Hospital Antimicrobial Stewardship Programs Research Articles

A cross-sectional study of hospital antimicrobial stewardship programmes in the COVID-19 era.

Antimicrobial resistance (AMR) continues to be a global public health issue amid the COVID-19 pandemic; however, unprecedented demands on hospital antimicrobial stewardship programmes (ASPs) potentially altered their core activities. We sought to understand how ASPs have been involved in and impacted by the pandemic. The 2021 Ontario ASP Landscape Survey was developed based on previous provincial questionnaires and emerging literature on the impact of COVID-19 on hospital ASPs. After pre-testing and piloting, the online questionnaire was distributed to hospital antimicrobial stewardship practitioners in the fall of 2021. Descriptive statistics and inductive thematic analysis were performed. The response rate was 78% (98/125 organizations); 96% (94/98) of organizations had or were in the process of formalizing an ASP and 53% (50/94) reported designated funding/resources. Despite 82% reporting no change in dedicated full-time equivalents during the pandemic, ASPs were frequently involved in developing treatment guidelines/clinical pathways (51%), anticipating/managing drug shortages (46%) and obtaining investigational use drugs (32%). While many core ASP activities continued, prospective audit and feedback and prescriber education were modified or suspended by 43% and 40% of programmes, respectively. Decreased frequency, adaptation of activities (i.e. virtual or other technology) and challenges with staffing/resources were commonly reported themes. Knowledge translation (KT) activities and 'collaboration and coordination' also emerged as salient themes. Hospital antimicrobial stewardship practitioners in Ontario have made significant contributions to the pandemic response while continuing to deliver adapted ASP services, despite resource constraints. Moving forward, ASPs will need to continue building capacity while leveraging broader networks to advance the antimicrobial stewardship agenda.

1753. Impact of a Pharmacist-Driven Home Hospital Antimicrobial Stewardship Program Pilot within a Large Community Health System

Abstract Background Home Hospital (HH) is a unique and rapidly expanding care model that allows patients to receive medical therapy and monitoring through telehealth communication and nursing visits, and there are currently no published studies evaluating antimicrobial stewardship interventions in the HH setting. The goal of this study is to evaluate the impact of a pharmacist-driven antimicrobial stewardship pilot for the HH program. Methods This was a pre-post quasi-experimental study of adult patients enrolled in HH program between January through March in 2021 (control cohort) and in 2022 (intervention cohort), who received antibiotics (oral/intravenous) during their HH admission. Patients on long-term prophylactic antimicrobials, antifungals, external antimicrobials, or mycobacterial treatment were excluded. The antimicrobial stewardship pharmacist performed prospective audit and feedback and provided recommendations to clinicians through the electronic medical record. The primary endpoint was antibiotic use (days of therapy per 1000 patient-days). Secondary endpoints included broad-spectrum antibiotic usage; appropriateness of antibiotic indication, dosing, and duration; compliance with the institution’s outpatient antibiotic reference guide or outpatient intravenous antibiotic therapy (OPAT) monitoring; treatment failure; antibiotic-associated adverse effects; and cost of antibiotic therapy. Results The study included 73 and 127 patients in the control and intervention group, respectively (Figure 1). On average, the pharmacist reviewed 8 eligible patients/day. Interventions were generally well received by HH providers (Figure 2). There was no significant difference in the primary outcome. More inappropriate antibiotic indication was identified in the intervention group (46 [36%] vs. 15 [19%], p=0.01), associated with post-surgical infection prophylaxis after orthopedic procedures (Figure 3). Other secondary outcomes did not vary significantly between the groups. Figure 1:Study inclusion flowchartFigure 2:Intervention breakdownFigure 3:Infection types Conclusion The pilot allows for better understanding of outpatient and HH antibiotic prescribing practices to provide targeted interventions, and suggests the need for additional antimicrobial stewardship involvement to optimize antibiotic therapy in this novel care setting. Disclosures Elizabeth B. Hirsch, PharmD, FCCP, FIDSA, Melinta: Advisor/Consultant|MeMed: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support.

