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Information technology (IT) is vitally important to making antimicrobial stewardship a scalable endeavor in modern health care systems. Without IT, many antimicrobial interventions in patient care would be missed. Clinical decision support systems and smartphone apps, either stand-alone or integrated into electronic health records, can all be effective tools to help augment the work of antimicrobial stewardship programs and support the management of infectious diseases in any health care setting.

Increasingly, demands are placed on healthcare systems to meet antimicrobial stewardship standards and reporting requirements. This trend, combined with reduced financial and personnel resources, has created a need to adopt information technology (IT) to help ease these burdens and facilitate action. The incorporation of IT into an antimicrobial stewardship program can help improve stewardship intervention efficiencies and facilitate the tracking and reporting of key metrics, including outcomes. This paper provides a review of the stewardship-related functionality within these IT systems, describes how these platforms can be used to improve antimicrobial use, and identifies how they can support current and potential future antimicrobial stewardship regulatory and accreditation standards. Finally, recommendations to help close the gaps in existing systems are provided and suggestions for future areas of development within these programs are delineated.

We used multivariable analyses to assess whether meeting core elements was associated with antibiotic utilization. Compliance with 7 elements versus not doing so was associated with higher use of broad-spectrum agents for community-acquired infections [days of therapy per 1,000 patient days: 155 (39) vs 133 (29), P = .02] and anti-methicillin-resistant S. aureus agents [days of therapy per 1,000 patient days: 145 (37) vs 124 (30), P = .03].

Background Procalcitonin (PCT) guidance alone or in conjunction with antibiotic stewardship programs (ASP) has been shown to reduce antibiotic utilization and duration of therapy without adversely affecting patient outcomes. Methods In a community hospital, we investigated the impact of PCT with ASP recommendations on length of stay (LOS), length of antimicrobial therapy (LOT) after ASP recommendation, and total LOT over a one-year period. Adult patients with at least one PCT value and concomitant ASP recommendations were included. Patients were grouped by provider ASP compliance and further stratified by normal versus elevated PCT values. No specific PCT algorithm was utilized. Results A total of 857 patients were retrospectively analyzed. Physicians complied with 73.7% of ASP recommendations. There were no significant differences in LOS based on ASP compliance. Mean LOT after ASP recommendations and mean total LOT were significantly shorter (2.5 vs. 3.9 days, p Conclusions PCT-guided ASP physician recommendations, when accepted by providers, led to reduction in antimicrobial LOT in a community hospital. This benefit was extended across patient groups irrespective of initial PCT levels.

Background The epidemic Clostridioides difficile ribotype 027 strain resulted from the dissemination of 2 separate fluoroquinolone-resistant lineages: FQR1 and FQR2. Both lineages were reported to originate in North America; however, confirmatory large-scale investigations of C difficile ribotype 027 epidemiology using whole genome sequencing has not been undertaken in the United States. Methods Whole genome sequencing and single-nucleotide polymorphism (SNP) analysis was performed on 76 clinical ribotype 027 isolates obtained from hospitalized patients in Texas with C difficile infection and compared with 32 previously sequenced worldwide strains. Maximum-likelihood phylogeny based on a set of core genome SNPs was used to construct phylogenetic trees investigating strain macro- and microevolution. Bayesian phylogenetic and phylogeographic analyses were used to incorporate temporal and geographic variables with the SNP strain analysis. Results Whole genome sequence analysis identified 2841 SNPs including 900 nonsynonymous mutations, 1404 synonymous substitutions, and 537 intergenic changes. Phylogenetic analysis separated the strains into 2 prominent groups, which grossly differed by 28 SNPs: the FQR1 and FQR2 lineages. Five isolates were identified as pre-epidemic strains. Phylogeny demonstrated unique clustering and resistance genes in Texas strains indicating that spatiotemporal bias has defined the microevolution of ribotype 027 genetics. Conclusions Clostridioides difficile ribotype 027 lineages emerged earlier than previously reported, coinciding with increased use of fluoroquinolones. Both FQR1 and FQR2 ribotype 027 epidemic lineages are present in Texas, but they have evolved geographically to represent region-specific public health threats.

