ID Specialists Research Articles

In-label, off-label prescription, efficacy and tolerability of dalbavancin: report from a National Registry

PurposeAlthough dalbavancin is currently approved for the treatment of ABSSIs, several studies suggest its efficacy and tolerance as long-term therapy for other off-label indications requiring prolonged intravenous antibiotic administration.MethodsWe conducted a prospective nationwide study of dalbavancin use in real-life settings for both approved and off-label indications analysing for each case the clinical and microbiological characteristics of infection the efficacy and safety of treatments.ResultsDuring the study period (from December 2018 to July 2021), the ID specialists from 14 different centres enrolled 223 patients treated with dalbavancin [141 males (63%) and 82 females (37%); male/female ratio 1.72; mean age 59 (SD 17.2) years, (range 15–96). Most patients in the study population (136/223; 61.0%) came from community rather than health care facilities and most of them were visited in Infectious Diseases wards (93/223; 41.7%) and clinics (55/223; 24.7%) even though some patients were cured in other settings, such as surgery wards (18/223; 8.1%), orthopaedic wards (11/223; 4.9%), Emergency Rooms (7/223; 3.1%) and non-surgical other than ID wards (6/223; 2.7%). The most common ID diagnoses were osteomyelitis (44 cases/223; 19.7%; of which 29 acute and 15 chronic osteomyelitis), cellulitis (28/223; 12.5%), cutaneous abscess (23/223; 10.3%), orthopaedic prosthesis-associated infection (22/223; 9.9%), surgical site infection (20/223; 9.0%) and septic arthritis (15/223; 6.7%).ConclusionIn conclusion, by virtue of its PK/PD properties, dalbavancin represents a valuable option to daily in-hospital intravenous or outpatient antimicrobial regimens also for off-label indications requiring a long-term treatment of Gram-positive infections.

EPASCORE: A new indicator for prescriptive appropriateness of antimicrobials: our experience

Abstract Background Antibiotic resistance is being a crucial issue in hospitals, and its control, passes through an appropriate use of antibiotics. To evaluate the prescriptive appropriateness, we introduced a new indicator which takes into account the rate of infections together with antimicrobial consumption and the median time of treatment of each event. Methods The “Estimated Prescriptive Appropriateness Rate” (EPA-SCORE) “has been calculated for each group of bacteria, as the rate between the observed consumption of an antibiotic (DDD/1000days of hospitalization) and the expected one as if the same antibiotic had been used for 10 days exclusively for the observed infections for which it was indicated, according to the following formula: EPASCORE = (DDD observed/expected)*1/(N.of infections). Data from January 2020 and June 2022 were collected while restrictive and persuasive strategies of Antimicrobial Stewardship were implemented. Changes in EPA-SCORE were evaluated through the years. Results In our hospital, in the first semester of 2022 prevalence of ESBL+ Gram negative-infections was 0.90 cases/1000 doh/year. The observed consumption of drugs indicated for those infections was 86.9 DDD/1000 dof, whilst the expected one for the registered number of infections was 9.01 DDD/1000doh, with an EPASCORE of 10.37%. Regarding multi-drug-resistant gram negative-infections, prevalence was 1.48/1000doh/year; observed antibiotic consumption for them (whose prescription was restricted to ID specialists) was 43DDD/1000doh, whilts the expected DDD was 29.6 DDD/1000doh (EPASCORE 67.7%). Comparing data between 2022 and the same period of 2020, a significant increase in EPASCORE was detected (+4.2% and +7.1% for ESBL+ and MDR Gram- infections in 2022 respectively) Conclusions Our date demonstrate that the EPASCORE represents a feasible indicator of appropriateness of antimicrobial prescription, and restrictive strategies of antimicrobial stewardship can help to improve its outcome. Key messages • Antimicrobial Stewardship has a leading role to face antimicrobial resistance. • EPA-SCORE is a feasible indicator to measure appropriateness of antimicrobial prescription.

Survey on infectious disease telephone hotlines in primary care: General practitioners’ satisfaction and compliance with advice

ObjectivesInfectious disease (ID) advice is a major part of antimicrobial stewardship programs. The objective of this study was to assess general practitioners’ (GPs)’ opinions and compliance with advice given by ID hotlines. Patients and methodsThis multicenter survey was based on the 7-day assessment of initial advice requested by GPs to a hotline set up by volunteer hospital ID teams to record advice for 3 years. The primary endpoint was the GPs’ satisfaction with the advice given by ID specialists. ResultsTen ID teams participated in the study and recorded 4138 requests for advice, of which 1325 requests included a proposal for antibiotic therapy and justified a follow-up call at seven days. Only 398 follow-up calls (30%) were carried out because many GPs were not reachable.GPs were very satisfied with ID hotlines: 58% considered them indispensable and 38% very useful. The recommendations provided by ID specialists were followed by GPs in more than 80% of cases. The two main motivations for GPs to call the hotline were to get quick advice (86%) and to receive help in managing a patient (76%). ConclusionsThe ID telephone consultations and advice systems for GPs are highly appreciated and are effective in terms of following the recommendations.

