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1780. Results of a Successful Implementation of a Antimicrobial Stewardship Program in a Public Hospital in São Paulo, Brazil

Abstract Background The implementation of antimicrobial stewardship program is one of the basis for the control of multidrug-resistant bacteria (MDR) and the reduction of unnecessary costs, especially in public hospitals. The use of a multimodal strategy is fundamental to the success of a stewardship program. Methods This is an analysis of antimicrobial consumption in intensive care unit (ICU) of a public hospital in São Paulo, Brazil, before and after the implementation of the antibiotic stewardship program. In the pre-intervention period—January 2014 to December 2015—the rational use of antimicrobials was based only on postprescription authorization by the infectious diseases doctor. Since January 2016 was established an antibiotic stewardship program based on authorization of antimicrobial use, implementation of an empirical antibiotic protocol according to institutional microbiological profile, measurement of adherence to the protocol and feedback to the leadership, pharmaceutical intervention, educational measures for medical staff and leadership engagement to the program. We compared consumption in DDD per 1,000 patient-days (1,000/pd) and mean cost with antimicrobials in the ICU in US dollars. Results The overall antimicrobial consumption reduced from 1,032 DDD/1,000 pd in the preintervention period to 785 DDD/1,000 pd postintervention. Analysis stratified by individual antibiotic was done for the five most commonly used antibiotics. A reduction of 51% consumption for meropenem, 41% for colistin, and 41% for vancomycin was observed. Antibiotic costs were reduced from a monthly median of US$71,176.49 to US$43,772.75 between the two periods. No difference in mortality or mean Apache was observed over the period. Conclusion The implementation of the antimicrobial stewardship program can lead to a safe reduction in antibiotic use in the ICU, with significant reduction of costs that can be reapplied in the patient care. Further analyzes are needed to assess the impact on clinical patient outcomes. Disclosures All authors: No reported disclosures.

Background. The implementation of antimicrobial stewardship program is one of the basis for the control of multidrug-resistant bacteria (MDR) and the reduction of unnecessary costs, especially in public hospitals. The use of a multimodal strategy is fundamental to the success of a stewardship program.
Methods. This is an analysis of antimicrobial consumption in intensive care unit (ICU) of a public hospital in São Paulo, Brazil, before and after the implementation of the antibiotic stewardship program. In the pre-intervention period-January 2014 to December 2015-the rational use of antimicrobials was based only on postprescription authorization by the infectious diseases doctor. Since January 2016 was established an antibiotic stewardship program based on authorization of antimicrobial use, implementation of an empirical antibiotic protocol according to institutional microbiological profile, measurement of adherence to the protocol and feedback to the leadership, pharmaceutical intervention, educational measures for medical staff and leadership engagement to the program. We compared consumption in DDD per 1,000 patient-days (1,000/pd) and mean cost with antimicrobials in the ICU in US dollars.
Results. The overall antimicrobial consumption reduced from 1,032 DDD/1,000 pd in the preintervention period to 785 DDD/1,000 pd postintervention. Analysis stratified by individual antibiotic was done for the five most commonly used antibiotics. A reduction of 51% consumption for meropenem, 41% for colistin, and 41% for vancomycin was observed. Antibiotic costs were reduced from a monthly median of US$71,176.49 to US$43,772.75 between the two periods. No difference in mortality or mean Apache was observed over the period.
Conclusion. The implementation of the antimicrobial stewardship program can lead to a safe reduction in antibiotic use in the ICU, with significant reduction of costs that can be reapplied in the patient care. Further analyzes are needed to assess the impact on clinical patient outcomes.
Disclosures. All authors: No reported disclosures. Background. Antimicrobial stewardship programs (AMSP) are effective in developed countries. This study assessed the effectiveness of an AMSP in a low middle-income country like India.

Impact of an Antimicrobial Stewardship Intervention in India: Evaluation of Post Prescription Review and Feedback as a Method of Promoting Optimal
Methods. An Infectious Diseases (ID) physician-driven prospective audit and feedback strategy to evaluate the effectiveness of an AMSP in two intensive care settings of a tertiary care hospital was performed from January 2016 to July 2017 in three phases: baseline, intervention and follow-up each consisting of 6 months. In the baseline and follow-up period, relevant data were recorded. In the intervention phase a patient on antibiotics for >48 hours was assessed by an ID physician and recommendations made. Primary outcome was days on antimicrobial therapy (DOT) and other secondary outcomes were assessed.
Results. A total of 401, 381, and 379 patients were recruited in the baseline, intervention, and follow-up phases. Baseline characteristics of the three groups were similar. Antimicrobial use decreased from 831.5 during baseline to 717 DOT per 1,000 patient days in the intervention (P < 0.0001) and the effect was sustained in the follow-up period (713.6 DOT per 1,000 patient-days). Among the study antimicrobials, DOTs were significantly lower in the intervention vs. baseline phase for Quinolones (21.5 vs. 33.3), Carbapenems (340.2 vs. 426.0) and Colistin (131.5 vs. 155.9) (P < 0.0001). De-escalation according to culture susceptibility was significantly higher in the intervention group compared with the baseline (42.7% vs. 23.6%; P < 0.0001). Compliance to hospital-based antibiotic guidelines significantly improved in intervention and follow-up phases compared with the baseline (19.5%, 21.8%, 33.2%; P < 0.0001). We found that 73.3% of antibiotic prescriptions were inappropriate and commonly occurred in the absence of an appropriate clinical indication. Recommendations by the ID team were accepted in 60.7% of the cases. All-cause in hospital mortality rates were 22.4% and 27.6% in the baseline and intervention phases respectively (P = 0.093).
Conclusion. An ID physician-driven antimicrobial stewardship programme was successful in reducing antibiotic utilization without compromising patient safety in low and middle-income countries; however, this needs further validation.