Background Antibiotic use (AU) and antibiotic resistance (AR; AUR) reporting to National Healthcare Safety Network (NHSN) is suboptimal by US hospitals. The Society of Infectious Diseases Pharmacists (SIDP) and the Society for Healthcare Epidemiology of America (SHEA) conducted a survey of their membership to 1) Identify characteristics of US health systems that report AUR data 2) Determine how NHSN AUR data are used by health systems and 3) Identify barriers to AUR reporting. Methods An anonymous survey was posted on SurveyMonkey from 1/21- 2/21/2020 and links were emailed to SIDP and SHEA Research Network members. Data were analyzed in Excel and RStudio. Respondent and hospital data were reported as frequencies and percentages. Fisher’s Exact test was used to compare survey responses from NHSN AUR reporters to non-reporters. Results A total of 238 individuals from 43 states responded to our survey. Respondents were primarily pharmacists (84%), from urban (45%), non-profit medical centers (80%) with >250 beds (65%). 62% of respondents reported to the AU option while 19% reported to the AR option. Respondents not using software for local AU or AR tracking were less likely than those using any software for local tracking to report to AU (19% vs 64%) and AR (2% vs 30%) options (P< 0.0001). Among AU and AR reporters 41% and 54% used clinical decision support software to aggregate compile data for upload while 54% and 38% used their electronic health record, and 5% and 8% used another method. Over half of AU (56%) and AR (51%) reporters upload data manually. Regular use of the NHSN data analysis tools was reported by 36% and 9% of those reporting AU and AR data respectively. The most common barriers to reporting were related to technical issues (software, IT support, data formatting) and time/salary support. Among non-reporters, increased expectations to report and better software solutions were most commonly identified as the best ways to increase reporting. Conclusion Efforts to improve AUR reporting should focus on software solutions and increasing the utility of AUR analytical tools. Increasing expectations to report may also help to improve reporting rates. The lower rate of AR vs AU reporting suggests that interventions should also target the AR option. Disclosures Brian J. Werth, PharmD, Shionogi Inc. (Grant/Research Support) Kerry LaPlante, PharmD, Merck (Advisor or Review Panel member, Research Grant or Support)Ocean Spray Cranberries, Inc. (Research Grant or Support)Pfizer Pharmaceuticals (Research Grant or Support)Shionogi, Inc. (Research Grant or Support)

Background Antibiotic use metrics are utilized by antimicrobial stewardship programs to benchmark performance against peer institutions and inform stewardship efforts. Benchmarking requires risk adjustment for patient- and facility-level factors so that remaining differences are attributable only to prescribing practices. Antibiotics for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) are one of the most frequently used drug classes. Our objective was to identify predictors of anti-MRSA antibiotic use in a nationwide network of hospitals. Methods We used data from inpatient encounters at facilities participating in the Vizient data repository between January 1, 2016 and December 31, 2016. The outcome, anti-MRSA antibiotic use, was calculated as days of therapy per patient-days present for each encounter. We constructed a multivariable negative binomial regression model and assessed the following predictors for inclusion: age, sex, race, ethnicity, diagnosis related groups (DRGs), ICU days, admit month, facility bed size, facility teaching status, and region. A clinical framework was used to categorize DRGs based on risk of anti-MRSA antibiotic use. A backwards stepwise approach was used to identify the final model. We evaluated predictor effect size and significance, and assessed model fit using a deviance-based pseudo-R2. Results One hundred forty-five facilities representing 3,608,711 encounters met inclusion criteria. All predictors considered in our model were significant. Predictors with the greatest magnitude of association included DRG categories and patient age. The DRG categories with the strongest associations were DRGs for infections likely due to Staphylococcus aureus (RR = 1.66, P < 0.0001) or for diagnoses likely to receive long-term MRSA coverage (RR = 1.49, P < 0.0001). The age group with the strongest association was age 2–10 years (RR = 1.64; P < 0.001). The deviance-based pseudo-R2 of the final model was 0.19, indicating good model fit. Conclusion DRGs and patient-level characteristics can be utilized to account for variability in anti-MRSA antibiotic use beyond what is explained through facility-level characteristics. Incorporation of the significant predictors identified in this study may aid in more meaningful interhospital comparisons of anti-MRSA antibiotic use in both adults and pediatrics. Disclosures J. C. McGregor, Merck: Grant Investigator, Research grant.

