Impact Of Antimicrobial Stewardship Research Articles

Clinical impact of multidisciplinary carbapenem stewardship interventions: a retrospective cohort study.

Antimicrobial stewardship (AMS) program aims to optimise antimicrobial utilisation and curb antimicrobial resistance. We investigated the clinical impact of AMS among patients with carbapenem in medical wards of a tertiary hospital. A retrospective cohort study was conducted on hospitalised adult patients treated with carbapenem and reviewed by a multidisciplinary AMS team. We compared the clinical outcomes of accepted (n = 103) and not-accepted AMS intervention cases (n = 37). The outcomes evaluated include trends of total white blood cells (TWBC), C-reactive protein (CRP), body temperature at day-7, and clinical status at day-30 post-AMS intervention. The interventions included discontinuation (50%), de-escalation (47.9%) and escalation (2.1%) of antibiotics, where the acceptance rate was 67.1%, 80.6% and 66.7%, respectively. Overall, we found no significant difference in clinical outcomes between accepted and not-accepted AMS interventions at day-7 and day-30 post-interventions. On day-7, 62.0% of patients in the accepted group showed decreased or normalised TWBC and CRP levels compared to 47.4% of the not-accepted group (p = 0.271). The mortality at day-30 (32% versus 35%, p = 0.73), discharge rate (53.4% versus 45.9%, p = 0.437), and median length of hospital stay (36.0 versus 30.0days, p = 0.526) between the groups were comparable. The predictors of 30-day mortality in the study subjects were Charlson Comorbidity Index > 3 (OR: 2.84, 95% CI 1.28-6.29, p = 0.010) and being febrile at day-7 (OR: 4.58, 95% CI 1.83-11.5, p = 0.001). AMS interventions do not result in significant adverse clinical impact and mortality risk.

Impact of Antimicrobial Stewardship on Reducing Antimicrobial Resistance.

Antimicrobial resistance has become a serious global issue, posing a significant threat to public health and healthcare professionals. Since the advent of penicillin, many antibiotics have lost their effectiveness in combating microbes simply due to inappropriate, irrational, unnecessary, and unrestricted use. The ineffectiveness of an increasing number of antibiotics necessitates the utilization of more potentantimicrobial agents for combatting uncomplicated infections. In response to the escalating prevalence of multidrug-resistant pathogens and the imperative to curtail the demand for novel antibiotics, the Antimicrobial Stewardship Program was conceived and implemented. This initiative is characterized by a lead physician, ideally possessing expertise in infectious diseases, alongside a pharmacist serving as a secondary leader and a microbiologist with defined responsibilities to achieve several objectives. These objectives include reducing indiscriminate usage of antimicrobial agents, promoting selective antimicrobial utilization based on culture results, de-escalating therapy from broad-spectrum to targeted antimicrobial agents, and transitioning from parenteral to oral administration when feasible. These objectives are pursued through a combination of pre-prescription and post-prescription strategies. While the Antimicrobial Stewardship Program is widely established in developed nations, a pressing need exists for its more comprehensive implementation in less developed regions.This review aims to examine the strategies used in antimicrobial stewardship programs to evaluate their effectiveness in preventing the development of multidrug-resistant organisms (MDROs) based on existing research studies.Under the Antimicrobial Stewardship Program, education of healthcare professionals and continuous disposal of information about antimicrobial resistance have helped to restrict the emergence of multidrug-resistant organisms.

1262. The Impact of Antimicrobial Stewardship on Antimicrobial Consumption and Resistance Trends at a Tertiary Care Center in Beirut

