170. Antimicrobial Use Before and During COVID-19 – Data from 108 VA Facilities

Abstract Background Increased antibiotic prescribing rates during the early phases of the COVID-19 pandemic have been widely reported. We previously reported that while both antibiotic days of therapy (DOT) and total days present (DP) declined in the first 5 months of 2020 at Veterans Affairs (VA) acute care facilities nationwide relative to the comparable period in 2019, antibiotic DOT per 1000 DP increased by 11.3%, largely reversing declines in VA antimicrobial utilization from 2015 – 2019. We now evaluate whether these changes in antibiotic use persisted throughout the COVID-19 pandemic. Methods Data on antibacterial use, patient days present, and COVID-19 care for acute inpatient care units in 108 VA level 1 and 2 facilities were extracted through the VA Informatics and Computing Infrastructure; level 3 facilities which provide limited acute inpatient services were excluded. DOT per 1000 DP were calculated and stratified by CDC-defined antibiotic classes. Results From 1/2020 to 2/2021, care for 34,096 COVID-19 patients accounted for 13% of all acute inpatient days of care in the VA. Following the onset of COVID-19 pandemic, monthly total acute care antibiotic use increased from 533 DOT/1000 DP in 1/2020 to a peak of 583 DOT/1000 DP in 4/2020; during that month COVID-19 patients accounted for 13% of all DP (Figure). In subsequent months, total antibiotic use declined such that for the full year the change of antibiotic use from 2019 to 2020 (a decrease of 18 DOT/1000 DP) was similar to the rate of decline from 2015 to 2019 (mean decrease of 13 DOT/1000 DP; Table). The decreased DOT/1000 DP from 5/2020 to 2/2021 occurred even as the percentage of all DP due to COVID-19 peaked at 14 - 24% from 11/2020 to 2/2021. Conclusion Although rates of antibiotic use increased within the VA during the early phases of the COVID-19 pandemic, rates subsequently decreased to below previous baseline levels even as the proportion of COVID-19 DP spiked between 11/2020 and 02/2021. Although the degree to which the initial increase in antibiotic use is attributable to concerns of bacterial superinfection versus changes in case-mix (e.g., decreased elective admission) remains to be assessed, these data support the continued effectiveness of antimicrobial stewardship programs in the VA. Disclosures Matthew B. Goetz, MD, Nothing to disclose

Download Full-text

12. Development of Provider-Specific Antibiotic Prescribing Feedback for Inpatient Antibiotic Stewardship Programs in Veterans Affairs (VA) Facilities (ASP)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.012 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S8-S9

Author(s):

Matthew B Goetz ◽

Michelle Fang ◽

Feliza Calub ◽

Pamela Belperio ◽

...

Keyword(s):

Acute Care ◽

Broad Spectrum ◽

Medical Records ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Days Of Therapy ◽

Control And Prevention ◽

Medical Wards ◽

Future Work

Abstract Background Provision of provider-specific outpatient antibiotic prescribing data has resulted in significant decreases in antibiotic use. We describe the development of reports of inpatient antibiotic prescribing by hospitalists attending on acute medical wards in VA medical facilities. Methods We created algorithms for determining the attending physician responsible for patient days present (DP), by considering changes of service (e.g., prior to admission from the emergency department) and transfers between services or physicians. Each antibiotic dose was assigned to a single attending, ward location, and service according to denominator assignment. Antibiotic use was grouped into Centers for Disease Control and Prevention drug categories and expressed as antibiotic days of therapy (DOT) per 1000 DP. Data were obtained from the VA Corporate Data Warehouse. Algorithms were iteratively refined based on reviews of medical records from three VA medical centers and applied to acute care patients at a single site for 2018-2020. Results In 2018-2020, 294 attendings oversaw acute inpatient care for >= 14 DP. 129 attendings with >= 300 DP oversaw 88.0% of all patient care and prescribed 87.6% of all antibiotics (480 DOT/1000 DP, IQR 375-559), 90.1% of broad-spectrum therapy for hospital-onset infections (55 DOT/1000 DP, IQR 31-72) and 88.3% of resistant Gram-positive therapy (70 DOT/1000 DP, IQR 39-89) in inpatient wards. The distribution of antibiotic use for acute care ward patients amongst these 129 staff is shown in the following figure. Conclusion We developed algorithms to attribute antibiotic therapy to inpatient attendings that can be broadly applied in facilities with electronic medical records. As with outpatient prescribing, we found large variation across inpatient attendings in overall antibiotic use and broad-spectrum antibiotic use. In future work, we will obtain provider feedback of report usability and interpretability and assess whether distribution of these reports allows antibiotic stewards to favorably influence provider prescribing practices. Disclosures Matthew B. Goetz, MD, Nothing to disclose Arjun Srinivasan, MD, Nothing to disclose

