1305. Application of Standard Antibiotic Use Criteria to Evaluate Inpatient Antibiotic Use

Abstract

BackgroundIt is estimated that 30–50% of antimicrobial agents prescribed inpatient are not optimal. Historically, antimicrobial evaluation has been based primarily upon expert opinion of ID trained individuals. Spivak and colleagues proposed standard terminology and definitions to assess antimicrobial prescribing practices. At UMass Memorial Medical Center we utilized Spivak’s criteria to measure antimicrobial use within point prevalence studies (PPS) and assessed the ability of Spivak’s criteria to provide consistent results between different evaluators.MethodsA PPS was conducted in September 2017 (SEPT) by infectious disease (ID) attendings and ID trained pharmacists. A follow-up PPS was completed in November 2017 (NOV) by a pharmacy practice resident (PGY-1) and first year ID fellow. Patients were included if they were prescribed antibiotics at the time of review, greater than 18 years of age, and admitted to an inpatient unit. Patients only receiving antiretroviral therapy or antifungal prophylaxis were excluded from the study. Antibiotics, indications, days of therapy, and appropriateness or reason for inappropriateness, as defined by Spivak’s criteria, were collected.ResultsFour hundred five patients in SEPT and 475 patients in NOV were reviewed. Baseline characteristics between SEPT and NOV, including sex, age, average length of hospital stay (LOS) at time of review were similar between groups, (SEPT vs. NOV: male sex: 53.2% vs. 51.1%; age: 60.4 vs. 61.7; LOS:8.55 vs. 8.36 days). Number of antibiotics per patient was different between PPS (SEPT 1.69 vs. NOV 1.28). For non-intensive care unit (ICU) patients, 64.9% of use was considered appropriate in SEPT vs. 69.3% in NOV. The top reasons for inappropriate use in non-ICU patients in both PPS were no indication and excess length of therapy. Within the ICU, 89.4% of use was considered appropriate in SEPT, with 75% of use considered appropriate in NOV. The top reason for inappropriate use in ICU patients in both PPS was overly broad therapy.ConclusionApplication of standard antibiotic evaluation criteria can assist healthcare professionals with different levels of ID training to assess antibiotic use in non-ICU patients. Further evaluation should be considered for critically ill patients.Disclosures All authors: No reported disclosures.