scholarly journals 211. A Comprehensive Assessment of Carbapenem Use across 90 Veterans Health Administration Hospitals with Defined Stewardship Strategies for Carbapenems

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S108-S109
Author(s):  
Hiroyuki Suzuki ◽  
Eli N Perencevich ◽  
Michihiko Goto ◽  
Bruce Alexander ◽  
Rajeshwari Nair ◽  
...  
Keyword(s):  
Veterans Health Administration ◽  
Audit And Feedback ◽  
Veterans Health ◽  
Health Administration ◽  
Prospective Audit ◽  
Assessment Scores ◽  
Important Target ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback ◽  
Research Grant

Abstract Background Carbapenems are an important target for antimicrobial stewardship (AS) efforts. In this study, we sought to compare different hospital-based strategies for improving carbapenem use. Methods We analyzed a cohort of all patients hospitalized at Veterans Health Administration (VHA) acute-care hospitals during 2016 and mandatory survey data that characterized each hospital’s carbapenem-specific AS strategy into one of three types: no strategy (NS), prospective audit-and feedback (PAF), or restrictive policies (RP). Sites that could not be classified were excluded. Inpatient carbapenem use was compared across strategies using risk-adjusted generalized estimating equations that accounted for clustering within hospitals. Two Infectious Disease (ID) physicians independently performed manual chart reviews in 425 randomly-selected carbapenem-treated cases (100 for PAF/NS and 225 for RP). Auditors assessed for the presence of ID consultation and carbapenem appropriateness on day 4 of therapy. Assessments were categorized as follows: appropriate (1), acceptable (2), suboptimal (3), unnecessary (4) and inappropriate (5). Assessment scores across strategies were compared with the Kruskal-Wallis test. Results There were 429,602 admissions in 90 sites (8 PAF, 24 NS, 58 RP). Median carbapenem use across sites was 17.4 (IQR 8.6–28.4) days of therapy/1,000 days-present. Inpatient carbapenem use was lower at PAF than NS sites [RR 0.67 (95% CI, 0.46–0.98); p=0.04] but similar between RP and NS sites [RR 0.86 (95% CI, 0.61–1.22); p=0.41]. Carbapenem use was considered appropriate or acceptable in 215 (50.6%) of the reviewed cases. Assessment scores were higher (i.e. worse) at NS than RP sites (mean 2.7 vs 2.3; p< 0.01) but did not differ significantly between NS and PAF sites (mean 2.7 vs 2.5; p=0.14). ID consultations were more common at PAF/RP than NS sites (51% vs 29%; p< 0.01). ID consultations were associated with lower (i.e. better) assessment scores (2.3 vs. 2.6; p< 0.01). Conclusion In this VHA cohort, AS strategies and ID consultations were associated with either less or more appropriate carbapenem-prescribing. The use of AS and ID consultations may be complementary, and hospitals could leverage both to optimize carbapenem use. Disclosures Daniel J. Livorsi, MD, MSc, Merck and Company, Inc (Research Grant or Support)

scholarly journals Inpatient Fluoroquinolone Stewardship Improves the Quantity and Quality of Fluoroquinolone Prescribing at Hospital Discharge: A Retrospective Analysis Among 122 Veterans Health Administration Hospitals

2019 ◽  
Vol 71 (5) ◽  
pp. 1232-1239 ◽  
Author(s):  
Hiroyuki Suzuki ◽  
Eli N Perencevich ◽  
Bruce Alexander ◽  
Brice F Beck ◽  
Michihiko Goto ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Retrospective Cohort ◽  
Veterans Health Administration ◽  
Audit And Feedback ◽  
Veterans Health ◽  
Health Administration ◽  
Patient Admissions ◽  
Days Of Therapy ◽  
Strategy Types ◽  
Prospective Audit And Feedback

