Antimicrobial Stewardship Blend from ICAAC 2014

blend-conf-logoThis ICAAC has been an antimicrobial-stewardship friendly conference with a handful of sessions and communications on this topic. In this post I will try to summarize the most relevant information. I hope that you enjoy it!

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Symposia

(146) Expanding the Focus of Antimicrobial Stewardship: Moving Beyond Cost and Utilization as Measures of Success. (Monday 08/09/2014)
  • This was a really well-oriented 2-hour educational activity focused on antimicrobial stewardship. Presenters reviewed the need to focus on AS interventions which could impact patient outcome rather than those merely pursuing a decrease of antimicrobial use/cost. JL Nagel reviewed the literature pointing out AS interventions that have showed a clinical benefit for patients (decreased mortality or length of stay). Problems to implement AS interventions were neatly reviewed by Dr Cosgrove and finally Dr Daneman discussed presented some key messages on how to implement AS interventions across different healthcare settings, from ICU to long-term care setting. Unfortunately, as opposed to ECCMID and other top conferences neither slides nor recordings are available for attendees or ASM members. 🙁
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Back to the Patient: Re-focusing Antimicrobial Stewardship.  (Saturday 06/09/2014). Symposium Satellite sponsored by Cubist Pharmaceuticals
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Communications.

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1. Evaluation of antimicrobial use

K-325. Quality Indicators for Monitoring Appropriate Antibiotic Use in Hospitals: an Important Tool for Antibiotic Stewardship C. M. van den Bosch1, M. E. Hulscher2, S. Natsch2, J. Wille3, J. M. Prins1, S. E. Geerlings1; 1Academic Med. Ctr., Amsterdam, Netherlands, 2Radboud Univ. Med. Ctr., Nijmegen, Netherlands, 3The Natl. Inst. for Publ. Hlth. and the Environment, Bilthoven, Netherlands.
  • This is a nice Dutch multi center study in the search of quality indicators (QI) to better evaluate antimicrobial use in hospitals. Although clinical validation of the proposed QI was not accomplished, research in this topic is greatly appreciated since these QI are needed to standardize the evaluation of antimicrobial use [Poster].
K-317. Aminoglycosides Prescribing In Health-care Centers In France In 2013-2014: Room For Improvement J. Robert1, Y. Pean2, S. Alfandari3, J. Bru4, J. Bedos5, C. Rabaud6, R. Gauzit7, on behalf of SPILF and ONERBA; 1CHU Pitie, Paris, France, 2ONERBA, Paris, France, 3CH, Tourcoing, France, 4CH, Annecy, France, 5CH, Versailles, France, 6CHU Brabois, Nancy, France, 7CHU Cochin, Paris, France
 

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2. Teaching AS interventions

K-323. Online Interactive Case-based Antibiotic Education for Internal Medicine Residents A. K. Sofjan1, L. Zickuhr2, N. Kirmani2, C-A. D. Burnham2, M. Czernikiewicz2, D. J. Ritchie1,3; 1Barnes-Jewish Hosp., Saint Louis, MO, 2Washington Univ. Sch. of Med., Saint Louis, MO, 3Saint Louis Coll. of Pharmacy, Saint Louis, MO
  •  The long-term impact of AS interventions seems to be more marked with non-restrictive rather than with restrictive interventions. Pure educational activities are one of the main non-restrictive interventions. In this communication, the Barnes-Jewish ASP designed case-based on-line educational activity targeting Internal Medicine residentes at their institution. Evaluation of the Infectious Diseases and antimicrobial therapy knowledge was evaluated before and after the educational activity was performed with a favorable impact. The impact of the activity on prescribing was not formally evaluated [Poster].

 

3. PK/PD AS Interventions

K-331. Impact of an Institutional Weight-Based Antimicrobial Dosing Guideline for Morbidly Obese Adults A. Polso, J. Lassiter, J. L. Nagel; Univ. of Michigan, Ann Arbor, MI

  • Lean body weight? Total body weight? Ideal body weight? This study evaluates the impact (antimicrobial consumption) of a dosing guideline for weight-based antimicrobials. The authors standardized dosing of 7 antimicrobials: IV acyclovir, colistin, daptomycin, foscarnet, IV ganciclovir, IV trimethoprim-sulfamethoxazole and voriconazole. Evaluation of antimicrobial dosing, compliance with guideline recommendations, and antimicrobial costs was conducted for adult morbidly obese patients for one year.  “Compliance with guideline recommendations occurred in 68% (range 44-100%) of doses for all agents, resulting in antimicrobial cost saving of $97,886. Daptomycin and voriconazole dose adjustments accounted for the majority of cost savings”.  
 

