2362. Back to the Future: The Impact of Multi-Step Algorithm C. difficile Testing at a Large Tertiary Medical Center

Abstract Background Antibiotic stewardship and infection control programs rely on C. difficile infection (CDI) test results to measure CDI incidence in the hospital setting. C. difficile carriage is common and distinguishing infection from colonization is difficult with the highly sensitive nucleic acid amplification testing (NAAT) commonly used. Current guidelines recommend a multi-step algorithm for testing. The impact on patient outcomes and CDI metrics are largely unknown. Methods This was a pre-post study at the University of Maryland Medical Center, evaluating the impact of a CDI testing strategy (introduced October 2018) that simultaneously reported NAAT and confirmatory enzyme immunoassay (EIA) when used with existing best practice alerts for appropriate testing. Pre-intervention (November 2017–September 2018) and post intervention (October 2018–March 2019) periods were compared for mean CDI incidence (CDI per 10,000 admissions) defined by: (1) positive NAAT, (2) reported CDI (last positive test), and (3) treated CDI (receiving oral vancomycin). Both community and hospital-onset cases were included. The NAAT CDI incidence was used as the pre-intervention comparison for all 3 measures. In addition, oral vancomycin days of therapy (DOT) per 1,000 patient-days (PD) was compared. Pre–post comparisons of mean CDI incidence and mean DOT rates were done using Student t-test. Results There were 3,237 samples tested (2,269 pre and 968 post-intervention) with 376 NAAT positive (262 pre and 114 post-intervention). Of the 99 tests with reflex EIA, there were 74 discordant tests (NAAT +/EIA -) with 35 (47%) treated for CDI. Mean NAAT CDI incidence pre-intervention was 54 per 10,000 admissions. Post-intervention mean CDI incidence decreased as follows: 45 NAAT CDI per 10,000 admissions (P = 0.13), 15 reported CDI per 1000 admissions (P < 0.0001), and 28 treated CDI per 10,000 admissions (P = 0.0007). Oral vancomycin DOT per 1,000 PD decreased from 16 to 9 (P = 0.0002). Conclusion C. difficile NAAT testing with confirmatory EIA, in combination with best practice alert, decreased reported and treated cases of CDI, which may distinguish infection vs. colonization and avoid unnecessary treatment, beyond that achieved with alerts that improve appropriate patient selection for testing. Disclosures All authors: No reported disclosures.

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2345. Reduction in Testing and Change in Testing Algorithm Associated with Decrease in Number of Nosocomial Clostridium difficile Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2023 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S806-S806

Author(s):

Susan Nichols ◽

Michelle D Jordan ◽

Michael Coogan ◽

Jackie Opera ◽

Paul P Cook

Keyword(s):