931. All Hands on Deck: Incorporation of Infectious Diseases Pharmacy Trainees in a Community Hospital Antimicrobial Stewardship Program

Abstract Background Community hospitals may have challenges implementing core elements of antimicrobial stewardship (ASP) due to lack of ID trained pharmacists (PharmD). The COVID-19 pandemic compounded these challenges with constrained resources and staffing. The pandemic also saw a rise in antimicrobial use (AU) and brought forth novel therapeutics, thus increasing the need for robust ASP. We established a community ASP rotation for ID PharmD fellows during the COVID-19 pandemic. Methods A community ASP rotation was established at a 151-bed community hospital. ID PharmD trainees rotated with the ID clinician and were responsible for daily prospective audit and feedback (PAF) under close supervision of the ID clinician. Fellows were involved in pandemic response, including protocol development and restrictions for COVID-19 therapeutics. Results A community ASP rotation was successfully implemented (Figure 1). For PAF activities, the most common indications were CAP (19%), HAP (3%), IAI (24%), SSTI (22%) and UTI (19%). Average DOT/1000 was 340.4 per quarter with increases each COVID-19 surge (Figure 2). Empiric AU was protocol adherent 77% of the time and 23% required ASP changes. ASP Interventions included change to protocol (23%), bug drug mismatch (2%), de-escalation (15%), duration change (25%), IV to PO (16%), discontinuation (19%). Fellows successfully developed protocols and managed restrictions for remdesivir, baricitinib, and anti-SARS-CoV-2 monoclonal antibodies in coordination with the ID clinician and assisted in mass vaccination campaign protocols. Conclusion A community ASP rotation was successfully established and sustained during COVID-19. Fellows received hands on experience and performed PAF under close supervision. The program enhanced ID clinician capabilities while leveraging PharmD expertise at a time when staffing and resources were stretched thin. The rotation provided firsthand experience in pandemic preparedness and response. This educational opportunity assisted in maintaining a strong ASP in a community hospital setting while preparing trainees with experiences to assist them throughout their future careers. Disclosures All Authors: No reported disclosures.

945. Development of Antimicrobial Stewardship Programs in Central and South America

Abstract Background There is a need to assess current development of hospital Antimicrobial Stewardship Programs (ASPs) in Latin America. Methods Cross-sectional evaluation of ASPs using a standardized and previously validated self-assessment tool derived from the Centers for Disease Control and Prevention Core Elements of Antibiotic Stewardship (AS). The assessment was deployed to 40 hospitals in Panama, Guatemala, Ecuador, Colombia, and Argentina in 3/2022 through a regional research network. The assessment included 94 questions, with each question including a graded response (meets criteria, partially meets criteria, does not meet criteria, and in some, not applicable). Results 22 public and 16 private hospitals completed the assessment (95% response rate), 10% and 25% of which were small hospitals (< 110 beds), respectively. 82% were academic, and all have an Infection Prevention and Control program/committee. >70% of ASPs have a physician and pharmacist involved, although 65% reported no salary support for AS activities. Only 13% and 29% of AS pharmacists and physicians, respectively, met recommended full-time equivalent/bed ratios; and 76% lacked information and technology (IT) support. 50% indicated the AS committee did not meet regularly, and another 50% reported not including non-AS physicians in the committee. Most hospitals have implemented prior-authorization and post-prescription review and feedback, with much fewer reporting a process to alert of duplicate therapy and use of auto-stops. 89% reported regular access to new antibiotics. While most hospitals monitor antibiotic consumption, few evaluate trends and/or appropriateness of use. Treatment guidelines for most common infections were missing in up to 50% of hospitals, especially in public hospitals. Most respondents indicated their hospitals promote teamwork, and in the vast majority, recommendations from AS are valued. Stratification of results by private and public hospitals in Table. Table:Results of a self-assessment of antimicrobial stewardship activities at the facility level in 38 hospitals in Latin America. Conclusion We found several opportunities for improvement, which differed between private and public hospitals. Common barriers to both settings include access to IT support; better pharmacist and physician resource allocation, education, and monitoring of process and outcomes measures. Disclosures Sara E. Cosgrove, MD, Basilea: Member of Infection Adjudication Committee.

