138. Tele-COVID Rounds and Tele-Stewardship Surveillance Reduces Antibiotic Use in COVID-19 Patients Admitted to 17 Small Community Hospitals

Abstract Background Early bacterial co-infection is rare in hospitalized COVID-19 patients, yet antibiotics are commonly prescribed. Antibiotic stewardship (AS) intervention is needed, especially in small community hospitals (SCHs), which often lack access to AS expertise. Methods We implemented daily remote multidisciplinary tele-COVID rounds (synchronous case review between SCH providers and ID clinicians) and tele-stewardship surveillance (ID pharmacist review of COVID patients on antibiotics) on 6/24/2020 in 17 SCHs. We retrospectively included adult symptomatic COVID-19 admissions between 3/2020 and 4/2021. The primary outcome was early use of antibiotics for pneumonia (started within 48 hours of admission); mean monthly days of therapy per 1,000 patient days (DOT) were compared pre- (3/2020-6/2020) and post-intervention (7/2020-4/2021). Secondary outcomes were early use of antibiotics for any indication, estimated days of antibiotics avoided (comparing pre- and post-intervention DOT), and in-hospital mortality. Analyses were conducted using a two-tailed unpaired t-test (antibiotic use) or Fisher’s exact test (mortality). Results Of the 1,976 patients included (124 pre- vs. 1852 post-intervention), 55.4% were male and 85.5% were white. Patients in the pre-intervention group were more likely to require hospital transfer [21.8% vs 8.8% (p< 0.001)] and ICU admission [18.5% vs. 9.7% (p=0.003)]. We observed a significant decrease in mean use of early antibiotics for pneumonia [656.9 vs. 240.1 DOT (p< 0.001)], including among non-ICU patients only [603.6 vs 240.2 DOT (p< 0.001)]. Early antibiotic use for any indication also decreased [686.2 vs. 359.3 DOT (p< 0.001)]. An estimated 3,697 days of unnecessary antibiotics for pneumonia were avoided in the 10-months post-intervention [370 days per month (95% CI 304 – 435)]. Unadjusted in-hospital mortality was not different pre- vs post-intervention (0.8% vs. 2.0%, p=0.511), but was higher among those prescribed early antibiotics (4.4% vs 0.5%, p< 0.001). Conclusion A significant, sustained reduction in antibiotic use among COVID-19 patients at 17 SCHs was observed after implementation of tele-COVID rounds and tele-stewardship surveillance without an observed difference in mortality. Disclosures All Authors: No reported disclosures

Download Full-text

889. Impact of an Infectious Disease Telehealth (IDt) Service on S. aureus Bacteremia (SAB) Outcomes in 15 Small Community Hospitals

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.048 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S22-S22

Author(s):

Alithea D Gabrellas ◽

John J Veillette ◽

Brandon J Webb ◽

Edward A Stenehjem ◽

Nancy A Grisel ◽

...

Keyword(s):

Hospital Mortality ◽

Health Department ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Categorical Variables ◽

Small Community ◽

Community Hospitals ◽

Post Discharge ◽

Exact Test ◽

The Impact

Abstract Background Infectious diseases (ID) consultation improves SAB readmission rates, compliance with care bundles and mortality. Small community hospitals (SCHs) (which comprise 70% of US hospitals) often lack access to on-site ID physicians. IDt is one way to overcome this barrier, but it is unknown if IDt provides similar clinical benefits to traditional ID consultation. Our study aims to evaluate the impact of IDt on patient outcomes at 15 SCHs (bed range: 16–146) within the Intermountain Healthcare system in Utah. Methods Baseline demographics, Charlson Comorbidity Index (CCI), hospital length of stay (LOS), and mortality (in-hospital, 30- and 90-day) were collected using an electronic health record database and health department vital records on all patients with a positive S. aureus blood culture from January 1, 2009 through December 31, 2018. Data from January 2014 through Sep 2016 were excluded to avoid potential influence of a concurrent antimicrobial stewardship study. Starting in October 2016 an IDt program (staffed by an ID physician and pharmacist) provided consultation for SCH providers and patients using electronic consultation and encrypted two-way audiovisual communication.Statistical analyses were performed using Fisher’s exact test or χ 2 test for categorical variables and Mann–Whitney U test for nonparametric continuous data. Results In total, 625 patients with SAB were identified: 127 (20%) received IDt and 498 (80%) did not (non-IDt). The two groups (IDt vs. non-IDt) were similar in median age (66 vs. 62 years; P = 0.76), percent male (62% vs. 58%; P = 0.35), and median baseline CCI (4 vs. 4; P = 0.54). There were no statistically significant differences in median LOS (5 vs. 5 days; P = 0.93) or in-hospital mortality (2% in both groups). The IDt group had a lower 30-day (9% vs. 15%; P = 0.049) and 90-day mortality (13% vs. 21%; P = 0.034). Conclusion IDt consultation was associated with a decrease in 30- and 90-day mortality for SCH SAB cases. Early transfer of critically ill patients might have affected LOS and in-hospital mortality. Post-discharge care factors might also contribute to 30- and 90-day mortality. While more work is needed to identify other factors associated with the effect of IDt on SAB, these data support the use of IDt to increase access to care and improve SAB outcomes in SCHs. Disclosures All Authors: No reported Disclosures.

