Antimicrobial stewardship programs (ASPs) aim to improve appropriate antimicrobial use. However, concerns of the negative consequences from accepting ASP interventions exist, particularly when deescalation or discontinuation of broadspectrum antibiotics is recommended. Hence, we sought to evaluate the impact on clinical outcomes when ASP interventions for inappropriate carbapenem use were accepted or rejected by primary providers. We retrospectively reviewed all carbapenem prescriptions deemed inappropriate according to institutional guidelines with ASP interventions between July 2011 and December 2014. Intervention acceptance and outcomes, including carbapenem utilization, length of stay, hospitalization charges, 30-day readmission, and mortality rates were reviewed. Data were analyzed in two groups, one in which physicians accepted all interventions ("accepted") and one in which interventions were rejected ("rejected"). A total of 158 ASP interventions were made. These included carbapenem discontinuation (35%), change to narrower-spectrum antibiotic (32%), dose optimization (17%), further investigations (including imaging and procalcitonin) (11%), infectious diseases referral (3%), antibiotic discontinuation (other than carbapenem) (1%), and source control (1%). Of 220 unique patients, carbapenem use was inappropriate in 101 (45.9%) patients. A significant reduction in carbapenem utilization was observed in the accepted group versus rejected group (median defined daily doses, 0.224 versus 0.668 per 1,000 patientdays, respectively; P Ͻ 0.001). There was a significant reduction in 30-day mortality in the accepted (none) versus rejected group (10 deaths, P ϭ 0.015), but there were no differences in length of stay, hospitalization charge, or 30-day readmission rates. Hypotension was independently associated with mortality in multivariate analysis (odds ratio, 5.25; 95% confidence interval, 1.34 to 20.6). In our institution, acceptance of carbapenem ASP interventions did not compromise patient safety in terms of clinical outcomes while reducing consumption.KEYWORDS antimicrobial stewardship, interventions, pediatric, safety A ntimicrobial stewardship programs (ASPs) promote the judicious use of antimicrobials, in particular, broad-spectrum antimicrobials, such as carbapenems (1). Multiple studies have demonstrated the effectiveness of ASPs in reducing inappropriate antimicrobial use and hospital antimicrobial expenditures, as well as in reducing rates of antimicrobial resistance among health care-associated pathogens (2-4). In addition, the goals of ASPs extend beyond cost-saving strategies, as patient safety, including improvement in patient care and outcomes, is an integral component of antimicrobial stewardship (5).The Infectious Disease Society of America has cited an evaluation of the effective-

BackgroundCatheter- line-associated bloodstream infection (CLABSI) is a serious complication of patients on long-term central venous catheters (CVC). Taurolidine-citrate solution (TCS) is a catheter-lock solution with broad- spectrum antimicrobial action that prevents biofilm formation. The aim of this study was to evaluate the efficacy of TCS in reducing CLABSI rate in pediatric patients with long-term CVC at a tertiary children’s hospital.MethodsThis was an open-label trial of hematology-oncology (H/O) and gastrointestinal (GI) inpatients with the following inclusion criteria: Pediatric patients < 17 years of age, at least 1 previous CLABSI, required long-term CVC, e.g., long-term parenteral nutrition or undergoing chemotherapy for malignancy and have a minimum dwell time of at least 8 hours for TCS. The period of surveillance was from each patient’s first CVC insertion till December 14, 2017 or discontinuation of TCS. CLABSI was calculated based on the number of CVC-associated BSI per 1,000 catheter-days. Statistics were derived using SPSS 19.0 and the student T-test for paired samples and nonparametric Wilcoxon analysis for two-related-samples test with a P value of < 0.05. OpenEpi v3.01 was used to compare 2 person-time rates and rate ratios with 95% confidence intervals.ResultsThirty-four patients were recruited with a median age of 3.4 years (IQR 1.5–10.1 years). H/O patients constituted 58.8% (n = 20) and GI patients 41.2% (n = 14). The majority of CVC were Hickman line (n = 16, 47.1%) followed by Port-a-Cath (n = 8, 23.5%) and PICC (n = 10, 29.4%). The median duration of TCS usage was 138 days (IQR 62.50–307.25 days). The longest duration of TCS was 1737 days (4.8 years). Median pre- and post-TCS CLABSI rates for the whole cohort, H/O and GI patients were 14.92 ± 13.50 and 2.65 ± 4.31 (P < 0.001); 16.55 ± 12.96 and 2.81 ± 4.66 (P < 0.001); 12.59 ± 14.39 and 2.42 ± 3.91 (P = 0.011) per 1000 catheter days respectively. For the whole cohort, pre and post-TCS rate ratio was 0.20 (95% CI 0.12–0.33, P < 0.001). TCS reduced markedly the risk of CLABSI for the whole cohort by 80%; for H/O patients by 79% and GI patients by 88%.ConclusionTaurolidine-citrate solution was highly successful in reducing CLABSI rates by 80% in patients on long-term CVC with high baseline CLABSI rates.Disclosures All authors: No reported disclosures.