IDSA Monitoring Use of Antibiotics

Surveillance of an Infectious Diseases Fellow Managed Antibiotic Restriction

Program at a Tertiary Care Hospital

SANJIV S SHAH, JEANNE CAREY, CARL ABRAHAM, KYAW HAN, ELMELA

ZLATANIC, Beth Israel Medical Ctr, New York, NY

Introduction: At Beth Israel Medical Center (BIMC), the majority of requests for release of antibiotics from a restricted formulary are initiated by telephone calls from health care providers to infectious diseases fellows (IDFs). We surveyed the outcome of this process over a month long period. Setting: BIMC is a 940-bed tertiary care hospital in New York City. Four IDFs run the antibiotic restriction program with attending supervision. Patients are admitted either by a private attending or by an assigned service attending.

Methods: The IDFs maintained a log of all requests for restricted antibiotic release over a 35-day period. Data collected included: patient identification, location, private vs. service attending, antibiotic requested, reason for request, acceptance or denial of request, alternative antibiotic offered, whether an appropriately offered ID consult was accepted or declined, follow-up of culture results if obtained.

All requests were monitored with an IDF initiated follow-up call after 3

days to ascertain the status of the patient.

Results: 169 requests were made, 130 (77%) for patients with private attendings, 130 (77%) requests were approved, 25 with dose modification. 11 (17%) offered ID consults were accepted, there was no difference in acceptance rate for consults between private and service cases.

Follow-up call revealed that 73% of cases had clinically improved (discharged home, antibiotics discontinued, defervesced, changed to oral therapy, or had decreased white blood cell count), 15% had no change or deteriorated, and 11% had further adjustment in antibiotics or request for ID consultation. There was no relation between use of requested antibiotic and outcome. None of the patients who had an

initial ID consultation had deterioration in their condition.

Conclusions: Most requests for restricted antibiotics were approved, three quarters of patients had clinical improvement. Most antibiotic requests were appropriate, however almost 20% required dose adjustment recommended by the IDF. Acceptance of ID consult was associated with a favorable outcome.

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492 A Multihospital Survey of Physician (MD) Perceptions of the Prevalence of

Antimicrobial Resistance (AR) and Satisfaction with Antimicrobial Prescribing

(AP)

M F WISNIEWSKI, DAVID N SCHWARTZ, R J RYDMAN, Cook County Hosp, Chicago, IL; S L PUR, Rush-Presbyterian-St Luke’s Medical Ctr, Chicago, IL; R A WEINSTEIN, Cook County Hosp, Chicago, IL

Background: Antimicrobial use is a major risk factor for development of AR infection. Interventions to improve AP should be tailored to MD needs. Methods: During 12/1999-12/ 2000 we distributed a 52-item survey to 1750 MDs in 4 hospitals.

The survey used a Likert scale to assess perception of AR, knowledge of local AR, perceived helpfulness of AP decision-support resources (DSR) (guidelines, handbooks, antibiogram), and satisfaction with AP decisions. Results: 1197 (70%) surveys were returned and represented medicine (37%), surgery (20%), pediatrics (9%), Ob/Gyn (8%), and others (27%). Although 77% of respondents strongly agreed (SA) that AR was a problem nationally, only 45% SA that AR

was a problem in their own hospital.

Perceived importance of local AR varied among medical specialties, with medicine MDs significantly more concerned than surgery and pediatric MDs (p􏰈 .003). Compared with other specialties, surgeons less often SA that AR is an im-

portant problem nationally and in their own practices and that widespread antibiotic use, excessively broad-spectrum antibiotic use, and failure to wash hands are important causes of AR. They also reported less frequent use of ID consultation and antibiotic handbooks such as the Sanford Guide when making AP decisions. Across specialties, respondents reported being satisfied with AP decisions often or always 78% to 91% of the time; use and perceived helpfulness of several decision support resources independently predicted AP satisfaction on multivariate analysis.

Conclusions: Perceptions of the importance of AR and its causes vary

greatly among MD groups; surgeons generally reported less concern than other specialties about these issues. Satisfaction with AP decisions is high and correlates with decision support resource use. Interventions to improve AP should emphasize user-friendly DSR and may require convincing MDs of the seriousness of the problem to achieve success.