Download Full-text

143. Modification of Linezolid Restriction Criteria Reduces ICU Gram-positive Antibiotic Consumption

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.453 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S201-S202

Author(s):

John M Boulos ◽

Kathryn DeSear ◽

Bethany Shoulders ◽

Veena Venugopalan ◽

Stacy A Voils ◽

...

Keyword(s):

Hospital Mortality ◽

Intervention Group ◽

Hospital Length Of Stay ◽

Post Intervention ◽

Gram Positive ◽

Stewardship Program ◽

Days Of Therapy ◽

Secondary Outcomes ◽

The Impact ◽

Post Intervention Group

Abstract Background Antibiotic time out (ATO) policies have been proposed by the Centers for Disease Control and Prevention to limit unnecessary use of antibiotics. Critically ill patients are often treated empirically with MRSA-active agents for a prolonged duration. The objective of this study was to assess the impact of an ATO policy by targeting empiric gram-positive coverage. Methods Before this intervention, linezolid required pre-approval by the antimicrobial stewardship program or infectious diseases (ID) consult service before dispensing, and no automatic ATO policy was in place for any agent. In 2018, restriction of linezolid was modified to allow 72 hours of empiric use in the intensive care unit (ICU). This retrospective, single-center, pre- post-intervention study looked at eight ICUs at our institution from two equal periods. Adults (age ≥ 18 years) were included who received an IV gram-positive antibiotic (IVGP-AB), specifically linezolid or vancomycin, used for empiric therapy and were admitted to the ICU. The primary outcome was antimicrobial consumption of IVGP-AB defined as days of therapy (DOT) per patient. Secondary outcomes included in-hospital length of stay (LOS), ICU LOS, in-hospital mortality, 30-day readmission, and incidence of acute kidney injury (AKI). Figure 1. Flowchart of patient inclusion into the study Results 2718 patients met criteria for inclusion in the study. 1091 patients were included in the pre-intervention group and 1627 patients were included in the post-intervention group. Baseline characteristics between the two groups were similar, with ID consults being higher in the pre-intervention group. Total mean DOT of IVGP-AB in pre- and- post-intervention groups was 4.97 days vs. 4.36 days, p< 0.01. Secondary outcomes of in-hospital LOS, ICU LOS, and in-hospital mortality did not vary significantly between groups. Thirty-day readmission was lower in the post-intervention group (12.9% vs. 3.9%, p< 0.01). AKI did not differ significantly between groups, however the need for renal replacement therapy was higher in the pre-intervention group (1.2% vs. 0.2%, p< 0.01). Conclusion This study assessed the impact of an ATO policy allowing 72 hours of empiric linezolid in the ICU. We found a statistically significant reduction in days of therapy of IVGP-AB without increases in LOS, mortality, readmission, and AKI. Disclosures All Authors: No reported disclosures

Download Full-text

1346. Implementation of a Multidisciplinary 48 Hour Antibiotic Timeout in a Pediatric Population

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1528 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S684-S684

Author(s):

Victoria Konold ◽

Palak Bhagat ◽

Jennifer Pisano ◽

Natasha N Pettit ◽

Anish Choksi ◽

...

