Search

Background Bezlotoxumab (BEZ) is a monoclonal antibody used to prevent recurrent Clostridioides difficile infection (rCDI). This study investigates BEZ effectiveness in relation to rCDI and patient-specific risk factors in a real-world setting. Methods A matched, retrospective cohort study was conducted from 2015 to 2019 to compare BEZ to historical standard of care (SoC) therapy with vancomycin or fidaxomicin. The primary outcome was incidence of 90-day rCDI. Secondary outcomes were incidence of all-cause hospital readmission and all-cause mortality at 90 days, infusion-related reactions, and incidence of heart failure exacerbation. Baseline confounding was addressed using inverse probability of treatment weighting (IPTW). Results Overall, 107 participants were included (54 BEZ and 53 SoC). Mean number of prior CDI episodes was 2, median number of risk factors for rCDI was 4, and 28% of participants had severe CDI. Incidence of 90-day rCDI was 11% BEZ vs 43% SoC (P = < .001) and 90-day all-cause readmission was 40% BEZ vs 64% SoC (P = .011). In IPTW-adjusted analyses, BEZ was associated with significantly reduced odds of rCDI (odds ratio [OR], 0.14 [95% confidence interval {CI}: .05–.41]) and all-cause readmission (OR, 0.36 [95% CI: .16–.81]). No safety signals were detected with BEZ use. Conclusions BEZ is effective for the prevention of rCDI and reduction in all-cause hospital readmission for patients at high risk for recurrence, supporting current guideline recommendations.

Treatment of serious gram-positive infections presents multiple challenges. Treatment often results in prolonged hospitalization for administration of intravenous antimicrobials and presents an inefficient use of hospital resources. Prolonged hospitalization is typically also unfavorable to patient preferences and potentially subjects patients to additional health care-associated complications. Current strategies of transition to outpatient settings-outpatient parenteral antimicrobial therapy and use of oral antibiotics-often do not adequately serve vulnerable populations for whom there is often no alternative to inpatient therapy. Specifically, people who use drugs, those who cannot reliably adhere to unsupervised treatment (poor mental or physical health), people with complicating life circumstances (e.g., homelessness, incarceration, rural location), and those with inadequate health insurance remain hospitalized for weeks longer than persons without such conditions. We suspected that long-acting lipoglycopeptides (laLGP), such as dalbavancin and oritavancin, may be useful in patient transitions to outpatient settings. Thus, we conducted a search of the peer-reviewed literature using the PubMed, Google Scholar, and MEDLINE databases. Based on accumulating literature, it appears that laLGPs offer a reliable alternative therapeutic strategy that addresses many of the personal and systemic barriers to the traditional transitioning approaches. Current evidence also suggests that these agents may be cost-effective from patient, payer, and hospital perspectives. Barriers to broader use of laLGPs include, among others, a relative lack of prospective data regarding efficacy in serious infections, a narrow United States Food and Drug Administration-approved indication restricted to only acute bacterial skin and skin structure infections, and lack of reimbursement infrastructure for inpatient settings.

Background National guidelines for pneumonia (PNA), urinary tract infection (UTI), and acute bacterial skin and skin structure infection (ABSSSI) do not address treatment duration for infections associated with bacteremia. We evaluated clinical outcomes of patients receiving shorter (5–9 days) versus longer (10–15 days) duration of antibiotics. Methods This was a multicenter retrospective cohort study of inpatients with uncomplicated PNA, UTI, or ABSSSI and associated bacteremia. The primary outcome was clinical failure, a composite of rehospitalization, reinitiation of antibiotics, or all-cause mortality within 30 days of antibiotic completion. Secondary outcomes included individual components of the primary outcome, Clostridioides difficile infection, and antibiotic-related adverse effects necessitating change in therapy. A propensity score-weighted logistic regression model was used to mitigate potential bias associated with nonrandom assignment of treatment duration. Results Of 408 patients included, 123 received a shorter treatment duration (median 8 days) and 285 received a longer duration (median 13 days). In the propensity-weighted analysis, the probability of the primary outcome was 13.5% in the shorter group and 11.1% in the longer group (average treatment effect, 2.4%; odds ratio [OR], 1.25; 95% confidence interval [CI], .65–2.40; P = .505). However, shorter courses were associated with higher probability of restarting antibiotics (OR, 1.62; 95% CI, 1.01–2.61; P = .046) and C. difficile infection (OR, 4.01; 95% CI, 2.21–7.59; P < .0001). Conclusions Shorter courses of antibiotic treatment for PNA, UTI, and ABSSSI with bacteremia were not associated with increased overall risk of clinical failure; however, prospective studies are needed to further evaluate the effectiveness of shorter treatment durations.