1001. Comparison of Periodic In-Person ID Care to Daily Tele-ID Care at a Community Hospital

Abstract Background Access to ID specialists is absent in most US counties. Remote access to ID specialists via telemedicine is a potential alternative to in-person ID care, although comparative data are lacking. We compared outcomes between periodic in-person and daily remote ID care. Methods Retrospective EHR analysis of 200 patients at a 164-bed community hospital, which historically had access to an in-person ID specialist every 3rd day with limited telephonic follow-up. In May of 2020, access to a team of Tele-ID specialists was provided through live audio-visual and e-consults, with telephonic consults after hours and on weekends. Outcomes for 100 consecutive patients cared for by the in-person physician from 01/2019 to 11/2019 were compared to the first 100 patients care for via Tele-ID from 05/2020 to 08/2020. Results Of the 100 patients seen via Tele-ID, 73 were live initial consults and 27 initial e-consults. These 100 consults occurred over 4 months compared with 11 months for the 100 in-person ID consults, revealing greater utilization. Most patients were Caucasian, male, and >60 years old (Table 1). Tele-ID patients had significantly higher Charlson Comorbidity Index (CCI) scores (5.3 vs 4.5, p=0.047), shorter LOS (7.5 vs 9.08 days, p=0.003), less frequent discharge on IV antibiotics (34% vs 51%, p=0.007), and more frequent discharge on PO antibiotics (39% vs 23%, p=0.014; Table 2). There were no significant differences in the frequency of transfer to tertiary care (13% vs 14%, p=0.84) or in-hospital mortality (2% vs 2%). The 30-day readmission rate was higher for Tele-ID (11% vs 1%, p< 0.01); however, only one readmission was ID-related (a new C.difficile). The diversity of ID diagnoses made was not different (Figure 1). Table 1.Patient DemographicsTable 2.OutcomesFigure 1.Diagnoses Conclusion A Tele-ID service with daily availability increased utilization of ID care at a community hospital. Despite higher CCI scores in Tele-ID patients, LOS was shorter and discharge on IV antibiotics was less frequent compared with the In-person service with no difference in ID related readmissions or in-house mortality. These findings support remote Tele-ID care as a solution where access to ID expertise is limited. Disclosures John W. Mellors, MD, Abound Bio: Multiple|Abound Bio: Ownership Interest|Gilead Sciences: Advisor/Consultant|Infectious Disease Connect: Advisor/Consultant|Infectious Disease Connect: Ownership Interest Rima Abdel-Massih, MD, Infectious Disease Connect: Co founder and Chief Medical Officer|Infectious Disease Connect: Ownership Interest.

Presumed Urinary Tract Infection in Patients Admitted with COVID-19: Are We Treating Too Much?

Despite the low rates of bacterial co-/superinfections in COVID-19 patients, antimicrobial drug use has been liberal since the start of the COVID-19 pandemic. Due to the low specificity of markers of bacterial co-/superinfection in the COVID-19 setting, overdiagnosis and antimicrobial overprescription have become widespread. A quantitative and qualitative evaluation of urinary tract infection (UTI) diagnoses and antimicrobial drug prescriptions for UTI diagnoses was performed in patients admitted to the COVID-19 ward of a university hospital between 17 March and 2 November 2020. A team of infectious disease specialists performed an appropriateness evaluation for every diagnosis of UTI and every antimicrobial drug prescription covering a UTI. A driver analysis was performed to identify factors increasing the odds of UTI (over)diagnosis. A total of 622 patients were included. UTI was present in 13% of included admissions, and in 12%, antimicrobials were initiated for a UTI diagnosis (0.71 daily defined doses (DDDs)/admission; 22% were scored as ‘appropriate’). An evaluation of UTI diagnoses by ID specialists revealed that of the 79 UTI diagnoses, 61% were classified as probable overdiagnosis related to the COVID-19 hospitalization. The following factors were associated with UTI overdiagnosis: physicians who are unfamiliar working in an internal medicine ward, urinary incontinence, mechanical ventilation and female sex. Antimicrobial stewardship teams should focus on diagnostic stewardship of UTIs, as UTI overdiagnosis seems to be highly prevalent in admitted COVID-19 patients.

