The Impact of Antibiotic Stewardship Program Resources on Infection Prevention Programs

Doernberg and colleagues describe the role and resourcing of the infectious disease (ID) physician for an effective hospital-based antibiotic stewardship program (ASP). There are similar resource requirements for the ID physician leader in an effective infection prevention (IP) program. This ID physician partnership is supported by professional organizations and predates the imperative of ID physician leadership in ASP. There are regulatory requirements for established IP programs, but they do not specify leadership structure to the same degree as ASP regulations. The Centers for Medicare and Medicaid and The Joint Commission have specified the inclusion of an ID-trained physician leader in ASP, and this has led to the development of curriculum to train more ASP physicians. More robust advocacy may ensure a similar regulatory mandate supporting the participation of ID-trained physicians in IP programs. This may encourage the development of a curriculum to meet the workforce.

A nationwide survey of antimicrobial dispensation practices in pharmacies and bodegas in the Dominican Republic

In many developing countries, antimicrobials are available without prescriptions in pharmacies and stores. We performed a survey to describe antimicrobial availability, training, and use recommendations for common symptoms in the Dominican Republic. Pharmacy recommendations varied, whereas aminopenicillins are routinely recommended at bodegas. Frontline staff are gatekeepers and potential targets for stewardship education.

1692. Epidemiology, Clinical Characteristics, and Outcomes of Candidemia in a Tertiary Hospital in the Dominican Republic

Background

Methods

Results

Conclusion

Disclosures

408. Impact of the COVID-19 Pandemic on Antimicrobial Use and Resistance in the United States and the Dominican Republic

Background

The disease caused by SARS-CoV-2, COVID-19, has caused a global public health crisis. Lower respiratory tract infections (LRTIs) caused by COVID-19 has led to an increase in hospitalizations. Disease severity and concerns for bacterial co-infections can increase antimicrobial pressure. Our aim is to define and compare the impact of COVID-19 on antimicrobial use (AU) and antimicrobial resistance (AMR) in the Dominican Republic (DR) and the United States (US).

Methods

We performed a retrospective review of AU and antimicrobial susceptibility patterns from 2019-20 at a hospital in the US (H-US) and the DR (H-DR). Our sites are community teaching hospitals with 151 beds in H-US and 295 beds in H-DR. After AU was tabulated, percent changes between 2019-20 were calculated. Resistance patterns for extended-spectrum beta-lactamase producing (ESBL) E coli, ESBL Klebsiella pneumoniae (ESBL-Kp), carbapenem resistant Pseudomonas aeruginosa (CR-PSAR) and Klebsiella pneumoniae (CR-Kp) were tabulated and percent changes between 2019-20 were calculated.

Results

AU increased by 10% in H-US and 25% in H-DR, with carbapenem use increasing by 268% and 144% respectively. Ceftriaxone use increased by 30% in H-US and 33% in H-DR. Azithromycin increased 54% in H-US and 338% in the H-DR. Resistance increased from 10% to 28% for ESBL-Kp and from 10% to 12% for ESBL E coli at H-US. CR-PSAR decreased from 20% to 12%, while cefepime and piperacillin resistance increased from 5% to 20% and 3% to 16% respectively (Figure 1). At H-DR, ESBL-Kp resistance decreased from 68% to 64% and increased from 58% to 59% for ESBL E coli. CR-PSAR and cefepime resistance increased from 5% to 19% and from 9% to 29% respectively (Figure 2).

Figure 1. Antimicrobial resistance (%) for select organisms at H-US in 2019 and 2020

Conclusion

COVID-19 had a major impact on antimicrobial consumption and resistance in the US and DR. A greater impact was seen on ESBL rates in the US whilst a greater impact on carbapenem resistance was seen in the DR. The rise in carbapenem use in H-US reflected a rise in ESBL rates. In the DR, ESBL producing organisms were common prior to COVID-19 and carbapenem use was more widespread. The impact of the COVID-19 pandemic on AU may accelerate AMR worldwide. The scale up of antimicrobial stewardship across the globe is urgently needed to curb AMR.

