Broad-Spectrum Antibiotic Use at Choice, Change, and Completion Throughout VA: Patterns of Initiation and De-escalation. (4th October 2017)

• Record Type: Journal Article
• Authors: Goetz, Matthew; Graber, Christopher J; Jones, Makoto; Madaras-Kelly, Karl; Samore, Matthew; Glassman, Peter
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S250
• Page End: S251
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.540
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Antimicrobial stewardship programs seek to reduce initiation of unwarranted therapy, promote de-escalation and prevent excessive duration. The CDC Antibiotic Use option provides ward-level reports of antibiotic use and risk-adjusted Standardized Antibiotic Administration Ratios for pre-specified antibiotics groups that allow for inter-facility comparison, but do not provide the indication for use or temporal patterns that allow de-escalation assessments. Methods: We characterized antibiotic use on days 0–2 (Choice), 3-4 (Change) and 5-6 (Completion) of therapy (CCC) for pneumonia (LRTI), skin-soft-tissue infections (SSTI) and urinary tract infection (UTI). We then explored the relationship between total MRSA or multi-drug-resistant GNR (MDRO) antibiotic use and use over CCC intervals for LRTI and SSTI for patients in acute non-ICU settings in 33 high-complexity VA facilities. Data were from 2016 and extracted from the VA Corporate Data Warehouse. Results: The mean rates of anti-MRSA and anti-MDRO therapy were 108 and 123 Days of Therapy (DOT)/1000 days present, respectively. The table shows the fraction (mean, range) of patients with SSTI or LRTI receiving anti-MRSA or anti-MDRO therapy at the CCC intervals and the change in use (i.e., de-escalation) over the treatment course. Conclusion: Syndrome-specific CCC metrics show substantial variations in the rates of de-escalation of antimicrobial use over treatment courses. Insights provided by these metrics will allow facilities to identify specific areas for improvement by targeting syndrome-specific initial choices of therapy or antibiotic de-escalation. Disclosures: All authors: No reported disclosures.