P-1766. Evaluation of a Comprehensive Antimicrobial Stewardship Initiative for Gram-Negative Bacteremia in 21 Acute Care Hospitals
Authors: Rogers Tara M , Trisler Michael J , Ours Rachael , Pickering Aaron , Stewart William N , Welch Joseph , Salata Heather , Heffern Mary-Teresa , Wein Megan , Abad Cybele , Oakes Amber A , Ergen Howard J , Jawanda Jasanjeet , Trzebucki Alex , Shah Sunish , Angelo Sahil , Khadem Tina , Ludwig Justin , Woodworth Chelsea , May Stephanie Shealy , Veillette John J , Shields Ryan K , McCreary Erin K , Ryan Bariola J 
Published: January 2025

Background

Shorter antibiotic courses are non-inferior to longer for treatment of uncomplicated gram-negative bacteremia (GNB). This study evaluated the impact of a pharmacist-driven stewardship effort to use clinical decision support software (CDSS; ILÚM Insight, Infectious Diseases Connect, Inc.) plus an evidence-based treatment algorithm on antibiotic duration of therapy (DOT) for GNB in the UPMC health system, USA.

Methods

This retrospective cohort study utilized CDSS alerts for Enterobacterales GNB in adults from March to August 2022 (pre-intervention) and March to August 2023 (post-intervention). We excluded patients with complicated or polymicrobial GNB, admission ≤ 24 hours or death ≤ 72 hours after blood culture result, index culture outside of a UPMC facility, or severe immunocompromising condition.

We matched patients using a propensity score incorporating age, sex, and comorbidities. We compared total antibiotic DOT using a Wilcoxon rank-sum test, and compared key secondary outcomes, including infection-related readmission, C. difficile infection (CDI), development of multi-drug resistant organisms (MDRO), and all-cause death using Cochran-Mantel-Haenszel statistics.

Results

After initial screening, 1586 patients met inclusion criteria; of these, 411 and 426 patients were included in final pre- and post-intervention analyses, respectively (Table 1). Primary reasons for exclusion were complicated (35.8%) or polymicrobial (7.3%) infection. Median DOT was shorter post-intervention (10.5 days) versus pre-intervention (12.5 days; p &lt; 0.0001), and patients receiving ≤ 7 days of therapy increased from 14.8% to 19.6% post-intervention. Pharmacist engagement with CDSS alerts increased from 29% to 41% (p &lt; 0.005). Rate of IV to oral de-escalation, percent discharge on antibiotics, length of stay, and rate of treatment-emergent adverse effects did not differ significantly pre- and post-intervention (Table 2).

Conclusion

Preliminary findings suggest that pharmacist engagement with CDSS alerts in combination with an evidence-based treatment algorithm is associated with shorter antibiotic therapy duration. Ongoing subgroup analyses will help target future stewardship efforts to certain patient populations or facilities for continued improvement.

Disclosures

Ryan K. Shields, PharmD, MS, Allergan: Advisor/Consultant|Cidara: Advisor/Consultant|Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Menarini: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Roche: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Utility: Advisor/Consultant|Venatorx: Advisor/Consultant|Venatorx: Grant/Research Support Erin K. McCreary, PharmD, Abbvie: Advisor/Consultant|Basilea: Advisor/Consultant|Ciadara: Advisor/Consultant|Entasis: Advisor/Consultant|Ferring: Advisor/Consultant|GSK: Advisor/Consultant|GSK: Honoraria|Melinta: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria