181. Antimicrobial Use in the Time of COVID-19 – Data from 84 VA Facilities

Abstract Background The VA initiated an antimicrobial stewardship program in 2011, which includes participation in the Center for Disease Control (CDC) Antimicrobial Use Option, educational webinars, training programs for antimicrobial stewards, required staffing & reporting, and quality improvement initiatives, that has led to ongoing decreases in antimicrobial therapy nationwide. With the onset of the COVID-19 pandemic, however, there are several factors that may contribute increases in antimicrobial use (increased presentations of lower respiratory tract infection, concern for bacterial co-infection with SARS-CoV-2, etc.). We sought to compare patterns of antibacterial use in the VA from January – May 2020 with corresponding time periods in prior years. Methods Data on antibacterial use from 2015 – 2020 were extracted from the VA Corporate Data Warehouse for acute inpatient care units in 84 VA facilities (facilities which provide limited acute inpatient services were excluded). To control for seasonal effects, only data from January to May for each year were included in the analysis. Days of therapy (DOT) per 1000 days-present (DP) were calculated and stratified by CDC-defined antibiotic classes. Results From 2015 – 2019, total antibiotic use from January to May decreased by a mean of 9.1 DOT/1000 DP per year. In contrast, from 2019 to 2020, antibiotic use over the same months increased by 26.4 DOT/1000 DP (Table). Increases were observed in all drug classes except for a decrease in narrow spectrum ß-lactam antibiotics. Total antibiotic DOT in 2020 increased by 27.9 and 7.3 DOT/1000 DP in facilities in the highest and lowest terciles of use in 2019 (Figure). Table – Trends in Yearly Antibiotic Use by CDC Drug Class, 2015 to 2019 versus 2019 to 2020 Figure – Facility Specific Total Antibiotic Use in 2019 and Change in Use from 2019 to 2020 Conclusion We observed a broad increase in antibacterial use during the initial surge of COVID-19 cases in VA facilities that abruptly reversed steady reductions in use over the prior 4 years. The degree to which this increase reflects potentially appropriate use in the setting of increased patient vulnerability and provider uncertainty, inappropriately decreased provider thresholds for initiating or continuing therapy, or stresses on the structure and staffing of antimicrobial stewardship programs requires further study. Disclosures All Authors: No reported disclosures

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Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections

Antibiotics ◽

10.3390/antibiotics10010005 ◽

2020 ◽

Vol 10 (1) ◽

pp. 5

Author(s):

Sílvia Simó ◽

Eneritz Velasco-Arnaiz ◽

María Ríos-Barnés ◽

María Goretti López-Ramos ◽

Manuel Monsonís ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Case Fatality ◽

University Hospital ◽

Antimicrobial Use ◽

Stewardship Program ◽

Days Of Therapy ◽

Length Of Therapy ◽

Intraabdominal Infections

The effectiveness of antimicrobial stewardship programs (ASP) in reducing antimicrobial use (AU) in children has been proved. Many interventions have been described suitable for different institution sizes, priorities, and patients, with surgical wards being one of the areas that may benefit the most. We aimed to describe the results on AU and length of stay (LOS) in a pre-post study during the three years before (2014–2016) and the three years after (2017–2019) implementation of an ASP based on postprescription review with feedback in children and adolescents admitted for appendix-related intraabdominal infections (AR-IAI) in a European Referral Paediatric University Hospital. In the postintervention period, the quality of prescriptions (QP) was also evaluated. Overall, 2021 AR-IAIs admissions were included. Global AU, measured both as days of therapy/100 patient days (DOT/100PD) and length of therapy (LOT), and global LOS remained unchanged in the postintervention period. Phlegmonous appendicitis LOS (p = 0.003) and LOT (p < 0.001) significantly decreased, but not those of other AR-IAI diagnoses. The use of piperacillin–tazobactam decreased by 96% (p = 0.044), with no rebound in the use of other Gram-negative broad-spectrum antimicrobials. A quasisignificant (p = 0.052) increase in QP was observed upon ASP implementation. Readmission and case fatality rates remained stable. ASP interventions were safe, and they reduced LOS and LOT of phlegmonous appendicitis and the use of selected broad-spectrum antimicrobials, while increasing QP in children with AR-IAI.

