Quality Project -- Antibiotic Susceptibility Mismatch Reduction

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Problem Statement

Scope of Problem: Published reports suggest that antibiotic susceptibility mismatch (ASM) is a significant problem. Buising and colleagues[1] noted that in a population of adult ICU patients, 14.3% of sterile and 30.8% of non-sterile isolates were treated inadequately initially, 4.0% of sterile and 21.3% of non-sterile isolates were treated inadequately after identification, and narrower-spectrum therapy was available for 30% of patients after microbe identification. In addition, Paterson et al[2] reported that 52% of mismatches occurred in patients who previously received a drug that was shown to be inadequate against the infecting organism, 30% of patients had a prior history of a drug’s ineffectiveness against an organism, and 62.5% of mismatches occurred in patients staying 14 days or longer (i.e., intensive care unit patients, cancer patients). These reports indicate that there are clear patterns and risk factors that describe ASM. Therefore, the process of identification and intervention for ASM is a particularly well-suited target for ongoing quality improvement efforts, which could identify workflow causes or process failures that promote ASM.

Impact: Published research reviewed in developing the guideline reported various improvements in antimicrobial use and patient outcomes, among them: a) a 22% to 36% decrease in antimicrobial use through more efficient prescribing practice and use of less expensive alternatives; b) savings of $200,000 to $900,000 in direct drug costs (savings dependent on institution size); c) short-term susceptibilities among gram-negative pathogens (e.g., Klebsiella); d) reduced use of broad-spectrum antimicrobials by 34% to 84%; and e) modification of 25% of antimicrobial orders, with prescription of narrower-spectrum drugs in 47% of these cases.[3]

Setting: A large metropolitan children's hospital

Aim: To reduce the use of ineffective antibiotics for documented infections

Specific Goal: To reduce the incidence of antibiotic susceptibility mismatches (ASM) for documented infections in urine and bloodstream through active surveillance of culture results and antibiotic use