203. Impact of an Infectious Diseases Fellow-Led Antimicrobial Stewardship Initiative in a Medical/Surgical ICU

Background Intensive care units carry the heaviest antibiotic burden within hospitals. Providing active and ongoing stewardship oversight in these areas is challenging for institutions with limited stewardship resources. The purpose of this study was to assess the impact of leveraging trainees, namely an infectious disease fellow, in implementing a stewardship initiative in an intensive care unit. Methods A single-center retrospective, quasi-experimental study assessed the impact of an infectious diseases fellow participating in daily medical rounds in a mixed medical and surgical ICU over a consecutive 4-month period. The ID fellow conducted physical examinations, reviewed antimicrobial therapy, and de-escalated or discontinued antimicrobials when appropriate. Monthly days of therapy (DOT) per 1,000 days at risk (DAR) for individual agents and total antimicrobial use were measured and compared for 4 months in the pre-, during-, and postintervention phases. Results Median overall antimicrobial use was similar between the pre-, during-, and postintervention periods at 1,089, 1,100, and 1,146 DOT/1,000 DAR, respectively. For the five most commonly used drugs, reductions in DOT/1,000 DAR were observed between the pre- and during-intervention groups for ampicillin/sulbactam (26%) and metronidazole (12%), while ceftriaxone, cefepime, and vancomycin use was unchanged. Conclusion While no change in median total antibiotic use was observed, a reduction in anti-anaerobic agent use noted, consistent with local efforts to reduce inappropriate antibiotic prescribing for aspiration pneumonitis. Actively involving medical residents and fellows in establishing evidenced-based approaches to antimicrobial stewardship is key to improving antibiotic utilization and minimizing the development of antimicrobial resistance. Disclosures All authors: No reported disclosures.