Abstract Background Despite increasing awareness of harms, fluoroquinolones are still frequently prescribed to inpatients and at hospital discharge. Our goal was to describe fluoroquinolone prescribing at hospital discharge across the Veterans Health Administration (VHA) and to contrast the volume and appropriateness of fluoroquinolone prescribing across 3 antimicrobial stewardship strategy types. Methods We analyzed a retrospective cohort of patients hospitalized at 122 VHA acute-care hospitals during 2014–2016. Data from a mandatory VHA survey were used to identify 9 hospitals that self-reported 1 of 3 strategies for optimizing fluoroquinolone prescribing: prospective audit and feedback (PAF), restrictive policies (RP), and no strategy. Manual chart reviews to assess fluoroquinolone appropriateness at hospital discharge (ie, postdischarge) were performed across the 9 hospitals (3 hospitals and 125 cases per strategy type). Results There were 1.7 million patient admissions. Overall, there were 1 727 478 fluoroquinolone days of therapy (DOTs), with 674 918 (39.1%) DOTs prescribed for inpatients and 1 052 560 (60.9%) DOTs prescribed postdischarge. Among the 9 reviewed hospitals, postdischarge fluoroquinolone exposure was lower at hospitals using RP, compared to no strategy (3.8% vs 9.3%, respectively; P = .012). Postdischarge fluoroquinolones were deemed inappropriate in 154 of 375 (41.1%) patients. Fluoroquinolones were more likely to be inappropriate at hospitals without a strategy (52.8%) versus those using either RP or PAF (35.2%; P = .001). Conclusions In this retrospective cohort, the majority of fluoroquinolone DOTs occurred after hospital discharge. A large proportion of postdischarge fluoroquinolone prescriptions were inappropriate, especially in hospitals without a strategy to manage fluoroquinolone prescribing. Our findings suggest that stewardship efforts to minimize and improve fluoroquinolone prescribing should also focus on antimicrobial prescribing at hospital discharge.

scholarly journals The Use of Rifampin Therapy to Treat Diabetic Patients with Osteomyelitis of the Foot in the Veterans Health Administration: Patient Characteristics and Clinical Outcomes

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S101-S101
Author(s):  
Brigid Wilson ◽  
Elie Saade ◽  
Gheorghe Doros ◽  
John Hermos ◽  
Mary Bessesen ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Composite Endpoint ◽  
Patient Characteristics ◽  
Veterans Health Administration ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Veterans Health ◽  
Health Administration ◽  
Short Treatment ◽  
Research Grant

Abstract Background Nearly 25% of Veterans Health Administration (VHA) patients are diagnosed with diabetes mellitus (DM). Among DM patients, the lifetime incidence of foot ulcers is 15%. Infection is a common complication of foot ulcers and 20–60% of infections result in diabetic foot osteomyelitis (DFO). Current treatment guidelines do not endorse any specific antibiotic agent for DFO, but small clinical trials suggest the addition of rifampin to antimicrobial regimens results in improved cure rates for osteomyelitis. Methods Using VHA databases, we identified index DFO cases from 2009 to 2013 and extracted patient and infection characteristics including demographics, comorbidities, chronic medications, antibiotic regimens, and microbiology data when present. We analyzed the subset of patients alive, without high-level amputation, and treated with antibiotics at 90 days after diagnosis. We summarized patient characteristics and compared a composite endpoint of amputation or death within 2 years of DFO diagnosis among those treated with rifampin to those not treated with rifampin. Results In total, 10,736 DFO cases met our criteria (Figure). Of these, 151 were considered treated with rifampin, based on 14 or more days of rifampin initiated within 90 days of diagnosis; 10,551 were unexposed to rifampin; and 34 were excluded for late or short treatment with rifampin. We observed significant differences between patients treated with and without rifampin (Table) and 44% of rifampin-treated patients were seen in 14 facilities. Amputation or death at 2 years was observed in 44 (29%) of patients treated with rifampin and 4,007 (38%) of patients not treated with rifampin (P = 0.03). Conclusion Rifampin was rarely used in the treatment of DFO in the VHA and a few facilities accounted for a large proportion of rifampin-treated cases. We observed higher rates of amputation-free survival in patients treated with rifampin, but in the presence of notable confounders including age, comorbidities, and organism. Disclosures E. Saade, Steris: Grant Investigator, Grant recipient. Janssen: Grant Investigator, Research grant. Sequiris: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. R. A. Bonomo, Entasis: Grant Investigator, Research grant. Allecra: Grant Investigator, Research grant. Wockhardt: Grant Investigator, Research grant. Merck: Grant Investigator, Research grant. Roche: Grant Investigator, Research grant. GSK: Grant Investigator, Research grant. Allergan: Grant Investigator, Research grant. Shionogi: Grant Investigator, Research grant

scholarly journals Inpatient antibiotic utilization in the Veterans’ Health Administration during the coronavirus disease 2019 (COVID-19) pandemic

