Duration Of Antibiotic Course Research Articles

Antibiotic use in first opinion equine practice in the United Kingdom: Serial point prevalence surveys in 17 practices

SummaryBackgroundMonitoring antibiotic use (AMU) is a key component of antimicrobial stewardship. Published data on AMU in first opinion equine practice are limited.ObjectivesTo document AMU in first opinion equine practices.Study designRepeated point prevalence surveys.MethodsAMU was recorded one day every month for 12 consecutive months in 17 equine practices.ResultsTwo hundred and fifty‐two horses were prescribed antibiotics across 2273 consultations (excluding routine appointments) (11.1%; 95% CI 9.8%–12.4%). Median number of consultations per practice was 121 (IQR 112–159; range 27–303). Across 17 practices, the proportion of horses receiving antibiotics varied by practice from 0% to 26.4%. Commonest indications for AMU included cellulitis (66; 26.8%), wounds (46; 18.7%), surgical prophylaxis (36; 14.6%), respiratory infection (27; 11.0%) and skin infection (20; 8.1%). Commonest antibiotics prescribed were potentiated sulphonamides (109; 43.6%), oxytetracycline (58; 23.2%), procaine penicillin (40; 16.0%) and doxycycline (36; 14.4%). 45.0% of oxytetracycline use was for surgical prophylaxis. 44.8% of procaine penicillin use was for cellulitis. 28.6% of ‘other antimicrobial’ use was for pyrexia of unknown origin. Use of antibiotics differed significantly depending on the underlying diagnosis (p < 0.001). Median antibiotic dose rates were: potentiated sulphonamides 30 mg/kg (IQR 27–75; range 10–75; n = 96); procaine penicillin 19 mg/kg (IQR 15–23; range 7–30; n = 35); oxytetracycline 6 mg/kg (IQR 5–6; range 4–30; n = 55); doxycycline 10 mg/kg (IQR 10–20; range 7–30; n = 34).Main limitationsWeight of horses were often estimated. Duration of antibiotic courses was not recorded.ConclusionsAntibiotics were prescribed in 11% of nonroutine consultations. Commonest indication for AMU was cellulitis. Potentiated sulphonamides, oxytetracycline and procaine penicillin were the commonest prescribed drugs. Critically important antibiotic use was infrequent. Dose rates varied, but median values were generally appropriate.

2799. Evaluating Resistance Patterns of LVAD-related Pseudomonas Infections

Abstract Background Left ventricular assist devices (LVADs) provide a clear benefit to patients with end-stage heart failure. Despite this, device-related infections such as driveline infections, device pocket infections, and LVAD-related bloodstream infections occur in up to 39% of implanted patients. Pseudomonas aeruginosa is a common causative organism in LVAD-associated infections and frequently develops resistance, limiting treatment options. This study aims to analyze the relationships between the frequency of acquired resistance (AR) and single-agent antibiotic courses, as well as the frequency of AR and duration of antibiotic courses; and compare the likelihood of AR between different antibiotic classes. Methods This was a single-center retrospective cohort study involving all patients with LVAD-associated P. aeruginosa infections between 2011-2023. Patients treated with piperacillin-tazobactam, cefepime, ciprofloxacin, or meropenem, were included (n = 37). Each antibiotic course (n = 117) was associated with a pre- and post-antibiotic sensitivity. AR was defined as culture-proven, newly developed resistance to the utilized antibiotic after starting therapy. The incidence and cumulative proportion of AR were estimated using Poisson regression and Kaplan-Meier curve analysis, respectively. A marginal proportional hazards model was used to analyze time to AR between different antibiotic groups. Results There was a significantly lower incidence of AR with cefepime [0.8 (95% CI 0.2-3.3) per 100 person-weeks] compared to piperacillin-tazobactam [3.6 (1.7, 8)], meropenem [7.6 (4.1, 14.5)], and ciprofloxacin [6.4 (3.4, 12.5)] (p=0.04). Similarly, the cumulative proportion of AR was significantly lower with cefepime as compared to other antibiotic classes (Figure 1). The hazard rate of AR was approximately 3.5 to 6.7 times higher with each antibiotic in comparison to cefepime (p = 0.02) (Table 1).Figure 1.Kaplan-Meyer curve demonstrating cumulative proportion of acquired resistance Resistance occurs early and more frequently with piperacillin-tazobactam, meropenem, and ciprofloxacin, but less frequently and late with cefepime. The cumulative proportion of acquired resistance over time differed significantly across antibiotic types (p = 0.02). Cefepime had a statistically significantly lower hazard of AR when compared to the rest of the antibiotic groups as a whole, and when compared individually, had a significantly lower hazard than ciprofloxacin and meropenem. Conclusion This study suggests a lower incidence of AR for LVAD-associated P. aeruginosa infection treated with cefepime. AR also seems to develop later in patients treated with cefepime. There is a 3.5-6.7-fold increase in the risk of acquiring resistance with other antibiotics compared to cefepime. Disclosures Jeffrey Alexis, MD, Abbott: Grant/Research Support