940. First situational diagnosis of the implementation of Antimicrobial Stewardship Programs in Mexican Hospitals, 2021

Abstract Background The development of antimicrobial stewardship programs (ASP) can help to improve the quality of care and contain the growing problem of antimicrobial resistance (AMR). In Mexico, there is little evidence on the design, implementation and evaluation of hospital ASP. The objective of this study is to present a situational diagnosis of the ASP structure, processes implemented and monitoring of results obtained in a sample of Mexican hospitals. Methods An online survey directed to ASP teams was applied to a purposive sample of 40 hospitals that perform regular antimicrobial stewardship activities in Mexico, during the last trimester of 2021. The survey was based on the ‘core elements’ instruments developed by the CDC and WHO. Results Forty hospitals (62% public and 38% private) were surveyed in 13 states in Mexico regarding ASP basic elements. Infrastructure and Organization elements: on average 52% of these hospitals carry basic actions that refer to: written ASP document and annual plan (46%); allocated human resources (68%); availability of material resources (59%) and use of technological platforms (37%). Processes: development of hospital treatment guidelines (49%); educational interventions (40%); persuasive and feedback interventions (42%); and in greater proportion, restrictive interventions (77%). Monitoring activities: interventions (25%); antimicrobial consumption (73%) and AMR (85%) Conclusion This first diagnosis serves as a baseline to determine the current state of ASP implementation per hospital and in the country. It also reflects on the ASP heterogeneity, that should be addressed by national policies. The greatest challenge lies in the program governance, and the systematic monitoring of the implementation of ASP interventions. Disclosures Anahí Dreser, PhD, MSD: Grant/Research Support.

Antibiotics use evaluation among hospitalized adult patients at Jimma Medical Center, southwestern Ethiopia: the way to pave for antimicrobial stewardship

BackgroundAn irrational antibiotic use is a common problem in developing countries like Ethiopia, which makes empiric antibiotics use difficult. It is considered to be the greatest health problem in our time and future unless intervened. Therefore, this study aimed to assess the patterns of antibiotics use among hospitalized adult patients to pave the way for antimicrobial stewardship.MethodsA hospital-based prospective observational study was conducted at Jimma Medical Center, southwestern Ethiopia, from 30 October 2020 to 29 January 2021 with 360 adult hospitalized patients participating. A semi-structured questionnaire and consecutive sampling technique was used for data collection. The data were collected through medical record reviews and patient interviews. The collected data were entered into Epi-data and exported to SPSS® version 23.0 for analysis. Days of therapy (DOT) and essential medicine lists “Access, Watch, and Reserve (AWaRe)” antibiotics classification were used to assess antibiotic use pattern among participants.ResultsThe majority of study participants were females (55.3%), attended formal education (59.4%), and live in rural areas (61.4%) with mean age ± (SD) of 37.65 ± (16.75). The overall rate of antibiotics consumption during the study was 111 days of therapy per 100 bed-days and about two-thirds (66%) of the prescribed antibiotics were from the “Watch” group antibiotics. The indicator level of antibiotics use for “Access” group antibiotics was 34% in this study based on the World Health Organization Essential Medicine List. Cephalosporins were the most commonly used class of antibiotics (93.9%).ConclusionHigher antibiotics exposure and their consumption frequently observed among adult hospitalized patients in the study setting. There was a rapid increase in “Watch” group antibiotics use and about two-thirds of the prescribed antibiotics were from this group. The third-generation cephalosporin were the most commonly used class of antibiotics. Generally, higher consumption and inappropriate antibiotics use among hospitalized adult patients showed the need for urgent interventions by implementing Antimicrobial Stewardship Programs in hospitals.

Implementation of a hospital antimicrobial stewardship program to improve vancomycin use in Cyprus: Challenges and opportunity

The Republic of Cyprus is among the highest consumers of antibacterials for systemic use in Europe. The antimicrobial resistance of invasive isolates in Cyprus is also high compared to the European Union. Formal antimicrobial stewardship initiatives are scarce in Cyprus, raising an urgent need to address the challenges for implementing hospital antimicrobial stewardship. To implement an antimicrobial stewardship program and improve vancomycin use in a tertiary care hospital in Cyprus, through implementation of a protocol for treatment and therapeutic drug monitoring (TDM) and to discuss the current challenges present in Cyprus. Following a local audit of practices, we established a hospital antimicrobial stewardship program with limited resources, towards a model of stewardship which included a persuasive approach, education, selective reporting of antimicrobial susceptibility, providing comments on the microbiology results and regular microbiology clinical ward rounds. By implementing our vancomycin protocol, we achieved a statistically significant improvement (P<0.01) in achieving vancomycin therapeutic levels over a 2-year period, while improving administration practices. Meaningful steps toward implementing a local antimicrobial stewardship program are possible even in resource-limited and unfavourable settings.

