119. Performance of Infectious Diseases Specialists, Hospitalists, and Generalists in Case-Based Scenarios Illustrating Antimicrobial Stewardship Principles at 16 VA Medical Centers

Abstract Background As part of a project to implement and evaluate antimicrobial dashboards at selected VA facilities nationwide, we assessed provider attitudes and knowledge related to antibiotic prescribing among physicians working in inpatient settings at 16 VA facilities. Methods The online survey explored attitudes toward antimicrobial use and assessed respondents’ management of four clinical scenarios: cellulitis, community-acquired pneumonia (CAP), non-catheter-associated asymptomatic bacteriuria (NC-ASB), and catheter-associated asymptomatic bacteriuria (C-ASB). Responses were scored by assigning +1 for an answer most consistent with guidelines, 0 for a less-guideline-concordant but acceptable answer and -1 for an incorrect answer. Scores were normalized to 100% correct to 100% incorrect across all questions within a scenario, and mean scores were calculated across respondents by specialty; differences in mean score per scenario were tested using ANOVA. Results One-hundred-thirty-nine physicians completed the survey (n=19 ID physicians, 62 hospitalists, 58 generalists). Attitudes were similar across the three specialties. There was a significant difference in cellulitis scenario scores (correct responses: ID=67.4%, hospitalists=51.2%, generalists=41.8% correct, p=0.0087). Scores were not significantly different across specialties for CAP (correct responses: ID 76.2%, hospitalists 63%, generalists 56.5%, p=0.0914) and NC-ASB (correct responses; ID 63%, hospitalists 55%, generalists 36.2%, p=0.322), though ID trended higher. Lowest scores were observed for C-ASB (ID 39.5% correct, hospitalists 4% incorrect, generalists 8.5% incorrect, p=0.12). Conclusion Significant differences in performance on management of cellulitis and low overall scores on C-ASB management point to these conditions as being potentially high-yield targets for antimicrobial stewardship interventions. Disclosures Matthew B. Goetz, MD, Nothing to disclose Peter A. Glassman, MBBS, US Pharmacopeia (formerly), PAG; Kaiser Permanente (current employee, spouse) (Advisor or Review Panel member, The above refers to USP (ended in 2020).)

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Influenza With an Infiltrate: Investigating the New Community-Acquired Pneumonia Guidelines

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.884 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s302-s302

Author(s):

Amanda Barner ◽

Lou Ann Bruno-Murtha

Keyword(s):

Demographic Data ◽

Retrospective Chart Review ◽

Vaccination Rate ◽

Community Acquired Pneumonia ◽

Teaching Hospitals ◽

Antibiotic Prescribing ◽

Supporting Evidence ◽

Radiographic Findings ◽

Significant Difference ◽

The Impact

Background: The Infectious Diseases Society of America released updated community-acquired pneumonia (CAP) guidelines in October 2019. One of the recommendations, with a low quality of supporting evidence, is the standard administration of antibiotics in adult patients with influenza and radiographic evidence of pneumonia. Procalcitonin (PCT) is not endorsed as a strategy to withhold antibiotic therapy, but it could be used to de-escalate appropriate patients after 48–72 hours. Radiographic findings are not indicative of the etiology of pneumonia. Prescribing antibiotics for all influenza-positive patients with an infiltrate has significant implications for stewardship. Therefore, we reviewed hospitalized, influenza-positive patients at our institution during the 2018–2019 season, and we sought to assess the impact of an abnormal chest x-ray (CXR) and PCT on antibiotic prescribing and outcomes. Methods: We conducted a retrospective chart review of all influenza-positive admissions at 2 urban, community-based, teaching hospitals. Demographic data, vaccination status, PCT levels, CXR findings, and treatment regimens were reviewed. The primary outcome was the difference in receipt of antibiotics between patients with a negative (<0.25 ng/mL) and positive PCT. Secondary outcomes included the impact of CXR result on antibiotic prescribing, duration, 30-day readmission, and 90-day mortality. Results: We reviewed the medical records of 117 patients; 43 (36.7%) received antibiotics. The vaccination rate was 36.7%. Also, 11% of patients required intensive care unit (ICU) admission and 84% received antibiotics. Moreover, 109 patients had a CXR: 61 (55.9%) were negative, 29 (26.6%) indeterminate, and 19 (17.4%) positive per radiologist interpretation. Patients with a positive PCT (OR, 12.7; 95% CI, 3.43–60.98; P < .0007) and an abnormal CXR (OR, 7.4; 95% CI, 2.9–20.1; P = .000003) were more likely to receive antibiotics. There was no significant difference in 30-day readmission (11.6% vs 13.5%; OR, 0.89; 95% CI, 0.21–3.08; P = 1) and 90-day mortality (11.6% vs 5.4%; OR, 2.37; 95% CI, 0.48–12.75; P = .28) between those that received antibiotics and those that did not, respectively. Furthermore, 30 patients (62.5%) with an abnormal CXR received antibiotics and 21 (43.7%) had negative PCT. There was no difference in 30-day readmission or 90-day mortality between those that did and did not receive antibiotics. Conclusions: Utilization of PCT allowed selective prescribing of antibiotics without impacting readmission or mortality. Antibiotics should be initiated for critically ill patients and based on clinical judgement, rather than for all influenza-positive patients with CXR abnormalities.Funding: NoneDisclosures: None