2020 ◽  
pp. 1-3 ◽  
Author(s):  
Thomas D. Dieringer ◽  
Daisuke Furukawa ◽  
Christopher J. Graber ◽  
Vanessa W. Stevens ◽  
Makoto M. Jones ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Veterans Health Administration ◽  
Antibiotic Prescribing ◽  
Veterans Health ◽  
Health Administration ◽  
Prescribing Practices ◽  
Antibiotic Utilization ◽  
Days Of Therapy

Abstract Antibiotic prescribing practices across the Veterans’ Health Administration (VA) experienced significant shifts during the coronavirus disease 2019 (COVID-19) pandemic. From 2015 to 2019, antibiotic use between January and May decreased from 638 to 602 days of therapy (DOT) per 1,000 days present (DP), while the corresponding months in 2020 saw antibiotic utilization rise to 628 DOT per 1,000 DP.

Effect of prospective audit and feedback on inpatient fluoroquinolone use and appropriateness of prescribing

2020 ◽  
Vol 41 (12) ◽  
pp. 1458-1460
Author(s):  
Caitlyn M. Marek ◽  
Karen J. Zurek ◽  
Owen Degenhardt ◽  
Shahileen Remtulla ◽  
Alastair S. Teale ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Audit And Feedback ◽  
High Yield ◽  
Prospective Audit ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback

AbstractWe report the effect of prospective audit and feedback (PAF) on inpatient fluoroquinolone (FQN) prescriptions. During the PAF period, FQN use decreased from 39.19 to 29.58 days of therapy per 1,000 patient days (P < .001) and appropriateness improved from 68% to 88% (P < .001). High-yield indications to target included noninfectious urinary tract and respiratory presentations.

scholarly journals 83. Staff Pharmacist-driven Prospective Audit and Feedback at a Community Hospital: Assessing an all Hands on Deck Approach to Antimicrobial Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S58-S59
Author(s):  
Casey J Dempsey ◽  
Natasha Weiner ◽  
Michele Riccardi ◽  
Kristin Linder
Keyword(s):  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Audit And Feedback ◽  
Small Community ◽  
Prospective Audit ◽  
Post Intervention ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback ◽  
The Impact ◽  
Feedback Program

Abstract Background Facilities with robust antimicrobial stewardship programs often have infectious disease (ID) pharmacists with devoted time to complete antimicrobial stewardship initiatives. Smaller facilities with limited resources or lacking ID pharmacists, may encounter challenges meeting antimicrobial stewardship regulatory requirements. The goal of this study is to assess the impact of a staff pharmacist-driven prospective audit and feedback program in a small community hospital. Methods A pre- and post-intervention study was performed to assess the primary outcome of days of therapy per 1,000 patient days (DOT) for targeted antimicrobials (ciprofloxacin, levofloxacin, piperacillin/tazobactam, cefepime, ceftazidime). Secondary outcomes were antibiotic expenditures and rates of Clostridioides difficile infection (CDI). Results Significant decreases in DOT were observed for piperacillin/tazobactam (29.88 vs. 9.25; p &lt; 0.001), ciprofloxacin (23.22 vs. 9.97; p &lt; 0.001), levofloxacin (11.2 vs. 5.07; p &lt; 0.001) and overall antipseudomonal DOT (62.91 vs. 51.67; p &lt; 0.001). There was no difference in ceftazidime DOT (8.75 vs. 6.47; p= 0.083) and an increase in cefepime DOT (20.47 vs. 34.35; p &lt; 0.001). A trend towards decreased rates of CDI was seen (4.9/10,000 patient days vs. 2.64/10,000 patient days; p= 0.931). There were significant decreases in antibiotic expenditures for piperacillin/tazobactam ($52,498 vs. $10,937; p &lt; 0.001), levofloxacin ($2,168 vs. $672; p &lt; 0.001), ciprofloxacin ($6,700 vs. $1,954; p &lt; 0.001). Lower expenditures for ceftazidime were seen ($9,952 vs. $7,457; p= 0.29). Cefepime expenditures increased ($25,638 vs. $40,097; p= 0.001). An overall decrease in the expenditure for the targeted antibiotics was seen ($95,715 vs. $62,837; p &lt; 0.001). Conclusion Implementation of a staff pharmacist-driven prospective authorization and feedback program led to a significant decrease in DOT and antibiotic expenditures for several targeted antibiotics and a trend towards decreased rates of CDI. Despite increased DOT and expenditures for cefepime, there was an overall decrease amongst the targeted antibiotics. With proper implementation, staff pharmacists can significantly benefit antimicrobial stewardship initiatives. Disclosures All Authors: No reported disclosures

scholarly journals The implementation and outcome of a 2-year prospective audit and feedback based antimicrobial stewardship program at a private tertiary care hospital

