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Background UTIs are the most common infection after renal transplant (RTx) with an incidence of 6–86%. Post-RTx UTI has been associated with risk for graft loss and mortality, and RTx recipients are at risk for multidrug-resistant (MDR) UTI given immunosuppression (IS) and instrumentation. We sought to evaluate the incidence, timing, microbiology, and MDR risk of post-RTx UTI, as well as to characterize asymptomatic bacteriuria (ASB) practices at our center. Methods This was a retrospective cohort of subjects with ≥1 positive culture (≥105 CFU/mL) during the first year post-RTx that were transplanted from September 1, 2012 to October 1, 2016. Each bacteriuria episode was adjudicated as cystitis, pyelonephritis, or ASB (Figure 1). Subjects without bacteriuria were excluded from primary analysis but used to calculate UTI incidence. The primary outcome was 1-year symptomatic UTI incidence. Secondary outcomes: incidence of cystitis, pyelonephritis, and ASB; time-to-first UTI; microbiologic trends; and presence of MDR risk factors. Results Baseline characteristics: 52% male, median age 57 years, 65% stented, 34% antithymocyte globulin induction, 94% standard IS regimen (tacrolimus/mycophenolate/prednisone), 93% trimethoprim/sulfamethoxazole prophylaxis, and 21% receipt of IV antibiotics for ≥48 hours within 90 days of first positive culture (IV Abx); Of 527 RTx subjects, 100 had ≥1 positive culture. The 100 subjects had 234 cultures representing 359 isolates. Primary outcome: 12.1% symptomatic UTI incidence. Secondary outcomes (1-year incidences): 18.6% positive culture, 4.3% cystitis, 8.6% pyelonephritis, 11.9% ASB. Time to the first symptomatic UTI was a median of 50 days. A summary of microbiologic results can be found in Figure 2. ASB occurred 130 times and was treated 74.6% of the time (Figure 3). Significant risk factors for MDR UTI included female gender (P = 0.005), IV abx (P = 0.001), and recurrent UTI (P = 0.017). Conclusion Incidence of symptomatic UTI at our center was lower than previous reports. E. coli and E. faecalis were the most common urinary pathogens identified. MDR risk factors identified were biologically plausible and consistent with prior literature. ASB treatment occurred frequently and is an area to target stewardship interventions. Disclosures All authors: No reported disclosures.

Background Adherence rates for recommended pre-transplant (pre-txp) vaccinations in pediatric solid-organ transplant (SOT) patients are variable and practice-dependent. Cleveland Clinic Children’s Hospital (CCCH) pre-txp adherence rates for select vaccines have not been described. The purpose of this study was to evaluate pre-txp adherence rates for the following vaccines: hepatitis B, influenza, pneumococcal conjugate (PCV13), pneumococcal polysaccharide (PPSV23), and hepatitis A (if at-risk). Methods This retrospective cohort study included patients undergoing initial pediatric heart, kidney, liver, or intestine/multi-visceral transplant at CCCH between 1/1/14 and 7/31/17. Data collected from the electronic medical record and Ohio Department of Health Statewide Immunization Information System included demographics, transplant-related data, immunization administration history, and quantitative/qualitative values for titer/serology. The primary objective of vaccination adherence rate was defined as the aggregate of patients who had completed the vaccine series, had positive titer/serology data, or were ineligible to receive the vaccine due to age or administration restrictions. Data are descriptive in nature and reported as number (percent) or median (interquartile range), as appropriate. Results 64 pediatric SOT recipients met inclusion criteria. Median age was 7.9 (2.1, 15.8) years. Majority of patients were American (73%) and male (63%). Most common organ was heart (41%), followed by liver (25%), kidney (21%), and intestine/multi-visceral (13%). Sixty-three (98%) patients underwent ID pre-txp evaluation. CCCH adherence rates were highest for hepatitis B at 92%, followed by PCV13 and PPSV23 at 84%, and influenza at 72%. Thirty-two (50%) patients were indicated to receive the hepatitis A vaccine and the respective adherence rate was 91%. Vaccination adherence by SOT team is described in Figure 1. Conclusion CCCH pre-txp vaccination adherence rates are higher than previously reported. Opportunities for improvement include influenza vaccination adherence across all SOT teams and PCV13/PPSV23 vaccination adherence in intestine/multi-visceral transplant patients. Figure 1: CCCH SOT team vaccination adherence rates. Disclosures All authors: No reported disclosures.

Background There is a demand for stewardship implementation and research in ambulatory and SOT populations. Few studies focus on outpatient stewardship interventions, and none has focused on timely recognition of CMV in outpatient SOT recipients. This study sought to determine the effect of real-time CMV result notification paired with pharmacist intervention on virologic and clinical outcomes in outpatient SOT recipients. Methods Quasi-experimental study comprised of two 6-month phases. In the pre-intervention phase, pharmacists were not involved in management of outpatient CMV viremia. In the intervention phase, pharmacists received real-time email notification of positive blood CMV results for review and intervention as necessary. The primary endpoint was rate of viremia eradication at 21 days from therapy initiation. Secondary endpoints: time to antiviral initiation and viremia eradication, rate of CMV invasive disease and hospital admission, and adverse drug events. Results 88 of 213 screened patients were included in the primary analysis (n = 49 and 39 in the pre-intervention and intervention groups, respectively). Baseline characteristics were similar, including transplant type (34% vs. 41% liver, 24% vs. 28% kidney, 14% vs. 17% lung, 14% vs. 10% heart), CMV serostatus (53% vs. 64% D+/R-), and maintenance immunosuppression. A total of 73 recommendations were made with 89% acceptance. Baseline CMV viral load >10,000 IU/mL occurred in 12 (24%) vs. 6 (15%) patients (P = 0.29). Of treated patients, 42 (85%) vs. 32 (82%) achieved CMV eradication at 21 days (P = 0.64), 10 (20%) vs. 5 (12%) required admission for CMV management (P = 0.35), 7 (14%) vs. 3 (7%) developed CMV invasive disease (P = 0.50), and 29 (60%) vs. 25 (66%) received antiviral within 5 days (P = 0.61). There were no statistically significant differences in time to antiviral initiation (45 vs. 41 hours; P = 0.64) or viremia eradication (19 vs. 18 days; P = 0.44). Conclusion CMV eradication at 21 days was not significantly different between groups; however, fewer patients in the intervention experienced elevated baseline viral load, CMV invasive disease, and hospital admission. These secondary endpoints suggest possible benefit from the intervention and warrant further characterization and study. Disclosures All authors: No reported disclosures.