1884. Assessment of Potential Antimicrobial-Related Harms in Hospitalized Adults With Common Infections

BACKGROUND: Recent data suggest antibiotic-related harm occurs in 1 in 5 hospitalized patients. The purpose of this study was to critically evaluate potential adverse-drug-events (ADE) associated with antimicrobial administration in hospitalized family medicine (FAM) patients. METHODS: Retrospective cohort of adults receiving antimicrobial therapy for respiratory, urinary, and skin infection on an inpatient FAM ward between January 2017 and March 2018. Primary endpoint: potential ADEs up to 30-day post-therapy, identified using inpatient and outpatient electronic medical records. ADEs were classified as mild, moderate, or severe; Naranjo scores were used to classify causality. Other endpoints included risk associated with ADE, subsequent 30-day readmissions, and infections due to multidrug-resistant organisms up to 90-days post-therapy. RESULTS: 1,499 antibiotic days were assessed in 150 hospitalized adults. Fifty-four patients with at least one potential ADE (68 total) were identified. By Naranjo score, 10 (6.7%) patients had “probable” antibiotic related ADEs (score 5–8), all others were “possible” (score 1–4). Excluding patients with diarrhea receiving concomitant laxatives, 36 patients (24%) suffered from 50 potential ADEs, approximately 3.33 per 100 antibiotic days (Table 1). Thirteen (9.3%) had serious ADEs; 6 were receiving concomitant medications which may have contributed to harm, primarily nephrotoxins (5/6). Alteration of antimicrobial therapy was attributed to ADEs in 12/54 cases (22.2%) while 6 (11.1%) led to 30-day hospital or emergency department (ED) revisits. ADEs were not associated with any specific antimicrobial. Patients with ADEs were more likely to have ED/hospital revisits (OR = 2.42 [1.16–5.05]) and receive more total antibiotic days (11 [6–15] vs. 8 days [6–12 days], P = 0.036) compared with those who did not. [Image: see text] CONCLUSION: One in four hospitalized FAM patients receiving antimicrobials experienced potential ADE. While varying in nature and severity, antimicrobial ADEs contribute to serious harm. These findings underscore need for improved awareness and judicious use. DISCLOSURES: S. L. Davis, Achaogen: Scientific Advisor, Consulting fee. Allergan: Scientific Advisor, Consulting fee. Melinta: Scientific Advisor, Consulting fee. Nabriva: Scientific Advisor, Consulting fee. Zavante: Scientific Advisor, Consulting fee.