Infectious Disease Physicians Research Articles

2130. Neonatal Immune Phenotypes and Neurodevelopmental Outcomes in Infants with Congenital Cytomegalovirus Infection (cCMV)

Abstract Background Infants with congenital cytomegalovirus infection (cCMV) are at risk for neurodevelopmental impairment (NDI). Antiviral therapy has been shown to improve neurodevelopmental outcomes but is not recommended for all infected infants. There are currently no predictive markers for NDI in infants with cCMV. Our objective was to compare neonatal T cell differentiation and memory phenotypes in CMV-infected infants with and without subsequent NDI. Methods Blood samples were collected from infants with cCMV and age-matched healthy controls. Peripheral blood mononuclear cells were analyzed by flow cytometry for CD4 and CD8 T cells expressing CD28, CD57, PD, CD45RA/RO, and CCR7. Demographic and clinical data were collected. NDI was defined as Bayley III/IV testing below the average range in at least one domain in infants for whom this developmental testing was available or based on diagnosis by infectious disease physician or primary care provider. Outcomes for infants with follow-up at least 6 months of age were included. Infants with isolated speech delay associated with hearing loss were not considered to have NDI. Results Samples were analyzed from 18 infants (Table 1) at time of diagnosis (≤ 60 days of age) and 5 uninfected age-matched controls. The frequencies of CD8+ T cells expressing CD28low (differentiation), CD57+ (terminal differentiation/senescence), PD1hi (inhibitory or exhausted phenotype) and CD45RO± (memory) phenotypes were higher for the cCMV group without NDI compared to that with NDI (Figure 1). The cCMV group without NDI had lower proportions of naïve (CCR7+/CD45RA+) effector memory, TEM (CCR7-/CD45RA-), and effector memory RA, TEMRA (CCR7-/CD45RA+) CD8+ T cells than those with NDI (Figure 2). There was no difference in memory distribution or surface marker expression of CD4+ T cells. Table 1 Demographic and clinical characteristics of the infants with congenital cytomegalovirus infection (cCMV) with and without neurodevelopmental impairment (NI) and age-matched controls. Continuous variables are compared using the Mann Whitney U test and categorical variables with the Fischer’s Exact test. There were no significant differences between infants with and without NI. Figure 1.CD8+ T cell phenotypes in cCMV groups with and without Neurodevelopmental Impairment (NDI) Frequencies of CD8+ T cells lacking expression of CD28 (A), or expressing CD57 (B), PD-1 (C), or CD45RO (D) are shown at age ≤ 60 days. Infants with congenital CMV (cCMV) and normal neurodevelopmental outcome are shown in blue, infants with neurodevelopmental impairment are shown in red, and uninfected age-matched controls are shown in black. Data are shown as medians [interquartile range]. Groups were compared using the Mann Whitney U Test. Infants with no NDI had significantly higher frequencies of CD28- (p = 0.002), CD57+ (p = 0.001), PD-1+ (p = 0.01) and CD45RO+ (p = 0.01) CD8 T cells. * p ≤ 0.05; ** p ≤ 0.01. Figure 2.T cell memory subset distributions among cCMV groups and uninfected controls Proportions of CD4+ (A) and CD8+ (B) naïve (CCR7+/CD45RA+), central memory, TCM (CCR7+/CD45RA-), effector memory, TEM (CCR7-, CD45RA-), and effector memory RA, TEMRA (CCR7-/CD45RA+) T cells. Infants with congenital CMV (cCMV) and normal neurodevelopmental outcome are shown in blue, infants with neurodevelopmental impairment (NI) are shown in red while uninfected age-matched controls are shown in black and gray. Comparisons between T cell groups were made using the Mann Whitney U test. Infants with cCMV without NI had significantly fewer naïve (p = 0.0001), greater TEM (p = 0.0001), and TEMRA (p = 0.005) CD8+ T cells than those with NI. The distributions of CD4+ T cells were not significantly different. Conclusion In this small cohort of infants infected with CMV, these data suggest that a more differentiated memory CD8+ T cell phenotype in the neonatal period may correlate with normal neurodevelopmental outcomes. Disclosures Alexandra K. Medoro, MD, Merck: Grant/Research Support.

