763. Impact of Two-Step Testing Algorithm on Hospital-onset Clostridioides difficile Infections and Oral Vancomycin Prescription Practices at an Academic Medical Center

Abstract Background Clostridioides difficile infection (CDI) is one of the leading causes of hospital –onset (HO) infections. Clinically distinguishing true CDI versus colonization with C.difficile is challenging. We implemented a two-step testing algorithm to discriminate true CDI from colonization then evaluated the effect on rate of HO CDI and oral vancomycin. Methods In May 2020, a two-step testing algorithm was implemented utilizing C. difficile PCR and enzyme immunoassay (EIA) glutamate dehydrogenase (Figure 1). Rates of HO CDI and use of oral vancomycin was compared in the three quarters preceding and after this intervention (July 2019-March 2020 and July 2020-March 2021, respectively). HO CDI was defined based on National Healthcare Safety Network (NHSN) Laboratory Identified (LabID) event as last positive C.difficile test result performed on a specimen collected >3 calendar days after admission to the facility. HO CDI rates were assessed based on Standardized Infection Ratio (SIR) data and antimicrobial use was reported in days of therapy (DoT) per 1000 patient days. Figure 1. Two-Step Testing Algorithm for Diagnosing Clostridioides difficile infection Results During the pre-intervention period 30 HO CDI cases were reported compared to 9 cases in the post-intervention period (p=0.02) (Figure 2). There was a non-statistically significant reduction in CDI SIR in post-intervention period (0.133 vs. 0.305, p=0.11). Oral vancomycin use was similar in the pre- and post-intervention periods (3.89 vs. 3.84, p=0.96). Fidaxomicin use was rare (< 0.2 DoT/1000 pt days). Of 26 HO C.difficile colonized patients in post-intervention period, 14 (54%) patients received oral vancomycin treatment. Infectious diseases was consulted on 7/14 and recommended discontinuation of treatment in 3 while treatment was continued for other patients based on clinical status and immunocompromising conditions. Figure 2. Comparison of pre- and post-intervention trend in Hospital-onset CDI rate Conclusion We successfully reduced our HO CDI infections and SIR below national average after implementation of two-step testing algorithm for CDI. There was no impact on the rate of oral vancomycin use. We observed at 54% rate of treatment for patients categorized as likely colonization. Provider education and stewardship interventions are necessary to reduce inappropriate use of oral vancomycin in colonized patients. Disclosures All Authors: No reported disclosures

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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.

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1154. Impact of Educational Feedback on Reducing Hospital-Onset Catheter-Associated Urinary tract Infections at an Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1017 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S412-S412

Author(s):

Bhagyashri D Navalkele ◽

Nora Truhett ◽

Miranda Ward ◽

Sheila Fletcher

Keyword(s):

Infection Prevention ◽

Medical Center ◽

Academic Medical Center ◽

Prevention Strategies ◽

Intervention Period ◽

Post Intervention ◽

Frontline Staff ◽

Post Intervention Period ◽

Tract Infections ◽

The Impact

Abstract Background High regulatory burden on hospital-onset (HO) infections has increased performance pressure on infection prevention programs. Despite the availability of comprehensive prevention guidelines, a major challenge has been communication with frontline staff to integrate appropriate prevention measures into practice. The objective of our study was to evaluate the impact of educational intervention on HO CAUTI rates and urinary catheter days. Methods At the University of Mississippi Medical Center, Infection prevention (IP) reports unit-based monthly HO infections via email to respective unit managers and ordering physician providers. Starting May 2018, IP assessed compliance to CAUTI prevention strategies per SHEA/IDSA practice recommendations (2014). HO CAUTI cases with noncompliance were labeled as “preventable” infections and educational justification was provided in the email report. No other interventions were introduced during the study period. CAUTI data were collected using ongoing surveillance per NHSN and used to calculate rates per 1,000 catheter days. One-way analysis of variance (ANOVA) was used to compare pre- and post-intervention data. Results Prior to intervention (July 2017–March 2018), HO CAUTI rate was 1.43 per 1,000 catheter days. In the post-intervention period (July 2018–March 2019), HO CAUTI rate decreased to 0.62 per 1,000 catheter days. Comparison of pre- and post-intervention rates showed a statistically significant reduction in HO CAUTIs (P = 0.04). The total number of catheter days reduced, but the difference was not statistically significant (8,604 vs. 7,583; P = 0.06). Of the 14 HO CAUTIs in post-intervention period, 64% (8/14) were reported preventable. The preventable causes included inappropriate urine culturing practice in asymptomatic patients (5) or as part of pan-culture without urinalysis (2), and lack of daily catheter assessment for necessity (1). Conclusion At our institute, regular educational feedback by IP to frontline staff resulted in a reduction of HO CAUTIs. Feedback measure improved accountability, awareness and engagement of frontline staff in practicing appropriate CAUTI prevention strategies. Disclosures All authors: No reported disclosures.