Abstract Background Antimicrobial Resistance (AMR) is a threat to public health, causing increased morbidity and mortality particularly among hospitalized patients. The COVID-19 pandemic has further worsened the situation globally, causing a surge in the number of critically ill patients, and an increase in antimicrobial consumption resulting in the spread of infections with multidrug-resistant organisms (MDROs). Antimicrobial Stewardship Programs (ASP) play a crucial role in optimizing antimicrobial consumption to fight AMR. In this study, we evaluate the impact of ASP interventions on antibiotic consumption and trends of AMR among bacterial pathogens at a tertiary care center in Beirut before and after the pandemic. Methods ASP team recommendations are labeled as interventions. We compiled the ASP interventions from January 2019 until December 2021. Data on antimicrobial consumption, expressed as defined daily dose (DDD) per 100 patient days, for all anti-infectives and restricted anti-infectives was collected per quarter. Data on MDRO resistance trends were obtained from the clinical microbiology laboratory from 2019 to 2022. Results The number of ASP recommendations is reported in Figure 1. There is a noticeable correlation between COVID-19 surges in Lebanon and the number of ASP interventions. We note an increase in all antimicrobial consumption after the onset of the pandemic, with a peak in Q4 2020 (142.8 DDD/100 patient days) (Figure 2), and in Q1 2021 for restricted antimicrobials (79.1 DDD/100 patient days) (Figure 3). Importantly, there were no noteworthy changes in resistance patterns for MDR gram-negative organisms, except for MDR Acinetobacter baumannii and Carbapenem resistant Klebsiella spp., which decreased by 27% and 8%, respectively. We witnessed a rise in Gram-positive resistance trends for Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococcus (f29% to 33% and 9% to 14% in 2019 to 2022, respectively).Figure 1.Number of ASP Interventions Pre- and During COVID-19Figure 2.All Antimicrobials Defined Daily Dose per 100 Patient Days and Resistance Trends of MDROsFigure 3.Restricted Antimicrobials Defined Daily Dose per 100 Patient Days and Resistance Trends of MDROs Conclusion This study highlights the importance of ASP activities despite and during a pandemic. The results emphasize the role of ASP to mitigate the impact of the pandemic on antimicrobial resistance. The ASP team maintained its operations, monitoring antibiotic consumption and providing recommendations to limit antibiotic misuse. Disclosures Souha S Kanj, MD, Gilead: Advisor/Consultant|Menarini: Advisor/Consultant|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant

The Impact of Antimicrobial Stewardship in Treating Patients with Escherichia coli Bacteremia in a Small Single Center Community Hospital.

Purpose: There are many challenges that pharmacist led antimicrobial stewardship programs can encounter including lack of resources, costs, and inaccurate antimicrobial susceptibility testing (AST) results. The COVID-19 pandemic has led to increased resistance especially with gram negative infections. At a small single center community hospital, gram negative infections, particularly Escherichia coli infections, predominately occur. Therefore, this study aims to address gram negative bacteremia burden and its impact on antimicrobial stewardship efforts for combatting Escherichia coli and ESBL organisms with such barriers during the pandemic. Methods: In a retrospective cohort study, patients ≥ 18 years of age from a small community hospital were reviewed. Patients were excluded if their blood cultures were not positive for Escherichia coli and if antibiotics were not initiated during hospital stay. The primary endpoint was to determine the length of hospital stay. Critical secondary endpoints include antibiotic de-escalations, duration of antibiotics, time to definitive antibiotic therapy, serum procalcitonin levels, blood culture availabilities, MIC breakpoints, co-infection of COVID-19, and Clostridioides difficile occurrences. Results: Out of 74 patients with gram negative bacteremia, 41 patients specifically had Escherichia coli bacteremia. The primary endpoint results showed that patients with Escherichia coli bacteremia that stayed in the ICU had a length of stay of 13.6 days. Patients with Escherichia coli bacteremia in the Non-ICU setting has a length of stay of 7.3 days, and patients with ESBL bacteremia in the Non-ICU setting had a length of stay of 6.8 days. Conclusions: Despite the various challenges that antimicrobial stewardship programs (ASP) face in a single center small community hospital, the ASP at this small community hospital utilizes various policies and tools to increase appropriate antibiotic use and decrease hospital length of stay in patients with Escherichia coli bacteremia.

Impact of antimicrobial stewardship in organisms causing nosocomial infection among COVID-19 critically ill adults

ObjectiveTo evaluate the implementation of an antibiotic stewardship program in critically ill COVID-19 patients and to establish risk factors for coinfection. Secondary objective was to analyze the evolution of the etiology of respiratory nosocomial infections. MethodsSingle-center observational cohort study of consecutive patients admitted to ICU due to COVID-19 pneumonia from March 2020 to October 2022. An antibiotic stewardship program was implemented at the end of the second wave. ResultsA total of 878 patients were included during 6 pandemic waves. Empirical antibiotic consumption decreased from the 96% of the patients during the first pandemic wave, mainly in combination (90%) to the 30% of the patients in the 6th pandemic wave most in monotherapy (90%). There were not differences in ICU and Hospital mortality between the different pandemic periods. In multivariate analysis, SOFA at admission was the only independent risk factor for coinfection in critically ill COVID-19 patients (OR 1,23 95%CI 1,14 to 1,35). Differences in bacterial etiology of first nosocomial respiratory infection were observed. There was a progressive reduction in Enterobacteriaceae and non- fermentative Gram Negative Bacilli as responsible pathogens, while methicillin-sensitive Staphylococcus aureus increased during pandemic waves. In the last wave, however, a trend to increase of potentially resistant pathogens was observed. ConclusionsImplementation of an antibiotic stewardship program was safe and not associated with worse clinical outcomes, being severity at admission the main risk factor for bacterial coinfection in covid-19 patients. A decline in potentially resistant pathogens was documented throughout the pandemic.

