An antimicrobial stewardship bundle was implemented in 23 community health system urgent care and primary care clinics to reduce fluoroquinolone prescribing in urinary tract infections. The percentage of urinary tract infection (UTI) visits prescribed a fluoroquinolone subsequently decreased from 17.6% to 3% in urgent care and from 23.8% to 6.8% in primary care.

Background Vancomycin (VAN)-associated acute kidney injury (AKI) is increased when VAN is combined with certain beta-lactam (BL) such as piperacillin-tazobactam (TZP) but not had been evaluated with ceftolozane-tazobactam (C/T). We aim to investigate the AKI incidence of VAN in combination with C/T (VAN/C/T) compared to VAN in combination to TZP (VAN-TZP). Method We conducted a multi-center observational comparative study across the United States. The primary analysis was a composite outcome of AKI: 1) RIFLE, 2) AKIN, or 3) VAN-induced-nephrotoxicity according to the consensus guidelines. Multivariable logistic regression analysis had been conducted to adjust for confounding variables and stratified Kaplan-Meir analysis to assess the time-to-nephrotoxicity between the two groups. Results We included (n = 90) VAN/C/T and (n = 284) VAN-TZP at an enrollment ratio of 3:1. The primary outcome occurred in 12.2% vs. 25.0% in the VAN-C/T and VAN-TZP groups, respectively (P = 0.011). After adjusting for confounding variables, VAN-TZP was associated with increased odds of AKI compared with patients receiving VAN-C/T; with an aOR of 3.308 [1.560-6.993]. Results of the stratified Kaplan-Meir with log-rank time-to-nephrotoxicity analysis indicate that time to AKI was significantly shorter among patients receiving VAN-TZP (P = 0.004). Cox proportional hazards analysis demonstrated that TZP was consistent with the primary analysis (P = 0.001). Conclusions Collectively, our results suggest that the AKI is not likely to be related to tazobactam but rather to the piperacillin which is a component in the VAN-TZP combination but not the VAN-C/T.

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Objective: To compare 2 methods of communicating polymerase chain reaction (PCR) blood-culture results: active approach utilizing on-call personnel versus passive approach utilizing notifications in the electronic health record (EHR). Design: Retrospective observational study. Setting: A tertiary-care academic medical center. Patients: Adult patients hospitalized with ≥1 positive blood culture containing a gram-positive organism identified by PCR between October 2014 and January 2018. Methods: The standard protocol for reporting PCR results at baseline included a laboratory technician calling the patient’s nurse, who would report the critical result to the medical provider. The active intervention group consisted of an on-call pager system utilizing trained pharmacy residents, whereas the passive intervention group combined standard protocol with real-time in-basket notifications to pharmacists in the EHR. Results: Of 209 patients, 105, 61, and 43 patients were in the control, active, and passive groups, respectively. Median time to optimal therapy was shorter in the active group compared to the passive group and control (23.4 hours vs 42.2 hours vs 45.9 hours, respectively; P = .028). De-escalation occurred 12 hours sooner in the active group. In the contaminant group, empiric antibiotics were discontinued faster in the active group (0 hours) than in the control group and the passive group (17.7 vs 7.2 hours; P = .007). Time to active therapy and days of therapy were similar. Conclusions: A passive, electronic method of reporting PCR results to pharmacists was not as effective in optimizing stewardship metrics as an active, real-time method utilizing pharmacy residents. Further studies are needed to determine the optimal method of communicating time-sensitive information.

Background Emerging literature has demonstrated a positive impact of emergency department (ED)-focused antimicrobial stewardship initiatives on antibiotic prescribing. To date, the majority of interventions focus on urinary tract infections (UTI) and few evaluate electronic medical record (EMR) integration. Methods This retrospective, quasi-experimental study was conducted at five EDs within a large-community health system. An antimicrobial stewardship intervention bundle was implemented in February 2022, consisting of ED-specific discharge antibiotic order sets for UTI and skin and soft tissue infections (SSTI) and education to ED prescribers and pharmacists. Adult patients receiving an ED discharge antibiotic prescription associated with a UTI or SSTI ICD10 code were included. The primary outcome was the percentage of prescriptions matching discharge order set antibiotic regimens for UTI and SSTI in the 2-month pre- and post-implementation periods. Secondary outcomes included evaluation of primary outcome indications (UTI or SSTI), use of recommended agents or durations of therapy, use of combination therapy (SSTI only), and rate of 30-day hospital admission. Results The implementation of this multi-intervention stewardship bundle was associated with a significant initial improvement in the percentage of prescriptions matching discharge order set recommendations for UTI and SSTI (30.9% vs. 35%, P = 0.04). There was a significant improvement in UTI prescribing (54.9% vs. 61.7%, P = 0.01), but the same benefit was not demonstrated for SSTI (6.2% vs. 3.6%, P = 0.04). A significant improvement was also observed in the use of recommended durations of therapy (34% vs. 38.5%, P = 0.023). No significant difference was observed in use of indication recommended agents (75.7% vs. 77.1%, P = 0.43), use of inappropriate combination therapy for SSTI (31.7% vs.26.3%, P = 0.07), or 30-day hospital admission (6% vs. 5%, P = 0.33). Conclusion This novel multi-intervention ED antimicrobial stewardship bundle was associated with overall immediate improvements in antibiotic prescribing for discharged patients. Future directions of research will include evaluation of methods to improve SSTI prescribing, implementation of prescriber data feedback, and expansion to additional indications. Disclosures All Authors: No reported disclosures.