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Deploying therapeutics for coronavirus disease 2019 (COVID-19) has proved challenging due to evolving evidence, supply shortages, and conflicting guideline recommendations. We conducted a survey on remdesivir use and the role of stewardship. Use differs significantly from guidelines. Hospitals with remdesivir restrictions were more guideline concordant. Formulary restrictions can be important for pandemic response.

Strategies for pandemic preparedness and response are urgently needed for all settings. We describe our experience using inverted classroom methodology (ICM) for COVID-19 pandemic preparedness in a small hospital with limited infection prevention staff. ICM for pandemic preparedness was feasible and contributed to an increase in COVID-19 knowledge and comfort.

Background: The disease caused by SARS-CoV-2, COVID-19, has caused a pandemic leading to strained healthcare systems worldwide and an unprecedented public health crisis. Lower respiratory tract infections (LRTIs) and hypoxia caused by COVID-19 has led to an increase in hospitalizations. We sought to define the impact of COVID-19 on antimicrobial use and antimicrobial resistance (AMR) in an urban safety-net community hospital. Methods: Retrospective review of antimicrobial use and AMR in a 151-bed urban community hospital. Antimicrobial use was calculated in days of therapy per 1,000 patient days (DOT/1,000 PD) for ceftriaxone, piperacillin-tazobactam and meropenem during 2019 and 2020. Ceftriaxone, piperacillin-tazobactam and meropenem were reviewed for calendar year 2019 and 2020. AMR was assessed by comparing the carbapenem resistant Enterobacteriaceae (CRE) infection incidence rate per 1,000 patient days between 2019 and 2020. Results: The average quarterly DOT/1,000 PD increased from 359.5 in 2019 to 394.25 in 2020, with the highest increase in the second and fourth quarters of 2020, which temporarily correspond to the first and second waves of COVID-19. Ceftriaxone and meropenem use increased during the first and second waves of COVID-19. Piperacillin-tazobactam use increased during the first wave and declined thereafter (Figure 1). Rates of CRE increased from a quarterly average of 0.57 to 0.68 (Figure 2). Conclusions: Antimicrobial pressure increased during the first and second waves of COVID-19. Ceftriaxone was the most commonly used antimicrobial, reflecting internal guidelines and ASP interventions. CRE rates increased during COVID-19. This finding may be due to an overall increase in antimicrobial pressure in the community and in critically ill patients. Antibiotics are a precious resource, and antimicrobial stewardship remains important during the COVID-19 pandemic. Appropriate use of antimicrobials is critical to preventing AMR.Funding: NoDisclosures: None

Background: The disease caused by SARS-CoV-2, COVID-19, has caused a pandemic leading to strained healthcare systems worldwide and an unprecedented public health crisis. The hallmark of severe COVID-19 is lower respiratory tract infection (LRTI) and hypoxia requiring hospitalization. A paucity of data on bacterial coinfection and a lack of therapeutic options for COVID-19 during the first surge of cases has increased pressure on antimicrobial use and has challenged antimicrobial stewardship programs (ASPs). We implemented a multimodal approach to antimicrobial stewardship in an urban safety-net community hospital targeting selection and duration of therapy. Methods: Retrospective review of cases during the first wave of COVID-19 in a 151-bed urban safety-net community hospital from March to June 2020. EMR order sets (Figure 1) and prospective audit and feedback by ASPs targeting empiric antimicrobial selection and duration were implemented as part of the COVID-19 response. Hospitalized patients with COVID-19 were reviewed retrospectively. Demographic information was collected. Data on antimicrobial use were tabulated, including selection and duration of antimicrobials (Figure 1). Results: In total, 302 patients were reviewed, of whom 221 (73%) received empiric antimicrobials. The most commonly used antimicrobials were ceftriaxone and azithromycin (Figure 2). Days of therapy per 1,000 patient days (DOT/1,000 PD) for ceftriaxone increased from 71 in the quarter prior to 113 during the study period. Average duration of therapy was 6 days. In the ICU, average duration was 8 days compared to 5 days in non-ICU settings. Average durations of parenteral therapy were 5.54 days in the ICU and 3.36 days in non-ICU settings. Procalcitonin was obtained in 37 cases (17%) and ranged from 0.09 to 12.57 ng/mL, with an average of 1.21 ng/mL. No cases had documented bacterial coinfection (Figure 1). Conclusions: Antimicrobials were commonly prescribed during the first wave of COVID-19 in a safety-net community hospital. Procalcitonin did not guide therapy nor did lack of documented coinfection change physician behavior. With limited resources, ASP successfully guided clinicians toward IDSA guideline recommendations for selection and duration, as evidenced by antimicrobial use. During this unprecedented surge of LRTIs, a multimodal approach to antimicrobial stewardship was used and guided toward early transition to oral agents and shorter durations.Funding: NoDisclosures: None