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Effects of a Remote Antimicrobial Stewardship Program on Antimicrobial Use in a Regional Hospital System

Pharmacy ◽

10.3390/pharmacy8010041 ◽

2020 ◽

Vol 8 (1) ◽

pp. 41 ◽

Cited By ~ 1

Author(s):

Joshua Knight ◽

Jessica Michal ◽

Stephanie Milliken ◽

Jenna Swindler

Keyword(s):

Antimicrobial Stewardship ◽

Antimicrobial Use ◽

Hospital System ◽

Physician Review ◽

Stewardship Program ◽

Time Period ◽

Days Of Therapy ◽

Before And After ◽

Implementation Time ◽

Acceptance Rates

While antimicrobial stewardship programs (ASPs) are well established at most large medical centers, small or rural facilities often do not have the same resources; therefore, different methods must be developed to start or expand ASPs for these hospitals. The purpose of this quality improvement study was to describe the implementation of a pharmacist-led remote ASP and assess the effect on antimicrobial use. Antimicrobial use in days of therapy per 1000 patient days (DOT/1000 PD) was compared between the six months before and after remote ASP implementation. Changes in system-wide, facility-specific, and target antimicrobial use were evaluated. Pharmacist interventions, acceptance rates, and number of times infectious disease (ID) physician assistance was sought were also tracked. System-wide antimicrobial use was 4.6% less in the post-implementation time period than in the pre-implementation time period, with vancomycin, piperacillin/tazobactam, and fluoroquinolones having the greatest reductions in use. Ninety-one percent of interventions made during the post-implementation period were accepted. ID physician review was requested 38 times, and direct ID physician intervention was required six times. Remote ASPs delivered from a central facility to serve a larger system may reduce antimicrobial use, especially against targeted agents, with minimal increase in ID physician workload.

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Profile of Antimicrobial Use in the Pediatric Population of a University Hospital Centre, 2015/16 to 2018/19

The Canadian Journal of Hospital Pharmacy ◽

10.4212/cjhp.v74i1.3037 ◽

2021 ◽

Vol 74 (1) ◽

Author(s):

Lydia R Rahem ◽

Bénédicte Franck ◽

Hélène Roy ◽

Denis Lebel ◽

Philippe Ovetchkine ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Antimicrobial Agents ◽