1658. Using remote Infectious Disease physician expertise to support inpatient antibiotic stewardship activities at three VA medical centers an implementation-effectiveness trial

Abstract Background Remote Infectious Disease (ID) physicians can provide stewardship support through telehealth. Using the RE-AIM framework, we assessed the implementation of telehealth-supported prospective-audit-and-feedback (tele-PAF) across 3 rural Veterans Administration medical centers (VAMC). Methods All 3 invited sites agreed to participate and lacked ID support for stewardship at baseline. During 2021, an ID physician met virtually 3 times/week with the stewardship pharmacist champion at each participating VAMC to review patients on antibiotics in acute-care (mean daily census 3/site) and nursing-homes (NHs; mean census 71/site); real-time feedback on antibiotic use was given to clinicians. The primary outcome of effectiveness was monthly antibiotic days of therapy (DOT) per 1,000 days-present aggregated across all sites; the secondary outcome was days of antibiotic spectrum coverage (DASC) per 1,000 days-present. An interrupted time-series analysis was performed to asses these outcomes during the 1-year intervention period vs. the 2-year prior baseline. Semi-structured interviews with 20 clinicians and pharmacists were conducted to assess implementation. Results RE-AIM elements are summarized in Table 1. Tele-PAF reviewed 502 unique patients and made 681 recommendations to 23 clinicians; 77% of recommendations were accepted. The most common recommendations were to stop antibiotics (28%) and change duration (20%). After the start of tele-PAF, antibiotic DOT and DASC immediately decreased in acute-care (-20%, p=0.01; -22%, p< 0.01) and NHs (-28%, p=0.03; -37%, p< 0.01). Both metrics began to rise again in acute-care (DOT: +2.5%/month, p=0.02; DASC: +2.7%/month, p=0.02) but were stable in NHs (Figure 1). Clinicians generally appreciated feedback, found it compatible with their workflow and responded favorably to collaborative discussions. Barriers included difficulty establishing rapport with some providers. Conclusion The implementation of tele-PAF was associated with sustained reductions in antibiotic use across 3 NHs but not in the studied small acute-care units. Overall, clinicians perceived the intervention as acceptable and appropriate. Wider implementation of telehealth-supported stewardship activities may achieve reductions in antibiotic use. Disclosures Daniel J. Livorsi, MD, Merck & Co.: Grant/Research Support.

1755. Interactive Provider Dashboards for Comparison of Outpatient Antimicrobial Prescribing for Respiratory and Otic Conditions in Urgent and Quick Care Clinics

Abstract Background Due to antibiotic overutilization, development of antimicrobial stewardship (AMS) in the outpatient setting has become a necessary focus for AMS programs. The cornerstone of AMS is utilization of antimicrobial prescribing data to provide feedback to individual providers and compare providers to each other in order to promote improved prescribing practices. Respiratory infections, especially conditions that never require antimicrobials, are a common target for this feedback. We aimed to create interactive data visualization dashboards of end-users prescribing for these respiratory and otic conditions in order for AMS and urgent/quick care program staff to identify potential areas of intervention. Methods A multidisciplinary work group consisting of data analysts, infectious diseases physicians, urgent/quick care physicians, and infectious diseases pharmacists determined dashboard content, layout, and comparison charts. Graph types were tested to determine optimal visual output. Using the electronic medical record ICD10 and antimicrobial prescription data was extracted for the encounter with focus on ICD10 codes for respiratory and otic conditions which never require antimicrobials. Rates were calculated as number of antimicrobial prescriptions over total number of visits for these conditions. Results A multi-faceted dashboard was developed in Tableau® to view antimicrobial prescribing rates. Dashboard capabilities include the option to view individual provider prescribing rates compared to other de-identified providers, overall clinic prescribing rate, or individual rate compared to clinic rate. This allows for quick direct comparison of antimicrobial prescribing on the same graph by clinic to identify outliers (Figure 1) and allows visualization of trends in prescribing rates by clinics and providers over time (Figures 2,3). Never Antimicrobial Prescribing Rate Comparison Scatter plot comparing individual prescribers rate of prescribing for never antimicrobial events Clinic Antimicrobial Prescribing Rate Trend Clinic prescribing rate trend over time for never antimicrobial events Prescriber and Clinic Antimicrobial Prescribing Rate Trend Individual prescriber rate compared to clinic rate over time for never antimicrobial events Conclusion We developed an interactive outpatient AMS dashboard to visualize prescribing of antimicrobials for never respiratory and otic conditions. These dashboards can be used by providers along with AMS and clinic leadership to determine areas of intervention in the urgent/quick care setting. Disclosures Kelly M. Percival, PharmD, Gilead Sciences Inc: Advisor/Consultant Patrick M. Kinn, PharmD, MPH, Gilead Sciences: Advisor/Consultant Dilek Ince, MD, Evergreen: Member of data monitoring board|Gilead Sciences: Grant/Research Support|Leidos: Grant/Research Support|Moderna: Grant/Research Support.