959. Online CME Successful at Improving Knowledge, Competence and Confidence on Incorporating mAbs for COVID-19 Among a Global Audience

BackgroundThe incorporation of effective treatments is critical to improving patient care for COVID-19. We assessed the educational impact of a series of continuing medical education (CME) activities on knowledge, competence, and confidence changes in US and OUS physicians related to the use of monoclonal antibodies (mAbs) for COVID-19.Methods10 online, CME-certified activities were delivered in multiple formats. For individual activities, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 1 to 7-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question. To assess changes in knowledge, competence, and confidence, data were aggregated across activities and stratified by learning theme. McNemar’s test or paired samples t-test (P< .05) assessed educational effect. The activities launched between November 2020 and May 2021; data were collected through May 2021.ResultsTo date, the 10 activities have reached over 50,000 clinicians, including 24,627 physicians. Selected improvement/reinforcement in knowledge/competence measured as relative % change in correct responses pre/post education across the learning themes are reported. (i) 89% improvement/reinforcement among US ID specialists in knowledge/competence incorporating mAbs into patient care and 83% improvement among outside the US (OUS) ID specialists (P < .001). (ii) 70% improvement/reinforcement among US PCPs in knowledge/competence incorporating mAbs into patient care and 55% improvement among OUS PCPs (P < .001). (iii) 52% improvement/reinforcement in knowledge/competence among US PCPs regarding clinical data for mAbs and 44% among OUS PCPs (P < .001). (iv) 42% of US ID specialists and 29% of OUS ID specialists had a measurable improvement in confidence in identifying patients who would benefit from mAbs (P < .001).ConclusionThis series of online, CME-certified educational activities resulted in significant improvements in knowledge, competence, and confidence regarding the appropriate use of mAbs for SARS-CoV-2 in clinical practice. These results demonstrate the effectiveness of global curriculum-based education for clinicians designed to address specific gaps in care. Disclosures All Authors: No reported disclosures

120. Antimicrobial Prescribing Guidance and Communication Among Health Care Professionals in Five Guatemalan Hospitals

BackgroundCommunication among health care professionals during antimicrobial prescribing is critical to ensure appropriate use. This is of concern in Guatemala where physicians seldom consider guidance from other professionals during antimicrobial prescribing activities. MethodsWe carried out a cross sectional questionnaire and open ended interviews with physicians from five hospitals in Guatemala to describe perceptions of communication between health care providers, and acceptance of antimicrobial guidance during prescribing. ResultsFrom January to April 2021 an electronic questionnaire was sent to enrolled physicians of which 74% completed participation (n=107/145). Fifty-five percent participated in open ended interviews (n=79/145). Respondents perceived high levels of communication between physicians and ID specialists (94% of respondents); 52%, and 54% perceived high levels of physician-pharmacist, and physician-nurse communication respectively. Significant differences in the perception of physician-pharmacist communication were detected when comparing responses between hospitals, and between respondent sex (chi2, p< 0.05). Barriers to communication between professionals included lack of local guidelines or protocols, patient overload, COVID-19 pandemic, lack of mentorship, and little room to discuss antimicrobial therapy with higher-ranking physicians. Eighty percent and 45% of physicians were open to receiving antibiotic optimization recommendations from other physicians, and pharmacists respectively. Notable barriers to accepting recommendations from pharmacists included lack of regular communication, lack of clinical experience, and concern about evidence based recommendations. ConclusionEffective communication is perceived between physicians during antimicrobial prescribing activities. Marginal levels of communication and acceptance of prescribing recommendations have been detected between physicians and pharmacists.In this milieu, there is an opportunity to strengthen multidisciplinary teams to optimize antimicrobial use.Disclosures Mario Augusto Melgar Toledo, MD, Merck (Grant/Research Support)Pfizer (Grant/Research Support)