Keyword(s):

Pediatric Patients ◽

Pediatric Population ◽

Intervention Group ◽

Post Intervention ◽

Days Of Therapy ◽

New Antibiotics ◽

Core Elements ◽

Quasi Experimental ◽

Empirical Antibiotics ◽

The Impact

Abstract Background To meet the core elements required for antimicrobial stewardship programs, our institution implemented a pharmacy-led antibiotic timeout (ATO) process in 2017 and a multidisciplinary ATO process in 2019. An antibiotic timeout is a discussion and review of the need for ongoing empirical antibiotics 2-4 days after initiation. This study sought to evaluate both the multidisciplinary ATO and the pharmacy-led ATO in a pediatric population, compare the impact of each intervention on antibiotic days of therapy (DOT) to a pre-intervention group without an ATO, and to then compare the impact of the pharmacy-led ATO versus multidisciplinary ATO on antibiotic days of therapy (DOT). Methods This was a retrospective, pre-post, quasi-experimental study of pediatric patients comparing antibiotic DOT prior to ATO implementation (pre-ATO), during the pharmacy-led ATO (pharm-ATO), and during the multidisciplinary ATO (multi-ATO). The pre-ATO group was a patient sample from February-September 2016, prior to the initiation of a formal ATO. The pharmacy-led ATO was implemented from February-September 2018. This was followed by a multidisciplinary ATO led by pediatric residents and nurses from February-September 2019. Both the pharm-ATO and the multi-ATO were implemented as an active non-interruptive alert added to the electronic health record patient list. This alert triggered when new antibiotics had been administered to the patient for 48 hours, at which time, the responsible clinician would discuss the antibiotic and document their decision via the alert workspace. Pediatric patients receiving IV or PO antibiotics administered for at least 48 hours were included. The primary outcome was DOT. Secondary outcomes included length of stay (LOS) and mortality. Results 1284 unique antibiotic orders (n= 572 patients) were reviewed in the pre-ATO group, 868 (n= 323 patients) in the pharm-ATO and 949 (n= 305 patients) in the multi-ATO groups. Average DOT was not significantly different pre vs post intervention for either methodology (Table 1). Mortality was similar between groups, but LOS was longer for both intervention groups (Table 1). Impact of an ATO on DOT, Mortality and LOS Conclusion An ATO had no impact on average antibiotic DOT in a pediatric population, regardless of the ATO methodology. Disclosures All Authors: No reported disclosures

Download Full-text

Abstract WP95: Feasibility of 24/7 Neurohospitalist Presence and Impact on Alteplase DTN Times and Mortality

Stroke ◽

10.1161/str.51.suppl_1.wp95 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Alexander T Schneider ◽

Reid Taylor ◽

Robin Jones ◽

Roy Nanz ◽

Edward Jauch

Keyword(s):

Ischemic Stroke ◽

Intervention Group ◽

Statistical Correlation ◽

Time Of Day ◽

Care Model ◽

Community Hospitals ◽

Post Intervention ◽

Anova Model ◽

Median Test ◽

After Hours

Introduction: After hours stroke coverage in community hospitals is typically provided on-call from home or through telehealth. Lack of immediate on-site stroke expertise may delay door-to-needle (DTN) times for IV alteplase. A 750-bed community hospital that had evening emergency stroke coverage by a neurologist on-call from home transitioned to 24/7 neurohospitalist coverage in October 2015. Methods: Data were obtained from patients treated with alteplase in the ED for ischemic stroke. We evaluated the DTN times at baseline and after intervention of the new care model dichotomized by daytime (7a-5p) and evening (5p-7a). Mortality (death in hospital and discharge (DC) to hospice) was assessed. Data were compared for statistical correlation using a Mood’s Median Test and 2-sample t-test. Results: There were 579 cases from January 2015 through July 2019 treated with alteplase in the ED for ischemic stroke. Patients available for study pre- and post-intervention were 84 and 495, respectively (Table 1). Daytime arrival was more common. Significant improvements in door-to-neurohospitalist at bedside and DTN time were observed regardless of time of day, but the greatest difference seen was in evening hours. Using an ANOVA model, EMS arrival was the most significant factor predicting DTN times. Despite fewer patients arriving via EMS in the post-intervention group (90% vs 94% baseline), the DTN times improved post intervention. Mortality was significantly improved after the intervention. Despite a 44% increase in code stroke arrivals to the ED, the feasibility of the care model over ~4 years was maintained by no loss of any neurohospitalists and the addition of 1 more. Conclusion: In-hospital 24/7 model of neurohospitalist coverage is a feasible model for large community hospitals and is associated with significantly faster DTN times and reduced mortality. We will explore other aspects of the care model and other changes occurring during the study period.