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1044. Impact of Interdisciplinary Rounds on Antimicrobial Use at a Community Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.908 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S368-S368

Author(s):

Emma Castillo ◽

Luke Heuts ◽

Elizabeth Dodds Ashley ◽

Rebekah W Moehring ◽

Michael E Yarrington ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Community Hospital ◽

Hospital Setting ◽

Antimicrobial Use ◽

Intervention Period ◽

Post Intervention ◽

Post Intervention Period ◽

Interdisciplinary Rounds ◽

Days Of Therapy ◽

The Impact

Abstract Background Antimicrobial stewardship (AS) implementation is challenging in resource-limited settings such as smaller community hospitals that may lack dedicated personnel resources or have limited access to infectious diseases experts with dedicated time for AS. Few studies have evaluated the impact of interdisciplinary rounds as a strategy to optimize antimicrobial use (AU) in the community hospital setting. Methods We evaluated the impact of interdisciplinary rounds in a 280-bed acute care nonteaching, community hospital with an established ASP. The primary outcome was facility-wide antibiotic utilization pre- and post-implementation. Rounds included key healthcare personnel (hospitalists, clinical pharmacists, case managers, nurses) reviewing all patients on inpatient wards Monday through Friday, with a discussion of diagnosis, antibiotic selection, dosing, duration, and anticipated discharge plans. AU was compared for a 7-month post-intervention period (June 1, 2018–December 31, 2018) vs. similar months in 2017 based on days of therapy (DOT)/1,000 patient-days and length of therapy (LOT) per antimicrobial use admission. In addition, trends in AU for the post-intervention period were compared with the previous 17 months (January 1, 2017–May 31, 2018) using segmented binomial regression. Results Interdisciplinary rounds incorporating AS principles was associated with a decrease in overall AU in this facility, with a significant decrease of 16.33% (P < 0.0001) in DOT/1,000 pd in the first month and was stable (decrease of 1.1% per month, P = 0.15) thereafter (Figure 1). There was no significant change in LOT/admission after the first month of the intervention, but the trend demonstrated a 2% per month decrease (P < 0.03) thereafter (Figure 2). Comparing 2018 intervention months with similar months of 2017, the use of antibacterial agents decreased on average by 191.3 (95% CI −128.2 to −254.4) DOT/1,000 patient-days (Figure 3) and 0.546 (95% CI: −0.28 to −0.81) days per admission (Figure 4). Conclusion In this community hospital with an existing antimicrobial stewardship program, implementation of interdisciplinary rounds was associated with a substantial decrease in antimicrobial use. This was sustained for at least a 7-month period. Disclosures All authors: No reported disclosures.

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1130. Impact of a New Pediatric Antibiotic Stewardship Program on Ceftriaxone Use at an Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1323 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S656-S656

Author(s):

Derek Evans ◽

Mariana M Lanata Piazzon ◽

Kaitlyn Schomburg

Keyword(s):