Impact of antimicrobial stewardship with the Xpert MRSA/SA BC assay at a tertiary hospital in Japan

IntroductionGenetic testing is gaining increasing importance as a part of antimicrobial stewardship (AS). Rapid identification and determination of methicillin susceptibility using the Xpert MRSA/SA BC assay can improve the management of Staphylococcus aureus bacteremia (SAB) and reduce inappropriate antibiotic use. However, few reports have described the effectiveness of this approach. MethodsThe present study aimed to assess the influence of AS using the Xpert MRSA/SA BC assay. Cases were classified into the pre-intervention group (n = 98 patients), in which SAB was identified by traditional culture (November 2017 to November 2019), and the post-intervention group (n = 97 patients), in which the Xpert MRSA/SA BC assay was performed when necessary (December 2019 to December 2021). ResultsPatient characteristics, prognosis, duration of antimicrobial use, and length of hospital stay were compared between the groups. The Xpert assay was performed in 66 patients in the post-intervention group (68.0%). The two groups showed no significant differences in severity and mortality. The rate of cases treated with anti-MRSA agents reduced following the intervention (65.3% vs. 40.4%, p = 0.008). The number of cases involving definitive therapy within 24 h was higher in the post-intervention group (9.2% vs. 24.7%, p = 0.007). The hospitalization rate at >60 days was lower in Xpert implementation cases among MRSA bacteremia cases (28.6% vs. 0%, p = 0.01). ConclusionsThus, the Xpert MRSA/SA BC assay has potential as an AS tool, especially for early definitive treatment to SAB and reduction of long-term hospitalization in MRSA bacteremia cases.

The impact of antimicrobial stewardship on appropriate use of antimicrobial agents for nosocomial infections caused by gram-negative bacilli in a university hospital in Thailand

The impact of antimicrobial stewardship on appropriate use of antimicrobial agents for nosocomial infections caused by gram-negative bacilli in a university hospital in Thailand

The Impact of Antimicrobial Stewardship and Infection Control Interventions on Acinetobacter baumannii Resistance Rates in the ICU of a Tertiary Care Center in Lebanon.

Antimicrobial resistance is a serious threat to global health, causing increased mortality and morbidity especially among critically ill patients. This toll is expected to rise following the COVID-19 pandemic. Carbapenem-resistant Acinetobacter baumannii (CRAb) is among the Gram-negative pathogens leading antimicrobial resistance globally; it is listed as a critical priority pathogen by the WHO and is implicated in hospital-acquired infections and outbreaks, particularly in critically ill patients. Recent reports from Lebanon describe increasing rates of infection with CRAb, hence the need to develop concerted interventions to control its spread. We set to describe the impact of combining antimicrobial stewardship and infection control measures on resistance rates and colonization pressure of CRAb in the intensive care units of a tertiary care center in Lebanon before the COVID-19 pandemic. The antimicrobial stewardship program introduced a carbapenem-sparing initiative in April 2019. During the same period, infection control interventions involved focused screening, monitoring, and tracking of CRAb, as well as compliance with specific measures. From January 2018 to January 2020, we report a statistically significant decrease in carbapenem consumption and a decrease in resistance rates of isolated A. baumannii. The colonization pressure of CRAb also decreased significantly, reaching record low levels at the end of the intervention period. The results indicate that a multidisciplinary approach and combined interventions between the stewardship and infection control teams can lead to a sustained reduction in resistance rates and CRAb spread in ICUs.

The Impact of Antimicrobial Stewardship in Children in Low- and Middle-income Countries: A Systematic Review.

Background:Antimicrobial stewardship (AMS) is central to the World Health Organisation Global Action Plan against antimicrobial resistance (AMR). If antibiotics are used without restraint, morbidity and mortality from AMR will continue to increase. In resource-rich settings, AMS can safely reduce antibiotic consumption. However, for children in low- and middle-income countries (LMIC), the impact of different AMS interventions is unknown.Aim:To determine the impact of different AMS interventions on antibiotic use and clinical and microbiologic outcomes in children in LMIC.Methods:MEDLINE, Embase and PubMed were searched for studies of AMS interventions in pediatric population in LMIC settings. Controlled trials, controlled before-and-after studies and interrupted time series studies were included. Outcomes assessed were antibiotic use, multidrug-resistant organism (MDRO) rates, clinical outcomes and cost.Results:Of 1462 studies, 34 met inclusion criteria including a total population of >5,000,000 in 17 countries. Twenty were in inpatients, 2 in ED, 10 in OPD and 2 in both. Seven studies were randomized controlled trials. All types of interventions reported a positive impact on antibiotic prescribing. AMS bundles with education, and clinical decision tools appeared more effective than guidelines alone. AMS interventions resulted in significantly decreased clinical infections (4/4 studies) and clinical failure (2/2) and reduced MDRO colonization rate (4/4). There was no concomitant increase in mortality (4/4 studies) or length of stay (2/2).Conclusion:Multiple effective strategies exist to reduce antibiotic consumption in LMIC. However, marked heterogeneity limit conclusions regarding the most effective approach, particularly regarding clinical outcomes. Overall, AMS strategies are important tools in the reduction of MDRO-related morbidity in children in LMIC.