4. Comprehensive AS interventions

K-324. Effects of a Multi-faceted Antimicrobial Stewardship Model on Clinical, Microbiological and Antibiotic Utilisation Outcomes in Hospitalised Patients T. Ng1, D. Kee1, A. Chow1, B. Teng1,2, M. Tan1, H. Tay1, E. Lew1, S. Tan1, E. Rowe1, L. Ling1, B. Ang1, D. Lye1,2; 1Tan Tock Seng Hosp., Singapore, Singapore, 2Natl. Univ. of Singapore, Singapore, Singapore.

  • The clinical impact of comprehensive, hospital-wide interventions on patient outcomes remains very difficult to ascertain. Before and after studies to prove the impact on antimicrobial consumption and resistance have significant limitations

K-329. Acceptance and Results of Non-compulsory Advice (NCA)-based Stewardship on Restricted Antibiotics and any Prescription with Duration Longer than 7 days P. Retamar, Red Española de Investigación en Patología Infecciosa, M. Núñez, M. Macías, M. Beltrán, S. Sandoval, M. de Cueto, J. Rodríguez-Baño, Red Española de Investigación en Patología Infecciosa; HUV Macarena, Seville, Spain

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5. AS interventions in specific populations

K-326. A Multi-Disciplinary Antimicrobial Stewardship Program (ASP) Decreases Duration of Antibiotic(abx)Prescription Safely in Adult Renal Patients in Singapore Y. Cai, P. Shek, I. Teo, S. Tang, Y. Liew, W. Lee, M. Chlebicki, A. L. Kwa; Singapore Gen. Hosp., Singapore, Singapore
  • Specialty focused and/or antimicrobial therapy targeted AS interventions might facilitate higher ASP intensity interventions. This is what researches from a Singapore hospital did acting (audit and feec-back) on patients being prescribed iv broad-spectrum antimicrobials in a renal department (1243). At least 47% of antimicrobial courses reviewed were amenable to change. Researchers found a high compliance rate with AS recommendations. Patients in which recommendations were followed had less antimicrobial exposure and expenditures with no decrease in clinical outcomes as compared with patients in which AS recommendations were not followed. 
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T-1803. Weekly Antimicrobial Coaching as an Antimicrobial Stewardship Intervention in a Hematology Ward G. Montalbán, F. Moreno, M. Canales, V. Jiménez, M. Romero-Gómez, J. R. Paño-Pardo; Hosp. La Paz-IDIPAZ, Madrid, Spain
  • Prospective, low-intensity (weekly) intervention of audit of targeted antimicrobial prescriptions in a Hematology ward and feed-back in a group session showed high rates of compliance without significant adverse events. 