Background Bezlotoxumab significantly reduces the incidence of recurrent Clostridioides difficile infection (CDI); however, limited data are available in solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients. Methods We conducted a single-center retrospective analysis comparing recurrent CDI in SOT and HCT recipients receiving standard of care alone (oral vancomycin, fidaxomicin, or metronidazole) or bezlotoxumab plus standard of care. The primary outcome was 90-day incidence of recurrent CDI, and secondary outcomes included 90-day hospital readmission, mortality, and incidence of heart failure exacerbation. Results Overall, 94 patients received bezlotoxumab plus standard of care (n = 38) or standard of care alone (n = 56). The mean age was 53 years; patients had a median of 3 prior Clostridioides difficile episodes and 4 risk factors for recurrent infection. Most patients were SOT recipients (76%), with median time to index CDI occurring 2.7 years after transplantation. Ninety-day recurrent CDI occurred in 16% (6/38) in the bezlotoxumab cohort compared to 29% (16/56) in the standard of care cohort (P = .13). Multivariable regression revealed that bezlotoxumab was associated with significantly lower odds of 90-day recurrent CDI (odds ratio, 0.28 [95% confidence interval, .08–.91]). There were no differences in secondary outcomes, and no heart failure exacerbations were observed. Conclusions In a cohort of primarily SOT recipients, bezlotoxumab was well tolerated and associated with lower odds of recurrent CDI at 90 days. Larger, prospective trials are needed to confirm these findings among SOT and HCT populations.

Background Antimicrobial stewardship (AS) programs are required by Centers for Medicare and Medicaid Services and should ideally have infectious diseases (ID) physician involvement; however, only 50% of ID fellowship programs have formal AS curricula. The Infectious Diseases Society of America (IDSA) formed a workgroup to develop a core AS curriculum for ID fellows. Here we study its impact. Methods ID program directors and fellows in 56 fellowship programs were surveyed regarding the content and effectiveness of their AS training before and after implementation of the IDSA curriculum. Fellows’ knowledge was assessed using multiple-choice questions. Fellows completing their first year of fellowship were surveyed before curriculum implementation (“pre-curriculum”) and compared to first-year fellows who complete the curriculum the following year (“post-curriculum”). Results Forty-nine (88%) program directors and 105 (67%) fellows completed the pre-curriculum surveys; 35 (64%) program directors and 79 (50%) fellows completed the post-curriculum surveys. Prior to IDSA curriculum implementation, only 51% of programs had a “formal” curriculum. After implementation, satisfaction with AS training increased among program directors (16% to 68%) and fellows (51% to 68%). Fellows’ confidence increased in 7/10 AS content areas. Knowledge scores improved from a mean of 4.6 to 5.1 correct answers of 9 questions (P = .028). The major hurdle to curriculum implementation was time, both for formal teaching and for e-learning. Conclusions Effective AS training is a critical component of ID fellowship training. The IDSA Core AS Curriculum can enhance AS training, increase fellow confidence, and improve overall satisfaction of fellows and program directors.

Background Bezlotoxumab significantly reduces the incidence of recurrent Clostridioides difficile infection (CDI); however, limited data are available in solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients. Methods We conducted a single-center retrospective analysis comparing recurrent CDI in SOT and HCT recipients receiving standard of care alone (oral vancomycin, fidaxomicin, or metronidazole) or bezlotoxumab plus standard of care. The primary outcome was 90-day incidence of recurrent CDI, and secondary outcomes included 90-day hospital readmission, mortality, and incidence of heart failure exacerbation. Results Overall, 94 patients received bezlotoxumab plus standard of care (n = 38) or standard of care alone (n = 56). The mean age was 53 years; patients had a median of 3 prior Clostridioides difficile episodes and 4 risk factors for recurrent infection. Most patients were SOT recipients (76%), with median time to index CDI occurring 2.7 years after transplantation. Ninety-day recurrent CDI occurred in 16% (6/38) in the bezlotoxumab cohort compared to 29% (16/56) in the standard of care cohort (P = .13). Multivariable regression revealed that bezlotoxumab was associated with significantly lower odds of 90-day recurrent CDI (odds ratio, 0.28 [95% confidence interval, .08–.91]). There were no differences in secondary outcomes, and no heart failure exacerbations were observed. Conclusions In a cohort of primarily SOT recipients, bezlotoxumab was well tolerated and associated with lower odds of recurrent CDI at 90 days. Larger, prospective trials are needed to confirm these findings among SOT and HCT populations.

