1872. Antimicrobial Utilization Variability Among Training Services at an Academic Medical Center. (26th November 2018)

• Record Type: Journal Article
• Authors: Schulz, Lucas T; Lalik, Edward; Sheehy, Ann; Fox, Barry
• Is Part Of: Open forum infectious diseases. Volume 5(2018)Supplement 1
• Page Start: S535
• Page End: S535
• Publication Date: 2018-11-26
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofy210.1528
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: The general medicine (GMed) and hospitalist (Hosp) services use antimicrobials at a relatively high rate among our teaching services. It is currently unknown if there is a difference in antimicrobial prescribing between various learner levels or attending type at our institution. Methods: We measured antimicrobial utilization between January 1, 2016 to April 22, 2018 (2.25 years) in our GMed services. Services are divided by resident-led and hospitalist only services. The GMed1 service is staffed by outpatient internists, the GMed2 service is split between geriatricians and hospitalists, and the GMed3 service is only hospitalists. The "A" service is junior residents while "B" is senior residents. We measured utilization using the WHO defined Days of Therapy (DOT) definition normalized per 1, 000 patient-days (PD). Secondary analysis based on antibiotic breadth and route were analyzed by average DOT/1, 000 patient-days. Results: GMed services prescribed at a higher rate of DOT than hospitalist services over the study timeframe (809 vs. 645, P < 0.0001). Junior resident-led services (A) used more antimicrobials than senior resident-led services (B) (894 vs. 606, P < 0.0001). There were no significant prescribing differences between the 1, 2, and 3 services by different attending roles (840 vs. 775 vs. 797). Similar trends continue in secondary analysis with hospitalists prescribing a lower average DOT/1, 000 PD of broad-spectrum antibiotics and A services prescribing higher rates of broad-spectrum, anti-MRSA, and anti-Pseudomonal therapy compared with B services (Table 1). Conclusion: Antimicrobials were prescribed at a significantly higher rate in services associated with trainees than those without. Junior resident-led services prescribed at a significantly higher rate than services-led by a senior resident. Interventions to reduce unnecessary antimicrobial exposure should be targeted toward learners, especially junior trainees. Disclosures: All authors: No reported disclosures.