1772. Evaluating the Impact of a Pilot Structured Antimicrobial Stewardship Prospective Audit and Feedback Program in Emergency General Surgery in a Community Hospital

Abstract

Abstract Background The benefits of prospective audit and feedback (PAF) are established in critical care settings but not in the surgical population. We piloted once-weekly structured face-to-face PAF with the Acute Care Surgery (ACS) Service surgeon(s) and compared outcomes to usual care which comprised of ad-hoc PAF on targeted antimicrobials once or twice weekly with recommendations made to ACS surgeon(s) using written or verbal methods. Methods Interrupted time series segmented negative binomial regression analysis was used to evaluate the change in the primary outcome of antimicrobial usage measured in Days of Therapy/1000 patient days (DOT/1000-PD) for all systemic and targeted antimicrobials ordered by the ACS team. The structured PAF period was from August 1, 2017- April 30, 2019 while the ad-hoc PAF period was from May 1, 2019-January 31, 2021. Targeted antimicrobials included 3rd generation cephalosporins, piperacillin/tazobactam, carbapenems and clindamycin. Secondary outcomes included C. difficile infections, length of stay and readmission within 30 days. The first two secondary outcomes were analyzed using a logistic regression model while a negative binomial regression model was used to evaluate readmission within 30 days. Results There were 776 ACS patients in the structured PAF period with 783 patients in the ad-hoc PAF period. = No significant changes in level or trend of the primary outcome of DOT/1000-PD in both periods was found for all and targeted antimicrobials. However, there was a trend to small reduction in DOT/1000-PD of 0.9% per month (rate ratio 1.0, CI 0.99-1.02) for all antimicrobials and 0.3% per month (rate ratio 1.0, CI 0.98-1.03) for targeted antimicrobials in the ad-hoc PAF period. Similarly, there were no significant differences with respect to any of the secondary outcomes. There was a trend of 10% increase in length of stay (rate ratio 1.07, CI 0.98-1.17) and 13% reduction in 30-day readmission (OR 0.87, CI 0.56-1.35) in the ad-hoc PAF period. Rates by Time Using Negative Binomial Models for All and Targeted Antimicrobials Conclusion Structured PAF showed similar clinical outcomes to ad-hoc PAF for the Acute Care Surgery Service at our institution. Other antimicrobial stewardship interventions can be explored to better support judicious antimicrobial use in General Surgery. Disclosures All Authors: No reported disclosures.