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5.7% of the courses. Out of 47 antibiotic courses audited, 42.5% met NG
QS while it was not applicable in 40.5% of cases.
Total antibiotic and tazocin consumption were significantly reduced
from a baseline of 4472 and 252 DDD/1000 admissions respectively
prior to intervention to 4211 (7%) and 170 (23%) DDD/1000 admissions
post intervention.
Discussion and/or Conclusion(s): Our ASW proved to be effective in
optimisation antibiotic therapy and significantly reducing antibiotic
consumption over short period without compromising patient care.
ID: 4969
Amikacin concentrations and target ranges for mycobacteria
infections
Tamara Cairney1, Alison Thomson1, Lock Xu Bao1, Fiona Robb 2.
1University of Strathclyde, 2NHS Greater Glasgow and Clyde
Background: Guidelines for amikacin use in multi-drug resistant
mycobacterial infection recommend 15 mg/kg once daily (OD) or
25 mg/kg thrice weekly (TW).
Aim(s)/Objective(s): To determine whether guideline doses achieve
peaks of 35–45 (OD) or 65–80 mg/L (TW) and troughs <5 mg/L.
Method(s): The following data were extracted for patients with a
mycobacterial infection and at least one amikacin dose and peak
concentration: age; weight; height; creatinine concentration; amika-
cin doses, concentrations and times. A MAP Bayesian pharmacokinetic
analysis provided individual estimates of amikacin volume of
distribution (V) and clearance (CL), which were used to predict end
of infusion (1 h) and trough amikacin concentrations using guideline
dosage regimens.
Results: Data were available from 83 patients (49 male) of whom 51
received OD and 32 TWdosing. Ages ranged from19– 79 years, weights
from 36–94 kg and estimated creatinine clearance from 28–158 mL/
min. Doses ranged from 330 to 1750 (OD) and 800 to 2250 mg (TW).
CL and V estimates ranged from 0.5 –10.4 L/h and 8.6–44 L, respect-
ively. Using these parameters, OD dosage regimens were predicted to
achieve 14% of concentrations below, 34% within and 52% above the
target peak and the TWregimen 28% below, 34% within and 39% above
the target peak. Predicted pre-dose troughs were >5 mg/L for 6% of
OD doses and 5% of TW doses (48 h post dose). High troughs were
observed in patients with poor renal function.
Discussion and/or Conclusion(s): Amikacin guidelines for mycobac-
terial infections achieve high peak concentrations but patients with
renal impairment require longer dosage intervals.
ID: 4974
The RAPID project: A clinical decision tool to support antibiotic
stewardship in acute respiratory infections
Jasmin Islam1, Marco Cotrufo1, Wendy Munro2, Catherine Sargent3,
Katherine Hurt 4, Juliet Wright5, Sally Curtis6, Martin Llewelyn7.
1Brighton and Sussex University Hospitals Trust, 2Department Acute
Medicine, Brighton and Sussex University Hospitals Trust, 3Department of
Infection & Microbiology, Brighton and Sussex University Hospitals Trust,
4Deaprtment of Respiratory Medicine, Brighton and Sussex University
Hospitals Trust, 5Brighton and Sussex Medical School, 6Deaprtment
Microbiology, Brighton and Sussex University Hospitals Trust,
7Department of Infection & Microbiology
Background: Antimicrobial resistance is a major public health risk and
excessive antibiotic use is recognised as a major driver of resistance.
UK Antimicrobial Stewardship guidance ‘Start Smart Then Focus’
encourages clinicians to undertake active ‘ review & revision’ of
prescribed antibiotics 48 hours after initiation.
Aim(s)/Objective(s): We developed and piloted an intervention to
support ‘ review and revise’ prescribing decisions in acute respiratory
infection (ARI), which remains the commonest indication for
antibiotics.