Antimicrobial stewardship in wound care implementation and measuring outcomes: results of an e-survey.

Antimicrobial resistance (AMR) occurs (as a result of misuse, such as over-prescribing) when certain pathogens fail to respond to treatment with antimicrobials. Consequently, patients can become severely ill and possibly die. A strategy referred to as antimicrobial stewardship (AMS) has been introduced which reduces the impact of this antimicrobial misuse. To explore health professionals' (working in wound care, treating both acute and hard-to-heal wounds) position in terms of the following: awareness of AMS; if they are aware of AMS, if they implement procedures to support its practice; and if they implement AMS, do they measure its impact by and compare pre- and post-implementation? An e-survey designed to explore health professionals' awareness of AMS and its implications for wound care. There were 987 respondents to the survey. The majority were specialist wound care nurses, mainly based in the UK or the US and Canada. A high proportion of those surveyed were completely/partially aware (35.1/57.9%, respectively) of AMS, and almost all implemented strategies to reduce antimicrobial prescribing. Of those surveyed, 36% took steps to measure the impact of AMS, and as a result 35.2% reported positive impacts (for example, cost reductions, a reduction in the systemic use of antimicrobials, a reduction in the topical use of antimicrobials and a reduced level of antimicrobial-resistant microorganisms). Challenging aspects of AMS implementation were reported by 33.2% of respondents (for example, poorer clinical outcomes in terms of healing and increased costs). The data highlighted that 40.49% felt that AMS would be 'easy' or 'very easy' to implement while 21.73% felt that AMS would be 'difficult' or 'very difficult' to implement. Education strategies need to be devised to raise awareness and support health professionals, including wound care practitioners, to understand and implement effective AMS programmes. Development of clear metrics is required to evaluate the effect of AMS programmes in clinical practice.

A commitment and call to strengthen and expand qualitative research efforts to improve the impact of antimicrobial stewardship.

Inadequate recognition of the value of qualitative research in healthcare, notably in antimicrobial stewardship (AMS), in addition to a lack of publishing space in medical journals has prompted JAC-Antimicrobial Resistance to focus on a qualitative series of AMS papers to incite interest in and support for pivotal qualitative approaches that make an indispensable contribution to our understanding of antibiotic use and how to address antimicrobial resistance. In this series, invited authors with diverse backgrounds and considerable expertise address and review intricate and varying qualitative research methods, behaviour change determinants, interventions and qualitative perspectives, with the aim of strengthening commitment and expanding qualitative initiatives to further the impact of AMS globally.

Divide and conquer: Feasibility and Impact of antimicrobial stewardship in a safety‐net community hospital after a syndrome‐based education initiative for pharmacists

AbstractIntroductionAntimicrobial stewardship programs (ASP) have been shown to reduce antimicrobial utilization (AU) and cost. ASP has been required by the Joint Commission for hospital accreditation since 2017. Community hospitals with limited pharmacy staffing and infectious diseases (ID)‐trained pharmacists may have barriers for implementing and sustaining comprehensive ASP.ObjectivesOur objective was to assess the feasibility and impact of syndrome‐based ASP training on pharmacist knowledge, perceptions, and AU in a community hospital with limited pharmacy staff.MethodsA quasi‐experimental study at a 151‐bed hospital was conducted. Pharmacist training on syndrome‐based guidelines was developed by an ID physician. A qualitative cross‐sectional survey to assess pharmacist knowledge and perceptions of ASP was administered before and 3 months after ASP training. Prospective audit and feedback (PAF) were deployed with responsibilities divided between shifts. The Centers for Disease Control and Prevention (CDC) checklist of core elements was done quarterly for 12 months. AU, Clostridium difficile rates, and cost were compared for 12 months before and after implementation.ResultsMost pharmacists did not feel comfortable managing infections before ASP training. All pharmacists found the guidelines helpful and felt more comfortable managing infections at 3 months. ASP was successfully deployed by dividing tasks between shifts. Days of therapy per 1000 patient days increased from 355.5 to 376. The proportion of parenteral antimicrobials decreased from 71% to 65%.Total antimicrobial expenditures decreased by 23%. C. difficile rates decreased by 21% (3.27 vs 2.56) per 10 000 patient days.ConclusionASP was successfully implemented in a safety‐net community hospital without ID‐trained pharmacists using a syndrome‐based education initiative. This strategy improved pharmacist knowledge and perceptions of ID syndromes and ASP. Dividing tasks between shifts can leverage existing resources to fulfill all core elements. Clear guidelines and access to an ID physician are necessary to develop materials and provide support for pharmacists without ID‐specific training and can help curb costs and optimize AU.