Download Full-text

Impact of Order-Set Modifications and Provider Education Following Guideline Updates on Broad-Spectrum Antibiotic Use in Patients Admitted With Community Acquired Pneumonia

Hospital Pharmacy ◽

10.1177/00185787211055797 ◽

2021 ◽

pp. 001857872110557

Author(s):

Jessica L. Colmerauer ◽

Kristin E. Linder ◽

Casey J. Dempsey ◽

Joseph L. Kuti ◽

David P. Nicolau ◽

...

Keyword(s):

Broad Spectrum ◽

Antibiotic Use ◽

Community Acquired Pneumonia ◽

Intervention Period ◽

Provider Education ◽

Broad Spectrum Antibiotic ◽

Post Intervention ◽

Post Intervention Period ◽

Days Of Therapy ◽

Order Set

Purpose: Following updates to the Infectious Diseases Society of America (IDSA) practice guidelines for the Diagnosis and Treatment of Adults with Community-acquired Pneumonia in 2019, Hartford HealthCare implemented changes to the community acquired pneumonia (CAP) order-set in August 2020 to reflect criteria for the prescribing of broad-spectrum antimicrobial therapy. The objective of the study was to evaluate changes in broad-spectrum antibiotic days of therapy (DOT) following these order-set updates with accompanying provider education. Methods: This was a multi-center, quasi-experimental, retrospective study of patients with a diagnosis of CAP from September 1, 2019 to October 31, 2019 (pre-intervention) and September 1, 2020 to October 31, 2020 (post-intervention). Patients were identified using ICD-10 codes (A48.1, J10.00-J18.9) indicating lower respiratory tract infection. Data collected included demographics, labs and vitals, radiographic, microbiological, and antibiotic data. The primary outcome was change in broad-spectrum antibiotic DOT, specifically anti-pseudomonal β-lactams and anti-MRSA antibiotics. Secondary outcomes included guideline-concordance of initial antibiotics, utilization of an order-set to prescribe antibiotics, and length of stay (LOS). Results: A total of 331 and 352 patients were included in the pre- and post-intervention cohorts, respectively. There were no differences in order-set usage (10% vs 11.3%, P = .642) between the pre- and post-intervention cohort, respectively. The overall duration of broad-spectrum therapy was a median of 2 days (IQR 0-8 days) in the pre-intervention period and 0 days (IQR 0-4 days) in the post-intervention period ( P < .001). Patients in whom the order-set was used in the post-intervention period were more likely to have guideline-concordant regimens ([36/40] 90% vs [190/312] 60.9%; P = .003). Hospital LOS was shorter in the post-intervention cohort (4.8 days [2.9-7.2 days] vs 5.3 days [IQR 3.5-8.5 days], P = .002). Conclusion: Implementation of an updated CAP order-set with accompanying provider education was associated with reduced use of broad-spectrum antibiotics. Opportunities to improve compliance and thus further increase guideline-concordant therapy require investigation.

Download Full-text

102. Effects of an Antimicrobial Stewardship-guided MRSA Nasal Screening Review on Vancomycin Utilization for Respiratory Infections: A Quasi-Experimental Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.147 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S65-S65

Author(s):

Ross Pineda ◽

Meganne Kanatani ◽

Jaime Deville

Keyword(s):

