SIGNIFICANT REDUCTION IN CARBAPENEM AND FLUOROQUINOLONE USE WITH IMPLEMENTATION OF MULTIFACETED ANTIBIOTIC STEWARDSHIP PROGRAM (ASP) INTERVENTIONS

Abstract

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: To study the impact of antimicrobial stewardship program (ASP) interventions on carbapenem and fluoroquinolone (FQ) use at our tertiary care center. METHODS: A multifaceted antimicrobial stewardship program (ASP) was implemented in July 2018 at a 160-bed tertiary care center serving the tristate area of Iowa, South Dakota and Nebraska. Carbapenem and FQ use during pre-ASP intervention period (P1: 12/01/2016-6/30/2018) was compared with ASP-intervention period (P2: 07/01/2018-1/31/2020). ASP interventions included: stewardship educational pearls in monthly physician newsletters; educational posters in high-traffic provider areas; suppression of carbapenem results on microbiology susceptibility reports; distributing monthly carbapenem and FQ use data to providers; provider counseling for appropriate ordering; creating carbapenem alternative alert in order-entry software; generating pharmacy decision-support software algorithms to aid in identifying intervention opportunities; removing FQ from HAP/VAP ordersets and carbapenems from order-sets where appropriate; default antibiotic stop dates changed to 7 days in EMR (Epic); adverse effects warning fired as an alert when ordering FQ. Additional ASP pharmacist interventions included procalcitonin protocol allowing pharmacists to reorder follow-up procalcitonin and make recommendations to discontinue therapy where appropriate. RESULTS: Carbapenem use declined significantly from a mean of 64.81 days of therapy (DOT) per 1000 patient days during P1 to 8.91 DOT per 1000 patient days in P2 (p< 0.001). FQ use declined from a mean of 133 DOT per 1000 days in P1 to 46 DOT per 1000 patient days (p< 0.0001) during P2. All hospital units showed a significant decrease in carbapenem and FQ use, with intensive care step-down unit noting 85.7% reduction (p< 0.00001) and intensive care units (ICUs, medical and surgical) noting 52% reduction (p< 0.00001) during P2 compared to P1. During P2, 55% of orders for carbapenems and FQ were found to be appropriate compared to only 39% in P1 (p< 0.0001). Sensitivity profile for Pseudomonas aeruginosa improved from 86% carbapenem sensitivity during P1 to 89% in P2. No Carbapenem-Resistant Enterobacteriaceae isolates were identified during the study period. FQ sensitivity remained stable at 81%. Cost savings of $757 per 1000 patient days were recognized during P2 as a result of reduced carbapenem and FQ use. CONCLUSIONS: A significant decline in total carbapenem and FQ utilization with ICUs showing >50% decline, an increase in proportion of appropriate use as well as cost savings were observed as a result of ASP interventions. CLINICAL IMPLICATIONS: According to the CDC, carbapenems and fluoroquinolones should be key targets for stewardship programs and reducing inappropriate antibiotic use is imperative to preventing emergence of multidrug resistance and potentially improving bacterial antimicrobial susceptibility patterns. With our multifaceted ASP interventions, we demonstrated a significant decrease in the utilization of these two classes of broad-spectrum antibiotics, notably in the intensive care step-down unit and the ICUs. We also noted significant increase in appropriate use; improved carbapenem sensitivity profile for Pseudomonas aeruginosa as well as considerable cost savings. DISCLOSURES: No relevant relationships by Sandeep Gupta, source=Web Response No relevant relationships by Ashlesha Kaushik, source=Web Response No relevant relationships by Michael Padomek, source=Web Response No relevant relationships by Corey Thieman, source=Web Response