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Background The University of Washington Tele-Antimicrobial Stewardship Program (UW-TASP) provides antimicrobial stewardship education and training to rural and critical access hospitals (CAHs) in the United States through collaborative tele-mentoring. In 2021, UW-TASP implemented a pilot stewardship cohort to reduce antibiotic treatment of asymptomatic bacteriuria (ASB). We sought to quantify the overall prevalence of ASB and proportion treated in participating hospitals. Methods Patients undergoing urine testing were identified through local electronic medical records and microbiology data. CAHs adjudicated their own cases and reported demographics, symptoms of urinary tract infection, systemic inflammatory response symptoms (SIRS), location at the time of culture, laboratory results, and antibiotic treatment through a RedCap collection tool. The data form was created and analyzed by UW-TASP faculty. This study was waived by the University of Washington institutional review board. Results Nineteen CAHs in 5 states participated in this pilot. Eight submitted urine analysis and culture data for 417 patients. Seventy-seven percent of patients were female and the median age was 70. The emergency department was the most common culture collection location (274/417, 66%), followed by ambulatory care clinics (111/417, 27%), and nursing facilities (13/417, 3%). SIRS criteria and/or organ dysfunction were present in 149/417 patients (36%). Two hundred sixty patients (62%) had a positive culture with Escherichia coli being the most common implicated organism (167/260, 64%). ASB was identified in 69/260 patients (27%), and antibiotics were prescribed for 53/69 (77%) of those with ASB. Oral antibiotics were prescribed for 311 (75%) patients. Of those, 22% were prescribed a fluoroquinolone. Median treatment duration was 7 days (range, 1-14). Conclusion Although the prevalence of ASB was only 27% among 417 patients, treatment of ASB was high at 77%. High numbers of culture collections from the emergency department and ambulatory care settings identify these locations as future foci for stewardship interventions in CAHs. Low hanging fruit for intervention include reducing unnecessary fluoroquinolone use and reducing duration of antibiotic therapy. Disclosures Chloe Bryson-Cahn, MD, Alaska Airlines: Advisor/Consultant.

Background Critical access hospitals (CAHs) in the United States service nearly one fifth of the US population, predominantly in rural areas. CAHs are required to provide antimicrobial stewardship (AMS) services, however, access to infectious diseases and antimicrobial stewardship expertise is limited. We assessed the feasibility of implementing a tele-AMS intervention in CAHs. Methods We piloted a one-year, biphasic, intensive quality improvement collaborative of self-selected CAHs to address asymptomatic bacteriuria (ASB). In phase 1, we engaged multidisciplinary teams from participating hospitals, facilitated goal-setting, and implemented a monthly curriculum to train local stewards regarding appropriate diagnosis and management of urinary tract infections (UTIs). In phase 2, we focused on quality improvement education and data collection. We discussed stewardship strategies and addressed barriers identified on a one-on-one basis. Results Nineteen CAHs in five states across the Western region participated in this pilot. Nine of 19 attended all 8 monthly didactic sessions. The median number of one-on-one sessions attended per site was 3 (range, 1-4). Eighteen of 19 hospitals set a goal and documented it in a Plan-Do-Study-Act framework. Six CAHs set a goal related to staff and/or patient education, 10 CAHs focused on workflow and processes surrounding identification of UTI including reflex of urine analyses to urine culture, and 2 CAHs set goals to prospectively review cases of ASB treated with antibiotics and provide feedback to prescribers. Commonly encountered barriers included turnaround time for urine culture data, difficulty obtaining data from the electronic medical record, resistance to change among personnel, high staff turnover, limited time and availability to perform stewardship, and short duration of the collaborative. Conclusion We successfully launched a tele-stewardship training program to mentor CAH antimicrobial stewards to identify and manage ASB and use quality improvement tools. A standardized approach to address asymptomatic bacteriuria or other AMS goals are unlikely to be successful in CAHs without significant tailoring to fit specific site and process needs. Disclosures Chloe Bryson-Cahn, MD, Alaska Airlines: Advisor/Consultant.