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Background Infection is a leading cause of admission to intensive care units (ICUs), with critically ill patients often receiving empiric broad-spectrum antibiotics. Nevertheless, a dedicated infectious diseases (ID) consultation and stewardship team is not routinely established. An ID–critical care medicine (ID-CCM) pilot program was designed at a 400-bed tertiary care hospital in which an ID attending was assigned to participate in daily rounds with the ICU team, as well as provide ID consultation on select patients. We sought to evaluate the impact of this dedicated ID program on antibiotic utilization and clinical outcomes in patients admitted to the ICU. Methods In this single-site retrospective study, we analyzed antibiotic utilization and clinical outcomes in patients admitted to an ICU during the postintervention period from January 1 to December 31, 2017, and compared it to antibiotic utilization in the same ICUs during the preintervention period from January 1 to December 31, 2015. Results Our data showed a statistically significant reduction in usage of most frequently prescribed antibiotics including vancomycin, piperacillin-tazobactam, and cefepime during the intervention period. When compared to the preintervention period there was no difference in-hospital mortality, hospital length of stay, and readmission. Conclusions With this multidisciplinary intervention, we saw a decrease in the use of the most frequently prescribed broad-spectrum antibiotics without a negative impact on clinical outcomes. Our study shows that the implementation of an ID-CCM service is a feasible way to promote antibiotic stewardship in the ICU and can be used as a strategy to reduce unnecessary patient exposure to broad-spectrum agents.

Background Severe sepsis and septic shock bundles have been shown to reduce mortality. Infectious Diseases (ID) consultation, particularly early in a hospital course, is associated with improved patient outcomes. Antibiotic Stewardship Program (ASP) decision support in the ED has also shown clinical benefit. We aim to examine the addition of early ID consultation to existing ASP decision support in the Emergency Department (ED) in patients with sepsis with organ dysfunction and/or shock (SODS) who completed the 3-hour bundle. Methods This is a retrospective study of 248 adult patients with clinical SODS who met inclusion criteria per Center for Medicare and Medicaid Services SEP-1 core measure in the ED and completed the recommended 3-hour sepsis bundle using ASP decision support tools. Patients who received ID consultation in the first 12 hours after ED triage (n = 111) were compared with patients who received standard care (n = 137). Pearson’s chi-square test was used to compare groups for all-cause 30-day readmissions and in-hospital mortality. Logistic regression was used to adjust for covariates (age, race/ethnicity, Charlson score, lactate level ≥4, hypotension, recent hospital admission, recent IV antibiotics, history of MDR organisms, intra-abdominal source of infection). Time from ED triage to death and time to hospital discharge alive were analyzed using Fine and Gray models for competing risks. Results In-hospital mortality was lower among patients who received early ID consultation (24.3% vs. 38.0%, P = 0.0220). This association persisted after adjustment for covariates (odds ratio 0.49, 95% CI 0.26–0.91, P = 0.0236). There was no significant difference in 30-day readmissions between groups (22.6% vs. 23.5%, P = 0.8883). Early ID consultation was predictive of time to death (adjusted hazard ratio 0.58, 95% CI 0.35–0.98, P = 0.0406) and time to hospital discharge alive (adjusted hazard ratio 1.51, 95% CI 1.07–2.12, P-value 0.0174) after adjustment. Conclusion Early ID consultation was associated with lower mortality and time to hospital discharge among patients receiving the 3-hour severe sepsis/septic shock bundle. Further investigation is needed to explore specific interventions by ID consultants that might reduce the risk of mortality in this population. Disclosures All authors: No reported disclosures.