Developing Interactive Antimicrobial Stewardship and Infection Prevention Curricula for Diverse Learners: A Tailored Approach

Nori, Priya; Madaline, Theresa; Munjal, Iona; Bhar, Shubha; Guo, Yi; Seo, Susan K.; Porrovecchio, Andrea; Gancher, Elizabeth; Nosanchuk, Joshua; Pirofski, Liise-anne; Ostrowsky, Belinda

One hundred four internal medicine residents completed the antibiotic pretest, and the majority had 0-1 of 3 correct responses. One hundred fifty residents received the ID core lectures with antibiogram and pocket prescribing card from November 2012 to September 2014, with an average of 3 lectures per resident per year. Antibiotic orders of 104 unique prescribers were audited for appropriateness, with an average of 4 orders per resident. Fifty-four percent of prescribers were interns, 28% were second-year residents, and 18% were thirdyear residents. A total of 425 patient charts were analyzed. Antibiotics were indicated for a true infection in at least 80% of all cases reviewed (no alternative noninfectious diagnosis such as congestive heart failure, cardiac ischemia, or pulmonary embolism was encountered). Preintervention appropriateness by indication was 60%, which improved to 70% at 1 month and 80% at 20 months postintervention (P = .049 and P < .01, respectively). At 20 months, appropriateness of antibiotic doses and durations was 92% and 86%, respectively (Table 4) . A preand postintervention analysis by syndrome showed a statistically significant prescribing improvement only for urinary tract infections (57% preintervention, 86% at 20 months postintervention; P = .011) and respiratory infections (59% preintervention, 75% at 20 months postintervention; P < .01) [17] . Syndrome-specific prescribing improvements for gastrointestinal, skin and soft tissue infections/osteomyelitis, and "other" infections (bloodstream, meningitis, C difficile, etc) were not statistically significant.