Antimicrobial Stewardship ◽

Respiratory Infections ◽

Intervention Group ◽

Small Sample ◽

Post Intervention ◽

Predictive Values ◽

Days Of Therapy ◽

Significant Difference ◽

Quasi Experimental ◽

The Impact

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant pathogen in patients with respiratory infections. Guidelines recommend empiric MRSA coverage in patients at increased risk, resulting in substantial vancomycin use. Recent literature highlights the use of MRSA nasal assays as a rapid screening tool for MRSA pneumonia, demonstrating high negative predictive values and allowing for shorter empiric coverage. We aimed to evaluate the impact of MRSA nasal screening review by the antimicrobial stewardship program (ASP) on vancomycin utilization for respiratory infections. Methods This was a retrospective, quasi-experimental, pre-post intervention study. The intervention saw the addition of an MRSA screening review tool into the ASP electronic record, highlighting patients on vancomycin (actively or recently administered) with a negative MRSA screening. Vancomycin days of therapy (DOT) was collected for all orders indicated for a respiratory infection in the two weeks following a negative screening. Additional outcomes include vancomycin total dose and DOT per 1,000 patient days. Outcomes were compared via independent samples t-tests. Results 1,110 MRSA screenings resulted across 2 months, of which the majority were excluded for either not having vancomycin ordered, or for having vancomycin ordered for a non-respiratory indication, leaving 37 and 35 evaluable screenings in the pre- and post-intervention groups, respectively. Regarding vancomycin DOT, we did not identify a significant difference between pre- and post-intervention groups with respective means of 2.45 (SD=1.52) and 2.14 (SD=1.12) (p=0.35). We identified a total 8.78 vancomycin DOT per 1,000 patient days in the pre-intervention group versus 6.69 in the post-intervention group. Conclusion ASP-guided review of MRSA screenings was associated with a nonsignificant decrease in mean vancomycin DOT and lower total DOT per 1,000 patient days for respiratory infections following a negative screen. Given the recent implementation of our intervention, our analysis covered a small sample size, highlighting the need for continued data collection. MRSA screenings are not always fully or immediately utilized in our institution, demonstrating room to de-escalate MRSA-targeted antibiotics. Disclosures All Authors: No reported disclosures

Download Full-text

82. Post-Prescription Review with Threat of Infectious Disease Consultation and Sustained Reduction in Meropenem Use Over Four Years

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.127 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S58-S58

Author(s):

Nandita S Mani ◽

Kristine F Lan ◽

Rupali Jain ◽

H Nina Kim ◽

John B Lynch ◽

...

Keyword(s):

Infectious Disease ◽

Medical Center ◽

Interrupted Time Series ◽

Antibiotic Use ◽

Percentage Change ◽

Post Intervention ◽

Sustained Reduction ◽

Days Of Therapy ◽

The University ◽

The Impact

Abstract Background Following a meropenem shortage, we implemented a post-prescription review with feedback (PPRF) in November 2015 with mandatory infectious disease (ID) consultation for all meropenem and imipenem courses > 72 hours. Providers were made aware of the policy via an electronic alert at the time of ordering. Methods A retrospective study was conducted at the University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC) to evaluate the impact of the policy on antimicrobial consumption and clinical outcomes pre- and post-intervention during a 6-year period. Antimicrobial use was tracked using days of therapy (DOT) per 1,000 patient-days, and data were analyzed by an interrupted time series. Results There were 4,066 and 2,552 patients in the pre- and post-intervention periods, respectively. Meropenem and imipenem use remained steady until the intervention, when a marked reduction in DOT/1,000 patient-days occurred at both hospitals (UWMC: percentage change -72.1%, (95% CI -76.6, -66.9), P < 0.001; HMC: percentage change -43.6%, (95% CI -59.9, -20.7), P = 0.001). Notably, although the intervention did not address antibiotic use until 72 hours after initiation, there was a significant decline in meropenem and imipenem initiation (“first starts”) in the post-intervention period, with a 64.9% reduction (95% CI 58.7, 70.2; P < 0.001) at UWMC and 44.7% reduction (95% CI 28.1, 57.4; P < 0.001) at HMC. Meropenem and Imipenem DOT (January 2013 – November 2019) Conclusion Mandatory ID consultation and PPRF for meropenem and imipenem beyond 72 hours resulted in a significant and sustained reduction in the use of these antibiotics and notably impacted their up-front usage. Disclosures All Authors: No reported disclosures

Download Full-text

808. Evaluating the Incidence of Bacteriuria in Female Patients Before and After Implementation of External Catheter Devices

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.998 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S447-S447

Author(s):

Mandee Noval ◽

Surbhi Leekha ◽

Meghna Bhatt ◽

Michael Armhazizer ◽

Abigale Celotto ◽

...

