Aballéa, S

Clements, KM

Hill, G

McGarry, LJ

Pawar, V

Taylor, DC

Thompson, D

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steroid administration, Drotrecogin Alfa administration, and gly-
cemic control goal. Outcome measures were; In-hospital mortal-
ity, ICU mortality, ICU LOS, hospital LOS and hospital discharge
location. RESULTS: Of 58 patients, 24 (41%) met the criteria for
severe sepsis with an average APACHE III score of 69  31. There
was a score of 60% on four (50%) of the eight process measures
and <35%on the other four. In-hospital mortality of 25% (16.7%
for ICU) compared favorably with 28.6% national. Average
hospital LOS (9.1  6.5 days) and ICU LOS (3.3  3.4 days)
were within expected benchmarks. Discharge to skilled nursing
facility was 21%. Compared to those who did not meet severe
sepsis criteria, the mortality rates were lower (25% vs. 29.1%)
and the LOS values higher (9.1 vs. 8.4 days) in the severe sepsis
group. The average direct cost of severe sepsis hospitalization was
$30,061, mean daily cost of $3303. CONCLUSIONS: Variation
in adoption of the SSC-IHI guideline is apparent. Though, severe
sepsis outcomes are above average, opportunities for process
improvement that should enhance outcomes in this setting exist.
PIN52
UTILIZATION ANALYSIS AND IMPACT OF ANTIBACTERIAL
AGENTS INTWO LEADING UNIVERSITY HOSPITALS IN
NEIGHBORING COUNTRIES WITH DIFFERENT GDP AND
HEALTH CARE SYSTEM
Francetic I1, Gavrankapetanovic F2, Begovic B2, Bielen L3, Bolanca S4
1University Hospital Center Zagreb, Zagreb, Croatia, 2Clinical Center
University of Sarajevo, Sarajevo, Bosnia, 3Medical School University of
Zagreb, Zagreb, Croatia, 4Pﬁzer Croatia, Zagreb, Croatia
OBJECTIVES: Antibacterial agents are still overused in many
developing countries with the main consequence of constant
increase in bacterial resistance. The purpose of this study is to
compare the utilization of antibacterial agents and its economic
impact on two leading University Hospitals in two neighboring
countries, Croatia and Bosnia and Herzegovina, having similar
historical values, but now having notable differences in health
care system and GDP. Secondary objective was to assess the
appropriateness of clinical guidelines and level of their imple-
mentation in each hospital. METHODS: Antibacterial utilization
in 2007 was assessed for each hospital using the ABC calculator
version 3.1. The results were compared at ATC levels 2–4. The
following calculated parameters were used for the adjusted hos-
pital to hospital comparison: number of utilized grams, number
of utilized DDD’s, number of grams utilized per 100 bed-days
and ﬁnally the number of DDD’s per 100 bed-days. Additional
analysis of each hospital’s treatment guidelines was performed
for those ATC classes having actual treatment guidelines and
results assessed in light of the level of implementation effective-
ness and impact on the cost and bacterial resistance rate.
RESULTS: Differences in antibacterial use between two leading
University Hospitals in Croatia and Bosnia and Herzegovina
were noted. Of all noted differences two classes of antibiotics
were further analyzed because of their well known impact on
bacterial resistance: third generation cephalosporins and quino-
lones. Subsequent analysis of the incidence of MRSA infections
and Gram negative ESBL bacteria are conclusive and in line with
the reported utilization ﬁndings. CONCLUSIONS: Although
some treatment guidelines for antibacterial prophylaxis and
treatment of bacterial infections were effectively implemented in
both hospitals, there were still those which have to be developed
and/or revised and subsequently implemented in order to ensure
the most beneﬁcial cost-effectiveness ratio and positive impact on
bacterial resistance. Additional intra-hospital measures are to be
developed and implemented in order to ensure the compliance
with treatment guidelines, such as internal audits and issue-
focused education of relevant health care professionals.
PIN53
PHARMACY-IMPLEMENTED GUIDELINES ON SWITCHING
FROM INTRAVENOUSTO ORAL ANTIBIOTICS: A
PROSPECTIVE STUDY IN ATEACHING HOSPITAL
Briquet C1, D’Hoore W2, Bisot-Locard S3, Simon A1,Tilleul P3
1Cliniques Universitaires Saint Luc, Brussels, Belgium, 2Université
Catholique de Louvain (UCL), Brussels, Belgium, 3Université Paris
Descartes, Paris cedex 12, France
OBJECTIVES: Intravenous (IV) to oral (PO) switch therapy is a
demonstrated method to achieve a more rational use of antibi-
otics. Several advantages have been associated with this strategy
such as less preparation time, easier administration, greater
comfort, lower risk of complications and lower antibiotic
budget. The objective was to evaluate the impact of promoting
an IV to PO switch of ﬂuoroquinolones (FQ) with three different
educational interventions. METHODS: A prospective observa-
