149. Impact of Stewardship on Antibiotic Utilization Rates During the COVID-19 Pandemic: Successes and Challenges in a Regional Hospital

Abstract Background Antibiotic stewardship (AS) is at the core of patient safety and prevention of antimicrobial resistance. Healthcare providers prescribe antibiotics for COVID-19 despite low rates of bacterial co-infection. Our regional hospital had antibiotic utilization (AU) rates higher than other health systems even prior to the emergence of SARS-Cov2. We analyzed the effect AS on AU during the pandemic. Total Antibiotic Utilization Rates Before and During COVID-19 Pandemic Methods Total and specific AU rates were benchmarked using BD MedMined’s medication analytics system from 2nd quarter 2019 to 1st quarter 2021. The AS team released yearly antibiogram and individual prescriber’s AU rates and performed weekly, and as needed, review of antibiotic ordering and feedback. To assist in appropriate prescribing decisions, remote educational sessions or mini-lectures and local antibiotic guidelines were developed during the pandemic period. AU rates were monitored quarterly to determine the effects of the AS interventions to prescribing practices. Results Total and specific AU rates were higher (up to 34% and 80%, respectively) in our index hospital compared to other non-teaching hospitals nationally prior to the pandemic. Total antibiotic utilization increased by only 5.5% in the 2nd quarter 2020, peak of AU during the pandemic. Total, vancomycin, piperacillin-tazobactam and quinolone utilization rates decreased by 19%, 41%, 38%, and 52%, respectively, at 1st quarter 2021 compared to 4th quarter 2019. Steeper decreases were noted with implementation of educational activities. Ceftriaxone use remained high and was 50% greater than comparator hospitals at 1st quarter 2021. Conclusion Although problematic during the COVID-19 pandemic, AS can have significant impact on provider prescribing practices and decrease total and specific antibiotic utilization rates. The use of ceftriaxone, an antibiotic commonly used for empiric bacterial coverage for community acquired pneumonia, presents as a continuing challenge. Disclosures All Authors: No reported disclosures


Session: P-09. Antimicrobial Stewardship: Trends in Antimicrobial Prescribing
Background. Antibiotic stewardship (AS) is at the core of patient safety and prevention of antimicrobial resistance. Healthcare providers prescribe antibiotics for COVID-19 despite low rates of bacterial co-infection. Our regional hospital had antibiotic utilization (AU) rates higher than other health systems even prior to the emergence of SARS-Cov2. We analyzed the effect AS on AU during the pandemic.

