Value of PCR as a de-escalation tool for an Antimicrobial Stewardship Program at a Community-based hospital
Background: A common ASP intervention recommended by the CDC and Joint Commission is the 48-hour timeout (48TO), which entails assessing the patient at 48 hours, and modifying antimicrobial therapy as indicated . This includes, but is not limited to the de-escalation and discontinuation of antibiotics, as well as antivirals.
Methods: Single-center, retrospective chart review. Study period: October 1, 2017 to March 31, 2018. Inclusion Criteria: All patients 18 years of age and older receiving oseltamivir during the study period, for which an ASP intervention was documented. Exclusion Criteria: Anyone younger than 18 years of age or who was not ordered oseltamivir during the study period; patients who re-ceived oseltamivir but had no ASP intervention documented. Pharmacy was educated to honor only the first oseltamivir dose pending PCR results. Under the ASP, pharmacists assessed patients receiving oseltamivir, and provided recommendations to prescribers based on PCR results. A list containing the medical record number of patients receiving oseltamivir during the study period, for which an ASP intervention was documented was obtained from Discern Analytics. Patients charts were reviewed in order to determine PCR results, procalcitonin levels, and 30-day readmission rate.
Results: During the 2017-2018 influenza season, a total of 119 ASP interventions were document-ed in 63 patients diagnosed with influenza. Of these, 50 were directly attributed to PCR results. Twenty seven (27) oseltamivir orders were discontinued by the ASP as a result of a negative PCR for influenza. Of these, 26 (96%) patients received only 1 dose of oseltamivir while PCR results were pending. A total of $3,728.63 US dollars in direct cost savings (i.e. medication cost) were attributed to the discontinuation of antimicrobials.
Conclusions: In this retrospective, evidence-based practice project, we demonstrate that the use of the FilmArray Respiratory Panel (BioFire) TM Diagnostics, Inc, translates to prompt discontinuation of antimicrobials. Significant cost-savings can be attributed to the use of PCR when used as an ASP tool for antimicrobial de-escalation.
14th Annual BHSF Research Conference
Fuerte, Wilbert; Mejia, Jorge; Pardo, Winifred; Yulkowski, Patricia; and Costales, Silvia, "Value of PCR as a de-escalation tool for an Antimicrobial Stewardship Program at a Community-based hospital" (2019). All Publications. 3306.