The echinocandin antifungals are recommended as initial therapy in hospitalized patients with candidemia. Contemporary usage rates and indication for use of echinocandins have not been studied in the United States. The purpose of this study was to evaluate echinocandin usage patterns in community and academic teaching hospitals over time and to evaluate dose, duration of therapy and indications for use.This study used hospital pharmacy databases from academic and community hospitals to collect information on adult inpatients given systemic antifungal agents from 2008 to 2012. Patient medical information was also obtained from randomly selected patients given an echinocandin over the same time period.Echinocandin use was determined for 4 academic and 34 community hospitals. A significant increase in echinocandin use was observed in academic and community hospitals during the time period (P0.001). Two hundred forty-two randomly selected patients receiving an echinocandin were retrospectively reviewed. Indications for echinocandin use did not change during the time period and included empiric therapy in a high-risk patient without subsequent mycologic confirmation from a normally sterile site (55%), systemic candidiasis (43%) and prophylactic (2%). Fifty-six percent of patients had at least 1 anatomic site of mycologic growth; most commonly urine only (14%), respiratory only (12%) or blood only (7%). In patients with candidemia, the hospital treatment course with an echinocandin averaged 8.4 ± 7.9 days (range, 1-35 days).This study provides useful benchmark data on antifungal use and indications for use that could be used for antifungal stewardship program comparisons.

Rapid diagnostic technologies (RDTs) significantly reduce organism identification time and can augment antimicrobial stewardship program (ASP) activities. An electronic survey quantified familiarity with and utilization of RDTs by clinical pharmacists participating in ASPs. Familiarity was highest with polymerase chain reaction (PCR). Formal infectious diseases training was the only significant factor influencing RDT familiarity.Infect Control Hosp Epidemiol 2017;38:863–866

Purpose: To describe antimicrobial stewardship programs (ASPs) of acute and long-term acute care (LTAC) hospitals in Houston, Texas. Methods: Two-part survey to clinical pharmacists and pharmacy directors. All acute care and LTAC facilities from the Harris County Medical Society database were invited to participate. Results: In part 1 of the telephone survey, 82 facilities within Houston, Harris county, were contacted by telephone of which 51 responded (response rate: 62%). Of respondents, 55% (n = 28) reported having an active ASP and 8% (n = 4) planned implementation within 12 months. Acute care and LTAC hospitals reported ASPs in 57% and 67% of facilities, respectively. Physician champions were involved in 71% (n = 20) of active ASPs; clinical pharmacists were involved in 75% (n = 21) of programs. In part II, 22 (43%) facilities completed the online survey; postprescription review with feedback was used in facilities with an ASP and medical training program (5 of 5) while formulary restriction was in facilities without stewardship or medical training (6 of 8). Conclusion: This is the first major survey of ASP in a major metropolitan area. The stewardship effort in the city of Houston is encouraging; we expect the number of stewardship programs in all facilities will continue to rise as focus on antimicrobial resistance grows.

Purpose The perioperative management of bariatric surgery patients is described. Summary Obesity and anatomical changes create unique challenges for clinicians when caring for bariatric surgery patients. Common bariatric surgery procedures performed include Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding. Pain management in the acute postoperative period depends on careful dosing of opioid agents and the use of adjunctive agents. Prevention and management of infectious complications include appropriate surgical prophylaxis, monitoring and rapid treatment of suspected intra-abdominal infections, and detection and treatment of Helicobacter pylori infection. Venous thromboembolism (VTE) prophylaxis and treatment are complicated by obesity, and the use of pharmacologic agents must be balanced with bleeding risk. Bleeding is a serious complication that should be closely monitored in the immediate postoperative period. Blood products remain first-line therapy for the treatment of bleeding in this population. Acute differences in drug absorption as well as emerging hormonal changes necessitate the immediate postoperative adjustment of chronic medications to ensure both safety and efficacy. Pharmacists are valuable members of interprofessional teams for bariatric surgery patients because they provide expertise on the availability of dosage forms and dosage modification to ensure that patient pharmacotherapy is not interrupted; assist in the management of hypertension, diabetes, and psychotropic medications; and ensure appropriate antimicrobial prophylaxis and VTE prophylaxis and treatment dosages. Conclusion The management of patients in the perioperative period of bariatric surgery requires appropriate selection and dosing of medications for pain management and treatment of infectious complications, VTE, bleeding, and other chronic diseases.

