192. More Low-hanging Fruit: Antibiotic Chelation Drug Interactions. (26th November 2018)

• Record Type: Journal Article
• Authors: Kenney, Rachel M; Makowski, Charles T; Church, Brian; Davis, Susan L
• Is Part Of: Open forum infectious diseases. Volume 5(2018)Supplement 1
• Page Start: S84
• Page End: S85
• Publication Date: 2018-11-26
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofy210.205
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Attainable, low-resource antimicrobial stewardship (AMS) interventions, "low-hanging fruit" can be facilitated by electronic medical record (EMR) enhancements. Oral (PO) fluoroquinolone (FQ) or tetracycline (TCN) coadministration with di- and tri-valent cations reduces antibiotic absorption by up to 75%, is common, and may represent low-hanging fruit. We evaluated concomitant administration and outcomes in a five hospital system before and after an EMR medication safety improvement. Methods: IRB approved quasi-experiment, emergency (ED) visits and hospital admissions September 2016–February 2017 and September 2017–February 2018. Standard of Care: cations were scheduled 0900 and 2100; FQ and TCN administration instructions stated: "Administer at least 2 hours before or 6 hours after (cations)." Intervention: April 2017 EMR change in the default timing of FQ and TCN to 0630 and 1530 with pharmacy and nurse education. Primary endpoint: coadministration, defined as administration of PO product containing calcium, magnesium, iron, or phosphate binder 2 hours before or 6 hours after PO doxycycline, ciprofloxacin, or moxifloxacin. Results: A total of 4, 414 and 5, 231 patients, representing 4, 887 and 5, 781 encounters, received PO FQ or TCN pre- and post-intervention, respectively. Average age (years) pre: 62.1, post: 61.3. Respiratory infection most common (25% pre, 27% post) followed by genitourinary (13% pre, 12% post). Concomitant administration: 3629/17, 702, 20.5% pre vs. 2, 184/20, 524, 10.6% post ( P < 0.001), see Table 1. Median hospital length of stay: 3 (0.3, 6) pre, 2.9 (0.3, 5.8) post. Thirty-day all-cause readmission: 28% pre and 27.2% post. Conclusion: A system-based change to the EMR was effective to reduce the frequency of FQ and TCN chelation interactions by half and represents a low-hanging fruit strategy for AMS programs. Our institution has subsequently employed this strategy to reduce chelation interactions with HIV integrase inhibitors. Disclosures: S. L. Davis, Achaogen: Scientific Advisor, Consulting fee. Allergan: Scientific Advisor, Consulting fee. Melinta: Scientific Advisor, Consulting fee. Nabriva: Scientific Advisor, Consulting fee. Zavante: Scientific Advisor, Consulting fee.