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Non-O157 serogroups contribute significantly to the burden of disease caused by Shiga toxin-producing Escherichia coli (STEC) and have been underrecognized by traditional detection algorithms. We described the epidemiology of non-O157 STEC in Alberta, Canada for the period of 2018 to 2021. All non-O157 STEC isolated from clinical samples were submitted for serotyping and qPCR targeting the stx1 and stx2 genes. A total of 729 isolates were identified. Increased detection occurred over the summer months, peaking in July. Patients 18 years and younger made up 42.4% of cases, with 31.1% in those 0–9 years of age. There was a slight female predominance (399/729, 54.7%) A total of 50 different serogroups were detected; the most common were O26 (30.3%), O103 (15.9%), O111 (12.8%), O121 (11.0%), O118 (3.3%) and O71 (2.9%). These six serogroups made up 76.2% of all isolates. In total, 567 (77.8%) were positive for stx1, 114 (15.6%) were positive for stx2 and 48 (6.6%) were positive for both stx1 and stx2. A wide variety of non-O157 serogroups have been detected in Alberta, with the most frequent serogroups differing from other locations. These results highlight the need for further characterization of their virulence factors and clinical impact.

Background Intravenous (IV) vancomycin is a commonly prescribed antimicrobial. However, there is limited literature assessing IV vancomycin appropriateness. The objective of the study was to assess the appropriateness of IV vancomycin prescriptions in a Canadian acute care hospital. Methods Prospective audit and feedback (PAF) was conducted on all new IV vancomycin prescriptions in hospitalized adults (age ≥ 18 years) at the University of Alberta Hospital from January 17 to February 11, 2022. Appropriateness was assessed against institutional prescribing guidelines (Bugs & Drugs® and Alberta Health Services Formulary Prescribing Guidelines). Verbal and written feedback were provided to the attending teams. Results A total of 109 prescriptions were audited. Median age was 57 (IQR 43-72) years and 42% were female. 65 (60%) were admitted to Medicine, 18 (17%) to Surgery, and 26 (24%) to Intensive Care units. MRSA colonization was present in 32 (29%) patients, β-lactam allergy recorded in 21 (19%), and acute kidney injury (AKI) in 21 (19%). Infectious Diseases consultation (IDC) occurred in 29 (27%). The top indications were skin and soft tissue, pulmonary, and bloodstream infections (Table 1); 70% of prescriptions were empiric in nature. Overall, 43 (39%) prescriptions were assessed to be suboptimal. Antimicrobial Stewardship program (ASP) recommendations were made in 56 prescriptions, totaling 63 unique recommendations. Vancomycin was recommended to be discontinued in 24 (43%) cases or changed to a different agent in 15 (27%). Regimen optimization (duration or frequency change) was recommended in 4 (7%). ASP recommended investigations in 8 cases and IDC in 12. Full or partial acceptance was achieved in 49 cases (88%). IDC was associated with greater appropriateness (83% vs 53%, p=0.004) as was MRSA colonization (75% vs 55%, p=0.047), but AKI was not (62% vs 60%, p=0.888). Adjusting for age, AKI, and MRSA colonization, IDC remained a significant predictor of vancomycin appropriateness (OR=4.27, [95%CI 1.44-12.70]; p=0.009). Conclusion IV vancomycin prescriptions were suboptimal in 39% of cases. IDC was associated with increased appropriateness. This pilot informs the need for antimicrobial stewardship intervention and the importance of IDC at our center. Disclosures Dima Kabbani, MD, MSc, AVIR Pharma: Grant/Research Support|AVIR Pharma: Honoraria|GSK: Honoraria|Merck: Grant/Research Support.