Pediatric Population ◽

University Hospital ◽

Antimicrobial Use ◽

Defined Daily Dose ◽

Centre Hospitalier ◽

Stewardship Program ◽

Centre Hospitalier Universitaire ◽

Days Of Therapy

Background: Antimicrobial stewardship is a standard practice in health facilities to reduce both the misuse of antimicrobials and the risk of resistance. Objective: To determine the profile of antimicrobial use in the pediatric population of a university hospital centre from 2015/16 to 2018/19. Methods: In this retrospective, descriptive, cross-sectional study, the pharmacy information system was used to determine the number of days of therapy (DOTs) and the defined daily dose (DDD) per 1000 patient-days (PDs) for each antimicrobial and for specified care units in each year of the study period. For each measure, the ratio of 2018/19 to 2015/16 values was also calculated (and expressed as a proportion); where the value of this proportion was ≤ 0.8 or ≥ 1.2 (indicating a substantial change over the study period), an explanatory rating was assigned by consensus. Results: Over the study period, 94 antimicrobial agents were available at the study hospital: 70 antibiotics (including antiparasitics and antituberculosis drugs), 14 antivirals, and 10 antifungals. The total number of DOTs per 1000 PDs declined from 904 in 2015/16 to 867 in 2018/19. The 5 most commonly used antimicrobials over the years, expressed as minimum/maximum DOTs per 1000 PDs, were piperacillin-tazobactam (78/105), trimethoprim-sulfamethoxazole (74/84), ampicillin (51/69), vancomycin (53/68), and cefotaxime (55/58). In the same period, the care units with the most antimicrobial use (expressed as minimum/ maximum DOTs per 1000 PDs) were hematology-oncology (2529/2723), pediatrics (1006/1408), and pediatric intensive care (1328/1717). Conclusions: This study showed generally stable consumption of antimicrobials from 2015/16 to 2018/19 in a Canadian mother-and-child university hospital centre. Although consumption was also stable within drug groups (antibiotics, antivirals, and antifungals), there were important changes over time for some individual drugs. Several factors may explain these variations, including disruptions in supply, changes in practice, and changes in the prevalence of infections. Surveillance of antimicrobial use is an essential component of an antimicrobial stewardship program. RÉSUMÉ Contexte : La gestion des antimicrobiens est une pratique courante dans les centres hospitaliers afin de réduire l’utilisation inappropriée des antimicrobiens et le risque de résistance. Objectif : Décrire l’évolution de l’utilisation des antimicrobiens dans un centre hospitalier universitaire de 2015-16 à 2018-19. Méthodes : Dans cette étude rétrospective, descriptive et transversale, les dossiers pharmacologiques ont servi à déterminer le nombre de jours de traitement (NJT) et la dose définie journalière (DDD) par 1000 jours-présence (JP) pour chaque antimicrobien et pour chaque unité de soins par année de l’étude. Pour chaque mesure, on a également comparé le ratio de 2018-19 à celui de 2015-16, qui est exprimé en proportion; lorsque la valeur de cette proportion était ≤ 0,8 ou ≥ 1,2, ce qui indiquait un changement important durant la période de l’étude, une note explicative a été attribuée par consensus. Résultats : Durant la période à l’étude, 94 antimicrobiens ont été disponibles dans notre centre : 70 antibiotiques (dont les antiparasitaires et les antituberculeux), 14 antiviraux et 10 antifongiques. Le nombre total de NJT par 1000 JP a diminué de 904 en 2015-16 à 867 en 2018-19. Les cinq antimicrobiens utilisés le plus fréquemment et présentés en minimum / maximum de NJT par 1000 JP étaient les suivants : piperacilline-tazobactam (78/105), trimethoprim-sulfamethoxazole (74/84), ampicilline (51/69), vancomycine (53/68) et cefotaxime (55/58). Pendant la même période, les unités de soins qui faisaient la plus grande utilisation d’antimirobiens (exprimée en minimum / maximum de NJT par 1000 JP) étaient hématologie-oncologie (2529/2723), pédiatrie (1006/1408) et soins intensifs pédiatriques (1328/1717). Conclusions : Cette étude démontre une consommation stable d’antimicrobiens entre 2015-16 et 2018-19 dans un centre hospitalier universitaire mère-enfant canadien. Malgré le fait que la consommation entre les groupes d’antimicrobiens (antibiotiques, antiviraux, antifongiques) était stable, on a constaté d’importantes variations concernant certains médicaments individuels. Plusieurs facteurs peuvent expliquer cette variation, notamment des ruptures d’approvisionnement, des changements de pratique et des changements dans la prévalence d’infections. La surveillance de la consommation des antimicrobiens est une partie essentielle de tout programme d’antibiogouvernance.

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101. Impact of an Integrated Tele-Antimicrobial Stewardship Program at a Rural Community Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.303 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S164-S165

Author(s):

Sui Kwong Li ◽

Erin K McCreary ◽

Tina Khadem ◽

Nancy Zimmerman ◽

...