Disclosures

All Authors: No reported disclosures

757. Impact of a Sepsis Improvement Team with Prospective Audit and Feedback on SEP-1 Core Measure Adherence in an Urban Community Hospital

Background

Adherence to the CMS sepsis core measure (SEP-1) has been a challenge for facilities nationwide. Checklists, electronic medical record (EMR) alerts and order sets have been shown to improve compliance. We implemented a comprehensive SEP-1 guideline with order sets, checklists and EMR alerts at an urban community hospital. Subsequently, a SEP-1 improvement team with an infectious disease physician and a nurse led a prospective audit and feedback (PAF) program to help improve adherence and reduce errors. We seek to understand the impact of PAF on SEP-1 compliance.

Methods

Quasi-experimental pre- and post-intervention study of SEP-1 compliance at a 151-bed urban community hospital from January 2015 to December 2018. PAF intervention was started on July 2017. Cases were reviewed, SEP-1 failures identified, and feedback given to nurses and clinicians involved within 48 hours of admission. Gaps in adherence are identified, education given, and corrective actions taken. SEP-1 adherence before and after PAF implementation was reviewed.

Results

A total of 307 cases met the SEP-1 inclusion criteria. PAF was successfully implemented. There were 169 SEP-1 cases before and 138 after implementation of PAF. The success rate increased from 44% to 52% with PAF (Figure 1). The most common reasons for failure were initial and repeat lactic acid on both groups (Figure 2).

Conclusion

Prospective audit and feedback for SEP-1 improved compliance rates at our facility. Prospective audit can help identify core measure failures early and provide immediate feedback to clinicians, nurses and laboratory personnel. Immediate feedback by the SEP-1 improvement team may help increase SEP-1 awareness, strengthen existing protocols and promote a culture of safety. SEP-1 is a complex core measure that may transition to pay-for-performance. An ID physician-led SEP-1 improvement team with PAF may be an area for future value-based care opportunities for ID physicians.

Disclosures

All authors: No reported disclosures.

Remdesivir use and antimicrobial stewardship restrictions during the coronavirus disease 2019 (COVID-19) pandemic in the United States: A cross-sectional survey

Deploying therapeutics for coronavirus disease 2019 (COVID-19) has proved challenging due to evolving evidence, supply shortages, and conflicting guideline recommendations. We conducted a survey on remdesivir use and the role of stewardship. Use differs significantly from guidelines. Hospitals with remdesivir restrictions were more guideline concordant. Formulary restrictions can be important for pandemic response.

1109. Rise and Fall of COVID-19 Therapies Throughout Different Waves of the Pandemic: Results of a Nationwide Survey

Background

The COVID-19 pandemic has caused a major public health crisis and is now a leading cause of death. At the start of the COVID-19 pandemic, treatment was limited to supportive care and off-label use of a variety of agents as we awaited the results of randomized controlled trials (RCTs). Our understanding of the disease has evolved and multiple evidence-based (EBM) treatment strategies supported by RCTs are now approved for use. Interpreting emerging data while responding to the pandemic can been challenging. We seek to understand the use of common medications during the COVID-19 pandemic.

Methods

A survey was developed and disseminated through Infectious Diseases Society of America (IDSA) IDea network, IDSA Antimicrobial Stewardship Centers for Excellence and the Society for Healthcare Epidemiology messaging boards. Data collected included city, therapeutic options including convalescent plasma (CP), hydroxychloroquine (HCQ), baricitinib and tocilizumab during each COVID-19 wave.

Results

A total of 78 responses were collected, representing wide geographic reach in the US (Figure 1). Use of HCQ declined by 96% and use of CP declined by 85% (Figure 2). The decline in CP was gradual each wave despite RCTs showing lack of benefit. Tocilizumab was used in 71% and 76% of hospitals during the first wave, prior to RCT data supporting its use. Baricitinib was used in 42% of hospitals prior to RCT data supporting its use. There was a 90% increase in baricitinib use after RCT data emerged. Figure 1Geographic distribution of hospitals represented in the survey

Figure 2 Use of Hydroxychloroquine, Convalescent Plasma, Tocilizumab and Baricitinib Throughout Different COVID-19 Waves

Conclusion

The use of therapies before proven benefit was common through the pandemic. Similarly, the use of therapies after benefit was in question continued. Hydroxychloroquine was widely used in the first wave and then halted by the majority of hospitals in subsequent COVID-19 surges. IL-6 and JAK-2 inhibitors were commonly used prior to evidence of benefit and were more widely adopted once evidence emerged. Convalescent plasma use was common despite lack of evidence and its use continued despite multiple negative RCTs. Overall, our survey shows a gap between evidence and practice. Communicating evidence-based treatment strategies is a vital priority for major professional societies. Translating evidence into practice remains challenging during public health emergencies like the COVID-19 pandemic.

