LAUSR

Abstract Background In recent years, antimicrobial stewardship has become an important topic, shaping policy throughout healthcare, most notably in inpatient institutions. Various strategies are implemented (often in combination) to achieve the goal of more responsible use of antimicrobials. While many facilities have initiated requirements for antimicrobial indications when ordering antimicrobials, there is little data to support their effect. We evaluated the effect of requiring antimicrobial indications on their overall use. Methods In July 2016 we implemented a requirement that an indication must be included on all antimicrobial orders placed in our electronic medical record among inpatients in a 772-bed urban academic hospital. We performed a pre- and post-intervention retrospective analysis of defined daily dosage (DDD) of antimicrobials per 1000 patient-days. DDD/1000 patient-days were calculated based on purchase data, evaluating total antimicrobial use, as well as breakdowns for specific classes and individual agents. Our pre-intervention period was from 7/1–12/31/15 and post-intervention period was 7/1–12/31/16. This was the only new stewardship intervention employed during the study period. Results There was a 21.7% overall reduction in the DDD/1000 patient-days of systemic antibiotics with net reductions in all major drug classes (Table). The largest reductions occurred in the penicillins and extended-spectrum penicillin drug classes. Drug class 2015 2016 % change Total systemic antibiotics 872.8 683.6 -21.7% Cephalosporins 208.4 204.1 -2.1% Penicillins 244.7 191.1 -21.9% Extended-spectrum penicillins 142 118.4 -16.6% Quinolones 25.9 23.3 -10% Carbapenems 10.9 9.6 -12% Conclusion Requiring antimicrobial orders to list an indication resulted in decreased overall use. Larger prospective studies should be done to confirm the generalizability of these results. Disclosures All authors: No reported disclosures.