The addition of NPPV to standard medical therapy does not improve outcome in heterogeneous groups of patients who develop respiratory distress during the first 48 hours after extubation.

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BackgroundEarly clinical failure criteria (ECFC) were recently proposed to predict poor clinical outcomes in patients with Gram-negative bloodstream infections (BSI). ECFC are measured between 72 and 96 hours from collection of index blood culture (Table 1). The objective of this study was to evaluate the performance of ECFC in predicting 28-day mortality in patients with Enterococcus spp. BSI.MethodsThis IRB-approved, retrospective, observational cohort study included adult patients hospitalized at Prisma Health–Midlands hospitals from January 1, 2015 to July 31, 2018 with a monomicrobial BSI due to Enterococcus spp. Patients with a previous episode of Enterococcus spp. BSI within one year prior to index culture or those who died within 72 hours were excluded. Multivariate logistic regression was used to examine the association between ECFC and 28-day all-cause mortality. The area under the receiver operating characteristic (ROC) curve was used to measure model discrimination.ResultsA total of 157 patients with Enterococcus spp. BSI were included. Overall, the median age was 66 years, 96 (61%) were men, and 106 (68%) had community-onset BSI. The urinary tract was the most common source of infection (45; 29%), followed by intraabdominal infections (34; 22%). Twenty-eight patients (18%) died within 28 days of BSI. After adjustments for age and Charlson Comorbidity Index, every one-point increase in the ECFC was associated with an 80% increase in the odds of 28-day mortality (OR 1.8, 95% CI 1.3–2.4, P < 0.001). Mortality increased from 4% in patients with ECFC of 0 to 11%, 28%, and 38% as ECFC increased to 1, 2, and ≥3, respectively. The area under ROC curve of ECFC model in predicting 28-day mortality was 0.74 with ECFC of 2 identified as the best cutoff point. Mortality was 8% in patients with ECFC < 2 compared with 33% in those with ECFC ≥2 (P < 0.001).ConclusionECFC demonstrated good discrimination to predict 28-day mortality in hospitalized adult patients with Enterococcus spp. BSI. These criteria may have utility as a stratification or randomization tool in future clinical investigations evaluating optimal antimicrobial treatment duration or effectiveness of intravenous to oral switch therapy in uncomplicated Enterococcus spp. BSI. Disclosures All authors: No reported disclosures.

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Background The Accelerate PhenoTM system yields identification (ID) and antimicrobial susceptibility testing (AST) within 7 hours of growth in blood culture. The objective of this study was to determine its impact on time to de-escalation of antimicrobial therapy. Methods This retrospective quasi-experimental, observational cohort study included patients hospitalized at the St. Louis VA who received intravenous antibiotics for a positive blood culture. Patients with blood cultures positive for polymicrobial growth or fungi or those requiring antibiotics for other infections were excluded. The primary endpoint was time to de-escalation of antimicrobial therapy from before and after implementation of Accelerate PhenoTM (September 2017 to August 2018 and September 2018 to August 2019, respectively). Secondary outcomes included time to ID and AST, length of hospital stay, and days of antimicrobial therapy. The variables of gram-positive infections, use of Accelerate PhenoTM, and presence of infectious diseases consult and/or pharmacist antimicrobial stewardship note were included in a univariate analysis. Variables with a p-value&lt; 0.2 were included in a multivariate regression. Results 168 patients were included, with 92 patients in the pre-implementation and 76 in the post-implementation group. Overall, mean age was 67 years and 162 (96%) were men. Staphylococcus spp. and Escherichia coli were the most common causative organisms. Time to de-escalation did not differ significantly between the post-implementation and pre-implementation groups (65 vs. 61 hours, p=0.47). Time to organism ID was decreased by 16 hours using Accelerate PhenoTM (50 vs. 66 hours, p=0.016). However, no difference was found in time to AST or length of hospital stay. Days of antimicrobial therapy while hospitalized was also similar between groups (6.8 vs. 5.9 days, p=0.256). Only gram-positive infections and presence of antimicrobial stewardship notes were included in the multivariate regression. Neither were independently associated with de-escalation within 48 hours. Conclusion Accelerate PhenoTM system did not impact time to de-escalation of antimicrobial therapy. Disclosures All Authors: No reported disclosures