2048. Antibiogram Use in Wisconsin Nursing Homes

BACKGROUND: A 2014 survey demonstrated that fewer than 10% of Wisconsin (WI) Nursing Homes (NHs) used an antibiogram. In 2016, the Centers for Medicare & Medicaid Services released regulations requiring NHs to track and report their antibiotic-related outcomes. The impact these regulations will have on the development and use of antibiograms in NHs is unknown. METHODS: To characterize antibiogram use in WI NHs, a mixed-methods approach was used consisting of two statewide surveys, a combination of semi-structured interviews with key NH personnel, and a structured survey administered to providers in a sample of facilities using an antibiogram. Answers to questions included on statewide surveys administered in 2014 and 2018 were used to assess change in antibiogram use over time. Semi-structured interviews with key NH personnel focused on antibiogram development and dissemination. Structured surveys of providers focused on their awareness of antibiogram existence and the extent to which it influenced their prescribing behavior. A copy of the antibiogram was obtained from some facilities to assess consistency with Clinical and Laboratory Standards Institute (CLSI) recommendations. RESULTS: Antibiogram use in WI NHs increased from 9.3% in 2014 to 32.5% in 2018. The majority of antibiograms were not facility-specific, primarily due to inadequate numbers of isolates at individual facilities. Most facilities reported that antibiogram tools were updated annually, and most made an effort to disseminate them to prescribers. However, 30% of surveyed prescribers reported being unaware of the existence of an antibiogram and only 40% reported it influenced their prescribing decisions. Review of antibiograms provided by NHs revealed that all were created using the traditional “drug-bug” format; however, none were fully compliant with CLSI recommendations. CONCLUSION: Antibiogram use in WI NHs increased significantly between 2014 and 2018. The majority of antibiograms used in WI NHs are not based on facility-specific data. A substantial number of providers are unaware of the existence of an antibiogram in their facility and only a minority felt that it impacted their prescribing decisions. More research is needed on how to increase antibiogram utility in NHs. DISCLOSURES: All authors: No reported disclosures.