1056. Evaluation of Clinical Outcomes Following Implementation of Real-Time Stewardship Team Interventions for Multi-Drug-Resistant Organisms

Abstract

BackgroundInfections due to multidrug-resistant organisms (MDRO) are associated with an increased risk of mortality. Accurate assessment of culture results and prompt initiation of effective antibiotic therapy have the potential to improve patient outcomes. The purpose of this study was to assess the time to effective therapy and associated clinical outcomes following the implementation of real-time stewardship alerts for infections due to MDRO.MethodsThis pre–post quasi-experimental study identified patients admitted to Michigan Medicine with a positive culture for one of 14 pre-defined MDRO. An alerting system was implemented within the institution’s electronic health record (EHR) in October 2018, which notifies the antimicrobial stewardship (ASP) pharmacist upon detection of an MDRO, regardless of source. The ASP pager is monitored 24/7 by a clinical pharmacy specialist who reviews the patient’s chart and recommends antibiotic modifications if necessary. In the pre-intervention period, no structured alerting or assessment was performed. Inclusion: ≥18 years old and trigger of an alert. Exclusions: pediatric service, cystic fibrosis, discharged or deceased prior to alert sensitivities, outside hospital (OSH) transfer growing identical organism upon admission, culture contamination or colonization. The primary outcome of time to effective therapy is determined from time of alert for MDRO to the order time of the effective antimicrobial agent. Secondary outcome measures include: length of stay, 30-day all-cause mortality, and 30-day readmission.Results152 alerts were included in the study (post, n = 75 and pre, n = 77). Outcomes were assessed in patients not on effective therapy at the time of alert (68.0% vs. 70.1%). Time to effective therapy was significantly improved in the intervention group (2.08hours vs. 3.72hours, P = 0.0010). Length of stay (18 days vs. 15.5 days, P = 0.1662) and 30-day all-cause mortality (17.6% vs. 18.5%, P = 0.9088) were not different between groups. However, 30-day readmission rates were significantly reduced with the intervention (21.4% vs. 43.2%, P = 0.0316).ConclusionReal-time stewardship team interventions for infections due to MDRO improve time to effective therapy and are associated with a decrease in hospital readmissions.Disclosures All authors: No reported disclosures.