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66. Impact of a Pharmacist-Driven Azithromycin De-escalation Protocol for Community-Acquired Pneumonia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.111 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S52-S52

Author(s):

Pegah Shakeraneh ◽

Jeffrey Steele ◽

Robert Seabury ◽

Stephen J Thomas ◽

Kristopher M Paolino ◽

...

Keyword(s):

Legionella Pneumophila ◽

Panel Member ◽

Community Acquired Pneumonia ◽

Hospital Length Of Stay ◽

Post Intervention ◽

Review Panel ◽

Icu Patients ◽

Significant Difference ◽

Atypical Bacteria ◽

Research Grant

Abstract Background Ceftriaxone and azithromycin are common empiric antibiotics for community-acquired pneumonia (CAP). Despite low suspicion for atypical infection, azithromycin is often continued for a full course. Negative laboratory data for atypical bacteria may assist with azithromycin de-escalation. Thus, a pharmacist-driven azithromycin de-escalation protocol was implemented for immunocompetent, non-intensive care unit (ICU) patients treated for CAP. The primary outcome was to compare azithromycin duration before and after protocol implementation. Secondary outcomes included hospital length of stay (LOS) and all-cause 30-day readmission. Methods This was a single-center, quasi-experimental study of hospitalized, non-ICU patients treated with azithromycin and a beta-lactam for CAP. The pre- and post-intervention cohorts were from 07/01/2018–04/30/2019 and 07/01/2019–04/30/2020, respectively. Patients were included if they were ≥18 years old, diagnosed with CAP, and had a negative Legionella pneumophila urinary antigen and negative nasopharyngeal swab PCR for Mycoplasma pneumoniae and Chlamydia pneumoniae. Patients were excluded if they were immunocompromised, admitted to an ICU, prescribed azithromycin for an alternative indication, or had evidence of atypical bacteria. Results After exclusion criteria were applied, 90 and 100 patients were included in the pre- and post-intervention cohorts, respectively. Demographic and clinical characteristics were mostly similar between cohorts. This initiative was associated with a statistically significant decrease in azithromycin duration (2 days (IQR 1–2.75) vs. 5 days (IQR 3–6), p < 0.001) and hospital LOS (3 days (IQR 2–5) vs. 5 days (IQR 3–8.25), p < 0.001). No statistically significant difference was observed for all-cause 30-day readmission (14 days (15.6%) vs 13 days (13.0%), p=0.614). Conclusion Implementation of a pharmacist-driven azithromycin de-escalation protocol for CAP was associated with reduced azithromycin duration and hospital LOS, but not all-cause 30-day readmission. Disclosures Jeffrey Steele, PharMD, Paratek Pharmaceuticals (Advisor or Review Panel member) Wesley D. Kufel, PharmD, Melinta (Research Grant or Support)Merck (Research Grant or Support)Theratechnologies, Inc. (Advisor or Review Panel member)

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A recipe for antimicrobial stewardship success: Using intervention mapping to develop a program to reduce antibiotic overuse in long-term care

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.281 ◽

2018 ◽

Vol 40 (1) ◽

pp. 24-31 ◽

Cited By ~ 9

Author(s):

Andrea Chambers ◽

Sam MacFarlane ◽

Rosemary Zvonar ◽

Gerald Evans ◽

Julia E. Moore ◽

...