Background Rifaximin (RFX) is a minimally absorbed antibiotic that achieves high concentrations after administration in the gut lumen. Previously, RFX showed activity against Clostridiodes difficile (C. difficile) recurrences post treatment with little overall impact on the normal fecal microbiota. Additional studies have found that while exposure to systemic antibiotics was associated with infection with multi drug-resistant organisms, such as VRE, exposure to only RFX was not. RFX has become widely used in hospitalized patients with advanced liver disease (ALD) who have refractory hepatic encephalopathy, but the impact of therapy on the occurrence of C. difficile and VRE is not well established. Methods ALD patients in the Vizient Clinical Database-Resource Manager (CDB-RM®) were identified based on ICD 10 and MS-DRG codes from January to December 2018. The data were further stratified based on receipt of RFX, documentation of C. difficile or VRE, and hospital type (academic medical centers, complex care medical centers or community hospitals). Wilcoxon signed-rank test was used to compare C. difficile rates while paired samples t-test was used to compare VRE. Chi-square analysis was used to evaluate differences in RFX use by hospital type. Results A total of 527,534 cases from 419 acute care hospitals were included in the ALD cohort. The frequency of C. difficile occurrence in patients who received RFX was lower than those who did not receive RFX (3.8% vs 4.3%, respectively, P = 0.25), However, VRE frequency was significantly lower in those that received RFX (0.43 cases per 10,000 patient-days) vs. the overall ALD population (2.3 cases per 10,000 patient-days) (P < 0.05). Percentage of ALD cases receiving RFX in the academic medical centers, complex care medical centers and community hospitals was 11.94%, 4.87%, and 8.76%, respectively (P < 0.05). Conclusion Patients with ALD who received RFX had a significantly lower frequency of documented VRE. There was a trend in the reduction in documented C. difficile, but this did not reach statistical significance. Utilization of RFX varied significantly by institutional type. These results support further studies on the relationship between receipt of RFX and protective effects against C. difficile and VRE in patients with ALD. Disclosures All authors: No reported disclosures.

Background The antibiotic timeout (ATO) is a stewardship tool that protocolizes review of objective clinical data after a predefined period of time and encourages antimicrobial regimen re-assessment. Methods Vizient member hospitals were utilized to recruit a variety of acute healthcare institutions, including institutions with and without an ATO process. Participating institutions submitted de-identified patient-level antibiotic therapy courses from a single day within a 5-week window to create a snapshot of overall antibiotic utilization. Therapy courses were evaluated on metrics including the prevalence of anti-pseudomonal agents, agents active against methicillin-resistant Staphylococcus aureus (MRSA), and oral (vs. intravenous) antibiotics. The outcome measures included: percent changes in prevalence of courses with antipseudomonal and anti-MRSA agents after day 3, and percent change in antibiotics ordered for oral administration after day 3. These outcome measures were compared between ATO institutions and non-ATO institutions. Results A total of 6,184 antibiotic therapy courses were collected from 61 participating institutions (17 ATO institutions; 44 non-ATO institutions). Of 71 institutions that completed enrollment survey, 10 did not complete submission of therapy course data. Antibiotic courses prescribed for prophylaxis (n = 975) and courses that extended beyond 7 days (n = 1,192) were excluded from analysis, resulting in an analysis group that included 4,017 therapy courses (1,396 from ATO institutions vs. 2,621 from non-ATO institutions). The prevalence of patients receiving anti-pseudomonal agents increased after day 3 by 3.03% (P = 0.28) at ATO institutions and decreased 0.45% (P = 0.84) at non-ATO institutions. The prevalence of patients receiving anti-MRSA agents decreased after day 3 by 2.16% (P = 0.41) at ATO institutions and decreased 5.05% (P = 0.005) at non-ATO institutions. Oral antibiotic use increased after day 3 by 3.09% (P = 0.08) at ATO institutions while use at non-ATO institutions increased 7.99% (P = 0.0001). Conclusion Antibiotic therapy course data collected across multiple sites provided no evidence for improved antimicrobial utilization among institutions that have implemented an antibiotic timeout compared with institutions without a timeout. Disclosures All authors: No reported disclosures.