Clostridium Difficile ◽

Best Practice ◽

Medical Center ◽

Nucleic Acid Amplification ◽

Antimicrobial Use ◽

Continuous Variables ◽

Laxative Use ◽

Days Of Therapy ◽

Before And After ◽

Testing Algorithm

Abstract Background Previous data at our facility indicated 37% of patients with Clostridium difficile infection (CDI) were receiving at least one laxative at the time of testing, suggesting the possibility of false-positive results. Nucleic acid amplification testing (NAAT) does not distinguish between colonization and infection with C. difficile. We implemented two interventions to address these issues and evaluated our rates of nosocomial CDI before and after these changes. Methods This was a retrospective study of all positive test results for adult patients with nosocomial C. difficile from October 1, 2017 through March 31, 2019 at Vidant Medical Center, a 911-bed hospital. In June, 2018, we implemented a best practice advisory (BPA) in our electronic health record to recommend against testing for CDI in patients receiving laxatives. We reviewed the number of C. difficile tests ordered before and after initiating the BPA. In December, 2018, we removed NAAT and replaced it with a cell cytotoxicity assay (CCA) for specimens that were enzyme immunoassay (EIA) negative and glutamate dehydrogenase (GDH) positive. Antimicrobial use was measured in days of therapy (DOT) per 10,000 patient-days (PD). Mann–Whitney U test was used for continuous variables. Linear regression was used to monitor antimicrobial use. Results The number of C. difficile tests ordered per month decreased 19.5% after implementing the BPA (P < 0.0001). There was a 44% reduction in the number of EIA+/GDH+ specimens per month after the BPA intervention (P = 0.003). Following substitution of CCA for NAAT for EIA-/GDH+ specimens, there was a 61% reduction in the rate of nosocomial CDI (8.6 cases/10,000 PD to 3.3 cases/10,000 PD; P = 0.005). Total antimicrobial use was unchanged over the course of the study (673 to 677 DOT/10,000 PD). Carbapenem use decreased 56% (P = 0.009); cefepime use increased 85%(p = 0.002); quinolone and clindamycin use were unchanged. Conclusion Laxative use in hospitalized patients is common and likely contributes to a false elevation in the CDI rate by identifying carriers in addition to those who have true infection. Implementing a BPA to reduce inappropriate testing and changing our testing algorithm for Clostridium difficile by substituting CCA for NAAT has resulted in a lower rate of nosocomial CDI. Disclosures All authors: No reported disclosures.

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Treatment Bundle Improves Outcomes in the Management of Candidemia at Large Urban Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.050 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S89-S89 ◽

Cited By ~ 1

Author(s):

Gregory Cook ◽

Shreena Advani ◽

Saira Rab ◽

Sheetal Kandiah ◽

Manish Patel ◽

...

Keyword(s):

Patient Outcomes ◽

Best Practice ◽

Medical Center ◽

Academic Medical Center ◽

Blood Cultures ◽

Source Control ◽

Post Intervention ◽

The Impact ◽

Early Source ◽

Order Set

Abstract Background A candidemia treatment bundle (CTB) may increase adherence to guideline recommended candidemia management and improve patient outcomes. The purpose of this study was to evaluate the impact of a best practice alert (BPA) and order-set on optimizing compliance with all CTB components and patient outcomes. Methods A single center, pre-/post-intervention study was completed at Grady Health System from August 2015 to August 2017. Post-CTB intervention began August 2016. The CTB included a BPA that fires for blood cultures positive for any Candida species to treatment clinicians upon opening the patient’s electronic health record. The BPA included a linked order-set based on treatment recommendations including: infectious diseases (ID) and ophthalmology consultation, repeat blood cultures, empiric echinocandin therapy, early source control, antifungal de-escalation, intravenous to oral (IV to PO) switch, and duration of therapy. The primary outcome of the study was total adherence to the CTB. The secondary outcomes include adherence with the individual components of the CTB, 30-day mortality, and infection-related length of stay (LOS). Results Forty-five patients in the pre-group and 24 patients in the CTB group with candidemia were identified. Twenty-seven patients in the pre-group and 19 patients in the CTB group met inclusion criteria. Total adherence with the CTB occurred in one patient in the pre-group and threepatients in the CTB group (4% vs. 16%, P = 0.29). ID was consulted in 15 patients in the pre-group and 17 patients in the CTB group (56% vs. 89%, P = 0.02). Source control occurred in three and 11 patients, respectively (11% vs. 58% P < 0.01). The bundle components of empiric echinocandin use (81% vs. 100%, P = 0.07), ophthalmology consultation (81% vs. 95%, P = 0.37), and IV to PO switch (22% vs. 32%, P = 0.5) also improved in the CTB group. Repeat cultures and antifungal de-escalation were similar among groups. Thirty-day mortality decreased in the CTB group by 10% (26% vs. 16%, P = 0.48). Median iLOS decreased from 30 days in the pre-group to 17 days in the CTB group (P = 0.05). Conclusion The CTB, with a BPA and linked order-set, improved guideline recommended management of candidemia specifically increasing the rates of ID consultation and early source control. There were quantitative improvements in mortality and iLOS. 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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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

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The Impact of Diagnostic Stewardship on Clostridium difficile Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.992 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S398-S398 ◽

Cited By ~ 2

Author(s):

Werner Bischoff ◽

Andrey Bubnov ◽

Elizabeth Palavecino ◽

James Beardsley ◽

John Williamson ◽

...