304. Impact of Antibiotic Prophylaxis Prior to Treatment with Steroids and Tocilizumab in COVID-19 Patients

BackgroundThe incidence of bacterial or fungal coinfections in COVID-19 patients is low. The incidence of nosocomial superinfections is higher, especially related to ICU admission. Treating COVID-19 with steroids plus tocilizumab (TCZ) has been associated with superinfections. Therefore, the use of antibiotic prophylaxis prior to infusion of TCZ could be considered to reduce the risk of life-threatening superinfections in critically ill patients.MethodsRetrospective, single center cohort study. COVID-19 patients older than 14 years, admitted to Hospital Central de la Defensa (Madrid, Spain) from Mar 5th to Nov 24th, 2020 with a diagnosis of COVID-19 were included. Local protocols suggested antimicrobial prophylaxis before the infusion of TCZ. Medical records, treatments received, and microbiological data of all patients who received TCZ were reviewed. Microbiological isolates were considered in the 14 days following the administration of TCZ. Two ID specialists independently reviewed the medical record and decided to qualify the isolate as superinfection or colonization.Results2,069 patient records were analyzed. 70 patients received TCZ; all of them were admitted to ID wards and under steroid treatment. 45 (64,5%) patients received antibiotic prophylaxis. The preferred antibiotics were ceftriaxone (N = 18) and ceftobiprole (N = 14). No significant differences were found in age, Charlson index or COVID-19 SEIMC-Score. 24 isolates were detected in 14 patients (18 bacterial, 6 fungal). 17 isolates were considered superinfections; the most frequent isolates were C. albicans (N=5), E. faecalis (N=3) and S. epidermidis (N=2). There were no statistically significant differences between the different prophylaxis strategies in terms of in-hospital mortality or ICU admission. However, patients who received ceftobiprole tended to have fewer isolates and fewer superinfections than those receiving ceftriaxone (ceftobiprole group: 2 isolates in 1 patient, 1 (7,1%) patient with superinfection; ceftriaxone 11 isolates in 5 patients, 4 (22,2%) patients with superinfection) (p= 0,35, Fisher exact test).Table 1. Characteristics of study population. Table 2. Outcomes according to antimicrobial prophylaxis prior to Tocilizumab. Table 3. Description of isolates. ConclusionAntibiotic prophylaxis prior to infusion of TCZ in patients with COVID-19 and receiving steroids could determine the profile of bacterial and fungal superinfections.Disclosures All Authors: No reported disclosures

Status of antimicrobial stewardship programmes in Korean hospitals including small to medium-sized hospitals and the awareness and demands of physicians: a nationwide survey in 2020

This study aimed to identify the status of antimicrobial stewardship programmes (ASPs) in small to medium-sized Korean hospitals as well as the awareness and demands about ASPs of physicians. A questionnaire was designed based on a questionnaire from a previous nationwide survey in 2018 targeting large hospitals in Korea and modified to reflect the results of in-depth interviews with non-infectious diseases (IDs) physicians at secondary care hospitals. The survey targeted all hospitals with ≥150 beds in South Korea and was performed in May-June 2020. Only one ASP-associated physician per hospital participated in the survey. The survey response rate was 31.9% (217/680). ID specialists comprised the majority of medical personnel participating in ASPs in tertiary care hospitals. Conversely, in secondary and primary care hospitals there was no predominant medical personnel for ASPs and the median full-time equivalent was 0 for all types of medical personnel. Tertiary care hospitals, more than secondary and primary care hospitals, tended to perform ASP activities more actively. 'Workforce for ASPs', 'Establishment of healthcare fees for ASPs' and 'Development of tools for ASPs' were the most important required support for ASP improvement. The level of ASP establishment was more limited in primary care hospitals than in secondary and tertiary care hospitals in Korea. To improve ASPs in Korean hospitals, a supporting workforce and the establishment of a healthcare fee for ASPs appear to be necessary.

Design and methods of a multi-site randomized controlled trial of an integrated care model of long-acting injectable buprenorphine with infectious disease treatment among persons hospitalized with infections and opioid use disorder

BackgroundHospitalization with co-occurring opioid use disorder (OUD) and infections presents a critical time to intervene to improve outcomes for these intertwined epidemics that are typically managed separately. A surge in life-threatening infectious diseases associated with injection drug use, including bacterial and fungal infections, HIV, and HCV accounts for substantial healthcare utilization, morbidity, and mortality.Infectious Disease (ID) specialists manage severe infections that require hospitalization and are a logical resource to engage patients in medication treatment for OUD (MOUD). An injectable long-acting monthly formulation of buprenorphine (LAB) has a potential advantage for initiating MOUD within hospital settings and bridging to treatment after discharge. MethodsA randomized multi-site trial tests a new model of care (ID/LAB) in which OUD and infections are managed by ID specialists and hospitalists using LAB coupled with referrals to community resources for long-term MOUD. A sample of 200 adults admitted to three U.S. hospitals for OUD and infections are randomly assigned 1:1 to ID/LAB or treatment as usual (TAU). The primary outcome measure is the proportion of patients enrolled in effective MOUD at 12 weeks after randomization. Secondary outcomes include relapse to opioid use, adherence to infectious disease treatment, infection morbidity and mortality, and drug overdose. ResultsWe describe the design, procedures, statistical analysis, and early implementation issues of this randomized trial. ConclusionsStudy findings will provide insight into the feasibility and effectiveness of integrated treatment of OUD and serious infections and have the potential to reduce morbidity and mortality in this vulnerable population.