Antibiotic Stewardship ◽

Medical Center ◽

Academic Medical Center ◽

Severe Infection ◽

Audit And Feedback ◽

Clinical Indication ◽

Intervention Period ◽

Post Intervention ◽

Post Intervention Period ◽

Stewardship Program

Abstract Background Hoop’s Family Children’s Hospital is a pediatric hospital with 72 beds, nested within Cabell Huntington Hospital. There is an established adult antibiotic stewardship program (ASP), however, since 2014 there has not been a pediatric infectious disease (ID) specialist and no pediatric ASP. With the recent hire of a pediatric ID specialist in Oct 2019 and the formation of a targeted pediatric ASP, we tracked the use of ceftriaxone (CRO) in our facility. Methods Starting January 2020, education was provided to pediatric providers in regards to appropriate CRO dosing and clinical indications via email communication. The main goals were to limit 100mg/kg/day dosing to severe infections and reduce CRO use in community-acquired pneumonia. This was sustained through intermittent prospective audits and feedback. A retrospective chart review was done from 2019-2021 for the months of January, April and December of each year. Patients ≤18 years of age who received CRO were included. Dosing, interval frequency, indication, and treatment duration were reviewed. Patients who received a single dose of CRO were excluded. Results From Jan 2019 – April 2021, 391 patient charts were reviewed (189 in the pre-intervention period and 202 in the post intervention period). There were no significant differences in age, race/ethnicity and gender in the two study groups. In the pre-intervention period, 86% of patients were prescribed CRO at severe infection dosing vs 33% in the post intervention period (p< 0.0001) (Figure 1). When dosing was paired with indication, only 20% of patients in the pre intervention period had the appropriate dosing per clinical indication compared to 83% in the post intervention period (p< 0.0001) (Figure 2). We also saw that in the pre-intervention period the most common indication for CRO was pneumonia (66%), which decreased to 57% in 2020 and to 35% in 2021 (p< 0.0001) (Figure 3). Figure 1 describes the percentage of patients receiving ceftriaxone at severe infection dosing. This changed from an average of 86% in the pre-intervention period to 33% in the post-intervention period. Figure 2 describes the percentage of patients receiving ceftriaxone at the appropriate dosing dependent on the clinical indication provided. This changed from 20% in the pre-intervention period to closer to 90% in the post-intervention period. Conclusion Pediatric specific ASP efforts and expertise proved to be crucial in appropriate CRO use in our institution. With a feasible education strategy and targeted prospective audit and feedback, there has been a sustained impact in inappropriate CRO use. This underscores the importance of targeted pediatric ASP efforts in pediatric hospitals within larger adult hospitals. Disclosures All Authors: No reported disclosures

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120. Stewardship Driven Reduction of Inappropriate Clostridioides difficile Testing at a Tertiary Military Medical Facility

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.165 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S73-S74

Author(s):

Laura Gilbert ◽

Sara Robinson ◽

Sorana Raiciulescu ◽

Roseanne Ressner

Keyword(s):

Reduction Rate ◽

Cost Savings ◽

Patient Characteristics ◽

Intervention Period ◽

Provider Education ◽

Post Intervention ◽

Antibiotic Overuse ◽

Post Intervention Period ◽

Clostridioides Difficile ◽

Intervention Patient

Abstract Background C. difficile infection (CDI) is the leading hospital associated (HA) infection in an era of antibiotic overuse and highly-sensitive PCR-based diagnostics. PCR does not differentiate CDI versus colonization making over-reporting a concern. HA-CDI can impact hospital reimbursement, lead to unnecessary treatment, increase costs and length of stay. Our aim was to implement an intervention to target inappropriate C. difficile (CD) testing. Methods Two-tiered testing is not utilized at our facility. After provider education on guidelines for appropriate CD testing, prompts were introduced into the electronic medical record (EMR) for CD test orders. At order input, providers are prompted to answer “yes” or “no” to two questions; 1) receipt of stool softeners within the preceding 48 hours and 2) criteria of 3 loose stools within 24 hours. The test order was completed regardless of the responses to the prompted questions. Six-month post-intervention data was compared to the same timeframe during the year prior. Results A total of 334 and 236 tests were ordered in the pre- and post-intervention periods respectively. Accounting for inpatient bed days, the incidence reduction rate (IRR) was 0.75 (CI 0.63–0.89, p < 0.001) corresponding to an estimated hospital cost-savings of $12,250 based on testing costs alone. The majority of CD tests were ordered by IM providers, who also demonstrated the greatest reduction in tests ordered post-intervention. Patient characteristics were analyzed in the pre- and post-intervention periods finding significantly less positive CD tests ordered for patients with recurrent C. difficileduring the post-intervention period (2 vs 7, p = 0.04). Patients who were transferred from another institution had significantly more positive CD tests in the post-intervention period (19 vs 7, p = 0.02). Conclusion In conclusion, the results demonstrate that implementing a systems-based EMR initiative led to a 25% reduction in CD testing with a cost-savings of $12,250 not accounting for potential associated cost savings. This project suggests that even without restricting order access, educational prompts integrated in the EMR can have meaningful impact on stewardship endeavors to help reduce inappropriate CD testing. Sustained effect would be an area to explore. Disclosures All Authors: No reported disclosures

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2360. Impact of a Two-Step Antimicrobial Stewardship Intervention on C. difficile Infection Diagnosis at an Urban Veteran’s Affairs Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2038 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S813-S813

Author(s):

Ryan T Kuhn ◽

Jennifer L Johnson ◽

Virginia Nelson ◽

Dustin Fitzpatrick ◽

Syed Ahmad ◽

...