Position statement of the Spanish Society of Paediatric Infectious Diseases on the introduction, implementation and assessment of antimicrobial stewardship programmes in paediatric hospitals

In the past few years, antimicrobial resistance has increased, becoming a serious public health problem. The irrational use of antimicrobials is one of the main contributors to antimicrobial resistance. The paediatric population is not free from this problem, as antimicrobials are widely prescribed in this age group, often inappropriately.The introduction of antimicrobial stewardship programmes (ASPs) has proven crucial in curbing the emergence of antimicrobial resistance. At the international level, the need to develop specific paediatric ASPs has been recognised on account of the differences between adult and paediatric patients as concerns infection and approaches to diagnosis and treatment. For this reason, paediatric ASPs should be multidisciplinary programmes led by paediatric infectious disease specialists and use specific paediatric indicators (such as days of treatment, antimicrobial susceptibility patterns in the paediatric population, or clinical indicators) to help identify areas of improvement and develop effective targeted interventions. On the other hand, the support and leadership of the pertinent scientific societies are also essential.The purpose of this document is to present the position of the Sociedad Española de Infectología Pediátrica (SEIP, Spanish Society of Paediatric Infectious Diseases) concerning the implementation of paediatric ASPs in hospitals in Spain and to provide tools to facilitate their application in hospitals throughout the regional health care systems in the country.

Posicionamiento de la Sociedad Española de Infectología Pediátrica sobre la implementación, ejecución y monitorización de los programas de optimización de uso de antimicrobianos en pediatría hospitalaria

In the past few years, antimicrobial resistance has increased, becoming a serious public health problem. The irrational use of antimicrobials is one of the main contributors to antimicrobial resistance. The paediatric population is not free from this problem, as antimicrobials are widely prescribed in this age group, often inappropriately.The introduction of antimicrobial stewardship programmes (ASPs) has proven crucial in curbing the emergence of antimicrobial resistance. At the international level, the need to develop specific paediatric ASPs has been recognised on account of the differences between adult and paediatric patients as concerns infection and approaches to diagnosis and treatment. For this reason, paediatric ASPs should be multidisciplinary programmes led by paediatric infectious disease specialists and use specific paediatric indicators (such as days of treatment, antimicrobial susceptibility patterns in the paediatric population, or clinical indicators) to help identify areas of improvement and develop effective targeted interventions. On the other hand, the support and leadership of the pertinent scientific societies are also essential.The purpose of this document is to present the position of the Sociedad Española de Infectología Pediátrica (SEIP, Spanish Society of Paediatric Infectious Diseases) concerning the implementation of paediatric ASPs in hospitals in Spain and to provide tools to facilitate their application in hospitals throughout the regional health care systems in the country.

Use of leading practices in US hospital antimicrobial stewardship programs.

To determine the proportion of hospitals that implemented 6 leading practices in their antimicrobial stewardship programs (ASPs). Design: Cross-sectional observational survey. Acute-care hospitals. ASP leaders. Advance letters and electronic questionnaires were initiated February 2020. Primary outcomes were percentage of hospitals that (1) implemented facility-specific treatment guidelines (FSTG); (2) performed interactive prospective audit and feedback (PAF) either face-to-face or by telephone; (3) optimized diagnostic testing; (4) measured antibiotic utilization; (5) measured C. difficile infection (CDI); and (6) measured adherence to FSTGs. Of 948 hospitals invited, 288 (30.4%) completed the questionnaire. Among them, 82 (28.5%) had <99 beds, 162 (56.3%) had 100-399 beds, and 44 (15.2%) had ≥400+ beds. Also, 230 (79.9%) were healthcare system members. Moreover, 161 hospitals (54.8%) reported implementing FSTGs; 214 (72.4%) performed interactive PAF; 105 (34.9%) implemented procedures to optimize diagnostic testing; 235 (79.8%) measured antibiotic utilization; 258 (88.2%) measured CDI; and 110 (37.1%) measured FSTG adherence. Small hospitals performed less interactive PAF (61.0%; P = .0018). Small and nonsystem hospitals were less likely to optimize diagnostic testing: 25.2% (P = .030) and 21.0% (P = .0077), respectively. Small hospitals were less likely to measure antibiotic utilization (67.8%; P = .0010) and CDI (80.3%; P = .0038). Nonsystem hospitals were less likely to implement FSTGs (34.3%; P < .001). Significant variation exists in the adoption of ASP leading practices. A minority of hospitals have taken action to optimize diagnostic testing and measure adherence to FSTGs. Additional efforts are needed to expand adoption of leading practices across all acute-care hospitals with the greatest need in smaller hospitals.