Keyword(s):

Urinary Catheter ◽

Clinical Signs ◽

Signs And Symptoms ◽

Antibiotic Use ◽

Urinary Catheters ◽

Post Intervention ◽

Icu Patients ◽

Female Population ◽

Days Of Therapy ◽

Positive Urine

Abstract Background Bacteriuria associated with indwelling urinary catheters is commonly linked to inappropriate antibiotic use in hospitals. The use of external catheter devices (ECD) has increased in recent years to reduce bacteriuria risk in women, based on data in male patients. Currently no studies have shown a similar benefit in the female population. Methods This was a quasi-experimental study among adult female ICU patients with urinary catheters (indwelling or external) between 12/2015 – 5/2017 (pre-ECD) and 12/2017 – 6/2019 (post-ECD). The primary outcome was the incidence of positive urine cultures pre- vs post-intervention. An a priori subgroup patient-level analysis evaluated positive urine cultures and antibiotic use pre- vs post-intervention in medical and surgical ICU patients who had a urinalysis ordered in the presence of an indwelling or external urinary catheter. Antibiotic use was considered appropriate when prescribed in the presence of a positive urine culture, clinical signs and symptoms of UTI, and a UTI order indication. Results There were 4,640 patient ICU encounters during the study period; 2,201 pre- vs 2,439 post-intervention. Mean age was 59.2 (SD 15.4) years, median Elixhauser Score was 6 (IQR 4, 7), and there were no significant differences between groups. In the overall cohort, there was a decrease in the monthly rate of indwelling urinary catheter use pre- versus post- intervention (Figure 1) of 182/1,000 vs 166/1,000 patient days, P = 0.03. There was also a decrease in rate of positive urine cultures from pre- to post- intervention (38/1,000 vs 28/1,000 patient days, P = 0.004). Antibiotic days of therapy (DOTs) for UTI indication was similar in the pre- versus post-intervention groups with 1.9/1000 vs. 1.8 DOT/1,000 patient days (P = 0.7). In the subgroup of 210 patients (73 pre- vs 137 post-intervention) who underwent urinalysis, there was also a decrease in the proportion of positive urine cultures from pre- to post-intervention (42.5% vs. 24.3%; P = 0.007). Of patient receiving antibiotics for UTI indication, appropriateness was numerically higher post-intervention (9.1% vs. 31.6%; P = 0.21). Conclusion The use of external urinary catheters may be beneficial in reducing bacteriuria and related antibiotic use among female ICU patients. Disclosures All Authors: No reported disclosures

Download Full-text

1136. Effect of Weekly Antibiotic Rounds as a Core Strategy of the Antimicrobial Stewardship Program on Antibiotic Utilization in a Terciary-care Neonatal Intensive Care Unit, Medellin, Colombia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1329 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S659-S659

Author(s):

Alejandro Diaz Diaz ◽

Juan Gonzalo Mesa-Monsalve ◽

Adriana M Echavarria-Gil ◽

Carolina Jimenez

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Hospital Mortality ◽

Neonatal Intensive Care ◽

Antibiotic Prescription ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Days Of Therapy ◽

