Open Access
Open access
Oxford University Press
Open Forum Infectious Diseases
,  volume 12 ,  issue Supplement_1

P-1766. Evaluation of a Comprehensive Antimicrobial Stewardship Initiative for Gram-Negative Bacteremia in 21 Acute Care Hospitals

Tara M Rogers 1
, 
Michael J. Trisler 2
, 
Rachael Ours 1
, 
Aaron Pickering 3
, 
William N. Stewart 1
, 
Joseph Welch 4
, 
Heather Salata 1
, 
Mary-Teresa Heffern 1
, 
Megan Wein 5
, 
Cybele Abad 1
, 
Amber A Oakes 6
, 
Howard J Ergen 7
, 
Jasanjeet Jawanda 8
, 
Alex Trzebucki 9
, 
Sunish Shah 10
, 
Sahil Angelo 8
, 
Tina Khadem 1
, 
Justin Ludwig 11
, 
Chelsea Woodworth 12
, 
Stephanie Shealy May 13
, 
John J Veillette 13
, 
Ryan K Shields 14
, 
Erin K Mccreary 8
, 
J Ryan Bariola 1
1
 
2
 
3
 
4
 
5
 
6
 
7
 
8
 
9
 
10
 
11
 
12
 
13
 
Intermountain Healthcare , Salt Lake City, UT | 
14
 
Publication type: Journal Article
Publication date: 2025-01-29
Oxford University Press
scimago Q1
wos Q1
SJR: 1.441
CiteScore: 6.0
Impact factor: 3.8
ISSN: 23288957
Abstract
Background

Shorter antibiotic courses are non-inferior to longer for treatment of uncomplicated gram-negative bacteremia (GNB). This study evaluated the impact of a pharmacist-driven stewardship effort to use clinical decision support software (CDSS; ILÚM Insight, Infectious Diseases Connect, Inc.) plus an evidence-based treatment algorithm on antibiotic duration of therapy (DOT) for GNB in the UPMC health system, USA.

Methods

This retrospective cohort study utilized CDSS alerts for Enterobacterales GNB in adults from March to August 2022 (pre-intervention) and March to August 2023 (post-intervention). We excluded patients with complicated or polymicrobial GNB, admission ≤ 24 hours or death ≤ 72 hours after blood culture result, index culture outside of a UPMC facility, or severe immunocompromising condition.

We matched patients using a propensity score incorporating age, sex, and comorbidities. We compared total antibiotic DOT using a Wilcoxon rank-sum test, and compared key secondary outcomes, including infection-related readmission, C. difficile infection (CDI), development of multi-drug resistant organisms (MDRO), and all-cause death using Cochran-Mantel-Haenszel statistics.

Results

After initial screening, 1586 patients met inclusion criteria; of these, 411 and 426 patients were included in final pre- and post-intervention analyses, respectively (Table 1). Primary reasons for exclusion were complicated (35.8%) or polymicrobial (7.3%) infection. Median DOT was shorter post-intervention (10.5 days) versus pre-intervention (12.5 days; p < 0.0001), and patients receiving ≤ 7 days of therapy increased from 14.8% to 19.6% post-intervention. Pharmacist engagement with CDSS alerts increased from 29% to 41% (p < 0.005). Rate of IV to oral de-escalation, percent discharge on antibiotics, length of stay, and rate of treatment-emergent adverse effects did not differ significantly pre- and post-intervention (Table 2).

Conclusion

Preliminary findings suggest that pharmacist engagement with CDSS alerts in combination with an evidence-based treatment algorithm is associated with shorter antibiotic therapy duration. Ongoing subgroup analyses will help target future stewardship efforts to certain patient populations or facilities for continued improvement.