An appraisal of the contextual drivers of successful antimicrobial stewardship implementation in Nigerian health care facilities

Antimicrobial resistance (AMR) is a consequence of inappropriate actions, including irrational antimicrobial prescribing and use. Antimicrobial resistance remains an emergent and significant public health threat, particularly in low and middle-income countries (LMICs), including Nigeria. Optimizing antimicrobial (AM) use through functional hospital antimicrobial stewardship (AMS) programs is one of the strategies to control the spread of AMR. Literature is replete with evidence, but few studies examined the contextual factors limiting AMS functionality at the facility levels. This study explored the intrinsic contextual factors shaping AMS practice at the three-tiered levels of care. This was a qualitative case study with a purposeful sample size of 30 participants drawn from two primary, two secondary, and two tertiary health facilities in Nigeria. Data were coded and categorized for thematic analysis. Emergent themes include lack of AMS programs, inadequate guidelines, lack of modern equipment and incorrect diagnosis, absence of continuous medical education, imbalance of power among professionals, and pervasive external influence of pharmaceutical marketing companies. These findings demonstrate that the AMS program is lacking or poorly implemented at the three-tiered level of care. We recommended that health facilities establish AMS programs in line with the World Health Organization's stepwise approach. These challenges, if addressed, will promote the successful performance of the AMS program, contributing to rational AM use at all levels of care. Since primary health centres constitute 85.4% of all health facilities, customizing the AMS core elements at this level will contribute to achieving the goals of universal health coverage.

A Nonrestrictive Approach to Fluoroquinolone Stewardship at Two Community Hospitals.

BackgroundFluoroquinolones are one of the most prescribed antimicrobials in the United States and have been increasingly used in inpatient and outpatient settings to treat various infectious diseases syndromes. Due to the unwanted collateral effects on antibiotic resistance, poor susceptibility rates among Gram-negative pathogens, and adverse effects, fluoroquinolones are often targeted by hospital antimicrobial stewardship programs to prevent overutilization. This study describes the association of nonrestrictive antimicrobial stewardship interventions at 2 nonacademic community hospitals on levofloxacin utilization, prescribing patterns on alternative antibiotics, and Pseudomonas aeruginosa nonsusceptibility rates to levofloxacin.MethodsNonrestrictive antimicrobial stewardship interventions included monitoring and reporting of fluoroquinolone susceptibility trends to physician groups, performing medication use evaluations of levofloxacin accompanied with prescriber detailing, daily prospective audit and feedback, implementation of beta-lactam-based institutional guidelines for empiric therapy in various infectious disease syndromes, review and adjustment of electronic medical record order sets containing fluoroquinolones, and intensive prescriber education. No preauthorization of levofloxacin was used during this study period. Antibiotic utilization data were collected for the time periods of August 2015 through January 2021. Correlation between levofloxacin and other broad-spectrum antibiotc use was investigated as well as the impact on Pseudomonas aeruginosa levofloxacin nonsusceptibility rates.ResultsBoth hospitals showed an overall downward trend in the prescribing of levofloxacin during the time period of August 2015 to January 2021. There was a significant negative correlation between monthly ceftriaxone and levofloxacin days of therapy for both hospitals (P < .0001). There was a positive correlation between levofloxacin days of therapy and P aeruginosa nonsusceptibility (P < .02 at both hospitals).ConclusionsOur results demonstrate that a nonrestrictive approach to fluoroquinolone stewardship interventions had a significant impact on reducing levofloxacin utilization, increasing ceftriaxone utilization, and improving P aeruginosa levofloxacin susceptibility.

Harvesting the low-hanging fruit? Comparative assessment of intravenous to oral route antimicrobial conversion policy implementation.

Policies that promote conversion of antibiotics from intravenous to oral route administration are considered "low hanging fruit" for hospital antimicrobial stewardship programs. We developed a simple metric based on digestive days of therapy divided by total days of therapy for targeted agents and a method for hospital comparisons. External comparisons may help identify opportunities for improving prospective implementation.

Implementing Leading antimicrobial stewardship practices in United States hospitals – A qualitative study