Keyword(s):

Behavior Change ◽

Antimicrobial Stewardship ◽

Long Term Care ◽

Asymptomatic Bacteriuria ◽

Barriers And Facilitators ◽

Antibiotic Prescribing ◽

Term Care ◽

Antibiotic Overuse ◽

Tract Infections

AbstractObjectiveTo better understand barriers and facilitators that contribute to antibiotic overuse in long-term care and to use this information to inform an evidence and theory-informed program.MethodsInformation on barriers and facilitators associated with the assessment and management of urinary tract infections were identified from a mixed-methods survey and from focus groups with stakeholders working in long-term care. Each barrier or facilitator was mapped to corresponding determinants of behavior change, as described by the theoretical domains framework (TDF). The Rx for Change database was used to identify strategies to address the key determinants of behavior change.ResultsIn total, 19 distinct barriers and facilitators were mapped to 8 domains from the TDF: knowledge, skills, environmental context and resources, professional role or identity, beliefs about consequences, social influences, emotions, and reinforcements. The assessment of barriers and facilitators informed the need for a multifaceted approach with the inclusion of strategies (1) to establish buy-in for the changes; (2) to align organizational policies and procedures; (3) to provide education and ongoing coaching support to staff; (4) to provide information and education to residents and families; (5) to establish process surveillance with feedback to staff; and (6) to deliver reminders.ConclusionsThe use of a stepped approach was valuable to ensure that locally relevant barriers and facilitators to practice change were addressed in the development of a regional program to help long-term care facilities minimize antibiotic prescribing for asymptomatic bacteriuria. This stepped approach provides considerable opportunity to advance the design and impact of antimicrobial stewardship programs.

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Clinical Diagnoses and Antimicrobials Predictive of Pediatric Antimicrobial Stewardship Recommendations: A Program Evaluation

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.45 ◽

2015 ◽

Vol 36 (6) ◽

pp. 673-680 ◽

Cited By ~ 13

Author(s):

Jennifer L. Goldman ◽

Brian R. Lee ◽

Adam L. Hersh ◽

Diana Yu ◽

Leslie M. Stach ◽

...

Keyword(s):

Program Evaluation ◽

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Multinomial Distribution ◽

Community Acquired Pneumonia ◽

Distribution Model ◽

High Yield ◽

Disease Category ◽

Predictive Probability ◽

Clinical Diagnoses

BACKGROUNDThe number of pediatric antimicrobial stewardship programs (ASPs) is increasing and program evaluation is a key component to improve efficiency and enhance stewardship strategies.OBJECTIVETo determine the antimicrobials and diagnoses most strongly associated with a recommendation provided by a well-established pediatric ASP.DESIGN AND SETTINGRetrospective cohort study from March 3, 2008, to March 2, 2013, of all ASP reviews performed at a free-standing pediatric hospital.METHODSASP recommendations were classified as follows: stop therapy, modify therapy, optimize therapy, or consult infectious diseases. A multinomial distribution model to determine the probability of each ASP recommendation category was performed on the basis of the specific antimicrobial agent or disease category. A logistic model was used to determine the odds of recommendation disagreement by the prescribing clinician.RESULTSThe ASP made 2,317 recommendations: stop therapy (45%), modify therapy (26%), optimize therapy (19%), or consult infectious diseases (10%). Third-generation cephalosporins (0.20) were the antimicrobials with the highest predictive probability of an ASP recommendation whereas linezolid (0.05) had the lowest probability. Community-acquired pneumonia (0.26) was the diagnosis with the highest predictive probability of an ASP recommendation whereas fever/neutropenia (0.04) had the lowest probability. Disagreement with ASP recommendations by the prescribing clinician occurred 22% of the time, most commonly involving community-acquired pneumonia and ear/nose/throat infections.CONCLUSIONSEvaluation of our pediatric ASP identified specific clinical diagnoses and antimicrobials associated with an increased likelihood of an ASP recommendation. Focused interventions targeting these high-yield areas may result in increased program efficiency and efficacy.Infect Control Hosp Epidemiol 2015;00(0): 1–8