Keyword(s):

Infectious Disease ◽

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Community Hospital ◽

Resistant Bacteria ◽

Antimicrobial Use ◽

Antimicrobial Stewardship Program ◽

Material Support ◽

Stewardship Program ◽

Days Of Therapy

Abstract Background Small hospitals in the US may lack access to infectious diseases (ID) expertise despite similar rates of antimicrobial use and drug-resistant bacteria as larger hospitals. A tele-antimicrobial stewardship program (TASP) is a force multiplier, expanding access to specialty care, training, and guidance on appropriate resource utilization. Data on the impact of TASPs in community or rural inpatient settings is limited. Methods We established a TASP at a 160-bed hospital in Armstrong County, PA (population < 5000) in September 2020. Tele-ID consult services were already being used (Figure 1). A non-local ID pharmacist or ID physician performed prospective audits and provided feedback with 1 local pharmacist on a 30-minute video conference call daily. At TASP implementation, all patients receiving intravenous (IV) fluoroquinolones, metronidazole, and azithromycin were reviewed. Figure 1 shows the additional support following TASP implementation, including addition of ceftriaxone, carbapenems, IV vancomycin, and tocilizumab to daily reviews. A patient monitoring form was developed to track interventions and the local pharmacists were trained in documentation. Table 1 lists other TASP features implemented. Figure 1. TASP Timeline Table 1. TASP Accomplishments Results From 09/01/2020 to 04/30/2021, 304 stewardship opportunities were identified and 77% of interventions were accepted. Recommending a duration of therapy was accepted most frequently (93.5%) and de-escalation of therapy least frequently (69.6%) (Table 2). Recommending an ID consultation or diagnostic testing was always accepted but only comprised 6.2% of all interventions. Daily calls involved an average of 5 patient reviews. Monthly antimicrobial use declined on average from 673 DOT (days of therapy)/1000 PD (patient days) to 638 DOT/1000 PD (Figure 2). Daily calls were cancelled on 31/166 weekdays (18.7%) due to staffing shortages. Table 2. TASP Interventions (9/2020 - 4/2021) Figure 2. Monthly Antimicrobial Use in Days of Therapy (DOT) per 1000 Patient Days (4/2019 - 5/2021) Conclusion Implementation of TASP in a community hospital resulted in a high percentage of accepted stewardship interventions and lower antimicrobial usage. Success is dependent on robust educational efforts, establishing strong relationships with local providers, and involvement of key stakeholders. Lack of dedicated stewardship time for local pharmacists is a very significant barrier. Disclosures Erin K. McCreary, PharmD, BCPS, BCIDP, AbbVie (Consultant)Cidara (Consultant)Entasis (Consultant)Ferring (Consultant)Infectious Disease Connect, Inc (Other Financial or Material Support, Director of Stewardship Innovation)Merck (Consultant)Shionogi (Consultant)Summit (Consultant) Erin K. McCreary, PharmD, BCPS, BCIDP, AbbVie (Individual(s) Involved: Self): Consultant; Cidara (Individual(s) Involved: Self): Consultant; Entasis (Individual(s) Involved: Self): Consultant; Ferring (Individual(s) Involved: Self): Consultant; Infectious Disease Connect, Inc (Individual(s) Involved: Self): Director of Stewardship Innovation, Other Financial or Material Support; Merck (Individual(s) Involved: Self): Consultant; Shionogi (Individual(s) Involved: Self): Consultant; Summit (Individual(s) Involved: Self): Consultant Tina Khadem, PharmD, Infectious Disease Connect, Inc. (Employee) Nancy Zimmerman, RN, BSN, I’d connect (Employee) John Mellors, MD, Abound Bio, Inc. (Shareholder)Accelevir (Consultant)Co-Crystal Pharma, Inc. (Other Financial or Material Support, Share Options)Gilead Sciences, Inc. (Advisor or Review Panel member, Research Grant or Support)Infectious DIseases Connect (Other Financial or Material Support, Share Options)Janssen (Consultant)Merck (Consultant) Rima Abdel-Massih, MD, Infectious Disease Connect (Employee, Director of Clinical Operations) Rima Abdel-Massih, MD, Infectious Disease Connect (Individual(s) Involved: Self): Chief Medical Officer, Other Financial or Material Support, Other Financial or Material Support, Shareholder J Ryan. Bariola, MD, Infectious Disease Connect (Other Financial or Material Support, salary support)

