1026. Ertapenem Use During Antibiotic Stewardship Interventions in Community Hospitals

BACKGROUND: Antimicrobial stewardship programs (ASP) promote the judicious use of antimicrobials to reduce antimicrobial resistance and improve patient outcomes. In our institution, we identified the overutilization of ertapenem and implemented several interventions to decrease its usage. The objective of this study was to assess the impact of these interventions on ertapenem use, rates of surgical site infection (SSI), carbapenem-resistant Enterobacteriaceae (CRE), and hospital-onset Clostridioides difficile infection. METHODS: This was a retrospective study conducted in 3 community hospitals in Iowa and Illinois using surveillance of anonymized antibiotic and infection control data from 2015 to 2018. Target ASP interventions included a daily retrospective review of ertapenem use, alternative alerts to providers through electronic health records (EHR), carbapenem restriction to infectious disease (ID) providers, and educational meetings with high-use provider groups. The primary outcome was the usage trend of ertapenem, and secondary outcomes were rates of SSI, CRE, and hospital-onset C. difficile infection. Interrupted time series analysis was performed to assess changes in the rates over the study period. RESULTS: An overall significant reduction in ertapenem use was observed in all 3-community hospitals from 2015 to 2018. Ertapenem days of therapy adjusted for case-mix index per 1000 patient-days was 11.2 in 2015 and 2.05 in 2018. Two breakpoints were identified; the addition of an ID trained pharmacist to the ASP (10/2016) and educational meetings with colorectal surgeons (5/2017). No significant difference was seen for hospital-onset C. difficile infection, SSI, or CRE. Purchase costs decreased for ertapenem by 81% in 2018 compared with 2015(P < 0.001). CONCLUSION: Adding an ID trained pharmacist to an ASP decreased usage of ertapenem. The majority of ertapenem use was for surgical prophylaxis, and our data suggested that educational meetings with a high-usage group were effective. Surgical site infection rates did not increase when narrower spectrum surgical prophylaxis was used. Overall hospital-acquired C. difficile rate was unchanged, possibly due to alternative antibiotic use. Our study suggests ASP interventions can be cost saving. [Image: see text] DISCLOSURES: All authors: No reported disclosures.