Prescribing and peritoneal dialysis.

Peritoneal dialysis is a home-based therapy for patients with end-stage kidney disease. It is less efficient in removing solutes and fluid than haemodialysis but offers more flexibility and independence. Peritoneal transport characteristics affect the dialysis prescription. The timing of drug administration is independent of the dialysis process except for the administration of intraperitoneal antibiotics. Dose reductions should follow current recommendations for patients with kidney disease. Fluid overload is common in patients undergoing peritoneal dialysis. Residual kidney function can ameliorate this problem and needs to be preserved. Dialysis solutions with high glucose concentrations contribute to adverse metabolic effects. Peritoneal dialysis-related catheter complications and infections may require patients to transition to haemodialysis. Antifungal prophylaxis needs to be co-administered for the duration of antibiotic courses for any indication to reduce the risk of fungal peritonitis. Close communication with the patient's supervising dialysis unit is required.

Patterns of Infections among Extremely Preterm Infants.

Infections remain a leading cause of neonatal death, especially among the extremely preterm infants. To evaluate the incidence, pathogenesis, and in-hospital outcomes associated with sepsis among hospitalized extremely preterm infants born at 24-0/7 to 27-6/7 weeks of gestation, we designed a post hoc analysis of data collected prospectively during the Preterm Epo Neuroprotection (PENUT) Trial, NCT #01378273. We analyzed culture positive infection data, as well as type and duration of antibiotic course and described their association with in-hospital morbidities and mortality. Of 936 included infants, 229 (24%) had at least one positive blood culture during their hospitalization. Early onset sepsis (EOS, ≤3 days after birth) occurred in 6% of the infants, with Coagulase negative Staphylococci (CoNS) and Escherichia Coli the most frequent pathogens. Late onset sepsis (LOS, >day 3) occurred in 20% of the infants. Nearly all infants were treated with antibiotics for presumed sepsis at least once during their hospitalization. The risk of confirmed or presumed EOS was lower with increasing birthweight. Confirmed EOS had no significant association with in-hospital outcomes or death while LOS was associated with increased risk of necrotizing enterocolitis and death. Extremely premature infants with presumed sepsis as compared to culture positive sepsis had lower rates of morbidities. In conclusion, the use of antibiotics for presumed sepsis remains much higher than confirmed infection rates. Ongoing work exploring antibiotic stewardship and presumed, culture-negative sepsis in extremely preterm infants is needed.

Institutional performance and validation of severity of illness score for children with acute hematogenous osteomyelitis.

A scoring system has recently been published that uses parameters within the first 4-5 days of hospitalization to determine the severity of illness (SOI) in children with acute hematogenous osteomyelitis (AHO). To our knowledge, no additional studies to date have examined the validity of the SOI score outside of the institution of origin. This study evaluates the performance of the SOI score in a retrospective cohort of cases at our institution. Patients admitted to our institution over the past 5 years with AHO who met inclusion and exclusion criteria were analyzed. Parameters including C reactive protein over the first 96 h of hospitalization, febrile days on antibiotics, ICU admission, and presence of disseminated disease were used to calculate the SOI score for each patient. Pearson and Spearman correlations were used when appropriate. SOI score comparison between groups was achieved with the Kruskal-Wallis and Wilcoxon two-sample tests. Seventy-four patients were analyzed. Significantly higher SOI scores were noted for patients with bacteremia, ICU admission, fever for two or more days on presentation, multiple surgeries, and any complication. Markers of disease severity that significantly correlated with SOI score were total length of stay, LOS, duration of antibiotic course, number of surgical procedures, and case mix index. The SOI score functioned well as higher scores were associated with sicker patients. The SOI score is helpful for determining which patients will require longer hospitalizations and more intense treatment in a setting other than the institution of origin.