Method(s): Options for a simple, evidence-based ‘RAPID’ (Reducing
unnecessary antibiotic prescribing in dyspnoea) decision tool were
developed, before being iteratively reviewed and refined by a
multidisciplinary working group. Stop criteria incorporated clinical
observations, biomarkers and radiology. Antibiotic prescribing
was reviewed at baseline and on day 2 of admission for unselected
patients over 45 days before and 35 days during the intervention.
Clinical teams were responsible for applying defined stopping criteria.
Results: Across both time-points, 318 patients were prescribed ARI
antibiotics. Criteria for stopping antibiotics at 48 hrs were defined as: a
normal chest radiograph, day2 average NEWS score ≤4 and CRP ≤ 100.
Antibiotics were prescribed unnecessarily in 35/144 patients (24.3%)
in the pre-intervention phase. During the intervention phase, 38/174
prescriptions should have been stopped according to the RAPID
criteria (21.8%) but only one fifth were actually stopped.
Discussion and/or Conclusion(s): Even with good stake-holder
engagement use of a stand-alone clinical decision tool did not
reduce antibiotic prescribing in the acute medical setting. Safely
reducing unnecessary antibiotic prescribing is likely to require more
resource intensive interventions such as dedicated stewardship ward-
rounds.
ID: 4980
Retrospective evaluation to antimicrobial stewardship programs
integrated with nosocomial infection control in patients with
spontaneous bacterial peritonitis
Bin Gao1, Shu Feng2, Jing Qian3, Wei Lu4. 1Tianjin 4th Center Hospial,
2Nosocomial Infection Management Department, Zunyi 1st People ’s
Hospital, Guizhou Province, 3Nosocomial Infection Management
Department, Tianjin Second People’ s Hospital, 4Tianjin Second People’ s
Hospital, China
Background: Inappropriated prescribing was a matter of salient
concern in China.
Method(s): To recruit all cirrhotic patients with primary or spontan-
eous bacterial peritonitis (SBP) according to ICD10 using admini-
strative data in a tertiary hospital from January 2006 to December
2014. ASP integrated into nosocomial infection control (NIC) was
implemented in the institute at the same time. Those with ascitic
polymorphonuclear leukocytes (PMNs) count <250 cells/mm3, or with
clinical and laboratory data suggesting secondary peritonitis or other
infections, or with antimicrobial use before 2 weeks before treatment
of SBP, or with hepatocellular carcinoma, or with discharged <5 days
after the treatment, without ascetic fluid test before antimicrobials use
to SBP were excluded The clinical outcomes of them were evaluated.
Results:
1. There were 1,110 episodes of cirrhotic with SBP collected from
administrative data during the investigation. The percentage of
those patients whose PMNs count >250 cells/mm 3 in the ascitic
fluid in the recruited SBP were increased from 27.4% in the first
triennium (2006–2008) to 38.4% in the second (2009–2011) and
59.3% in the third (2012–2014).
2. There were 386 episodes of SBP identified.
• The majority initial prescribed antibiotic was fluoroquino-
lone and the 3rd generation of cephalosporin in the first 2
triennium (90.3%, 77.8% respectively) and beta-lactam anti-
bacterials/enzyme inhibitors in the last one (67.9%), P = 0.00.
• Antimicrobial treatment longer than 10 days was decrease
from 81.2%, to 52.7% and 33.6% respectively, P = 0.00.
• 30-day mortality was slightly lower (1%, 9.9% and 9.2%,
P = 0.86).
Discussion and/or Conclusion(s): Adoption to ASP and NIC combin-
ation model in China was slow, but promising.
ID: 4985
Diagnosis and management of urinary tract infections (UTI) in
adults over 65 years of age in a large district hospital
Eleni Mavrogiorgou, Hala Kandil, Prema Singh, Tejal Vaghela. West
Hertfordshire NHS Trust
Background: Obtaining microbiological samples from patients pre-
scribed antibiotics and reviewing their treatment when result become
Abstracts of FIS/HIS 2016 – Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24–S134 S43