121. Evaluation of Multifaceted Antimicrobial Stewardship in Optimizing Antimicrobial Usage in Intraabdominal Infection at a Community Hospital

Abstract Background Treatment of intraabdominal infections (IAI) commonly involves broad spectrum antimicrobials based on the severity and etiology of infections as well as the underlying medical conditions. However, the overuse of broad-spectrum agents has driven selection for Gram-negative and -positive resistance, as well as collateral consequences such as Clostridioides difficile colitis. We sought to evaluate the utilization of a pharmacy-driven multifaceted antimicrobial stewardship (AMS) intervention to optimize empiric antimicrobial therapy by risk stratification among IAI patients and reduce the number of antibiotic treatment days. Methods This is a single-center case observation study in hospitalized adult IAI patients on antimicrobial therapy from Dec 2019-Feb 2020 compared to patients from Dec 2020-Feb 2021 after initiation of AMS with daily prospective audit and feedback. The composite primary outcome is reduction of antibiotic treatment days and de-escalation from broad spectrum antibiotics (fluoroquinolones, piperacillin/tazobactam, and carbapenems) to cephalosporins. Results We identified 40 patients each in the baseline (pre-AMS group) and post-AMS group via electronic medical record. Baseline characteristics were well-matched between groups. The majority of patients were diagnosed with community-acquired IAIs such as appendicitis, diverticulitis, and cholecystitis. Fluoroquinolone use as empiric therapy was significantly lower in the post-AMS group vs. pre-AMS group (2.5% vs. 25%, p< 0.001), while non-Pseudomonas cephalosporin use was increased (25% post-AMS vs. 0% pre-AMS, p< 0.001). Oral fluoroquinolone use at discharge was significantly decreased in the post-AMS group (p< 0.001). Antibiotic treatment days remained unchanged. There was no statistical difference between the two groups in 30-day mortality, 30-day readmission, relapse, and C. difficile colitis. Conclusion A multifaceted antimicrobial therapy intervention successfully reduced the use of fluoroquinolones in patients with community-acquired IAI during hospitalization and discharge. No differences in mortality, readmission, or relapse rates were observed. Disclosures All Authors: No reported disclosures


Evaluation of Multifaceted Antimicrobial Stewardship in Optimizing Antimicrobial Usage in Intraabdominal Infection at a Community Hospital
Background. Treatment of intraabdominal infections (IAI) commonly involves broad spectrum antimicrobials based on the severity and etiology of infections as well as the underlying medical conditions. However, the overuse of broad-spectrum agents has driven selection for Gram-negative and -positive resistance, as well as collateral consequences such as Clostridioides difficile colitis. We sought to evaluate the utilization of a pharmacy-driven multifaceted antimicrobial stewardship (AMS) intervention to optimize empiric antimicrobial therapy by risk stratification among IAI patients and reduce the number of antibiotic treatment days.
Methods. This is a single-center case observation study in hospitalized adult IAI patients on antimicrobial therapy from Dec 2019-Feb 2020 compared to patients from Dec 2020-Feb 2021 after initiation of AMS with daily prospective audit and feedback. The composite primary outcome is reduction of antibiotic treatment days and de-escalation from broad spectrum antibiotics (fluoroquinolones, piperacillin/tazobactam, and carbapenems) to cephalosporins.
Results. We identified 40 patients each in the baseline (pre-AMS group) and post-AMS group via electronic medical record. Baseline characteristics were well-matched between groups. The majority of patients were diagnosed with community-acquired IAIs such as appendicitis, diverticulitis, and cholecystitis. Fluoroquinolone use as empiric therapy was significantly lower in the post-AMS group vs. pre-AMS group (2.5% vs. 25%, p< 0.001), while non-Pseudomonas cephalosporin use was increased (25% post-AMS vs. 0% pre-AMS, p< 0.001). Oral fluoroquinolone use at discharge was significantly decreased in the post-AMS group (p< 0.001). Antibiotic treatment days remained unchanged. There was no statistical difference between the two groups in 30-day mortality, 30-day readmission, relapse, and C. difficile colitis.