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The outcome of implementing antimicrobial stewardship program for hospitalized children

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20183381 ◽

2018 ◽

Vol 5 (9) ◽

pp. 3737

Author(s):

Ahmed A. El-Nawawy ◽

Reham M. Wagdy ◽

Ahmed Kh. Abou Ahmed ◽

Marwa A. Moustafa

Keyword(s):

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Antimicrobial Use ◽

Hospitalized Children ◽

Antimicrobial Stewardship Program ◽

Stewardship Program ◽

Group I ◽

Significant Difference ◽

Patient’S Outcome ◽

The Impact

Background: An effective approach to improve antimicrobial use for hospitalized patients is an antimicrobial stewardship program (ASP). The present study aimed to implement ASP for inpatient children based on prospective-audit-with-feedback intervention in order to evaluate the impact on patient’s outcome, antimicrobial use, and the hospital cost.Methods: The study was conducted throughout 6 months over 275 children admitted with different infections at Main Children’s hospital in Alexandria included; group I (with ASP) and group II (standard antimicrobials as controls).Results: The study revealed that on patient’s admission, single antibiotic use was higher among the ASP group while double antimicrobial therapy was higher among the non-ASP with significant difference (p=0.001). Less percentage of patients who consumed vancomycin, meropenem amoxicillin-clavulanic and metronidazole was observed among ASP group with a significant difference of the last two drugs when compared to controls (p=<0.001, 0.011, respectively). The study reported the higher percent of improved ASP patient’s after 72 hours of admission with a significant difference to controls (73.2% versus 62.5%, p=0.038). Complications occurred more likely for the non-ASP group (odds ratio 7.374 with 95% CI 1.68-32.33). In general, there was a clear reduction of the patient antibiotic cost/day and overall cost per patient, however, it was not significant among the studied patients.Conclusions: Our local ASP model provided a high quality of care for hospitalized children and effectively reduced the antimicrobial consumption.

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Comparison of Prior Authorization and Prospective Audit with Feedback for Antimicrobial Stewardship

Infection Control and Hospital Epidemiology ◽

10.1086/677624 ◽

2014 ◽

Vol 35 (9) ◽

pp. 1092-1099 ◽

Cited By ~ 39

Author(s):

Jimish M. Mehta ◽

Kevin Haynes ◽

E. Paul Wileyto ◽

Jeffrey S. Gerber ◽

Daniel R. Timko ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Academic Medical Center ◽

Antimicrobial Use ◽

Prior Authorization ◽

Antimicrobial Consumption ◽

Prospective Audit ◽

Gram Negative ◽

Stewardship Program ◽

Days Of Therapy

(See the commentary by Van Schooneveld and Rupp, on pages1100–1102.)ObjectiveAlthough prior authorization and prospective audit with feedback are both effective antimicrobial stewardship program (ASP) strategies, the relative impact of these approaches remains unclear. We compared these core ASP strategies at an academic medical center.DesignQuasi-experimental study.MethodsWe compared antimicrobial use during the 24 months before and after implementation of an ASP strategy change. The ASP used prior authorization alone during the preintervention period, June 2007 through May 2009. In June 2009, many antimicrobials were unrestricted and prospective audit was implemented for cefepime, piperacillin/tazobactam, and vancomycin, marking the start of the postintervention period, July 2009 through June 2011. All adult inpatients who received more than or equal to 1 dose of an antimicrobial were included. The primary end point was antimicrobial consumption in days of therapy per 1,000 patient-days (DOT/1,000-PD). Secondary end points included length of stay (LOS).ResultsIn total, 55,336 patients were included (29,660 preintervention and 25,676 postintervention). During the preintervention period, both total systemic antimicrobial use (−9.75 DOT/1,000-PD per month) and broad-spectrum anti-gram-negative antimicrobial use (−4.00 DOT/1,000-PD) declined. After the introduction of prospective audit with feedback, however, both total antimicrobial use (+9.65 DOT/1,000-PD per month; P < .001) and broad-spectrum anti-gram-negative antimicrobial use (+4.80 DOT/1,000-PD per month; P < .001) increased significantly. Use of cefepime and piperacillin/tazobactam both significantly increased after the intervention (P = .03). Hospital LOS and LOS after first antimicrobial dose also significantly increased after the intervention (P = .016 and .004, respectively).ConclusionsSignificant increases in antimicrobial consumption and LOS were observed after the change in ASP strategy.Infect Control Hosp Epidemiol 2014;35(9):1092-1099