Download Full-text

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.273 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S116-S116

Author(s):

Julia Sessa ◽

Helen Jacoby ◽

Bruce Blain ◽

Lisa Avery

Keyword(s):

Patient Care ◽

Teaching Hospital ◽

Antimicrobial Stewardship ◽

Rank Order ◽

Antibiotic Use ◽

Outpatient Setting ◽

Antibiotic Prescribing ◽

Full Time ◽

Days Of Therapy ◽

The Impact

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

Download Full-text

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.983 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S397-S398

Author(s):

Natalie Tucker ◽

Ezzeldin Saleh ◽

Marcela Rodriguez

Keyword(s):

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Antibiotic Prescribing ◽

Successful Implementation ◽

Custom Made ◽

Days Of Therapy ◽

Before And After ◽

The Individual

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

Download Full-text

Inpatient antibiotic utilization in the Veterans’ Health Administration during the coronavirus disease 2019 (COVID-19) pandemic

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1277 ◽

2020 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Thomas D. Dieringer ◽

Daisuke Furukawa ◽

Christopher J. Graber ◽

Vanessa W. Stevens ◽

Makoto M. Jones ◽

...

Keyword(s):

Antibiotic Use ◽

Veterans Health Administration ◽

Antibiotic Prescribing ◽

Veterans Health ◽

Health Administration ◽

Prescribing Practices ◽

Antibiotic Utilization ◽

Days Of Therapy

Abstract Antibiotic prescribing practices across the Veterans’ Health Administration (VA) experienced significant shifts during the coronavirus disease 2019 (COVID-19) pandemic. From 2015 to 2019, antibiotic use between January and May decreased from 638 to 602 days of therapy (DOT) per 1,000 days present (DP), while the corresponding months in 2020 saw antibiotic utilization rise to 628 DOT per 1,000 DP.

Download Full-text

Association of Hospital-Onset Clostridium difficile Infection Rates and Antibiotic Use in US Acute Care Hospitals, 2006–2012: An Ecologic Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx162.171 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S1-S1 ◽

Cited By ~ 1

Author(s):

Sophia Kazakova ◽

James Baggs ◽

Lawrence McDonald ◽

Sarah Yi ◽

Kelly Hatfield ◽

...

Keyword(s):

Acute Care ◽

Inpatient Treatment ◽

Acute Care Hospitals ◽

Antibiotic Use ◽

Estimating Equation ◽

The United States ◽

Fourth Generation ◽

Days Of Therapy ◽

Facility Level ◽

Hospital Characteristics

Abstract Background This study investigated the association between facility-level rates of hospital-onset CDI (HO-CDI) and inpatient antibiotic use (AU) in a large group of U.S. acute care hospitals over a 7-year period. Methods We used adult discharge and antibiotic use data from 552 acute care hospitals participating in the Truven Health MarketScan Hospital Database from January 1, 2006 to December 31, 2012 to determine facility-level CDI rates and AU. HO-CDI was defined as a discharge with a secondary ICD-9-CM diagnosis code for CDI (008.45) and inpatient treatment with metronidazole or oral vancomycin. The relationship between facility-level HO-CDI (HO-CDI per 10,000 patient-days (PD)) and AU (days of therapy (DOT) per 1,000 PD) was examined through multivariate general estimating equation models that accounted for the correlation between annual HO-CDI rates within a hospital. The models controlled for hospital characteristics and a facility-level rate of community-onset CDI (CO-CDI), defined as a discharge with a primary ICD-9-CM code for CDI and inpatient treatment. Results During 2006 to 2012, the mean HO-CDI rate was 11 per 10,000 PD (interquartile range (IQR): 5.7–14.7) and mean AU was 811 DOT/1,000 PD (IQR: 710–932). After controlling for facility-level CO-CDI and other hospital characteristics, overall AU was significantly associated with facility-level HO-CDI rate; for every 50 DOT/1,000 PD increase in AU, there was a 4.4% increase in the HO-CDI rate. Similarly, the only antibiotic classes significantly associated with HO-CDI were third- and fourth-generation cephalosporins (P < 0.0001) and carbapenems (P = 0.0011) with respective increases of 2.1% and 2.4% of HO-CDI per 10 DOT/1,000 PD increase. Fluoroquinolones and β-lactam/β-lactamase inhibitor combinations were not significantly associated with HO-CDI. Conclusion In this ecologic analysis of over 500 hospitals, overall antibiotic use was associated with increased rates of HO-CDI. In contrast to recent patient-level analyses in the United States and national observations in England, only third- and fourth-generation cephalosporins and carbapenems were associated with HO-CDI. Disclosures All authors: No reported disclosures.

