Stewardship Service Research Articles

1241. Outcomes of a Novel Antimicrobial Handshake Stewardship Service in the Immunocompromised Population at an Academic Medical Center

Abstract Background Prospective audit and feedback (PAF) is integral to antimicrobial stewardship programs (ASP) and is typically conducted electronically. Handshake stewardship (HS) is a form of in-person PAF advocated by the CDC and IDSA. There is scarce data regarding successful ASP interventions within the immunocompromised (IC) population, and even less data on the impact of HS. The objective of this study was to describe the outcomes of a novel HS service on the IC population and identify ASP interventions that may be generalizable. Methods This is a retrospective study of hospitalized adult patients (≥ 18 years old) with IC conditions on pre-determined antimicrobials for at least 72 hours between May 1st, 2022 and January 31st, 2023. IC patients included those with active malignancy on chemotherapy or with functional immunosuppression, solid organ transplant (SOT), and rheumatological conditions on active immunosuppressants. The ASP team comprised of 1 infectious disease (ID) physician and 1 ID pharmacist who provided all recommendations to the intensive care unit (ICU), transplant, and oncology services. Primary outcomes included recommendation acceptance and recommendation types. Additional outcomes included incidence of C. difficile, resumption of antibiotics after discontinuation, lengths of stay (LOS), and 60-day readmission and mortality. Descriptive statistics were performed. Results Twenty-nine patients with IC conditions were identified. Majority were White (41.4%) or Hispanic/Latino (44.8%). The median age was 57 years old (IQR 22-78). Fifteen patients had active malignancy, 11 were SOT recipients, and 3 had rheumatologic disorders. Primary teams accepted 45/51 (85%) of recommendations for 27/29 (93.1%) patients. Common recommendations included discontinuation of empiric therapy for febrile neutropenia or for non-infectious etiologies, de-escalation, or escalation to ID consults. Primary teams only resumed antibiotics in 1 patient after early discontinuation. The median LOS was 14 days with 2 patients testing positive for C. difficile and only 1 patient readmitted due to infection. Conclusion HS was well received and most recommendations targeting the IC population were accepted and did not lead to poor patient outcomes. Disclosures Anna Zhou, PharmD, BCIDP, Melinta Therapeutics: Honoraria

A retrospective study investigating the management, risk factors, and outcomes of patients diagnosed with Clostridioides difficile infection

AbstractBackgroundThe rate of clostridioides difficile infection (CDI) in Australia has increased by more than 8% between 2016–2018. This can be attributed to multiple factors including an ageing population, widespread antibiotic and proton‐pump‐inhibitor usage.AimThe aim of this study was to investigate the management, risk factors and outcomes for CDI to identify strategies to reduce its incidence.MethodA single‐centre retrospective audit was completed using medical records for patients admitted to a 250‐bed regional Queensland hospital with CDI in 2020–2021. Data surrounding CDI management for each patient was analysed against the Therapeutic Guidelines. This study was approved by The Prince Charles Hospital Human Research Ethics Committee (Reference No: LNR/HREC/QPCH/81287).ResultsThere were 72 cases with CDI during the study timeframe. Recent antibiotic prescription, proton‐pump‐inhibitor (PPI) use and antibiotic allergy labels were common. Thirty‐five per cent of cases were treated appropriately. Eight per cent died, and nine per cent had relapsed CDI within 12 weeks of diagnosis. Common gaps found in the results included inappropriate selection of antibiotics based on the severity of disease and lack of documentation surrounding CDI cases left untreated.ConclusionThere are multiple opportunities for pharmacists to improve the care of patients with CDI which range from promoting guideline adherence, influencing prescriber antibiotic selection based on disease severity, prompting review of PPIs upon CDI diagnosis and prompting provider follow‐up of CDI laboratory results pending at the point of patient discharge. The results of this study have prompted antimicrobial stewardship service review of all CDI admissions at the study site and indicates the need for a larger multiple‐site study to raise awareness of CDI risk factors and severity criteria.

A Qualitative Study on the Implementation of the National Action Plan on Antimicrobial Resistance in Singapore.