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1134. The Effect of Telehealth Antimicrobial Stewardship Program on Antimicrobial Use in a Pediatric Intensive Care Unit

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1327 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S658-S658

Author(s):

Mohammad Alghounaim ◽

Ahmed Abdelmoniem ◽

Mohamed Elseadawy ◽

Mohammad Surour ◽

Mohamed Basuni ◽

...

Keyword(s):

Intensive Care ◽

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Pediatric Intensive Care ◽

Antimicrobial Use ◽

Antimicrobial Stewardship Program ◽

Research Support ◽

Material Support ◽

Stewardship Program ◽

Days Of Therapy

Abstract Background Inappropriate antimicrobial use is common in pediatric intensive care units (PICU). We aimed to evaluate the effect of telehealth antimicrobial stewardship program (ASP) on the rate of PICU antimicrobial use in a center without a local infectious diseases consultation service. Methods Aretrospective cohort study was performed between October 1st, 2018 and October 31st, 2020 in Farwaniyah Hospital PICU, a 20-bed unit. All pediatric patients who were admitted to PICU and received systemic antimicrobials during the study period were included and followed until hospital discharge. Patients admitted to the PICU prior to the study period but still receiving intensive care during the study period were excluded. Weekly prospective audit and feedback on antimicrobial use was provided starting October 8th, 2019 (post-ASP period) by the ASP team. A pediatric infectious diseases specialist would join ASP rounds remotely. Descriptive analyses and a pre-post intervention comparison of days of therapy (DOT) were used to assess the effectiveness of the ASP intervention Results There were 272 and 152 PICU admissions before and after initiation of ASP, respectively. Bronchiolitis and pneumonia were the most common admission diagnoses, together compromising 60.7% and 61.2% pre- and post-ASP. Requirement for respiratory support was higher post-ASP (76.5% vs 91.5%, p< 0.001). Average monthly antimicrobial use decreased from 92.2 (95% CI 74.5 to 100) to 48.5 DOT/1,000 patient-days (95% CI 24.6 to 72.2, P < 0.05) (figure). A decline in DOT was observed across all antibiotic classes, except for ceftriaxone and clarithromycin. No effect on length of PICU stay, hospital length of stay, or mortality was observed. Most (89.7%) ASP recommendations were followed fully or partially changes in antimicrobial days of therapy (DOT)/1,000 patient-days over time. The dashed line represents the start of the antimicrobial stewardship program (ASP) Conclusion In settings where infectious diseases services are not available, telehealth stewardship can be effectively implemented and associated with a significant reduction of antimicrobial use. Disclosures Jesse Papenburg, MD, AbbVie (Grant/Research Support, Other Financial or Material Support, Personal fees)Medimmune (Grant/Research Support)Sanofi Pasteur (Grant/Research Support)Seegene (Grant/Research Support, Other Financial or Material Support, Personal fees)

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1631. Made to Measure: Development of a Scoring Tool to Customize Antimicrobial Stewardship Goals Across a Large Health System

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.101 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S42-S43

Author(s):

Andrea Y Logan ◽

Julie E Williamson ◽

Steven Jarrett ◽

Lisa E Davidson

Keyword(s):

