P-896. Long-term Impact of Automatic Stop Orders on Prolonged Broad Spectrum Antimicrobial therapy

TL;DR

A hospital implemented automatic stop orders for vancomycin and meropenem to reduce prolonged antibiotic use, but the initial reduction in long-term courses was not sustained over six years.

Contribution

The study evaluates the long-term effectiveness of automatic stop orders in reducing prolonged antibiotic therapy and finds the initial impact was not sustained.

Findings

Automatic stop orders initially reduced prolonged vancomycin and meropenem courses by 6-10%.

The reduction in prolonged courses was not sustained over six years.

88% of vancomycin and 90% of meropenem courses were prescribed appropriately in the long-term period.

Abstract

Prolonged use of broad-spectrum antibiotics like meropenem and vancomycin is linked to development of antimicrobial resistance. Starting June 20, 2017, our hospital implemented a 72-hour stop date for vancomycin and meropenem orders in the electronic health system (EHS, Allscripts Sunrise Enterprise™ 2017-2018; Epic 2018-2024). This resulted in reduction in the number of prolonged vancomycin and meropenem courses ( >72 hours) from 44% to 38% (p=0.001). The objective of our study was to examine whether this reduction was sustained six years later by examining length of therapy (LOT) of vancomycin and meropenem courses.

All patients who received at least one dose of vancomycin/meropenem during the study period were included. LOT of an antibiotic was defined as the number of days a patient received at least one dose of the antibiotic. Courses interrupted for ≥24 hours were considered new courses. LOT data was compared across three periods: pre-intervention (Dec 20, 2016 – June 20, 2017), immediately post-intervention (June 20, 2017 – Dec 20, 2017), and long-term post-intervention (June 2, 2018 – June 1, 2024). Appropriateness of prolonged ( >72 hours) courses in the long-term post-intervention period were described (April 1, 2021, to March 31, 2023). Courses beyond 72 hours were considered appropriate if there was a resistant organism was isolated, or the course was approved by ID or ASP. The LOT was compared between periods using Chi-square.Figure 1:Percentage of Meropenem and Vancomycin courses >72 hrs from 2016-2024

Percentage of Meropenem and Vancomycin courses >72 hrs from 2016-2024

There was also no statistical difference in the median LOTs for vancomycin or meropenem between the three time periods (Table 1). 63% of meropenem courses given between June 2, 2018 – June 1, 2024, were prolonged while 35% of vancomycin courses administered during same period was prolonged. During the period of assessment of appropriateness data 88% of vancomycin and 90% of meropenem courses were prescribed appropriately.

Automatic stop orders can reduce the duration of antibiotic therapy and demonstrated 6-10% reduction in prolonged courses of vancomycin and meropenem immediately post-intervention. Unfortunately, this trend was not sustained, and further strategies are needed to sustain the impact of automatic stop dates.

All Authors: No reported disclosures

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