229. Hospitalists Antimicrobial Scorecard Improves Antibiotic Prescribing at a Community Teaching Hospital

Abstract Background Measuring antimicrobial consumption data is a foundation of antimicrobial stewardship programs. There is data to support antimicrobial scorecard utilization to improve antibiotic use in the outpatient setting. There is a lack of data on the impact of an antimicrobial scorecard for hospitalists. Our objective was to improve antibiotic prescribing amongst the hospitalist service through the development of an antimicrobial scorecard. Methods Conducted in a 451-bed teaching hospital amongst 22 full time hospitalists. The antimicrobial scorecard for 2019 was distributed in two phases. In October 2019, baseline antibiotic prescribing data (January – September 2019) was distributed. In January 2020, a second scorecard was distributed (October – December 2019) to assess the impact of the scorecard. The scorecard distributed via e-mail to physicians included: Antibiotic days of therapy/1,000 patient care days (corrected for attending census), route of antibiotic prescribing (% intravenous (IV) vs % oral (PO)) and percentage of patients prescribed piperacillin-tazobactam (PT) for greater than 3 days. Hospitalists received their data in rank order amongst their peers. Along with the antimicrobial scorecard, recommendations from the antimicrobial stewardship team were included for hospitalists to improve their antibiotic prescribing for these initiatives. Hospitalists demographics (years of practice and gender) were collected. Descriptive statistics were utilized to analyze pre and post data. Results Sixteen (16) out of 22 (73%) hospitalists improved their antibiotic prescribing from pre- to post-scorecard (χ 2(1)=3.68, p = 0.055). The median antibiotic days of therapy/1,000 patient care days decreased from 661 pre-scorecard to 618 post-scorecard (p = 0.043). The median PT use greater than 3 days also decreased significantly, from 18% pre-scorecard to 11% post-scorecard (p = 0.0025). There was no change in % of IV antibiotic prescribing and no correlation between years of experience or gender to antibiotic prescribing. Conclusion Providing antimicrobial scorecards to our hospitalist service resulted in a significant decrease in antibiotic days of therapy/1,000 patient care days and PT prescribing beyond 3 days. Disclosures All Authors: No reported disclosures

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Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Acute Bronchitis

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.510 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s32-s32

Author(s):

Ebbing Lautenbach ◽

Keith Hamilton ◽

Robert Grundmeier ◽

Melinda Neuhauser ◽

Lauri Hicks ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Predictive Value ◽

Gold Standard ◽

Chart Review ◽

Acute Bronchitis ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Diagnostic Codes ◽

Icd 10 ◽

The Impact

Background: Antibiotic resistance has increased at alarming rates, driven predominantly by antibiotic overuse. Although most antibiotic use occurs in outpatients, antimicrobial stewardship programs have primarily focused on inpatient settings. A major challenge for outpatient stewardship is the lack of accurate and accessible electronic data to target interventions. We sought to develop and validate an electronic algorithm to identify inappropriate antibiotic use for outpatients with acute bronchitis. Methods: This study was conducted within the University of Pennsylvania Health System (UPHS). We used ICD-10 diagnostic codes to identify encounters for acute bronchitis at any outpatient UPHS practice between March 15, 2017, and March 14, 2018. Exclusion criteria included underlying immunocompromising condition, other comorbidity influencing the need for antibiotics (eg, emphysema), or ICD-10 code at the same visit for a concurrent infection (eg, sinusitis). We randomly selected 300 (150 from academic practices and 150 from nonacademic practices) eligible subjects for detailed chart abstraction that assessed patient demographics and practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for assessment of the electronic algorithm. Because antibiotic use is not indicated for this study population, appropriateness was assessed based upon whether an antibiotic was prescribed or not. Results: Of 300 subjects, median age was 61 years (interquartile range, 50–68), 62% were women, 74% were seen in internal medicine (vs family medicine) practices, and 75% were seen by a physician (vs an advanced practice provider). On chart review, 167 (56%) subjects received an antibiotic. Of these subjects, 1 had documented concern for pertussis and 4 had excluding conditions for which there were no ICD-10 codes. One received an antibiotic prescription for a planned dental procedure. Thus, based on chart review, 161 (54%) subjects received antibiotics inappropriately. Using the electronic algorithm based on diagnostic codes, underlying and concurrent conditions, and prescribing data, the number of subjects with inappropriate prescribing was 170 (56%) because 3 subjects had antibiotic prescribing not noted based on chart review. The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were the following: sensitivity, 100% (161 of 161); specificity, 94% (130 of 139); positive predictive value, 95% (161 of 170); and negative predictive value, 100% (130 of 130). Conclusions: For outpatients with acute bronchitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. This algorithm could be used to efficiently assess prescribing among practices and individual clinicians. The impact of interventions based on this algorithm should be tested in future studies.Funding: NoneDisclosures: None