Best Practices ◽

Antimicrobial Stewardship ◽

Action Plan ◽

Antibiotic Use ◽

Stewardship Program ◽

Days Of Therapy ◽

Minimum Score ◽

Percentile Scores ◽

Scoring Tool ◽

Multi Disciplinary Team

Abstract Background The 2015 National Action Plan for Combating Antimicrobial Resistance called for a 20% decrease in antibiotic use among inpatients. Atrium Health (AH), formerly Carolinas HealthCare System, established reductions in antibiotic use (determined by days of therapy [DOT] per 1,000 patient days [PD]) as a yearly system-wide quality goal since 2016. Hospitals in the AH inpatient network vary by size, scope, and antimicrobial stewardship program (ASP) maturity. Prior to our third year, we recognized the need to develop an objective method for determining antibiotic use reduction goals (AURGs); understanding that as ASPs mature, opportunities for reduction stabilize over time and may eventually plateau with consistent ASP. We sought to develop a tool that would better identify hospitals in need of aggressive AURGs. Methods A scoring tool was developed to assess ASP implementation and metric achievement at individual hospitals to determine AURGs. Tool components were developed from ASP best practices and consensus among a multi-disciplinary team. The tool yields a maximal score of 41.5 points, with higher scores corresponding to more established ASPs who require less aggressive AURGs. An additional 6 points could be earned for tracked intervention data. Figure 1. Scoring Tool Components The tool was applied and a score calculated for each of 27 hospitals. Achieved score placed each hospital into one of 4 AURG ranges: maintain, 1–2.5%, 2.5–5%, and 5–7.5% of DOT/1000 PD. Goals were determined in relation to the median and 75th percentile scores. A minimum score of 39.5, representing full implementation of ASP score components, was required for a maintenance goal. Results Scores ranged from 3 to 34.5 points across facilities (median 27.5; 75th percentile 31). Twelve facilities scored below 27.5 points, 10 hospitals between 27.5 and 31 points, and 5 facilities between 31 and 39.5 points corresponding to 5–7.5%, 2.5–5% and 1–2.5% AURGs, respectively. Figure 2. Facility Scores and AURGs Conclusion Scores and corresponding AURGs were generally well accepted by stakeholders at facilities within the AH network. Next steps include examining the feasibility of achieving AURGs and obtaining feedback from facilities to refine the tool. The tool will also be applied to other healthcare networks to assess external validity. Disclosures All authors: No reported disclosures.

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1018. Using prediction modeling to inform risk-adjustment strategy for hospital antimicrobial use: Can we predict who gets an inpatient antimicrobial?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.882 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S358-S359

Author(s):

Rebekah W Moehring ◽

Matthew Phelan ◽

Eric Lofgren ◽

Alicia Nelson ◽

Melinda M Neuhauser ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Risk Adjustment ◽

