143 - Modification of Linezolid Restriction Criteria Reduces ICU Gram-positive Antibiotic Consumption

Background: Antibiotic time out (ATO) policies have been proposed by the Centers for Disease Control and Prevention to limit unnecessary use of antibiotics. Critically ill patients are often treated empirically with MRSA-active agents for a prolonged duration. The objective of this study was to assess the impact of an ATO policy by targeting empiric gram-positive coverage.

Methods: Before this intervention, linezolid required pre-approval by the antimicrobial stewardship program or infectious diseases (ID) consult service before dispensing, and no automatic ATO policy was in place for any agent. In 2018, restriction of linezolid was modified to allow 72 hours of empiric use in the intensive care unit (ICU). This retrospective, single-center, pre- post-intervention study looked at eight ICUs at our institution from two equal periods. Adults (age ≥ 18 years) were included who received an IV gram-positive antibiotic (IVGP-AB), specifically linezolid or vancomycin, used for empiric therapy and were admitted to the ICU. The primary outcome was antimicrobial consumption of IVGP-AB defined as days of therapy (DOT) per patient. Secondary outcomes included in-hospital length of stay (LOS), ICU LOS, in-hospital mortality, 30-day readmission, and incidence of acute kidney injury (AKI).Figure 1. Flowchart of patient inclusion into the study


Results: 2718 patients met criteria for inclusion in the study. 1091 patients were included in the pre-intervention group and 1627 patients were included in the post-intervention group. Baseline characteristics between the two groups were similar, with ID consults being higher in the pre-intervention group. Total mean DOT of IVGP-AB in pre- and- post-intervention groups was 4.97 days vs. 4.36 days, p< 0.01. Secondary outcomes of in-hospital LOS, ICU LOS, and in-hospital mortality did not vary significantly between groups. Thirty-day readmission was lower in the post-intervention group (12.9% vs. 3.9%, p< 0.01). AKI did not differ significantly between groups, however the need for renal replacement therapy was higher in the pre-intervention group (1.2% vs. 0.2%, p< 0.01).Table 1. Baseline Characteristics of Study Participants
Table 2. Primary and Secondary Outcomes
Table 3: Multivariate Analysis Evaluating Impact of Baseline Characteristics on the Primary Outcome


Conclusion: This study assessed the impact of an ATO policy allowing 72 hours of empiric linezolid in the ICU. We found a statistically significant reduction in days of therapy of IVGP-AB without increases in LOS, mortality, readmission, and AKI.

Presenting Author(s)

• 

  John M. Boulos, PharmD

  PGY2 Infectious Diseases Pharmacy Resident
  The Johns Hopkins Hospital
  Baltimore, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides Slides and Audio

Co-Author(s)

• KD

  Kathryn DeSear, PharmD, BCIDP

  Clinical Infectious Diseases Pharmacist
  University of Florida Health Shands Hospital
  Gainesville, Florida

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• BS

  Bethany Shoulders, PharmD, BCCCP

  Clinical Assistant Professor
  University of Florida College of Pharmacy
  Gainesville, Florida

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• VV

  Veena Venugopalan, Doctor of Pharmacy

  Clinical Associate Professor
  University of Florida College of Pharmacy
  Gainesville, Florida

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• SV

  Stacy A. Voils, PharmD, M.Sc.

  Clinical Associate Professor
  University of Florida College of Pharmacy
  Gainesville, Florida

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• CV

  Catherine Vu, PharmD

  PGY2 Infectious Diseases Pharmacy Resident
  University of Florida Health Shands Hospital
  Gainesville, Florida

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• ML

  Megan Logan, PharmD, BCCCP

  Pharmacy Clinical Specialist
  University of Florida Health Shands Hospital
  Gainesville, Florida

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• BS

  Barbara A. Santevecchi, PharmD, BCPS, BCIDP

  Clinical Assistant Professor, Infectious Diseases
  University of Florida College of Pharmacy
  Gainesville, Florida

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.