1186. Beta is Better: Impact of a Multifaceted Stewardship Initiative on the Sequential Timing of Beta-Lactam Administration

Abstract

Abstract Background Appropriate antibiotic sequence (i.e. beta-lactam before vancomycin) may reduce early mortality in patients with bloodstream infections (BSIs). Herein, we describe the impact of a multifaceted stewardship initiative on the sequence of antibiotic administration across three hospitals. Methods We performed a pre-post analysis describing the impact of a multifaceted stewardship initiative from March 1, 2021 – May 22, 2022 (pre) and May 31, 2022 – Feb 12, 2023 (post) on the sequence of antibiotic administrations in adults > 18 years old with at least one positive blood culture who received vancomycin and a beta-lactam (i.e. cefepime, meropenem, or piperacillin-tazobactam) across three hospitals: a major university hospital and two community hospitals. Our initiative consisted of 1) a health-system wide adult beta-lactam order panel combining load and maintenance doses for select beta-lactams (Figure 1) 2) nursing administration instructions facilitating the appropriate sequential order of antibiotic administration (i.e. beta-lactam before vancomycin) (Figure 2) and 3) system-wide education to physicians, pharmacists, and nurses. The rate of beta-lactam first administration was compared between groups. Beta-lactam first rates were further stratified by hospital and antibiotic administration locations. Chi-square tests were used to compare rates between groups. Beta-Lactam Order Panel, Piperacillin-tazobactam Beta-Lactam First: Nursing Administration Instructions, Cefepime Results 361 patients were included for analysis: 224 pre- and 137 post-intervention. Piperacillin-tazobactam was the most common beta-lactam among studied patients (71.5%, Table 1). Beta-lactam first rates were already high at baseline, then higher post-intervention compared to pre-intervention (96.4% vs 93.8%, p = 0.283) (Table 2).Table 1.Receipt of Beta-Lactam Therapy in Adult Patients with Positive Blood CulturesTable 2.Sequence of Antibiotic Administration Conclusion A multifaceted initiative to promote beta-lactam before vancomycin administration increased adherence to this preferred practice in our health system, though baseline rates were high. Clinical decision support paired with system-wide education involving key stakeholders can help standardize appropriate antibiotic sequence. Future study could evaluate impact on a larger scale, on patient outcomes, and evaluate sustainability of beta-lactam first practice. Disclosures Rebekah W. Moehring, MD, MPH, FIDSA, FSHEA, UpToDate, Inc.: Author Royalties