246. Antimicrobial Stewardship Program (ASP) Efforts to Reduce Antimicrobial Usage in Geriatric Patients without Affecting Outcomes

Abstract

BackgroundThere is limited literature evaluating ASP outcomes in patients 65 years and older. The primary objective of this study was to show that ASP efforts to deescalate and/or discontinue antimicrobial therapy in older patients did not lead to an increased rate of 30-day hospital readmissions due to treatment failure. The secondary objective was to show a decrease in antimicrobial expenditure per adjusted patient day (APD).MethodsA retrospective chart review was performed to compare the rates of 30-day readmissions of patients 65 years and older who received ASP interventions between January and June 2017 with a control sample who received antibiotics between January and June 2015 (pre-ASP). Patients were included if they received antibiotics for pneumonia (PNA), urinary tract infection (UTI), acute bacterial skin and skin structure infection (ABSSSI) and complicated intra-abdominal infection (cIAI). The ASP team met daily to review patients identified by the clinical pharmacist. ASP interventions consisted of de-escalation of empiric or definitive therapy, change in the duration of therapy or discontinuation of therapy. Treatment failure was defined as readmission due to re-infection or a new infection (e.g., Clostridium difficile).ResultsOverall, 461 patients (150 control; 311 intervention) were included. The 30-day readmission rate for all infections decreased during the intervention period (10.7% vs. 3.9%, P = 0.004). There was a statistically significant decrease in 30-day readmissions in the PNA subgroup (9.8% vs. 2.9%, P = 0.038), a marginally significant decrease among UTI patients (12.5% vs. 4.7%, P = 0.097), and no statistically significant change in the ABSSSI (5.6% vs. 8.6%, P = 0.694) and cIAI (20.8% vs. 6.7%, P = 0.233, CI) subgroups. The total APD was 16,267 (control) and 15,487 (intervention). Total antimicrobial expenditure during the control period was $379,643 ($23.33/APD) vs. $67,721 ($4.37/APD) during the intervention period.ConclusionASP efforts did not lead to an increase rate of 30-day readmissions due to treatment failure. Furthermore, there was a statistically significant decrease in readmission rates in the intervention group as well as a large decrease in antimicrobial expenditure per APD.Disclosures All authors: No reported disclosures.