2037. A Novel Strategy of Antimicrobial Stewardship in Shanghai: Preliminary Practice with Integration of Three Surveillance Networks

Abstract

BackgroundThe bacterial resistance surveillance networks, antimicrobial clinical use surveillance networks and provincial hospital-acquired infection (HAI) surveillance have been well established in China. They aim to inform the current situation of bacterial resistance, antimicrobial use and HAI, and to guide the rational use of antimicrobials. However, these three networks presently are running separately. To increase the data value in antimicrobial stewardship (AMS)practice, those three surveillance networks are integrated in ShanghaiMethodsThe Committee of Rational Use of Antimicrobials and AMS of Shanghai Municipal Health Commission, consisting of health administrators, clinical physicians and microbiologists, clinical pharmacologists and infection control experts, was formed in 2017. The oversight committee developed a comprehensive AMS score index mainly based on the surveillance data of the three networks to evaluate the AMS requirements in the hospitals. The AMS score index consists of 3 surveillance network indexes: resistance weight index; antimicrobial weight index and HAI weight index; each of the indexes is further divided into two parts, namely the surveillance quality score and data-related score. For example, the data-related score in the resistance index is calculated for the prevalence of 6 most important MDR/XDR bacteria (CRKP, CRAB, CRPA, ESBL, MRSA, VRE). A multi-disciplinary AMS team was convened to provide expert on-site visit of the hospitals and offered AMS support in the form of practical guidance and advice.ResultsAMS score and detailed score such as the prevalence of CRKP were ranked among 50 hospitals within the networks. These scores will support the AMS team to find out the main drivers of resistance/antibiotic use and thereby support appropriate interventions during the on-site visit. For example, a hospital visited which had a high consumption of carbapenems (ranked third in Shanghai) and also had a high percentage of carbapenems used in the department of liver transplantation. The advice of the on-site visit team was to encourage a more diverse group of antibiotics so as to spare carbapenems.ConclusionInvolvement of the multi-disciplinary team and integration of surveillance networks are very helpful in AMS practice.Disclosures All authors: No reported disclosures.