Antibiotic prescribing patterns in patients hospitalized with COVID-19: lessons from the first wave.

BackgroundA high proportion of hospitalized patients with COVID-19 receive antibiotics despite evidence to show low levels of true bacterial coinfection.MethodsA retrospective cohort study examining antibiotic prescribing patterns of 300 patients sequentially diagnosed with COVID-19. Patients were grouped into 3 sub-cohorts: Group 1 received no antibiotics, Group 2 received antibiotics for microbiologically confirmed infections and Group 3 was empirically treated with antibiotics for pneumonia. The primary aim was to identify factors that influenced prescription and continuation of antibiotics in Group 3. Secondary aims were to examine differences in outcomes between groups.ResultsIn total, 292 patients were included (63 Group 1, 35 Group 2, 194 Group 3), median age was 60 years (IQR 44–76) and the majority were ethnically Irish (62%). The median duration of antibiotics was 7 days (IQR 5–10). In Group 3, factors associated with prescription IV antibiotics on admission were raised C-reactive protein (CRP) (P = 0.024), increased age (P = 0.023), higher quick SOFA (P = 0.016) score and fever >37.5 °C (P = 0.011). Factors associated with duration of antibiotic course were duration of hypoxia (P < 0.001) and maximum respiratory support requirement (P = 0.013). Twenty-one patients in Group 3 had one or more antibiotic escalation events, most (n = 139) had no escalation or de-escalation of therapy.ConclusionsDuration of hypoxia and need for respiratory support may have acted as surrogate measures of improvement where usual response measures (CRP, neutrophilia, culture clearance) were absent. Continuous review of antibiotic prescriptions should be at the forefront of clinical management of hospitalized patients with COVID-19.

Shorter and Longer Courses of Antibiotics for Common Infections and the Association With Reductions of Infection-Related Complications Including Hospital Admissions

BackgroundAntimicrobial resistance is a serious global health concern that emphasizes completing treatment course. Recently, the effectiveness of short versus longer antibiotic courses has been questioned. This study investigated the duration of prescribed antibiotics, their effectiveness, and associated risk of infection-related complications.MethodsClinical Practice Research Datalink identified 4 million acute infection episodes prescribed an antibiotic in primary care between January 2014—June 2014, England. Prescriptions were categorized by duration. Risk of infection-related hospitalizations within 30 days was modelled overall and by infection type. Risk was assessed immediately after or within 30 days follow-up to measure confounders given similar and varying exposure, respectively. An interaction term with follow-up time assessed whether hazard ratios (HRs) remained parallel with different antibiotic durations.ResultsThe duration of antibiotic courses increased over the study period (5.2–19.1%); 6–7 days were most common (66.9%). Most infection-related hospitalizations occurred with prescriptions of 8–15 days (0.21%), accompanied by greater risk of infection-related complications compared to patients who received a short prescription (HR: 1.75 [95% CI: 1.54–2.00]). Comparing HRs in the first 5 days versus remaining follow-up showed longer antibiotic courses were no more effective than shorter courses (1.02 [95% CI: 0.90–1.16] and 0.92 [95% CI: 0.75–1.12]). No variation by infection-type was observed.ConclusionsEqual effectiveness was found between shorter and longer antibiotic courses and the reduction of infection-related hospitalizations. Stewardship programs should recommend shorter courses of antibiotics for acute infections. Further research is required for treating patients with a complex medical history.SummaryPrescribing of longer courses increased over the study period. The majority of hospitalizations occurred for patients receiving longer courses. Risk of developing a complication (immediate vs remaining follow-up) found longer courses were no more effective than shorter courses.

