BackgroundInappropriate Antimicrobial use, its associated resistance and suboptimal patient outcomes are important quality and safety concerns. Antimicrobial stewardship programs (ASP) can help reduce the risk of development of multi-drug resistant organisms, and Clostridium difficile infections. The Centers for Disease Control and Prevention (CDC) recommended core elements for successful implementation of ASPs in 2014. We describe the adoption of the core elements and associated outcomes at a large health system in the United States.MethodsWe organized our program based on the seven core elements. We focused on 1) making antimicrobial stewardship a system priority with full leadership support, 2) creating an infrastructure to promote and disseminate best practices, 3) standardizing indications for use of the different antimicrobial classes promoting most narrow-spectrum agents, and 4) building capacity for hospitals to achieve their goals from local leadership buy-in to infrastructure to do the work.ResultsLocal ASPs were established in 89 hospitals. 3.3 million defined daily doses (DDDs) were used in FY15 compared with 2.9 million in FY16 and 2.8 million in FY 17. There was a drop in systemic antimicrobial use from 877 (FY15) to 809 (FY16) and 776 (FY17) DDDs/ 1000 patient-days ((7.7% and 4.1% reduction in FY 16 and FY 17; P <0.001) (Figure 1 and 2). In addition, hospital onset C. difficile lab ID events standardized infection ratios (SIR) dropped from 0.89 (events=2292) in FY15 to 0.84 (events=2056) in FY16 (5.6% reduction) and 0.75 in FY 17 (events=1818), a 10.7% reduction compared with FY16.ConclusionImplementation of the CDC core elements in a very large system has led to both an improvement in total systemic and targeted antibiotic use and reduction in C. difficile infections.Disclosures All authors: No reported disclosures.

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BackgroundOveruse of fluoroquinolones has been associated with increased rates of Clostridioides difficile infections, MRSA, and resistant Gram-negative infections due to selective pressure on normal flora. In addition, the FDA has issued several safety alerts regarding systemic use of fluoroquinolone antibiotics due to concerns for serious adverse events and antimicrobial resistance. Considerable variability in the utilization of this antibiotic class across the system resulted in a system-wide initiative to reduce inappropriate prescribing.MethodsA national initiative included the integration of system-wide approved adult criteria for use into electronic health record order sets and pharmacy clinical decision support systems. System-wide education on the initiative involved learning modules, education toolkits and webinars. Fluoroquinolone utilization rates were reported monthly to help facilities determine the success of initiatives to improve performance.ResultsThe fluoroquinolone criteria for use were integrated into several disease-specific order sets system-wide to include: pneumonia, acute exacerbation of COPD, chronic bronchitis, sepsis, acute pyelonephritis, and skin and soft-tissue infection. The learning modules were assigned to all acute care pharmacists resulting in 1,783 completions. Education toolkits were utilized by antimicrobial stewardship teams for provider education. A significant reduction in fluoroquinolone utilization rates, defined by days of therapy (DOT) per 1000 patient-days, was seen across 94 facilities (Figure 1). This resulted in a 45.84% reduction in fluoroquinolone rates from 2017 (56.96, 95% CI 56.72, 57.21) to 2018 (30.85, 95% CI 30.66, 31.04).ConclusionDeveloping and implementing a multi-pronged approach to maximize the effective use of fluoroquinolones can result in significant reductions in utilization across a diverse health system. Disclosures All authors: No reported disclosures.

Background Clostridioides difficile infections (CDIs) are the most prevalent healthcare-associated infection in the U.S. Of all CDIs, most are related to healthcare exposures and are potentially preventable by reducing unnecessary antibiotic use and interrupting patient-to-patient transmission of CDI.MethodsThe adult SAARs for 4 antimicrobial agent categories were compared with the CDI SIR at 28 facilities with greater than 100 beds across the health system for the calendar year of 2018. The 4 adult antimicrobial agent categories chosen for comparison were: antibacterial agents posing the highest risk for CDI, broad-spectrum antibacterial agents predominantly used for hospital-onset infections (BSHO), broad-spectrum antibacterial agents predominantly used for community-acquired infections (BSCA) and all antibacterial agents.ResultsThe 2018 aggregate CDI SIR for the 28 facilities was 0.609. The aggregate SAAR for the adult antimicrobial agent categories were 1.05 for the antibacterial agents posing the highest risk for CDI, 1.05 for BSHO, 0.88 for BSCA, and 1.03 for all antibacterial agents. No correlation was seen between any of the 4 adult SAAR antimicrobial agent categories and the facility CDI SIR (Figure 1–4).ConclusionWhile reducing unnecessary antibiotics is an important strategy in preventing CDIs, having a higher observed vs. predicted administration ratio in the four antimicrobial agent categories studied was not correlated with a higher CDI SIR, including the CDI SAAR category. Reduction of CDI is challenging requiring a multipronged approach to include infection control strategies, appropriate testing, and antimicrobial stewardship. Disclosures All authors: No reported disclosures.