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103. Expansion of an Antimicrobial Stewardship Program Through Implementation of a Discharge Verification Queue

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.305 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S166-S166

Author(s):

Ellen C Rubin ◽

Alison L Blackman ◽

Eleanor K Broadbent ◽

David Wang ◽

Ilda Plasari ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Dose Adjustment ◽

Safety Monitoring ◽

Outpatient Setting ◽

Community Acquired Pneumonia ◽

Quality Improvement Initiative ◽

Antibiotic Prescribing ◽

Effective Interventions ◽

Stewardship Program ◽

Appropriate Prescribing

Abstract Background Antimicrobial stewardship programs (ASPs) have traditionally focused interventions on inpatient care to improve antibiotic prescribing. Support of effective interventions for ASPs targeting antibiotic prescriptions at hospital discharge is emerging. Our objective was to expand stewardship services into the outpatient setting through implementation of a process by the antimicrobial stewardship team (AST) to verify antimicrobials prescribed at discharge. Methods This quality improvement initiative incorporated a discharge order verification queue managed by AST pharmacists to review electronically prescribed antimicrobials Monday through Friday, from 8:00 am to 4:00 pm. The queue was piloted Sep 2020 and expanded hospital-wide Feb 2021. Patients < 18 years old and those with observation or emergency department status were excluded. The AST pharmacist reviewed discharge prescriptions for appropriateness, intervened directly with prescribers, and either rejected or verified prescriptions prior to transmission to outpatient pharmacies. Complicated cases were reviewed with the AST physician to evaluate intervention appropriateness. Interventions were categorized as either dose adjustment, duration, escalation or de-escalation, discontinuation, or safety monitoring. Results A total of 602 prescriptions were reviewed between Sep 2020 and Apr 2021. An AST pharmacist intervened on 28% (171/602) of prescriptions. The most common intervention types were duration (41%, 70/171), discontinuation (18%, 31/171), and dose adjustment (17%, 30/171). The most common indications in which the duration was shortened was community acquired pneumonia (26%, 18/70), skin and soft tissue infection (21%, 15/70), and urinary tract infection (17%, 12/70). The most common antibiotics recommended for discontinuation were cephalexin (32%, 10/31) and trimethoprim-sulfamethoxazole (10%, 3/31). The overall intervention acceptance rate was 78%. Conclusion An AST pharmacist review of antimicrobial prescriptions at discharge improved appropriate prescribing. The discharge queue serves as an effective stewardship strategy for inpatient ASPs to expand into the outpatient setting. Disclosures All Authors: No reported disclosures

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173. Antimicrobial Stewardship Education Changes Prescribing Behavior and Reduces Treatment of Asymptomatic Bacteriuria

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.375 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S196-S196

Author(s):

Niki Arab ◽

Bali Gupta ◽

Brian Kim ◽

Arthur Jeng

Keyword(s):