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1119. Implementation of Pediatric Antimicrobial Stewardship Rounds in a Children’s Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.983 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S397-S398

Author(s):

Natalie Tucker ◽

Ezzeldin Saleh ◽

Marcela Rodriguez

Keyword(s):

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Antibiotic Prescribing ◽

Successful Implementation ◽

Custom Made ◽

Days Of Therapy ◽

Before And After ◽

The Individual

Abstract Background Antimicrobial stewardship programs (ASP) are required in all acute care hospitals per The Joint Commission. ASP must adhere to the recommendations laid out by the Centers for Disease Control and Prevention, but how each ASP chooses to implement these recommendations is left to the individual program. In January 2018, we began formal antimicrobial stewardship (AMS) walking rounds, led by infectious diseases trained physician and pharmacist, in our 99-bed pediatric hospital. Methods In January 2018, we started twice-weekly AMS rounds on the pediatric hospitalist service. A custom-made “Antimicrobial Stewardship Patient List” was designed in our electronic medical record (EMR) to generate a list of all patients receiving antibiotics. The ASP team (comprised of an infectious diseases pharmacist and a pediatric infectious diseases physician) reviewed EMR charts to determine antibiotic prescribing appropriateness and design recommended interventions. Any recommendations and teaching points were then discussed with the hospitalist team in person. After piloting the hospitalist service, AMS rounds were extended to include the general surgery patients and finally the intensive care unit. Data on number of charts reviewed, proposed interventions, and acceptance rates were collected throughout the process. Descriptive statistics were used to assess the intervention data. Results In the first year of the program, 427 patient charts were reviewed with 186 identified interventions. In total, 156 (84.3%) of the interventions were accepted and implemented by the primary team. The most common types of interventions were the duration of therapy (29%), antibiotic discontinuation (16.7%), intravenous to oral conversion (11.3%), de-escalation (10.2%), and infectious diseases consult (5.9%). Conclusion Pediatric AMS rounds led to the successful implementation of the majority of recommended interventions. Future goals of the program include calculating days of therapy per 1000 patient-days to assess antibiotic consumption before and after AMS rounds and to expand into other services to further promote appropriate antibiotic use in hospitalized pediatric patients. Disclosures All authors: No reported disclosures.

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2075. Transforming Outpatient Antimicrobial Stewardship Through a Clinical Surveillance System

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1755 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S699-S700

Author(s):

David B Portman ◽

Victoria M Pattison

Keyword(s):

