1042. Antibiotic Stewardship Program (ASP) Implementation of Short-course Antimicrobials for Low-Risk Enterobacteriaceae Blood Stream Infection (EBSI) at a Tertiary Care Center

• Published in: Open forum infectious diseases Vol. 6; no. Supplement_2; p. S367
• Main Authors: Alex Viehman, J, Scott, Gordon, Goshorn, Eli S, Volpe, Peter, Marini, Rachel V, McCreary, Erin K, Nguyen, Minh-Hong
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 23.10.2019
• Subjects: Abstracts
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofz360.906

Abstract Background Literature demonstrates short course (e.g., 7 days) of antibiotic therapy for EBSI is appropriate in low-risk patients. Real-world experience with the implementation of this approach is not known. Methods In January 2019, a prospective ASP pathway was implemented to review all ESBI. The ASP contacted treatment teams of patients (patients) with low-risk ESBI between day 4–6 of antibiotic therapy to recommend short-course antimicrobial therapy (SC, ≤10 days). Low-risk ESBI was defined as: (1) venous catheter-associated infection (with removal), or an uncomplicated urinary tract infection (UTI), and 2) absence of: organ transplant, polymicrobial or persistent bacteremia ( ≥3d), or lack of improvement at 72h. Controls were pre-intervention patients with low-risk EBSI between July 2016-December 2017. Carbapenem-resistant isolates were excluded; multi-drug-resistant (MDR, ≥3 class acquired resistance) and extended-spectrum β-lactamase (ESBL) bacteria were included. Results Pre-intervention, 107 patients met low-risk ESBI criteria. In the intervention period, 15 patients had low-risk ESBI. The ASP pathway was executed in 13/15 patients (87%) with an 85% success rate. Charlson Comorbidity Index scores and Pitt Bacteremia Scores were similar pre- and post-intervention. The post-intervention group was older (median 71y vs. 63y, P = 0.02). Otherwise, clinical characteristics did not differ pre- and post-intervention: cirrhosis (8 vs. 13%), renal failure (4% vs. 0%), ICU admission (29% vs. 33%) and BSI with ESBL or MDR bacteria (8% vs. 7%) and (21% vs. 20%). UTI was the most common source pre- and post-intervention (61% and 73%) Time to active therapy did not differ (median 0.15d vs. 0.12d). The median duration of active therapy for ESBI was 15d pre-intervention and 8d post-intervention (P < 0.001). SC rate improved from 11% to 67% post-intervention. There was no significant difference in recurrence (2% vs. 0%), mortality (2% vs. 0%) or readmission rates (25% vs. 20%) at 30d. Conclusion A multidisciplinary ASP pathway for low-risk ESBI resulted in the decreased duration of antimicrobial therapy without increased rates of recurrence, readmission, or morality at 30d. SC therapy was also effective for BSI due to MDR or ESBL producing bacteria. Disclosures All authors: No reported disclosures.