Prescription Costs

Abstract Background Antibiotics are among the most prescribed drugs in the neonatal intensive care unit (NICU), but frequently are used inappropriately exposing preterm neonates to additional harm. Antibiotic stewardship programs (ASP) have demonstrated impact on antibiotic use in the hospital setting, but implementation in neonatal units is challenging. We sought to determine the effects of weekly antibiotic rounds on overall antibiotic consumption in the NICU. Methods Single-center, retrospective observational study. In November 2014, we implemented weekly antibiotic rounds in a 60-bed tertiary-care NICU, led by a pediatric infectious disease physician. Antibiotic therapy decisions were made in collaboration with neonatologists. Data collected included the proportion of patients receiving antibiotics, irrespective of the indication. Multimodal ASP was implemented hospital-wide in 2015. Antibiotic consumption was measured with days of therapy (DOT). Data on costs and in-hospital mortality were obtained from pharmacy and hospital records. Results From November 2014 to December 2020, we evaluated 13609 neonates admitted to the NICU during rounds. Of those, 3607 (27%) were receiving at least one antibiotic. Overall, the proportion of patients with antibiotics decreased from 31% to 19% during the study period (p< 0.001). In 2017, an outbreak of neonatal necrotizing enterocolitis (NEC) occurred. Specific countermeasures as well as reinforcement of ASP were implemented. Despite Antibiotic usage by DOT increased in 2017 driven by empiric treatment with piperacillin tazobactam in patients with NEC, overall antibiotic consumption decreased from 254.4 DOT/1000 patient days (PD) to 162.4 DOT/1000 PD (Figure 1). Annual costs from antibiotic prescriptions were US&23,161 in 2015 and decreased to US&12.046 in 2020 saving over US&3,800/year (fig 2a). During the study period, we did not observe an increase in crude in-hospital mortality rate (Figure 2b). Primary Y axis indicates the proportion of patients with at least one antibiotic prescription during rounds. Secondary Y axis indicates antibiotic consumption by days of therapy metrics. Antibiotic prescription costs and NICU mortality rates during study period A. Annual antibiotic prescription costs; B. NICU mortality rate Conclusion Weekly antibiotic rounds led to a significant decrease in antibiotic utilization in our NICU. This strategy is relatively simple and low-cost, saves hospital resources and has a large impact on antibiotic use. Hence, its implementation is encouraged as part of successful antimicrobial stewardship programs. Disclosures All Authors: No reported disclosures

Download Full-text

1986. Impact of Two-Step Testing on the Diagnosis and Management of Clostridium difficile in a Multi-Hospital Healthcare System

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1666 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S665-S666

Author(s):

Angelina Davis ◽

Todd Parker ◽

Julia Coluccio ◽

Kimberly Mann ◽

Elizabeth Dodds Ashley ◽

...

Keyword(s):

Health System ◽

Community Health ◽

Negative Binomial ◽

Cohort Analysis ◽

Antibiotic Use ◽

Baseline Period ◽

Post Intervention ◽

Care Community ◽

Days Of Therapy ◽

The Impact

Abstract Background Distinguishing active C. difficile infection (CDI) from asymptomatic colonization remains a significant challenge. A multi-step testing algorithm can improve the diagnostic accuracy of CDI and associated antibacterial prescribing. This study evaluated the impact of two-step testing on CDI rates and management in a multi-hospital community health system. Methods Two-step C. difficile testing (PCR for initial screening followed by EIA for toxin detection) was implemented in 6 acute care community hospitals in April 2018. EIA testing was automatically performed on all stool samples with a positive C. difficile PCR result. Prior to implementation, PCR alone was used to identify CDI. Messaging attached to the PCR laboratory report alerted prescribers of discrepant results (PCR +/EIA -). Anti-C. difficile therapy was at the discretion of the prescriber. We performed a retrospective cohort analysis over a 2-year period to evaluate the effect of two-step testing on system-wide hospital-onset CDI (HO-CDI) per 10,000 patient-days (PD) and anti-CDI antimicrobial use (AU) in days of therapy (DOT) per 1,000 PD. Segmented negative binomial regression with hospital clustering was used to estimate predicted HO-CDI rate for the baseline period between April 1, 2017 through March 31, 2018 and the post-intervention between May 1, 2018 through March 31, 2019. The implementation date at all sites in April 2018 was unknown; therefore, this month was removed from the analysis. Anti-CDI agents included fidaxomicin, metronidazole, and oral vancomycin, but may have included non-CDI indications for metronidazole. Results A total of 115 HO-CDI cases were identified; 91 (79%) before and 24 (21%) after. Prior to implementation of two-step testing, CDI rates declined at 4% per month (P = NS). The rate immediately dropped by 36% (P = 0.004) after two-step testing was implemented, but the trend did not significantly change (P = 0.52, Figure 1). Community-onset CDI rates also decreased during this time period. Combined facility-wide anti-CDI agent use was 824.87 before and 838.21 DOT/1,000 PD after and did not significantly change. Conclusion Use of a two-step approach for CDI testing reduced HO-CDI rates, but did not have a significant impact on anti-CDI antibiotic use in a multi-hospital community health system. Disclosures All authors: No reported disclosures.

Download Full-text