Antimicrobial Stewardship ◽

Surveillance System ◽

Chart Review ◽

Performance Metrics ◽

Outpatient Setting ◽

Direct Approach ◽

Antibiotic Prescribing ◽

Clinical Surveillance ◽

The Impact

Abstract Background Multiple studies have highlighted the predominance of inappropriate antibiotic prescribing in the outpatient setting, thus making an area ripe for antimicrobial stewardship interventions. One way to identify intervention opportunities and monitor performance metrics is through utilization of a clinical surveillance system (CSS). Methods In October 2017, TheraDoc (DSS Inc.) was obtained which serves as a CSS. Upon installation, the antimicrobial stewardship committee designed the alerts found in Figure 1 that would be utilized to identify potential interventions. Alerts that were deemed to be of high value or time sensitive were to be emailed to pharmacists involved with antimicrobial stewardship. It was theorized that this method would help transform outpatient antimicrobial stewardship from a predominately retrospective approach, to a prospective approach. Outpatient stewardship metrics were compared for pre- and post-CSS implementation to evaluate the impact of a CSS. The pre-implementation group (PreCSS) represented outpatient stewardship interventions that occurred January 2017 through June 2017 where all antibiotic prescriptions were reviewed. The post-implementation group (PostCSS) represented outpatient stewardship interventions that occurred April 2018 through September 2018 which were predominantly driven by CSS alerts. Results The PostCSS group had substantially fewer charts reviewed compared with the PreCSS group (267 vs. 1,415). In addition, the PostCSS group completed 77.6% more interventions compared with the PreCSS group (87 vs. 49). Thirty-one less charts were reviewed per one intervention, which led to 469 less minutes of chart review per one intervention. See Figure 2 for list of interventions. The PostCSS group received a significant increase in consults due to the direct approach to interventions compared with the PreCSS group (45 vs. 11). Conclusion The use of a clinical surveillance system has demonstrated an efficient way to transition outpatient antimicrobial stewardship to a prospective, interventional approach. Disclosures All authors: No reported disclosures.

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Defining the Scope of Antimicrobial Stewardship Interventions on the Prescription Quality of Antibiotics for Surgical Intra-Abdominal Infections

Antibiotics ◽

10.3390/antibiotics10010073 ◽

2021 ◽

Vol 10 (1) ◽

pp. 73

Author(s):

Güzin Surat ◽

Ulrich Vogel ◽

Armin Wiegering ◽

Christoph-Thomas Germer ◽

Johan Friso Lock

Keyword(s):

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Baseline Period ◽

Tertiary Hospital ◽

Significant Decline ◽

Wound Complications ◽

Postoperative Therapy ◽

Days Of Therapy ◽

Abdominal Infections ◽

The Impact

Background: The aim of this study was to assess the impact of antimicrobial stewardship interventions on surgical antibiotic prescription behavior in the management of non-elective surgical intra-abdominal infections, focusing on postoperative antibiotic use, including the appropriateness of indications. Methods: A single-center quality improvement study with retrospective evaluation of the impact of antimicrobial stewardship measures on optimizing antibacterial use in intra-abdominal infections requiring emergency surgery was performed. The study was conducted in a tertiary hospital in Germany from January 1, 2016, to January 30, 2020, three years after putting a set of antimicrobial stewardship standards into effect. Results: 767 patients were analyzed (n = 495 in 2016 and 2017, the baseline period; n = 272 in 2018, the antimicrobial stewardship period). The total days of therapy per 100 patient days declined from 47.0 to 42.2 days (p = 0.035). The rate of patients receiving postoperative therapy decreased from 56.8% to 45.2% (p = 0.002), comparing both periods. There was a significant decline in the rate of inappropriate indications (17.4% to 8.1 %, p = 0.015) as well as a significant change from broad-spectrum to narrow-spectrum antibiotic use (28.8% to 6.5%, p ≤ 0.001) for postoperative therapy. The significant decline in antibiotic use did not affect either clinical outcomes or the rate of postoperative wound complications. Conclusions: Postoperative antibiotic use for intra-abdominal infections could be significantly reduced by antimicrobial stewardship interventions. The identification of inappropriate indications remains a key target for antimicrobial stewardship programs.

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106. Impact and Evaluation of BioFire® FilmArray® Respiratory Panel on Clinical Decision Making and Antibiotic Prescribing

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.151 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S67-S68

Author(s):

Jenna J Manatrey-Lancaster ◽

Amanda Bushman ◽

Meagan Caliguri ◽

Rossana Rosa Espinoza

Keyword(s):

