Presented by :Vincent Nault PhD(c)

How to Win the War on Bugs: EHR with Automated

Antimicrobial Prescription Surveillance System.

Presenter DisclosurePresenter: Vincent Nault

Relationships with commercial interests:Shareholder of Lumed inc.

Disclosure of Commercial Support

Potential for conflict(s) of interest:Lumed inc. is the company licenced to develop and commercialize the product that will be discussed in this program: APSS.Vincent Nault is also an employee of Lumed inc. and he is receiving a salary from the same company.

Mitigating Potential Bias

Data used in this presentation was collected before the establishment of Lumed inc.

Data was produced and managed by the Centre Hospitalier Universitaire de Sherbrooke and the Université de Sherbrooke.

Why optimizing antibiotics (Abx) ?

Negative impacts on patients’ healthToxicityMain risk factor of C. difficileIncreased length of stay

Inadequate spectrum coverageIncreased Abx resistance

Bacteria Mutations Resistant bacteriaAbx

Major Clinical and Health Concerns

It is costly

10 000 hospitalisations10 000 hospitalisations35 000 Abx 35 000 Abx

prescriptions prescriptions 210 000 doses210 000 doses

713-Bed Academic Hospital, 713-Bed Academic Hospital, 30 000 30 000 hospitalizationshospitalizations

1,7 M$/ year1,7 M$/ year

50% inappropriate50% inappropriate

7

Unanimous Recommendation

Accreditation Canada

Ministère Santé et Services sociaux

Infectious Disease Society of America

It is urgent to implement Abx stewardship

EHR

LaboratoryPharmacy MicrobiologyAdmission

- Length of stay

- Drug consumption

- Antimicrobials DDD

- Susceptibiliy profiles

- Intervention reports

- Filter : age, ward, time, etc.

Surveillance is Good…

Computerized optimization is better

10

EHR

Posology

Pip-Tazo 3g q6hCrCl < 20 ml/min

Multistep Process

Redundancy

Pip-Tazo+

Metronidazole

Interaction

Fluconazole+

Statin

Microbiology

Resistant bacteria

IV to PO

Quinolones

WBC normal

To normal

Cost

Unjustified use of meropenem

Sequential Therapy

Ceftriaxone IV3$

2

Ceftriaxone +

moxifloxacin IV

28$

1

Penicillin IV

3$

3

Amoxicillin PO

0,25$

4+

Patient Lab

Micro Tx

ATM

The Right Choice, the Right Time

Impacts of APSS at the CHUS

Types of Interventions (n=2733)

Oral Abx Consumption

Time-series analysis; p<0.05

APSS APSS APSS

PO DOT/1000PD PO Abx$/1000PD PO $

Time-series analysis; p<0.05

IV Abx Consumption

APSS APSS APSS

IV DOT/1000PD IV Abx$/1000PD IV $

22% of reduction in Abx IV consumption

Time-series analysis; p<0.05

Overall Abx Consumption

APSS APSS APSS

DOT/1000PD Abx$/1000PD $

13% of reduction in Abx consumption

APSS

Savings$922 000

Direct Savings After 30 Months

Questions ?

• APSS + EHR, a proven synergy• Reduction of 18 % in Abx expenditures

Reduction of 22 % in Abx consumption IV• Intervention was sustainable and

persistent

Conclusion

PopulationsP

rop

ort

ion

65+

PD

w/o

Ab

x

Pro

port

ion

PD

w/

Ab

x-2500 PD year

Targeted ATM (n=2733)

Valiquette et al. CID 2006.

Impact of stewardship on CDI

-54% -43%

-22% -6%

Return to baseline in 2 years

22 936

38718 no error

17 116 not reviewed

2809Pharmacist disagreed

278 Physician refused

5820

3011

61 654 prescriptions*

2733 accepted (91%)

From August 2010 to August 2012

Interventions