THE IMPACT OF ANTIMICROBIAL STEWARDSHIP ON THE PATTERNS OF ANTIBIOTICS’ PRESCRIPTION AND CLINICAL OUTCOMES IN THE MEDICAL WARD OF A MALAYSIAN TERTIARY CARE HOSPITAL

Objective: To evaluate the impact of antimicrobial stewardship (AMS) on antibiotic prescribing patterns and certain clinical outcomes, the length of stay (LOS) and the re-admission rate (RR) of the patients treated within the medical ward of a tertiary care hospital in Malaysia.
 Methods: This quasi-experimental study was conducted retrospectively. The prescriptions of the AMS included alert antibiotics (AA) such as cefepime, ceftazidime, colistin (polymyxin E), imipenem-cilastatin, meropenem, piperacillin-tazobactam and vancomycin were reviewed for the period of 24 mo before (May, 2012–April, 2014) and after (May, 2014–April, 2016) the AMS implementation for the patients who were treated within the medical ward of a Malaysian tertiary care hospital. Patterns of antibiotics prescribed were determined descriptively. The impact of the AMS on the length of stay (LOS) and readmission rate (RR) was determined by the interrupted time series (ITS) comparative analysis of the pre-and post-AMS segments segregated by the point of onset (May, 2014) of the AMS program. Data analysis was performed through autoregressive integrated moving average (ARIMA) Winter Additive model and the Games-Howell non-parametric post hoc test by using IBM Statistical Package for Social Sciences version 25.0 for Windows (SPSS Inc., Chicago, IL, USA).
 Results: A total of 1716 prescriptions of the AA included for the AMS program showed that cefepime (623, 36.3%) and piperacillin-tazobactam (424, 24.7%) were the most prescribed antibiotics from May 2012 to April 2016. A 23.6% drop in the number of the AA prescriptions was observed during the 24-month post-AMS period. The LOS of the patients using any of the AA showed a post-AMS decline by 3.5 d. The patients’ LOS showed an average reduction of 0.12 (95% CI, 0.05–0.19, P=0.001) with the level and slope change of 0.18 (95% CI, 0.04–0.32, P=0.02) and 0.074 (95% CI, 0.02–0.12, P=0.002), respectively. Similarly, the percent RR reduced from 20.0 to 9.85 during the 24-month post-AMS period. The observed post-AMS mean monthly reduction of the RR for the patients using any AA was 0.38 (95% CI, 0.23–0.53, P<0.001) with the level and slope change of 0.33 (95% CI, 0.14–0.51, P=0.02) and 0.37 (95% CI, 0.16–0.58, P=0.001), respectively.
 Conclusion: The AMS program of a Malaysian tertiary care hospital was a coordinated set of interventions implemented by the AMS team of the hospital that comprised of the infectious diseases (ID) physician, clinical pharmacists and microbiologist. The successful implementation of the AMS program from May, 2014 to April, 2016 within the medical ward resulted in the drop of the number of AA prescriptions that sequentially resulted in the significant (P<0.05) post-AMS reduction of the LOS and the RR.

Bibliometric analysis of peer-reviewed literature on antimicrobial stewardship from 1990 to 2019

