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Impact of Two Different Antimicrobial Stewardship Methods on Frequency of Streamlining Antimicrobial Agents in Patients with Bacteremia

Published online by Cambridge University Press:  09 November 2016

Jennifer Lukaszewicz Bushen ,
Jimish M. Mehta ,
Keith W. Hamilton ,
Shawn Binkley ,
Daniel R. Timko ,
Ebbing Lautenbach  and
David A. Pegues
Jennifer Lukaszewicz Bushen*
Affiliation:
Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Jimish M. Mehta
Affiliation:
Teqqa, LLC
Keith W. Hamilton
Affiliation:
Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Shawn Binkley
Affiliation:
Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Daniel R. Timko
Affiliation:
Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Ebbing Lautenbach
Affiliation:
Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
David A. Pegues
Affiliation:
Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
*
Address correspondence to Jennifer Lukaszewicz Bushen, 3400 Spruce Street, Philadelphia, PA19104, 856-904-0979 (JenniferMBushen@gmail.com).
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Abstract

OBJECTIVE

To assess the likelihood of antimicrobial streamlining between 2 antimicrobial stewardship methods.

DESIGN

Retrospective cohort study.

SETTING

Large academic medical center.

METHODS

Frequency and time to antimicrobial streamlining were compared during a prior authorization and a prospective audit period. Streamlining was defined as an antimicrobial change to a narrower agent if available or to a broader agent if the isolate was resistant to empiric therapy. Patients included were ≥18 years old with monomicrobial bacteremia with S. aureus, Enterococcus spp., or any aerobic Gram-negative organism.

RESULTS

A total of 665 cases of bacteremia met inclusion criteria. Frequency of streamlining was similar between periods for all cases of bacteremia (audit vs restriction: 60.7% vs 53.2%; P=.12), S. aureus bacteremia (73.2% vs 76.9%; P=.671), and Enterococcus bacteremia (81.6% vs 71.9%; P=.335). Compared to restriction, the audit period was associated with an increased frequency of streamlining for cases of Gram-negative bacteremia (51.4% vs 35.6%; odds ratio [OR], 1.85; 95% confidence interval [CI], 1.06–3.25), those on the medical service (67.9% vs 53.1%; OR, 1.86; 95% CI, 1.09–3.16), and those admitted through the emergency department (71.6% vs 51.4%; OR, 2.32; 95% CI, 1.24–4.34). Characteristics associated with increased streamlining included: absence of β-lactam allergy (P<.001), Gram-negative bacteremia (P<.001), admission through the emergency department (P=.001), and admission to a medical service (P=.011).

CONCLUSIONS

Compared with prior authorization, prospective audit increased antimicrobial streamlining for cases of Gram-negative bacteremia, those admitted through the emergency department, and those admitted to a medical but not surgical service.

Infect Control Hosp Epidemiol 2016:1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 1 , January 2017 , pp. 89 - 95
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. The data included in this article were presented at IDWeek 2013 in San Francisco, California, on October 2, 2013.

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