2021 ◽  
Author(s):  
Pooja Thakkar ◽  
Tanu Singhal ◽  
Sweta Shah ◽  
Rohit Bhavsar ◽  
Shweta Ladi ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Audit And Feedback ◽  
Care Hospital ◽  
Prospective Audit ◽  
Colistin Resistance ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback ◽  
Resistance Rates

AbstractPurposeAntimicrobial resistance has emerged as a major public health problem with India being one of the worst affected nations. Hence effective antimicrobial stewardship programs (AMSP) are needed. We report the design, implementation and results of a prospective audit and feedback based AMSP at a private tertiary care hospital.MethodsDuring the study period – January 2018 to December 2019 – the prescription of restricted antimicrobials required the filling of a justification form which was reviewed by the antimicrobial stewardship committee (AMSC) at 48-72 hours. Patients in whom the restricted antimicrobial was stopped earlier than 48 hours were not applicable for review. The eligible prescriptions were judged as justified/unjustified by AMSC based on the patient’s clinical and previous antimicrobial history, course and results of investigations/ cultures, and communicated to the treating team. Compliance to the recommendations of the AMSC was measured. Days of therapy for each restricted antimicrobial/1000 patient days was calculated. Colistin resistance rates in pathogens causing central line associated blood stream infections were compared with previous years.ResultsA total of 2397 restricted antimicrobials in 1366 patients were prescribed in the study period of which 1801 prescriptions were applicable for review (75%). Overall, 1.4% of admitted patients were prescribed restricted antimicrobials. The total days of therapy with restricted antimicrobials was 41.5/1000 patient days. The AMSC committee adjudged 12.5% of prescriptions as unjustified and recommendations for de-escalation were accepted in 89%. There was no significant difference in any of the study outcomes between 2018 and 2019. Colistin resistance rates in CLABSI remained stable as compared to previous years.ConclusionThe prospective audit and feedback component of AMSP provides insights into the use of restricted antimicrobials. This component should be considered by hospitals for inclusion in their program on an ongoing basis even if limited for a few drugs and in few areas of the hospital.

scholarly journals 71. Impact of Prospective Audit and Feedback on Fluoroquinolone Use: A Large Academic Medical Center Experience

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S54-S54
Author(s):  
Julio C Simon ◽  
Ana Vega
Keyword(s):  
Antimicrobial Stewardship ◽  
Statistical Significance ◽  
Academic Medical Center ◽  
Qt Prolongation ◽  
Prescribing Patterns ◽  
Audit And Feedback ◽  
Hospital Length Of Stay ◽  
Prospective Audit ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback

Abstract Background Fluoroquinolones are an effective class of antimicrobials; however, their use is not without consequence. Recent warnings have resulted in the FDA recommending to reserve this class for infections lacking alternative options. Antimicrobial stewardship significantly reduces targeted antimicrobial use, improves susceptibility patterns, decreases rates of Clostridium difficile infection (CDI), and reduces healthcare-associated costs. Literature on fluoroquinolone stewardship by antimicrobial stewardship programs report similar outcomes in addition to reductions in rates of extended-spectrum beta-lactamase (ESBL)-producing and methicillin-resistant S. aureus (MRSA) infection. Methods This study was a retrospective cohort study of adult patients receiving at least 3 days of a fluoroquinolone for an indication of pneumonia or urinary tract infection. Retrospective orders were assessed for prescribing patterns, duration of therapy, and antibiotic choice by indication. The primary outcome was reduction of fluoroquinolone consumption as a result of a prospective audit and feedback intervention, determined with days of therapy (DOT) and DOT per 1000 patient days. Secondary outcomes included hospital length-of-stay (LOS), 3-month post-exposure incidence of CDI, ESBL and MRSA infections, percentage of interventions accepted, and QT prolongation events. Mann-Whitney U was used to determine statistical significance for DOT and LOS, unpaired student t-test was used for DOT per 1000 patient days. Results 333 patients were reviewed. Fluoroquinolone median days-of-therapy (DOT) was significantly reduced in the intervention phase (7 vs. 4 days, P &lt; 0.001). Median LOS was 8 days for the cohort and did not differ between groups. After adjusting for identifiable alternative causes, no difference in QT prolongation, CDI or ESBL infection was observed. However, these results were limited by lack of diagnostic testing for QT prolongation and inability to assess for other contributing factors related to infection control. Conclusion Antimicrobial stewardship is an effective intervention to reduce fluoroquinolone use. An increased LOS was not observed despite patients switching to parenteral therapies. More data is needed to assess differences related to adverse events. Disclosures All Authors: No reported disclosures