Background: In May 2018, The Joint Commission, The Pew Charitable Trusts, and the CDC cosponsored a meeting of experts who identified 6 evidence-based leading practices that antimicrobial stewardship programs (ASPs) should be doing beyond having basic infrastructure for improving antibiotic prescribing. The Joint Commission Department of Research working with external experts in 2020 conducted a prevalence study to assess what proportion of Joint Commission-accredited hospitals had implemented the 6 leading practices identified (results presented at SHEA Spring 2021). In this qualitative study, we collected information about how hospitals implemented ASP leading practices to identify facilitators and barriers to implementation among diverse hospitals. Methods: We conducted in-depth telephone interviews with a subset of ASP leaders from hospitals that participated in the 2020 prevalence study. We used purposive sampling to select 30 hospitals from 288 hospitals based on leading practices implemented, hospital size, and system membership. An experienced qualitative researcher (M.K.) not previously affiliated with the Joint Commission interviewed all participants using a semistructured interview guide. The framework method of analysis was used to review and organize data. We used the constant comparative approach to ensure that factors were not missed. Each transcript was reviewed by at least 2 researchers who compared coded findings in group discussion sessions. Two researchers independently identified key factors and combined findings following discussion and review. We focused on super factors that are relevant to implementing multiple leading practices. Results: ASP leaders from 30 hospitals were interviewed. Participating hospitals were evenly distributed across hospital size (10 small, 10 medium, 10 large) and membership in a health system (16 system, 14 nonsystem). At least 14, (46.7%) interviewees had pharmacist in their title; 11 (36.7%) had pharmacist-antimicrobial stewardship; and 5 (16.6%) had other titles (eg, infection preventionist). Super factors included ASP team capacity, ID expertise, having a physician champion, relationships with clinicians and relevant departments, structure of electronic health records, adequate software, and information technology resources. Small and rural nonsystem hospitals often lacked resources related to ID expertise, dedicated staff, and software tools, whereas hospitals that belong to a system benefit from centralized ID expertise and technical infrastructure provided. Conclusions: Specific factors related to personnel, relationships and IT resources have an outsized impact on implementing multiple leading antimicrobial stewardship practices in hospitals. Hospital ASPs could benefit by targeting resources toward these areas.Funding: NoneDisclosures: None

Characteristics of antimicrobial stewardship programmes in hospitals of Uganda.

While interest in antimicrobial stewardship programmes (ASPs) is growing in most low- and middle-income countries (LMICs), there is a paucity of information on their adoption or implementation in Africa, particularly Uganda. The study assessed the presence and characteristics of ASPs, implemented antimicrobial stewardship (AMS) strategies and the challenges to their implementation in hospitals in Uganda. We conducted a cross-sectional study among heads of infection prevention committees (IPCs) in regional referral hospitals, general hospitals, and private-not-for-profit (PNFP) hospitals from November 2019 to February 2020. An interviewer-administered questionnaire was used to collect data. We analysed data using descriptive statistics. A total of 32 heads of IPCs were enrolled in the study. Of these, eight were from regional referral hospitals, 21 were from general hospitals, and three were from PNFPs. Most heads of IPC were pharmacists (17/32, 53.1%) with a mean age and standard deviation (sd) of 36.1 (±1.1) years. A formal ASP was adopted or implemented in 14 out of the 32 (44%, 95% CI 26-62) studied hospitals. Thirty out of 32 hospitals implemented at least one type of AMS strategy. Sixty-eight percent (22/32) of the hospitals implemented pre-authorisation and approval as their primary AMS core strategy to optimise antibacterial use. The most commonly reported challenges to the implementation of ASP across all 32 hospitals (with or without ASP) were lack of time for the ASP team (29/32, 90.6%) and lack of allocated funding for antimicrobial stewardship team (29/32, 90.6%). In this study, most hospitals in Uganda implemented at least one AMS strategy despite the low implementation of ASPs in hospitals. The ministry of health needs to sensitise and support the establishment of ASP in hospitals across the country.

Point Prevalence Surveys of Antimicrobial Prescribing in a Non-Acute Care Hospital in Saitama Prefecture, Japan

Background The global point prevalence survey (Global-PPS) is the standard for the surveillance of prescribed antimicrobials among inpatients and provides data for the development of hospital antimicrobial stewardship programs. Aim To evaluate the prevalence and quality of antimicrobial prescriptions using the universally standardized Global-PPS protocol in a non-acute care hospital in Saitama Prefecture, Japan. Methods Antimicrobial prescriptions for inpatients, staying at the hospital overnight, were surveyed on three separate week days in November 2018, January 2019, and May 2019. Information on the prescribed antimicrobials on the survey target day was obtained from the in-hospital pharmacy. Survey data were collected by physicians, based on the extracted information. Patient information was anonymized and entered in the Global-PPS Web application by physicians. We report the antimicrobial use prevalence, the indication for prescription, diagnosis, the most prescribed antimicrobials, and a set of quality indicators related to antimicrobial prescribing. Results In total, 6.7% of the surveyed inpatients (120/1796) were prescribed antimicrobials on the survey day. Sulfamethoxazole/trimethoprim was the most commonly prescribed, with 20.0% of systemic antibiotic prescriptions (ATC J01). Of all antibiotics for systemic use, up to 58.4% were Watch antibiotics, as defined by the World Health Organization AWaRe classification. The most prescribed group of systemic antibiotics was non-penicillin beta-lactam antibiotics (34.4%), followed by penicillin antibiotics in combination with beta-lactamase inhibitors (25.6%), and sulfonamides with trimethoprim (20.8%). Healthcare-associated infections and medical prophylaxis were the most common indications reported in 69.3% and 26.3% of prescriptions, respectively. The most common diagnosis for systemic antibiotic prescriptions was pneumonia (49.6%). Reasons for antimicrobial prescriptions were indicated in the medical records for 67.1% of prescriptions, and the stop/review date was documented to be 50.3%. Compliance with local guidelines reached 66.7%. Conclusions This study highlights important challenges related to antimicrobial prescription in a highly specific, non-acute care patient population.

