Hospital Pharmacy - October 2017 - 632

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Hospital Pharmacy 52(9)

Antimicrobial Utilization

Table 1. (continued)
Intervention type or recommendation
Cefepime
Meropenem
Piperacillin-tazobactam
Discontinue antibioticc
Vancomycin
Azithromycin
Metronidazole
Initiate new anti-infective
Initiate alternative anti-infective (ie,
drug-bug mismatch)
De-escalate/narrow therapy
Therapeutic drug monitoringc
Vancomycin
Aminoglycosides
IV to PO switch
Other
Total
Accepted
Average interventions per day

No. of
interventions (%)
150 (13)
111 (10)
79 (7)
582 (12)
177 (30)
98 (17)
57 (10)
550 (11)
480 (10)
188 (4)
524 (11)
392 (75)
47 (9)
307 (6)
1122 (23)
4888
4839 (99)
13

Hospital pharmacists interventions at the point of
verification
4229 (75)
Dosing regimen adjustmentc
Vancomycin
1388 (33)
Cefepime
651 (15)
Piperacillin-tazobactam
301 (7)
Aminoglycosides
212 (5)
Fluoroquinolones
145 (3)
Restricted antibiotic-approval
523 (9)
clarification
335 (6)
Restricted antibiotic-overnight 9 pm-8
am verification (24 h only)
Drug interaction prevention: major
209 (4)
Allergic reaction prevention: major
195 (3)
Vancomycin drug level reviewed/
96 (2)
supratherapeutic level
IV to PO switch
52 (1)
Total
5639
Accepted
5131 (91)
Average interventions per day
15
Note. ASP = antimicrobial stewardship program; IV = intravenous;
PO = oral; ART = antiretroviral therapy; CPS = clinical pharmacotherapy
specialists.
a
Interventions for adult services only included.
b
Interventions performed by pharmacy residents during weekends and
weekdays included in the count.
c
Most common antibiotics related to intervention.

major drug-drug interactions (4%), and clarification of
severe allergy (3%). The acceptance rate of pharmacy
interventions by providers and clinicians was high: 97%
for ASP CPS, 99% for non-ASP CPS, and 91% for hospital pharmacists.

Annual aggregate antimicrobial use during the study period
decreased by 6.4 DOT/1000 PD from the preceding 12-month
period (P = 1.0; Table 2). Ceftriaxone use increased by 8.4
DOT/1000 PD (P = .029) without a significant compensatory
change in the use of antipseudomonal agents. Of note, combined use of PTZ and cefepime decreased by 5.4 DOT/1000
PD (P = .114) during the study period. Fluoroquinolone use
remained low and decreased by 0.6 DOT/1000 PD (P = 1.0).
Carbapenem use increased by 1.2 DOT/1000 PD (P = .686).
In line with our new ASP initiative incorporating RDT of
positive blood cultures, there was a corresponding increase of
2.6 DOT/1000 PD in use of antistaphylococcal penicillins for
methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia (P = .029). Use of antibiotics with activity against
methicillin-resistant Staphylococcus aureus (MRSA)
increased during the study period as compared with the previous 12 months (P = .886). Although vancomycin and linezolid use increased by 4.8 DOT/1000 PD (P = .486) and 1.7
DOT/1000 PD (P = .686); daptomycin and ceftaroline use
decreased by 2.1 DOT/1000 PD (P = .2) and 0.8 DOT/1000
PD (P = .2), respectively. Micafungin use also decreased by
1.0 DOT/1000 PD (P = 1.0). Overall, the shift in antimicrobial utilization aligned with institutional guidelines and ASP
initiatives.

Outcome Measures
The rate of hospital-onset CDI decreased slightly from to 1.2
to 1.1 cases/1000 PD (ie, 122 CDI cases/108 772 PD during
the study period and 128 CDI cases/103 650 PD in 2014).
The observed lower CDI rate was likely due to multifactorial
initiatives implemented by our IPC department, including
hospital-wide campaigns to improve hand-hygiene, cleaning
of frequently touched surfaces, and oral vancomycin suppressive therapy for patients with prior episodes of CDI.
Establishing pharmacy participation in ASP and extending
ASP hours may have contributed to maintaining CDI rates
low as well. CRE rates remained low, with hospital-onset
CRE rate of 0.2 cases/1000 PD (18 cases/103 650 PD) and
0.1 cases/1000 PD (16 cases/108 772 PD) in 2015 and 2014,
respectively. In addition, there was a 2% reduction in
Enterobacteriaceae nonsusceptible to ceftriaxone in 2015
compared with 2014 (17% [207 of 1231] and 15% [170 of
1152], respectively). The 30-day readmission rate for patients
who received at least 1 dose of antibiotics during their hospital stay decreased by 0.6% (from 7.2% [1259/17 354] in
2014 to 6.6% [1181/17 900] in 2015, P = .019).