BackgroundThe World Health Organization recommended the implementation of antimicrobial stewardship (AMS) in the clinical settings to minimize the development and spread of antimicrobial resistance (AMR). The current study aimed to assess global research activity on AMS as one measure for efforts dedicated to contain AMR.MethodA bibliometric method was applied using Scopus. A validated search query was implemented. Bibliometric indicators and mapping were generated. The study period was from 1990 to 2019. The search query utilized the keywords “antimicrobial stewardship” or “antibiotic stewardship” in the titles or abstracts. In addition, documents with the term “restrict” or “restriction” if used with the terms “antimicrobial” or “antibiotic” were retrieved.ResultsThe search query returned 4402 documents. The keyword “antimicrobial stewardship” returned 2849 documents while the keyword “antibiotic stewardship” returned 1718 documents. The terms restrict/restriction and antimicrobial/antibiotics returned 209 documents. The number of publications and cumulative citations showed a steep and parallel increase in the last decade. The region of the Americas returned the most while the Eastern Mediterranean region returned the least. The United States (n = 1834, 41.7%) ranked first. Main research themes in the retrieved literature were the (1) impact of AMS on hospital length stay, (2) role of pharmacists, and (3) development of resistance of various pathogens. Clostridium difficile (n = 94) and Staphylococcus aureus (n = 76) were among the most frequently encountered author keywords. The Infection Control and Hospital Epidemiology journal ranked first (n = 245, 5.6%, h-index = 134) while documents published in the Clinical Infectious Diseases journal (h-index = 321) received the highest number of citations per document (70.7). At the institutional level, the US Centers for Disease Prevention and Control (n = 93, 2.1%) ranked first followed by the Imperial College London (n = 86, 2.0%). The main funding sponsors were the National Institute of Health. Pfizer, Merck, and Bayer pharmaceutical companies played a key role in funding AMS research. International research collaboration between developed (n = 3693, 83.9%) and developing countries (n = 759, 17.2%).ConclusionThe fight against AMR is a global responsibility and implementation of AMS need to be carried out across the globe. International research collaboration between developing and developed countries should be encouraged.

Evaluation on the impact of antimicrobial stewardship programme (AMS) in a tertiary hospital

Background: Antimicrobial Resistance (AMR) is a serious threat to global public health. Hence, in Malaysia, Antimicrobial Stewardship (AMS) was developed to optimize antimicrobial use in health care setting. Not many studies have been conducted and the impact of AMS in Hospital Serdang is unknown. This study was conducted to assess the impact of antimicrobial stewardship in Hospital Serdang. Methods and materials: Prospective observational cross-sectional study. Universal sampling where all patients intervened during AMS round (patient empirically started on carbapenem, vancomycin, and polymyxin B & E) in study period from 1st January 2017 to 31st December 2017. Patient's data were retrieved from the electronic hospital information system (eHIS) and ward medication charts. Clinical outcome includes clinical cure rate, discharged alive, mortality rate, readmission rate and length of stay were evaluated. Results: A total of 142 patients intervened in the AMS round throughout the study period. Majority of the patients were male (60.6%), mean age 54.1 years, with comorbidities (77.5%) and most of the antibiotics were initiated for respiratory tract infections (39.4%). Similar clinical cure rate (46.3% vs. 42.1%), discharged alive rate (72.4% vs. 73.7%) and mortality rate (27.6% vs. 26.3%) were demonstrated between interventions accepted group and rejected group. Readmission rate were 8.9% among accepted group and no readmission was reported in rejected group. De-escalation of antibiotic (42%) was the most common interventions accepted. This was followed by escalation of antibiotic, inappropriate choice of antibiotic, inappropriate dose, inappropriate duration, polypharmacy and inappropriate frequency. High acceptance rate (86.6%) of AMS interventions were demonstrated in this study. Conclusion: Implementation of AMS helps to guide physician in optimizing the appropriate use of antimicrobial therapy in healthcare setting.

Improving Prescribing Practices at Hospital Discharge With Pharmacist-Led Antimicrobial Stewardship at Transitions of Care

Background: Antimicrobial stewardship (AMS) is recommended in hospital, postacute, and outpatient settings. Transitions of care (TOC) are important in each of these settings; however, AMS efforts during TOC have been limited. Beginning in October 2018, we sequentially implemented a pharmacist-led multidisciplinary review of oral antimicrobial therapy prescribed at hospital discharge from general and specialty medicine wards across a health system. Pharmacists facilitated data input of discharge prescriptions following early identification and collaborative discussion of patients to be discharged on oral antimicrobials The purpose of this study was to evaluate the impact of AMS during TOC. Methods: This project was an IRB-approved stepped-wedge, quasi-experimental study in a 5-hospital health system that included hospitalized adults with skin, urinary, intra-abdominal, and respiratory tract infections who had been discharged from general and specialty wards with oral antimicrobials. Patients with complicated infections, neutropenia, or who were transferred from an outside hospital were excluded. The primary end point was optimization of antimicrobial therapy at time of hospital discharge, defined by correct selection, dose, and duration according to institutional guidance. Outcomes were compared before and after the intervention. Results: In total, 800 patients were included: 400 in the preintervention period and 400 in the postintervention period. Among this cohort, 252 (63%) received the intervention by a pharmacist per protocol during TOC. Patients had similar comorbid conditions before and after the intervention. Preintervention patients were more likely to be discharged from community hospitals. Before the intervention, 36% of discharge regimens were considered optimized, compared to 81.5% after the intervention (P < .001); this difference was largely driven by a reduction in patients receiving a duration of therapy beyond the clinical indication (44.5 vs 10%; P < .001). We observed similar clinical resolution, 30-day readmission, and adverse drug events (ADEs) between the pre- and postintervention periods. Postdischarge antimicrobial duration of therapy was reduced from 4 days (range, 3–5) to 3 days (range, 2–4) (P < .001) Severe ADEs occurred more frequently in the preintervention group (9 vs 3.3%; P = .001), which was driven by isolation of multidrug-resistant pathogens (7 vs 2.5%; P = .003) and Clostridioides difficile (1.8 vs 0.5%; P = .094). Patients who received optimal therapy at discharge were less likely to develop an ADE (aOR, 0.530; 95% CI, 0.363–0.773). Conclusions: Implementation of an AMS TOC protocol reduced antimicrobial days, optimized therapy selection, and reduced duration. This intervention was associated with improved safety without compromise of clinical effectiveness. To increase patient safety, AMS programs should target antimicrobial optimization during TOC.Funding: This work was completed under CDC contract number 200-2018-02928.Disclosures: None