Coaching ward pharmacists in antimicrobial stewardship: A pilot study

BackgroundWard pharmacists are well-positioned to enhance the activities of hospital antimicrobial stewardship (AMS) programs by reviewing the appropriateness of antimicrobials and making recommendations to prescribers. However, recent studies have identified gaps in ward pharmacists' AMS practice, knowledge, skills, and confidence which suggests education and training programs are needed. Objective(s)To describe, for the first time, an interactive educational activity – coaching in AMS – targeted at ward pharmacists and explore their perceptions of coaching as a mode of delivering education to improve AMS knowledge, skills, confidence, and practice. A secondary objective was to describe the type, frequency, and acceptance of AMS recommendations made by coached pharmacists. MethodsThis was a descriptive pilot study with a qualitative evaluation of pharmacists' perceptions and experiences of coaching. AMS coaching was delivered over 2 months in 2019 to pharmacists providing clinical pharmacy services to general medical and surgical wards. A focus group was conducted one month after the coaching period to elicit pharmacists' perceptions of coaching as a mode of delivering AMS education and how it impacted their AMS knowledge, skills, confidence, and practice. AMS recommendations made by coached pharmacists were prospectively recorded, and the prescriber acceptance rate was determined. ResultsWard pharmacists reported positive experiences with AMS coaching and believed it helped them identify a range of recommendations to improve antimicrobial prescribing and increased their confidence to communicate recommendations to prescribers. Workload issues were identified as the main barrier to implementation. Suggestions were provided to improve coaching implementation feasibility. During coaching, 162 AMS recommendations were identified for a range of antimicrobials, and 69% (113/162) were accepted and implemented. ConclusionsWard pharmacists believed coaching improved their AMS knowledge, skills, confidence, and practice, including their confidence to discuss recommendations with prescribers. These results can assist with the design and evaluation of future hospital-based AMS educational initiatives.

Evaluating the Prevalence and the Risk Factors of Gram-Negative Multi-Drug Resistant Bacteria in Eastern Saudi Arabia.

PurposeMultidrug-resistant organisms (MDROs) among Gram-negative bacteria (GNB) are a major public health concern worldwide, which can even lead to death. This study was conducted to determine the prevalence of MDROs among isolated GNB in the Security Forces Hospital Dammam (SFHD) and identify its associated risk factors.Materials and MethodsA cross-sectional study was performed on the most commonly isolated GNB in SFHD, Acinetobacter spp., Enterobacter spp., Escherichia coli (E. coli), Klebsiella pneumoniae, Proteus spp., and Pseudomonas aeruginosa, of non-duplicated clinical samples collected from all hospital units throughout the period from January 2017 to December 2018. Data were collected retrospectively from patients’ medical records, and analyses were conducted using the chi-square test and logistic regression models.ResultsOf the 1508 GNB included in the study, 969 were multidrug-resistant (MDR; 64.3%). The most commonly identified multidrug-resistant GNB (MDR-GNB) were found in female patients (66.4%) and those aged between 20 and 29 years (21.8%). Urine samples had the highest number of isolated GNB (926 of a total of 1508, 61.4%), and E. coli isolates (53.8%) were the most frequently isolated GNB. Enterobacter spp. had the highest rate of multidrug resistance during the 2 years (64 out of 74, 86.5%). Mechanical ventilation for three or more calendar days was a significant direct risk factor for the development of MDR-GNB (odds ratio [OR]: 2.600, 95% confidence interval [CI]: 1.124–6.012, P = 0.025).ConclusionMultidrug resistance is common among GNBs in SFHD. Antimicrobial stewardship programs in hospitals should be supported and implemented. Medical and public awareness of antibiotic use is another significant way to decrease the burden of MDR.