Antimicrobial resistance (AMR) is a global public health threat that affects humans, animals, and the environment across the One Health spectrum. Singapore launched its own National Strategic Action Plan (NSAP) on AMR in 2017 with the aim of tackling the growing threat of AMR in Singapore through coordinated approaches. However, little is known about the implementation of the NSAP. In this study, we analysed the implementation of the NSAP with guidance from an AMR governance framework. We conducted in-depth interviews with 20 participants across the One Health spectrum. The interviews were transcribed verbatim and analysed thematically. Overall, the implementation of activities against AMR was more advanced with respect to human health compared to other sectors such as (1) AMR and antimicrobial use (AMU) surveillance systems in hospitals; (2) the hospital antimicrobial stewardship (AMS) service and legislation to optimise AMU; (3) the national children and adults vaccination programme for IPC; (4) multiple avenues for education and awareness for both professionals and public; and (5) extensive research and collaboration networks with many sources of funding. Areas that were lacking presented problems including (1) an incomplete surveillance system for AMR and AMU across all sectors; (2) the need for better AMS and legislation in some sectors; (3) insufficient innovation in education for sustained behavioural modification; and (4) the need for more open research collaborations and the translation of research into policy outcomes. Improvements in these areas will enhance the overall implementation of the NSAP through a more holistic One Health approach.

P13 Development of a consult and antimicrobial stewardship service in Manchester Foundation Trust

ObjectivesTo prospectively audit the first year of the North Manchester infectious diseases AMS and Consult service June 2020 to June 2021 to: (i) characterize the number of patients who had antibiotic treatment narrowed, duration reduced and/or switch to oral options; (ii) assess documentation of indication and duration of antibiotic prescriptions; (iii) determine whether or not the appropriate microbiological specimens have been performed and with the lab; (iv) identify the impact on antibiotic consumption measured in defined daily dose (DDDs); and (v) establish whether base teams act on the advice given by the Consult/AMS team (data over a 6 week period).MethodsOn weekdays an electronic prescribing list of all patients prescribed piperacillin/tazobactam, meropenem and ciprofloxacin was generated, and the consults team performed either a bedside or notes review. Data was collected prospectively on 730 patients on which infection was treated, which specialty managed the patient, microbiology samples sent, duration and indication of treatment documentation, and advice given by consults team. Data was then collected over a further 6 weeks looking at whether the base specialty carried out the advice of the AMS team.ResultsThe main indication for broad spectrum antibiotic use was urinary tract infection (151/720) and hospital acquired pneumonia (104/720). Poor documentation of antimicrobial indication and duration was observed across all specialties (277/720). Just over 50% of appropriate microbiology samples were sent (422/726). For 42% of cases (311/730), colleagues were advised to stop or reduce antibiotic duration. In 30% of cases (220/730), narrowing of antibiotic spectrum was advised. Thirty percent (219/730) were advised on IV to oral switch. There was a modest reduction in antimicrobial consumption in some specialties comparing the year prior to the introduction of the service 2019–20 to 2020–21; 17.4% reduction respiratory (7810/9137), 0.2% increase in medicine (272698/267351) and 2.1% surgery (68722/67309). In 81 patients reviewed to look at outcomes over 6 weeks, 88% of Consult/AMS team advice was actioned by the lead specialties involved in the patients’ care.Conclusions(i) There is a substantial need for an AMS service within the hospital. (ii) Outcome data shows the ward teams engage with the service and most follow advice. (iii) The service contributed to limiting inappropriate prescribing during the COVID-19 pandemic. There was a modest rise in hospital-wide consumption. (iv) The AMS service needs to be available to provide patient equity across Manchester Foundation Trust, fostering a city-wide AMS strategy that encompasses education, guidelines, audit and quality improvement.