Discussion
We describe a multilayer model that we implemented to
leverage pharmacy personnel resources for the purposes of
ASP. Integration of non-ASP CPS to perform ASP activities



Table of Contents for the Digital Edition of Hospital Pharmacy - October 2017

Pharmacists and Medical Missions
Current FDA-Related Drug Information
Summaries of Safety Labeling Changes Approved By FDA- Boxed Warnings Highlights April-June 2017
Pharmaceutical Pipeline Update
Cholesterol Ester Transfer Protein Inhibitor Review
Formulary Drug Review
Ocrelizumab
Patient Outcomes Associated With Phenobarbital Use With or Without Benzodiazepines for Alcohol Withdrawal Syndrome: A Systematic Review
Development of a Pharmacy Technician–Driven Program to Improve Vaccination Rates at an Academic Medical Center
Safety and Efficacy of Enoxaparin Compared With Unfractionated Heparin for Venous Thromboembolism Prophylaxis in Hemodialysis Patients
Multilayer Model of Pharmacy Participation in the Antimicrobial Stewardship Program at a Large Academic Medical Center
Impact of Inpatient Automatic Therapeutic Substitutions on Postdischarge Medication Prescribing
Impact of Respiratory Viral Panel Polymerase Chain Reaction Assay Turnaround Time on Length of Stay and Antibiotic Use in Patients With Respiratory Viral Illnesses
Administration of Injectable Vitamin K Orally
Hospital Pharmacy - October 2017 - 577
Hospital Pharmacy - October 2017 - 578
Hospital Pharmacy - October 2017 - 579
Hospital Pharmacy - October 2017 - 580
Hospital Pharmacy - October 2017 - 581
Hospital Pharmacy - October 2017 - 582
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Hospital Pharmacy - October 2017 - 584
Hospital Pharmacy - October 2017 - 585
Hospital Pharmacy - October 2017 - 586
Hospital Pharmacy - October 2017 - 587
Hospital Pharmacy - October 2017 - 588
Hospital Pharmacy - October 2017 - Pharmacists and Medical Missions
Hospital Pharmacy - October 2017 - Current FDA-Related Drug Information
Hospital Pharmacy - October 2017 - Summaries of Safety Labeling Changes Approved By FDA- Boxed Warnings Highlights April-June 2017
Hospital Pharmacy - October 2017 - 592
Hospital Pharmacy - October 2017 - Pharmaceutical Pipeline Update
Hospital Pharmacy - October 2017 - Cholesterol Ester Transfer Protein Inhibitor Review
Hospital Pharmacy - October 2017 - 595
Hospital Pharmacy - October 2017 - Formulary Drug Review
Hospital Pharmacy - October 2017 - Ocrelizumab
Hospital Pharmacy - October 2017 - 598
Hospital Pharmacy - October 2017 - 599
Hospital Pharmacy - October 2017 - 600
Hospital Pharmacy - October 2017 - 601
Hospital Pharmacy - October 2017 - 602
Hospital Pharmacy - October 2017 - 603
Hospital Pharmacy - October 2017 - 604
Hospital Pharmacy - October 2017 - Patient Outcomes Associated With Phenobarbital Use With or Without Benzodiazepines for Alcohol Withdrawal Syndrome: A Systematic Review
Hospital Pharmacy - October 2017 - 606
Hospital Pharmacy - October 2017 - 607
Hospital Pharmacy - October 2017 - 608
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Hospital Pharmacy - October 2017 - 612
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Hospital Pharmacy - October 2017 - Development of a Pharmacy Technician–Driven Program to Improve Vaccination Rates at an Academic Medical Center
Hospital Pharmacy - October 2017 - 616
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Hospital Pharmacy - October 2017 - 618
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Hospital Pharmacy - October 2017 - 620
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Hospital Pharmacy - October 2017 - 622
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Hospital Pharmacy - October 2017 - Multilayer Model of Pharmacy Participation in the Antimicrobial Stewardship Program at a Large Academic Medical Center
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Hospital Pharmacy - October 2017 - 629
Hospital Pharmacy - October 2017 - 630
Hospital Pharmacy - October 2017 - 631
Hospital Pharmacy - October 2017 - 632
Hospital Pharmacy - October 2017 - Impact of Inpatient Automatic Therapeutic Substitutions on Postdischarge Medication Prescribing
Hospital Pharmacy - October 2017 - 634
Hospital Pharmacy - October 2017 - 635
Hospital Pharmacy - October 2017 - 636
Hospital Pharmacy - October 2017 - 637
Hospital Pharmacy - October 2017 - Impact of Respiratory Viral Panel Polymerase Chain Reaction Assay Turnaround Time on Length of Stay and Antibiotic Use in Patients With Respiratory Viral Illnesses
Hospital Pharmacy - October 2017 - 639
Hospital Pharmacy - October 2017 - 640
Hospital Pharmacy - October 2017 - 641
Hospital Pharmacy - October 2017 - 642
Hospital Pharmacy - October 2017 - Administration of Injectable Vitamin K Orally
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