, no consensusCRO 43 LVX 14 CFZ 2Gastrointestinal or abscess drainage55Yes, no consensusCRO 36 LVX 10 CFZ 9Embolization or chemoembolization44Yes, no consensusCRO 22 CFZ 18 LVX 2 VAN 2Gastrostomy tube placement40Yes, CFZCFZ 30 CRO 7 LVX 2 VAN 1Vascular28No, noneCFZ 23 CRO 4 LVX 1Biopsy3No, noneCFZ 2 CRO 1CFZ, cefazolin; CRO, ceftriaxone; LVX, levofloxacin; VAN, vancomycin.Disclosures All authors: No reported disclosures.