Disclosures

All Authors: No reported disclosures.

929. A Nationwide Survey on the Role of Antimicrobial Stewardship Programs during the COVID-19 Pandemic: What is restricted and who decides?

Background

During the COVID-19 pandemic, evolving literature and emerging therapies have led to significant controversies on what constitutes optimal therapy for hospitalized patients with COVID-19. In addition, multiple guidelines emerged exhibiting variable recommendations in key areas of therapeutic management. Thus, interpreting emerging data and deploying novel therapeutics during the pandemic has been challenging. Antimicrobial stewardship programs (ASP) have been proven to help promote evidence-based practices and are now common the United States (US). We seek to further understand the role of ASP during the COVID-19 pandemic.

Methods

A survey was developed and disseminated through Infectious Diseases Society of America (IDSA) IDea network, IDSA Antimicrobial Stewardship Centers for Excellence and the Society for Healthcare Epidemiology messaging boards. Data collected included city, hospital size, facility type, and existence of active ASP. COVID-19 therapeutic restrictions and type of provider who decides on treatment allocation was surveyed.

Results

A total of 92 surveys were completed, representing wide geographic reach within the United States (Figure 1). Hospital size by beds were 14% less than 200 (13), 18.5% 201-300 beds (17), 15.2% 301-400 beds (14), and 52.2% over 400 beds (48). Community hospitals accounted for 31.5% (29), county/public hospital 3.3% (3, 3.3%), University-affiliated Community-Based Teaching Hospitals 10.9% (10), University-based Teaching Hospital 45.7% (42), and 8.7% selected other. ASP were present in 97.2% of hospitals. COVID-19 therapeutic restrictions were common (Figure 2). Infectious diseases (ID) approval was required in 87.9% of facilities (Figure 3). Figure 1Geographic distribution of hospitals represented in the survey

Figure 2. Restricted COVID-19 therapies by medication type (%)

Figure 3 Specialties or providers that are able to order or approve restricted COVID-19 therapies (%)

Conclusion

COVID-19 therapeutics were commonly restricted during the COVID-19 pandemic. Approval by ID clinicians was required almost universally (87.9%). The role of other specialties was significantly lower, representing less than 45% of hospitals. ID clinicians have played a vital role in guiding therapy and supporting ASP during the COVID-19 pandemic. This survey highlights the value of ID clinicians to healthcare systems in allocating resources and promoting evidence-based practices through ASP.

Disclosures

All Authors: No reported disclosures.

1815. Effects of Syndrome-Based Antimicrobial Stewardship Prospective Audit and Feedback Interventions on Antimicrobial Use in an Urban Community Hospital

Background

Establishing antimicrobial stewardship programs (ASP) in community hospitals with limited resources can be challenging. Many hospitals do not have infectious disease (ID) trained pharmacists (PharmD) available. We implemented a comprehensive ASP with syndrome-based prospective audit and feedback at an urban community hospital.

Methods

ASP was implemented at a 151-bed urban community hospital in October 2017. PharmD training on syndrome-based treatment guidelines, including definitions, severity, empiric regimens, de-escalation, and duration was created. Prospective audit by PharmDs was established. This program was implemented and overseen by an ID physician. Days of therapy per 1,000 patient-days (DOT/1,000) was assessed 3 months before and after ASP. Prospective audit and feedback data were reviewed.

Results

At 3 months, antimicrobial use decreased (370 vs. 350 DOT/1,000) while the proportion of oral antimicrobials used increased (32% vs. 43%). Antibiotic expenditures decreased by 11% ($42,500 vs. $37,900). Most cases reviewed by prospective audit (58%) fit pre-determined syndromes (Figure 1). Soft tissue and urinary tract infections were the most common syndromes. Interventions occurred in 53% of cases. De-escalation from broad-spectrum agents was more successful in noncritical care settings (Figure 2).