Background An antibiotic timeout (ATO) provides a potential opportunity to improve antibiotic utilization and decrease inappropriate antibiotic prescribing. The CDC and Joint Commission suggest ATO as an antimicrobial stewardship program (ASP) action to support optimal antibiotic use. Unfortunately, little is known about the design and implementation of an ATO. Our primary objective was to describe different ATO models established by hospitals across the United States. Methods Data describing ATO strategies and ASP efforts were collected via a Qualtrics survey as a part of a multicenter study conducted by Vizient™ member hospitals to research the impact of an ATO on various ASP reporting metrics. Results Seventy-one hospitals responded to the survey. Twenty (28%) had a formalized ATO. Most institutions utilizing an ATO were community hospitals (60%) and had formalized ASPs (95%). Hospitals with an ATO program trended toward a higher average combined number of ASP physician and pharmacist FTEs than those without a formalized ATO (1.72 vs. 1.2, P = 0.28). Prescribers were responsible for the ATO in 40% of programs (N = 8), 30% were pharmacist-led, and the remainder were multidisciplinary. ATOs were most commonly performed daily (75%) as opposed to on select days of the week and targeted patients receiving antibiotics for 72 hours. Electronic medical record (EMR)-based ATOs (where the EMR prompted the responsible personnel to respond) existed at 14 programs, whereas 4 programs performed an ATO manually through chart review. Forty percent of hospitals conducted ATO on all antibiotics and antifungals; 20% included only antibiotics in their ATO. For the remaining 40% of institutions, only select drugs were included in the ATO. Conclusion Multiple ATO strategies are used in the United States. Most ATOs are electronic-based, performed at 72 hours of antibiotic therapy, inclusive of all antibiotics, and supported by established ASPs. To our knowledge, this is the largest descriptive study on ATO implementation in the United States. Figure 1. Distribution of hospital type and duration of ASPs by the presence of ATO Figure 2. Personnel responsible for conducting ATOs Disclosures All authors: No reported disclosures.

Background Antibiotic utilization for geographically diverse areas can be difficult to obtain. The purpose of this study was to characterize patterns of US antibiotic use over a defined period to provide comparative data for benchmarking and to assist with identifying antibiotic stewardship opportunities. Methods Data were obtained as part of a larger study evaluating antibiotic time out practices. Participating institutions submitted de-identified patient-level antibiotic use data from a single day (between October 16, 2017 and November 17, 2017). Indication, expected duration, and antibiotic stop dates were documented. Antibiotics were classified by American Hospital Formulary Service (AHFS) therapeutic category and evaluated to identify duplicate anti-anaerobic, anti-MRSA, and AHFS classes. Hospital teaching status and US Census region were recorded. Results A total of 6,184 courses of therapy (8,996 individual antibiotics) were evaluated from 61 hospitals. Sixty-four percent of therapy courses submitted were from academic medical centers. Distribution by census region was Midwest (44.7%), Northeast (15.11%), South (23.2%), and West (16.9%). Over half (53.7%) of therapy was empiric and 33.4% was directed. Sixty-six percent of courses did not include a stop date within the electronic medical record. Twelve drugs comprised 80% of total antibiotic use. Percentage of antipseudomonal use was similar across regions, but anti-MRSA therapy was higher in the South and Midwest. Duplicate β-lactam therapy and duplicate anti-anaerobe therapy were identified in 1.5% of total courses (each). Duplicate anti-MRSA therapy occurred in 0.29% of therapy courses. Three percent of patients developed a Clostridium difficile infection during their hospitalization. Conclusion Vancomycin and piperacillin–tazobactam were the most common antibiotics used which is consistent with other analyses, but anti-anaerobic use as a percentage of overall use was higher than expected. Duplicate anti-anaerobe and β-lactam therapy is less frequent, but still represents an opportunity for stewardship. Antipseudomonal and anti-MRSA agents represent two key categories for stewardship given the high percentage of use. The addition of a stop date to the antibiotic order presents an opportunity to improve overall utilization. Disclosures All authors: No reported disclosures.

