1. Presented by : Vincent Nault PhD(c) How to Win the War on Bugs: EHR with Automated Antimicrobial Prescription Surveillance System.

2. Presenter Disclosure Presenter: Vincent Nault Relationships with commercial interests: Shareholder of Lumed inc.

3. 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.

4. 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.

5. Why optimizing antibiotics (Abx) ?

6. Negative impacts on patients’ health Toxicity Main risk factor of C. difficile Increased length of stay Inadequate spectrum coverage Increased Abx resistance BacteriaMutationsResistant bacteriaAbx Major Clinical and Health Concerns

7. It is costly 10 000 hospitalisations 35 000 Abx prescriptions 210 000 doses 713-Bed Academic Hospital, 30 000 hospitalizations 1,7 M$/ year 50% inappropriate 7

8. Unanimous Recommendation Accreditation Canada Ministère Santé et Services sociaux Infectious Disease Society of America It is urgent to implement Abx stewardship

9. EHR Laboratory Pharmacy MicrobiologyAdmission - Length of stay - Drug consumption - Antimicrobials DDD - Susceptibiliy profiles - Intervention reports - Filter : age, ward, time, etc. Surveillance is Good…

10. Computerized optimization is better 10

11. EHR Posology Pip-Tazo 3 g q6h CrCl < 20 ml/min Multistep Process Redundancy Pip-Tazo + Metronidazole Interaction Fluconazole + Statin Microbiology Resistant bacteria IV to PO Quinolones WBC normal T o normal Cost Unjustified use of meropenem

12. Sequential Therapy Ceftriaxone IV 3$ 2 Ceftriaxone + moxifloxacin IV 28$ 1 Penicillin IV 3$ 3 Amoxicillin PO 0,25$ 4+

13. PatientLab MicroTx ATM The Right Choice, the Right Time

14. Impacts of APSS at the CHUS

15. Types of Interventions (n=2733)

16. Oral Abx Consumption Time-series analysis; p<0.05 APSS PO DOT/1000PDPO Abx$/1000PDPO $

17. Time-series analysis; p<0.05 IV Abx Consumption APSS IV DOT/1000PDIV Abx$/1000PDIV $ 22% of reduction in Abx IV consumption

18. Time-series analysis; p<0.05 Overall Abx Consumption APSS DOT/1000PDAbx$/1000PD$ 13% of reduction in Abx consumption

19. APSS Savings $922 000 Direct Savings After 30 Months

20. Questions ?

21. APSS + EHR, a proven synergy Reduction of 18 % in Abx expenditures Reduction of 22 % in Abx consumption IV Intervention was sustainable and persistent Conclusion

22. Populations Proportion 65+ PD w/o Abx Proportion PD w/ Abx -2500 PD year

23. Targeted ATM (n=2733)

24. Valiquette et al. CID 2006. Impact of stewardship on CDI

25. -54% -43% -22% -6% Return to baseline in 2 years

26. 22 936 38718 no error 17 116 not reviewed 2809 Pharmacist disagreed 278 Physician refused 5820 3011 61 654 prescriptions* 2733 accepted (91%) From August 2010 to August 2012 Interventions