Introduction: In June 2017, the antimicrobial stewardship team at Wesley Healthcare implemented a combination of strategies aimed at reducing fluoroquinolone usage. The components included suppression of fluoroquinolone susceptibility inEnterobacterales isolates, removal of fluoroquinolones as first-line options in order sets, and introduction of a respiratory-specific antibiogram.Objectives: The objective was to evaluate the impact of combined stewardship strategies on fluoroquinolone utilization. Methods:This was a quality improvement study evaluating fluoroquinolone use within a health-care system. The primary outcome was ciprofloxacin and levofloxacin usage in days of therapy (DOT) per 1000 inpatient days collected at monthly intervals for 24 months before and after the intervention. Overall antibacterial usage in DOT served as a control variable. The secondary outcomes were Escherichia coli and Pseudomonas aeruginosa susceptibility to ciprofloxacin measured at the same time points.An interrupted time series analysis using segmented regression was performed for all variables.Results: The mean monthly levofloxacin usage was reduced from 14.1 (95% confidence interval [CI], 12.7-15.4) to 8.4 (95% CI, 7.6-9.3) DOT. The mean monthly ciprofloxacin usage was reduced from 26.9 (95% CI, 24.6-29.4) to 15.8 (95% CI, 14.0-17.5) DOT. The trend in levofloxacin usage was reduced (P = .035), while a preexisting downward trend in ciprofloxacin usage was unchanged (P = .430). Overall antibacterial usage increased (P = .001). There were no differences in Escherichia coli or Pseudomonas aeruginosa susceptibilities observed. Conclusion:The use of combined antimicrobial stewardship strategies may be a viable intervention method to reduce fluoroquinolone usage. The combined strategy was effective in reducing levofloxacin usage, as demonstrated by the reduction of use and the downward usage trend.

Background Advancements in laboratory diagnostics are constantly occurring and accuracy in interpreting results directly affects optimal patient care. The purpose of this process use evaluation was to assess the efficacy of our current presentation of microbiology results in facilitating appropriate clinical decisions and antibiotic stewardship. Methods A six question multiple choice survey was sent to prescribers and pharmacists. Each question used our healthcare system’s current presentation of microbiology results. The recipients were asked to make a clinical decision based on patient history and results presented. The topics surveyed included de-escalation of antibiotics based on polymerase chain reaction (PCR) for positive blood cultures (Image 1), evaluation of C. difficile PCR and enzyme immunoassays (Image 2), impact of recent immunization on results of S. pneumoniae urine antigen (Image 3), susceptibilities of Group C Streptococcus and H. influenzae (Images 4 and 5), and understanding of minimum inhibitory concentrations (MIC, Image 6). The anonymous surveys were collected either electronically or by paper. Image 1 Image 2 Results Several trends were seen in the 64 responses received (n, %). Questions with lab results containing detailed comments with guidance on how to interpret the results had the highest percentage of correct responses. This included our C. difficile (59, 92%) and S. pneumoniae urine antigen (61, 95%) results. Culture results with presumed susceptibilities and/or lack of guidance (H. influenzae (55, 86%); Group C Streptococcus (46, 72%)) had lower rates of correct interpretation and resulted in provider reluctance to de-escalate antibiotics. A similar trend was seen with the word “presumptive” on blood culture results by PCR (37, 58%). MICs were frequently misinterpreted as being able to compare activity between antibiotics (46, 72%). Image 3 Image 4 Image 5 Conclusion This study highlights that stewardship programs should focus on how lab results are reported and interpreted and should work with their microbiology lab to determine the presentation of results. Additions of detailed interpretations to Microbiology results may lead to improved de-escalation and antibiotic selection. Image 6 Disclosures All Authors: No reported disclosures

Background Fluoroquinolones are broad spectrum antimicrobials associated with a growing list of adverse effects, such as Clostridioides difficile infection, arrhythmias, central nervous system effects, tendon rupture and aortic aneurysm. Due to increasing concerns regarding adverse events and growing resistance, the antimicrobial stewardship team at Wesley Healthcare implemented a bundle aimed at reducing fluoroquinolone usage beginning in June 2017. The components of this bundle included suppression of fluoroquinolone susceptibility in Enterobacteriaceae isolates, removal of fluoroquinolones as first line options on order sets, and introduction of a respiratory specific antibiogram. Methods The objective was to evaluate the impact of the stewardship bundle on fluoroquinolone utilization. The primary outcome was ciprofloxacin and levofloxacin usage in days of therapy per 1000 inpatient days (DOT) collected at monthly intervals for 24 months before and after intervention. Overall antimicrobial usage in DOT served as a control variable. The secondary outcomes were E. coli and P. aeruginosa susceptibility to ciprofloxacin measured at the same time points as the primary outcome. An interrupted time-series analysis using segmented regression was performed for all variables. Results The mean monthly levofloxacin usage was reduced from 14.1 (95% CI, 12.7 - 15.4) to 8.4 (95% CI, 7.6 - 9.3) DOT. The mean monthly ciprofloxacin usage was reduced from 26.9 (95% CI, 24.6 - 29.4) to 15.8 (95% CI, 14.0 - 17.5) DOT. The trend in levofloxacin usage was reduced (p=0.035), while a pre-existing downward trend in ciprofloxacin usage was unchanged (p=NS). Overall antimicrobial usage increased, likely due to increasing hematology/oncology populations during the study period. There were no differences in E. coli or P. aeruginosa susceptibilities observed. Conclusion This antimicrobial stewardship bundle may be a useful intervention to reduce fluoroquinolone usage. The bundle may be of particular utility in reducing levofloxacin usage, as our results demonstrated a change in both its usage and trend in usage. Disclosures All Authors: No reported disclosures