title: Antimicrobial Stewardship Intervention and Feedback to Infectious Disease Specialists: A Case Study in High-Dose Daptomycin.
abstract: Infectious Diseases specialists have used high-dose daptomycin (≥6 mg/kg/day) in select patients with difficult to treat methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) infections to optimize outcomes. Antimicrobial stewardship programs enforce antimicrobial formulary restrictions; however, interventions specifically aimed at Infectious Disease specialists can be particularly challenging. The purpose of this study was to create a high-dose daptomycin algorithm for Infectious Disease specialists that are consistent with best-practices. Daptomycin prescribing habits pre- and post-daptomycin algorithm implementation were evaluated using a quasi-experimental study design. Patients were included if ≥18 years of age and received daptomycin for ≥48 h. Patients were excluded if daptomycin was initiated on an outpatient setting. During the 12-month pre-intervention phase, 112 patients were included, with 73 patients in the 12-month post-intervention phase. A statistically significant decrease in the mean daptomycin dose from 9.01 mg/kg to 7.51 mg/kg (p < 0.005) was observed, resulting in an annual drug cost-savings of over $75,000 without adversely affecting readmission rates due to infection. Creation of a daptomycin algorithm with consideration of pathogen, disease state, and prior treatment, is an effective means of influencing prescribing habits of Infectious Disease specialists.
authors.affiliation: Department of Pharmaceutical Services, University of New Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA. jeross@salud.unm.edu.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Ross
authors.affiliation: Department of Pharmaceutical Services, University of New Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA. srankin@salud.unm.edu.
authors.forename: Shannon
authors.initials: S
authors.lastname: Rankin
authors.affiliation: College of Pharmacy, University of New Mexico Health Sciences Center, MSC09 5360, 1 University of New Mexico, Albuquerque, NM 87131, USA. pmarshik@salud.unm.edu.
authors.forename: Patricia
authors.initials: P
authors.lastname: Marshik
authors.affiliation: College of Pharmacy, University of New Mexico Health Sciences Center, MSC09 5360, 1 University of New Mexico, Albuquerque, NM 87131, USA. rmercier@salud.unm.edu.
authors.forename: Renée-Claude
authors.initials: RC
authors.lastname: Mercier
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, 1 University of New Mexico, Albuquerque, NM 87131, USA. mbrett@salud.unm.edu.
authors.forename: Meghan
authors.initials: M
authors.lastname: Brett
authors.affiliation: Department of Pharmaceutical Services, University of New Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA. cwalraven@salud.unm.edu.
authors.forename: Carla J
authors.initials: CJ
authors.lastname: Walraven
keywords: antimicrobial stewardship; daptomycin; infectious diseases