2068. Outpatient Antimicrobial Stewardship: Optimizing Patient Care Via Pharmacist Led Culture Review

BACKGROUND: Antimicrobial stewardship programs are well established in the inpatient setting; however, progress has lagged in the outpatient setting. With a growing need for outpatient stewardship, data are needed to guide the development of new services to improve patient care. Many times, cultures are taken in the outpatient setting but results are not acted upon, leading to unnecessary re-presentations to the healthcare setting. METHODS: This study was a prospective chart review via the computerized patient record system with interventions made as needed between January 1, 2018 and January 1, 2019. Infectious Diseases received alerts when oral antibiotics for outpatient use were ordered. Cultures were reviewed daily to ensure drug-bug match and timely interventions. The primary objective of this study was to compare outcomes in patients with accepted interventions vs. rejected interventions: 30-day re-presentation rates, 30-day admission rates, and 30-day treatment failure. Descriptive statistics were used to summarize data. RESULTS: A total of 7,360 antibiotic orders were reviewed in real time by Infectious Diseases. Of which, 965 encounters with cultures were included in the culture review service. Pharmacists intervened on 20.1% (n = 194) of patient encounters. The majority of antibiotic prescriptions that required intervention were from the emergency department (42%) and primary care (39%), with the remaining 19% being from various outpatient specialty clinics. The most common antibiotics prescribed for patients requiring intervention were ciprofloxacin (26%), third-generation cephalosporins (22%), and sulfamethoxazole/trimethoprim (18%). The most common indication for use was urinary tract infection. The intervention acceptance rate was 76%. Intervention significantly decreased rates of 30-day treatment failure (5% vs. 28%, P < 0.0001) and 30-day admission (0.7% vs. 11%, P = 0.0005) when interventions were accepted rather than rejected. CONCLUSION: Culture review service positively impacted outcomes for patients in the outpatient setting. For those antibiotic orders that required intervention, the intervention significantly decreased rates of 30-day treatment failure and 30-day admission when interventions were accepted. DISCLOSURES: All authors: No reported disclosures.