Antibiotic Treatment ◽

Antimicrobial Stewardship ◽

Medical Center ◽

Asymptomatic Bacteriuria ◽

Antibiotic Prescribing ◽

Visual Aids ◽

Provider Education ◽

Prescribing Practices ◽

Prescribing Behavior ◽

The Impact

Abstract Background Treatment of asymptomatic bacteriuria (ASB) outside of pregnancy and urological procedures increases the risk of antibiotic resistance without improving outcomes. At Olive View-UCLA Medical Center (Sylmar, CA), the CDC U.S. Antibiotic Awareness Week (AAW) was utilized as a platform to promote antimicrobial stewardship (AS) for ASB. We evaluated the incidence of antibiotic treatment of ASB pre-AAW vs post-AAW, and the impact of AS education on future prescribing practices for ASB. Methods In this single-center retrospective observational study, AS education defining ASB vs urinary tract infection (UTI) was provided via visual aids distributed throughout the hospital during AAW from 11/18/2020 to 11/24/2020 (Figure 1). All positive urine cultures (Ucx) for adult inpatients were reviewed prior to AAW from 9/2020 to 11/2020 and after AAW from 12/2020 to 1/2021. Patients were excluded if they were unable to report UTI symptoms, pregnant, or undergoing urological procedure. The incidence of ASB treatment pre- and post-AAW was compared. A survey was sent to providers to compare the impact on antibiotic prescribing behavior for ASB pre- and post-AAW. Fisher’s exact and Chi-squared tests were used for statistical analysis. Figure 1. Antimicrobial Stewardship Education and Poster Distribution Results A total of 260 cases met study eligibility. In the pre-AAW group, 56 of 131 cases presented with ASB, of which 16 were treated with antibiotics (28.6%). In the post-AAW group, 55 of 129 cases presented with ASB, and 5 were treated with antibiotics (9.1%). Antibiotics were prescribed more often for patients with ASB in the pre-AAW group compared to those in the post-AAW group (p=0.014). Forty providers completed the survey, of which 97.5% had seen the visual aids, 70% had found the education "very” or “extremely" useful, and 43.6% reported they “always or sometimes” treated ASB pre-AAW vs 15% post-AAW (p< 0.01). Conclusion AS posters and education defining ASB significantly decreased the treatment of ASB. AAW education on ASB antimicrobial stewardship demonstrated a high value and shifted prescribing behavior to avoid antibiotic treatment of ASB. A similar approach to deliver provider education could serve as a valuable model to change provider AS practices for ASB. Disclosures All Authors: No reported disclosures

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How Can National Antimicrobial Stewardship Interventions in Primary Care Be Improved? A Stakeholder Consultation

Antibiotics ◽

10.3390/antibiotics8040207 ◽

2019 ◽

Vol 8 (4) ◽

pp. 207 ◽

Cited By ~ 5

Author(s):

Aleksandra J. Borek ◽

Marta Wanat ◽

Anna Sallis ◽

Diane Ashiru-Oredope ◽

Lou Atkins ◽

...

Keyword(s):

Primary Care ◽

Antimicrobial Stewardship ◽

Online Survey ◽

Telephone Interview ◽

Antibiotic Prescribing ◽

Staff Time ◽

Healthcare Organizations ◽

Stakeholder Consultation ◽

Individual Level ◽

Primary Care Settings

Many antimicrobial stewardship (AMS) interventions have been implemented in England, facilitating decreases in antibiotic prescribing. Nevertheless, there is substantial variation in antibiotic prescribing across England and some healthcare organizations remain high prescribers of antibiotics. This study aimed to identify ways to improve AMS interventions to further optimize antibiotic prescribing in primary care in England. Stakeholders representing different primary care settings were invited to, and 15 participated in, a focus group or telephone interview to identify ways to improve existing AMS interventions. Forty-five intervention suggestions were generated and 31 were prioritized for inclusion in an online survey. Fifteen stakeholders completed the survey appraising each proposed intervention using the pre-defined APEASE (i.e., Affordability, Practicability, Effectiveness, Acceptability, Safety, and Equity) criteria. The highest-rated nine interventions were prioritized as most promising and feasible, including: quality improvement, multidisciplinary peer learning, appointing AMS leads, auditing individual-level prescribing, developing tools for prescribing audits, improving inductions for new prescribers, ensuring consistent local approaches to antibiotic prescribing, providing online AMS training to all patient-facing staff, and increasing staff time available for AMS work with standardizing AMS-related roles. These prioritized interventions could be incorporated into existing national interventions or developed as stand-alone interventions to help further optimize antibiotic prescribing in primary care in England.

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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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Asymptomatic bacteriuria: Impact of an antimicrobial stewardship bundle to reduce unnecessary antibiotics in patients without urinary catheters

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab220 ◽

2021 ◽

Author(s):

Matthew Rico ◽

Rand Sulaiman ◽

Rachel MacLeod

Keyword(s):