Antifungal susceptibility testing is not as commonly performed as antibacterial susceptibility testing. The methodology for detecting antifungal resistance is newer and requires different testing supplies that may not be readily available in a clinical laboratory setting. Breakpoints for molds are lacking. Yeast breakpoints are available for most antifungals but are continually updated based on epidemiologic surveillance. Reliable and reproducible antifungal susceptibility testing methods, as well as more research on the role of susceptibility testing in patient care, are necessary in order to provide the clinician with information that can be translated into positive clinical outcomes at the bedside. There are nuances with current testing methods that, if unrecognized, could lead to misinterpretation of results and inappropriate antifungal selection. Clinicians who have an understanding of qualitative and quantitative methods, automated susceptibility testing systems, and other commercial tests can successfully engage this knowledge to improve antifungal use and patient outcomes. This primer describes the common antifungal susceptibility tests used in the clinical microbiology laboratory and reviews literature related to the impact of appropriate drug selection, timing, fungal resistance mechanisms, pharmacokinetics, and pharmacodynamics on clinical outcomes. Both conventional and modern testing methods are discussed.

Background In July 2007, the Pharmacy Department at Suburban Hospital implemented an antimicrobial stewardship program (ASP) using existing clinical pharmacy resources that did not include an on-site infectious diseases (ID) pharmacist. Medical staff personnel were supportive of the ASP, but there were no ID physician resources actively dedicated to the program. Remote access to an ID pharmacist was available. Objectives This program evaluated the impact of a pharmacy-driven ASP on cost, antimicrobial utilization, and quality indicators in a community hospital with limited ID professional resources. Methods The tenets of the program were adopted from recommendations in the most current Infectious Diseases Society of America/Society for Healthcare Epidemiology of America antimicrobial stewardship guidelines. Antimicrobial utilization, cost, prospective medication use data, and interventions were tracked using customized spreadsheets. Three years of utilization and cost data were captured to provide a baseline and post implementation comparison. Results Antimicrobial utilization decreased 5.2% compared to baseline ( P < .001) as measured by the defined daily dose (DDD) per 1,000 patient days. The associated cost reduction during the period was 24% compared to baseline ( P < .001), resulting in estimated savings of approximately $290,000. Quality of care indicators improved, and physicians were responsive to daily clinical pharmacist review and pharmacy interventions. Conclusions An ASP can be implemented in a community hospital setting with existing clinical pharmacy resources that do not include an ID specialist dedicated full time to the program. Prospective monitoring of antimicrobial usage resulted in decreased antimicrobial cost and utilization and improvements on key quality of care indicators. Based on this evidence of success, the program continues.

Health-care-associated infections (HAIs) are increasingly problematic. The Centers for Disease Control and Prevention (CDC) examined HAI rates from three major surveillance databases and found that HAIs accounted for an estimated 1.7 million infections and 99,000 deaths annually.[1][1] HAIs prolong

