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BackgroundOvertreatment of asymptomatic bacteriuria (ASB) is a major challenge for antimicrobial stewardship (ASP). A February 2017 review of our health-system showed >50% of inpatients with a positive urine culture (PUC) were treated despite no urinary tract infection (UTI) symptoms or compelling indications (CI) [pregnancy or pending urologic procedure]. In Fall 2017, we piloted a multifaceted toolkit (MTK) to support an ASB educational campaign (EC) at 26 hospitals.MethodsA MTK of flyers, a urinary testing algorithm, and narrated slides (Figure 1) was distributed in Fall 2017 and implementation was customized by each hospital’s ASP. Impact of EC on treatment of patients with no urinary symptoms (NUS) or altered mental status (AMS) alone were assessed retrospectively by sampling inpatient PUCs from February 1–28, 2018 in a manner identical to a pre-EC sample. Patients were excluded if: CI, age <18 years, neutropenic, or admitted on UTI therapy or with nephrolithiasis. Demographic, clinical, and laboratory data; UTI symptoms; microbiology results; and antimicrobial therapy received, were collected via an adapted CDC UTI assessment form. Each hospital was surveyed on MTK implementation.Figure 1.MTK ComponentsResultsPreliminary pre- and post-EC data from the same 14 hospitals are shown. Patients with NUS decreased slightly post-EC, while those with ≥1-specific symptom increased. Treatment of those with NUS declined post-EC, and those with AMS alone received less empiric therapy.Figure 2.Patient Symptoms Pre- and Post-ECFigure 3. Treatment of Patients with NUS or with AMS as Only SymptomTwelve hospitals (86%) completed the MTK survey. Six used all components, five some, and one none. Those who implemented the MTK cited flyers and slides as most useful and preferred the AMS flyer. Although available, only 55% of hospitals affirmed provider algorithm use.ConclusionPost-EC, less patients with a PUC: had NUS, those with NUS were less likely to be treated, and those with AMS alone received less empiric therapy. MTK implementation appeared to impact ASB treatment, and perhaps, testing. Lower use of the testing algorithm may signal a need for simplification. More data are needed to identify which component(s) of the MTK are most effective.Disclosures L. Davidson, Duke Endowment: Grant Investigator, Grant recipient

BackgroundData have shown that many patients with asymptomatic bacteriuria (ASB) receive unnecessary antibiotics, increasing risk of adverse events and resistance. Positive urine culture (PUC) and urinalysis (UA) results have been shown to prompt treatment without symptoms or compelling indication (pregnancy or prior to urologic procedure). We reviewed clinician action based on PUCs across 28 acute-care hospitals of varied size, scope, and antimicrobial stewardship program (ASP) maturity prior to an ASB educational campaign.MethodsWe conducted a retrospective sampling of inpatient PUCs collected February 1– 28, 2017. Patients were excluded if: pregnant, undergoing urologic procedure, aged < 18 years, neutropenic, or were admitted on active urinary tract infection (UTI) therapy or with nephrolithiasis. A CDC UTI assessment form was adapted to collect: demographic, clinical, and laboratory data, The presence of UTI symptoms, microbiological results, antimicrobial therapy and duration, and rate of ASP intervention.ResultsData from the First 200 included patients at 14 hospitals are shown. Most patients(84/200 (42%)) presented with only non-specific symptoms (NSS) or no symptoms (62/200 (31%)) vs. (vs) at least 1 specific urinary symptom (SUS) (54 / 200 (27%)).Ceftriaxone was the most common empiric therapy in those with no symptoms (17/40(42.5%)) or NSS (35/74(47%)) who were treated. Interventions were documented on 18/200 (9%) patients, despite daily use of clinical decision support (CDS) at 58% of hospitals.ConclusionASB presents many targets and challenges. UA and UC were often performed in patients with no symptoms or NSS. Thus, optimal ordering of UA and UC should be targeted to avoid unnecessary cost and therapy. Treatment of patients with no symptoms appeared to be more common in rural vs. urban hospitals and may help focus education. Low ASP intervention rates, despite use of CDS, may indicate challenges in identifying ASB patients. Many patients received ceftriaxone, which may not be targeted for initial review by ASP. Due to high volume at many sites, daily review of all PUCs may not be feasible.Figure 1.Presenting Symptoms.Figure 2.Results by Presenting Symptoms.Figure 3.Empiric Treatment by Urban Vs. Rural Hospital.Disclosures All authors: No reported disclosures.

BackgroundThe 2015 National Action Plan for Combating Antimicrobial Resistance called for a 20% decrease in antibiotic use among inpatients. Atrium Health (AH), formerly Carolinas HealthCare System, established reductions in antibiotic use (determined by days of therapy [DOT] per 1,000 patient days [PD]) as a yearly system-wide quality goal since 2016. Hospitals in the AH inpatient network vary by size, scope, and antimicrobial stewardship program (ASP) maturity. Prior to our third year, we recognized the need to develop an objective method for determining antibiotic use reduction goals (AURGs); understanding that as ASPs mature, opportunities for reduction stabilize over time and may eventually plateau with consistent ASP. We sought to develop a tool that would better identify hospitals in need of aggressive AURGs.MethodsA scoring tool was developed to assess ASP implementation and metric achievement at individual hospitals to determine AURGs. Tool components were developed from ASP best practices and consensus among a multi-disciplinary team. The tool yields a maximal score of 41.5 points, with higher scores corresponding to more established ASPs who require less aggressive AURGs. An additional 6 points could be earned for tracked intervention data.Figure 1. Scoring Tool Components The tool was applied and a score calculated for each of 27 hospitals. Achieved score placed each hospital into one of 4 AURG ranges: maintain, 1–2.5%, 2.5–5%, and 5–7.5% of DOT/1000 PD. Goals were determined in relation to the median and 75th percentile scores. A minimum score of 39.5, representing full implementation of ASP score components, was required for a maintenance goal.ResultsScores ranged from 3 to 34.5 points across facilities (median 27.5; 75th percentile 31). Twelve facilities scored below 27.5 points, 10 hospitals between 27.5 and 31 points, and 5 facilities between 31 and 39.5 points corresponding to 5–7.5%, 2.5–5% and 1–2.5% AURGs, respectively.Figure 2. Facility Scores and AURGs ConclusionScores and corresponding AURGs were generally well accepted by stakeholders at facilities within the AH network. Next steps include examining the feasibility of achieving AURGs and obtaining feedback from facilities to refine the tool. The tool will also be applied to other healthcare networks to assess external validity.Disclosures All authors: No reported disclosures.