Decision Making ◽

Influenza Virus ◽

Clinical Decision Making ◽

Clinical Decision ◽

Antibiotic Use ◽

Influenza Viruses ◽

Antibiotic Prescribing ◽

Adjusted Analysis ◽

Days Of Therapy ◽

The Impact

Abstract Background The BioFire® FilmArray® respiratory panel (RFA) has been proposed as a tool for timely diagnosis and treatment of respiratory tract infections. However, the impact of the RFA on clinical decision making, most notably antibiotic prescribing, de-escalation and duration has been varied. Methods We aimed to determine the impact of RFA results on antibiotic days of therapy (DOT) depending on patient disposition. We conducted a retrospective chart review of adults who had an RFA performed within 48 hours of admission or presentation to the emergency departments (ED) of 3 hospitals in Des Moines, Iowa, between March 3 and March 16, 2019. Patients were excluded if they had a non-respiratory infection with defined indication for antibiotics. RFA results were categorized as influenza, non-influenza virus or negative. Negative binomial regression models were used to calculate rate ratios (RR) for the association between RFA result and DOT. Results A total of 486 total patients were included. Patients were divided according to disposition status, with 243 patients admitted and 243 discharged from the ED. Among inpatients, the median DOT was 2 (IQR 0–7). The results of the adjusted analysis for inpatient are shown on Table 1. In this group, RFA result was not associated with DOT (p=0.598 for non-influenza viruses and 0.706 for negative RFA), while having a urine culture done was independently associated with higher rate ratio of DOT (RR 1.85, 95% CI 1.32–2.59; p< 0.001). Among patients discharged from the ED, the median DOT was 0 (0–8). The results of the adjusted analysis for this group are shown on Table 2. Compared to patients with influenza, those with non-influenza viruses had a RR for DOT of 4.18 (95% CI 1.16–14.9; p=0.028) and those with a negative RFA had an RR for DOT of 5.24 (95% CI 1.99–13.8; p= 0.028). Adjusted analysis for the association between Respiratory Film Array results and Days of Therapy among hospitalized patients Adjusted analysis for the association between Respiratory Film Array Results and Days of Therapy among patients discharged from the ED Conclusion Among inpatients, RFA results did not impact DOT, and in this group, antibiotic use was driven by urine cultures. In contrast, among patients discharged from the ED, a non-influenza virus or a negative RFA was associated with much higher rates of DOT. Our results suggest that different strategies need deployment in the ED compared to inpatient services in order to guide utilization of rapid molecular tests and antibiotic use. Disclosures All Authors: No reported disclosures

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Evaluating a Pharmacy-Driven 72-Hour Antibiotic Monitoring Program Implemented in a Community Hospital

Hospital Pharmacy ◽

10.1177/0018578719867661 ◽

2019 ◽

pp. 001857871986766

Author(s):

Vishal Patel ◽

Shaina Doyen

Keyword(s):

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Community Hospital ◽

Monitoring Program ◽

Antibiotic Use ◽

Audit And Feedback ◽

Broad Spectrum Antibiotic ◽

Days Of Therapy ◽

The Impact

Background: Antimicrobial stewardship programs commonly utilize infectious diseases pharmacists to guide appropriate utilization of broad-spectrum antimicrobials. Strategies should be developed to increase staff pharmacist’s participation in decreasing broad-spectrum antibiotic use. Objective: The purpose of this study was to determine the effectiveness of a pharmacy-driven 72-hour antimicrobial stewardship initiative. Methods: A pharmacy-driven 72-hour antibiotic review policy was implemented at a community hospital. Targeted antibiotics included ertapenem, meropenem, and daptomycin. The hospital’s infectious diseases pharmacist provided policy education to staff pharmacists. All pharmacists provided prospective audit and feedback to physicians. Preimplementation and postimplementation data were collected through a retrospective chart review to analyze the impact of the initiative. Results: There were a total of 570 targeted antibiotic orders for review, of which 155 antibiotic orders met criteria for inclusion; 97 in the preimplementation group and 58 in the postimplementation group. Targeted antibiotic orders decreased postimplementation during the study period. Days of therapy per 1000 patient days decreased between the 2 groups, although this was statistically significant neither for the pooled targeted antibiotics nor for each individual antibiotic. There was a statistically significant increase in the number of appropriately prescribed targeted antibiotics from preimplementation compared to postimplementation (from 35% to 64%, P < .01). Pharmacist interventions documented for patients receiving the targeted antibiotics increased significantly during the intervention period ( P < .01). In addition, there was a total of $28 795.96 in cost avoidance based on the difference in antibiotic use between the 2 groups. Conclusion: Implementation of a pharmacy-driven 72-hour broad-spectrum antibiotic review in a large community-based hospital resulted in a reduction in utilization and hospital spending and a significant increase in appropriate use of targeted antibiotics, while also increasing pharmacist engagement with antimicrobial stewardship.