Conclusion

Syndrome-based prospective audit and feedback was successfully implemented in an urban community hospital with non-ID trained PharmDs using ID physician leadership. Our program led to a decrease in antibiotic use, increase use of oral alternatives, and decreased antibiotic expenditures. Empiric use of broad-spectrum agents was common at our facility. ASP likely contributed to an increase in ceftriaxone and decrease in piperacillin–tazobactam use in medical-surgical floors. Stewardship in critically ill patients remains a challenge. Clear guidelines and access to an ID physician are necessary to provide adequate support for PharmDs without ID-specific training and can help curb antibiotic use. Expanding the list of syndromes may further impact antimicrobial use.

Disclosures

All authors: No reported disclosures.

207. Impact of Educational Interventions on Antibiotic Prescribing for Acute Upper Respiratory Tract Infections in the Ambulatory Care Setting

Background

Methods

Results

Conclusion

Disclosures

Changing the culture: impact of a diagnostic stewardship intervention for urine culture testing and CAUTI prevention in an urban safety-net community hospital

Cultures from urinary catheters are often ordered without indication, leading to possible misdiagnosis of catheter-associated urinary tract infections (CAUTI), increasing antimicrobial use, and C difficile. We implemented a diagnostic stewardship intervention for urine cultures from catheters in a community hospital that led to a reduction in cultures and CAUTIs.

2111. Changing the Culture: A Quasi-Experimental Study Assessing the Burden of Urine Cultures and the Impact of Stewardship of Testing in an Urban Community Hospital

Background

Indwelling urinary catheters (IUC) may cause inflammation and colonization, decreasing the diagnostic yield of urinalysis and urine cultures (UC). Indiscriminate testing can lead to misinterpretation of positive results as a catheter associated urinary tract infection (CAUTI), increasing antibiotic use and CAUTI rates. We studied the burden of UC and implemented a UC stewardship initiative (UCSI) as part of a comprehensive CAUTI reduction program.

Methods

A retrospective review of cases with IUC and positive UC in 2014 was performed. UCSI was implemented in March 2017 (Figure 1). Nursing staff were instructed to contact the infectious diseases physician when UC from IUC were ordered. Cases were reviewed and, if no UC indication based on IDSA guidelines was met, cultures were discontinued after conferring with ordering physician. Twelve months pre- and post-intervention data were collected; including case description, catheter days, UC ordered, alternative cause of fever, and recommendations.

Results

The pre-USCI cohort had 23 UC in 19 cases. One UC (4%) met indication (Figure 2). Three (16%) met NHSN criteria for CAUTI and did not meet UC indication. The USCI cohort had 21 UC orders in 13 cases. Most UC did not meet indication and were cancelled (90%, 19/21). Alternative causes for fever were found in all cases with cancelled UC orders (19/19), including pneumonitis, pneumonia, pancreatitis and tuberculosis. Antimicrobials were used in 53% (7/13). UC orders per hospitalization ranged 1–4 (average 1.7). IUC days ranged from 3 to 18 days (average 8). In both cohorts, UC with indication (3) did not meet NHSN criteria for CAUTI and did not receive antimicrobials.

Conclusion

Patients with IUC frequently underwent UC without evidence-based indications. This may lead clinicians down the wrong diagnostic path and contribute to antimicrobial use. Critically ill patients with inflammatory conditions are at high risk of UC testing. USCI is a cost-effective intervention that reduced indiscriminate testing, antibiotic use and CAUTIs. USCI can play an important role in CAUTI prevention strategies and antibiotic stewardship programs.

Disclosures

All authors: No reported disclosures.

417. COVID-19 Aerostudy: Evaluation of SARS-CoV-2 Virus in the Air of Patients Hospitalized with COVID-19

Background

At the onset of the COVID-19 pandemic, hospitals implemented infection control measures with limited data on predictors of nosocomial SARS-CoV-2 transmission. We aimed to quantify SARS-CoV-2 presence in an inpatient setting to understand nosocomial risk.