A 10 Year clinical, laboratory and arthroscopic data analysis of bacterial septic arthritis of adult native knee: A hospital-based study

ObjectiveA hospital-based study was conducted to analyze the clinical, laboratory and arthroscopic data of bacterial septic arthritis of the native knee in adults treated over ten years. MethodBetween 2010 and 2019, the clinical, laboratory and arthroscopic data of all adult patients who underwent Arthroscopic debridement for diagnosed or suspected septic arthritis of the knee were reviewed from the medical records. Statistical analysis was performed to compare these characteristics between positive and negative cultures and between patients with or without co-morbidities. Further, these characteristics were also compared between patients who had Staphylococcus aureus infection versus non-Staphylococcal infection. ResultsThe data from 106 cases comprising of 86 males and 20 females were analyzed. The mean age of the study population was 51.04±15.38 years. Positive cultures were observed in only 38 cases (35.84%). Between positive and negative cultures, statistically significant differences were found for haemoglobin levels, CRP, total protein in the synovial fluid, duration of antibiotic course and length of hospital stay. Between patients with or without co-morbidities, statistically, significant differences were found for patients ‘age, haemoglobin levels, RBS, HbA1c, Serum Urea, Creatinine, ESR, CRP, the total duration of antibiotic course and length of hospital stay. No major differences were observed between patients with Staphylococcus aureus related and non-Staphylococcus aureus related infections. ConclusionIn most of the cases no organisms were isolated from the synovial fluid or the tissues. Among the positive cultures, Staphylococcus aureus was the most common organism isolated, with nearly half of them (42.8%) being MRSA. Patients with positive cultures and associated medical co-morbidities were treated with a longer duration of the antibiotic course and had a longer hospital stay. Awareness among the clinicians and microbiologists about the new emerging infections in the native knee is vitally important.

Duration of Outpatient Antibiotic Therapy for Common Outpatient Infections, 2017.

Our objective was to describe the duration of antibiotic therapy for the management of common outpatient conditions. The median duration of antibiotic courses for most common conditions, except for acute cystitis, was 10 days, in many cases exceeding guideline-recommended durations.

Fever Management in Sickle Cell Disease in Low- and Middle-Income Countries: A Survey of SCD Management Programs.

Management of fever is a key element of care for children with sickle cell disease (SCD). There exist few studies of current practices in managing fevers in SCD in low- and middle-income countries (LMICs) and malaria-endemic regions where SCD is prevalent. We surveyed medical providers in these settings to characterize current practices in infection prevention and fever management for children with SCD. We found wide variation in use of newborn screening for early diagnosis and infection prevention, pneumococcal vaccination, use of antibiotics and antimalarials, and route of antibiotic administration. Counter to established guidelines, 78% (95% CI: 59-100%) of respondents would consider using oral antibiotics for a febrile child with SCD. Only 17% (95% CI: 0-37%) would administer antibiotics to a well-appearing child with a positive malaria test. Availability of blood cultures did not affect duration of antibiotic course. Further study and standardization of fever management in SCD in LMICs are urgently needed.

Enough is enough – is it time for the Scottish Antimicrobial Prescribing Group (SAPG) to develop the third age of antimicrobial stewardship in primary care in Scotland?

Background From 2008 the SAPG focused on ‘what to prescribe’ to tackle Clostridium difficile infection and from 2013 on ‘whether to prescribe’ to tackle unnecessary prescribing for self-limiting infections. Following these successes SAPG is now moving to the age of ‘how much to prescribe’ to ensure correct duration of therapy. We aimed to compare current prescribing practice with guidance from Public Health England (PHE)/NICE which recommends five days’ treatment for most common community respiratory infections (RTI). Methods The durations of antibiotic courses for treatment of respiratory tract infections was derived from data on dispensed prescriptions in 2018 from the Prescribing Information System, a national database of all NHS prescriptions dispensed in Scotland. Observed course durations were compared to course lengths recommended by PHE/NICE and modelling was undertaken on the impact on antibiotic use if durations were in line with guidance. Results For antibiotics recommended for RTI, the most common length of treatment used was seven days. For amoxicillin the proportion of five day prescriptions varied across health boards from 1.8% to 68.7%. Modelling estimated if 75% of seven day prescriptions for antibiotics recommended for RTI were changed to five days this would deliver a 4.1% reduction in antibiotic use. Conclusion SAPG has agreed to lead work to encourage the use of five day courses of antibiotics where indicated. Switching to five day courses would support reduction in total antibiotic use to achieve the ambitions of the UK AMR National Action Plan.