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1075. The Impact of Physician Peer Comparison of a Novel Inpatient Antimicrobial Stewardship Metric: the Start-Stop Ratio (SSR)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.939 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S381-S381

Author(s):

Stacy Volk ◽

Michelle Fagenstrom

Keyword(s):

Antimicrobial Stewardship ◽

High Ratio ◽

Antibiotic Prescribing ◽

Post Intervention ◽

Entire Study ◽

Diagnostic Uncertainty ◽

Open Disclosure ◽

Days Of Therapy ◽

Significant Difference ◽

The Impact

Abstract Background The 48-hour “Antibiotic Timeout” (ATO), one of the CDC’s interventions defined in the Core Elements of Antimicrobial Stewardship Programs (ASP), has not reliably proven to impact inpatient antibiotic use. Given the reported history of utilizing peer-comparison data to change prescribing behavior, it was hypothesized that open disclosure of individual inpatient antibiotic start-stop ratios (SSR) would be an effective tool to increase prescribers’ tendency to (1) observe patients off antibiotics upon admission while pursuing treatments perceived more likely to provide syndromic resolution and (2) discontinue antibiotics in the setting of diagnostic uncertainty at 48 hours, or possibly even earlier, without introducing harm. Methods In a community, nonteaching hospital, all adult systemic antibiotic orders initiated by an inpatient hospitalist with at least one administration during the baseline period of January - March of 2018 were retrieved. A prescriber-specific count of all antibiotic orders (“starts”) and discontinuations (“stops”) was collected. Each provider received a document with their baseline SSR compared with the group SSR and was assigned a visual cue that corresponded to the quartile in which they performed at baseline. The same antibiotic data were then collected and evaluated for the post-intervention period of February–April 2019 to determine whether open disclosure of inpatient SSRs impacted antibiotic prescribing. Results Of 19 providers that were included in both study periods, there was no significant difference in the pre- and post-intervention SSR (1.93 to 2.09, P = 0.19). However, in the pre-intervention high-ratio target group (n = 10) for whom we felt open SSR reporting would impact the most, the SSR decreased from 2.41 to 2.26 (P = 0.24). In the entire study population, 68% of providers had a reduction or no change in their SSR. Overall facility-wide antibiotic utilization decreased from 561 to 478 days of therapy per 1,000 days present (P < 0.05). Conclusion Open reporting of antibiotic SSRs to an inpatient provider group may be utilized as an ASP tool to reduce overall inpatient antibiotic consumption, especially by providers that are found to be high-ratio prescribers at baseline. Disclosures All authors: No reported disclosures.

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Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-019-0659-3 ◽

2020 ◽

Vol 9 (1) ◽

Cited By ~ 11

Author(s):

D. Donà ◽

E. Barbieri ◽

M. Daverio ◽

R. Lundin ◽

C. Giaquinto ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Healthcare Costs ◽

Cost Savings ◽

Carbapenem Resistance ◽

Antibiotic Use ◽

Outpatient Setting ◽

Cochrane Library ◽

Extended Spectrum Beta Lactamase ◽

Days Of Therapy ◽

The Usa

Abstract Background Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0–18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.

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Description of the methods for describing and assessing the appropriateness of antibiotic prescribing and adherence to published treatment guidelines in an academic medical clinic

INNOVATIONS in pharmacy ◽

10.24926/iip.v7i1.412 ◽

2016 ◽

Vol 7 (1) ◽

Cited By ~ 4

Author(s):

Michael E Klepser ◽

Ashley Altom ◽

Colleen MacCallum ◽

Eric Nordquist ◽

Donald G Klepser

Keyword(s):

