Background. Antimicrobial stewardship can minimize adverse events from antibiotics, development of resistance, and costs. Two potential stewardship targets are in initiation and streamlining of therapy.
Methods. We examined indicators of quality in initiating and streamlining antibiotic therapy between two Veterans Affairs (VA) hospitals with different stewardship programs: VA Greater Los Angeles (GLA), which has a dedicated full-time infectious diseases (ID) pharmacist who reviews all broad-spectrum parenteral antibiotic usage, and the Denver VA (DEN), which has a more decentralized model where individual ward pharmacists are responsible for stewardship. We reviewed a sample of 300 cases of inpatient parenteral antibiotic use (200 at GLA from October 2011-October 2012 and 100 at DEN from July 2010-June 2011).
Results. For antibiotic indication, GLA cases were more likely to have an indication for antibiotic therapy documented [199/200 (99%) vs 95/100 (95%), p = 0.017] and appropriate empirical therapy prescribed [194/200 (97%) vs 87/100 (87%), p = 0.002] but were less likely to have appropriate cultures collected [121/186 (65%) vs 82/100 (82%), p = 0.002]. For antibiotic streamlining, GLA cases were more likely to have therapy modified within 24 hours of lab data being available [133/152 (87%) vs 37/51 (73%), p = 0.016], to be converted to oral medication appropriately [100/123 (81%) vs 41/67 (61%), p = 0.003], and to have antibiotics discontinued when bacterial infection was determined to not be present [39/50 (78%) vs 11/33 (33%), p < 0.0001]. The presence of any streamlining activity was higher at GLA regardless of whether ID consultation was obtained [174/191 (91%) vs 47/95 (49%) overall and 128/143 (90%) vs 36/70 (51%) without ID consult, p < 0.0001 for both].
Conclusion. Our findings strongly support the presence of a full-time ID pharmacist in antimicrobial stewardship, particularly in influencing streamlining of therapy, but opportunities for improvement in both initiation of and streamlining of therapy still exist even when a full-time ID pharmacist is present.
Disclosures. All authors: No reported disclosures.