573. Continuing Medical Education: Leveraging a Digital Tool to Help Improve CMV Management Strategies

BackgroundIncreasing the risk for complications and negatively impacting patient health outcomes, an estimated 45% - 80% of HSCT patients experience CMV infection/reactivation, with mortality rates sometimes reaching as high as 60%.Figure. Assessment of Educational Effectiveness MethodsThis study assessed the ability of digital education to improve the ability of ID specialists to make evidence-based recommendations for CMV management in HSCT recipients. A CME/ABIM MOC educational program featuring interactive discussion between two ID faculty was developed and launched on 12/12/19, on a website dedicated to continuous professional development. Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design; each individual served as his/her own control. A chi-square test assessed changes pre- to post-assessment. P values < 0.05 are statistically significant. Effect sizes were evaluated using Cramer’s V (< 0.05 modest; 0.06–0.15 noticeable effect; 0.16–0.26 considerable effect; > 0.26 extensive effect). Data for this matched-learner analysis were collected through 04/14/20.ResultsTo date, 3315 HCPs (2891 physicians; 162 nurses/NPs) have participated in the activity. Data from the subset of ID specialists (n=190) who answered all pre-/post-assessment questions during the initial study period were analyzed. Following activity participation, significant improvements were observed in the proportion of ID specialists who answered all assessment questions correctly (8% pre vs 28% post; P < .0001; V=.217). Improvements were also observed in several specific areas of assessment (Figure). Additionally, 65% of ID specialists indicated they planned to modify their patient assessment or treatment approach because of participating in the education.ConclusionParticipation in this digital educational program significantly improved ID specialists’ ability to differentiate among therapeutic options when developing management strategies for HSCT recipients with CMV infection/reactivation. These findings highlight the potential for well-designed online education to positively impact physicians’ competence and confidence.Disclosures All Authors: No reported disclosures

1114. Identifying and Addressing Knowledge Gaps in Influenza Management with Targeted Continuing Medical Education

BackgroundInfluenza represents a year-round disease burden. Despite CDC recommendations, providers do not always effectively test for and treat influenza. To address identified knowledge gaps regarding the care of patients with or at-risk for influenza infection, a series of continuing education (CE) initiatives were implemented for distinct specialty audiences, and the impact of the education on provider knowledge was measured.MethodsBetween July 2018 and June 2020, Vindico Medical Education provided 35 CME programs (19 web, 14 live, and 2 print) targeted primarily to any of 4 specialty audiences – ID specialists, pulmonologists, emergency medicine providers, or primary care providers (PCPs). Baseline knowledge and educational impact were assessed via pre-and post-test, respectively, across 3 primary topics – testing, mechanisms of therapeutic agents, and treatment.ResultsAs of June 1, 2020, 39,677 healthcare providers participated in the education and 19,209 had obtained CE credit. Baseline knowledge was lowest regarding testing (44%) and antiviral mechanisms (43%), particularly among all but the pulmonology specialists. Average post-test scores were highest among pulmonology (85%) and primary care (85%) providers. The average relative increase in knowledge across all topics and specialties was 69%. A total of 17,480 providers who see on average 8.5 patients per month presenting with flu-like symptoms committed to practice improvements, resulting in approximately 150,000 patients per month who are more likely to receive the latest evidence-based care. Moreover, three months following the education, 68% of providers reported implementing practice improvements, including applying the latest clinical guidelines and recommendations.ConclusionAs data regarding new options for the treatment of influenza continues to emerge, CE education on these topics will be needed. This study highlights the efficacy of multimodal CE to address knowledge gaps among providers who see patients with or at-risk for influenza infection.Disclosures All Authors: No reported disclosures

2565. Initial and Recurrent Episodes of Clostridioides difficile: Online Education as a Tool to Improve Management Strategies

