Antimicrobial Stewardship Blend from ICAAC 2014
- By José Ramón Pano-Pardo
- 15 September, 2014
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Symposia
- 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. 🙁
Communications.
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1. Evaluation of antimicrobial use
- 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].
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2. Teaching AS interventions
- 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
5. AS interventions in specific populations
- 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.
- 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
- 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.
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
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