Category: Pediatric Antimicrobial Stewardship (inpatient/outpatient pediatric focused)

Poster Session: Pediatric Antimicrobial Stewardship (inpatient/outpatient pediatric focused)

1344 - Impact of Pharmacist-Physician Team on Antimicrobial Utilization at a Pediatric Hospital

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Presenting Author(s)

Julia Sapozhnikov

Pediatric Infectious Diseases Pharmacist
Ascension Texas- Dell Children's Medical Center of Central Texas
Austin, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

MF

Marisol Fernandez

Physician
Ascension Texas- Dell Children's Medical Center of Central Texas and Dell Medical School at the University of Texas at Austin
Austin, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: “Handshake stewardship” is now considered a leading practice in antimicrobial stewardship (AMS) by The Joint Commission. This study aims to evaluate the impact of a pharmacist-led and physician-pharmacist led handshake stewardship method on antimicrobial utilization at a pediatric hospital.

Methods: This was a single-center, retrospective quality improvement study at a teaching children’s hospital in central Texas. We retrospectively measured hospital-wide antimicrobial utilization from June 2015 to May 2020. We compared the time periods with an ID pharmacist participating in handshake stewardship ([A] July 2012 to April 2015,[B] May 2015 to May 2018 and [D] August 2019 to May 2020) and without an ID pharmacist ([C] June 2018 to July 2019). We also compared time periods with only an ID pharmacist led ASP [A] compared to a physician-pharmacist led ASP [B].The primary endpoint was days of therapy per 1,000 patient days (DOT/1000 PD).Table 1. Overall Antimicrobial Utilization During Changes in ASP Structure

Results: Antimicrobial utilization during pharmacist-led ASP [A] was significantly higher than during the pharmacist-physician led ASP time period [B] (95% CI, 68.8-76.8; P=0.001). No significant difference was observed for mean hospital-wide antimicrobial, meropenem, piperacillin-tazobactam, or cefepime DOT/1000 PD from period [B] to [C]. However, the increase in mean DOT/1000 PD during these time periods was statistically significant for ceftriaxone (95% CI, 6.3-23.9; P=0.001) and vancomycin (95% CI, 1.2-18.1; P=0.03). For time period [C] to [D], there was a statistically significant reduction in mean DOT/1000 PD seen in overall antimicrobial use (95% CI, 156.9-313.6; P< 0.0001). Statistically significant decreases in DOT/1000 patient days were also seen for cefepime (95% CI, 11.4-36.4; P< 0.0007), ceftriaxone (95% CI, 5.0-24.8; P=0.005), and vancomycin (95% CI, 6.1-23.1; P=0.002). No difference was seen for piperacillin-tazobactam or meropenem DOT from [C] to [D].Figure 1. Hospital-Wide Monthly Days of Therapy per 1000 Patient Days

Conclusion: Active engagement with frontline providers via handshake stewardship offers a more successful approach to decreasing antimicrobial utilization. A greater reduction in overall antimicrobial utilization was seen when the ASP was led by a pharmacist-physician team compared to when it was pharmacist-led without a physician champion.