Clinical Importance of Lymphocytopenia in Pediatric Head and Neck Lymphatic Malformations

Introduction: Small case series have suggested that lymphocytopenia may be associated with a more aggressive lymphatic malformation (LM) disease course; however, the clinical importance of lymphocytopenia in the setting of LM still remains unclear. The objective of this study was to determine if LM-associated lymphocytopenia was associated with higher rates of antibiotic use and more frequent hospitalizations for infections. Methods: An IRB-approved, retrospective case series review was performed on all patients with the ICD-10 codes corresponding to LM between 2008 and 2018 at a single institution. Patients with a complete blood cell count and lymphocyte differential were included. Lymphocytopenia was defined as &lt;1500/cm3. Variables including LM location, lymphocyte count, frequency and duration of antibiotic utilization, and number of infection-related hospitalizations were recorded. Data was analyzed with Mann-Whitney U and Fisher’s Exact tests. Results: From a total of 131 patients with a diagnosis of head and neck lymphatic malformation, there were 45 pediatric patients with documented laboratory values included in the cohort. Lymphocytopenia was present in 24 (53%) patients. There were no differences in the number of patients requiring hospitalization for infection (8 vs 7, p=1.000), mean length of hospital stay (0.38 vs 0.48, p=0.891), or mean duration of antibiotic course (14 vs 15 days, p=0.833) between those with and without lymphocytopenia, respectively. Similarly, the subset of 5 patients on sirolimus treatment had no increased infection-related parameters when compared to the remainder of the cohort. Discussion: Lymphocytopenia was not associated with higher rates of infection requiring hospitalization or increased duration of antibiotic course in head and neck LM.&nbsp; Furthermore, patients receiving sirolimus did not incur higher rates of infection. Larger prospective studies are needed to follow disease course in patients with and without LM-associated lymphocytopenia.

Antimicrobial use in an Indonesian community cohort 0-18 months of age.

BackgroundAntimicrobial resistance has become a global health emergency and is contributed to by inappropriate antibiotic use in community clinical settings. The aim of this study was to evaluate the antimicrobial use pattern in infants from birth until 18 months of age in Indonesia.MethodsA post-hoc analysis was conducted in 1621 participants from the RV3BB Phase IIb trial conducted in Indonesia from January 2013 through July 2016. Any health events were documented in the trial as adverse events. Concomitant medication surveillance recorded all medications, including antibiotics during the 18 months of follow-up. Information included the frequency, duration of usage, formulation, classes, and their indications, including prophylactic antibiotic and perinatal use.ResultsOf 1621 participants, 551 (33.99%) received at least one antibiotic for treatment of infections during the 18 months observation period. Additionally, during the perinatal period, prophylactic antibiotics were used in 1244 (76.74%) participants and antibiotics consumed in 235 mothers of participants (14.50%). A total of 956 antibiotic consumptions were recorded for 18 months follow up, 67 (7.01%) as part of antimicrobial combinations. The average duration of antibiotic course was 4.92 days. Penicillin and sulfonamides were the most common antibiotic classes consumed (38.81% and 24.48%, respectively).ConclusionsDespite the low community consumption rate, the overuse of antibiotic in URTIs and non-bloody diarrhea in our setting represents a major opportunity for antimicrobial stewardship, particularly in early life.

Antibiotic Overuse in Premature Low Birth Weight Infants in a Developing Country.

Neonatal sepsis is a leading cause of child morbidity and mortality, especially in premature and low birth weight infants. Prompt antibiotic therapy is warranted, but its inappropriate use leads to bacterial resistance and adverse outcomes. Our objective is to describe the antibiotic use for late-onset sepsis in Peruvian premature infants. This study is a prospective study as a secondary analysis of a clinical trial in 3 neonatal care units in Peru. We included infants in the first 72 hours of life, with birth weight (BW) <2000 g. We described the antibiotic use as length of therapy (LOT) per 1000 patient days (PD) and antibiotic courses. We included 408 neonates, with 12,204 PD of follow-up; 253 infants (62%) had a BW ≤1500 g. Total antibiotic use for late-onset sepsis was 2395 LOT (196 LOT/1000 PD). Two-hundred and seventy-one patients (66.4%) did not receive antibiotics for late-onset sepsis during their hospitalization. In total, 204 antibiotic courses were administered; 92 infants (22.5%) received 1 course, and 45 (11.0%) received 2-5 antibiotic courses. Mean duration of antibiotic course was 10.8 days (standard deviation: ±7.3). We found a significant association between a lower BW and increased antibiotic use per day (P < 0.001). The most commonly used antibiotics were vancomycin (143 LOT/1000 PD), carbapenems (115 LOT/1000 PD), aminoglycosides (72 LOT/1000 PD) and ampicillin (41 LOT/1000 PD). Premature infants receive antibiotics for longer than recommended periods of time. Antibiotic overuse is greater in neonates with lower BW. Vancomycin is the most used antibiotic. There is an urgent need to develop antimicrobial stewardship programs in our setting.

