1783. Implementation of New Strategy for Real-time Antimicrobial Stewardship (ASP) in a Secondary Healthcare Hospital, in Mexico City

Background

Real-time antimicrobial stewardship programs are associated with improved time to optimal an effective therapies and decreased unnecessary antimicrobial use. However, these programs are often expensive and need special hardware or software for their implementation. Real-time communication technologies based on smartphones and texting media applications have not been used previously as a tool that emulates these clinical decision support programs (CDSP). We evaluated the clinical impact of implementing this technologies as fundamental part of an ASP in a Secondary Healthcare Hospital. Preauthorization, prospective audit, and feedback interventions were combined into a texting media group alert, composed by infectious diseases physicians, pharmacists, microbiologist and epidemiology department, which evaluated and decided the best treatment option in a real-time period consisting of 2 hours for each patient. Preauthorization rules included carbapenems, glycopeptides, quinolones, clindamycin, Linezolid, and amphotericin.

Methods

We conducted an observational and descriptive study for the total number of interventions in a 3-year period. Data collection included hospital service for application, authorization or restriction, consumption in terms of defined daily dose, economic outcomes, nosocomial bacteria’s resistance patterns, and overall mortality rates.

Results

A total of 8,004 interventions were carried out; only 7.7% (636) were unanswered within the 2 hour period. Emergency department (34.35%) and Internal Medicine (24.6%) were the most monitored services. The most restricted ones were Surgery and Intensive Care Unit with at least 25% of prescriptions. The most restricted antibiotics were piperacillin/tazobactam, clindamycin and quinolones, restraining up to 80%. Saving cost represents US$130,000.00 for colisitin and US$64,800.00 for carbapenems. The isolates of P. aeruginosa and A. baumanii resistant decreased by 75% and the overall mortality rate for nosocomial infections, were not increased.

Conclusion

This is the first report in Mexico of an ASP that incorporates mobile phone technology as a part of real-time surveillance program that emulates CDSP and allows to know in detail the correct use of antibiotics, saving costs and decreasing bacterial resistances

Disclosures

All authors: No reported disclosures.