123. Formal Pediatric Antimicrobial Stewardship Program at a Children’s Hospital Within a Larger Academic Medical Center Decreases Antimicrobial Prescribing

Abstract

Abstract Background Antimicrobial stewardship is a coordinated approach to antimicrobial overprescribing, an avoidable contributor to adverse events in children. Implementation of a formal pediatric antimicrobial stewardship program (pASP) in a children’s hospital within a hospital poses unique challenges due to staffing, funding, and institutional priorities. We hypothesized that a formalized pASP would decrease antimicrobial prescribing in a children’s hospital within a large academic medical center. Methods We extracted pharmacy administration data for all patients receiving systemic antimicrobials in a tertiary care, academic children’s hospital in Upstate NY from 3/1/2020-5/31/2021. We grouped patients into floor (including patients with surgical, hematologic, and oncologic processes), pediatric intensive care unit (PICU), and neonatal intensive care unit (NICU). We calculated antimicrobial days of therapy per 1000 patient days (DOT/1000PD) for 6 months before, 3 months during, and 6 months after institution of pASP. The formalized pASP involved physician and pharmacy leadership of prospective audit and feedback. We developed run charts and used two-way analysis of variance (ANOVA) with an effect of location, an effect of the intervention, and an interaction effect. Significant effects were then tested using Tukey’s test for multiple comparisons. Results Run charts are displayed in figures 1-3. Overall, the pediatric floor(DOT/1000PD=1181) had significantly higher prescribing than the PICU(847), which was significantly higher than the NICU(327) (p< 0.001, ANOVA). Antimicrobial prescribing after pASP dropped by 80 DOT/1000PD (98%CI: 23 to 137) (p=0.008; Tukey’s test) after including the effect of location. The interaction effect was not significant (p=0.77; ANOVA) suggesting that the intervention did not have a significantly different effect in the three locations. Variation in Antimicrobial Prescribing on the Pediatric Floors Variation in Antimicrobial Prescribing in the Pediatric Intensive Care Unit Variation in Antimicrobial Prescribing in the Neonatal Intensive Care Unit Conclusion Antimicrobial prescribing decreased following implementation of a formalized pASP in a children’s hospital within a large academic medical center. Despite unique challenges with implementation in this environment, antimicrobial stewardship remains effective. Variation between floor, PICU, and NICU antimicrobial prescribing was also notable. Disclosures All Authors: No reported disclosures