Methods

Patients admitted with confirmed SARS-CoV-2 infection at an urban academic hospital were enrolled. Demographic/clinical characteristics, a PCR nasal swab(NS), and air samples on filter media in the near- (< 6ft) and far-field ( >6ft) of each patient for 3.5 hours were collected. PCR was used to detect SARS-CoV-2 on filter media. Associations between clinical characteristics and presence of SARS-CoV-2 in air samples used Fisher’s exact and Wilcoxon rank sum tests.

Results

Of 52 subjects, 46% had no detectable virus by nasal swab on the day of sampling. Of 104 room air samples, 16% had detectable virus from 25% of rooms, including 10 near and 7 far field samples. Subjects with a positive room air sample had fewer days from symptom-onset compared with those with a negative air sample (median 6 vs. 8, p=0.24). Being on room air and having a nasal swab positive increased the odds of detecting virus in air samples but were not statistically significant.

Conclusion

A small number of air samples with detectable SARS-CoV-2 may suggest lower nosocomial risk than previously anticipated. Multiple subject and environmental factors may have contributed to this finding including patient source control masking, anti-viral therapies and HEPA filtration. The decreased association of virus in the air of those with more days of symptoms but with the need for supplemental oxygen may be related to what is now known about the COVID-19 inflammatory response after the infectious period.

Disclosures

All Authors: No reported disclosures

600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

Background

Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program.

Methods

This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p< 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission.

Results

Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2.

Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention

Table 2. Factors independently associated with hospital readmission in OPAT patients

Conclusion

An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future.

Disclosures

All Authors: No reported disclosures

1199. Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae: A Comparative Study Between Facilities in the United States and the Dominican Republic

Background

The prevalence of multi-drug-resistant organisms (MDRO) is on the rise globally. MDRO infections carry high morbidity and mortality. There is a paucity of data on Carbapenem-resistant Klebsiella pneumoniae (CRKp) in the Dominican Republic (DR). Evaluating CRKp in various settings will provide data on contrasting epidemiologic risk factors. We evaluated the epidemiology of CKRp in three contrasting settings, a 495-bed urban academic center (AC), a 151-bed urban community hospital (CH) and a 200 bed teaching hospital in the DR (DRH).

Methods

We performed a retrospective cohort study of patients with CRKp cultures from 2014 to 2016 from AC, CH and DRH. A comparative evaluation of the epidemiology of CRKp between the cohorts was performed. Demographics, co-morbid conditions, antibiotic sensitivity, and outcomes were compared between hospital cohorts.

Results

Cohort AC had 64 patients, compared with eight from CH and eight from DRH. AC (59%) and CH (62%) cohorts included more men than the DRH cohort (25%). Average age was 62, 66, and 51, respectively. History of MDRO, antibiotic use in the past 6 months and hospitalization within the past year were common risk factors (Figure 1). Diabetes and end-stage renal disease were common comorbidities at all facilities (Figure 2). Charleston Comorbidity Index (CCI) score was highest at AC (6.6) and DRH (6.4) compared with CH (4). Mortality was highest in DRH (63%, 6/8) and AC (11%, 7/64) while CH had no deaths. Urine was the most common source at AC (67%) and CH (75%) while blood was most common at DRH (62.5%). CRKp isolates were susceptible to colistin at varying rates (AC=85%, CH = 63%, DRH = 80%).

Conclusion

Prior antibiotic use and hospitalization were common risk factors in all settings. Mortality and CCI scores for CRKp was highest at AC and DRH, which are tertiary referral centers. CH had less overall mortality and higher rates of colistin resistance. Further studies are needed to understand these risk factors. Strengthening antimicrobial stewardship and infection control practices in the United States and abroad may help curb the spread of resistance in different clinical settings.

Disclosures

All authors: No reported disclosures.

1107. A Survey on Remdesivir Use and Antimicrobial Stewardship Restrictions Throughout the COVID-19 Pandemic

Background

Remdesivir (RDV) was the first agent with proven clinical benefit against COVID-19, shortening the time to recovery in a randomized placebo-controlled trial (RCT). Based on this trial, the Food and Drug Administration approved RDV via emergency use authorization. Despite its wide use, RDV remains controversial. Early use of RDV in patients requiring low flow nasal canula has robust evidence. However, benefit in mechanical ventilation (MV), high-flow nasal canula (HFNC) and non-invasive positive pressure ventilation (NIPPV) is conflicting. Multiple studies, most notably the SOLIDARITY and DisCoVeRy trial, have conflicting results on who benefits from RDV. Deploying novel therapeutics in this changing landscape is challenging. We seek to understand RDV practices and the role of antimicrobial stewardship (ASP) in hospitals across the US.

