2603. Acceptance of Pharmacist-Led Stewardship Recommendations for Patients with Community-Acquired Pneumonia

BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of hospitalizations and mortality in the US. Overuse of extended spectrum antibiotics (ESA) for CAP contributes to antimicrobial resistance. The 2019 Infectious Diseases Society of America/American Thoracic Society guidelines emphasize de-escalation of ESA following negative cultures, early switch to oral (PO) antibiotics and limited duration of therapy (DOT). This study describes physician acceptance of pharmacist-led stewardship recommendations in hospitalized CAP patients. METHODS: This intervention is part of an ongoing, large, pragmatic, 2×2 factorial, cluster-randomized, controlled trial across 12 Cleveland Clinic hospitals evaluating the independent and combined effects of pharmacist-led de-escalation and rapid diagnostic testing versus usual care in adults with CAP. The pharmacist developed and delivered the following interventions: ESA de-escalation, DOT, intravenous (IV) to PO transition, and antimicrobial discontinuation. Descriptive statistics were used to describe acceptance rates by prescribers for each pharmacist intervention types. RESULTS: From November 1, 2022 to March 16, 2023, the pharmacist recommended 317 interventions for 212/1533 CAP patients (14%). Of the recommended interventions, 57.5% were for patients receiving an ESA during their hospitalization, and 16% were for patients classified as having severe CAP. ESA de-escalation, DOT, IV to PO transition, antimicrobial discontinuation, and other interventions made up 22%, 45%, 18%, 11%, and 4% of the total recommended interventions, respectively. Providers accepted 238 recommendations (75%); they were most likely to accept recommendations for ESA de-escalation (60/69, 87%) and IV to PO transition (48/56, 86%), followed by antimicrobial discontinuation (26/35, 74%), and other (10/13, 77%). Recommendations to limit DOT were least likely to be accepted (94/144, 65%). CAP recommendations were made to the following prescribers: physicians (83%) and advanced practice providers (17%) with equal acceptance rate (75%). [Figure: see text] Summary of CAP-targeted intervention acceptance rates by intervention category CONCLUSION: Approximately 1 in 7 patients garnered a CAP recommendation. While most recommendations were accepted, prescribers were most receptive to de-escalating ESA and least receptive to limiting DOT. DISCLOSURES: Abhishek Deshpande, MD; PhD, Merck: Advisor/Consultant|Seres Therapeutics: Grant/Research Support Michael Rothberg, MD, MPH, Blue Cross Blue Shield: Advisor/Consultant