Antimicrobial Stewardship ◽

Primary Outcome ◽

Antimicrobial Agents ◽

Urine Culture ◽

Asymptomatic Bacteriuria ◽

Urinary Catheters ◽

Positive Urine Culture ◽

Significant Difference ◽

Quasi Experimental ◽

The Difference

Abstract Purpose The purpose of this study was to evaluate the effect of an antimicrobial stewardship bundle on the management of asymptomatic bacteriuria (ASB). Methods In this quasi-experimental study, patients were selected by retrospective, consecutive sampling of patients with a positive urine culture report in 3 separate groups: preintervention, postdiagnostic intervention, and posteducation. Patients met the prespecified criteria for non–catheter-associated ASB. The diagnostic intervention involved a new urinalysis/urine culture ordering process in place of urinalysis with reflex to urine culture. Additionally, an educational intervention involved pharmacist-led sessions to educate providers with patient cases and guideline-based recommendations. The primary outcome of this study was the difference in the rate of inappropriate management of ASB, defined as the use of antimicrobial agents intended to treat ASB. Secondary outcomes included length of antimicrobial therapy, length of stay, and change in urine culture orders per 1,000 patient-days. Results A total of 120 patients were included. There was a significant reduction in the inappropriate management of ASB between the preintervention and postdiagnostic intervention groups (P = 0.0349). This was not seen when comparing the postdiagnostic intervention and posteducation groups (P = 0.93). Additionally, there was a significant difference in urinalysis/urine culture ordering between the preintervention and postdiagnostic intervention groups (370 vs 224 urinalysis orders per 1,000 days present, P < 0.0001; 131 vs 54 urine culture orders per 1,000 days present, P < 0.0001). Conclusion An antimicrobial stewardship bundle involving a diagnostic stewardship intervention and pharmacist-led education reduced treatment of ASB in patients without urinary catheters.

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219. Characteristics Associated with Inappropriate Antibiotic Prescribing in Patients with Asymptomatic Bacteriuria (ASB)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.263 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S111-S111

Author(s):

Morgan L Bixby ◽

Brian R Raux ◽

Aakansha Bhalla ◽

Christopher McCoy ◽

Elizabeth B Hirsch

Keyword(s):

Antibiotic Treatment ◽

Inappropriate Prescribing ◽

White Blood Cells ◽

Asymptomatic Bacteriuria ◽

Panel Member ◽

Culture Collection ◽

Antibiotic Prescribing ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Klebsiella Spp

Abstract Background Antibiotic treatment of asymptomatic bacteriuria (ASB) is considered inappropriate, does not improve patient outcomes, and may lead to adverse events such as antibiotic resistance and Clostridioides difficile infection. Previous stewardship interventions have focused on reducing unnecessary urine culture collection in individuals without urinary symptoms; however, further interventions to reduce inappropriate prescribing in ASB are warranted. This study sought to identify characteristics associated with treatment of ASB in order to implement future stewardship interventions. Methods This two-center, retrospective cohort study included unique emergency department or inpatient adults with consecutive non-duplicate monomicrobial urine isolates of Enterobacterales or Pseudomonas aeruginosa collected between 8/2013 and 1/2014 from two academic hospitals in Boston, Massachusetts. Patients with ASB (without chart-documented urinary-specific symptoms) were identified through chart review and stratified into two groups: those treated with empiric urinary tract infection (UTI) antibiotics and those untreated. Logistic regression analyses were performed to identify variables independently associated with antibiotic treatment of ASB. Results During the study, 255 patients were determined to have ASB and a majority (80.8%) were treated with empiric UTI antibiotics. Most patients were female (71.4%) and elderly (mean age 70 years). The most common organisms isolated were Escherichia coli (59.2%), Klebsiella spp. (23.1%), and P. aeruginosa (9.8%). The presence of isolated fever (OR, 7.83 [95% confidence interval, 1.51, 144.20]); p = 0.05), urinalysis positive for pyuria (>10 white blood cells) (OR, 2.52 [95% CI, 1.15, 5.54]; p = 0.02), and Klebsiella spp. urine isolate (OR, 2.99 [95% CI, 1.19, 8.60]; p = 0.02) were independently associated with treatment. Conclusion A large proportion of ASB patients were treated with antibiotics despite clinical practice guidelines recommending against this practice. Isolated fever, pyuria, and Klebsiella spp. culture were all significantly associated with the treatment of ASB; targeted review of these patients by stewardship programs may help to reduce inappropriate ASB treatment within these institutions. Disclosures Elizabeth B. Hirsch, PharmD, Merck (Grant/Research Support) Nabriva Therapeutics (Advisor or Review Panel member)

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