Background The Centers for Disease Control and Prevention National Healthcare Safety Network (NHSN) provides hospitals a mechanism to report antibiotic use (AU) data to benchmark against peer institutions and direct antibiotic stewardship efforts. Differences in patient populations need to be adjusted for to ensure unbiased comparisons across hospitals. Our objective was to identify predictors of total AU across a nationwide network of hospitals. Methods Data from 126 academic hospitals were extracted from the Vizient Clinical Data Base Resource Manager for adult inpatients (age ≥ 18 years) in 2015. AU was expressed as total antibiotic days of therapy/patient-days. We constructed a negative binomial regression model to explore potential predictors of AU including age, race, sex, case mix index, hospital bed size, length of stay, geographic region, transfer cases, service line, and illness severity. A backwards stepwise approach based on likelihood ratio test was used to identify significant (P < 0.05) predictors and construct the final, parsimonious model. We calculated dispersion-based R2 to assess the percent variability explained by the full and final models. Results A total of 3,076,394 total admissions, representing 17,544,763 patient days, were included. Factors identified as significant predictors in the final model are shown in the Table. The percent variance explained by the full and final models was 90.3% and 89.6%, respectively. Table: Independent predictors of total facility antibiotic use per patient days Relative Risk 95% Confidence Interval Case Mix Index 1.36 1.16, 1.60 Region West Ref – Midwest 1.05 0.92, 1.20 Northeast 0.92 0.81, 1.04 South 1.07 0.94, 1.23 Transfer cases 0.31 0.15, 0.63 Surgery service line 0.45 0.25, 0.81 Major illness severity 3.24 1.04, 10.09 Conclusion The current NHSN AU risk adjustment metric, the standardized antimicrobial administration ratio (SAAR), has been developed separately for different antibiotic groupings and adjusts for a limited set of facility characteristics. Further work is needed to assess if the independent predictors identified in this model can improve upon the performance of existing SAAR metrics and aid in directing stewardship strategies. Disclosures All authors: No reported disclosures.

Background Facilities enrolled in the National Healthcare Safety Network (NHSN) provide annual information on their antibiotic stewardship programs (ASPs) via a mandatory survey. The survey contains 12 questions that explore uptake of CDC’s Core Elements for Hospital ASPs. Respondents (typically Infection Preventionists) are advised to seek input from pharmacist and physician ASP champions, but the professional completing the survey and the extent of input provided by ASP program personnel are unknown. A separate survey provided an opportunity to assess ASP responses reported to NHSN. Methods Individuals from 446 academic and community hospitals participating in the Vizient list-serve were surveyed in March 2016. The Vizient survey included the 12 ASP questions in the 2015 NHSN survey. Vizient responses were compared with NHSN survey responses to assess differences in reported uptake of core elements based on the professional completing the survey. Results 189 of the 211 hospitals completing the Vizient survey were successfully matched to NHSN hospitals. The majority of respondents were pharmacists; 83% were either Directors of Pharmacy or clinical pharmacists of which 48% and 61% reported assisting with the NHSN survey, respectively. Reported implementation of all 7 elements in this subset of 189 hospitals was 58.2% in the Vizient survey compared with 54.5% in NHSN. Results differed by respondent position and core element surveyed. Clinical pharmacists in the Vizient survey reported higher rates of core element adherence than Directors of Pharmacy (Figure 1). The position of survey respondents varied by hospital size. Of hospitals with less than 250 beds, 87.5% of surveys were completed by Directors of Pharmacy, whereas 77.1% of surveys were completed by clinical pharmacists in hospitals with ≥250 beds. Conclusion Overall similarities between NHSN and Vizient survey results indicate that ASP questions based on CDC’s Core Elements are interpreted in similar ways and answered consistently when analyzed overall. However, individual core element responses may differ based on position of respondent, ASP familiarity, ASP infrastructure, and/or hospital bed size. CDC is exploring improved wording of the survey questions to help further improve consistency in responses. Disclosures All authors: No reported disclosures.

Purpose The most important articles pertaining to infectious diseases (ID) pharmacotherapy published in 2012, as nominated and ranked by panels of pharmacists and physicians with ID expertise, are summarized. Summary Members of the Houston Infectious Diseases Network were asked to nominate articles on ID research published in prominent peer-reviewed journals during the period January 1–December 31, 2012, with a major impact in the field of ID pharmacotherapy. A list of 42 nominated articles on general ID-related topics and 8 articles pertaining to human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) was compiled. In a survey conducted in January 2013, members of the Society of Infectious Diseases Pharmacists (SIDP) were asked to select from the list 10 general ID articles and 1 HIV/AIDS-related article that they considered to be the most important. Of the 180 SIDP members surveyed, 100 (55%) and 44 (24%) participated in ranking the general ID and HIV/AIDS-related articles, respectively. Summaries of the highest-ranked articles in both categories are presented here. Conclusion With the volume of published ID-related research growing each year, both ID specialists and nonspecialists are challenged to stay current with the literature. Key ID-related publications in 2012 included updated recommendations on management of diabetic foot infections, articles on promising approaches to prevention and early treatment of HIV disease, and reports on developments in research on pharmacotherapies for methicillin-resistant Staphylococcus aureus bacteremia and Klebsiella pneumoniae infections.

