19 / 150
Method(s):
From an administrative dataset of community pharmacy
dispensed prescriptions, details of acute UTI antibiotics and patient
identifier were extracted from January 1st 2013 to 31st of April 2016
for 89,835 GP registered adult women in GGC.
The first courses of nitrofurantoin or trimethoprim following a 365
day washout period was identified. Course length was estimated.
Repeated course of UTI antibiotic (trimethroprim, nitrofurantoin,
co-trimoxazole, co-amoxiclav, quinolones or cephalexin) was deter-
mined in the following 42 days.
Results:
Proportion requiring a repeat antibiotic course was not
related to nitrofurantoin course length (17.1%, 16.8% and 17.3% for 3, 5
and 7 day courses respectively; Pearson chi-square = 0.31 P = 0.86).
Shorter course lengths of trimethoprim was associated with a larger
proportion of repeated courses (13.6%, 12.7%, 12.5% for 3, 5 and 7 day
courses respectively; Pearson chi-square = 9.94 P < 0.01).
Discussion and/or Conclusion(s):
Shorter course lengths of trime-
thoprim but not nitrofurantoin was associated with a higher rate of
repeat antibiotic prescription. Course length specific to microbio-
logical isolate was not assessed.
ID: 4867
Starting smart is easier than focusing
–
challenges faced in an
elderly population
Frances Edwards
1
, Hugo Donaldson
2
, Mark Gilchrist
2
.
1
London North
West Hospitals NHS Trust,
2
Imperial College Healthcare NHS Trust
Background:
Current national guidance for antimicrobial stewardship
in secondary care recommends a strategy of
“
Start Smart
–
then Focus
”
.
Aim(s)/Objective(s):
We audited our adherence to this guidance
on our weekly Microbiology/Pharmacy Antimicrobial Stewardship
rounds in the Department of Medicine for the Elderly.
Method(s):
Data from 127 patient reviews over 10 weeks were
analysed.
Results:
All the patients (n = 127) had an indication documented and
87% had evidence of an infection (two or more of a clinically relevant
sign, symptomor diagnostic result for the documented indication). The
most common indication was urinary tract infection (n = 37, 26.1%),
followed by community acquired pneumonia (27, 19.0%), cellulitis (15,
10.6%) and hospital acquired pneumonia (13, 9.2%). Antibiotics were
prescribed according to Trust guidance in 54% (n = 68) and on the
advice of the infection team in 36% (n = 46). Only 10% (n = 13) of
prescriptionswere inappropriate. Cultures were sent from68% patients
but only 30% of patients had a relevant culture result. The antibiotic
review resulted in no change to initial plan in 56% of cases and stop
completely in 17%. Many patients remained on broad spectrum
antibiotics, with 26% (n = 42) prescribed piperacillin/tazobactam.
Discussion and/or Conclusion(s):
While adherence to the
“
Start
Smart
”
guidancewas high, the
“
focus
”
element including de-escalation
was challenging due to the lack of relevant culture results in the
majority of cases.
ID: 4883
Significant and sustained reduction of meropenem consumption
following the introduction of daily meropenem stewardship
programme
Tejal Vaghela
1
, Singh Prema
2
, Eleni Mavrogiorgou
2
, Rakan El-Hamad
2
,
Wael Elamin
2
, Hala Kandil
2
.
1
West Hertfordshire Hospitals NHS Trust
Watford General Hospital,
2
West Hertfordshire Hospitals NHS Trust
Background:
Judicious meropenem use is an important goal of
antimicrobial stewardship programme (ASP). At our Trust the use of
meropenem is restricted. We noticed an increase (100%) in merope-
nem consumption in February 16.
Aim(s)/Objective(s):
We report a successful ASP initiative introduced
in March 2016 to reduce meropenem consumption.
