908. Impact of Antimicrobial Stewardship Protocol Mandating Infectious Diseases Consultation Post 72 Hours of Meropenem Usage

Abstract

Abstract Background Carbapenem use correlates with the development of carbapenem-resistant organisms, prompting our antimicrobial stewardship program (ASP) to develop a policy mandating infectious diseases (ID) consultation after 72 hours of meropenem use. Our objective was to evaluate the impact of this policy on meropenem utilization and associated clinical outcomes. Methods This quasi-experimental, observational study evaluated the impact of the new ASP policy in adult patients across four campuses. Administered meropenem orders were retrieved retrospectively six months before (11/2020-4/2021) and after (6/2021-11/2021) policy implementation. The primary outcome was meropenem days of therapy per 1000 patient-days (DOTs). Secondary outcomes included DOTs of select broad-spectrum antimicrobials, 30-day all-cause mortality, hospital length of stay (LOS), and Clostridioides difficile (C. difficile) infection incidence. All outcomes were assessed in pre- and post-intervention periods. Results There were 1493 and 1404 meropenem orders in the pre- and post-intervention periods, respectively. Pre-intervention group patients had slightly higher modified Charlson Comorbidity Index scores (2.1 vs 1.9, p=0.02). Pre-intervention group had more patients with penicillin allergies but less patients with sulfa allergies (p=0.007 and p=0.03, respectively). The most common meropenem indications were bloodstream, respiratory, abdominal, and urinary tract infections. The incidence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales and cefepime-resistant Pseudomonas spp. was similar in both groups (p=0.7 and p=0.1, respectively). ID consultation increased after policy implementation (44.1% vs 51.7%, p=0.001). Meropenem DOTs decreased significantly after intervention (50.3 vs 35.5, p=0.0003). We observed increases in ceftriaxone and cefepime DOTs (94 vs 103.8, p=0.006 and 39 vs 58.5, p=0.0005, respectively). An increase in C. difficile incidence was seen. Hospital LOS was similar pre- and post-intervention (mean 18.5 days, p=0.9). Conclusion The ASP policy mandating ID consultation after 72 hours of meropenem use helped decrease meropenem DOT and encouraged use of antimicrobial agents with narrower spectrum. Disclosures All Authors: No reported disclosures.