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BackgroundThere is limited literature evaluating the effect of antibiotic stewardship programmes (ASPs) in hospitalized geriatric patients, who are at higher risk for readmissions, developing Clostridioides difficile infection (CDI) or other adverse outcomes secondary to antibiotic treatments.MethodsIn this cohort study we compare the rates of 30 day hospital readmissions because of reinfection or development of CDI in patients 65 years and older who received ASP interventions between January and June 2017. We also assessed their mortality rates and length of stay. Patients were included if they received antibiotics for pneumonia, urinary tract infection, acute bacterial skin and skin structure infection or complicated intra-abdominal infection. The ASP team reviewed patients on antibiotics daily. ASP interventions included de-escalation of empirical or definitive therapy, change in duration of therapy or discontinuation of therapy. Treatment failure was defined as readmission because of reinfection or a new infection. A control group of patients 65 years and older who received antibiotics between January and June 2015 (pre-ASP) was analysed for comparison.ResultsWe demonstrated that the 30 day hospital readmission rate for all infection types decreased during the ASP intervention period from 24.9% to 9.3%, P ConclusionsRigorous de-escalation and curtailing of antibiotic therapies were beneficial and without risk for the hospitalized patients 65 years and over.

Background Antimicrobial Stewardship Programs (ASP) aim to ensure the appropriate use of antibiotics. There is limited literature evaluating ASP outcomes in hospitalized geriatric patients who are at higher risk for developing Clostridium difficile infection (CDI) or other adverse outcomes. The primary objective of this study was to determine if ASP efforts in this age group decreases the rate of 30-day hospital readmissions due to reinfection or development of CDI, hospital length of stay (LOS) and mortality. Methods A retrospective chart review was performed to compare the rates of 30-day hospital readmissions because of reinfection or development of CDI in patients 65 years and older who received ASP interventions between January and June 2017. A control group of patients 65 years and older who received antibiotics between January and June 2015 (pre-ASP) was analyzed for comparison. We also assessed their mortality rate and LOS. Patients were included if they received antibiotics for pneumonia (PNA), urinary tract infection (UTI), acute bacterial skin and skin structure infection (ABSSSI) and complicated intra-abdominal infection (cIAI). The ASP team consisted of an infectious diseases physician and a clinical pharmacist who met daily to review patients on broad spectrum antibiotics. ASP interventions consisted of de-escalation of empiric or definitive therapy, change in duration of therapy or discontinuation of therapy. Results Overall, 834 patients (540 control; 294 intervention) were included. The 30-day hospital readmission rate for all infection types decreased during the intervention period (19.6% vs 4.8%, P=0.0001). Both the development of CDI during hospital stay and 30-day readmission due to CDI during the intervention period decreased (2.6% vs 0.34%, P=0.019). There was no statistically significant decrease in 30-day hospital readmissions in the PNA (58.5% vs. 35.7%, P=0.11), UTI (18.9% vs. 35.7%, P=0.15), ABSSSI (12.3% vs. 21.4%, P=0.34) or cIAI (10.4% vs 7.1%, P=0.14) arms. There was no statically significant change in LOS (7.50 days vs 7.26 days, P=0.48) or mortality (9.6% vs 6.5%, P=0.12). Conclusion Multidisciplinary ASP efforts significantly reduced 30-day hospital readmission rates and development of CDI in hospitalized patients 65 years and older. Disclosures All Authors: No reported disclosures

Background There is limited literature evaluating ASP outcomes in patients 65 years and older. The primary objective of this study was to show that ASP efforts to deescalate and/or discontinue antimicrobial therapy in older patients did not lead to an increased rate of 30-day hospital readmissions due to treatment failure. The secondary objective was to show a decrease in antimicrobial expenditure per adjusted patient day (APD). Methods A retrospective chart review was performed to compare the rates of 30-day readmissions of patients 65 years and older who received ASP interventions between January and June 2017 with a control sample who received antibiotics between January and June 2015 (pre-ASP). Patients were included if they received antibiotics for pneumonia (PNA), urinary tract infection (UTI), acute bacterial skin and skin structure infection (ABSSSI) and complicated intra-abdominal infection (cIAI). The ASP team met daily to review patients identified by the clinical pharmacist. ASP interventions consisted of de-escalation of empiric or definitive therapy, change in the duration of therapy or discontinuation of therapy. Treatment failure was defined as readmission due to re-infection or a new infection (e.g., Clostridium difficile). Results Overall, 461 patients (150 control; 311 intervention) were included. The 30-day readmission rate for all infections decreased during the intervention period (10.7% vs. 3.9%, P = 0.004). There was a statistically significant decrease in 30-day readmissions in the PNA subgroup (9.8% vs. 2.9%, P = 0.038), a marginally significant decrease among UTI patients (12.5% vs. 4.7%, P = 0.097), and no statistically significant change in the ABSSSI (5.6% vs. 8.6%, P = 0.694) and cIAI (20.8% vs. 6.7%, P = 0.233, CI) subgroups. The total APD was 16,267 (control) and 15,487 (intervention). Total antimicrobial expenditure during the control period was $379,643 ($23.33/APD) vs. $67,721 ($4.37/APD) during the intervention period. Conclusion ASP efforts did not lead to an increase rate of 30-day readmissions due to treatment failure. Furthermore, there was a statistically significant decrease in readmission rates in the intervention group as well as a large decrease in antimicrobial expenditure per APD. Disclosures All authors: No reported disclosures.

The incorporation of a clinical pharmacist in daily rounding can help identify and correct errors related to anticoagulation dosing. Inappropriate anticoagulant dosing increases the risk of developing significant bleeding diathesis. Conversely, inappropriate dosing may also fail to produce a therapeutic response. We retrospectively reviewed electronic medical records of 41 patients to confirm and analyze the errors related to various anticoagulants. A clinical pharmacist in an integrated rounding between the period of February 2016 and April 2016 collected this data. We concluded that integrated rounding improves patient safety by recognizing anticoagulant dosage error used for the purpose of prophylaxis or treatment. It also allows us to make dose adjustments based on renal function of the patient. We think that it is prudent for physicians to pay particular attention to creatinine clearance when dosing anticoagulants in order to achieve the intended dosing effect and reduce the risk of adverse drug events.