246. Antimicrobial Stewardship Program (ASP) Efforts to Reduce Antimicrobial Usage in Geriatric Patients without Affecting Outcomes

BACKGROUND: There is limited literature evaluating ASP outcomes in patients 65 years and older. The primary objective of this study was to show that ASP efforts to deescalate and/or discontinue antimicrobial therapy in older patients did not lead to an increased rate of 30-day hospital readmissions due to treatment failure. The secondary objective was to show a decrease in antimicrobial expenditure per adjusted patient day (APD). METHODS: A retrospective chart review was performed to compare the rates of 30-day readmissions of patients 65 years and older who received ASP interventions between January and June 2017 with a control sample who received antibiotics between January and June 2015 (pre-ASP). Patients were included if they received antibiotics for pneumonia (PNA), urinary tract infection (UTI), acute bacterial skin and skin structure infection (ABSSSI) and complicated intra-abdominal infection (cIAI). The ASP team met daily to review patients identified by the clinical pharmacist. ASP interventions consisted of de-escalation of empiric or definitive therapy, change in the duration of therapy or discontinuation of therapy. Treatment failure was defined as readmission due to re-infection or a new infection (e.g., Clostridium difficile). RESULTS: Overall, 461 patients (150 control; 311 intervention) were included. The 30-day readmission rate for all infections decreased during the intervention period (10.7% vs. 3.9%, P = 0.004). There was a statistically significant decrease in 30-day readmissions in the PNA subgroup (9.8% vs. 2.9%, P = 0.038), a marginally significant decrease among UTI patients (12.5% vs. 4.7%, P = 0.097), and no statistically significant change in the ABSSSI (5.6% vs. 8.6%, P = 0.694) and cIAI (20.8% vs. 6.7%, P = 0.233, CI) subgroups. The total APD was 16,267 (control) and 15,487 (intervention). Total antimicrobial expenditure during the control period was $379,643 ($23.33/APD) vs. $67,721 ($4.37/APD) during the intervention period. CONCLUSION: ASP efforts did not lead to an increase rate of 30-day readmissions due to treatment failure. Furthermore, there was a statistically significant decrease in readmission rates in the intervention group as well as a large decrease in antimicrobial expenditure per APD. DISCLOSURES: All authors: No reported disclosures.