Treatment Guidelines ◽

Antibiotic Use ◽

Electronic Medical Record System ◽

Outpatient Setting ◽

Therapeutic Regimen ◽

Original Research ◽

Antibiotic Prescribing ◽

Dose Frequency ◽

Record System ◽

The Impact

Overuse and inappropriate use of antibiotics have been associated with increased rates of antimicrobial resistance and increased healthcare expenditures. Tracking inpatient antimicrobial use has helped quantify the value of stewardship programs aimed at improving the rational use of antibiotics among hospitalized patients. Unfortunately, similar methods for tracking and assessing antibiotic use in the outpatient setting have not been well described. We developed a novel method to capture trends and assess appropriateness of antibiotic usage. This strategy is based on identification of antimicrobial prescriptions in an electronic medical record system, linking prescribing to patient data, and capturing information regarding dosing and indications for use. Using information on dose, frequency, and duration of the antibiotic prescribed, a parameter to quantify antibiotic exposure (Prescribed Therapeutic Regimen, PTR) is calculated. This parameter is compared to a database of information on agents recommended in published guidelines (Recommended Therapeutic Regimen, RTR). By linking an ICD-9 code and the prescribed antibiotic we determine the appropriateness of the PTR by comparing it to the RTR for a given indication. Data are used to establish a baseline pattern of antibiotic use in the clinic to gauge the impact of future stewardship activities. Additionally, individual clinics and prescribers are given a snapshot of their antibiotic use compared to other clinics and prescribers. This is a novel means of describing antibiotic use in the outpatient setting that could serve as a standardized model for various adult and pediatric outpatient practices. Type: Original Research

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114. Optimization of Inpatient Antibiotic Use via an Electronic Antimicrobial Stewardship Module and an Infectious Diseases Pharmacy Resident

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.316 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S171-S171

Author(s):

Victor Chen ◽

Lauren Allen ◽

Hongkai Bao ◽

Kelsie Cowman ◽

Priya Nori ◽

...

Keyword(s):

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Cost Reduction ◽

Medical Center ◽

Antibiotic Use ◽

Health Crisis ◽

Days Of Therapy ◽

The Impact ◽

Research Grant

Abstract Background Antibiotic resistance is a public health crisis and antimicrobial stewardship (AMS) pharmacists serve a crucial role in preventing inappropriate use. At Montefiore Medical Center (1,500-bed hospital), a new electronic medical record AMS module was implemented with assistance from an infectious diseases (ID) pharmacy resident in October 2020. The module utilizes a dynamic scoring system to assist in prioritizing interventions, including bug-drug mismatches, insufficient coverage, or de-escalation. The AMS module is operationalized by ID pharmacists during the week and an ID pharmacy resident every other weekend. The objective of this study was to assess the impact of an ID pharmacy resident performing AMS module interventions on broad spectrum antibiotic use. Methods An observational study of AMS module interventions on antibiotic use (AU) in days of therapy per 1,000 days present and standardized antimicrobial administration ratio (SAAR) was performed. AU data for piperacillin-tazobactam (P/T) and SAAR prior to (October 2019– December 2019) and after (October 2020 – December 2020) the integration of an ID pharmacy resident and the AMS module was compared. Additional data collected included total number and type of interventions. Results A total of 539 interventions were made by AMS pharmacists and 36.5% of these were completed by the ID pharmacy resident. Across 6 different units, there was a statistically significant decrease in the SAAR for broad spectrum antibacterial agents (Figure 1), and a decrease of at least 10% in P/T use during the two different time periods (Table 1). An estimated P/T cost reduction of 26% of (&48,708 to &36,235.80) was observed. AMS pharmacists made 63 interventions in respective units. The top three intervention types were dose/frequency/duration recommendations, pharmacokinetic vancomycin dosing/monitoring, and de-escalation. The acceptance rate of interventions was 99% (534 accepted interventions/539 total interventions). Figure 1. SAAR Comparison of Broad-Spectrum Agents Table 1. AU Rate of Piperacillin-tazobactam Conclusion Overall, there was a statistically significant impact on SAARs and a >10% change in P/T AU rate with an estimated cost reduction >25% on select units after implementation of the AMS module with an ID pharmacy resident. Disclosures Kelsie Cowman, MPH, Merck (Research Grant or Support) Priya Nori, MD, Merck (Grant/Research Support) Priya Nori, MD, Nothing to disclose Yi Guo, PharmD, BCIDP, Merck (Research Grant or Support)

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