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Abstract: SA-PO998

Implementation of Antibiotic Stewardship (AS) in a Large Dialysis Organization

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Mysayphonh, Chance, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Scoggins, Tory, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • McCarley, Patricia, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Dalrymple, Lorien S., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Ofsthun, Norma J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Weinhandl, Eric D., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Hymes, Jeffrey L., Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background

Fresenius Kidney Care (FKC) implemented an antibiotic stewardship (AS) program to ensure blood cultures were drawn prior to antibiotic administration and to optimize the selection of empiric antibiotic therapy, timing of de-escalation of broad-spectrum antibiotics, and the duration of antibiotic therapy.

Methods

The FKC AS program consisted of the following: 1) a care pathway for catheter-related blood stream infection (BSI); 2) implementation of a software platform that allowed for real-time monitoring of blood cultures, prescription of IV antibiotics, and blood culture (BC) and sensitivity results; 3) a pharmacist to monitor BC results and IV antibiotic treatment; and 4) educational programs. Starting in 2018, a targeted deployment of the AS program was undertaken sequentially in four regions.
To examine the effect of AS on BSI rates, we identified hemodialysis (HD) patients in FKC facilities between January 1, 2016, and March 31, 2019 and ascertained vascular access (VA) type in use during each HD session and positive BC results. To estimate effects of the intervention, we fit a series of Poisson regression models of BSI incidence, adjusted for region, VA type, secular trend, seasonality, and region-specific timing of the launch of the intervention.

Results

The cohort included 42,535 HD patients; 696,106 patient-months (80% with fistula/graft, 20% with catheter); and 3,747 BSIs (39% with fistula/graft, 61% with catheter). Among all 4 regions, the adjusted secular trend during the study era was 7% lower BSI incidence per year. After accounting for this trend and seasonality, the adjusted relative rate (ARR) of BSI incidence after the launch of AS was 0.58 (95% CI 0.48-0.70), relative to expected incidence in the absence of the intervention. The ARR was 0.78 with fistula/graft and 0.48 with catheter; ARR varied among the regions (Table).

Conclusion

Implementation of AS was associated with a reduction in BSI incidence relative to modeled trends. However, outcomes differed by access type and region.

Funding

  • Commercial Support –