Download Full-text

Impact of the Use of Procalcitonin Assay in Hospitalized Adult Patients with Pneumonia at a Community Acute Care Hospital

Infection Control and Hospital Epidemiology ◽

10.1086/664764 ◽

2012 ◽

Vol 33 (4) ◽

pp. 424-426 ◽

Cited By ~ 11

Author(s):

Janet L. Kook ◽

Stephanie R. Chao ◽

Jennifer Le ◽

Philip A. Robinson

Keyword(s):

Cohort Study ◽

Acute Care ◽

Acute Care Hospital ◽

Antibiotic Use ◽

Adult Patients ◽

Care Hospital ◽

Days Of Therapy ◽

Before And After ◽

Quasi Experimental

A retrospective, quasi-experimental cohort study compared antibiotic use before and after implementation of a procalcitonin assay at a community acute care hospital. This study demonstrated that the implementation of the procalcitonin assay was associated with a decrease in antibiotic days of therapy in adult patients with pneumonia.

Download Full-text

246. Antibiotic Prescribing Patterns for Residents in Assisted Living Facilities

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.290 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S122-S123

Author(s):

Chi-Yin Liao ◽

Christopher J Crnich ◽

James Ford II

Keyword(s):

Antibiotic Treatment ◽

Assisted Living ◽

Antibiotic Use ◽

Prescribing Patterns ◽

Clinical Indication ◽

Antibiotic Prescribing ◽

Assisted Living Facilities ◽

Days Of Therapy ◽

Using Data ◽

The Individual

Abstract Background Knowledge about antibiotic utilization in Assisted Living Facilities (ALFs) is limited. Studies have primarily focused on aggregate prescribing patterns, clinical indications for antibiotics, and the types of antibiotics prescribed. Information about individual resident prescribing patterns is limited. This project addresses the gap by using data from a convenient sample of ALFs. Methods Data on antibiotic prescriptions from 3 ALFs in Wisconsin were collected for a one-year period. Information included start and stop dates, clinical indication, and antibiotic prescribed. Antibiotic orders for the same resident were categorized as distinct events to capture treatment courses if 1) the days between the end date of the prior antibiotic and the initiation date of subsequent antibiotic orders were > 4 days, or 2) if the identified indications for the prior and subsequent antibiotic were different. Event-level indication was further defined based on (2). Descriptive statistics were used to understand antibiotic prescribing patterns at the individual and event level. Results A total of 207 antibiotic events among 110 assisted-living residents were identified. The patterns of antibiotic use at the resident and treatment course levels are described in tables 1 and 2, respectively. On average, each resident was received 1.9 (range:1 to 10) antibiotic treatment courses for an average of 24.8 (range: 1 to 237) total antibiotic days. The treatment duration of each treatment course averaged 14.5 days (range: 1 to 306). About 10 % of residents had 4 or more antibiotic events and days of therapy over 56 days. 43% of residents were prescribed an antibiotic without a clinical indication and 26% of the antibiotic events were not indicated. UTI was the most common indication for antibiotic treatment (31%) and ciprofloxacin was the most commonly prescribed antibiotic (22%). Conclusion The current study demonstrates multiple opportunities to improve antibiotic use in ALFs, including: 1) specification of indication for the antibiotic; 2) reducing unnecessary antibiotic treatments; 3) shortening durations of treatments; and 4) reducing use of broad-spectrum antibiotics. Studies on interventions that target these areas are needed. Disclosures All Authors: No reported disclosures