tional study was conducted in 16 different wards of a teaching
hospital of 959 beds. For all patients treated with a FQ, what-
ever the site of infection, data related to infection and therapy
were collected during four different 3-month periods. The ﬁrst
period (A) was observational without intervention to identify
the prescription habits. The second period (B) was a period of
“passive” intervention with publication of IV/PO switch criteria
in the hospital bulletin and personal letter to each physician. The
third and fourth periods C and D were two crossover active
interventions: intervention 1) IV/PO switch training sessions by
clinical pharmacist to all physicians of the selected wards, and
intervention 2) proactive interventions by clinical pharmacist.
RESULTS: A total of 349 prescriptions were recorded. There
was a signiﬁcant reduction in number of overprescription days
of IV treatment during period B compared to period A
(4.6  0.5 and 3.1  0.4, p = 0.027) and period B compared to
periods C + D (3.1  0.4 and 1.5  0.2, p < 0.001). Antibiotics
budget and number of FQ vials were also reduced. There was no
statistical difference between the two different active interven-
tions (p = 0.82). CONCLUSIONS: Passive and active interven-
tions to teach early switch from IV to PO FQ therapy are highly
effective (p < 0.05). Active intervention by a clinical pharmacist
whatever it is team-focused or case-focused is more efﬁcient than
passive.
INFECTION—Conceptual Papers & Research on Methods
PIN54
ADAPTATION & CALIBRATION OF A UK MODEL OF
MENINGOCOCCAL DISEASETOTHE US SETTING
Aballéa S1, McGarry LJ2,Taylor DC2, Hill G2, Pawar V2,
Clements KM2,Thompson D2
1i3 Innovus, Uxbridge, Middlesex, UK, 2i3 Innovus, Medford, MA, USA
OBJECTIVES: To evaluate vaccination policies for meningococ-
cal disease in the US, we adapted and calibrated a dynamic model
of meningococcal disease originally developed for the UK.
METHODS: We adapted an age-stratiﬁed mathematical model
of meningococcal transmission, carriage, and disease from the
UK to the US setting. The model focus was expanded from
serogroup C to serogroups A, C, W, and Y disease to reﬂect
newer vaccines. The most recent available US cross-sectional
carriage data were used to extract serogroups A, W, and Y
carriage from the non-C (“other”) serogroup data used in the UK
model. We used recently-published contact matrix data for trans-
mission calculations and performed formal calibrations to pub-
lished US surveillance data. We ﬁrst calibrated age-speciﬁc force
of infection to ACWY carriage data and solved for transmission
rates (b) at equilibrium for a cohort of 75,000 individuals rep-
resentative of the US population. We then calibrated the risk of
Abstracts A445
meningococcal disease conditional on carriage (q) to US inci-
dence data. Calibration used the maximum likelihood method;
goodness-of-ﬁt was assessed using deviance. RESULTS: The cal-
culated b for infant-to-infant transmission is 1.86 effective con-
tacts per 100,000 infants per year. b peaks at 29.7/100,000 for
transmission between 14 year olds and 11–14 year olds, and
ranges from 0 to 16.3/100,000 for adult-adult transmission. The
q is highest in infants (0.015), declines steeply and plateaus at
0.00013 in those aged >20 years. The model predicted yearly
cases of ACWY-related meningococcal disease are 132 among
infants, 439 among 1–20 year-olds, and 202 among those aged
>20, compared with 129, 433, and 211 for US benchmarks
(deviance = 184, with 72 degrees of freedom). CONCLUSIONS:
Calibration techniques can be used to adapt a UK meningococcal
disease model to the US using modiﬁed serogroup and contact
data such that a reasonable ﬁt is achieved with US benchmarks.
RESPIRATORY-RELATED DISORDERS—
Clinical Outcomes Studies
PRS1
SMOKING,ASTHMA AND COPD IN ADULTS:ATOO
FREQUENT RELATION
Sicras A1, Navarro-Artieda R2
1Badalona Servicios Asistenciales, Barcelona, Spain, 2Hospital Germans
Trias i Pujol, Barcelona, Spain
OBJECTIVES: To determine the relation with active smoking
patients in presence of asthma and COPD, and to know its
association with some cardiovascular risk factors and its cost
repercussion of attended patients in a Spanish population setting.
METHODS: Multi-centric retrospective design realised begin-
ning from subjects older than 14 years demanding assistance
during year 2006. Smoking habit, asthma and COPD were
deﬁned as a clinical illness obtained according to International
Classiﬁcation CIAP-2. Main measures: age, gender, co-
morbidities (cardiovascular), Charlson index (patient severity)
and costs model (ﬁxed/semi-ﬁxed: in operation) and variable
ones (diagnostics/therapeutics tests and referrals). Statistic analy-
sis: logistics regression and covariance (ANCOVA) for the
correction of the model (recommendations: Thompson-Barber).
Program SPSSWIN, p < 0.05. RESULTS: A total of 65,768
