Antimicrobial stewardship improves appropriateness of antimicrobial therapy prescription in a neurosurgical unit
Abstract number: O88
Pagani L., Vernaz N., Aschbacher R., Falciani M., Mian P., Schwarz A.
Objectives: To assess the impact of an Antimicrobial Stewardship Program (ASP) on antimicrobial usage and consumption, and patients' outcome in the neurosurgical setting of an Italian 850-bed tertiary hospital.
Methods: Between January 2007 and December 2008, a multidisciplinary Antimicrobial Management Team (AMT) provided a two-phase intervention in our 21-bed Division of Neurosurgery (NSU). In the observational period (2007), clinical, microbiological and pharmaceutical data of the year were collected, and reviewed with the ward medical staff thereafter. In the interventional period (2008), the AMT provided antimicrobial recommendation prescription on a regular and on-call basis, together with formulary restrictions and encouraged appropriate prophylaxis or targeted therapy whenever indicated. Recommendations were driven by updated specific pathogen resistance patterns and clinical pharmacology parameters; pharmaceutical data analysis was performed through the ESGAP ABC 3.1 program.
Results: The total number of admissions was 797 (bed-occupancy index = 0.87) in 2007 and 761 (bed-occupancy index = 0.82) in 2008, accounting for 6668.55 and 6302.52 bed-days, respectively. Among antimicrobial drugs commonly used for prophylaxis, the defined daily doses/100 bed-days (DDD) decreased from 558.33 to 406 for cefazolin, and from 363.66 to 239 for amoxicillin/clavulanate between 2007 and 2008. Among therapeutically used antimicrobials, vancomycin decreased from 205.5 to 37, meropenem from 360 to 249.5, levofloxacin from 804 to 564, and linezolid from 275.5 to 199, whereas ertapenem slightly increased (from 17 to 30) because of few invasive infections caused by ESBL-producing Enterobacteriaceae. However, mean length of stay decreased from 9.29 days to 8.90 between the two years, and no patients died in NSU due to infection-related causes during 2008. The grand total of antimicrobial expenditures also decreased from Euros 88,787.94 to 60,584.34.
Conclusion: The interventional policy by an AMT, based on the development of agreed upon prophylactic and therapeutic antimicrobial regimens, regular educational activities and microbiological and pharmaceutical monitoring significantly improved not only the appropriateness of antimicrobial prescription in this high-risk setting, but also the economical costs of antimicrobial acquisition.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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