Impact of antimicrobial stewardship and rapid diagnostics in children with Staphylococcus aureus bacteremia

AbstractIntroductionRapid diagnostic testing (RDT) in combination with antimicrobial stewardship programs (ASPs) has been associated with improved outcomes in adults with Staphylococcus aureus bacteremia (SAB); however, pediatric data are limited.ObjectivesThe primary objective of this study was to assess the clinical impact of concomitant implementation of an ASP and RDT in children with SAB.MethodsThis pre‐post quasi‐experimental study compared time to optimal antibiotic in children with SAB in 2015/2016 (pre‐intervention [PRE]) and 2017/2018 (post‐intervention [POST]). During the PRE period there was no RDT or ASP available. However, in the POST period, RDT was performed on all positive blood cultures, followed by feedback from an ASP. Secondary outcomes included time to effective antibiotic, antibiotic exposure, duration of bacteremia, hospital length of stay (LOS), transfer to the intensive care unit (ICU), SAB recurrence, and inpatient mortality.ResultsSixty‐eight patients were included in the study (PRE: n = 32, POST: n = 36). Median time to optimal antibiotic therapy decreased by 23 hours (PRE: 44.3 hours vs POST: 21.3 hours; P = .008). Duration of bacteremia (PRE: 65 hours vs POST: 40.9 hours; P = .03) and inpatient mortality (PRE: 12.5% vs POST: 0%; P = .04) were also reduced. However, further review revealed that only one death was related to SAB. Differences in time to effective therapy, antibiotic exposure, and hospital LOS were not significantly different between the groups. There were similar rates of infectious disease (ID) consultation (PRE: 78% vs POST: 89%, P = .23), but a shorter time to central line removal in the POST group (PRE: 68.2 hours vs POST: 19.8 hours; P = .04). Throughout the study period, recurrence of SAB only occurred in one patient (PRE).ConclusionASP interventions, facilitated by RDT, resulted in a shorter time to optimal antibiotic therapy in children with SAB. Although these interventions may have led to improved overall SAB management, further studies are needed to confirm clinical benefits.

PIN79 ECONOMIC EVALUATION OF ANTIMICROBIAL STEWARDSHIP PROGRAMS IN CHINESE HOSPITALS

As part of the nationwide initiative to optimize antibiotic use and control antimicrobial resistance, many Chinese hospitals have started antimicrobial stewardship (AMS) programs. We conducted a study to understand the impact of AMS in China. A previously developed China-specific conceptual economic evaluation framework based on the U.S. Centers for Disease Control and Prevention guidelines and Chinese experts’ feedback was used for this study. Data were collected from three tertiary teaching hospitals (bed size: 1159 to 2300) in Beijing (n=2) and Hunan (n=1). Hospital AMS coordinators responded to the evaluation questionnaire and follow-up calls/emails for data clarification. Data were analyzed in an Excel economic model developed based on the conceptual economic evaluation framework. Among the three participating hospitals, core elements of the AMS programs included pre-authorization, “no indication, no treatment,” post-operative antibiotic use monitoring, nosocomial infection reporting, and training programs. After implementing AMS (vs. pre-AMS), the average length of stay decreased in all three hospitals by 3.5% to 5.7%. Occupancy rates increased in two hospitals (2.5%, 6.1%) and decreased in the other (3.6%). Mortality rates decreased by approximately 14% in two hospitals and remained the same in the other hospital. The proportion of hospitalized patients receiving antimicrobial treatment decreased by 1.4% to 7.3%. The defined daily dose of antimicrobial drugs decreased by approximately 10% in two hospitals. Two hospitals reported the costs of implementing the AMS programs, including labor and equipment for susceptibility testing or laboratory data collection. All three hospitals experienced an increase in revenue (1.8% to 11.9%) and net benefit (23 to 139 million RMB). These findings indicate a positive impact of AMS on economic and clinical outcomes in these hospitals and provide insights into the costs and benefits that can be considered when implementing AMS in other Chinese hospitals.

