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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.


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


, Hugo Donaldson


, Mark Gilchrist




London North

West Hospitals NHS Trust,


Imperial College Healthcare NHS Trust


Current national guidance for antimicrobial stewardship

in secondary care recommends a strategy of

Start Smart

then Focus



We audited our adherence to this guidance

on our weekly Microbiology/Pharmacy Antimicrobial Stewardship

rounds in the Department of Medicine for the Elderly.


Data from 127 patient reviews over 10 weeks were



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



guidancewas high, the


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


Tejal Vaghela


, Singh Prema


, Eleni Mavrogiorgou


, Rakan El-Hamad



Wael Elamin


, Hala Kandil




West Hertfordshire Hospitals NHS Trust

Watford General Hospital,


West Hertfordshire Hospitals NHS Trust


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.


We report a successful ASP initiative introduced

in March 2016 to reduce meropenem consumption.


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.


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


Sarah Drake, Anne Melhuish, Damian Mawer, Abimbola Olusoga,

Emily Williams, Raymond Mak, Jonathan Sandoe.

Leeds Teaching

Hospitals NHS Trust



Start smart

then focus

guidelines (2015)

recommend undertaking antimicrobial stewardship reviews 48


hours after prescribing an antimicrobial.


We performed an audit cycle aiming to improve

the frequency and quality of day 3 antimicrobial reviews at Leeds

Teaching Hospitals.


Standards were developed from local guidelines and



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.


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


, Emma Budd


, Sejal Hansraj


, Philip Howard



Stuart Brown


, Susan Hopkins




Public Health England,


NHS England


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.


To collect details of existing AMS audits in

English Trusts using a central audit tool.


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