54. The Effect of Targeting High-Risk Patients for Antimicrobial Stewardship Intervention on Hospital-Onset Clostridioides Difficile Infection Rates

Background Clostridioides difficile infection contributes to significant burden on patients and the healthcare system, costing billions in excess costs every year for hospital care. Continued use of antibiotics after C. difficile infection diagnosis is a risk factor for recurrent infection. Also, individuals who have had a recurrence of C. difficile infection are at a higher risk of subsequent episodes. MethodsThis prospective, observational, pre-post study evaluated the effect of implementing a targeted antimicrobial stewardship initiative towards a high-risk target population on the rate of in-hospital C. difficile infection rates. High-risk targets were identified through an electronic health system report of admitted patients at a large academic medical center who were toxin assay positive or had a documented history of C. difficile infection. Subjects who met the criteria were assessed for interventions by the pharmacy-driven antimicrobial stewardship service. The primary outcome compared the hospital-onset C. difficile rates and standardized infection ratio (SIR) before and after implementation of the initiative. The SIR is reported to the National Healthcare Safety Network (NHSN) and is calculated as a ratio between the number of observed and predicted infections, which is adjusted for facility-specific factors that contribute C. difficile risk. Negative binomial regression was used to calculate the predicted C. difficile infections in the SIR. Poisson regression was used to generate a 95% prediction interval for the predicted C. difficile infection rate. ResultsThe mean age of subjects was 63 years old and 85% had no history of prior C. difficile infection. The most common intervention was de-escalation of antibiotics (46%). The post-implementation SIR was 0.55 and hospital-onset C. difficile rate was 13, both of which were significantly lower than predicted. ConclusionTargeting patients who have a history of or are newly diagnosed with C. difficile infection may decrease hospital-onset C. difficile rates.Disclosures All Authors: No reported disclosures

Implementation of a novel antimicrobial stewardship strategy for rural facilities utilising telehealth

A significant portion of healthcare takes place in small hospitals, and many are located in rural and regional areas. Facilities in these regions frequently do not have adequate resources to implement an onsite antimicrobial stewardship programme and there are limited data relating to their implementation and effectiveness. We present an innovative model of providing a specialist telehealth antimicrobial stewardship service utilising a centralised service (Queensland Statewide Antimicrobial Stewardship Program) to a rural Hospital and Health Service. Results of a 2-year post-implementation follow-up showed an improvement in adherence to guidelines [33.7% (95% CI 27.0-40.4%) vs. 54.1% (95% CI 48.7-59.5%)] and appropriateness of antimicrobial prescribing [49.0% (95% CI 42.2-55.9%) vs. 67.5% (95% CI 62.7-72.4%) (P < 0.001). This finding was sustained after adjustment for hospitals, with improvement occurring sequentially across the years for adherence to guidelines [adjusted odds ratio (aOR)=2.44, 95% CI 1.70-3.51] and appropriateness of prescribing (aOR=2.48, 95% CI 1.70-3.61). There was a decrease in mean total antibiotic use (DDDs/1000 patient-days) between the years 2016 (52.82, 95% CI 44.09-61.54) and 2018 (39.74, 95% CI 32.76-46.73), however this did not reach statistical significance. Additionally, there was a decrease in mean hospital length of stay (days) from 2016 (3.74, 95% CI 3.08-4.41) to 2018 (2.55, 95% CI 1.98-3.12), although this was not statistically significant. New telehealth-based models of antimicrobial stewardship can be effective in improving prescribing in rural areas. Programmes similar to ours should be considered for rural facilities.

Stepwise Development and Yearlong Assessment of a Pharmacist-Driven Molecular Rapid Diagnostic Test Result Service for Bloodstream Infections.

Provide a stepwise approach to the design and implementation of a service that integrates all staff pharmacists into the communication and interpretation of molecular rapid diagnostic tests (mRDT) for bloodstream infections and summarize outcomes from a 12-month post-implementation assessment. Physician and pharmacist impressions of the service are also described. mRDT have proven clinical benefit in the treatment of bacteremia. Pharmacy leadership can collaborate with other health system leaders to develop policies and a workflow that route result calls to pharmacists to maximize the impact of this technology. Pharmacist education, development of clinical resources and documentation templates allow all pharmacists to perform this antimicrobial stewardship service consistently and confidently. Physicians overwhelmingly recognize the value of this service and often accept the pharmacist's recommendations. Antibiotic de-escalation was the most frequent outcome when changes to the antibiotic regimen were made. Pharmacists are well positioned to utilize results from mRDT to improve antibiotic selection. Through the use of competencies and internally-derived resources, all pharmacists, rather than just infectious diseases pharmacy specialists, can perform this important antibiotic stewardship activity and positively influence patient outcomes.