Methods

A survey was developed and disseminated through Infectious Diseases Society of America (IDSA) IDea network, IDSA Antimicrobial Stewardship Centers for Excellence and the Society for Healthcare Epidemiology messaging boards. Data collected included city, presence of RDV therapeutic restrictions, and RDV use by degree of oxygen needs for each COVID-19 wave.

Results

A total of 78 responses were collected, representing wide geographic reach in the US (Figure 1). RDV was restricted in 53% of facilities. Hospitals without restrictions commonly used RDV for patients on MV, NIPPV and HFNC, with more use on HFNC than on NC during the first winter, Delta and Omicron waves (Figure 2). Use on MV declined with each surge. Hospitals with RDV restrictions had more use of RDV on NC than all other ordinal scales (Figure 3). Use in MV, NIPPV and HFNC compared to NC declined in the restricted group with each COVID-19 surge. Figure 1.Geographic distribution of hospitals represented in the survey

Figure 2. Remdesivir use by oxygen requirements in hospitals without remdesivir therapeutic restrictions.

Figure 3 Remdesivir use by oxygen requirements in hospitals without remdesivir therapeutic restrictions.

Conclusion

A wide gap between evidence-based guidelines and actual practice exists. This gap was wider in hospitals without COVID-19 therapeutic restrictions in place for RDV. In the unrestricted group, RDV was commonly used for MV, HFNC and NIPPV, where robust RCT evidence of benefit is lacking. Though this practice occurred in both groups, the restricted RDV group prioritized RDV use in NC and did so at higher percentages each subsequent COVID-19 surge. ASP restrictions can have an important role in guiding COVID-19 therapy.

Disclosures

All Authors: No reported disclosures.

1666. Sources and Preventability of Hospital-onset Bacteremia and Fungemia in the United States: Evaluation of a Potential Healthcare Quality Measure

Background

Hospital-onset bacteremia and fungemia (HOB) is being proposed as a potential healthcare quality measure due to its clinical significance, objectivity, and ease of detection. However, information is lacking on sources of HOB and the proportion and types of cases considered preventable.

Methods

We evaluated sources and potential preventability of HOB cases at 12 hospitals using retrospective chart review. HOB was defined as a positive blood culture &gt;= day 4 (admission date=day 1) for one or more organisms. Stratified sampling of cases by commensal and noncommensal organisms was used. Infectious disease physicians determined the source of HOB and rated preventability from 1-6 (1=definitely preventable to 6=definitely not preventable) using a previously validated guide. Ratings of 1–3 were collectively considered potentially preventable and 4–6 likely not preventable.

Results

We evaluated sources and potential preventability of HOB cases at 12 hospitals using retrospective chart review. HOB was defined as a positive blood culture &gt;= day 4 (admission date=day 1) for one or more organisms. Stratified sampling of cases by commensal and noncommensal organisms was used. Infectious disease physicians determined the source of HOB and rated preventability from 1–6 (1=definitely preventable to 6=definitely not preventable) using a previously validated guide. Ratings of 1–3 were collectively considered potentially preventable and 4–6 likely not preventable.

Conclusion

Gastrointestinal and endovascular sources account for a large majority of noncommensal HOB cases. A high proportion of noncommensal HOB cases are likely not preventable. The presence of non-preventable events should be considered when using HOB as a quality measure. Approaches to identifying the subset of preventable noncommensal HOB events should be explored.

Disclosures

Scott Fridkin, MD, Pfizer: Grant/Research Support Andi L. Shane, MD, MPH, MSc, International Scientific Association for Probiotics and Prebiotics (ISAPP): travel and lodging to attend international meeting to deliver a presentation, June 2022 Aaron Milstone, MD, Merck: Grant/Research Support Rajeshwari Nair, MBBS, PhD, Vertex Pharmaceuticals: Salary.