Keyword(s):

Clostridium Difficile ◽

Kidney Failure ◽

Medical Center ◽

Academic Medical Center ◽

Antibiotic Use ◽

Nucleic Acid Amplification ◽

Acute Kidney Failure ◽

Complication Rates ◽

Post Intervention ◽

The Impact

Abstract Background Clostridium difficile infections (CDI) pose a growing threat to hospitalized patients. This study assesses the impact of changing from a nucleic acid amplification test (NAAT) to a stepwise testing algorithm (STA) by using an enzyme immunoassay (GDH and toxin A/B) and confirmatory NAAT confirmation in specific cases. Methods In an 885 bed academic medical center a 24 month pre-/post design was used to assess the effect of the STA for the following parameters: rates of enterocolitis due to C.diff (CDE), NHSN C.diff LabID events, CDI complications, mortality, antimicrobial prescription patterns, cluster occurrences; and testing, treatment, and isolation costs. Inpatient data were extracted from ICD-9/10 diagnosis codes, infection prevention, and laboratory databases. Results The STA significantly decreased the number of CDE ICD9/10 codes, HO, CO, and CO-HCFA C.diff LabID event rates by 65%, 78%, 75%, and 75%, respectively. Similar reductions were noted for associated complications such as NHSN defined colon surgeries (-61%), megacolon (-64%), and acute kidney failure (-55%). CDE unrelated complication rates for colon surgeries and acute kidney failure remained constant while the diagnosis of megacolon decreased but not significantly (-71%; P > 0.05). Inpatient mortality did not change with or without CDE. Significant reductions were observed in the use of oral metronidazole (total: -32%; CDE specific: -70%) and vancomycin (total: -58%; CDE specific: -61%). There were no clusters detected pre-/post STA introduction. The need for isolation decreased from 748 to 181 patients post-intervention (-76%; P < 0.05). Annual cost savings were over $175,000 due to decreases in laboratory testing followed by isolation, and antibiotic use. Conclusion The switch to an STA from NAAT did not affect the diagnosis, treatment, or control of clinically relevant CDI in our institution. Benefits included avoidance of unnecessary antibiotic treatment, reduction in isolation, achieving publicly reported objectives, and costs savings. Selection of clinically relevant tests can help to improve hospitalization and treatment of patients and should be considered as part of diagnostic stewardship. 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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2085. Bedside Nurses Improve Antimicrobial Stewardship and Infection Prevention Outcomes: Results of a 3.5-Year Study in Three Hospital Telemetry Units

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1765 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S704-S704

Author(s):

David Ha ◽

Mary Bette Forte ◽

Victoria Broberg ◽

Rita Olans ◽

Richard Olans ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Infection Prevention ◽

