Antimicrobial stewardship of anti-infectives prescribed upon hospital discharge was implemented to improve the rate of appropriate prescribing at discharge. Appropriate prescribing significantly improved from 47.5% to 85.2% (P < .001), antimicrobial days of therapy decreased, and 30-day readmission rates decreased. Discharge antimicrobial stewardship was effective in improving anti-infective prescribing practices.

BackgroundRapid molecular methods have created new opportunities for the clinical microbiology laboratory to affect patient care in the areas of initial diagnosis and therapy. Rapid diagnostic tests provide collaborative opportunities for antimicrobial stewardship Teams (AST) to improve patient outcomes and decrease antimicrobial use. In January of 2017 our institution initiated use of a FDA approved multiplex polymerase chain reaction (PCR) Respiratory Panel. The objective of this evaluation was to assess the clinical impact along with procalcitonin (PCT) on quality of patient care when used in conjunction with antimicrobial stewardship.MethodsMolecular testing was performed using the BioFire FilmArray® Respiratory Panel [RP] (BioMerieux). The medical staff was encouraged to order an Influenza/RSV PCR test prior to ordering the full RP. The results of RP and PCT were available the same day as ordered. AST recommended the RP as part of its intervention on several patients and provided advice based on results.ResultsFrom January-April the results of 81 tests for the respiratory panel were evaluated. Of these 30 were positive (+) for virus (most common-Human Metapneumovirus [HMV]-13, Coronavirus-7). PCT (ng/mL) results were available on 69. Most common final diagnosis: Pneumonia-31; AECOPD-16. Effect on duration of antimicrobial therapy (ABX) and hospital length of stay (LOS):RP result for virusMean Duration ABX after test resultLength of Hospital Stay (LOS) after test resultVirus + (n = 30)1.6 days3.6 daysVirus – (n = 51)4 days4.9 daysVirus +; PCT < 0.25 (n = 17)1.2 days2.9 daysVirus+; PCT < 0.25; AST* (n = 10)0.6 days2.7 days*AST recommendation. There was no difference in 30-day readmission rates.Of the patients with pneumonia; 11 had + RP for virus (7-HMV), 4 had co-infection with + bacteria with mean PCT of 0.62 and mean duration of ABX 6 days after test result; of the 7 with no bacterial co-infection the mean PCT was 0.12 with mean duration of ABX 0.28 days after the test resultConclusionThe results of the RP led to a decrease in ABX duration, which was most profound in the patients for whom AST intervened. LOS was also reduced. Utilization of RP and PCT facilitated better ABX use.Disclosures T. M. File Jr., BioMerieux: Scientific Advisor, Consulting fee

Asymptomatic bacteriuria is a common cause of unnecessary antimicrobial use. The Infectious Diseases Society of America has published an update of the clinical practice guideline for the management of asymptomatic bacteriuria. The guideline provides recommendations for avoidance of antimicrobial use for the great majority of patients with asymptomatic bacteriuria. Included in the recommendations is to refrain from screening with urinalysis and/or urine culture for older patients with cognitive impairment or fall and rather to look for alternative causes of altered mental status (eg, dehydration, metabolic causes, medication effects).

Background Endemic coronaviruses [EC] (NL63, 229E, OC43, HKU1) have been identified in humans since the 1960s. Most are associated with mild upper respiratory tract infections (RTIs) but can be associated serious disease. More recently, novel coronaviruses associated with SARS, MERS, and COVID-19 caused by SARS-CoV-2 have emerged and are often associated with serious disease and death. With this report, we compare presenting clinical characteristics and some outcomes of patients hospitalized with RTIs caused by ECs or by SARS-CoV-2 (COVID-19). Methods Patients admitted to the Summa Health System with RTIs associated with EC were identified via multiplex PCR method (BioFire™). Patients admitted with COVID-19 were identified by real-time, reverse transcriptase-PCR method using one of several platforms. Patients were selected from two existing quality improvement registries encompassing EC and COVID-19 cases. We compared clinical characteristics and outcomes of EC patients to those of COVID-19 patients using chi-squared tests for proportions and independent samples t-tests for means. Results Shown in Table 1. Significant differences in patient characteristics with EC vs. COVID-19 included: older age, primarily Caucasian, smoking history, requiring O2 supplementation on admission, and having chronic heart, lung, or renal disease. Significant differences in patient characteristics with COVID-19 vs. EC included: admission from extended care facility, obesity, presenting with fever, gastrointestinal symptoms and/or myalgia, presence of radiographic infiltrates, abnormal liver tests, and longer length of stay (LOS). A non-significant difference was noted in 30 day mortality rates. Coronavirus OC43 accounted for 54% of EC strains. Conclusion There were significant differences in clinical characteristics between the two groups with EC patients more likely to have lung disease (often COPD) and requiring admission for need of O2 supplementation. COVID-19 patients were more likely to present with a febrile illness associated with pneumonia and require longer LOS (often requiring O2 supplementation later in hospitalization). Patients admitted with COVID-19 present with different clinical characteristics than those with EC with numerically higher mortality rate. Disclosures All Authors: No reported disclosures

Background Patients admitted to the hospital with SARS-CoV-2 infection are often treated with antibacterial agents in addition to antivirals, although bacterial co-infection in this population is uncommon. Overuse of unnecessary antibiotics can lead to suboptimal outcomes, including increased bacterial resistance, adverse events, and costs. Our Antimicrobial Stewardship (AS) Program routinely provides recommendations for appropriate therapy based on molecular/microbiologic tests, clinical findings, and procalcitonin (PCT). PCT can assist in differentiating bacterial from viral respiratory infections, and can be useful in the decision to discontinue antibiotic therapy if viral monomicrobial infection is suspected. The purpose of our quality improvement project was to review the appropriateness of antibiotics utilized for patients admitted with SARS-CoV-2 and to promote optimal patient care and AS at our institution. Methods We performed a retrospective review of SARS-CoV-2 patients from our institution’s COVID-19 registry for patients hospitalized from March 2020-April 2021. We compared patients with PCT &lt; 0.25 ng/mL to those with PCT &gt; 0.25 ng/mL and assessed differences in patient characteristics and disease presentation, including: age, gender, WBC, serum creatinine, culture results, disease severity, patient location, duration of antibiotics, length of stay, 30 day readmission and mortality. Characteristics were compared using descriptive statistics and appropriate inferential statistics. Results Shown in Table 1. If prescribed antibiotics, median duration of antibiotic therapy was significantly reduced in the PCT &lt; 0.25 group vs. the PCT &gt; 0.25 group (2 days vs. 4.1 days). Median WBC, SOFA score, serum creatinine, and length of stay were significantly lower in the PCT &lt; 0.25 group compared to the PCT &gt; 0.25 group. Severity adjusted models showed significantly decreased duration and overall likelihood of antibiotic use for PCT &lt; 0.25 vs. PCT &gt; 0.25. 30 day readmission and 30 day mortality were significantly lower in the PCT &lt; 0.25 group vs. the PCT &gt; 0.25 group. Conclusion Antibiotic utilization was reduced in patients admitted with SARS-CoV-2 infection and PCT &lt; 0.25, and if prescribed antibiotics, duration was significantly shorter vs. those in the PCT &gt; 0.25 group. Disclosures Michael J. Tan, MD, FACP, FIDSA, Pfizer: Honoraria|Thermo Fisher Scientific: Honoraria Thomas M. File, Jr., MD, MSc, MACP, FIDSA, Nabriva Therapeutics: Advisor/Consultant|Nabriva Therapeutics: Honoraria.