91. Gaps and Opportunities in Antimicrobial Stewardship Programs in Asia: A Survey of 10 Countries

BackgroundMost studies on hospital antimicrobial stewardship (AMS) status and practices are conducted in the west, and there is a lack of such data from Asian countries. The objective of this survey was to determine existing AMS practices and gaps, and challenges in implementing AMS programs in secondary and tertiary acute-care hospitals in 10 Asian countries.MethodsA 70-item questionnaire was disseminated to hospitals fulfilling inclusion criteria and responses were collected from 10 April 2020 to 9 April 2021. The survey, specific to the Asian hospital setting, enquired about hospital leadership support for AMS; AMS team membership and training; AMS interventions; AMS monitoring and reporting; hospital infrastructure; and education. These were subdivided into core and supplementary components, adapted from the Transatlantic Taskforce on Antimicrobial Resistance set of core and supplementary indicators for hospital AMS programs, and the US Centers for Disease Control and Prevention checklist for core elements of hospital AMS programs.ResultsA total of 349 hospitals from Cambodia, India, Indonesia, Japan, Malaysia, Pakistan, Philippines, Taiwan, Thailand and Vietnam responded. Overall, only 47 hospitals fulfilled all 12 core components, and there were inter-country differences in terms of performance. The hospitals generally did well in terms of the AMS team (ie, comprising at least a physician leader responsible for AMS activities, a pharmacist, and infection control and microbiology personnel), and access to a timely and reliable microbiology service, with mean positive response rates (PRR) of ≥ 80% for these indicators (Figure 1). In the core components of AMS program interventions, and AMS monitoring and reporting, the lower mean PRR ( > 60%) revealed that Asia has wider gaps in these areas versus gold standards. Although many hospitals had formal hospital leadership statements to support AMS (mean PPR 85.6%), this was not always matched by allocated financial support for AMS activities (mean PPR 57.1%).Figure 1 ConclusionFor all core components of an AMS program, most Asian hospitals participating in this survey fell short of international gold standards. Inter-country differences in gaps highlight that country-specific solutions are needed to improve current standards in AMS.Disclosures Tetsuya Matsumoto, MD; PhD, MSD (Speaker's Bureau)Pfizer (Speaker's Bureau)

125. Antimicrobial Stewardship Hospital Activities to Promote Antibiotic Awareness Week 2019, Chicago, IL

BackgroundU.S. Antibiotic Awareness Week (USAAW) is an annual campaign to increase knowledge of antimicrobial resistance (AMR) threats and the importance of appropriate antibiotic use. USAAW will be observed November 18-24, 2021 in cadence with World Antimicrobial Awareness Week. MethodsIn October 2019, the Chicago Department of Public Health (CDPH) surveyed 25 Chicago acute care hospital (ACH) antimicrobial stewardship programs (ASPs) via REDCap, an electronic data capture system, to assess their planned activities for USAAW in November 2019. Survey results from 14 (56%) respondent ACHs were collated and disseminated to all 25 ACHs prior to USAAW. ResultsACH ASP survey responses were categorized by ACH size: smaller hospitals (SH) < 350 beds (n=7) and larger hospitals (LH) > 350 beds (n=7) and displayed in the Table. Nine respondents were Infectious Disease (ID) Pharmacists, 3 were ID Physicians, 1 was an Administrator and 1 was an Infection Prevention Nurse. Among SHs, the ASP was funded for an ID Pharmacist salaried position (FTE) < 0.5 at 4 ACHs, 0.5 in 2, and 1 FTE at 1 ACH. LHs reported ID Pharmacist funding ranging from < 0.5 – 2.5 FTE, with the majority with 1 FTE at 3 LHs. All ACHs reported 0.5 FTE or less ID Physician support for their ASPs. Eleven (79%) of respondent ACHs did not report an annual budget for ASP activities. Ten (71%) ACHs disagreed or strongly disagreed that funding was adequate in the outpatient setting compared to inpatient both for adult and pediatric ASP services. Types of planned activities for USAAW included social media posts, provider education, digital displays, and/or go-live with a new antimicrobial policy. Top three barriers to ASP advancements were financial considerations (n=9), competing responsibilities for ASP leads (n=7), and tied for third was personnel shortages (n=6) and other clinical initiatives with higher priority (n=6). ConclusionPublic Health Departments can facilitate assessment of ACH ASPs within their jurisdiction to identify ways to advance the ASP agenda and combat AMR. A variety of strategies were used by Chicago ACHs to promote ASP initiatives during USAAW. Challenges continue with inadequate funding, especially in outpatient settings.Disclosures All Authors: No reported disclosures