Keyword(s):

Intervention Group ◽

Nucleic Acid Amplification ◽

Inpatient Setting ◽

Intervention Period ◽

Oral Vancomycin ◽

Post Intervention ◽

Post Intervention Period ◽

Bed Days ◽

The Impact ◽

Post Intervention Group

Abstract Background C. difficile infection (CDI) is a common healthcare-associated infection and quality measure for hospitals. Diagnosis of CDI is challenging as testing modalities, i.e., nucleic acid amplification test (NAAT), are highly sensitive but cannot differentiate between colonization and infection. Therefore, judicious use of testing is critical to avoid unnecessary diagnosis and treatments. Methods This single-center, retrospective chart review evaluated the impact of a two-step diagnostic stewardship intervention on C. difficile diagnosis and use of oral vancomycin in the inpatient setting. For the first step of the intervention, providers were educated on appropriate diagnosis and treatment, and given access to an optional electronic CDI clinical decision support system (CDSS). For the second step of the intervention, the CDI NAAT stand-alone testing option was removed from the lab ordering menu and providers were required to use the CDSS to order testing. Clinical data including bed-days of care (BDOC), total number tests ordered, number of positive tests and use of oral vancomycin was collected for the pre-intervention period (1/1/16 – 3/31/17), post intervention period 1 (April 1, 2017–October 31/18) and post-intervention period 2 (November 1, 2018–March 31, 2019). Results Compared with the pre-intervention group, there were no significant differences in the number of total CDI NAATs ordered, positive CDI NAATs or vancomycin DOT/10,000 BDOC in post-intervention group 1. There was a reduction in the number of total CDI NAATs ordered (341 vs. 42 [87.7%]) and the number of positive CDI NAATs (56 vs. 7 [87.5%]) in post-intervention group 2, respectively. When this data were normalized based on bed days of care (BDOC), there were still significant reductions in NAATs ordered and number of positive CDI NAATs (64 vs. 27 [57.8%]; 11 vs. 5, respectively, [54.5%]) and with vancomycin oral DOT/10,000 BDOC (72 vs. 7 [90.3%]) (Table 1). Conclusion Provider education and an optional CDSS did not significantly impact CDI NAAT ordering or use of oral vancomycin for CDI. However, implementation of a mandatory CDSS for CDI testing was shown to significantly decrease the number of tests ordered, the number of positive tests, and the use of oral vancomycin. Disclosures All authors: No reported disclosures.

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A Pharmacy-Based Electronic Handoff Tool to Reduce Discharge Prescribing of Atypical Antipsychotics Initiated in the Intensive Care Unit: A Quality Improvement Initiative

Journal of Pharmacy Practice ◽

10.1177/0897190018761412 ◽

2018 ◽

Vol 32 (4) ◽

pp. 434-441

Author(s):

Bridgette L. Kram ◽

Jennifer M. Schultheis ◽

Shawn J. Kram ◽

Christopher E. Cox

Keyword(s):

