1815. Effects of Syndrome-Based Antimicrobial Stewardship Prospective Audit and Feedback Interventions on Antimicrobial Use in an Urban Community Hospital

BACKGROUND: Establishing antimicrobial stewardship programs (ASP) in community hospitals with limited resources can be challenging. Many hospitals do not have infectious disease (ID) trained pharmacists (PharmD) available. We implemented a comprehensive ASP with syndrome-based prospective audit and feedback at an urban community hospital. METHODS: ASP was implemented at a 151-bed urban community hospital in October 2017. PharmD training on syndrome-based treatment guidelines, including definitions, severity, empiric regimens, de-escalation, and duration was created. Prospective audit by PharmDs was established. This program was implemented and overseen by an ID physician. Days of therapy per 1,000 patient-days (DOT/1,000) was assessed 3 months before and after ASP. Prospective audit and feedback data were reviewed. RESULTS: At 3 months, antimicrobial use decreased (370 vs. 350 DOT/1,000) while the proportion of oral antimicrobials used increased (32% vs. 43%). Antibiotic expenditures decreased by 11% ($42,500 vs. $37,900). Most cases reviewed by prospective audit (58%) fit pre-determined syndromes (Figure 1). Soft tissue and urinary tract infections were the most common syndromes. Interventions occurred in 53% of cases. De-escalation from broad-spectrum agents was more successful in noncritical care settings (Figure 2). CONCLUSION: Syndrome-based prospective audit and feedback was successfully implemented in an urban community hospital with non-ID trained PharmDs using ID physician leadership. Our program led to a decrease in antibiotic use, increase use of oral alternatives, and decreased antibiotic expenditures. Empiric use of broad-spectrum agents was common at our facility. ASP likely contributed to an increase in ceftriaxone and decrease in piperacillin–tazobactam use in medical-surgical floors. Stewardship in critically ill patients remains a challenge. Clear guidelines and access to an ID physician are necessary to provide adequate support for PharmDs without ID-specific training and can help curb antibiotic use. Expanding the list of syndromes may further impact antimicrobial use. DISCLOSURES: All authors: No reported disclosures.