Professional societies serve many functions that benefit constituents; however, few professional societies have undertaken the development and dissemination of formal, national curricula to train the future workforce while simultaneously addressing significant healthcare needs. The Infectious Diseases Society of America (IDSA) has developed 2 curricula for the specific purpose of training the next generation of clinicians to ensure the future infectious diseases (ID) workforce is optimally trained to lead antimicrobial stewardship programs and equipped to meet the challenges of multidrug resistance, patient safety, and healthcare quality improvement. A core curriculum was developed to provide a foundation in antimicrobial stewardship for all ID fellows, regardless of career path. An advanced curriculum was developed for ID fellows specifically pursuing a career in antimicrobial stewardship. Both curricula will be broadly available in the summer of 2021 through the IDSA website.

Complicated methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA-BSIs), particularly those with delayed culture clearance, are associated with high mortality. Combination therapy with daptomycin and ceftaroline (DAP+CPT) represents a novel therapeutic approach to MRSA-BSI owing to synergistic bactericidal activity. This study aimed to compare DAP+CPT with historical standard of care (SoC) for treatment of complicated MRSA-BSI. This single-centre retrospective cohort study included patients with complicated MRSA-BSI at University of Colorado Hospital. Patients receiving DAP+CPT for ≥48 h between November 2013 and March 2020 or SoC with vancomycin or DAP ± gentamicin and/or rifampicin from November 2011 to December 2013 were compared. The primary outcome was clinical failure defined as a composite of MRSA-related mortality and recurrent infection at 60 days. A total of 60 patients received DAP+CPT (n = 30) or SoC (n = 30). Median age was 56 years and median Pitt bacteremia score was 3. Common infectious sites were endovascular (63%) and musculoskeletal (40%). DAP+CPT was associated with a numerically lower incidence of clinical failure compared with SoC (20% vs. 43%; P = 0.052). Multivariable analysis controlling for immunocompromised status (OR, 6.90, 95% CI 1.08–44.15), Charlson comorbidity index (OR, 1.12, 95% CI 0.90–1.39) and source control (OR, 0.35, 95% CI 0.08–1.46) associated DAP+CPT with 77% lower odds of clinical failure (OR, 0.23, 95% CI 0.06–0.89). In patients with complicated MRSA-BSI with delayed clearance, DAP+CPT trended towards lower rates of clinical failure than SoC and was significantly associated with decreased clinical failure after adjustment for baseline differences.

Background The Infectious Diseases Society of America (IDSA) has supported the development of the Core and Advanced Antimicrobial Stewardship (AS) Curricula for fellows to ensure the future ID workforce is effectively prepared to practice, participate in and lead AS efforts in health care institutions. The Core AS Curriculum is currently available; the Advanced AS Curriculum pilot will begin July, 2020. Methods IDSA formed the AS Curriculum Workgroup, comprised of leaders in AS and medical education from institutions across the country, to lead the AS Curricula development process. The workgroup conducted two surveys of ID Fellowship Program Directors, one in 2016 for the core curriculum and a second in 2018 for the advanced curriculum, to assess existing AS educational resources and determine needs for additional AS educational and evaluation resources. The workgroup used the evaluation data to inform the content, delivery methods, and assessment tools for the curricula. The Core AS Curriculum is designed to provide fellows foundational knowledge and skills in AS. The Advanced AS Curriculum is designed to provide fellows the knowledge and skills to become leaders in AS. The Core AS Curriculum was piloted by 56 ID Fellowship Programs in 2018 and then made broadly available via IDSA Academy in 2019. Pilot data will be used to improve future iterations of the curriculum. The Advanced AS Curriculum pilot will begin in 2020 and will be broadly available in 2021. Results The curricular packages contain a variety of training resources including eLearning modules, lectures slides, case-based questions, videos, reading materials, pocket cards, group-based learning, role play exercises and simulations. The modules can be taught by faculty to fellows or conducted as a self-directed learning experience. Program directors and fellows who participated in the Core AS Curriculum pilot reported that their fellowship program was significantly more effective in teaching multiple key stewardship content areas (Table). Table. Conclusion Evaluation data from programs who piloted the Core AS Curriculum indicate that this blended learning experience is an effective method for teaching AS and in providing educational and assessment tools for ID fellowship programs. The Advanced AS Curriculum will be similarly evaluated. Disclosures Julie Ann Justo, PharmD, MS, BCPS-AQ ID, bioMerieux (Speaker’s Bureau)TRC Healthcare (Speaker’s Bureau)