patients (use: 73.1%; frequentation: 4.7 visits/100 inhabitants).
The 4.1% (n = 2,693, conﬁdence intervals of the 95% [CI]:
3.9–4.3%) presented asthma and the 2.7% (n = 1,769, CI: 2.6–
2.8%) COPD. The percentage of active smokers was 20.2% (CI:
18.7–21.7%) and 27.0% (CI: 24.9–29.1%), p = NS, respectively.
In general, asthmatic patients were associated to feminine gender
(OR = 1.7) and in younger ages (15–44 years: 52.2%),
p < 0.001; while COPD to masculine gender (women: OR = 0.2),
older ages (65–74 years: 64.5%) and cardiovascular events (OR:
1.2). In both patients of high co-morbidity and with obesity
(OR = 1.5 and OR = 1.4; in asthma and COPD respectively).
The average of adjusted total cost/unitary was superior in COPD
(€1,146.30) especially in pharmaceutical cost. CONCLUSIONS:
The existence of active smoking patients in presence of asthma
and COPD is high. In primary prevention should be established
measures to carry out the reduction of cardiovascular risk factors
(smoking and obesity), above all in subjects with COPD, were
the resources consume and risks are higher.
PRS2
RELATIVE EFFECTIVENESS OF INHALED CORTICOSTEROIDS
AND LEUKOTRIENE-RECEPTOR ANTAGONISTSTO PREVENT
MODERATE-TO-SEVERE EXACERBATIONS AMONG
ASTHMATIC CHILDREN
Blais L1, Kettani FZ1, Lemière C2, Beauchesne MF1, Perreault S1,
Elftouh N1
1Université de Montréal, Montreal, QC, Canada, 2Hôpital du
Sacré-Coeur de Montréal, Montreal, QC, Canada
OBJECTIVES: To investigate the relative effectiveness of inhaled
cortcosteroids (ICS) and leukotriene-receptor anragonists to
prevent moderat-to-severe exacerbations among asthmatic chil-
dren. METHODS: From the linkage of two administrative health
databases from Quebec, Canada, we reconstructed a cohort of
asthmatic children aged 5 to 15 years that initiated a treatment
with either ICS or LTRA between January ﬁrst 1998 and August
31, 2005. Patients were followed between 4 and 12 months. The
primary outcome was moderate-to-severe asthma exacerbations
deﬁned as an emergency department (ED) visit for asthma, a
hospitalization for asthma or a dispensed short-course (14
days) prescription of oral corticosteroids. Patients’ adherence to
their controller therapy was estimated with the medication pos-
session ratio (MPR). All analyses were stratiﬁed by the presence
or not of an asthma exacerbation in the year before treatment
initiation with ICS or LTRA. We estimated the adjusted rate
ratios of moderate-to-severe asthma exacerbations comparing
patients treated with ICS and LTRA with Poisson regression
models including a dispersion parameter. The mean MPR was
compared between ICS and LTRA users with a t-test. RESULTS:
A total of 27,355 children were included in the cohort: 7,494
(27%) with and 19,861 (73%) without an exacerbation in the
year prior to treatment initiation. Among children with no exac-
erbation before treatment initiation, the risk of exacerbations
was signiﬁcantly more than twice with ICS versus LTRA
(adjusted RR = 2.3; 95% CI; 1.3–4.0), while the RR was not
signiﬁcant among children who had at least 1 exacerbation
before treatment initiation (adjusted RR = 1.6; 95% CI: 0.8–
3.1). The mean MPR was 0.16 for ICS compared to 0.35 for
LTRA, among children with at least 1 exacerbation prior to
treatment initiation (p < 0.001). These means were 0.15 and
0.30, respectively, among children with no previous exacerbation
(p < 0.001). CONCLUSIONS: Among children free of exacerba-
tions prior to treatment initiation, our study showed that ICS
users were more than twice more likely to have an exacerbation
than LTRA users and that higher adherence to LTRA may have
accounted for this result.
PRS3
PREVALENCE OF CHRONIC OBSTRUCTIVE
PULMONARY DISEASE FROM ADMINISTRATIVE
HEATH SERVICES DATABASES
Citarella A, Menditto E, Cammarota S, De Portu S, Riegler S,
Mantovani LG
University of Naples, Federico II, Naples, Italy
OBJECTIVES: To identify subjects affected by Chronic Obstruc-
tive Pulmonary Disease (COPD) in a local health authority of
approximately 441 thousand inhabitants situated in Campania,
a region in the southwest of Italy. METHODS: A retrospective
naturalistic longitudinal study was conducted using record
linkage between administrative health services databases (drug
prescription, hospital admissions, demographic). We enrolled
subjects with greater than or equal to 45 years old who had
during the period 2006/2007 an hospital admission for Chronic
Bronchitis (ICD-9 cod.491) and/or received drugs chronic pre-
scription for obstructive diseases from the R03 Anatomical
A446 Abstracts


PIN54 ADAPTATION & CALIBRATION OF A UK MODEL OF MENINGOCOCCAL DISEASE TO THE US SETTING 

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PIN54 ADAPTATION & CALIBRATION OF A UK MODEL OF MENINGOCOCCAL DISEASE TO THE US SETTING

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