212. Impact of a Prospective Audit and Feedback Antimicrobial Stewardship Initiative on Pneumonia Treatment at an Academic Teaching Hospital

Abstract

BackgroundAntimicrobial stewardship programs (ASPs) may improve patient outcomes by reducing antimicrobial adverse effects and resistance. Pneumonia is the most common infectious reason for hospitalization and is a key target for improvement in antimicrobial use. The purpose of this study was to measure the impact of a prospective audit and feedback program for patients with pneumonia in addition to an already robust pre-authorization program at an academic teaching hospital.MethodsWe analyzed the impact of a prospective audit and feedback initiative among inpatients with pneumonia treated with antimicrobials for at least 72 hours. The primary outcome was the percent of optimal antimicrobial days of therapy received based on hospital-approved pneumonia guidelines, compared pre- and postintervention. This outcome was defined as the number of optimal days of therapy compared with the total days of therapy over the entire study period from the hospital’s perspective. Secondary outcomes included the incidence rate of optimal antimicrobial days of therapy on a patient-specific level, overall antimicrobial days of therapy, length of hospital stay, rates of Clostridium difficile infection (CDI), and in-hospital mortality.ResultsThe study included 248 patients, 125 pre- and 123 postintervention. Forty interventions were made post-implementation, with duration (47.5%) and de-escalation (35%) recommendations most commonly suggested. 50.8% of patients were male, the median [interquartile range (IQR)] age was 71 (60–83) years old, 45.6% of patients had community-acquired pneumonia, and patients had a median (IQR) Elixhauser comorbidity score of 5 (3–6). The overall rate of guideline concordance was 65.8% pre- and 77.5% postintervention (P = 0.041). On an individual level, patients were 17% more likely to have optimal antimicrobials postintervention [Incidence rate ratio 1.17 (95% confidence interval 1.03–1.32, P = 0.013)]. Length of stay, days of therapy, CDI, and in-hospital mortality rates did not differ significantly between groups.ConclusionInitiating a prospective audit and feedback program in addition to pre-authorization led to a significant increase in concordance with hospital pneumonia guidelines, but no difference in secondary outcomes in our patient population.Disclosures M. V. Mahoney, Melinta Therapeutics: Consultant, Consulting fee. Cutis Pharma: Consultant, Consulting fee. Tetraphase Pharmaceuticals, Inc.: Consultant, Consulting fee. Roche Diagnostics USA: Consultant, Consulting fee. C. McCoy, Merck Inc: Scientific Advisor, Consulting fee. Allergan: Scientific Advisor, Consulting fee.