Background Recurrent Clostridioides difficile infection (rCDI) within 180 days of the index episode is associated with a 33% increase in mortality and, to-date, few treatment options exist to prevent recurrent infection. Bezlotoxumab (BEZ) is a novel therapeutic option for the prevention of rCDI, yet limited data exist regarding its effectiveness in patients at high-risk for recurrence outside of controlled trials. This study aimed to compare BEZ to a historical standard of care (SoC) cohort for the prevention of rCDI in patients at high risk for recurrence. Methods A multi-center retrospective cohort study of patients within an academic health-system with one or more risk factors for rCDI. Patients received SoC with oral vancomycin (VAN) or fidaxomicin (FDX) from January 2015 to December 2017 or BEZ, in addition to oral SoC, from September 2017 to September 2019. The primary outcome was rCDI within 90 days of completion of oral VAN or FDX. Secondary outcomes included all-cause readmission, all-cause mortality, and safety events at 90 days. Results One-hundred twenty patients received BEZ in addition to SoC (n=47) or SoC alone (n=73). Mean (SD) age was 55 (16) years, mean (SD) number of lifetime CDI was 3 (2) episodes, and 30.8% of patients had severe CDI. Six (12.8%) patients in the BEZ cohort and thirty-one (42.5%) in the SoC cohort experienced rCDI at 90 days [OR (95% CI) = 0.20 (0.07-0.53), p=< 0.01]. Incidence of all-cause mortality (2.1% vs 5.5%, p=0.67) and all-cause readmission (42.6% vs 56.2%, p=0.20) within 90 days were not statistically different between groups. Patient body weight, timing of BEZ administration, CDI severity, nor prior receipt of fecal microbiota transplantation significantly affected BEZ effectiveness. BEZ was well tolerated with one infusion-related reaction. There were no heart failure exacerbations among BEZ recipients and two exacerbations identified from control group. Conclusion In patients with at least one risk factor for rCDI, BEZ in addition to SoC was associated with lower rates of recurrent infection than SoC alone and may be a reasonable adjunct therapy in high risk patient populations. Disclosures matthew miller, PharmD, Allergan (Speaker’s Bureau)Tetraphase (Speaker’s Bureau)

Background Bloodstream infections (BSI) with Enterobacterales (formerly Enterobacteriaceae) group organisms are a frequently encountered complication, often stemming from urinary tract infections. Recent studies have demonstrated similar outcomes among patients transitioned to oral antibiotics compared to those managed solely with parenteral routes; however, most transitions utilize highly bioavailable agents such as fluoroquinolones (FQ). With limited comparative evidence on oral b-lactams (OBL) and mounting concerns over FQ safety and resistance, we sought to compare outcomes of FQ vs. OBL for Enterobacterales BSI step-down. Methods Single-center, retrospective cohort of adults at University of Colorado Hospital from 2015–2017 with uncomplicated Enterobacterales BSI who stepped down to OBL or FQ after initial parenteral therapy. Exclusions were: pregnant or incarcerated, causative organism identified as Salmonella spp., Enterobacter spp., Citrobacter freundii, Serratia spp. and/or Klebsiella aerogenes, parenteral antibiotic duration ≥ 5 days, death before day 5, total antibiotic duration < 5 days or > 21 days. Primary outcome was clinical failure, a composite of any of the following within 30-days of antibiotic completion: death, recurrence or antibiotic change for presumed failure, or readmission for original infection. Results Overall, 74 patients were included (n=36 OBL, n=38 FQ). Baseline characteristics were not different between groups, with overall mean age (SD) 60 (17) years and 62% female. E. coli was most commonly identified (65%), with 70% originating from the urinary tract. ICU admission was present in 18%, and median (IQR) Pitt Bacteremia Score was 2 (1–3). Treatment failure occurred in 25% OBL vs. 24% FQ recipients, p=0.55. No deaths were identified in either group within 30-days, and adverse events were rarely reported in either group. Multivariable analysis identified presence of nephrostomy tubes (OR 8.1; 95% CI: 1.1–61) but not OBL (OR 1.5; 95% CI: 0.3–7.2) as associated with clinical failure. Conclusion In a cohort of uncomplicated Enterobacterales BSIs there does not appear to be a difference in clinical failure associated with OBLs compared to FQs. Additional studies with a larger cohort, or prospective trials are needed to confirm these findings. Disclosures matthew miller, PharmD, Allergan (Speaker’s Bureau)Tetraphase (Speaker’s Bureau)