Disclosures

Ryan K. Shields, PharmD, MS, Allergan: Advisor/Consultant|Cidara: Advisor/Consultant|Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Menarini: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Roche: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Utility: Advisor/Consultant|Venatorx: Advisor/Consultant|Venatorx: Grant/Research Support Erin K. McCreary, PharmD, Abbvie: Advisor/Consultant|Basilea: Advisor/Consultant|Ciadara: Advisor/Consultant|Entasis: Advisor/Consultant|Ferring: Advisor/Consultant|GSK: Advisor/Consultant|GSK: Honoraria|Melinta: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria

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Rogers T. M. et al. P-1766. Evaluation of a Comprehensive Antimicrobial Stewardship Initiative for Gram-Negative Bacteremia in 21 Acute Care Hospitals // Open Forum Infectious Diseases. 2025. Vol. 12. No. Supplement_1.
GOST all authors (up to 50) Copy
Rogers T. M., Trisler M. J., Ours R., Pickering A., Stewart W. N., Welch J., Salata H., Heffern M., Wein M., Abad C., Oakes A. A., Ergen H. J., Jawanda J., Trzebucki A., Shah S., Angelo S., Khadem T., Ludwig J., Woodworth C., May S. S., Veillette J. J., Shields R. K., Mccreary E. K., Ryan Bariola J. P-1766. Evaluation of a Comprehensive Antimicrobial Stewardship Initiative for Gram-Negative Bacteremia in 21 Acute Care Hospitals // Open Forum Infectious Diseases. 2025. Vol. 12. No. Supplement_1.
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TY - JOUR
DO - 10.1093/ofid/ofae631.1929
UR - https://academic.oup.com/ofid/article/doi/10.1093/ofid/ofae631.1929/7987721
TI - P-1766. Evaluation of a Comprehensive Antimicrobial Stewardship Initiative for Gram-Negative Bacteremia in 21 Acute Care Hospitals
T2 - Open Forum Infectious Diseases
AU - Rogers, Tara M
AU - Trisler, Michael J.
AU - Ours, Rachael
AU - Pickering, Aaron
AU - Stewart, William N.
AU - Welch, Joseph
AU - Salata, Heather
AU - Heffern, Mary-Teresa
AU - Wein, Megan
AU - Abad, Cybele
AU - Oakes, Amber A
AU - Ergen, Howard J
AU - Jawanda, Jasanjeet
AU - Trzebucki, Alex
AU - Shah, Sunish
AU - Angelo, Sahil
AU - Khadem, Tina
AU - Ludwig, Justin
AU - Woodworth, Chelsea
AU - May, Stephanie Shealy
AU - Veillette, John J
AU - Shields, Ryan K
AU - Mccreary, Erin K
AU - Ryan Bariola, J
PY - 2025
DA - 2025/01/29
PB - Oxford University Press
IS - Supplement_1
VL - 12
SN - 2328-8957
ER -
BibTex
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BibTex (up to 50 authors) Copy
@article{2025_Rogers,
author = {Tara M Rogers and Michael J. Trisler and Rachael Ours and Aaron Pickering and William N. Stewart and Joseph Welch and Heather Salata and Mary-Teresa Heffern and Megan Wein and Cybele Abad and Amber A Oakes and Howard J Ergen and Jasanjeet Jawanda and Alex Trzebucki and Sunish Shah and Sahil Angelo and Tina Khadem and Justin Ludwig and Chelsea Woodworth and Stephanie Shealy May and John J Veillette and Ryan K Shields and Erin K Mccreary and J Ryan Bariola},
title = {P-1766. Evaluation of a Comprehensive Antimicrobial Stewardship Initiative for Gram-Negative Bacteremia in 21 Acute Care Hospitals},
journal = {Open Forum Infectious Diseases},
year = {2025},
volume = {12},
publisher = {Oxford University Press},
month = {jan},
url = {https://academic.oup.com/ofid/article/doi/10.1093/ofid/ofae631.1929/7987721},
number = {Supplement_1},
doi = {10.1093/ofid/ofae631.1929}
}