Ceftolozane-tazobactam and ceftazidime-avibactam showed comparable activity against ESBL and P. aeruginosa, with ceftazidime-avibactam having lower MICs against ESBL isolates and ceftolozane-tazobactam having lower MICs against P. aeruginosa. Ceftazidime-avibactam showed better activity against all CRE isolates except for those carrying the NDM-1 enzyme.

Purpose The implementation of an advanced antimicrobial stewardship program (ASP) at a quaternary care hospital in the United Arab Emirates is described, including a report on the implementation and outcomes of the program. Methods This was a single‐center quasi‐experimental study to assess the impact of the ASP on antimicrobial use measures, ASP interventions performed, and clinical outcomes by comparing the data collected at baseline, from the third quarter (Q3) 1 July 2015 to the fourth quarter (Q4) of 31 December 2017, approximately 2 years following program implementation. Results From 1 July 2015 until 31 December 2017, the program reported a total direct cost savings estimated at $1 339 499, despite a significant increase in patient discharges and total patient‐days. The antimicrobial cost per inpatient‐day decreased by 32% from $47.2 to $32.3. Usage of monitored antimicrobials decreased despite an increase in patient census since hospital opening. Hospital‐onset Clostridioides difficile infection (CDI) rates decreased from 0.46 cases per 1000 patient days in 2015 to 0.12 cases per 1000 patient days in 2017 (P = 0.035, 95% CI 0.08 to 0.91). Hospital‐onset infections due to multidrug‐resistant organisms (MDROs) decreased from 2.39 cases per 1000 patient days in 2015 to 0.38 cases per 1000 patient days in 2017 (P = 0.05, 95% CI 0.09 to 0.28). Overall, the number of ASP interventions amounted to a total of 4123 interventions, with an acceptance rate of 91%. Conclusion The implementation of an advanced ASP at a quaternary care hospital in the United Arab Emirates was associated with a decrease in antimicrobial utilization, antimicrobial expenditure, and a reduction in hospital‐onset CDI and MDRO rates. To our knowledge, this is the first report describing the outcomes of an advanced ASP program at a quaternary care hospital utilizing real‐time surveillance software and CDSS in the Middle East.

We report a case of acute disseminated encephalomyelitis (ADEM) secondary to Mycoplasma pneumoniae infection that failed to improve with methylprednisolone and intravenous immunoglobulin (IVIG); who responded with plasmapheresis. A 21- year- old female with an unremarkable medical history, initially presented to an outside hospital with fever and an influenza-like illness and was subsequently intubated for worsening sensorium. Brain magnetic resonance imaging was suggestive of ADEM or vasculitis for which she received five days of pulse steroids and IVIG. She showed no signs of improvement and was transferred to our hospital for plasmapheresis. Her work up revealed an elevated IgM antibody and positive sputum for Mycoplasma pneumonia by polymerase chain reaction, suggesting the pathogen as the culprit for her ADEM. Intravenous azithromycin and daily plasmapheresis were initiated for seven consecutive days. Following commencement of her treatment, the patient experienced good recovery and was subsequently extubated. She continued to improve with physical therapy and gained mobility, with the help of a walker. Patients commonly present with ADEM following viral infection or vaccination and less frequently post bacterial infection. The current treatment of ADEM due to Mycoplasma pneumoniae is based on limited case reports. Our patient poorly responded to pulse steroids and IVIG, while she markedly improved on azithromycin and plasmapheresis. In patients presenting with encephalopathic signs and neurological manifestations following pneumonia; Mycoplasma pneumoniae infection and subsequent immune-mediated demyelination should be considered.

BackgroundAntimicrobial stewardship programs (ASPs) are pivotal in healthcare facilities to curb antimicrobial resistance, improve patient outcomes and decrease healthcare costs. There is lack of literature on integrating the electronic medical record and electronic surveillance into antimicrobial stewardship in the Middle East. We describe our experience with implementing an advanced antimicrobial stewardship program using computerized clinical decision support system (CDSS) and electronic real-time surveillance software at a newly operated quaternary care hospital in the United Arab Emirates.MethodsThe ASP was implemented at hospital inception in April 2015. ASP utilized strategies described in the IDSA/SHEA guidelines including the use of rapid diagnostics, CDSS and electronic real-time surveillance. Antimicrobial therapy consumption was monitored monthly and reported in days of therapy per (DOT) per 1,000 inpatient days. Antimicrobial cost was analysed as total antimicrobials dispensed (AED) per 1,000 inpatient days. Antimicrobial therapy consumption and cost were analysed from the third-quarter of 2015 until the first quarter of 2017.ResultsAlthough our program has only been active for a little over 2 years, it has achieved significant decrease in the use of targeted antimicrobials. Carbapenem use decreased by 32%, from 105 to 71 DOT/1,000 inpatient days (P = 0.05). Anti-MRSA agents use decreased by 57% from 109 to 46 DOT/1,000 inpatient days (P = 0.003), and anti-pseudomonal β-lactam use decreased by 49% from 84 to 43 DOT/1,000 inpatient days (P = 0.015). Total cost of antimicrobial therapy decreased as well by 67% from 323 AED/1,000 inpatient days to 105 AED/1,000 inpatient days, (P = 0.01), with a hard cost total saving of 943,324 AED (256,338 USD) since program inception. There was no change in the severity of illness scores as measured by the hospital Case Mix Index (CMI) during the study period.ConclusionTo our knowledge this is the first advanced ASP program in the United Arab Emirates utilizing CDSS and electronic real-time surveillance. Our program demonstrated a significant decrease in the use and total cost of antimicrobials since hospital inception despite a significant increase in patient volume.Disclosures All authors: No reported disclosures.

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