Background Predictive scoring systems, such as the Pitt Bacteremia Score (PBS) and Acute Physiology and Chronic Health Evaluation II (APACHE-II), can optimize clinical decisions and provide adjustment for confounding among patients with Methicillin-Resistant Staphylococcus aureus bacteremia (MRSAB). The recently introduced MRSAB score demonstrated superior discriminatory ability in mortality prediction compared to APACHE-II and PBS, however external validation is lacking. Methods Single center, retrospective cohort study of adult patients admitted to University of Colorado Hospital from 2013–2020 with initial episode of MRSAB were included. Patients transferred from an outside hospital, left against medical advice, or died/pursued comfort care within 24 hours of index culture were excluded. The primary outcome was discrimination of 30-day all-cause mortality. The discriminatory abilities of APACHE-II, PBS and MRSAB were compared using receiver operating characteristic (ROC) analysis. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were analyzed, and optimal MRSAB score was identified by Youden Index. Results Overall, 170 patients met study inclusion. The median (IQR) age was 57 (47-66) years, 69% were male, and 19% were in an ICU during blood culture collection. The most common infection sites were skin and soft tissue (41%), musculoskeletal (23%), and line-related (19%), whereas endovascular (14%) infections were less common. The median (IQR) PBS, APACHE-II and MRSAB scores were 2 (0-4),17 (12-23), and 6.5 (3-11), respectively. Thirty-day all-cause mortality was 12.9%. ROC curve analysis revealed an area (95% CI) for the APACHE-II, PBS, and MRSAB scores of 0.84 (0.77-0.92), 0.71 (0.57-0.85), 0.79 (0.68-0.90), respectively. A threshold MRSAB score of ≥10 was identified, whereby mortality was 3.6% with MRSAB < 10, and 30% with MRSAB ≥10. A MRSAB ≥10 had a sensitivity, specificity, PPV and NPV with corresponding 95% CIs of 0.82 (0.63-0.94), 0.72 (0.68-0.79), 0.30(0.19-0.42) and 0.96(0.92-0.99), respectively. Receiver operator characteristic (ROC) curves for the prediction of 30-day mortality Conclusion The MRSAB score is a useful predictive scoring model, with discriminatory ability comparable to APACHE-II, and excellent NPV at ≥10. Our findings support routine clinical and research application. Disclosures matthew miller, PharmD, Allergan (Speaker’s Bureau)Tetraphase (Speaker’s Bureau)

Background The Centers for Medicaid and Medicare Services (CMS) state that hospital antimicrobial stewardship (AMS) policies require indications be documented for all orders. This may be included in the electronic medical record (EMR) or during order entry per CMS. Reliance solely on EMR documentation may be inconsistent or absent at times. In an effort to optimize compliance to this new measure and improve antibiotic use tracking, the University of Colorado AMS committee implemented required indications for all systemic antimicrobial orders. To follow up on this intervention we sought to determine the accuracy of ordered indication based on EMR documentation. Methods Retrospective review of antibiotics ordered between May 2, 2017 and December 1, 2017 among hospitalized patients aged 18–89 years. The primary objective was the accuracy of provider-selected indications (PSI) compared with EMR documented-clinical indication (DCI). Secondary objectives included accuracy comparison between check-box and free-text PSI format, and adherence to institutional antibiotic use guidelines. Differences between proportions of antibiotic orders with certain variables were assessed with Pearson’s chi-square and Fisher’s exact as appropriate. Results A total of 304 patients were evaluated with a median age of 56 years, 49% male, and 31% identified as immunocompromised. Check-box was most utilized in 81%, with 93% having a single indication selected. Most orders were classified as empiric (63%), followed by prophylaxis (23%) and definitive (15%). Frequent indications chosen were pneumonia (17%), bacteremia (13%), skin and soft tissue (10%), urinary tract infection (9%), and intra-abdominal infections (5%). Accuracy by PSI/DCI match was 78%, which was not different by a method of indication entry. Only indication type (P = 0.023) and care team specialty (P = 0.009) were shown to significantly impact accuracy. Nonadherence to institutional guidelines was 19%. Conclusion Antibiotic indications on order entry are an effective strategy to improve documentation and meet compliance around new CMS standards. Ordering by surgical services and prophylactic indications had lower PSI/DCI match, mostly resulting from absent EMR indication documentation. Disclosures All authors: No reported disclosures.