Evaluation of a national telemedicine initiative in the Veterans Health Administration: Factors associated with successful implementation

2016 ◽  
Vol 24 (3) ◽  
pp. 168-178 ◽  
Author(s):  
Lauren Stevenson ◽  
Sherry Ball ◽  
Leah M Haverhals ◽  
David C Aron ◽  
Julie Lowery
Keyword(s):  
Primary Care ◽  
Implementation Research ◽  
Primary Care Providers ◽  
Veterans Health Administration ◽  
Audit And Feedback ◽  
Successful Implementation ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Design Quality

Background The Consolidated Framework for Implementation Research was used to evaluate implementation facilitators and barriers of Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) within the Veterans Health Administration. SCAN-ECHO is a video teleconferencing-based programme where specialist teams train and mentor remotely-located primary care providers in providing routine speciality care for common chronic illnesses. The goal of SCAN-ECHO was to improve access to speciality care for Veterans. The aim of this study was to provide guidance and support for the implementation and spread of SCAN-ECHO. Methods Semi-structured telephone interviews with 55 key informants (primary care providers, specialists and support staff) were conducted post-implementation with nine sites and analysed using Consolidated Framework for Implementation Research constructs. Data were analysed to distinguish sites based on level of implementation measured by the numbers of SCAN-ECHO sessions. Surveys with all SCAN-ECHO sites further explored implementation information. Results Analysis of the interviews revealed three of 14 Consolidated Framework for Implementation Research constructs that distinguished between low and high implementation sites: design quality and packaging; compatibility; and reflecting and evaluating. The survey data generally supported these findings, while also revealing a fourth distinguishing construct – leadership engagement. All sites expressed positive attitudes toward SCAN-ECHO, despite struggling with the complexity of programme implementation. Conclusions Recommendations based on the findings include: (a) expend more effort in developing and distributing educational materials; (b) restructure the delivery process to improve programme compatibility; (c) establish an audit and feedback mechanism for monitoring and improving the programme; (d) engage in more upfront planning to reduce complexity; and (e) obtain local leadership support for providing primary care providers with dedicated time for participation.

scholarly journals Evaluating the Prevalence of Leading Practices in Antimicrobial Stewardship

2021 ◽  
Vol 1 (S1) ◽  
pp. s41-s41
Author(s):  
Barbara Braun ◽  
Salome Chitavi ◽  
Eddie Stenehjem ◽  
Mushira Khan ◽  
David Baker ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Treatment Guidelines ◽  
Diagnostic Testing ◽  
Text Message ◽  
Specific Treatment ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Sampling Weights ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback

Background: Most hospitals have a basic infrastructure in place for antimicrobial stewardship programs (ASPs). Although this is a critical first step, we need to ensure that ASPs are working to implement effective evidence-based approaches nationally. In 2018, a group of leading antibiotic stewardship organizations met and identified specific, effective, and recommended ASP activities based on current scientific evidence and their experience (Baker et al, Joint Comm J Qual Pat Saf 2019;45:517–523). To determine the extent to which hospitals are currently implementing the recommended practices, we conducted an electronic questionnaire–based assessment. Methods: A 50-item questionnaire-based assessment was sent via QualtricsTM to the hospital’s designated ASP leader. The sample comprised 992 Joint Commission accredited hospitals. The practices of interest related to (1) development of facility-specific treatment guidelines, (2) measuring appropriate use and concordance of care with these guidelines, (3) engaging clinicians while the patient is on the unit, (4) diagnostic stewardship, (5) measurement of antimicrobial utilization data, and (6) measuring hospital-acquired Clostridioides difficile infection (CDI) rates. Sampling weights were used to adjust the results for nonresponse using R software. Results: In total, 288 hospitals completed the questionnaire. Small and nonteaching hospitals were significantly less likely to respond (p < 0.005, p=0.01 respectively), however there were no differences by healthcare system membership or urban/rural location. 49% of respondents had the specialist term ASP or infectious disease (ID) in their title. Most hospitals (93.1%) had developed facility-specific treatment guidelines for specific inpatient conditions, often community-acquired pneumonia (85%), sepsis (81%), UTI (75%), and SSTI (69%). However, only 37% had formally assessed compliance with 1 or more of these guidelines. Also, 83% reported having a process for prospective audit and feedback, of which 43% do this 4–5 days per week. Similarly, 49% reported that they review all antimicrobials ordered. Recommendations are commonly given by the ASP pharmacist (69%) via some combination of telephone (78%), face-to-face (69%), text message (54%), and/or EHR alert (36%). Overall, 66% of hospitals had procedures in place to prevent inappropriate diagnostic testing for C. difficile, and 39% of hospitals had similar policies for urine specimens. Furthermore, >80% were routinely measuring days of therapy and CDI rates. Conclusions: Most hospitals have facility-specific treatment guidelines and measure CDI and days of therapy. Practices for active engagement with frontline staff in prospective audit and feedback vary widely. Greater understanding of barriers to assessing adherence to hospitals’ treatment guidelines is critical to improving this practice.Funding: The Pew Charitable TrustsDisclosures: None

scholarly journals 21. Association of MRSA Prevalence and Hospital-level Antibiotic Use: A Retrospective Study Across 122 Acute-care Hospitals

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S11-S11
Author(s):  
Daniel J Livorsi ◽  
Rajeshwari Nair ◽  
Brian Lund ◽  
Bruce Alexander ◽  
Brice Beck ◽  
...  
Keyword(s):  
Acute Care ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Antibiotic Use ◽  
Case Mix ◽  
Veterans Health ◽  
Health Administration ◽  
Hospital Level ◽  
Days Of Therapy ◽  
Research Grant

Abstract Background The prevalence of methicillin-resistant Staphylococcus aureus (MRSA), varies across geographic regions, which could contribute to regional variation in antibiotic use. In this study, we evaluated whether local MRSA prevalence rates were associated with hospital-level antibiotic use across the Veterans Health Administration (VHA). Methods This retrospective cohort included all acute-care patients admitted in VHA hospitals during 2016. Anti-MRSA antibiotics were identified per National Healthcare Safety Network definitions and use was quantified as days-of-therapy (DOT) per 1000 days-present. Hospital-level MRSA prevalence (colonization and/or infection) was determined by calculating the proportion of admissions with a positive MRSA nasal swab and/or a MRSA-positive clinical culture obtained ≤1 day before or ≤2 days after admission. Negative binomial regression models were used to determine the association between a hospital’s MRSA prevalence and its antibiotic use, after accounting for intra-hospital clustering, patient case-mix, month of admission, and use of hospital-based stewardship strategies. Results There were 548,476 admissions across 122 hospitals. The median rate of MRSA prevalence at admission was 8.0% (IQR 6.7–9.7%). Hospital level median use of anti-MRSA and total antibiotics was 96.5 (interquartile range [IQR] 81.1–116.9) and 562.1 (IQR 505.9–631.6) DOT per 1,000 days-present, respectively. In a hospital-level risk adjusted analysis, a hospital’s MRSA prevalance was significantly associated with its monthly use of both anti-MRSA and total antibiotics (IRR=1.05, 95% 1.02–1.07; IRR=1.02, 95% CI, 1.01–1.03). A 5% increase in the hospital’s MRSA prevalence was associated with an increase in the monthly use of anti-MRSA antibiotics and total antibiotics by 23.6 and 8.3 DOT per 1,000 days-present, respectively. Conclusion Higher hospital-level MRSA prevalence was associated with significantly higher rates of antibiotic utilization, even after adjusting for case-mix and reported antibiotic stewardship strategies. Future benchmarking of anti-MRSA antibiotic use across hospitals may need to risk-adjust using baseline rates of MRSA prevalence. Disclosures Daniel J. Livorsi, MD, MSc, Merck and Company, Inc (Research Grant or Support) Rajeshwari Nair, PhD, Merck and Company, Inc. (Research Grant or Support)

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