Effects on quality prescription of a prospective interventional study based on a restrictive antibiotic policy
Abstract number: 1733_888
Jover F., Cuadrado J.M., Sánchez V., Ortiz de la Tabla V., Gonzalez M., Martinez R., López-Calleja E., Martin C.
Objective: To assess the impact of a programme to evaluate the quality of an antibiotic restriction policy at an University hospital.
Methods: A multidisciplinary antimicrobial management team (AMT) composed by Infectious Diseases, Microbiology and Pharmacy members daily evaluated restricted antibiotic prescriptions. We designed a prospective study with two periods: observational (October 1st 2003March 31th 2004) and interventional (April 1st 2004February 28th 2006). A specific prescription formulary aiming to evaluate the usage of broad spectrum antibiotics was introduced. Revision criteria were according to ID Comittee guidelines and Sanford Guide to Antimicrobial Therapy. Clinical, microbiological and pharmaceutical data were collected from each patient. Antibiotic therapy appropiateness, restricted therapy elegibility and economic outcomes were evaluated. During interventional period, antibiotic recommendation prescriptions were formulated. Statistical analysis with non-parametric tests were performed. A p value of <0.05 was accepted as significant.
Results: 1,212 patients were evaluated (21% observational/79% interventional period). Overall, restricted agents prescribed were imipenem (26.1%), ceftazidime (23.5%), piperacilin-tazobactam (15.3%), amikacin (12.3%), vancomicin (10.6%), cefepime (5%). Most frequent diagnostic groups were sepsis (36.3%), respiratory (16.2%), prophylaxis (14.6%), gastrointestinal (14.4%), soft-tissue and bone infections (13.7%) and UTI (4.9%). Any microbiological sample was taken in 78.8% of cases. Comparing both periods, adequate prescription of antibiotherapy increased from 90.7% to 97.3%. Restricted antibiotic prescription significantly improved from 59.4% to 88.5%, while concordance to AMT prescription increased from 54.8% to 81.1%. We found a significant reduction in DDD/1,000 patients-day in two periods (52.36 vs 46.21: p < 0.05). Other several statistically significant diferences in DDD/1,000 patients-day were detected: decrease in ceftazime (15.3 vs 8.9) and teicoplanin (3.11 vs 0.5). Economic outcomes were significantly reduced. In the interventional period, 329 written recommendations were formulated (27.1%), while 73% of them were accepted.
Conclusions: The development of prophylactic and therapeutics local guidelines reached by consensus, and the evaluation and interventional policy by an AMT group have significantly improved the quality and economical costs of restricted antibiotic prescription in our hospital.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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