1990. A Strategy of Mandatory Infectious Disease Consultations on Hospital-acquired Clostridium difficile Infection and Antimicrobial Utilization

BACKGROUND: An antibiotic stewardship program (ASP) is critical to ensure the appropriateness of treatment for infections and to help avert Clostridium difficile infection (CDI). In a three-hospital system, infection preventionists (IP) found that hospital-acquired CDI rates were higher than expected in spite of a robust ASP program. The Medical Executive Board mandated infectious diseases (ID) consults for all patients with sepsis, severe sepsis, and septic shock. If consults to ID are mandatory, the hypothesis is that this may help to lower antibiotic days of therapy (DOT)/1,000 patient-days (PD) and HO-CDI rates. METHODS: The ASP program started in November 2014, and mandatory ID consults for all types of sepsis started in March 2016. Data were selected from the time period between 2014 (Quarter 1) to 2017 (Quarter 2). The IP assessed the HO-CDI, and business intelligence generated a monthly report of the total number of ID consults (for any infectious diagnosis). The researchers retrospectively analyzed the data and then performed Pearson correlation statistics. RESULTS: Data on ID consults at hospital sites A, B, and C were correlated against DOT/1000 PD. Hospital A was statistically significant (P = 0.015) for a moderate correlation—where higher ID consults contributed to decreased DOT/1,000 PD. Hospital B showed moderate significance (P = 0.002), and the strongest correlation was at hospital C (P = 0.0007). Then ID consults at all three hospital sites were compared against HO-CDI rates. Hospital A (P = 0.76) and Hospital B (0.18) did not achieve any correlation. Hospital C was strongly correlated (P = 0.004). CONCLUSION: In a three-hospital system, mandatory ID consults led to moderate to strong correlations with decreased DOT/1,000 PD. However, HO-CDI rates were most likely to decrease at only of the hospitals. Overall, ID consultations should be considered as an antimicrobial stewardship strategy to address the appropriateness of antibiotics and to combat CDI. DISCLOSURES: All authors: No reported disclosures.