Medical Center ◽

Bloodstream Infections ◽

Urinary Catheters ◽

Bedside Nurse ◽

Post Intervention ◽

Days Of Therapy ◽

Tract Infections ◽

The Impact

Abstract Background Minimal literature exists to demonstrate the quantitative impact of bedside nurses in antimicrobial stewardship (AMS). We initiated bedside nurse-driven AMS and infection prevention (AMS/IP) rounds on three inpatient telemetry units of a community regional medical center. Rounds were nurse-driven, involved an infectious diseases (ID) pharmacist and infection preventionist, and were designed to complement traditional ID pharmacist and ID physician AMS rounds. Rounds were focused on use of antibiotics, urinary catheters (UCs), and central venous catheters (CVCs). Recommendations from rounds were communicated by the bedside nurse either directly to providers or to the ID pharmacist and ID physician for intervention. Methods This was an observational, multiple-group, quasi-experimental study conducted over 3.5 years (July 2015 to December 2018) to characterize the impact of bedside nurse-driven AMS/IP rounds on antibiotic, urinary catheter and CVC use, hospital-onset C. difficile infection (CDI), catheter-associated urinary tract infections (CAUTI), and central line-associated bloodstream infections (CLABSI). Outcomes were assessed in two cohorts based on time of AMS/IP rounds implementation (Cohort 1 implemented on one telemetry unit in July 2016, Cohort 2 implemented in two telemetry units in January 2018). Results A total of 2,273 patient therapy reviews occurred (Cohort 1: 1,736; Cohort 2: 537). Of these reviews, 1,209 (53%) were antibiotics, 879 (39%) were urinary catheters, and 185 (8%) were CVCs. Pre- vs. post-intervention, significant reductions were observed in both cohorts for mean monthly antibiotic days of therapy per 1,000 patient-days (Cohort 1: 791 vs. 688, P < 0.001; Cohort 2: 615 vs. 492, P < 0.001), UC days per patient day (Cohort 1: 0.25 vs. 0.16, P < 0.001; Cohort 2: 0.19 vs. 0.14, P < 0.001), CVC days per patient day (Cohort 1: 0.15 vs. 0.11, = 0.002; Cohort 2: 0.09 vs. 0.07, p = 0.005), and CDI per 10,000 patient-days (Cohort 1: 17.8 vs. 7.1, p = 0.035; Cohort 2: 19.1 vs. 5.4, p = 0.003). Numerical reductions were observed in CAUTI and CLABSI per 10,000 patient-days. Conclusion Bedside nurses can improve AMS and IP outcomes in a scalable fashion when supported by an interdisciplinary AMS/IP team and are complimentary to traditional AMS and IP practices. Disclosures All authors: No reported disclosures.

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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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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

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Implementation of a Rapid Phenotypic Susceptibility Platform for Gram-Negative Bloodstream Infections With Paired Antimicrobial Stewardship Intervention: Is the Juice Worth the Squeeze?

Clinical Infectious Diseases ◽

10.1093/cid/ciab126 ◽

2021 ◽

Author(s):

Evan D Robinson ◽

Allison M Stilwell ◽

April E Attai ◽

Lindsay E Donohue ◽

Megan D Shah ◽

...

Keyword(s):

Median Time ◽

Antimicrobial Stewardship ◽

A Priori ◽

Bloodstream Infections ◽

Standard Of Care ◽

Post Intervention ◽

Gram Negative ◽

Stewardship Program ◽

Days Of Therapy ◽

The Impact

Abstract Background Implementation of the Accelerate PhenoTM Gram-negative platform (RDT) paired with antimicrobial stewardship program (ASP) intervention projects to improve time to institutional-preferred antimicrobial therapy (IPT) for Gram-negative bacilli (GNB) bloodstream infections (BSIs). However, few data describe the impact of discrepant RDT results from standard of care (SOC) methods on antimicrobial prescribing. Methods A single-center, pre-/post-intervention study of consecutive, nonduplicate blood cultures for adult inpatients with GNB BSI following combined RDT + ASP intervention was performed. The primary outcome was time to IPT. An a priori definition of IPT was utilized to limit bias and to allow for an assessment of the impact of discrepant RDT results with the SOC reference standard. Results Five hundred fourteen patients (PRE 264; POST 250) were included. Median time to antimicrobial susceptibility testing (AST) results decreased 29.4 hours (P < .001) post-intervention, and median time to IPT was reduced by 21.2 hours (P < .001). Utilization (days of therapy [DOTs]/1000 days present) of broad-spectrum agents decreased (PRE 655.2 vs POST 585.8; P = .043) and narrow-spectrum beta-lactams increased (69.1 vs 141.7; P < .001). Discrepant results occurred in 69/250 (28%) post-intervention episodes, resulting in incorrect ASP recommendations in 10/69 (14%). No differences in clinical outcomes were observed. Conclusions While implementation of a phenotypic RDT + ASP can improve time to IPT, close coordination with Clinical Microbiology and continued ASP follow up are needed to optimize therapy. Although uncommon, the potential for erroneous ASP recommendations to de-escalate to inactive therapy following RDT results warrants further investigation.

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