System Slashed Use of Unnecessary Antibiotics
Onscreen system limited utilization of tigecycline and linezolid outside of FDA-approved indications.
ACEP News
June 2010
By Miriam E. Tucker
Elsevier Global Medical News
ATLANTA -- A computerized antibiotic stewardship program for tigecycline and linezolid led to an overall decrease in prescriptions of both medications and a significant increase in their appropriate use in a 214-bed community hospital.
A physician order entry system with decision support "provides a nonconfrontational, evidence-based system that can be rapidly implemented," Dr. John Leander Po and his associates said in a poster at the Decennial International Conference on Healthcare-Associated Infections 2010.
Previous strategies to reduce unnecessary use of antibiotics have included prior authorization, prescriber feedback/education, and antibiotic order forms. But little is known about the effectiveness of a computerized interface that is triggered whenever a prescription is entered, requiring input, said Dr. Po and his associates, of Banner Estrella Medical Center, Phoenix.
The onscreen system used in this study was designed to limit utilization of tigecycline and linezolid outside of Food and Drug Administration-approved indications. The FDA has approved the drugs for treatment of patients infected with a multidrug-resistant organism with no other options; for those at risk of penicillin or vancomycin anaphylaxis with no other options; or as second-line therapy for pneumonia, urinary tract infection, and staphylococcal infection. The interface also delivered recommendations for alternative antibiotics, with hyperlinks to evidence-based articles.
Antimicrobial use was monitored, and direct feedback was delivered to the prescriber--primarily hospitalists, surgeons, and emergency physicians--when inappropriate use of either antimicrobial occurred.
During the 4 months before the intervention, 36 prescriptions for tigecycline were ordered, compared with 12 during the 4 months with the computerized system in place. The proportion of appropriate orders rose significantly, from 8% (3) to 92% (11). Examples of inappropriate use in the preintervention phase included for empiric postoperative prophylaxis; for gastroenteritis; when a single, narrow-spectrum antibiotic was indicated (i.e., vancomycin); and in a patient without penicillin allergy.
During the intervention, the one inappropriate tigecycline prescription was for a postcolectomy patient with fever and negative blood cultures and no evidence of penicillin allergy.
Similarly, total linezolid prescriptions fell from 168 to 3 with the computerized system, and the proportion of appropriate orders also increased significantly, from 19% to 91%. Inappropriate linezolid use prior to the intervention included empiric therapy for skin and soft tissue infection (SSTI) and initial therapy for methicillin-resistant Staphylococcus aureus bacteremia and endocarditis. After the intervention, inappropriate use included empiric SSTI therapy, initial therapy for osteomyelitis, and vancomycin-resistant urinary tract infection with a negative urinalysis, Dr. Po and his associates reported.
The computerized system used in this study could serve as a model to reduce inappropriate prescribing of other antimicrobial agents, they commented.
Dr. Po stated he had no disclosures.