Cytomegalovirus antiviral stewardship in the COVID-19 Era: Increasing complexity of prophylaxis and treatment and potential mitigation strategies.

Cytomegalovirus (CMV) infection is one of the most common and significant complications after solid organ transplant (SOT). Severe acute respiratory coronavirus 2 (SARS‐CoV‐2), which causes the novel betacoronavirus 2019 disease (COVID‐19), has become the first global pandemic in 100 years. The world's attention has turned to address this unanticipated development; however, the viral infection that has long plagued outcomes after solid organ transplantation still requires vigilance. With physical distancing as the key intervention to reduce the healthcare burden, and the unease related to healthcare contact within the transplant population given the associated morbidity and mortality of COVID‐19 in transplant recipients, providers have struggled to evaluate and streamline essential in‐person healthcare contact, including laboratory visits. Owing to this, the COVID‐19 pandemic has placed a significant strain on the delivery of CMV prophylaxis and treatment after solid organ transplantation. In this piece, we will describe issues our CMV antiviral stewardship service has encountered in the care of the transplant recipient with CMV during the this unprecedented time and share our expert opinion to approaches to providing optimal, evidenced based care during a pandemic associated with a seemingly unrelated viral infection.

Hotel Selection Criteria of Solo Traveling Females

Consumers use online e-reviews as a popular tool for information and obtaining guidance. E-reviews have therefore become an important barometer in conducting product evaluations, and more importantly, to make purchasing decisions. This includes decisions about hotel selection. For hospitality industry marketers, the information in e-reviews is particularly important in translating and understanding consumer-specific needs. The current study brings valuable awareness to the limited academic research into hotel selection criteria among solo-traveling females. TripAdvisor’s top 25 list of cost-efficient hotels worldwide received 345 total consumer reviews. Noteworthy findings of the current study show unique selection criteria considered important to the solo traveling female including a hotel-provided cell phone programmed with emergency local contact information, and a nearby or on-premise automated teller machine. Study results also indicate that stewardship service, such as intimate and personalized hotel staff who “go the extra mile” is an important selection criterion. Also discussed are research limitations and implications.

Hotel Selection Criteria of Solo Traveling Females

Consumers use online e-reviews as a popular tool for information and obtaining guidance. E-reviews have therefore become an important barometer in conducting product evaluations, and more importantly, to make purchasing decisions. This includes decisions about hotel selection. For hospitality industry marketers, the information in e-reviews is particularly important in translating and understanding consumer-specific needs. The current study brings valuable awareness to the limited academic research into hotel selection criteria among solo-traveling females. TripAdvisor’s top 25 list of cost-efficient hotels worldwide received 345 total consumer reviews. Noteworthy findings of the current study show unique selection criteria considered important to the solo traveling female including a hotel-provided cell phone programmed with emergency local contact information, and a nearby or on-premise automated teller machine. Study results also indicate that stewardship service, such as intimate and personalized hotel staff who “go the extra mile” is an important selection criterion. Also discussed are research limitations and implications.

Implementation of a chemotherapy stewardship process.

To design and implement a chemotherapy stewardship process to optimize the location of chemotherapy administration in an effort to decrease the number of inappropriate inpatient anticancer regimen administrations and decrease institutional costs associated with inpatient administration. As the costs of anticancer agents continue to rise, it is crucial that multidisciplinary efforts are aimed at managing anticancer medication utilization; this is especially important for high-cost medications, medications whose use requires increased monitoring due to safety concerns, and medications that do not exert effects quickly and, as such, can be more appropriately administered in the outpatient setting. It is imperative that pharmacists play a role in managing chemotherapy medication utilization, as pharmacists provide expertise in formulary management, a vast knowledge of financial impact and reimbursement processes, and clinical knowledge that can help predict the expected effectiveness and adverse effects of each anticancer regimen. Our institution sought to develop and implement a multidisciplinary chemotherapy stewardship program targeting the optimization of site of anticancer agent administration with a goal of decreasing both cost and inappropriate utilization of high-cost, high-risk anticancer agents. Implementation of a chemotherapy stewardship service may decrease the number of inappropriate inpatient anticancer regimen administrations and decrease inpatient resource use, thereby decreasing costs to institutions. The concept of a chemotherapy stewardship process was well received by multidisciplinary healthcare colleagues, and a collaborative approach should be used to design and implement such processes.