Intensive Care ◽

Quality Improvement ◽

Hospital Discharge ◽

Atypical Antipsychotics ◽

Academic Medical Center ◽

Transitions Of Care ◽

Intervention Period ◽

Post Intervention ◽

Post Intervention Period ◽

Icu Transfer

Purpose: To evaluate whether a pharmacist-initiated electronic handoff tool can reduce the overall, and potentially inappropriate, hospital discharge prescribing rate of atypical antipsychotics (AAP) initiated in AAP-naive critically ill adults. Methods: This pre–post quality improvement study was initiated in 5 intensive care units (ICUs) at a large academic medical center. An electronic handoff tool (iVent) was utilized in the post-intervention period to enhance pharmacist communication at inpatient transitions of care. Results: Of the 358 included patients, the proportion of hospital survivors with an AAP initiated in the ICU receiving a hospital discharge prescription was not different between the pre- and post-intervention period (28.6% vs 22.2%, P = .12). The proportion of ICU survivors with an AAP continued at the time of ICU transfer to the floor was reduced post-intervention (78.7% vs 66.7%, P = .012). Additionally, the overall proportion of a patient’s hospitalization receiving an AAP was also reduced (50.4% vs 42.8%, P = .008). A multivariate logistic regression demonstrated thatutilization of the electronic handoff tool was not associated with a reduction in hospital discharge prescribing of an AAP (odds ratio [OR]: 0.97, 95% confidence interval [CI]: 0.57-1.65). Conclusions: A pharmacy-initiated electronic handoff tool may reduce the proportion of AAP-naive ICU survivors with an AAP continued at the time of ICU transfer. The handoff tool was not associated with a significant reduction in the discharge prescribing rates of AAPs for hospital survivors, but a clinically meaningful reduction was possibly achieved due to enhanced communication enabled by this tool.

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Quality improvement interventions to reduce chemotherapy dose-modification ordering errors at a large academic medical center.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.264 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 264-264

Author(s):

Margaret Soriano ◽

Anne Chang ◽

Aralee Galway ◽

Laura Listro ◽

Evaline Liu ◽

...

Keyword(s):

Dose Escalation ◽

Medical Center ◽

Academic Medical Center ◽

Near Miss ◽

Common Source ◽

Intervention Period ◽

Post Intervention ◽

Post Intervention Period ◽

Dose Modification ◽

Chemotherapy Administration

264 Background: Despite clear advantages of Electronic Health Records (EHR) systems for safe cancer chemotherapy administration, persistent opportunities exist to further reduce chemotherapy order errors. Unintended dose escalation orders of previously dose reduced chemotherapy were the most commonly reported “near-miss” medication safety events at our institution. This can lead to potential patient harm, delays in care, decreased patient satisfaction, reduced infusion room efficiency, and increased care team workload and decreased satisfaction. We sought to reduce chemotherapy order errors using interventions developed with process improvement techniques. Methods: Unintended dose escalation errors per month (the primary outcome measure) were identified through the hospital safety reporting system and by monitoring the EHR (EPIC) chemotherapy administration reports to identify dose escalations. All cases were confirmed with primary chart review. The pre-intervention baseline assessment period was 6/2017-11/2017, and the post intervention period was 12/2017-5/2018. Two interventions were selected: 1) Revision of the nursing chemotherapy checklist posted on all infusion room workstations for use prior to releasing chemotherapy orders; and 2) educating ordering providers and nurses about new EHR functionality to display prior and future chemotherapy orders. Statistical Process Control chart analysis was conducted with upper (UCL) and lower (LCL) control limits of 3 standard deviations. The primary aim was to reduce the number of chemotherapy errors by 50% in the post-intervention period. Results: The pre-intervention period averaged 3.83 chemotherapy ordering errors per month (UCL = 9.71, LCL = 0). The post-intervention period significantly reduced the average errors per month to 1.33 (UCL = 4.97, LCL = 0). The copy/forward feature in multi-day cycles was the most common source of unintended dose escalations. Conclusions: Implementation of the 2 interventions resulted in a 65% reduction of unintended dose modification errors. Based on successful results and positive staff feedback, we plan to roll out these interventions at additional satellite facilities.

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197. Bridging the Divide Between Antimicrobial Stewardship and Surgical Services: Successful Use of Handshake Stewardship with Hepato-Pancreato-Biliary Surgical Services in Adult Patients at a Large Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.241 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S103-S103

Author(s):

Jacqueline Meredith ◽

Danya Roshdy ◽

Rupal K Jaffa ◽

Leigh A Medaris ◽

Cesar Aviles ◽

...

Keyword(s):