BackgroundThe most common cause of infectious diarrhea in hospitalized patients, C. difficile is responsible for nearly half a million infections annually. Among persons over the age of 65 years, 1 in 11 die within a month of diagnosis.MethodsA CME-certified/ABIM MOC educational program was developed to evaluate and improve ID specialists’ application of the latest guideline recommendations for the diagnosis and management of individuals with C. difficile. Modeled on the interactive grand rounds approach, the activity blended case-based presentation with multiple-choice questions. Using a “test then teach” approach to elicit cognitive dissonance, the activity provided evidence-based feedback following each learner response. Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design; each individual served as his/her own control. A chi-square test assessed changes pre- to post-assessment. P values < 0.05 are statistically significant. Effect sizes were evaluated using Cramer’s V (< 0.05 modest; 0.06–0.15 noticeable effect; 0.16–0.26 considerable effect; > 0.26 extensive effect). The activity launched on a website dedicated to continuous professional development on May 29, 2018. Data for this initial analysis were collected through March 27, 2019.ResultsTo date, 3274 HCPs, including 2946 physicians have participated in the activity. Data from the subset of ID specialists (n = 82) who answered all pre-/post-assessment questions during the initial study period were analyzed. Following activity participation, significant improvements were observed in the proportion of ID specialists who answered all assessment questions correctly (4% pre vs. 74% post; P < 0.0001; V = .555). Improvements were also observed in several specific areas of assessment (table). Additionally, 50% of ID specialists indicated they planned to modify their treatment approach and 18% planned to modify their diagnostic strategies for C. difficile.ConclusionParticipation in this online, interactive, case-based, educational intervention significantly improved ID specialists’ management strategies for initial and recurrent episodes of C. difficile. These findings highlight the positive impact of well-designed online education. Disclosures All authors: No reported disclosures.

461. Management of ABSSSIs: An Assessment of Knowledge, Competence and Clinical Practices among ID Specialists

BackgroundOne of the most common bacterial infections overall and among the most common causes for ED referral and/or hospital admission, ABSSSIs continue to impart a significant public health burden. The rising tide of MDROs has limited the clinical utility of many traditional antibiotics and increasing age and comorbid conditions such as diabetes, impaired renal or hepatic function, and CVD disease further complicate patient management strategies, putting patients at increased risk for treatment failure.MethodsA continuing medical education (CME)-certified clinical practice assessment comprising 25 multiple choice questions that measured ID specialists’ knowledge, competence, confidence and current practices in the management of ABSSSIs. The survey instrument was launched on a website dedicated to continuous professional development on July 27/18. Respondent confidentiality was maintained and responses were de-identified and aggregated prior to analyses.ResultsTo date, 2921HCPs, including 2,380 physicians have participated in the activity. Data for ID specialists who had participated as of April 17, 2019 are presented; data collection are ongoing. The majority of ID specialists (68%; n = 268) practiced in the inpatient setting. Despite a relatively high level of confidence in several areas (Table 1 and data not shown), the data identified several knowledge and competence gaps with regard to antimicrobial agent selection, treatment duration, and management of complicated ABSSSIs (Table 2). The most frequently cited barriers to optimal care included: (i) logistical challenges in arranging for appropriate patient follow-up (33%; n = 122); (ii) knowledge about appropriate duration of antibiotic therapy (19%; n = 71); and (iii) access to more expensive antibiotic therapies that may be more effective (19%; n = 71).ConclusionThis activity identified knowledge and competency gaps in the management of patients with ABSSSIs. These findings will be used to inform the development of educational programs that may help narrow these gaps and improve patient care. Disclosures All authors: No reported disclosures.

1331. Interpretation and Application of Rapid Diagnostic Methodologies: The Positive Impact of Online, Curriculum-Based Learning

BackgroundAntibiotic resistance has become one of the most serious public health threats today. Used appropriately, newer rapid diagnostic methodologies have the potential to positively impact care by informing a more targeted treatment approach that can reduce inappropriate antibiotic use, support antimicrobial stewardship, shorten hospital stays, and improve clinical outcomes.MethodsTo improve ID specialists’ knowledge and application of rapid diagnostic tests, a CME/ABIM MOC/ACCENT certified curriculum was developed. The curriculum comprised a series of 4 educational episodes, each with a video commentary from a clinical expert and each focused on a different site of infection: (a) Episode 1: CNS; (b) Episode 2: Gastrointestinal tract; (c) Episode 3: Respiratory tract; and (d) Episode 4: Bloodstream. The episodes in the curriculum were launched in serial fashion between October 30, 2018 and February 11, 2019, on a website dedicated to continuous professional development. Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design; each individual served as his/her own control. A chi-square test assessed changes pre- to post-assessment. P values of < 0.05 are statistically significant. Effect sizes were evaluated using Cramer’s V (<0.05 modest; 0.06–0.15 noticeable effect; 0.16–0.26 considerable effect; >0.26 extensive effect).Results15,092 HCPs, including 10,894 physicians have participated in the curriculum. This initial analysis comprises data from the subset of ID specialists from each episode who answered all pre-/post-assessment questions through March 18, 2019; data collection is ongoing. Following participation, significant improvements were observed overall (P ≤ 0.002 for each episode) and on the specific topics assessed in each episode (Graph). Additionally, 51%–55% of ID specialists indicated an intent to modify their diagnostic approach and 15%–29% had increased confidence in applying the rapid diagnostic results into patient care.ConclusionThis educational curriculum significantly improved ID specialists’ knowledge of the strengths and limitations of different rapid diagnostic methodologies and improved the applications of test findings into clinical decision-making. These findings highlight the positive impact of well-designed online education. Disclosures All authors: No reported disclosures.