186. Effective Antimicrobial StewaRdship StrategIES (ARIES): Cluster-Randomized Trial of a Clinical Decision Support System to Supplement Antibiotic Prospective Review and Feedback

BackgroundProspective review and feedback (PRF) of antibiotic prescriptions is a tenet of antimicrobial stewardship (ASP), but labour intensive. Clinical Decision Support Systems (CDSS) have the potential to automate some of this work. We hypothesised that increasing prescriber engagement with the CDSS would reduce the requirement for PRF by the ASP team and improve prescribing behaviour without causing harmMethodsA parallel-group, 1:1 block-cluster randomized, cross-over study was conducted in 32 medical and surgical wards from March 2017 to August 2017. Participants in Arm A were allocated to voluntary use of CDSS by the clinician at first prescription of piperacillin–tazobactam or a carbapenem, while in Arm B, CDSS use was compulsory. PRF continued for both arms.ResultsSix hundred fourty-one and 616 participants were included in Arms A and B, respectively. At baseline, Charlson’s co-morbidity and APACHE II scores were comparable. Initial antibiotic prescriptions were similar, and the majority were for respiratory (67.0% vs. 68.2%) or urinary (17% vs. 19.6%) infections.CDSS recommendations were provided to 20.6% of participants in Arm A and 99.4% in Arm B (P < 0.01). Arm B adopted a higher number of CDSS antibiotic de-escalation (1.1% vs. 2.6%), dose optimization (9.7% vs. 30.7%), antibiotic optimization (8.9% vs. 31.3%), and duration setting recommendations (10.9% vs. 50%). The proportion of participants receiving PRF recommendations were not, however, significantly different between arms (8% vs. 11.5%, P = 0.13). The types of PRF recommendations and prescriber acceptance rates were also similar. The duration of antibiotic use was significantly shorter when prescribers were compelled to use the CDSS (daily defined doses ≤3: 71.8% in Arm B, 64.9% in Arm A, P < 0.01). There was no evidence of harm from the CDSS, with similar 30-day mortality (HR 0.87, 95% CI 0.67–1.12), 30-day re-infection (20.6% vs. 23.1%, P = 0.29) and 30-day re-admission rates (14.4% vs. 14.1%, P = 0.91). The median length of hospital admission was also similar (15 IQR 5–64 vs. 15, IQR 4–70 days).ConclusionCompulsory use of a CDSS at antibiotic prescription did not reduce the requirement for PRF, but limited the duration of antibiotic courses, without compromising clinical outcomesDisclosures All authors: No reported disclosures.

How to choose the duration of antibiotic therapy in patients with pneumonia

The appropriate duration of antimicrobial treatment in patients with pneumonia remains a matter of controversy. The purpose of this article is to review different approaches that have been used to determine the duration of antimicrobial therapy mainly driven either by the antibiotic chosen, isolated pathogen, host characteristics, or severity of the disease. When considered individually, every approach has strengths and weaknesses. Targeting the duration of antibiotic therapy based on a single biomarker, such as procalcitonin, is a promising approach that showed a reduction in antibiotic exposure in different settings, diseases, and study populations. Furthermore, an individualized approach according to time to reach clinical stability takes into account all the previous cited factors and may be another feasible and effective strategy to determine the most appropriate duration of the antibiotic therapy in patients with pneumonia. A shorter duration of antibiotic course based on response to treatment may be favorable in patients with pneumonia due to a potential reduction of adverse events and antibiotic resistance, the opportunity to enhance patients' compliance and to decrease healthcare costs.

