238. Sharing Unit-Specific Stewardship Metrics With Front-line Providers to Improve Antibiotic Prescribing

Inpatient antibiotics are estimated 30–50% inappropriate and novel antimicrobial stewardship (AS) strategies to engage prescribers are needed. The objective of this study was to describe the implementation of a customized antibiotic use and outcome report with family medicine (FAM) providers and the impact on prescribing behaviors for routine infections in hospitalized adults. Single-center quasiexperiment before and after AS/FAM collaborative intervention. January–March 2017 Standard of Care: routine audit and feedback. FAM leadership worked with AS pharmacists to design reporting process. January–March 2018 Monthly Interventions: reports of antimicrobial use, appropriateness, harms; positive-deviance cases highlighting successful stewardship; education and survey of rotating FAM providers; handheld prescribing tools/guidelines. Consecutive admissions to the adult FAM ward with respiratory, urinary, and skin infections were evaluated. Primary endpoint: duration of optimal prescribing. Each day of therapy (DOT) was classified as optimal, suboptimal, unnecessary, or inappropriate. Antimicrobials were stratified by spectrum and propensity to cause harm. Secondary endpoints: use of broad-spectrum agents, appropriate duration of therapy, and safety. Adults (n = 150, 76 pre, 74 post) were similar in age, comorbid conditions, and antimicrobial indications (Figure 1). Following intervention, unnecessary antimicrobial days decreased from 2 to 0 days (P < 0.001) per patient, optimal therapy selection increased from 25% to 58% (P < 0.001). Narrow-spectrum agents increased from 41% to 59% (P = 0.05) while use of broader (52 vs. 48%) and extended spectrum agents (57 vs. 44%) were not significantly different in the cohort. Guideline concordant duration of therapy improved from 37% to 57% (P = 0.015). Concurrent unit-wide DOTs of broad and extended agents decreased (Figure 2). Reporting unit-specific antimicrobial use, harms and successes, without change in standard audit and feedback, improved antimicrobial prescribing and quality of care. These findings support the need to engage front-line providers like FAM in stewardship interventions and reporting. S. L. Davis, Achaogen: Scientific Advisor, Consulting fee. Allergan: Scientific Advisor, Consulting fee. Melinta: Scientific Advisor, Consulting fee. Nabriva: Scientific Advisor, Consulting fee. Zavante: Scientific Advisor, Consulting fee.