1979. Five-Year Impact of an Antimicrobial Stewardship Program on Nosocomial Candidemia: An Interrupted Time-Series Analysis Study

BackgroundAntimicrobial stewardship programs allow a reduction in antibiotic prescription and, consequently, in the incidence of multidrug-resistance infections. However, the impact on nosocomial candidemia is still unclear.MethodsThe present study is an interrupted time-series (ITS) before-after study, based on an ecological time-trend analysis. Since 2014, an antimicrobial stewardship program (ASP) has been implemented at an Italian tertiary-care hospital. The first objective of the program was to reduce carbapenem consumption, through an active and computerized surveillance of all carbapenem prescriptions, each of which was checked and validated by ID specialists always after audit of the cases with treating physicians. We retrospectively evaluated the changing in the consumption of antimicrobials, carbapenems, and in the incidence of candidemia, during two study periods: before (2007–2013) and after (2014–2018) the implementation of the ASP.ResultsThe implementation of ASP was followed by a significant decrease in antibiotic consumption, which was consistent through the following 5 years. At the end of the study, total antibiotic consumption has decreased by 38.476 DDDs per 100 patient-days (PDs) per quarter (95% CI: −21.784 to −55.168; P < 0.001) and carbapenems decreased by 4.452 DDD per 100 PDs per quarter (95% CI: −3.658 to −5.246; P = 0.001). After 5 years of ASP, incidence of candidemia decreased by 2.034 episodes per 1,000 PDs per quarter (95% CI: −0.738 to −3.330; P = 0.003), decreasing, at the end of 2018, by 53% compared with the expected value if the program had not been implemented.ConclusionAt our Institution, the ASP had a positive impact on the consumption of carbapenems, and antimicrobials. The incidence of candidemia was also favorably affected by the program, reversing the trend after 2014. The ASP, even if not directly targeted to fungal infections, indirectly caused a reduction in the incidence of candidemia, probably reducing the number of patients colonized by Candida spp.Disclosures All authors: No reported disclosures.

1987. Impact of Updated IDSA Clostridium difficile Guidelines on the use of Fidaxomicin in a Large Health System

BackgroundFidaxomicin (fidax) is approved for treatment of Clostridioides difficile infection. In February 2018 IDSA/SHEA released updated guidelines suggesting expanded use of fidax, recommending it or oral vancomycin (po vanc) in severe or non-severe initial episodes or for most recurrences. In April 2018, University of Pittsburgh Medical Center (UPMC) relaxed system-wide guidelines to allow for fidax use in the first recurrence of C. difficile or later, with earlier use allowed by ID or GI specialists or with local Pharmacy and Therapeutics Chair approval. Hospitals could continue to be more restrictive if desired. We reviewed changes in fidax, po vanc, and IV/PO metronidazole (metro) use at UPMC hospitals after guideline changes.MethodsFor the reviewed antibiotics, hospital-level usage was evaluated at 15 UPMC hospitals before/after system-level changes. Usage was measured as days of therapy per 1,000 patient-days (DOT/1,000 PD). Sites were further grouped by the level of restrictions: Standard (following new system guidelines) or more restrictive (additional restrictions remained in place locally). Hospitals were also grouped by type of local stewardship programs (ASP): Robust (included an Infectious Diseases trained clinical pharmacist or ID physician with specific time dedicated to antibiotic review) or Non-Robust.ResultsFigure 1 shows before/after changes in usage at all hospitals. Figure 2 shows changes in Standard vs. More Restrictive hospitals, and Figure 3 shows changes in Robust vs. Non-Robust hospitals.ConclusionFidax use remained low, but an increase was seen after the release of the guidelines and relaxation of system restrictions, mainly in hospitals without additional restrictions in place. PO vanc also increased across the system, possibly indicating better adherence to updated guidelines regarding less metro use for C. difficile treatment. Although minimal decrease, if any, was seen with metro itself. This could have been compounded by the recent fluid shortage as well as other common uses for metro. Dissemination of new guidelines to providers should be a key function of ASPs as well as monitoring for changes in usage after implementation of local changes. Further studies are needed to define any differences in practice patterns and clinical outcomes related to changes in guidelines. Disclosures All authors: No reported disclosures.