Download Full-text

Antibiotic prescribing patterns among patients admitted to an academic teaching hospital for COVID-19 during the first wave of the pandemic in Toronto: A retrospective, controlled study

Official Journal of the Association of Medical Microbiology and Infectious Disease Canada ◽

10.3138/jammi-2021-0020 ◽

2021 ◽

Author(s):

Miranda So ◽

Andrew M Morris ◽

Alexander M Walker

Keyword(s):

Antibiotic Use ◽

Antibiotic Consumption ◽

Community Acquired Pneumonia ◽

Prescribing Patterns ◽

Secondary Outcome ◽

Controlled Study ◽

Antibiotic Prescribing ◽

General Internal ◽

Days Of Therapy ◽

Empirical Antibiotics

Background: Empirical antibiotics are not recommended for coronavirus disease 2019 (COVID-19). Methods: In this retrospective study, patients admitted to Toronto General Hospital’s general internal medicine from the emergency department for COVID-19 between March 1 and August 31, 2020 were compared with those admitted for community-acquired pneumonia (CAP) in 2020 and 2019 in the same months. The primary outcome was antibiotics use pattern: prevalence and concordance with COVID-19 or CAP guidelines. The secondary outcome was antibiotic consumption in days of therapy (DOT)/100 patient-days. We extracted data from electronic medical records. We used logistic regression to model the association between disease and receipt of antibiotics, linear regression to compare DOT. Results: The COVID-19, CAP 2020, and CAP 2019 groups had 67, 73, and 120 patients, respectively. Median age was 71 years; 58.5% were male. Prevalence of antibiotic use was 70.2%, 97.3%, and 90.8% for COVID-19, CAP 2020, and CAP 2019, respectively. Compared with CAP 2019, the adjusted odds ratio (aOR) for receiving antibiotics was 0.23 (95% CI 0.10 to 0.53, p = 0.001) and 3.42 (95% CI 0.73 to 15.95, p = 0.117) for COVID-19 and CAP 2020, respectively. Among patients receiving antibiotics within 48 hours of admission, compared with CAP 2019, the aOR for guideline-concordant combination regimens was 2.28 (95% CI 1.08 to 4.83, p = 0.031) for COVID-19 and 1.06 (95% CI 0.55 to 2.05, p = 0.856) for CAP-2020. Difference in mean DOT/100 patient-days was –24.29 ( p = 0.009) comparing COVID-19 with CAP 2019, and +28.56 ( p = 0.003) comparing CAP 2020 with CAP 2019. Conclusions: There are opportunities for antimicrobial stewardship to address unnecessary antibiotic use.

Download Full-text

Association Between Antibiotic Use and Hospital-onset Clostridioides difficile Infection in US Acute Care Hospitals, 2006–2012: An Ecologic Analysis

Clinical Infectious Diseases ◽

10.1093/cid/ciz169 ◽

2019 ◽

Vol 70 (1) ◽

pp. 11-18 ◽

Cited By ~ 16

Author(s):

Sophia V Kazakova ◽

James Baggs ◽

L Clifford McDonald ◽

Sarah H Yi ◽

Kelly M Hatfield ◽

...

Keyword(s):