Abstracts of the 29th Annual Pediatric Pharmacy Association (PPA) Meeting April 29 to May 3, 2020

Abstracts of the 29th Annual Pediatric Pharmacy Association (PPA) Meeting April 29 to May 3, 2020

Experience of pharmacist-led antimicrobial stewardship ward rounds in a regional hospital

Background: Antimicrobial stewardship ward rounds and phone advice are fundamental to improvement of infection treatment and prevention in hospitals. In response to a local and national shortage of consultant medical microbiologists, a pharmacist-led antimicrobial stewardship service was established. Methods: Antimicrobial stewardship interventions in a large regional hospital were analysed from 8 January 2018 to 14 March 2019. Collaborative ward rounds were conducted with infection prevention and control nurses, and microbiology staff when available. Ad hoc ward rounds and phone interventions (via a dedicated “antibiotic advice hotline”) were also conducted, with most referrals coming from junior doctors and ward pharmacists. The commonest clinical areas visited were elderly care, respiratory and general surgery. Results: 1507 antimicrobials were reviewed from 1006 interventions (16 per week). Antimicrobials most reviewed were piperacillin/tazobactam (n=152; 10%), metronidazole (n=152), co-amoxiclav (n=140; 9%), teicoplanin (n=137, 9%) and gentamicin (n=116; 8%). The commonest organisms were Escherichia coli (n=115), Staphylococcus aureus (n=95) and Clostridium difficile (n=52). The most common recommendations were intravenous to oral switch (n=185; 18%), continue (n=175; 17%), escalate (n=136; 14%) and review dose (n=97; 10%). Antimicrobials were optimised for discharge in 270 cases, through oral switch, home intravenous antimicrobial referral or cessation. Conclusion: The results demonstrate the value of novel antimicrobial stewardship approaches that are required in today’s NHS given shifts in staff availability and recognising advanced clinical practice among non-medical staff. Future planned interventions will focus on improving the home intravenous antimicrobial referral and review process.

Evaluation of a pharmacist-led antimicrobial stewardship service in a pediatric emergency department.

Background To improve antimicrobial use, incorporation of a pharmacist in antimicrobial stewardship initiatives in the emergency department has been recommended. Recognizing the potential value, a pharmacist-led antimicrobial stewardship (AMS) service which included review and follow up of microbiology results for patients discharged from the pediatric emergency department (PED) with suspected infections was implemented at our local institution. Objective The objective of this study was to evaluate the impact of pharmacists delivering this service compared to usual care. Setting Pediatric emergency department at the IWK Health Centre in Halifax, Canada. Method This study was completed as a retrospective chart review of pediatric patients discharged from the PED 6months before and after implementation of the pharmacist-led AMS service. Data was extracted from electronic medical records. Data were reported descriptively and compared using a two-sided chi-square test and ordinal logistic regression. Main outcome measures The primary outcome measure was rate of return visits to the PED within 96h of initial presentation. Results This study included 1070 patient encounters pre-implementation and 1040 patient encounters post-implementation. The rate of return visits to the PED within 96h was 12.0% (129/1070) pre-implementation vs. 10.0% (100/1049) post-implementation (p = 0.07). The rate of return visits or hospitalization at 30days was 22.1% (237/1070) pre-implementation compared to 19.9% (207/1040) in the post-implementation phase (p = 0.21). Inappropriate antimicrobial therapy was identified more often in the pre-implementation phase (7.0%, 68/975) vs. the post-implementation phase (5.0%, 46/952), p = 0.047. Time to notification within the first day after discharge occurred more frequently in the post-implementation phase (53.3%, 80/150) as compared to the pre-implementation phase (40.3%, 52/129, p = 0.0298). Conclusion Although this pharmacist-led AMS service did not significantly affect the rate of return visits or hospitalization, it may have led to more judicious use of antimicrobial agents and faster time to notification.