Method(s):
All patients prescribed meropenem were identified daily
using the pharmacy system. ITUpatients were excluded as meropenem
use in this setting is daily reviewed by microbiologists. Patients
prescribedmeropenemwithout microbiology input or justified clinical
indication were clinically reviewed on the wards by the Antimicrobial
Stewardship Team. Data on meropenem consumption (DDD/1000
admissions) were collected monthly over 3 month
’
s period.
Results:
There was a significant and sustained monthly reduction
of meropenem consumption as follow: 98, 67, 56, 26 DDD/1000
admissions in February, March, April andMay 2016 respectively, with a
total reduction of 73% after the introduction of meropenem steward-
ship initiative. There was 20% reduction of Piperacillin & Tazobactam
consumption during this 3 month period. We noticed marginal
increase in cephalosporins (11%) and quinolones (19%) consumption
during the same period.
Discussion and/or Conclusion(s):
Our meropenem stewardship
program has promoted appropriate use of meropenem and resulted
in decreased consumption of meropenem. The impact of this program
on mortality rate, Clostridium difficile infection and re-admission
warrants further investigation.
ID: 4913
The challenges of improving day 3 antimicrobial stewardship
reviews
Sarah Drake, Anne Melhuish, Damian Mawer, Abimbola Olusoga,
Emily Williams, Raymond Mak, Jonathan Sandoe.
Leeds Teaching
Hospitals NHS Trust
Background:
PHE
‘
Start smart
–
then focus
’
guidelines (2015)
recommend undertaking antimicrobial stewardship reviews 48
–
72
hours after prescribing an antimicrobial.
Aim(s)/Objective(s):
We performed an audit cycle aiming to improve
the frequency and quality of day 3 antimicrobial reviews at Leeds
Teaching Hospitals.
Method(s):
Standards were developed from local guidelines and
‘
Start
smart
–
then focus
’
. Data was collected prospectively from the clinical
notes and drug charts of patients requiring day 3 review on four wards,
for one month. A reminder sticker was then piloted for four weeks,
alongsidewhich we visited thewards regularly to promote and embed
its use. Data collection was then repeated for one month.
Results:
In the initial phase 33/94 (35%) of patients had no
documented evidence of a review. Only 13% had a review documented
in the medical notes and drug chart (the audit standard). 46/66 (70%)
continued broad-spectrum intravenous antimicrobials. After intro-
duction of the sticker, the re-audit showed they were not being used
and the day 3 review process had not improved. Medical staff from all
grades reported several reasons why this intervention failed: lack of
antimicrobial knowledge, challenges in reviewing antimicrobials
without microbiological samples, and difficulty reviewing antimicro-
bials when the initial indication was unclear.
Discussion and/or Conclusion(s):
Undertaking day 3 reviews is a
complex process that may not be improved by interventions targeting
this stage of antimicrobial prescribing alone. A multifaceted approach
is likely to be necessary. Identifying future interventions requires
further studies to improve our understanding of how medical staff
approach and undertake antimicrobial prescribing.
ID: 5023
Developing national Antimicrobial Stewardship (AMS) surveillance
in England
Diane Ashiru-Oredope
1
, Emma Budd
1
, Sejal Hansraj
1
, Philip Howard
2
,
Stuart Brown
2
, Susan Hopkins
1
.
1
Public Health England,
2
NHS England
Background:
A survey conducted by PHE in 2014 highlighted that the
majority of Trusts completed AMS related ward audits frequently (>6
monthly). In March 2016 PHE developed an AMS surveillance tool and
conducted a pilot to test the feasibility of centrally collecting details
across England.
Aim(s)/Objective(s):
To collect details of existing AMS audits in
English Trusts using a central audit tool.
Method(s):
A web based tool was circulated to the national
antimicrobial pharmacist network across 146 Acute NHS Trusts. This
was a voluntary pilot audit completed by healthcare professionals;
ethics approval was not required.
Abstracts of FIS/HIS 2016
–
Oral Presentations / Journal of Hospital Infection 94S1 (2016) S11
–
S21
S14