263. Effect of Microbiologic Data on Prospective Audit and Feedback Recommendations

BACKGROUND: Prospective audit and feedback (PAF) is an effective method of antimicrobial stewardship. Given the time-intensive nature of PAF and low rates of intervention, understanding predictors of PAF recommendation and acceptance is imperative. Prior studies have not examined the impact of microbiologic data on the rate of PAF recommendation or recommendation acceptance. We evaluated whether antimicrobials prescribed for patients with positive microbiologic culture data were more or less likely to have a PAF recommendation and whether the presence of culture data impacted recommendation acceptance. METHODS: All PAF audits on antibiotic and antifungal medications for patients admitted to Lucile Packard Children’s Hospital Stanford between April 18, 2017 and April 17, 2018 were included. The PAF program included all pediatric units and injectable antimicrobials active for >48 hours. PAF documentation was completed in the electronic health record and included the presence or absence of positive microbiologic culture data. Our primary outcome was a comparison of PAF recommendation rate based on the presence or absence of positive culture data. We also evaluated whether there were differences in the recommendation acceptance rate and the type of recommendation based on the presence or absence of positive culture data. RESULTS: Of the 3,250 audits performed during the study period, 802 (25%) had positive cultures at the time of audit documentation. Of the 802 audits with positive cultures, 299 resulted in a recommendation compared with 824 of the 2,448 audits without positive cultures (37% vs. 34%, P = 0.07). PAF recommendations were more likely to be followed when positive culture data were present at the time of audit (80% vs. 73%, P = 0.03). The most common recommendation in the presence of positive culture data was to change the antimicrobial (27%) while the most common recommendation in the absence of positive culture data was to stop the antimicrobial (30%). CONCLUSION: The presence of positive microbiologic culture data did not impact the PAF recommendation rate. However, recommendations were more likely to be followed when there was concurrent positive culture data. This highlights the importance of obtaining culture data to direct antimicrobial therapy. DISCLOSURES: All authors: No reported disclosures.