Outcomes of an electronic medical record (EMR)-driven intensive care unit (ICU)-antimicrobial stewardship (AMS) ward round: Assessing the "Five Moments of Antimicrobial Prescribing".

The primary objective of this study was to examine the impact of an electronic medical record (EMR)-driven intensive care unit (ICU) antimicrobial stewardship (AMS) service on clinician compliance with face-to-face AMS recommendations. AMS recommendations were defined by an internally developed "5 Moments of Antimicrobial Prescribing" metric: (1) escalation, (2) de-escalation, (3) discontinuation, (4) switch, and (5) optimization. The secondary objectives included measuring the impact of this service on (1) antibiotic appropriateness, and (2) use of high-priority target antimicrobials. A prospective review was undertaken of the implementation and compliance with a new ICU-AMS service that utilized EMR data coupled with face-to-face recommendations. Additional patient data were collected when an AMS recommendation was made. The impact of the ICU-AMS round on antimicrobial appropriateness was evaluated using point-prevalence survey data. For the 202 patients, 412 recommendations were made in accordance with the "5 Moments" metric. The most common recommendation made by the ICU-AMS team was moment 3 (discontinuation), which comprised 173 of 412 recommendations (42.0%), with an acceptance rate of 83.8% (145 of 173). Data collected for point-prevalence surveys showed an increase in prescribing appropriateness from 21 of 45 (46.7%) preintervention (October 2016) to 30 of 39 (76.9%) during the study period (September 2017). The integration of EMR with an ICU-AMS program allowed us to implement a new AMS service, which was associated with high clinician compliance with recommendations and improved antibiotic appropriateness. Our "5 Moments of Antimicrobial Prescribing" metric provides a framework for measuring AMS recommendation compliance.

MP11: Evaluation of a pharmacist-led antimicrobial stewardship service in a pediatric emergency department

Introduction: We implemented a pharmacist-led antimicrobial stewardship (AMS) service for patients discharged from the pediatric emergency department (PED). This service, supported by a collaborative practice agreement, allows pharmacists to follow up with patients and independently stop, start, or adjust antimicrobial agents based on culture results. The primary objective of our study was to evaluate the impact of this service on the rate of return visits to the PED within 96 hours. The secondary objective was to evaluate the appropriateness of the prescribed antimicrobial agent at follow up. Methods: This study was completed as a retrospective chart review 6 months pre-implementation (January 1st, 2016 to June 31st, 2016) and 6 months post-implementation (February 1st, 2017 to July 31st, 2017) of a pharmacist-led AMS service. A research assistant extracted data from electronic medical records using a standardized data collection form. All patients discharged from the PED with a suspected infection whose cultures fell within the parameters of the collaborative practice agreement were included in this study. Data were reported descriptively and compared using a two-sided chi-square test. Results: This study included 1070 patient encounters pre-implementation and 1040 patient encounters post-implementation of the AMS service. The most commonly reviewed culture was urine (38% pre-implementation and 41% post-implementation). The rate of return visits to the PED within 96 hours was 12.0% (129/1070) pre-implementation vs 10.0% (100/1049) post-implementation phase (p = 0.07). A significantly higher percentage of inappropriate antimicrobial therapy was identified at the time of follow up in the pre-implementation phase (7.0%, 68/975) compared to the post-implementation phase (5.0%, 46/952), p = 0.047. Conclusion: Although this pharmacist-led AMS service did not affect the rate of return visits within 96 hours, it may have led to more judicious use of antimicrobial agents.

Development of Multidisciplinary Anticoagulation Management Guidelines for Patients Receiving Durable Mechanical Circulatory Support.