Background C. difficile infection (CDI) remains a significant cause of morbidity and mortality. The most appropriate clinical scenario for CDI testing is unclear. The IDSA/SHEA guideline recommends testing patients with unexplained new-onset ≥3 stools in 24 hours. This study sought to evaluate clinical factors associated with a positive C. difficile PCR test. Methods We conducted a retrospective cohort study of adults (age >18 years old) admitted to the University of Colorado Hospital for whom a C. difficile PCR, either as a standalone test or part of the Biofire® Filmarray® Gastrointestinal Panel (GI Panel), was ordered between October 1, 2015 and August 31, 2017. Data collected included time since admission to test order, hospital length of stay, history of CDI, antibiotic use in the past 90 days, clinical presentation in the 24 hours preceding test order (fever, leukocytosis, number of stools), and laxative or antibiotic administration within 24 hours of test order. Multivariate logistic regression was used to evaluate the association of the above variables with having a positive C. difficile PCR test. If multiple tests were ordered during a single hospital encounter, only the first test was included in our analysis. Results 3,070 tests were performed; of these, 72% were ordered in the first 72 hours of admission. Overall, 19% of tests were positive. After adjusting for clinical variables, patients with a prior history of C. difficile or who had received antibiotics in the past 24 hours were significantly more likely to have a positive test [OR 2.2 95% CI (1.54, 3.18) P < 0.0001] and [OR 16 95% CI (8.22, 31.41) P < 0.0001], respectively. Patients who used laxatives were significantly less likely to have a positive test [OR 0.75 95% CI (0.61, 0.91) P = 0.004]. The number of stools and presence of fever or leukocytosis were not significantly associated with a positive test. Conclusion Prior history of C. difficile and antibiotics use was highly associated with a positive C. difficile test, while laxatives use was associated with a negative test. The number of stools was not significantly associated with a positive C. difficile test, suggesting this may be less important clinical factor than previously believed; however, restricting testing in patients receiving laxatives is likely warranted. Disclosures All authors: No reported disclosures.

Background Urinary tract (UTI), skin and soft tissue, and respiratory infections are among the most frequently reported indications for antibiotics, such that focusing stewardship efforts here would expectedly have dramatic effects. Antimicrobial stewardship (AMS) programs vary in structure and available resources. At the University of Colorado Hospital, a 740-bed academic medical center, dedicated resources for AMS are limited to a pharmacist, pharmacy resident, and physician; however, there is a large clinical pharmacist group. For the past 2 years, pharmacy management incorporated AMS targets as group goals tied to performance bonuses. Methods This is a descriptive report utilizing incentives to achieve AMS goals. The first goal (July 1, 2016 to June 30, 2017) set out to reduce inpatient antibiotic use by 10%. The second goal (July 1, 2018 to June 30, 2018) was a 10% reduction in median antibiotic duration for UTIs. The AMS team provided guidelines, education, and oversight throughout target periods. Antibiotic use was calculated as days of therapy (DOT) per 1000 patient-days. Data related to UTI treatment was collected retrospectively on a quarterly basis. This was compared with baseline data previously collected during a statewide hospital stewardship collaborative project. Results During the first period, overall antibiotic use declined from 497 to 403 DOT per 1000 patient-days (18.9%), and broad-spectrum antibiotic use declined 22%. During the second period, 30 patient charts were reviewed quarterly, and the median UTI duration declined from 10 to 7 days (P = 0.002). The most common UTI diagnoses were similar between periods with complicated cystitis and pyelonephritis comprising 60–70% of cases. The 30-day readmission rate was not different between the baseline and goal period, 11% vs. 6% respectively (P = 0.18). Conclusion The use of group pharmacist goals tied to annual performance bonuses was effective in achieving AMS goals at our institution. In larger facilities with fewer dedicated AMS personnel, clinical pharmacists covering ward and intensive care units are an essential resource to achieving AMS goals. Group performance incentives may be a feasible strategy to generate interest and motivation to achieve AMS program goals. Disclosures All authors: No reported disclosures.