Model Performance ◽

Area Under The Curve ◽

Absolute Error ◽

Antimicrobial Use ◽

Antimicrobial Stewardship Program ◽

Stewardship Program ◽

Days Of Therapy ◽

Tier 1

Abstract Background Hospital antimicrobial stewardship program (ASP) assessments based on comparisons of antimicrobial use (AU) among multiple hospitals are difficult to interpret without risk-adjustment for patient case-mix. We aimed to determine whether variables of varying complexity, derived retrospectively from the electronic health record (EHR), were predictive of inpatient antimicrobial exposures. Methods We performed a retrospective study of EHR-derived data from adult and pediatric inpatients within the Duke University Health System from October 2015 to September 2017. We used Random Forests machine learning models on two antimicrobial exposure outcomes at the encounter level: binary (ever/never) exposure and days of therapy (DOT). Antimicrobial groups were defined by the NHSN AU Option 2017 baseline. Analyses were stratified by pediatric/adult, location type (ICU/ward), and antimicrobial group. Candidate variables were categorized into four tiers based on feasibility of measurement from the EHR. Tier 1 (easy) included demographics, season, location, while Tier 4 (hard) included all variables from Tier 1–3 and laboratory results, vital signs, and culture data. Data were split into 80/20 training and testing sets to measure model performance using area under the curve (AUC) for the binary outcomes and absolute error for DOT. Results The analysis dataset included 170,294 encounters and 204 candidate variables from three hospitals. A total of 80,190 (47%) encounters had antimicrobial exposure; 64,998 (38%) had 1–6 DOT, and 15,192 (9%) had 7 or greater DOT. Models strongly predicted the binary outcome, with AUCs ranging from 0.70 to 0.95 depending on the stratum (Figure A, B). The addition of more complex variables increased accuracy (Figure Model Tiers 1–4). Model performance varied based on location and antimicrobial group. Models for infrequently used groups performed better (Figure C, D). Models underestimated DOTs of encounters with extremely long lengths of stay. Conclusion Models utilizing EHR-derived variables strongly predicted antimicrobial exposure. Risk-adjustment strategies incorporating measures of patient mix may provide more informative benchmark comparisons for use in Antimicrobial Stewardship Program assessments. Disclosures All authors: No reported disclosures.

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86. Use of a Novel Clinical Decision Support Tool for Pharmacist-Led Antimicrobial Stewardship in Patients with Normal Procalcitonin

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.131 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S60-S60

Author(s):

Andrew B Watkins ◽

Trevor C Van Schooneveld ◽

Craig Reha ◽

Jayme Anderson ◽

Kelley McGinnis ◽

...

Keyword(s):

Decision Support ◽

Clinical Decision Support ◽

Antimicrobial Stewardship ◽

Clinical Decision ◽

Antibiotic Use ◽

Pharmacist Intervention ◽

Support Tool ◽

Stewardship Program ◽

Days Of Therapy ◽

Tract Infections

Abstract Background Our Antimicrobial Stewardship Program (ASP) instituted review of patients on antibiotics with procalcitonin (PCT) < 0.25 mcg/L in 2012. In 2018, a clinical decision support (CDS) tool was implemented as part of a “daily checklist” for frontline pharmacists to assist in this patient review. We sought to validate the effectiveness of this tool for pharmacist-led PCT-based antibiotic stewardship. Methods A retrospective cohort design was used to assess antibiotic de-escalation after PCT alert in patients on antibiotics for lower respiratory tract infections (LRTI). Secondary outcomes included antibiotic use and length of stay (LOS) in patients with PCT interventions vs those without. Results From 1/2019 to 11/2019, 652 of 976 (66.8%) PCT alerts were addressed by pharmacists. Of these, 331 were in patients with a respiratory-related diagnosis at discharge and 165 alerts were in patients on antibiotics specifically for LRTI over 119 encounters. Pharmacists made or attempted interventions after 34 (20.6%) of these alerts, with narrowing spectrum or converting to oral therapy being the most common interventions. Antibiotics were completely stopped in 4 of these interventions (11.8%). Patients with pharmacist intervention had 125 fewer antibiotic days of therapy (DOT) in the hospital, and changes were made to an additional 56 DOT (narrower therapy, IV to PO, dose optimization) following the alert. Two cases (5.9%) subsequently had therapy escalated within 48 hours. Vancomycin was the most commonly discontinued antibiotic with an 85.3% use reduction in patients with interventions compared to 27.4% discontinuation in patients with no documented intervention (p=0.0156). Alerts eligible for de-escalation but with no pharmacist intervention represented 140 DOT. LOS was similar in patients from both groups (median 6.4 days vs. 7 days, p=0.81). Conclusion Interventions driven by a CDS tool for pharmacist-driven antimicrobial stewardship in patients with normal PCT resulted in fewer DOT and significantly higher rates of vancomycin discontinuation. Additional interventions could have potentially prevented 140 DOT. We feel refinement of this tool can lead to more meaningful CDS, reduce alert fatigue, and likely increase intervention rates. Disclosures All Authors: No reported disclosures

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