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Audit and Feedback to Reduce Broad-Spectrum Antibiotic Use among Intensive Care Unit Patients A Controlled Interrupted Time Series Analysis

Published online by Cambridge University Press:  02 January 2015

Marion Elligsen ,
Sandra A. N. Walker ,
Ruxandra Pinto ,
Andrew Simor ,
Samira Mubareka ,
Anita Rachlis ,
Vanessa Allen  and
Nick Daneman
Marion Elligsen
Affiliation:
Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Sandra A. N. Walker
Affiliation:
Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Leslie L. Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada Department of Microbiology and Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Ruxandra Pinto
Affiliation:
Sunnybrook Research Institute, Toronto, Ontario, Canada
Andrew Simor
Affiliation:
Department of Microbiology and Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Samira Mubareka
Affiliation:
Sunnybrook Research Institute, Toronto, Ontario, Canada Department of Microbiology and Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Anita Rachlis
Affiliation:
Department of Microbiology and Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Vanessa Allen
Affiliation:
Department of Microbiology and Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Public Health Ontario, Toronto, Ontario, Canada
Nick Daneman*
Affiliation:
Sunnybrook Research Institute, Toronto, Ontario, Canada Department of Microbiology and Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
*
Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 2M5, Canada (nick.daneman@sunnybrook.ca)
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Abstract

Objective.

We aimed to rigorously evaluate the impact of prospective audit and feedback on broad-spectrum antimicrobial use among critical care patients.

Design.

Prospective, controlled interrupted time series.

Setting

Single tertiary care center with 3 intensive care units.

Patients and Interventions.

A formal review of all critical care patients on their third or tenth day of broad-spectrum antibiotic therapy was conducted, and suggestions for antimicrobial optimization were communicated to the critical care team.

Outcomes.

The primary outcome was broad-spectrum antibiotic use (days of therapy per 1000 patient-days; secondary outcomes included overall antibiotic use, gram-negative bacterial susceptibility, nosocomial Clostridium difficile infections, length of stay, and mortality.

Results.

The mean monthly broad-spectrum antibiotic use decreased from 644 days of therapy per 1,000 patient-days in the preintervention period to 503 days of therapy per 1,000 patient-days in the postintervention period (P < .0001); time series modeling confirmed an immediate decrease (± standard error) of 119 ± 37.9 days of therapy per 1,000 patient-days (P = .0054). In contrast, no changes were identified in the use of broad-spectrum antibiotics in the control group (nonintervention medical and surgical wards) or in the use of control medications in critical care (stress ulcer prophylaxis). The incidence of nosocomial C. difficile infections decreased from 11 to 6 cases in the study intensive care units, whereas the incidence increased from 87 to 116 cases in the control wards (P = .04). Overall gram-negative susceptibility to meropenem increased in the critical care units. Intensive care unit length of stay and mortality did not change.

Conclusions.

Institution of a formal prospective audit and feedback program appears to be a safe and effective means to improve broad-spectrum antimicrobial use in critical care.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 4: Special Topic Issue: Antimicrobial Stewardship , April 2012 , pp. 354 - 361
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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