1005. The Antibiotic Optimization DOOR: Refining Assessment of Antibiotic Therapy with Desirability of Outcome Ranking

Abstract

BackgroundDesirability of outcome ranking (DOOR) is a novel methodology for incorporating multiple outcomes into a single value to more comprehensively compare therapeutic strategies. Its primary application has been limited to antibiotic clinical trials, incorporating treatment success and antibiotic toxicity into a single measure. We describe the application of DOOR methodology to a retrospective study evaluating antibiotic optimization.MethodsThis was a single-center, retrospective quasi-experimental study conducted at an academic medical center evaluating the impact of prospective pharmacist review of rapid molecular diagnostic testing (RDT) of blood cultures on antibiotic optimization. Two 8-week time periods were evaluated, corresponding to RDT implementation prior to prospective pharmacist review (RDT-only) and RDT with prospective pharmacist review (RDT-PPR). Patients with a positive blood culture who were not on optimal therapy at the time of gram stain were included in the study. Outcomes included the percentage of patients who received optimal therapy, time to optimal antibiotic therapy, and percentage of patients who had therapy de-escalated. An antibiotic optimization DOOR was created with 3 ordinal ranks. The most desirable outcome, rank one, was patients receiving optimal therapy with no missed de-escalation opportunities. Rank two was patients receiving optimal therapy with a missed de-escalation opportunity. The least desirable outcome, rank three, consisted of patients not receiving optimal antibiotic therapy. Time to optimal therapy was used as a tiebreaker for patients in ranks one and two.ResultsA total of 19 and 29 patients were included in the pre and post-intervention periods, respectively. The percentage of patients reaching optimal therapy was 84% (16/19) and 97% ([28/29], P = 0.16). Median time to optimal therapy was 30:28:26 and 22:40:17 (P = 0.32), respectively. DOOR analysis indicated that the probability of a better outcome for the RDT-PPR group than the RDT-only group was 58% (95% CI 54–62).ConclusionIn this small retrospective study, the use of a novel composite methodology identified the benefit of an intervention that was not detected by standard comparison of individual outcomes.Disclosures All authors: No reported disclosures.