920. Leveling Up: Evaluation of IV vs. PO Linezolid Utilization and Cost after an Antimicrobial Stewardship Program Revision of IV to PO Conversion Criteria within a Healthcare System. (15th December 2022)

• Record Type: Journal Article
• Authors: Jaggar, Jessica H; Cleveland, Kerry O; Twilla, Jennifer D; Patterson, Shanise; Hobbs, Athena L V
• Is Part Of: Open forum infectious diseases. Volume 9:(2022)Supplement 2
• Publication Date: 2022-12-15
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac492.765
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Intravenous (IV) to oral (PO) conversion is specifically listed as a pharmacy-based intervention in the CDC's Core Elements of an Antimicrobial Stewardship Program (ASP). Due to linezolid's high PO availability and high IV cost, it is used as a marker for pharmacist-driven IV to PO conversion within our healthcare system, which remained low despite the existence of a pharmacist-driven IV to PO protocol. The system ASP implemented an intervention aimed at improving rates of IV to PO conversion of antimicrobials. Methods: This retrospective, observational cohort was conducted within a healthcare system composed of 5 adult acute care facilities. The system ASP reviewed and revised the conversion eligibility criteria November 30, 2021 (Table 1). Education was conducted, and a compulsory computerized training module was assigned to every pharmacist in the system. Two follow-up emails reporting results were also sent to the system ASP pharmacy leaders during the post-intervention period, and leaders were encouraged to share results with their departments. The primary objective of this study was to determine if there was a difference in PO linezolid utilization reported as days of therapy per 1000 patient days (DOT/1000 PD) between the pre- and post-intervention periods. Secondary objectives included IV linezolid utilization and cost savings. Results: The average DOT/1000 PD for PO linezolid in the pre-intervention period (February-November 2021) was 38.9 compared to 58.8 for the post-intervention period (December 2021-March 2022), p< 0.01 (Figure 1). This reflected an increase in the average percentage of PO use from 42.9 to 62.4% for the pre- and post-intervention periods, respectively (p< 0.01, Figure 2). Inversely, the average DOT/1000 PD for IV linezolid fell from 52.1 to 35.4 in the pre- and post-intervention periods, respectively (p< 0.01). A cost savings analysis revealed a monthly post-intervention savings of $7, 091.34 with a projected total annual cost savings of $85, 096.09 for the system. Conclusion: An ASP intervention that revised criteria for IV to PO conversion, educated pharmacists, and tracked and reported results led to significantly more PO linezolid use and reduced overall cost in a large healthcare system. Disclosures: Kerry O. Cleveland, MD, AbbVIe: Honoraria|Merck: Honoraria.