Category: Professional Posters
Purpose: To assess the effectiveness of prospective audit and prescriber-directed utilization metrics on antibiotic utilization.
Centers for Disease Control and Prevention (CDC) cites that 20-50% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate. Providing personalized communication about how prescribers can improve their antibiotic prescribing is one strategy suggested by the CDC. While acceptance of pharmacist interventions demonstrates success of an Antibiotic Stewardship Program (ASP), shaping prescriber habits was given equal weight in evaluating sustained ASP outcome measures.
Methods: This was a two-phase, single-center study evaluating the impact of pharmacist-led prospective audit and education to prescribers regarding their individual prescribing. Phase I (Jan-Dec 2016) consisted of antimicrobial stewardship program team (AST: infectious diseases physician and pharmacist) prospective audit and feedback targeting de-escalation, escalation, unnecessary duplicative coverage, and duration of therapy. Additionally, focused group presentations were provided to hospitalists as well as quarterly individualized report cards with comparison vs. peers were provided to prescribers. Phase II (Jan-Dec 2018) included targeted prescriber group education to all medical staff providers. The primary endpoint was antibiotic utilization (days of therapy (DOT)/1000 adjusted patient days [AdjPD]) before (Jul-Dec 2015) and after implementation of each phase. Secondary endpoint included assessment of the required number of AST interventions per prescriber within the same time period. A Student’s T-test was utilized to assess the impact of the interventions.
Results: No difference in DOT/1000 AdjPD (mean+SD) was experienced post-implementation of Phase I vs. baseline (571.5+28.9 vs. 576.7+20.0; p=0.53). However, a significant reduction was observed following Phase II vs. baseline (503.6+36.6 vs. 576.7+20.0; p<0.0001). Reduction in utilization from baseline was mainly driven by decreases in DOT/1000 AdjPD of the following antimicrobial classes: fluoroquinolones (55.8 vs. 81.2), metronidazole (24.6 vs. 45.8), and first generation cephalosporins (40.9 vs. 55.0), carbapenems (22.1 vs. 34.1), and penicillinase-resistant penicillins (15.7 vs. 29.8). Additionally, significantly fewer AST interventions per month (mean+SD) were necessitated post-implementation of Phase I (26.6+7.5 vs 38.0+6.5; < 0.0001) and II (25.6+6.7 vs. 38.0+6.5; < 0.0001).
Conclusion: This study highlights the importance of prescriber group focused education regarding antibiotics. AST-led prospective audit along with individualized hospitalist education and report cards did not significantly decrease antibiotic utilization but resulted in fewer AST interventions. Incorporating targeted antibiotic education to all prescriber groups led to a reduction in DOT/1000 AdjPD.