6. Microbiology based AS interventions

Microbiology results are crucial to guide antimicrobial therapy and significant advances in rapid identification and antimicrobial susceptibility testing are being accomplished in the last few years. From the clinical outcomes perspective and from the  antimicrobial prescribing standpoint AS is key to obtain a maximum yield of new microbiological tech. Many abstracts were focused on the synergy between Micro Lab and AS. Many to these studies used a before-after design to evaluate the implementation of new Microbiological workflows and processes, especially for patients with bloodstream infections.
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6.1. Synergy between new Microbiology tests and AS
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D-910 Randomized Trial of Blood Culture Pathogen Identification Using the FilmArray Blood Culture ID Panel (BCID) vs. Standard Culture Techniques: Impact on Antimicrobial Use and Outcomes R. Banerjee, C. Teng, S. Cunningham, S. Ihde, J. Steckelberg, J. Mandrekar, R. Patel; Mayo Clin., Rochester, MN
  • This is one of the most remarkable abstracts presented on this topic. The study conducted at the Mayo Clinic and involves the introduction of the Film Array Blood Culture ID Panel (BCID) which “identifies 24 bacteria and fungi and 3 antimicrobial resistance genes (mecA, vanA/B, KPC) within 1 hour of a positive blood culture (BC)”. Researchers randomized all positive blood cultures between 08/2013 and 04/2014 (617) to one of these three arms: Arm A: standard workflow (207); Arm B: BCID + template comments (198) and Arm C: BCID + AS (212). As expected, time to identification was shorter in Arm B and Armc C (1.4h) as compared with Arm A (23.6h). Time to de-escalation was shorter in Arm C (27.2) as compared with Arm B (45h) and Arm A (40.4h). “Groups did not differ in mortality, LOS, cure, C. difficile infection, or colonization with multidrug-resistant organisms within 30 days after enrollment”.  Nice design to show that Micro and AS should walk together.
D-912 Impact of Integrating the Nanosphere Verigene Gram-Positive Blood Culture (BC-GP) Test with Antimicrobial Stewardship in a Non-Teaching Community Hospital B. Crane, J. Akin; Blount Mem. Hosp., Maryville, TN
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6.2. AS interventions in patients with bloodstream infections
K-334. Impact of a Antimicrobial Stewardship Team Intervention in Adult Patients with Bacteremia E. Merino, E. Caro, V. Boix, A. Gimeno, J. Rodríguez, G. Riera, M. Patricio, S-P. José, S. Reus, T. Diego, J. Portilla; Hosp. Gen. Univ.o, Alicante, Spain
K-336. Impact of an Antimicrobial Stewardship Team on the Outcomes of Patients with Staphylococcus aureus Bacteremia in a Community Hospital System J. J. Frens1, J. R. Smith2, C. B. Snider1; 1Cone Hlth., Greensboro, NC, 2Wayne State Univ., Detroit, MI
K-344. Impact of an Antimicrobial Stewardship Directed Comprehensive Care Bundle on the Management of Staphylococcus aureus Bacteremia C. Nguyen, T. Gandhi, C. Chenoweth, J. Lassiter, J. Dela Pena, J. Nagel; Univ. of Michigan Hlth. Syst. (UMHS), Ann Arbor, MI
M-1753. Opportunities for Antimicrobial Stewardship in the Management of Invasive Candidiasis D. M. Martirosov1, R. M. Kenney1, J. A. Vazquez2, S. L. Davis3,1; 1Henry Ford Hosp., Detroit, MI, 2Med. Coll. of Georgia at Georgia Regents Univ., Augusta, GA, 3Eugene Applebaum Coll. of Pharmacy and Hlth. Sci. at Wayne State Univ., Detroit, MI
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6.3. AS interventions in patients with MDRO
Some of these papers are focused on multi-drug resistant Gram-negative microorganisms
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K-345. Impact of Antimicrobial Stewardship Program (ASP) Intervention on Outcomes of Pseudomonas aeurginosa (PsA) Infection with Reduced Susceptibility to Cefepime (CFM) or Piperacillin-Tazobactam (PTZ) J. Nagel, C. Nguyen, A. Hunt, M. Hur, A. Kunapuli, G. Eschenauer, T. Gandhi; Univ. of Michigan Hlth. Syst. (UMHS), Ann Arbor, MI
K-343. Impact of Antibiotic Stewardship Program Interventions on Multi-drug Resistant Organism Resistance Rates and Hospital Costs N. Prasad, N. Warren, A. Kula, N. Mariano, C. Urban, D. Figueroa, S. Segal-Maurer; New York Hosp. Queens, Flushing, NY
K-346. Clinical and Economic Impact of a Formal Intervention Program Targeting Carbapenem-Resistant Klebsiella pneumoniae (CRKP) Bacteremia B. A. Potoski1,2, R. K. Shields1,2, G. A. Eschenauer2, M. H. Nguyen1,2, C. J. Clancy1; 1Univ. of Pittsburgh, Pittsburgh, PA,2Antibiotic Stewardship Program, UPMC Presbyt., Pittsburgh, PA
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7. Pathology-driven AS interventions

Other opportunity to trigger AS interventions are clinical conditions (..and others such as PCT determinations). Here you will find some interesting AS interventions on these topics

K-337. Evaluation of a Novel Vancomycin vs. Linezolid ICU Cycling Protocol in Documented MRSA Nosocomial Pneumonia N. Vyas1, D. Slain2, L. Keller1, A. Sarwari2, R. McKnight1; 1West Virginia Univ. Hlth.care, Morgantown, WV, 2West Virginia Univ., Morgantown, WV
L-1072. Impact of an Antimicrobial Stewardship Intervention on Urinary Tract Infection Treatment in the Emergency Department K. M. Percival1, S. J. Bergman2, K. M. Valenti1, S. E. Schmittling1, B. D. Strader1, R. R. Lopez3; 1St. John’s Hosp., Springfield, IL, 2Southern Illinois Univ. Edwardsville Sch. of Pharmacy, Edwardsville, IL, 3Southern Illinois Univ. Sch. of Med., Springfield, IL
D-181. Antimicrobial Stewardship: Role of ProCalcitonin (PCT) J. B. Sarma, D. Tait, B. Marshall, T. Oswald, S. Banerjee; Northumbria Hlth.care NHS Fndn. Trust, North Shields, United Kingdom

 

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