1010. Exploring Antimicrobial Prescriptions in a National Audit of Hematology/Oncology Inpatients Compared with the General Inpatient Population: Targeted Analysis Highlights Key Areas for Targeted Intervention

BACKGROUND: Little is known about the antimicrobial prescribing practices in hematology and oncology (haemonc) populations. We aimed to explore antimicrobial prescribing practices in haemonc patients compared with other acute inpatients, in order to target areas for intervention. METHODS: In Australia, facilities nationwide participate in an annual point-prevalence survey of antimicrobial prescribing in hospitalized patients (Hospital National Antimicrobial Prescribing Survey (Hospital NAPS)). The results for adult inpatients from 2015–2018 were analyzed. Assessments of appropriateness were undertaken by local antimicrobial stewardship teams according to a structured algorithm, and defined as: 1 (optimal); 2 (adequate); 3 (suboptimal); 4 (inadequate); 5 (not assessable). A score of 1 or 2 is considered to be”appropriate’ and 3 or 4 ‘inappropriate’; those not assessable were excluded. Antimicrobial class, indication and appropriateness were compared between haemonc and other acute inpatient populations. Using logistic regression analysis, factors associated with appropriate prescribing of antibacterials were explored. RESULTS: The survey comprised 95809 antibiotic prescriptions for 63668 adult inpatients (4097 haemonc, 59571 other inpatients) in 423 acute facilities. The top treatment and prophylactic indications for all classes of antimicrobials were highly disparate between haemonc and other inpatients (table). Of note in the haemonc group, vancomycin use was high, and amphotericin B was used frequently for antifungal treatment. In multivariate analysis, haemonc patients were strongly associated with antibacterial appropriateness compared with other inpatients (adjusted OR 1.72, 95% CI 1.59–1.87, P < 0.001); factors associated with inappropriate prescription included antibiotic allergies and prophylactic indications. CONCLUSION: Haemonc patients were more likely to receive appropriate antimicrobials compared with other inpatients. However, we have identified key areas for targeted interventions (prophylaxis use, antimicrobial allergy labels, vancomycin and amphotericin B treatment). Separate analysis of haemonc populations is necessary to identify key areas of concern specific to this patient group. [Image: see text] DISCLOSURES: All authors: No reported disclosures.