'Do no harm' Long term outcomes of an antimicrobial stewardship program

Abstract

‘Do no harm’ – Long term outcomes of a sustained, collaborative antimicrobial stewardship program in spinal cord injury patients

1. Department of Infectious Diseases, Austin Health, Heidelberg, Vic., Australia; 2. Department of Pharmacy, Austin Health, Heidelberg, Vic., Australia; 3. Department of Medicine, St Vincent’s Health, The University of Melbourne, Fitzroy, Vic., Australia; 4. Victorian Spinal Cord Service, Austin Health, Heidelberg, Vic., Australia; 5. Department of Infectious Diseases, Doherty Institute, University of Melbourne, Melbourne, Vic., Australia; 6. National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia; 7. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic., Australia Aim Infections continue to be a leading cause of morbidity, mortality and hospital admission for patients with spinal cord injury (SCI). Multidisciplinary Spinal/Antimicrobial Stewardship (AMS) meetings at our centre reduced antimicrobial exposure by 40% for SCI patients, but rates of relapsed infection and antibiotic recommencement were not assessed.1 This study aims to review long-term patient outcomes following Spinal/AMS meetings. Methods Patients from three 6-month blocks pre- (25/4/2017-24/10/2017), immediately post- (27/3/2018-25/9/2018) and 3-years post-implementation (2/3/2021-31/8/2021) of Spinal/AMS meetings, were followed up for 90-days post completion of included antimicrobial course. The primary outcome was recommencement of antimicrobials in hospital for under-treated infection. Results A total of 289 antimicrobial courses were reviewed for 185 patients (77% male, median age 56 years). Despite shorter duration of antimicrobial therapy1, there was no significant change in readmission for the same infection indication (OR 1.18 [95% CI 0.49, 2.86], p=0.712), recommencing antimicrobials for the same indication (OR 0.61 [95% 0.30, 1.25], p=0.174), or ICU admission for the same infection indication (OR 2.77 [95% 0.25, 31.31], p=0.410) following introduction of the AMS meeting.

Conclusion This medium-term follow-up shows that shorter duration antimicrobials are safe and effective in a complex patient cohort. Impact Spinal/AMS meetings can continue to implement judicious use of antimicrobials, without adversely impacting patient outcomes.