Patients receiving durable mechanical circulatory support (MCS) require life-long anticoagulation with a vitamin K antagonist (VKA). Due to alternations in hemostasis, concomitant therapy with antiplatelet agents and critical illness, they are at increased risk of thromboembolic and bleeding complications compared with the general population managed on VKAs. To prevent thrombotic events, current guidelines recommend that patients with MCS receive long-term anticoagulation with a VKA to maintain a target international normalized ratio (INR) as specified by device manufacturers, but limited data exist regarding specific routine management of anticoagulation therapy and its potential complications. To optimize anticoagulation management and minimize risk in these patients, we have centralized anticoagulation management in a collaborative approach between the inpatient hemostatic and antithrombotic (HAT) stewardship service and between ambulatory anticoagulation management service (AMS) and the advanced heart disease team. Patients are followed by these three services beginning when the device is implanted and extending the duration that patients have the device. The teams include multiple clinicians from cardiac surgery, cardiology, hematology, pharmacy, nursing, case management, nutrition, and psychiatry, therefore, in order to standardize practice among clinicians without compromising patient centered decision making, we assembled an interdisciplinary team to create multiple treatment guidelines. In addition to a centralized and collaborative approach, our guidelines ensure seamless transitions of care between the inpatient and outpatient settings. We believe our approach has demontrated a positive improvement in the care of these challenging patients. In this article, we present our comprehensive centralized anticoagulation management approach for patients with left ventricular assist systems (LVAS).

220. Taking Off With Antimicrobial Intervention Rounds (AIR): Successes of a Pilot Stewardship Service at a Tertiary-Care VA Medical Center

BackgroundProspective audit and feedback is one of the core strategies of an antimicrobial stewardship program (ASP). Here, we hypothesized that the addition of AIR to our extant ASP would enhance appropriate use of parenteral (IV) antibiotics (ABs) on a large inpatient medical service.MethodsAdult patients on medicine wards beginning in October 2017 and not followed by the infectious diseases (ID) service were included for stewardship intervention if they were on IV ABs ≥48 hours. Recommendations were classified into: (1) duration of therapy; (2) dose adjustment; (3) IV to oral conversion; (4) adverse event prevention; (5) AB avoidance; (6) anti-pseudomonal or (7) vancomycin de-escalation; (8) AB discontinuation; (9) ID consult; (10) Δ alternative AB; (11) allergy assessment; or (12) diagnostics. Early impact of the interventions was assessed after 3 months via the Standardized Antimicrobial Administration Ratio (SAAR) and compared with the 3-month, pre-AIR period. The SAAR is used to benchmark facilities’ AB use against those of similar complexity; SAAR = 1 indicates that observed = predicted use.ResultsFor 158 interventions made, the most common syndromes were pneumonia (41%), skin and soft tissue (29.4%), and urinary tract infection (17.7%). Intervention categories other than 4, 9, and 11 had acceptance rates >85% (Figure 1). The SAAR decreased from the pre- to post-AIR period in terms of agents for: broad-spectrum use in HAI (SAAR relative ratio [RR]: 0.80, 95% CI [0.73–0.88]); MRSA (SAAR RR: 0.81, 95% CI [0.73–0.91]); and all indications (SAAR RR: 0.86, 95% CI [0.82–0.90]). During the same periods, surgical wards without AIR showed no Δ in AB use.ConclusionThe majority of AB use recommendations delivered by a pharmacist–physician stewardship team were highly accepted by medical providers and led to a 15–20% decrease in overall AB use, without adverse effect during the immediate postintervention period. Potential clinical benefits, such as decreased rates of Clostridium difficile disease, will need to be measured as the AIR program advances. It is worth noting that interventions for AB allergy assessment were least accepted by providers, possibly due to time required to comply. Design of prospective audit and feedback programs may need to address this potential deficiency. Disclosures All authors: No reported disclosures.

How to implement a global antibiotic stewardship service? Evidence translation to Cape Verde context

How to implement a global antibiotic stewardship service? Evidence translation to Cape Verde context

How to implement a global antibiotic stewardship service? Evidence translation to Cape Verde context

How to implement a global antibiotic stewardship service? Evidence translation to Cape Verde context