Bologna, 18 novembre 2014

Il modello di antimicrobial stewardship dell’Azienda ospedaliero-universitaria di Bologna

Francesco Cristini

Clinica

di Malattie Infettive

Pierluigi Viale

Direttore Clinica

Cristina Puggioli

Direttore Farmacia

di Malattie Infettive

Policlinico S. Orsola – Malpighi Policlinico S. Orsola – Malpighi Policlinico S. Orsola – Malpighi

The S.Orsola-Malpighi Stewardship program • • • •

Formulary restrictions Preauthorization requirements Retrospective Audits Diffusion of international and local guidelines

Run for the appropriateness n n n

Shared definitions of appropriateness No pre defined restrictions but … “Real time” evaluation of any prescription by the ID consultant team

The MULTIFACETED concept of APPROPRIATENESS

- RIGHT INDICATION - RIGHT DRUG - RIGHT DAILY DOSE - RIGHT MODALITY OF ADMINISTRATION - RIGHT DURATION - IMPROVEMENT OF MICROBIOLOGICAL WORK UP

Run for the appropriateness – METHODS

Antimicrobials checked

DAPTOMYCIN LINEZOLID MEROPENEM TIGECYCLIN L-AMPH B CASPOFUNGIN VORICONAZOLE

Run for the appropriateness – METHODS FREE Prescription

ID team

on duty pharmacist

registration

NO

YES

Distribution Coverage for 48 h

Shift Stop

5-7 days of therapy

Run for the appropriateness

The S.Orsola-Malpighi Stewardship program

GOAL -Contain

the misuse of cardinal antimicrobials

-Give

a clinical value to the consumption data, matching them with levels of appropriateness -Improve

knowledge and practice patterns of prescribers, working at the cultural level

S. Orsola-Maplighi Teaching Hospital – the ID consultant team Three Seniors + 3 Youngs Daily Consultation in TX Center / Cardio Surgery / ICUs / Hospitalwide on demand

Stewardship program “Run for the app ropriateness”

Run for the appropriateness – RESULTS October 31, 2014 Prescriptions checked

1667

Patients

1177

Admissions

1275 BSI

MAJOR ABDOMINAL SURGERY OSTEOMIELITIS HEART SURGERY ESLD

SOT

Run for the appropriateness – RESULTS October 31, 2014

DDD per 100 patient-days – PRE/POST INTERVENTION

Run for the appropriateness – RESULTS October 31, 2014

DDD per 100 patient-days – PRE/POST INTERVENTION

Run for the appropriateness – RESULTS October 31, 2014

DDD per 100 patient-days * Case Index Mix – PRE/POST INTERVENTION

Run for the appropriateness – RESULTS October 31, 2014

DDD per 100 patient-days * Case Index Mix – PRE/POST INTERVENTION 0,91 0,78 LAMB CASPO 0,21 0,18

pre

VORI 0,25 0,15 post

Run for the appropriateness – RESULTS October 31, 2014

DELTA DDD per 100 patient-days * CIM – PRE/POST INTERVENTION

%

Run for the appropriateness – RESULTS October 31, 2014 TREND of OVERALL APPROPRIATENESS and ID PRESCRIPTIONS overall appropriateness

ALL DRUGS 87,8%

71,4%

mag-ott13

89,5%

77,1%

nov13-feb14

91,6%

81,3%

mar-giu14

92,6%

81,8%

ID prescription

lug-ott14

Run for the appropriateness – RESULTS October 31, 2014

TREND of OVERALL APPROPRIATENESS and ID PRESCRIPTION

overall appropriateness

ID prescription

Run for the appropriateness – RESULTS October 31, 2014

stewardship period (May 2013 to Oct 2014) OVERALL APPROPRIATENESS and CONSUMPTIONS MATCHING Appropriatenes rate

DDD 100 ggdd *ICM

Meropenem

83%

1.69

Daptomycin

99%

1.21

Linezolid

93%

0.57

Tigecycline

95%

0.40

Run for the appropriateness – RESULTS October 31, 2014

stewardship period (May 2013 to Oct 2014) OVERALL APPROPRIATENESS and CONSUMPTIONS MATCHING Appropriatenes rate

DDD 100 ggdd *ICM

L-AMB

97%

0.78

CASPOFUNGIN

96%

0.25

VORICONAZOLE

87%

0.15

Run for the appropriateness – RESULTS October 31, 2014 TRENDS of CONSUMPTIONS of DAPTOMYCIN

> 200 cases of bone & joint infections per year MR Staph (MRSA with MIC >2 mg/L > 20%) MR Staph Rifampicin-R > 20%

Run for the appropriateness – RESULTS October 31, 2014 TRENDS of APPROPRIATENESS and CONSUMPTIONS OF MEROPENEM

2,31

1,15

KPC BSI n=

3

17 !

2

(ottobre 2014)

Run for the appropriateness – RESULTS October 31, 2014

MEAN TIMES OF TREATMENT DRUG

Treatments

DAYS

Mean lengths (days)

DAPTOMYCIN LINEZOLID MEROPENEM TIGECYCLINE ANTIBACTERIAL

323 315 601 206 1169

1818 1599 3305 1131 7853

5,6 5,1 5,5 5,5 6,7

L-AMPHOTERICIN B CASPOFUNGIN VORICONAZOLE ANTIFUNGAL

98 88 30 211

495 609 267 1371

5,1 6,9 8,9 6,5

S. Orsola-Maplighi Teaching Hospital – the ID consultant team Three Seniors + 3 Youngs

4350*

4000 3500

3728* 3842

Consultations per year

3000

2944 * estimated

2483

2500 2000

1963

1500 1000

Stewardship program “Run for the appropriateness”

978

500 0

2009

2010

2011

2012

2013

2014*

Grazie a

Cristina Puggioli Chiara Sacripanti Marta Morotti