The Journal of Hospital Infection - Supplement 1

ID: 4880

Influence of empirical antimicrobial guidelines on piperacillin &

tazobactam consumption in Acute Trust in East of England (EoE)

region

Tejal Vaghela

, Netta Tyler

, Rachel Leff

, Claire Allen

, Emma Cramp

Ting Yau

, Currie Naomi

, Shayi Shali

, Dawn Whitbourn

David Ladenheim

West Hertfordshire Hospitals NHS Trust Watford

General Hospital,

Papworth Hospital NHS Foundation Trust,

Luton &

Dunstable Hospital NHS Foundation Trust,

Colchester University Hospital

NHS Foundation Trust,

Hinchingbrooke Health Care NHS Trust,

Mid

Essex Hospitals Services NHS Trust,

Bedford Hospitals NHS Trust,

Princess Alexandra Hospitals NHS Trust,

Norfolk and Norwich

University Hospitals NHS Foundation Trust,

East and North

Hertfordshire NHS Trust

Background:

The recommendation of Piperacillin & Tazobactam (PTZ)

as first line empirical therapy for clinical infections varies across acute

Trusts in the EoE region.

Aim(s)/Objective(s):

We studied the relation between PTZ consump-

tion rate and the clinical indications with PTZ being recommended as

first line empirical therapy.

Method(s):

10 acute Trusts provided PTZ consumption data (expressed

as DDD/1000 admissions) for 2015/16. ESPAUR PPS Survey 2011

results showed that five clinical indications (Respiratory, Skin and Soft

Tissue/Bone/Joint, Urinary Tract, Sepsis and Gastrointestinal indica-

tions) accounted for 90% of antimicrobial use. We reviewed first line

empirical PTZ recommendations for these five indications for each of

acute Trust in the region. PTZ consumption data and antimicrobial

guidelines were compared and analysed.

Results:

The results showed that Trusts with higher (6/6 Trust) and

lower (3/4 Trust) than average PTZ consumption recommended PTZ

as first line therapy for the majority of clinical indications (=>3/5

indications).

Discussion and/or Conclusion(s):

Our results show that the

empirical guidelines do not influence PTZ consumption data. Other

factors such as duration of PTZ use, dosage used (Three times a day vs

Four times a day) and guideline compliance may influence the

consumption data. Further analysis which includes these factors

would be useful to understand the different PTZ consumption data

within the region.

ID: 4926

A Novel, NICE teamwork approach for the antimicrobial

stewardship in a teaching hospital

Milind Khare, Deborah Gnanarajah, Wijitha Weerakoon, Julia Lacey.

Royal Derby Hospital

Background:

‘

Start Smart

–

Then Focus

’ –

Antimicrobial Stewardship

Toolkit for English Hospitals was introduced in March 2015 by Public

Health England. NICE guideline for Antimicrobial Stewardship came in

August 2015.

Aim(s)/Objective(s):

To review effectiveness of continuing weekly

antibiotic audits by clinicians from April 2015 onwards.

Method(s):

The audits are carried by medical staff auditing all patients

on an antimicrobial on a particular day, either on a weekly or monthly

basis depending on past performance. Audits are forwarded to the

antimicrobial pharmacist who reviews them in conjunction with the

consultant microbiologist.

Audit criteria are (1) Antibiotic choice is in line with Trust guidelines

OR culture and sensitivity results OR there is a documented justified

reason for deviation from the guidelines. (2) There is a stop or review

date on the prescription. (3) Antibiotic treatment is reviewed 48

–

hours after starting and the prescribing decision documented added

for 2016/17 antimicrobial CQUIN.4) Appropriate samples sent for

cultures and sensitivity testing

Results:

There was an increase in the overall number of audits

completed in May 2016, with the highest number since October 2015.

Results improved in May 2016, with the target for stops dates being

achieved and appropriateness improving from 80% to 83%. Sending of

samples for culture and sensitivity fell slightly to 78%, however, this

was still a big improvement on previous results.

Discussion and/or Conclusion(s):

Continuing weekly audits by

clinicians and review of feedback and action plan is a time consuming

mammoth task for the team and has led to establishment of good

antimicrobial stewardship practice.

ID: 4936

Review of high dose broad spectrum antibiotic use in NHS Lothian

primary care

Simon Hurding, Carol Philip, Maria McMenemy, Angela Timoney.

NHS Lothian

Background:

Reduction in the use of broad-spectrum antibiotics

is an important priority for antimicrobial stewardship. NHS Lothian

has been slower to reduce use and one factor may be recommenda-

tions for prolonged courses of broad-spectrum antibiotics by second-

ary care.

Aim(s)/Objective(s):

This study looks at prescribing data to identify

whether or not extended courses of broad-spectrum antibiotics are a

significant contributory factor to overall use

Method(s):

The Prescribing Information System for Scotland provided

a six year time series analysis, comparing NHS Lothian with the

other NHS Boards for overall antibiotic, and broad-spectum use.

Prescribing Information System identified prescribing of prolonged

courses of broad-spectrum antibiotics. Current Lothian Joint

Formulary (LJF) clinical indications were reviewed and the expected

resultant prevalence calculated. This was compared with current use.

The amount of antibiotics prescribed for longer duration than LJF

recommendations was analysed.

Results:

NHS Lothian remains the lowest total user of antibiotics

in primary care. There has been much slower reduction in broad-

spectrum use, but it is now below the Scottish average. 10% of

prescriptions were for longer than 14 days, the recommended longest

duration in the LJF. The majority of these prescriptions were for 21

days, with only 0.8% of all co-amoxiclav prescriptions being for longer

than 28 days.

Discussion and/or Conclusion(s):

Analysis of PIS data confirms that

there is some prescribing of prolonged courses of broad-spectrum

antibiotics, but not at a significant level. Prescribing duration of

co-amoxiclav is mostly in line with the LJF, and at an expected level for

the clinical conditions indicated for treatment.

ID: 4958

Antimicrobial stewardship ward rounds

–

Are we making a

difference?

Hala Kandil, Hala Kandil, Tejal Vaghela.

West Hertfordshire Hospitals

NHS Trust

Background:

Antibiotic stewardship ward round is key to promote

appropriate antibiotic use.

Aim(s)/Objective(s):

The aim of this study is to evaluate the impact of

the interventions made by antimicrobial stewardship team (AST)

during their ward rounds on antimicrobial consumption and clinical

outcome in a large district Hospital.

Method(s):

Twice weekly antibiotic stewardship ward round (ASW)

was introduced in April 2016. Information on patients on antibiotics

was collected from pharmacy records. Outcome of AST interventions

over two month period were analysed. Monthly antibiotic consump-

tion per 1000 admissions was monitored. Compliance with NG Quality

standard 121 Statement 4 was audited. Data on clinical outcome and

readmission within 28 days were also collected.

Results:

We reviewed 157 courses of antibiotic. The most commonly

prescribed antibiotic during this period was tazocin (23.5%) followed

by augmentin (21.6%). Approximately 88.5% of prescribed antibiotics

were compliant with the trust antimicrobial guideline. AST stopped

54.7% of antibiotic courses, specified stop date for 19.7%, optimised

dose in 2%, switched 5% to PO, de-escalated 7% & escalated 1.5%.

More than one of the previous intervention was recommended for

Abstracts of FIS/HIS 2016

–

Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24

–

S134

S42