Total Antibiotic Utilization Rates Before and During COVID-19 Pandemic
Methods. Total and specific AU rates were benchmarked using BD MedMined's medication analytics system from 2 nd quarter 2019 to 1 st quarter 2021. The AS team released yearly antibiogram and individual prescriber's AU rates and performed weekly, and as needed, review of antibiotic ordering and feedback. To assist in appropriate prescribing decisions, remote educational sessions or mini-lectures and local antibiotic guidelines were developed during the pandemic period. AU rates were monitored quarterly to determine the effects of the AS interventions to prescribing practices.
Results. Total and specific AU rates were higher (up to 34% and 80%, respectively) in our index hospital compared to other non-teaching hospitals nationally prior to the pandemic. Total antibiotic utilization increased by only 5.5% in the 2 nd quarter 2020, peak of AU during the pandemic. Total, vancomycin, piperacillin-tazobactam and quinolone utilization rates decreased by 19%, 41%, 38%, and 52%, respectively, at 1 st quarter 2021 compared to 4 th quarter 2019. Steeper decreases were noted with implementation of educational activities. Ceftriaxone use remained high and was 50% greater than comparator hospitals at 1 st quarter 2021.
Conclusion. Although problematic during the COVID-19 pandemic, AS can have significant impact on provider prescribing practices and decrease total and specific antibiotic utilization rates. The use of ceftriaxone, an antibiotic commonly used for empiric bacterial coverage for community acquired pneumonia, presents as a continuing challenge.
Disclosures Background. Background: Pseudomonas aeruginosa continues to be an important cause of nosocomial infections associated with a high morbidity and mortality. Despite the availability of ceftazidime-avibactam (CAZ-AVI) and ceftolozone-tazobactam (CFT-TAZO), CEF continues to be an empiric agent of choice in several institutions. Aim: To evaluate the prevalence and trend in susceptibilities of P. aeruginosa to CEF over a 7-year period, identify possible correlation with the use of CAZ, AZT, PTZ, CIP, and CAR, (DOT/1000 patient days), as a quality improvement (QI) measure for optimizing CEF use, introduce antibiotic cycling as a tool to avoid emergence of drug-resistance in P. aeuriginosa.
Methods. A retrospective review of antimicrobial susceptibility data of all isolates of P. aeruginosa, (inpatient and outpatient) at the Detroit VAMC pre and post implementation of antibiotic cycling, over a 7-year period (2011-2017) was performed. Susceptibility testing was performed by reference broth micro-dilution methods in a central laboratory. Data analysis was performed using Pearson correlation coefficient score. Being a QI project, clinical data were not reviewed.
Results. A total of 977 isolates were identified during the study period. (drug usage are in DOT/1000 PD); CAZ and AZT use surged during 2013-14 from 5 to 8 dropping in 2015-17 to < 3; PTZ usage increased to 100 during 2011-14 but dropped to 38 in 2015-17 (drug shortage); CAR use averaged at 10 until 2016 and dropped to 8 in 2017; CIP use dropped by 50% from 30 in 2012 to 15 in 2017; P. aeruginosa susceptible to CEF decreased from 88% in 2012 to 81% in 2014 mirroring the increased use of CEF, AZT, CAZ, and CIP; AG use was very low at < 5. With restrictions on the use of AZT, CAZ, and CIP, from 2014-15, CEF susceptibility increased significantly to 95.5% in 2015. Drug shortage of PTZ in 2015 and increased use of CEF from 2015-17 led to a drop in susceptibility to (82%); P. aeruginosa susceptible to CAR and AG averaged at 88% and 97% respectively . However, reintroduction PTZ, resulted in improved susceptibility of P. aeuruginosa to CEF by 40% within a year.
Conclusion. Judicious antimicrobial use and antibiotic rotation play a significant role in reversing drug resistance in P. aeuruginosa. Background. Antibiotic prescribing (AP) and resistance (AR) may influence severity of illness in urinary tract infection (UTI). Limited data exist assessing the relationship between county-level AP and AR on initial presentation to hospital for UTI. This study evaluated the association between county-level AP and AR on UTI severity of illness among hospitalized patients in New York State.

Association Between Outpatient Antibiotic Prescribing, Antimicrobial Resistance, and Initial Presentation to Inpatient Setting for Urinary Tract Infections Among Older Adults in New York
Methods. Retrospective, cross-sectional analysis, combining data from New York State Statewide Planning and Research Cooperative System (SPARCS) and previously published data on countywide antimicrobial resistance and antimicrobial prescribing. Inclusion criteria: female patients admitted to a New York inpatient setting in 2017, UTI (CCS 159), Medicare insurance. Exclusion criteria: missing countywide prescribing or resistance. All-patient refined (APR) clinical severity ≥ 3 was the primary outcome. Counties were classified as prescribing above or below the median prescribing proportion, and above or below the median prevalence of E. coli resistance for TMP-SMX and NTF. Countywide prescribing practices, antimicrobial resistance, patient factors, and location factors were evaluated for association with APR clinical severity ≥ 3 using chi-squared and logistic regression.

Conclusion.
Prescribing patterns may have a significant influence on initial presentation to the hospital for urinary tract infections. Outpatient antimicrobial stewardship should endeavor to promote guideline driven prescribing. Further research is needed to corroborate the findings from this cross-sectional study.
Disclosures. All Authors: No reported disclosures