Objective To determine the independent association between diabetes and SSI across multiple surgical procedures. Design Systematic review and meta-analysis. Methods Studies indexed in PubMed published between December 1985 and through July 2015 were identified through the search terms “risk factors” or “glucose” and “surgical site infection”. A total of 3,631 abstracts were identified through the initial search terms. Full texts were reviewed for 522 articles. Of these, 94 articles met the criteria for inclusion. Standardized data collection forms were used to extract study-specific estimates for diabetes, blood glucose levels, and body mass index (BMI). Random-effects meta-analysis was used to generate pooled estimates and meta-regression was used to evaluate specific hypothesized sources of heterogeneity. Results The primary outcome was SSI, as defined by the Centers for Disease Control and Prevention surveillance criteria. The overall effect size for the association between diabetes and SSI was OR=1.53 (95% Predictive Interval 1.11, 2.12, I2: 57.2%). SSI class, study design, or patient BMI did not significantly impact study results in a meta-regression model. The association was higher for cardiac surgery 2.03 (95% Predictive Interval 1.13, 4.05) compared to surgeries of other types (p=0.001). Conclusion These results support the consideration of diabetes as an independent risk factor for SSIs for multiple surgical procedure types. Continued efforts are needed to improve surgical outcomes for diabetic patients.

Objective:To characterize antifungal stewardship among antimicrobial stewardship programs (ASPs) at a diverse range of hospitals and to correlate antifungal stewardship with hospital characteristics.Design:Cross-sectional survey.Participants:ASP physician and/or pharmacist members at Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) hospitals.Methods:An electronic survey administered August–September 2018 via the SRN to 111 hospitals. The χ2 test was used to test associations between ASP and hospital characteristics and use of antifungal stewardship strategies.Results:Of 111 hospitals, 45 (41%) responded; most were academic medical centers (65%) caring for stem-cell patients (73.3%) and solid-organ transplant patients (80.0%). Most hospitals have large, well-established ASPs: 60% had >5 team members and 68.9% had a duration ≥6 years. In 43 hospitals (95.6%), ASPs used antifungal stewardship strategies, most commonly prospective audit and feedback (73.3%) by a pharmacist (71.4%). Half of ASPs (51.1%) created guidelines for invasive fungal infection (IFI) management. Most hospitals (71.1%) offered rapid laboratory tests to diagnose IFI, but polymerase chain reaction (PCR) testing and antifungal susceptibility testing varied. Also, 29 ASPs (64.4%) perform surveillance of antifungal utilization, but only 9 (31%) reported to the CDC National Healthcare Safety Network. ASP size, duration, and presence of transplant populations were not associated with a higher likelihood of using antifungal stewardship strategies (P > .05 for all).Conclusions:The use of antifungal stewardship strategies was high at SRN hospitals, but they mainly involved audit and feedback. ASPs should be encouraged (1) to disseminate guidelines for IFI management, (2) to promote access to laboratory tests for rapid and accurate IFI diagnosis, and (3) to perform surveillance for antifungal utilization with reporting to the CDC.

Background Infections caused by extended-spectrum ß-lactamase (ESBL) producing organisms pose a unique challenge for infection control. The preferred agents for treatment of infections due to ESBL-producing bacteria are carbapenems. Data from prior studies suggest that hypoalbuminemia may have a profound effect on the pharmacodynamic properties of ertapenem. Our hypothesis is that ertapenem usage in patients with hypoalbuminemia will lead to negative clinical outcomes such as infection recurrence, hospital readmission, and mortality when compared to subjects with higher albumin levels. Methods This was a retrospective, observational, single-centered, cohort study of hospitalized patients at Loyola University Medical Center between January 2010 and August 2020. Patients were divided into 2 groups to include those who received ertapenem with serum albumin >2.5 g/dL and those who received ertapenem with serum albumin < 2.5 g/dL. The primary outcome of interest was 30-day all-cause mortality. Baseline characteristics that were collected included age, sex, nutrition status, patient comorbidities. Data regarding predictors of mortality within 24 hours of initiation of ertapenem including the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Charlson Comorbidity Index (CCI) was also collected. Study Criteria Results Of the 146 subjects that were included, 73 patients had serum albumin levels of < 2.5 g/dL during treatment with ertapenem. 30 day all-cause mortality was 19.7% for subjects with low albumin and 9.6% for subjects with normal albumin levels (p=0.09). Our study found that although not statistically significant, there is potentially a clinical significance between hypoalbuminemia and our primary endpoint, 30-day all-cause mortality, with higher rates of mortality in the low albumin group and a 9.6% between group difference. This data suggests that in subjects with hypoalbuminemia, treatment with once-daily ertapenem may lead to suboptimal outcomes regarding patient mortality. Outcome Data Conclusion The present study data suggests that in subjects with hypoalbuminemia, treatment with ertapenem dosed as a once-daily intravenous infusion may be associated with suboptimal clinical outcomes that may include an increased mortality, hospital readmission, and length of stay. Disclosures All Authors: No reported disclosures.

Pneumonia is common in the intensive care unit (ICU), infecting 27% of all critically ill patients. Given the high prevalence of this disease state in the ICU, optimizing antimicrobial therapy while minimizing toxicities is of utmost importance. Inappropriate antimicrobial use can increase the risk of antimicrobial resistance, Clostridiodes difficile infection, allergic reaction, and other complications from antimicrobial use (e.g., QTc prolongation, thrombocytopenia). This review article aims to discuss methods to optimize antimicrobial treatment in patients with pneumonia, including the following: procalcitonin use, utilization of methicillin-resistant Staphylococcus aureus nares testing to determine need for vancomycin therapy, utilization of the Biofire® FilmArray® pneumonia polymerase chain reaction (PCR), and microbiology reporting techniques.