384Impact of a New Restriction Policy: Limiting Duration of Therapy of Restricted Antimicrobials to 7 Days in a Pediatric Hospital

IDWEEK 2014 POSTER ABSTRACTS 384. Impact of a New Restriction Policy: Limiting Duration of Therapy of Restricted Antimicrobials to 7 Days in a Pediatric Hospital Justin Markham, PharmD1; Shannon Chan, PharmD1; Jobayer Hossain, PhD1; Sanjeev Swami, MD2; 1Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; 2Infectious Diseases, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE Session: 44. Pediatric Antimicrobial Stewardship Thursday, October 9, 2014: 12:30 PM Background. Pediatric Antimicrobial Stewardship Programs (ASPs) are known to reduce antimicrobial (AM) use and hospital costs, and to improve patient ( pt) outcomes. Our institution implemented an ASP in 2004 and found significant decreases in AM use. To further optimize AM use, the ASP adopted a defaulted 7 day duration limit to restricted AM orders in November 2011. Treatment beyond 7 days with restricted AMs required re-approval from an ID Attending. Our objective was to determine whether this policy modification decreased overall and prolonged AM use. Open Forum Infectious Diseases 2014;1(S1):S70–472 © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. DOI: 10.1093/ofid/ofu051 S70 • OFID 2014:1 (Suppl 1) • Poster Abstracts Methods. We conducted a retrospective review of restricted antibiotic (ABX) use from one year pre- and two years post-implementation of the 7-day restriction policy. The study was conducted at Alfred I. duPont Hospital for Children. We included carbapenems and MRSA-active ABX (linezolid, daptomycin, and ceftaroline). We excluded vancomycin as it was used as a pilot for this policy. We included all hospitalized pts who received a restricted ABX between November 2010 and November 2013. ABX use was measured using days of therapy (DoT) per 1,000 pt days. The length of therapy (LoT) of each treatment course was compared between the two study periods. Pts who received ABXs for approved indications with prolonged duration (e.g., febrile neutropenia, osteomyelitis) were excluded from the LoT analysis. Data were analyzed using Pearson Χ2, Χ2 test for trend in proportion and analysis of variance as appropriate. Results. DoT/1,000 pt days of restricted ABX decreased from 48.5 in the baseline period to 32.7 in year 2 ( p < 0.001). Carbapenem use decreased significantly from 30.8 to 22.9 by year 2 ( p = 0.03). Anti-MRSA ABX decreased from 17.7 to 9.8 by year 2 ( p = 0.2). 477 ABX courses in 304 unique pts were evaluated for LoT. Treatment courses lasting >14 days significantly decreased over the study period ( p < 0.001). Mean LoT decreased from 5.1 to 3.4 days in year 2 ( p < 0.001). Unintentional discontinuation of ABX was rare (2 cases) and was not found to result in harm to patients. Pharmacy costs for studied ABX in year 2 were reduced by 57% ($125,156) compared to baseline. Conclusion. Enhanced restrictions on the duration of ABX therapy with an automatic 7-day order duration contributed to additional reductions in restricted ABX use and costs in an established ASP. Disclosures. All authors: No reported disclosures.