G423 Service evaluation of the management of osteoarticular infection over 8 years in a single centre

Aims There is no national consensus on the management of osteoarticular infection (OAI). Practice varies widely throughout the United Kingdom, with differences in duration of antibiotic treatment, switching from intravenous (IV) to oral antibiotics and requirement for peripherally inserted central venous catheters (PICC). Data about recurrence and complication rates is scant. We aimed to evaluate local practice: analyse demographic data, antibiotic course duration and administration route, use of invasive lines and associated complications with a view to guideline development. Methods OAI in children aged 0–17 years, presenting to one centre, from 01/09/2006–01/09/2014, identified through hospital coding, clinician and microbiology records. Results Demographic Data 82 confirmed OAI cases: 55% male, 45% female, mean age 4.8 years. Preliminary data from the first 24 cases revealed none had significant co–morbidities, sickle cell disease or immuno–suppression. Pathogenesis Tibia most commonly affected site, followed by femur. Organisms isolated in under half the cases. 2 cases of severe PVL-MSSA disease identified Management Median duration of antibiotic course (IV and Oral) was 45 (range 7–358) days. Median duration of IV antibiotic course was 20 (range 6–75) days. Oral switch occurred in 76%, after a median of 18 (range 3–17 days) of IV antibiotics. Most had PICC lines inserted, complications included line sepsis (x1). Complication of OAI included hyperesthesia, and prolonged chronic OAI Conclusions The first 24/82 cases analysed confirm wide variation in management, partly due to the diversity in age, presentation and organism. This highlights the difficulties for guideline development for this heterogeneous group. Full analysis will be presented at the conference. It will provide a comprehensive picture of current local practice, and add to national data being collected as part of the DINOSAUR study, to further understanding of this serious condition.

An Audit-Based, Infectious Disease Specialist-Guided Antimicrobial Stewardship Program Profoundly Reduced Antibiotic Use Without Negatively Affecting Patient Outcomes.

Background. Antimicrobial stewardship programs are increasingly implemented in hospital care. They aim to simultaneously optimize outcomes for individual patients with infections and reduce financial and health-associated costs of overuse of antibiotics. Few studies have examined the effects of antimicrobial stewardship programs in settings with low proportions of antimicrobial resistance, such as in Sweden. Methods. An antimicrobial stewardship program was introduced during 5 months of 2013 in a department of internal medicine in southern Sweden. The intervention consisted of audits twice weekly on all patients given antibiotic treatment. The intervention period was compared with a historical control consisting of patients treated with antibiotics in the same wards in 2012. Studied outcome variables included 28-day mortality and readmission, length of hospital stay, and use of antibiotics. Results. A reduction of 27% in total antibiotic use (2387 days of any antibiotic) was observed in the intervention period compared with the control period. The reduction was due to fewer patients started on antibiotics as well as to significantly shorter durations of antibiotic courses (P < .001). An earlier switch to oral therapy and a specific reduction in use of third-generation cephalosporins and fluoroquinolones was also evident. Mortality, total readmissions, and lengths of stay in hospital were unchanged compared with the control period, whereas readmissions due to a nonresolved infection were fewer during the intervention of 2013. Conclusions. This study demonstrates that an infectious disease specialist-guided antimicrobial stewardship program can profoundly reduce antibiotic use in a low-resistance setting with no negative effect on patient outcome.

894 Reducing the Duration of Antibiotic Course in a Neonatal Unit: Results of a Two Year Audit

Background and AimsNeonatal intensive care units (NICU) across the UK use different guidelines for the treatment of neonates at risk of sepsis. However, unless specific symptoms/risk factors for sepsis are...

Antibiotic Duration and Postoperative Infection Rates in Mandibular Fractures

Although the use of preoperative antibiotics has been proven effective, the value of postoperative antibiotics in the setting of mandibular fracture remains in question as does the appropriate duration of therapy. A retrospective study of all patients 18 years and older who presented with mandibular fractures to St Louis University Hospital between December 2001 and July 2006 was conducted. Collected variables included age, injury severity score, fracture type and location, preoperative antibiotic administration, antibiotic type, duration of antibiotic course, and postoperative infection. Infections were statistically compared with each. Of 253 identified patients, 197 qualified for study inclusion. A total of 9 postoperative infections were documented. When comparing individuals with postoperative infection to those without, age was the only significant difference between infected and uninfected groups, with older patients more likely to acquire infection. Injury severity score, fracture type, duration of antibiotic course, and antibiotic type were not significantly different. Our findings suggest that patient factors make a greater contribution to postoperative infection when compared with iatrogenic factors in the treatment of mandibular fractures. We found no evidence to support prolonged postoperative antibiotic therapy. Our findings bring into question the need for postoperative antibiotics for the treatment of mandibular fractures.