Conclusion.
A multifaceted antimicrobial therapy intervention successfully reduced the use of fluoroquinolones in patients with community-acquired IAI during hospitalization and discharge. No differences in mortality, readmission, or relapse rates were observed.
Disclosures. Background. The Infectious Diseases Society of America estimates that up to 50% of antibiotic use in hospitals is inappropriate. In order to assist with reducing inappropriate antibiotic use, the Centers for Disease Control and Prevention has recommended systemic evaluation of ongoing antibiotic therapy need, such as antibiotic time-outs (ATOs), be implemented. This has further been supported by the Joint Commission in their antimicrobial stewardship medication management standard. Our system implemented a prescriber-led ATO process in 2018, but documented completion of the ATO remained low. Due to this, pharmacists were integrated into the ATO process with the goal of increasing completion rates.
Methods. This pre-post interventional study analyzed the impact of an antibiotic time out process implemented for patients receiving piperacillin/tazobactam (P/T) or cefepime (CEF) for a minimum of 48 hours. The pre-group (Jan-April 2018) had ATOs completed by the primary medical team, while pharmacists completed the ATO in the post group (Jan-April 2020). For each group, a computerized alert prompted completion of the ATO in the electronic health record (EHR). The alert included systematic questions to assess the need for continued P/T and CEF use. The primary outcome was percentage of ATO documentation completed. Secondary outcomes included inappropriate continuation of P/T and CEF and de-escalation within 24 hours after ATO completion.
Results. A total of 248 and 234 patients in the pre-and post-groups were included, respectively. Significantly more ATOs were documented in the post-group compared to the pre-group (65.5% vs 48.5%, p< 0.001). Similarly, inappropriate continuation of P/T and CEF after the ATO process was significantly lower in the post-group compared to the pre-group (11.6% vs 64.0%, p< 0.001). While not statistically significant, there was a trend toward increased de-escalation in the post-group within 24 hours of ATO completion (58.9% vs 47.9%, p=0.105).
Conclusion. A pharmacist-led ATO process reduced inappropriate use of P/T and CEF compared to a prescriber-led process. Incorporating pharmacists into an ATO process may optimize antimicrobial stewardship outcomes.
Disclosures. All Authors: No reported disclosures

Formal Pediatric Antimicrobial Stewardship Program at a Children's Hospital Within a Larger Academic Medical Center Decreases Antimicrobial Prescribing
Paul Feustel, PhD 1 ; Mark Botti, PharmD 1 ; Shannon Andrews, MD 1 ; 1 Albany Medical Center, Albany, New York

Session: P-07. Antimicrobial Stewardship: Program Development and Implementation
Background. Antimicrobial stewardship is a coordinated approach to antimicrobial overprescribing, an avoidable contributor to adverse events in children. Implementation of a formal pediatric antimicrobial stewardship program (pASP) in a children's hospital within a hospital poses unique challenges due to staffing, funding, and institutional priorities. We hypothesized that a formalized pASP would decrease antimicrobial prescribing in a children's hospital within a large academic medical center.
Methods. We extracted pharmacy administration data for all patients receiving systemic antimicrobials in a tertiary care, academic children's hospital in Upstate NY from 3/1/2020-5/31/2021. We grouped patients into floor (including patients with surgical, hematologic, and oncologic processes), pediatric intensive care unit (PICU), and neonatal intensive care unit (NICU). We calculated antimicrobial days of therapy per 1000 patient days (DOT/1000PD) for 6 months before, 3 months during, and 6 months after institution of pASP. The formalized pASP involved physician and pharmacy leadership of prospective audit and feedback. We developed run charts and used two-way analysis of variance (ANOVA) with an effect of location, an effect of the intervention, and an interaction effect. Significant effects were then tested using Tukey's test for multiple comparisons.
Results. Run charts are displayed in figures 1-3. Overall, the pediatric floor(DOT/1000PD=1181) had significantly higher prescribing than the PICU(847), which was significantly higher than the NICU(327) (p< 0.001, ANOVA). Antimicrobial prescribing after pASP dropped by 80 DOT/1000PD (98%CI: 23 to 137) (p=0.008; Tukey's test) after including the effect of location. The interaction effect was not significant (p=0.77; ANOVA) suggesting that the intervention did not have a significantly different effect in the three locations.
Variation in Antimicrobial Prescribing on the Pediatric Floors