Background Pneumonia (PNA), urinary tract infection (UTI), and acute bacterial skin and skin structure infection (ABSSSI) are the most common infections treated in the inpatient setting and often are associated with bacteremia. Though short courses of treatment are advocated for these infections in general, no established guidelines exist for cases involving bacteremia. We evaluated the clinical outcomes of patients receiving short (5–9 days) vs. long (10–15 days) duration of antibiotic treatment. Methods A retrospective study was conducted at 3 area hospitals comprising a university-based tertiary center, a public safety net hospital, and a Veterans’ Affairs hospital. We included hospitalized adult patients with transient bacteremia associated with uncomplicated cases of PNA, UTI, or ABSSSI. The primary outcome consisted of a composite of rehospitalization or resumption of antibiotic treatment attributed to the original infection or death due to any cause within 30 days of the antibiotic start date. Secondary outcomes included the individual composite components, Clostridioides difficile infection, and antibiotic-related adverse effects leading to change in antibiotic therapy. A propensity score weighted logistic regression model was used to mitigate factors which could bias a patient toward receiving a shorter or longer treatment duration. Results Of 411 patients included in the study, 123 (29.9%) received a short duration of therapy and 288 (70.1%) received a long duration of therapy. The median duration of treatment was 8 days in the short group and 13 days in the long group. In the propensity-weighted analysis, the probability of meeting the composite primary outcome was not statistically different between the short and long groups (Table 1). However, receiving a short course was associated with a higher probability of restarting antibiotics and Clostridioides difficile infection. Conclusion Shorter vs. longer courses of antibiotic treatment for bacteremia associated with PNA, UTI, and ABSSSI were not significantly different in a composite of readmission, restart of antibiotics, and mortality; however, further study is needed to evaluate the safety and effectiveness of short-course therapy. Disclosures All authors: No reported disclosures.

Background Up to 80% of cases of acute infectious gastroenteritis do not have an identifiable etiologic agent. Molecular syndromic diagnostic panels, such as the Biofire® Filmarray® gastrointestinal (GI) panel, can improve pathogen detection, including frequent causes of community-onset diarrhea. There are little data about the real-world use and test characteristics of the GI panel in the clinical setting. The objective of this study was to evaluate the patterns of use and clinical utility of the GI panel. Methods We conducted a retrospective cohort study of adults (age >18 years) admitted to the University of Colorado Hospital for whom a GI Panel was ordered from October 1, 2015 to August 31, 2017. Primary outcomes included patient demographics and co-morbidities, time since admission to test order, and cumulative test results. Descriptive statistics were utilized to summarize the frequencies of the primary outcome measures. Results 1684 panels were ordered and completed during the study period compared with 1379 stand-alone C. difficile PCRs. Seventeen of the 22 components of the panel had been validated by our lab prior to the study period; therefore, results were only available for these pathogens. Most GI panels (78%) were ordered in the first 48 hours of admission, with 6% ordered between 48 and 72 hours after admission, and 16% >72 hours after admission. The GI panel yielded an organism 34% of the time. The most frequently identified organism was C. difficile (18.5%) followed by Norovirus (5.2%) and Enteropathogenic E. coli (5.1%). Conclusion Over a 2-year period at a University hospital, the GI panel only had a positive result in 20% of patients tested. Although most of the tests were ordered in the first 48 hours after admission, 22% were ordered after 48 hours, after which etiologies of hospital-onset diarrhea are expected to be more common. Among all GI Panel tests ordered, C. difficile was the most common organism identified, followed by Norovirus. Each of these organisms has an accurate and less costly alternative test. Stand-alone testing for C. difficile and Norovirus should be considered prior to the GI Panel for patients admitted to the hospital, particularly when admitted >48 hours. Disclosures All authors: No reported disclosures.