Appropriate use of antimicrobials in health care continues to be a challenge. Reliable and reproducible antimicrobial susceptibility testing methods are necessary to provide the clinician with valuable information that can be translated into positive clinical outcomes at the bedside. However, there are nuances with these testing methods that, if unrecognized, could lead to misinterpretation of results and inappropriate antibiotic selection. This primer describes the common antimicrobial susceptibility tests used in the clinical microbiology laboratory and reviews how subtle differences in testing methods and technique can influence reported results. Clinicians who have a thorough understanding of qualitative and quantitative methods, automated susceptibility testing systems, and commonly used screening and confirmatory tests for antibiotic-resistant organisms can strengthen institutional antibiotic stewardship programs and improve patient outcomes.

Purpose. Significant publications on infectious diseases (ID) pharmacotherapy in 2008 were compiled and summarized. Summary. On December 31, 2008, the Houston Infectious Diseases Network compiled a listing of published articles identified as having a significant impact on ID pharmacotherapy. The publication period was limited to January 1 through December 31, 2008. Articles were selected based on prior presentations at ID and pharmacy meetings or were listed as major articles in prominent ID journals. Priority was given to articles that were published in peer-reviewed journals and to treatment guidelines endorsed by major medical and pharmacy organizations. A bibliography of 56 articles (40 not related to human immunodeficiency virus [HIV] infection and 16 related to HIV infection) was distributed to members of the Society of Infectious Diseases Pharmacists (SIDP) via an Internet survey in early January 2009. Members were asked to select 10 publications not related to HIV infection and 1 HIV-related publication that they believed made the greatest contribution to the antimicrobial-related medical literature in 2008. A total of 115 SIDP members participated in the survey. Summaries of the top articles selected, along with an interpretation of their effect on clinical practice, are included. Conclusion. The increasing number of articles in the peer-reviewed medical literature related to the diagnosis and treatment of ID has made it challenging to maintain a contemporary knowledge base of key publications. This summary of significant ID articles published in 2008 can help to alleviate this burden.

It has been more than 60 years since Alexander Fleming discovered the drug that came to be known as penicillin. Antibiotics are now one of the most frequently used medications in the United States and are prescribed by medical professionals in almost every specialty. The past decade has seen an alarming increase in the number of pathogens that are resistant to antimicrobial drugs, in the hospital as well as in the community.(1) Among the gram-positive pathogens, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus species are the biggest threats. The situation is even more alarming with respect to gram-negative pathogens, especially because there are currently no late clinical trials involving new anti-infective drugs that are active against these pathogens.

Purpose. Significant publications on infectious diseases (ID) pharmacotherapy in 2007 were compiled and summarized. Summary. On January 2, 2008, the 21 members of the Houston Infectious Disease Network (HIDN) were asked to select an article that was published in a peer-reviewed journal between January 1 and December 31, 2007, and write a summary highlighting why the article was significant to the diagnosis or treatment of ID. Articles were selected based on prior “top 10” presentations at major ID and pharmacy meetings or were listed as major articles in prominent ID journals. Priority was given to peer-reviewed publications and nationally recognized clinical treatment guidelines. Nineteen articles and summaries were submitted by HIDN members. The publication listing was distributed to Society of Infectious Diseases Pharmacists members via an Internet survey in early February 2008. Members were asked to select the 10 most significant articles relating to ID pharmacotherapy from the list of 19 and were allowed to add an additional article that was not already listed. A total of 102 individuals participated in the survey. A listing of the top 10 articles published in 2007 and one honorable mention was compiled, and the significance of each article was summarized. Conclusion. The increased number of articles in the peer-reviewed medical literature related to the diagnosis and treatment of ID has made it challenging to maintain a contemporary knowledge base of key publications. This summary of significant ID articles published in 2007 can help to alleviate the burden of knowledge management.