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non-protected option, whilst allergy to penicillin was a contributing

factor in choosing a carbapenem in around 20% of patients.

The prescription was judged as appropriate in approximately 3/4 of all

cases. Treatment de-escalation or stopping the whole antibiotic

therapy was recommended for all patients receiving an inappropriate

prescription and in some of the patients receiving an appropriate


Discussion and/or Conclusion(s):

Our study shows that a proactive

and multi-disciplinary strategy of reviewing every prescription of

protected antibiotic can lead to marked reduction in the use of these

precious options.

ID: 5048

Stewardship opportunities in the treatment of urinary tract

infection using oral fosfomycin. Much more to be learnt

Helmi Sulaiman, Aqtab Mazhar Alias, Shu Jiun Khoo,

Saufi Irzat Che Yusoff.

University of Malaya


Fosfomycin (FM) was first introduced following the

fermentation of Streptomyces strain in 1969. Following its unique

position for uncomplicated UTI, its appropriate use is of paramount

importance to mitigate the emergence of resistance.


We aim to look at the current practice of

prescription in our large outpatient clinic.


This is a retrospective study carried fromApril 2015 toMay

2016 in primary care clinics affiliated to University Malaya Medical

Centre, Malaysia. We recruited any patients above 12 years old who

received single dose oral FM. We divided the patients into guideline

compliant (GC) and non-guideline compliant (NGC) groups based on

available consensus.


100 patients were recruited from a list of 139. The median age

was 54.6 (IQR 15

88) and female predominates (81%). 57 of the

subjects had at least one co-morbidity and hypertension predominates

(40%). There were 91 NGC occurrences. Reasons for NGC were

asymptomatic bacteriuria/ABU (18, 19.7%), acute pyelonephritis (13,

14.2%), complicated UTI (16, 17.6%) and inappropriate investigations

(urine culture (21, 23.1%) and ultrasound of kidney (4, 4.3%)). Urine

analysis was the commonest test performed (87, 97%). FMT was

prescribed wrongly in 66 subjects (wrong indications).

Discussion and/or Conclusion(s):

The data above illustrates the dire

need for education in term of UTI management by the primary care

physicians. The misuse of FM was common and not in accordance to

the guideline. The additional investigations may be reflective of



nature of UTI. In addition, the lack of susceptibility

data on FM against the local contemporary urinary isolates should be


ID: 5053

QASI-2: Measuring the quality of Antimicrobial Stewardship

Andrew Berrington


, Rachel Bruce


, Amy Penni




City Hospitals

Sunderland NHS FT,


City Hospitals Sunderland NHSFT


It is not straightforward to measure how good we are

at antimicrobial stewardship. Real outcome measures like




resistance pressure

are elusive. Surrogate outcome

measures like antibiotic consumption metrics are tendentious and

confounded by other factors. So usually we measure process, typically

by audit of antimicrobial prescribing.

But audit is easy to do badly and difficult to do well: decisions are

spread out in time and place as new information emerges, objective

standards are difficult to set and we need to be careful that we are

auditing stewardship specifically rather than medical practice more

generally. The typical

compliance audit

is unlikely to capture these


We have developed an audit tool that assigns a score out of 10 to the

decisions made at initiation (

start Smart

) and a score out of 5 to the

decisions made as treatment continues. We have refined this over

several years and have now piloted its use in a systematic programme

of audit and feedback on our Integrated Assessment Unit and back-of-

house medical wards.


To describe deployment of our QASI-2 tool in a

pilot systematic audit programme designed to assess the feasibility of

the QASI-2 approach and to measure the quality of antimicrobial

prescribing in our medical unit.


QASI-2: key aspects of the tool


Summary charts describing 322 initiation audits and 369 continuation


Data on time taken to perform QASI-2 audits

Discussion and/or Conclusion(s):

Useful and feasible approach though time consuming

Acceptable to clinical teams

good engagement

Importance of defining what constitutes a course.

ID: 5081

Development of a Clinical Decision Support (CDS) mobile app for

antimicrobial prescribing

Jacqueline Sneddon


, Ann Wales


, Dilip Nathwani





Improvement Scotland,


NHS Education for Scotland,


NHS Tayside


Development of clinical decision support (CDS) is a

priority for Scottish Government to give clinicians easy access to

decision support tools and relevant guidance at the point of care.

Antimicrobial prescribing was identified as a

quick win

to demon-

strate CDS as national evidence-based guidance, treatment algorithms

and a robust clinical networks were already available.


To develop a national antimicrobial app through

collaboration between the Scottish Antimicrobial Prescribing Group

and NHS Education for Scotland.


A proposal was developed, funding secured from Scottish

Government, a developer appointed via a tendering process and a

multi-professional clinical reference group established.


The app was launched in August 2016 available to download

free via app stores for use on any mobile device.

The app includes:

Dosage calculators for gentamicin and vancomycin (registered

with the Medicines and Healthcare Products Regulatory Agency)

Antibiotic guidance for primary care and hospitals customised by

each health board

A decision aid to support management of urinary tract infection in

older people

An audit tool to support data gathering and reporting for local and

national improvement work

Discussion and/or Conclusion(s):

This bespoke national app provides

customised local guidance and CDS tools to enable clinicians to use

antibiotics safely and effectively across all care settings. The unique

audit component will support improved practice through timely audit

and feedback of key prescribing measures. An evaluation of its impact

is underway using an outcomes chain model and contribution


ID: 5113

Thinking beyond tazocin: improving antibiotic prescribing in

cancer care

Anastasia Theodosiou, Kieran Hand, Tat Shing Yam, Hayley Wickens.

University Hospital Southampton


Excessive broad-spectrum antibiotic use is associated

with adverse outcomes, including

Clostridium difficile

and antibiotic-

resistant infection. Oncology inpatients are susceptible to infection

due to cancer and chemotherapy-associated immunocompromise,

but use of broad-spectrum antibiotics is not always warranted.


This project aims to identify and tackle barriers

to appropriate antibiotic prescribing in oncology inpatients at

Abstracts of FIS/HIS 2016

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