Want to know a few of the highlights from the IDWeek conference but you’ve been a bit too busy? Between COVID-19 and the holiday period, it’s hard to find the time and keep up with everything that is going on at virtual conferences. To help, here is a short summary of IDWeek key posters and presentations on precision medication dosing of antimicrobials and antimicrobial stewardship.
This Article Contains:
- Vancomycin Dosing by AUC24/MIC in Comparison to Traditional Trough Dosing in Office Infusion Centers
- Vancomycin Infusion Frequency and Intensity: Analysis of Real-World Data Generated from Automated Infusion Devices
- SCORE -UC: Antibiotic Stewardship in Urgent Care
- Measuring Empiric Antibiotic Spectrum Patterns Across Space and Time
- Initial Impact of COVID-19 on Ambulatory Antibiotic Prescribing for Respiratory Viral Infections
- Outcomes from the AHRQ Safety Program for Improving Antibiotic Use Across 439 Long-Term Care Facilities
Even though, as expected, COVID-19 was a major focus at the ID Week 2020 Virtual Conference, a variety of other interesting infectious diseases topics were covered.
Precision Medication Dosing
Vancomycin Dosing by AUC24/MIC in Comparison to Traditional Trough Dosing in Office Infusion Centers
A number of research posters focused on implementation of an AUC-guided dosing program for vancomycin. We are particularly excited to highlight a study conducted by one of our DoseMeRx partners, Healix.
Healix is a large infusion services provider that retrospectively evaluated the relationship between trough and AUC dosing in the outpatient setting.
- 100 patients receiving vancomycin for methicillin resistant Staphylococcus aureus infections were evaluated.
- These patients were typically receiving prolonged therapy (median duration 28 days), and 69% had received vancomycin in the hospital.
- Mean trough levels of 17.1 +/- 6.4mg/L corresponded with an AUC24 of 498+/- 98mg*h/L. Four cases of reversible acute kidney injury were documented, all in patients with an AUC24 of >540.
- A correlation between trough levels and AUC24. This relationship can be used to identify patients at risk for developing AKI.
- AUC24 usefulness in the outpatient infusion setting when true troughs can be difficult to obtain.
Vancomycin Infusion Frequency and Intensity: Analysis of Real-World Data Generated from Automated Infusion Devices
In addition to the clinically focused posters on vancomycin dosing, one unique poster on vancomycin infusion practices stood out.
- Researchers from BD (manufacturer of automated infusion devices) analyzed data from more than 13,000 vancomycin infusion sessions from 2417 adult patients.
- The majority of patients received doses of 1 gram (53.7%) or 1.5 gram (24.6%) and the most common dosing interval was every 12 hours (42.9%).
- More than one quarter of patients only had a single vancomycin dose documented, highlighting an opportunity for improved vancomycin stewardship.
- The actual infusion duration often exceeded the prescribed 1- or 2-hour infusion orders. This was attributed to infusion interruptions due to patient movement, procedures or IV access compromise.
- Awareness of these interruptions is important as it could alter both the pharmacokinetics of the drug as well as AUC calculations.
This category continues to grow each year at IDWeek. There were over 200 posters and 27 oral abstracts presented on this topic including the below which you may find of interest based on your area of clinical practice.
Precision Medication Dosing in Urgent Care
SCORE UC: Antibiotic Stewardship in Urgent Care (Oral Abstract 4. Authors: Hersh A, Stenehjem E, Fino N, et al.– Urgent care is the fastest growing site of outpatient care delivery and an ideal care environment for antimicrobial stewardship.
- This study highlighted a successful program that was implemented across 39 urgent care sites affiliated with Intermountain Healthcare.
- Utilizing a multifaceted stewardship intervention comprised of education, electronic health record tools, provider benchmarks, and media campaigns, antibiotic prescribing was reduced by 20% across all clinics and clinician types.
- Results included improvement in other aspects of antibiotic use, including antibiotic selection.
Measuring Empiric Antibiotic Spectrum Patterns Across Space and Time (SHEA Decennial Top Oral Abstract Awards. Authors: Yarrington ME, Moehring RW, Anderson DJ, Wrenn R, et al.)
- This study, conducted at Duke Medical Center over a 5 year period, is one of the first quantitative evaluations of using antibiotic spectrum to target antimicrobial stewardship interventions.
- They evaluated 90,455 unique “antibiotic” admissions across several areas of care (medical, surgical, and critical care units). Antibiotics with a wider spectrum of activity were more likely to be prescribed during the overnight hours in medical wards vs surgical wards.
- Notable differences in antimicrobial spectrum were noted in the surgical wards based on day of week but these differences were not observed as frequently in the medicine patients. Also, physician scheduling impacted antimicrobial use in medical units (e.g., 7 day schedules for hospitalists and intensivists) whereas operating room schedules had a bigger influence on antimicrobial use in surgical wards.
Initial Impact of COVID-19 on Ambulatory Antibiotic Prescribing for Respiratory Viral Infections (Poster 143. Authors Escobar ZK, Bouchard T, Lansang JM, et al )
- This was a single center observational study conducted at the University of Washington Valley Medical Center.
- MITIGATE Toolkit was implemented to reduce inappropriate antibiotic prescribing for viral respiratory tract infections across several care sites including urgent care, primary care, and emergency departments.
- With toolkit interventions, rates of inappropriate antibiotic prescribing were lowered by half across matching time periods in 2019 to 2020 in 3 ambulatory care settings. (Note: this reduction was not sustained during April 2020, likely associated with an increase in COVID-19 cases.)
Precision Medication Dosing in Long Term Care
Outcomes from the AHRQ Safety Program for Improving Antibiotic Use Across 439 Long-term care Facilities (Oral Abstract: Session 4. Authors: Katz M, Rowe T, Cosgrove S, et al.)
- This was a study, led by a multi-disciplinary, multi-site team and focused on evaluating the impact of a bundle of stewardship interventions designed specifically for nursing homes.
- This bundle included monthly case-based webinars, ‘ask the expert’ office hours, provider and family educational materials, and a designated quality expert for each site.
- Antimicrobial utilization and select microbiology data were also tracked.
- Over the one-year study, 439 nursing homes participated. By the end of the program, there were significant reductions in antibiotic starts and urine cultures collected, and there were non-statistically significant declines in overall antibiotic use and C. difficile LabID events.
- Highlight: the researchers were able to keep participants highly engaged throughout the program. Tools and resources from the program available here.
For more information about these posters and the conference, go to https://idweek.org/
Special thanks to Masasad Alumtari, PharmD, BCPS , Post-Doctoral Fellow in Infectious Diseases at the University of Houston College of Pharmacy for his contribution to this summary.
Contact me for more information about how we have supported other institutions through this change management process and optimize precision medication dosing.