223. Impact of Different Stewardship Strategies Applied to a Single Antibiotic Over Time

BACKGROUND: Recommended strategies for antimicrobial stewardship (AMS) include prospective audit with feedback (PAF) and preauthorization (PA). Depending on hospital culture, initiation of PA can be difficult. The impact of various single AMS strategies on antibiotic consumption has been described, although the impact of several strategies over time has not been reported. METHODS: At an academic institution, the impact of various AMS strategies on daptomycin utilization was evaluated over time. A progression of four different approaches was used for restriction: Period 1 (P1): September 2012–June 2013—PAF. Period 2 (P2): July 2013–January 2016—8-day automatic stop. Period 3 (P3): February 2016–December 2017—3-day automatic stop, PA for >3-day use required. Period 4 (P4): January 2018–May 2018—PA. Transition to each strategy was supported by a policy change, approved through the Pharmacy and Therapeutics Committee and Hospital Medical Board. During P1–3, reserved medication orders were reviewed daily by AMS with recommended interventions when appropriate and providers were notified of pre-set stop dates (P2–3). During P4, ordering providers were required to call AMS prior to initiation. Daptomycin utilization rates (DOT/1,000 PD) and mean unique patients receiving daptomycin were collected for each period. RESULTS: As restriction strategies enhanced, mean rate of daptomycin use (DOT/1,000 PD) progressively declined with a significant decrease during each period transition (Figure 1); P1–>P2 (11.6 vs. 8.3; P < 0.01), P2->P3 (8.3 vs. 6.6; P = 0.017), and P3–>P4 (6.6 vs. 3.2; P < 0.01). The mean number of unique patients on daptomycin decreased with implementation of new AMS strategies; P1–>P2 (30.1 vs. 27.6; P = 0.18), P2–>P3 (27.6 vs. 23.8; P < 0.01) and P3–>P4 (23.8 vs. 13.3; P < 0.01). Of note, linezolid “balloon effect” only occurred following transition from P3 to >P4 (6.1 vs. 10.5 DOT/1,000 PD; P < 0.01). CONCLUSION: This single-center descriptive analysis of AMS restriction strategies reveals a progressive decrease in daptomycin use with stepwise implementation. This significant decrease was most profound with ultimate transition to PA. AMS programs unable to initially implement highly restrictive policies can consider using a stepwise approach to ease practitioners into the new model and still have a meaningful impact on antimicrobial utilization. [Image: see text] DISCLOSURES: All authors: No reported disclosures.