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Broad spectrum antibiotic use at Choice, Change, and Completion throughout VA: patterns of initiation and de-escalation

Goetz MB, Graber CJ, Jones M, Madaras-Kelly K, Samore MH, Glassman PA. Broad spectrum antibiotic use at Choice, Change, and Completion throughout VA: patterns of initiation and de-escalation. [Abstract]. Open forum infectious diseases. 2017 Oct 4; 4(suppl_1):S250-S251.

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Background Antimicrobial stewardship programs seek to reduce initiation of unwarranted therapy, promote de-escalation and prevent excessive duration. The CDC Antibiotic Use option provides ward-level reports of antibiotic use and risk-adjusted Standardized Antibiotic Administration Ratios for pre-specified antibiotics groups that allow for inter-facility comparison, but do not provide the indication for use or temporal patterns that allow de-escalation assessments. Methods We characterized antibiotic use on days 0-2 (Choice), 3-4 (Change) and 5-6 (Completion) of therapy (CCC) for pneumonia (LRTI), skin-soft-tissue infections (SSTI) and urinary tract infection (UTI). We then explored the relationship between total MRSA or multi-drug-resistant GNR (MDRO) antibiotic use and use over CCC intervals for LRTI and SSTI for patients in acute non-ICU settings in 33 high-complexity VA facilities. Data were from 2016 and extracted from the VA Corporate Data Warehouse. Results The mean rates of anti-MRSA and anti-MDRO therapy were 108 and 123 Days of Therapy (DOT)/1000 days present, respectively. The table shows the fraction (mean, range) of patients with SSTI or LRTI receiving anti-MRSA or anti-MDRO therapy at the CCC intervals and the change in use (i.e., de-escalation) over the treatment course. Conclusion Syndrome-specific CCC metrics show substantial variations in the rates of de-escalation of antimicrobial use over treatment courses. Insights provided by these metrics will allow facilities to identify specific areas for improvement by targeting syndrome-specific initial choices of therapy or antibiotic de-escalation. Disclosures All authors: No reported disclosures.

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