Medical Center ◽

Pediatric Population ◽

Academic Medical Center ◽

Support Network ◽

Intervention Period ◽

Post Intervention ◽

Surgical Services ◽

Days Of Therapy ◽

Acceptance Rates ◽

The Impact

Abstract Background Handshake stewardship has displayed promise in engaging providers in the pediatric population but literature in adults are lacking. Face-to-face interactions are proposed to improve antibiotic stewardship (ASP) efforts in challenging services that have low ASP acceptance and commonly utilize broad-spectrum antibiotics (BSA) such as Hepato-Pancreato-Biliary surgical services (HPBSS). Methods Handshake stewardship was initiated by the Antimicrobial Support Network (ASN) with the HPBSS at the Carolinas Medical Center in January 2019. In-person rounding was completed. Treatment algorithms were created to assist in standardizing antibiotic selection and de-escalation for common HPB infections. To evaluate the impact of handshake stewardship, we assessed antimicrobial utilization of BSA by measuring days of therapy (DOT) per 1000 patient days (PD), comparing the pre- (Jan – Dec 2018) and post-intervention period (Jan – Dec 2019). ASN intervention acceptance rates and rates of hospital-acquired (HA) carbapenem-resistant Enterobacterales (CRE) infections/colonization and C. difficile infections (CDI) were also collected. Results After implementation of handshake stewardship, antipseudomonal use decreased significantly by 32.5 DOT/1000 PD as compared to the pre-intervention period (174.4 vs 141.9 DOT/1000 PD, p = 0.04). A numeric decrease in carbapenem use was also observed (21.7 vs 57.5 DOT/1000 PD, p = 0.275). ASN intervention acceptance rates significantly increased by 31% (p < 0.01). HA-CRE infections, CRE colonization and CDI decreased by 87.7%, 66% and 38.8%, respectively (p = ns). Figure 1: HPB Antibiotic Utilization FIgure 2: ASN Intervention Rates with HPB Table 1. Rates of CRE and C. difficile Infections Conclusion Use of handshake stewardship assisted in reducing BSA use, improving provider acceptance of ASN interventions and decreasing HA-infection rates. Based on these findings, handshake stewardship may be useful in services that display challenges in implementing ASP due to their complex patient populations, such as HPBSS. Disclosures All Authors: No reported disclosures

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1376. Oral Vancomycin as Secondary Prophylaxis Against Clostridioides difficile Infection in Pediatric Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1558 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S698-S698

Author(s):

Hongkai Bao ◽

Yanina Dubrovskaya ◽

John Papadopoulos ◽

Justin Siegfried ◽

Cristian Merchan ◽

...

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Protective Factor ◽

Pediatric Patients ◽

Antibiotic Exposure ◽

Oral Vancomycin ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

History Of ◽

Systemic Antibiotics

Abstract Background Secondary oral vancomycin prophylaxis (OVP) has been utilized in adults with a history of Clostridioides difficile infection (CDI) while receiving systemic antibiotics to prevent CDI recurrence. However, this practice is poorly described in pediatric patients. Rates of CDI recurrence in pediatric patients range from 10-40% and is associated with morbidity and mortality. This study assessed the efficacy and safety of secondary OVP in pediatric patients with subsequent antibiotic exposure. Methods This retrospective study evaluated pediatric patients ≤18 years with any history of clinical CDI and receiving systemic antibiotics in a subsequent encounter during the time period of 2013-2019. Patients who received OVP 10 mg/kg (up to 125 mg per dose) every 12 hours during concomitant antibiotics were compared to those who did not. The primary outcome was CDI recurrence within 8 weeks following antibiotic exposure. Secondary outcomes included time to recurrence, severity of recurrence, and isolation of vancomycin-resistant enterococci (VRE) from any site. Risk factors for CDI recurrence were assessed using logistic regression. Results A total of 153 patients were screened for inclusion, of which 32 and 47 patients were assigned to the OVP and no OVP group, respectively. Median age was 8.6 years and the most common comorbidities were malignancy (47%) and immunosuppression (46%). Median time since last CDI to study inclusion was 64.5 days in the OVP group and 90 days in the no OVP group, P=0.320. Compared to the no OVP group, OVP patients had longer hospital stays (5 vs 14 days, P=0.001) and more concomitant antibiotic exposure (8 vs 12.5 days, P=0.001). Median duration of OVP was 12 days. CDI recurrence occurred in 12 patients and was significantly lower in the OVP vs no OVP group (3.1% vs 23.4%; odds ratio, 0.106; 95% confidence interval, 0.013-0.864; P=0.022). VRE was not isolated in any patients. After adjustment in a multivariate analysis, only secondary OVP remained as a protective factor against recurrence (odds ratio, 0.082; 95% confidence interval, 0.009-0.748; P=0.027). Conclusion Secondary OVP effectively reduces the risk of recurrent CDI in pediatric patients with a history of CDI while receiving systemic antibiotics. Future prospective studies should validate these findings. Disclosures Cristian Merchan, PharMD, BCCCP, abbive (Speaker’s Bureau)

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