Acute Care ◽

Acute Care Hospitals ◽

Antibiotic Use ◽

Generation Cephalosporin ◽

Fourth Generation ◽

Cross Sectional ◽

Clostridioides Difficile ◽

Days Of Therapy ◽

Clostridioides Difficile Infection ◽

The Impact

Abstract Background Unnecessary antibiotic use (AU) contributes to increased rates of Clostridioides difficile infection (CDI). The impact of antibiotic restriction on hospital-onset CDI (HO-CDI) has not been assessed in a large group of US acute care hospitals (ACHs). Methods We examined cross-sectional and temporal associations between rates of hospital-level AU and HO-CDI using data from 549 ACHs. HO-CDI was defined as a discharge with a secondary International Classification of Diseases, Ninth Revision, Clinical Modification code for CDI (008.45), and treatment with metronidazole or oral vancomycin > 3 days after admission. Analyses were performed using multivariable generalized estimating equation models adjusting for patient and hospital characteristics. Results During 2006–2012, the unadjusted annual rates of HO-CDI and total AU were 7.3 per 10 000 patient-days (PD) (95% confidence interval [CI], 7.1–7.5) and 811 days of therapy (DOT)/1000 PD (95% CI, 803–820), respectively. In the cross-sectional analysis, for every 50 DOT/1000 PD increase in total AU, there was a 4.4% increase in HO-CDI. For every 10 DOT/1000 PD increase in use of third- and fourth-generation cephalosporins or carbapenems, there was a 2.1% and 2.9% increase in HO-CDI, respectively. In the time-series analysis, the 6 ACHs with a ≥30% decrease in total AU had a 33% decrease in HO-CDI (rate ratio, 0.67 [95% CI, .47–.96]); ACHs with a ≥20% decrease in fluoroquinolone or third- and fourth-generation cephalosporin use had a corresponding decrease in HO-CDI of 8% and 13%, respectively. Conclusions At an ecologic level, reductions in total AU, use of fluoroquinolones, and use of third- and fourth-generation cephalosporins were each associated with decreased HO-CDI rates.

Download Full-text

199. Evaluating long-term care pharmacy dispense data to monitor antibiotic use in U.S. nursing homes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.243 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S104-S104

Author(s):

Katryna A Gouin ◽

Stephen M Creasy ◽

Manjiri Kulkarni ◽

Martha Wdowicki ◽

Nimalie D Stone ◽

...

Keyword(s):

Nursing Homes ◽

Long Term Care ◽

National Level ◽

Antibiotic Use ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Term Care ◽

Days Of Therapy ◽

Antibiotic Courses

Abstract Background Automated reporting of antibiotic use (AU) in nursing homes (NHs) may help to identify opportunities to improve antibiotic prescribing practices and inform implementation of stewardship activities. The majority of U.S. NHs contract with long-term care (LTC) pharmacies to dispense prescriptions and provide medication monitoring and reviews. We investigated the feasibility of leveraging LTC pharmacy electronic dispensing data to describe AU in NHs. Methods We analyzed all NH antibiotic dispenses and monthly resident-days in 2017 reported by a large LTC pharmacy. The dispense-level data included facility and resident identifiers, antibiotic class and agent, dispense date and days of therapy (DOT) dispensed. We identified NH antibiotic courses, inclusive of both antibiotic starts and continuations from hospital-initiated courses, by collapsing dispenses of the same drug to the same resident if the subsequent dispense was within three days of the preceding end date. The course duration was the sum of DOT for all dispenses in the course. The AU rate was reported as DOT and courses per 1,000 resident-days. Results AU was described in 326,713 residents admitted to 1,348 NHs (9% of U.S. NHs), covering 38.1 million resident-days. There were 576,228 dispenses for a total of 3.3 million antibiotic DOT at a rate of 86 DOT/1,000 resident-days. After collapsing dispenses, 324,306 antibiotic courses were defined at a rate of 9 courses/1,000 resident-days. During the year, 45% of residents received an antibiotic. The most frequently prescribed classes by DOT and courses were cephalosporins, penicillins, urinary anti-infectives and quinolones (Fig. 1). The top agents by DOT were levofloxacin (12%), sulfamethoxazole/trimethoprim (12%) and cephalexin (11%). Most course durations were 1–7 days (54%) or 8–14 days (35%) (Fig. 2). Long-term antibiotic courses (> 30 days) contributed to 5% of courses and 30% of overall DOT. The mean duration per course was 7.5 days when courses > 30 days were excluded. Figure 1. Distribution of antibiotic courses and days of therapy by antibiotic class for 324,306 antibiotic courses and 3.3 million days of antibiotic therapy dispensed to 1,348 nursing homes from a long-term care pharmacy in 2017 Figure 2. Distribution of antibiotic course duration and cumulative percent of total antibiotic days of therapy for 324,306 antibiotic courses dispensed to 1,348 nursing homes from a long-term care pharmacy in 2017 Conclusion LTC pharmacy dispenses may be an accessible data source to report NH AU rates and prescribing patterns by antibiotic class and agent. Further evaluation of data sources for facility- and national-level AU reporting in NHs is needed to support stewardship implementation. Disclosures All Authors: No reported disclosures

Download Full-text