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Background Converting intravenous (IV) antibiotics to an oral (PO) route is an important stewardship activity to reduce patient harm, including extravasation, thrombophlebitis, and catheter-related infections. The INFORMER Project aims to develop a "smart" electronic tool to streamline IV to PO conversion in eligible patients using an algorithm derived from patient-level data. In designing the algorithm, we noted significant clinician subjectivity in reviewing PO eligibility criteria. To support algorithm development and frontline clinician buy in for future e-tool use, an initial step of our project explored agreement level for IV to PO switch between general internal medicine (GIM) vs. ID clinicians. Methods A convenience sample of GIM patients (tertiary teaching hospital) were reviewed in a 4-month pilot. Patients were still on the ward and received a target IV antibiotic (fluoroquinolone, sulfamethoxazole/trimethoprim, clindamycin, metronidazole, linezolid, fluconazole, voriconazole, azithromycin). To mimic real-time decision-making, clinicians (MD and PharmDs) retrospectively assessed IV to PO eligibility of the last IV antibiotic dose on admission for (1) GI/absorption, (2) clinical stability and (3) global review (but not given specific thresholds/criteria). Agreement level was compared for ID vs. non-ID reviews. Results Overall, 52 patients' IV to PO eligibility was assessed by multiple clinicians; 5 GIM teams and 6 ID MDs or PharmDs participated. ID vs. GIM respective assessment of Global eligibility was 61% vs. 48% (agreement in 71% of cases). ID vs. GIM assessment of acceptable absorption was 82% vs. 67%; acceptable clinical stability was 64% vs. 62% (Fig 1). Clinician comments were reviewed to identify algorithm improvements and areas for frontline education. Conclusion Our results are consistent with prior data suggesting up to 40–50% of patients may be eligible for IV to PO conversion, even at institutions that have IV to PO protocols. Our data also shows that overall, ID clinicians were more likely to assess a patient as ready for PO antibiotics vs. non-ID clinicians. Our findings are important as understanding cases of non-agreement and obtaining GIM consensus for tool utility are important for our next step, assessing INFORMER implementation on realtime IV to PO conversion rates. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background A goal of Antimicrobial Stewardship Programs (ASP) is to optimize antimicrobial use; many using audit and feedback (AAF). Although AAF decreases unnecessary target antimicrobial use, it is resource-intensive. As a result, temporary suspensions in AAF activity may occur from human resource limitations or other factors. We describe the impact of these temporary suspensions and intensity of care on antimicrobial utilization trends. Methods This retrospective study describes the initiation and temporary suspensions of AAF in the General Internal Medicine (GIM) unit at an urban teaching hospital. Data were collected over 65 months. During active-AAF, a dedicated ID trained clinical pharmacist and ID physician-reviewed antimicrobial use for all GIM patients and provided patient-specific advice to physicians. Antimicrobial use was measured by Defined Daily Doses (DDD) normalized per 1,000 patient-days. To assess the impact of temporary suspensions, data were compared in two ways: 1. All nonactive-AAF time-frames were compared with active AAF 2. Pre-ASP was compared with Post-ASP Initiation which includes suspension periods. To determine whether differences in trends were seen based on acuity level of the patients (identified at admission as benefiting from frequent monitoring), analyses were repeated after stratification of patients admitted to the Step-Up unit (GIM-SU) and the regular ward (GIM-W). Results Comparing nonactive AAF vs. active-AAF, significant changes (P < 0.05) in mean normalized DDD were observed for total antimicrobials (-19%), antipseudomonals (-21%) fluoroquinolones (−41%) and first-generation β lactams (−30%). Pre ASP vs. Post ASP comparisons showed similar but less pronounced trends. Following stratification to GIM-SU and GIM-W, greater variation in significant changes to targeted antimicrobials between comparisons was observed. Different significant antimicrobial changes were seen in SU vs. W. Conclusion Our results show that the temporary suspension of ASP AAF impacts antimicrobial utilization trends. Greater sustained decreases in targeted antimicrobials utilization were associated with active AAF. Stratification by patient acuity lead to increased variation in the impact on target antimicrobials and increased the impact of suspension. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]