242. Evaluating the Effectiveness of Antimicrobial Restriction at an Academic Medical Center

Abstract

BackgroundAntimicrobial Stewardship Programs (ASPs) promote the optimal use of antimicrobial agents with the goal of preserving the effectiveness of existing drugs. One core ASP strategy is formulary restriction and preauthorization (PA). We evaluated restricted antimicrobial use at an academic medical center in Virginia; our program has a comprehensive restriction program that applies to adults only.MethodsData from August 2012 to June 2017 were evaluated at the hospital unit level by month in days of therapy (DOT) per 1,000 patient-days. Ordinary least squares regression was used to compare the time trend of restricted use with that of nonrestricted agents within the same unit.ResultsAcross the study period significant decreases in restricted antibiotic use were detected for medical and pediatric units with no significant increases in use. However, significant increases were identified for surgical units. Table 1: Results of Time Trend Analysis by Unit for Restricted Drugs.RestrictedTypeUnitTime Trend P MedicalOncology0.640.0924Acute Care Medicine0.390.4058Cardiac ICU−0.370.1057Medical ICU−2.060.0002Bone Marrow Transplant0.520.5002Digestive Health−0.140.3004Progressive Care−0.930.0002PediatricGeneral Pediatrics−0.360.1363Neonatal ICU−0.290.0007Pediatric ICU−0.120.7849Progressive Care−0.290.0993SurgicalAcute Care Surgery−0.300.1574Burn ICU0.840.0021Cardiac Surgery ICU−0.500.2766Surgical Trauma ICU−0.520.1019 Table 2: Significant Increases/ Decreases in Restricted Antimicrobials by Unit TypeRestrictedUnit TypeIncreaseDecreaseMedical0/7 (0%)2/7 (29%)Pediatric0/4 (0%)1/4 (25%)Surgical1/4 (25%)0/4 (0%)ConclusionThese data suggest that the PA strategy for medical wards was effective across the time period whereas the PA strategy for surgical wards was suboptimal. However, it is unclear why pediatric wards (that were not subject to PA activities) also saw reductions in use; more research into this is needed. These data will help us to refine our PA strategy by targeting use on surgical wards. We believe that this type of analysis may be useful for other ASPs utilizing the PA strategy.Disclosures All authors: No reported disclosures.