Telemedicine and Infectious Diseases Practice: A Leap Forward or a Step Back?

Infectious Diseases (ID) specialists pride themselves on performing a thorough history and physical exam, and developing a comprehensive diagnosis and management plan. A timely question is whether this tradition is at risk from the coming wave of telemedicine in clinical practice? It would not be if ID specialists embrace the changes ahead and leverage new technologies to enhance the efficiency and reach of their clinical practices. In this report, we highlight the opportunities and challenges offered by telemedicine for ID practice (Table 1).

2017. Improving Timely Diagnosis of Meningitis and Encephalitis: The Effectiveness of Online CME

BackgroundTimely and accurate diagnosis of meningitis and encephalitis not only guides the patient care strategy, but can reduce inappropriate antibiotic use, support antimicrobial stewardship, shorten hospital stays, and decrease morbidity and mortality.MethodsTo address knowledge and competence gaps among ID specialists, a CME/CE-certified. Thrity-minute, video-based, multidisciplinary panel discussion was developed and posted online on August 2, 2017. Featuring three faculties with therapeutic expertise, the activity addressed: Distinguishing characteristics of various diagnostic methods; considerations when interpreting test results; and applying findings to patient care decisions Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design, in which each individual served as his/her own control. Responses to three multiple-choice, knowledge/competence questions and 1 self-efficacy confidence question were analyzed. A chi-squared test assessed changes pre- to post-assessment. P value of <0.05 is statistically significant. Effect sizes were evaluated using Cramer’s V (<0.05 modest; 0.06–0.15 noticeable effect; 0.16–0.26 considerable effect; >0.26 extensive effect). Data were collected through September 7, 2017.ResultsA total of 4,712 healthcare providers, including 3,317 physicians have participated in the activity. Data from ID specialists (n = 266) who answered all pre-/post-assessment questions during the study period were analyzed. Significant improvements were observed overall (P = 0.0002; V = 0.156) and in several specific areas of assessment (figure). Following activity participation, 29% of ID specialists indicated increased confidence in diagnosing meningitis and encephalitis using rapid molecular tests and 89% of ID specialists indicated a commitment to incorporate one or more changes into practice. Finally, the findings also uncovered educational needs that are the focus of ongoing interventions.ConclusionParticipation in this online education significantly improved ID specialists’ knowledge and competence with regard to using rapid molecular tests to diagnose meningitis and encephalitis. These findings highlight the positive impact of well-designed online education. Disclosures S. Hurst, BioFire Diagnostics: Independent Medical Education, Educational grant. S. Smith, BioFire Diagnostics: Independent Medical Education, Educational grant.

1307. Emerging Treatments in Ongoing Battle Against Community-Acquired Bacterial Pneumonia (CABP): The Positive Impact of Online Education

BackgroundThe leading infectious cause of hospitalization and infection-related mortality, pneumonia imparts a significant, but often underappreciated, burden. Agents in the antibiotic pipeline have the potential to improve both individual and public health, as well as support antibiotic stewardship programsMethodsTo address knowledge gaps among ID specialists, a CME/CE-certified, 30-minute, video-based, multidisciplinary panel discussion was developed and posted online on March 27, 2018. Featuring four expert faculty, the activity addressed: The evolving etiology of CABP; Emerging antibiotics for CABP treatment; and Antibiotic stewardshipEducational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design, in which each individual served as his/her own control. Responses to multiple-choice, knowledge questions and a self-efficacy confidence question were analyzed. A chi-squared test assessed changes pre- to post-assessment. P values <0.05 are statistically significant. Effect sizes were evaluated using Cramer’s V (<0.05 modest; 0.06–0.15 noticeable effect; 0.16–0.26 considerable effect; >0.26 extensive effect). Data were collected through April 23, 2017.ResultsA total of 6,146 healthcare providers, including 2,936 physicians have participated in the activity. Data from ID specialists (n = 130) who answered all pre-/post-assessment questions during the study period were analyzed. Significant improvements were observed overall (P = 0.024; V = 0.080) and in several specific areas of assessment (figure). Following activity participation, 34% of ID specialists indicated increased confidence in assessing key attributes of emerging agents and 79% of ID specialists indicated a commitment to incorporate one or more changes into practice. Lastly, the findings uncovered educational needs that require further educational intervention.ConclusionParticipation in this online educational intervention significantly improved ID specialists’ knowledge with regard to the key similarities and differences between agents in the CABP antibiotic pipeline and the potential role of these agents in patient care. These findings highlight the positive impact of well-designed online education. Disclosures All Authors. Nabriva Therapeutics: Independent Medical Education, Educational grant.