1125. In with the Out-patient Antimicrobial Stewardship Initiative: A Collaboration between a Children’s Hospital Antimicrobial Stewardship Program and a Nonaffiliated Pediatric Private Practice

Abstract

BackgroundWhile antibiotic stewardship programs have been well described in the inpatient setting, data on effectiveness and guidance on implementing outpatient stewardship in pediatric patients is scarce. To the best of our knowledge, this is the first study describing the impact that an established inpatient pediatric antimicrobial stewardship program (ASP) has had on antimicrobial prescribing practices in a multi-site (14 locations) nonacademic, nonaffiliated pediatric outpatient practice. This study’s main objective was to compare the prescribing patterns for urinary tract infections (UTIs) at baseline (before education was provided on local uropathogen resistance patterns, implications of broad-spectrum antibiotic usage, national practice guidelines, cost, etc.) and after antimicrobial stewardship education and interventions.MethodsPrescribing patterns for UTIs at baseline were reviewed and assessed for appropriateness by the inpatient ASP the summer of 2018. Following this review, education was provided to the outpatient prescribers that included discussion on local uropathogen resistance patterns, UTI guidelines, antimicrobial properties, risk for adverse effects, appropriate antimicrobial selections and dosing for UTIs. After education was provided prescribing patterns from the various sites and prescribers was reviewed on a quarterly basis. Email reminders were also sent out to providers reminding them to use cephalexin as first-line treatment. Unblinded peer comparison was utilized as a behavioral intervention in which all prescribers received reports comparing their antibiotic prescribing rates for UTIs to their peers.ResultsThe rate by which cephalexin was prescribed for UTIs has steadily improved from 4.02% of all prescriptions for UTIs during the reporting period of December 2017 - February 28, 2018 to 67.55% during the reporting period January 1 - March 31, 2019.ConclusionCollaboration between an established inpatient pediatric ASP and a nonaffiliate, multi-site private pediatric outpatient practice resulted in decreased utilization of broad-spectrum antibiotics and optimization of empiric treatment of urinary tract infections based on local resistance patterns.Disclosures All authors: No reported disclosures