Influence of empirical antimicrobial guidelines on piperacillin &
tazobactam consumption in Acute Trust in East of England (EoE)
, Netta Tyler
, Rachel Leff
, Claire Allen
, Emma Cramp
, Currie Naomi
, Shayi Shali
, Dawn Whitbourn
West Hertfordshire Hospitals NHS Trust Watford
Papworth Hospital NHS Foundation Trust,
Dunstable Hospital NHS Foundation Trust,
Colchester University Hospital
NHS Foundation Trust,
Hinchingbrooke Health Care NHS Trust,
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
The recommendation of Piperacillin & Tazobactam (PTZ)
as first line empirical therapy for clinical infections varies across acute
Trusts in the EoE region.
We studied the relation between PTZ consump-
tion rate and the clinical indications with PTZ being recommended as
first line empirical therapy.
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.
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
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.
A Novel, NICE teamwork approach for the antimicrobial
stewardship in a teaching hospital
Milind Khare, Deborah Gnanarajah, Wijitha Weerakoon, Julia Lacey.
Royal Derby Hospital
Toolkit for English Hospitals was introduced in March 2015 by Public
Health England. NICE guideline for Antimicrobial Stewardship came in
To review effectiveness of continuing weekly
antibiotic audits by clinicians from April 2015 onwards.
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
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
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.
Review of high dose broad spectrum antibiotic use in NHS Lothian
Simon Hurding, Carol Philip, Maria McMenemy, Angela Timoney.
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-
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
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.
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.
Antimicrobial stewardship ward rounds
Are we making a
Hala Kandil, Hala Kandil, Tejal Vaghela.
West Hertfordshire Hospitals
Antibiotic stewardship ward round is key to promote
appropriate antibiotic use.
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.
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.
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