Impact of a sustained, collaborative antimicrobial stewardship programme in spinal cord injury patients

D Perera; S Vogrin; S Khumra; S Motaganahalli; A Batrouney; K Urbancic; M Devchand; E Mitri; R Clements; A Nunn; G Reynolds; J A Trubiano

doi:10.1093/jacamr/dlad111

Impact of a sustained, collaborative antimicrobial stewardship programme in spinal cord injury patients

JAC Antimicrob Resist. 2023 Nov 22;5(6):dlad111. doi: 10.1093/jacamr/dlad111. eCollection 2023 Dec.

Authors

D Perera^{1

2}, S Vogrin^{1

3}, S Khumra^{1

2}, S Motaganahalli¹, A Batrouney^{1

2}, K Urbancic^{1

2}, M Devchand^{1

2}, E Mitri^{1

2

4}, R Clements⁵, A Nunn⁵, G Reynolds^{1

6

7}, J A Trubiano^{1

4}

Affiliations

¹ Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia.
² Department of Pharmacy, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia.
³ Department of Medicine, St Vincent's Health, The University of Melbourne, 29 Regent Street, Fitzroy 3065, Victoria, Australia.
⁴ Department of Infectious Diseases, Doherty Institute, University of Melbourne, 792 Elizabeth St, Melbourne 3000, Victoria, Australia.
⁵ Victorian Spinal Cord Service, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia.
⁶ National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne 3000, Victoria, Australia.
⁷ Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne 3000, Victoria, Australia.

Abstract

Background: In patients with spinal cord injuries (SCIs), infections continue to be a leading cause of morbidity, mortality and hospital admission.

Objectives: This study evaluated the long-term impact of a weekly, multidisciplinary Spinal/Antimicrobial Stewardship (AMS) meeting for acute-care SCI inpatients, on antimicrobial prescribing over 3 years.

Methods: A retrospective, longitudinal, pre-post comparison of antimicrobial prescribing was conducted at our tertiary hospital in Melbourne. Antimicrobial prescribing was audited in 6 month blocks pre- (25 April 2017 to 24 October 2017), immediately post- (27 March 2018 to 25 September 2018) and 3 years post-implementation (2 March 2021 to 31 August 2021). Antimicrobial orders for patients admitted under the spinal unit at the meeting time were included.

Results: The number of SCI patients prescribed an antimicrobial at the time of the weekly meeting decreased by 40% at 3 years post-implementation [incidence rate ratio (IRR) 0.63; 95% CI 0.51-0.79; P ≤ 0.001]. The overall number of antimicrobial orders decreased by over 22% at 3 years post-implementation (IRR 0.78; 95% CI 0.61-1.00; P = 0.052). A shorter antimicrobial order duration in the 3 year post-implementation period was observed (-28%; 95% CI -39% to -15%; P ≤ 0.001). This was most noticeable in IV orders at 3 years (-36%; 95% CI -51% to -16%; P = 0.001), and was also observed for oral orders at 3 years (-25%; 95% CI -38% to -10%; P = 0.003). Antimicrobial course duration (days) decreased for multiple indications: skin and soft tissue infections (-43%; 95% CI -67% to -1%; P = 0.045), pulmonary infections (-45%; 95% CI -67% to -9%; P = 0.022) and urinary infections (-31%; 95% CI -47% to -9%; P = 0.009). Ninety-day mortality rates were not impacted.

Conclusions: This study showed that consistent, collaborative meetings between the Spinal and AMS teams can reduce antimicrobial exposure for acute-care SCI patients without adversely impacting 90 day mortality.