854. Impact of Antimicrobial Stewardship and Rapid Diagnostics in Children with Staphylococcus aureus Bacteremia

BackgroundRapid diagnostic testing (RDT) in combination with antimicrobial stewardship programs (ASPs) has been associated with improved outcomes in adults with Staphylococcus aureus bacteremia (SAB). Data in children are lacking. In January 2017, Atrium Health implemented a pediatric ASP with blood culture RDT. The objective of this study was to determine the impact of those interventions.MethodsThis was a retrospective, multicenter, quasi-experimental study of children ≤18 years with monomicrobial SAB from March 2015 to August 2016 (pre-intervention; PRE) and March 2017 to August 2018 (post-intervention; POST). The primary outcome was time to an optimal antibiotic. Secondary outcomes included time to effective antibiotic, total antibiotic exposure in the first 5 days, duration of bacteremia, infectious diseases (ID) consultation, time to central line removal, hospital and pediatric ICU length of stay (LOS), need for vasopressors or intubation, recurrence of SAB within 90 days, and inpatient mortality.ResultsOf 101 patients with SAB, 32 and 36 met inclusion criteria for the PRE and POST groups, respectively. The median time to optimal antimicrobial therapy decreased by 23 hours (PRE 44.3 hours vs. POST 21.3 hours; P = 0.008). Duration of bacteremia (65h vs. 40.9 hours; P = 0.028) and mortality (12.5% vs. 0%; P = 0.044) was also significantly reduced. Differences in median time to effective therapy (7 hours vs. 5.1 hours; P = 0.74), total antibiotic exposure in the first 5 days (160.4 hours vs. 152 hours; P = 0.4), hospital LOS (9.9 vs. 8.5 days; P = 0.25), and pediatric ICU LOS (7 vs. 4 days; P = 0.11) did not meet statistical significance, but trended downward. The POST group had more patients with ID consultation (78% vs. 89%, P = 0.23) and shorter time to central line removal (68 hours vs. 20 hours; P = 0.037). There was no difference in the need for vasopressors (3 vs. 3 patients; P = 0.99) or intubation (2 vs. 4 patients; P = 0.68). Throughout the study period, recurrence of SAB only occurred in one patient (PRE).ConclusionConcurrent implementation of RDT and an ASP in pediatric patients with SAB decreased time to optimal antimicrobial therapy, duration of bacteremia, and mortality. RDT coupled with timely feedback from an ASP contributed to improved SAB management and clinical outcomes in children.Disclosures All Authors: No reported Disclosures.

1069. Implementation and Results of a Health-System Antimicrobial Stewardship (AMS) Program

BackgroundAMS expansion initiative was implemented in fiscal year 18 (FY18) across a 14-member health system (~1,000 average daily census combined) consisting of 8 community hospitals, 5 rural critical access hospitals and 1 academic medical center.MethodsThe expansion initiative included a 0.5 full-time equivalent (FTE) infectious diseases (ID) physician and 2.5 FTE ID-trained clinical pharmacists to support daily AMS activities. Clinical decision support software (Theradoc) had previously been implemented across the health system. Here we report our continuation results for the first 9 months of year 2 (FYTD19) of the expansion initiative.ResultsAMS personnel documented an average of 319.8 and 313.2 interventions per month in FY18 vs. FYTD19, respectively. Mean acceptance rate of AMS interventions by providers was 87.9% and 89.4% in FY18 vs. FYTD19. Provider groups with the highest acceptance rate were Hospital Medicine, Pulmonary/Critical Care and Infectious Disease. Highest interventions in FYTD19 included recommending other diagnostic testing (17%) followed by de-escalating/targeting therapy based on culture results and recommending alternative therapy (both at 11%). Most common ID disease states AMS intervened included bacteremias (29%), pneumonias (ventilator-associated or community-acquired) 13% each, and UTIs 13%. AMS interventions generated 168 ID consults in FYTD19. The financial impact of AMS across the health system was a cumulative saving in antimicrobial expenditures of $1.29 million and $1.27 million in FY18 and FYTD19, respectively.ConclusionThe ability to review offsite electronic medical records daily for antimicrobial optimization with ID pharmacist and physician support, identify facility-specific needs and opportunities, and collect available data endpoints to determine program effectiveness has helped to ensure program success.Disclosures All authors: No reported disclosures.