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antibiotics for pharyngitis remain important sources of inappropriate antibiotic prescribing. Expansion of the HEDIS performance measure for appropriate testing to include adults may promote more appropriate testing and treatment of pharyngitis in adults.

and clinical practice, we suggest a framework for the investigation of suspected recurrence cases (Fig. 1). However, the challenge of this detailed investigation lies in the high resource load required to allow truly robust conclusions, especially considering complicating factors in a postvaccination setting.Nonetheless, we propose that studies that employ such techniques must be undertaken to appropriately answer the multitude of pressing questions that pertain to COVID-19 recurrence. These investigations are particularly significant considering recent reports of reinfection by novel SARS-CoV-2 variants, which may lead to a more severe second episode of disease. 8 Thus, only when we comprehend the complex interplay between COVID-19 recurrence and the other components of the pandemic will we be able to quantify and react to its impact on both the patient and population levels.

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BackgroundThe Standardized Infection Ratio (SIR) is a metric used to gauge catheter-associated urinary tract infection (CAUTI) prevention, both locally and nationally. The device utilization ratio (DUR) is a process metric that captures catheter harm. More recently, the cumulative attributable difference (CAD) was introduced, which identifies the number of excess infections that need to be prevented to reach the desired goal. Our objective was to evaluate these metrics across all acute care hospitals in Connecticut (CT) by facility size.MethodsA CAUTI Targeted Assessment for Prevention (TAP) Report for acute care hospitals across CT was generated from 1/1/2018 to December 31/2018, using the National Healthcare Safety Network (NHSN) database. CAUTI events, SIR, DUR, and CAD were compared across all hospitals. The SIR goal of 0.75 was used to calculate the CAD. Hospitals were stratified into large ( >425 beds), medium (250 to 424 beds), and small ( <249 beds) based on the Healthcare Cost and Utilization Project NIS Description of Data Elements, Agency for Healthcare Research and Quality for urban hospitals in the northeast region.ResultsA comparison of CAUTI metrics for 29 acute care hospitals across CT is shown in Table 1. Median SIR and DUR were 0.97, 1.02, 0.77, and 22%, 14%, 14.5% for large, medium and small hospitals, respectively. Of the 20 small hospitals, SIR could not be calculated for 5 hospitals, while 2 hospitals had an SIR = 0, as they had no reported infections. Median CAD for large, medium and small hospitals was 6.17, 1.3 and 0.25, respectively. Of note, 40% of small hospitals (J – CC, as in Table 1) had a negative CAD. Interestingly, 5 of these 8 hospitals with a negative CAD had a DUR higher than 16%.ConclusionBased on CT hospital data, metrics like CAD and SIR may be more suitable for larger hospitals or hospitals with higher CAUTI events, whereas DUR may be a more useful metric for smaller hospitals or hospitals with rare events. Hospitals with high SIR and low DUR may represent a population with high-risk catheter use, poor catheter care or higher rates of urine culturing. On the other hand, hospitals with high DUR and low SIR may represent low-risk populations, better catheter care practices or lower rates of urine culturing. Ultimately, we need a combination of metrics to measure preventable catheter harm. DisclosuresLouise Dembry, MD, MS, MBA, ReadyDock: Consultant, Stock options.

Background Antimicrobial treatment at the end of life is common. However, there is limited evidence on whether antimicrobial use during hospice care provides symptom palliation or contributes to discomfort. We sought to further investigate antimicrobial use at the transition to CMO in immunocompromised patients with active malignancies. Methods We conducted a retrospective cohort study of patients with active malignancies over 18 years of age admitted to Beth Israel Deaconess Medical Center from 3/1/2018 to 3/1/2021, who were transitioned to CMO. From hospital databases and from subsequent chart review, we examined: receipt of antimicrobials at any point in the admission; indication for antimicrobials; timing of CMO order; underlying hematologic/oncologic diagnosis; and concomitant COVID-19 diagnosis. Among the patients who received antimicrobials, we identified patients on antibiotics 48 hours prior to and after CMO order placement. Patients were excluded if CMO orders were reversed. Results 384 patients met study criteria. The mean age was 67 years, and 50.5% patients were female. 31.8% of patients carried a hematologic malignancy diagnosis while the remaining had solid tumor diagnoses. 88% patients received antimicrobials at any point during their hospitalization. Of the patients who received antimicrobials during their admission, 84% received them in the 48 hours prior to transition to CMO and 15.3% continued receiving antimicrobials after CMO transition. Patients received a mean of 5.7 antibiotics. Most common indications for antimicrobials included pneumonia (22.2%), intra-abdominal infections (13.6%), sepsis (13.3%), and prophylaxis (3.5%), but most (39.8%) received antimicrobials for more than one infection or indication. Conclusion Hospitalized patients with active malignancy at the end of life are heavily exposed to antimicrobials. The majority of patients transitioned to CMO receive antimicrobials during their last hospital admission, and a significant subset (15.3%) continue antimicrobials after placement on CMO. Further studies are needed to investigate the potential benefits and harms of continuing antimicrobials in CMO patients, as decisions are complex and individualized. Disclosures All Authors: No reported disclosures.

BackgroundLarge-scale tuberculosis (TB) exposure investigations cause anxiety to healthcare personnel (HCP) and patients, in addition to being resource and time intensive. TB contact tracing in England and Singapore follow the “stone in the pond” principle. We propose a similar risk-stratified approach to TB exposure investigations in an area of low incidence.MethodsThis retrospective study was conducted at a 1,541 bed academic medical center in New Haven, CT between January 14 and 11, 2017. Microbiology records, patient charts, and infection prevention databases were reviewed to find TB exposures. A scoring system adapted from CDC’s “Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis” was developed to predict infectivity (two points for laryngeal TB, one point each for: cavitary TB, ≥1 positive respiratory acid fast bacilli smear or Xpert MTB/RIF, multi-drug-resistant (MDR) TB, foreign-born status, immunocompromised status, cough/hemoptysis, or procedure associated with positive TB culture). Using the “stone in the pond” principle, contacts were graded based on the type of exposure (Figure 1). Based on high, medium, and low risk, our new risk-stratified approach was applied to contact tracing.ResultsDuring the study period, 17 of 29 patients with pulmonary TB led to exposures. A subset of seven TB patients with complete exposure data was selected for further analysis. The original exposure investigations led to contact tracing of 586 HCP and 72 patients. No active or latent TB cases were identified among these exposed contacts. Using our scoring system, these seven patients were categorized into three high, two medium, and two low infectivity risk groups. On applying our new risk-stratified approach, contact tracing could be reduced by 42% and 84% for medium and low-risk exposures, respectively, by excluding these HCP groups from investigation (Figure 2).ConclusionWe recommend a risk-stratified approach to healthcare-associated TB exposure investigations similar to the “stone in the pond” principle, based on index patient’s infectivity risk and type of exposure. This has potential to optimize resources and possibly reduce anxiety in medium and low-risk TB exposures in an area of low TB incidence. Disclosures All authors: No reported disclosures.