674. Successful Management of ESBL Infections in Physician Outpatient Infusion Centers (POICs)

Abstract Background Infections with extended-spectrum β-lactamase (ESBL)-producing pathogens present treatment challenges with higher costs of care. Hospitalized patients (pts) with ESBL infections often require outpatient antimicrobial therapy (OPAT) following discharge. An Infectious Disease (ID) physician can facilitate optimal management in both the inpatient and outpatient setting, particularly when a POIC is an option. The increase of ESBL incidence led us to evaluate management and outcomes of genitourinary (GU) and intra-abdominal infections (IAI), the top two ESBL diagnoses treated in POICs. Methods Records were queried for pts hospitalized with ESBL infection and discharged to a POIC between 2019 and 2020. Primary outcome was completion of OPAT. Non-successful completion was defined as premature discontinuation of OPAT including hospital readmission. Adverse events (AEs) and re-treatment within 30 days were captured. Results A total of 112 pts (mean age: 59±17 years, 50% female) from 14 POICs were identified (93 GU, 19 IAI). Of these, 51% had their first ESBL infection and 52% were community-acquired prior to hospitalization. A total of 38% presented with concomitant bacteremia. ESBL E. coli was the predominant Gram-negative pathogen in both infection types (Table 1). Mean hospital LOS was 6±4 days (5±2 days GU, 11±6 days IAI) followed by 13±9 days of OPAT (12±7 days GU, 16±11 days IAI). Carbapenems were most frequently used as treatment (89% ertapenem, 7% meropenem). Overall, 106 pts (95%) successfully completed OPAT. Six pts (5%) discontinued due to hospital readmission. AEs were reported in 15 pts (13%), the majority of which were mild. Re-treatment in the POIC within 30 days post OPAT completion occurred in 6 GU pts. None were lost to follow-up. Table 1 summarizes primary outcome by clinical characteristics. Both GU and IAI pts had 95% successful OPAT completion. Table 1.Successful and non-successful completion of OPAT in patients with ESBL infections Conclusion Outpatient treatment of ESBL infections in POICs post-hospitalization showed high completion rates with low occurrence of readmissions and re-treatments. Consistent with a rise in ESBL infections, our incidence of community-acquired ESBL infections prior to hospitalization were high at 52%. Once ESBL infections were identified in the hospital, the ID physicians with a POIC rapidly facilitated discharge to OPAT. Disclosures Ramesh V. Nathan, MD, FIDSA, Eli Lilly & Co.: Grant/Research Support Brian S. Metzger, MD, MPH, AbbVie: Advisor/Consultant|Cumberland: Advisor/Consultant Lucinda J. Van Anglen, PharmD, Merck & Co.: Grant/Research Support|Paratek: Grant/Research Support.

2365. Fostering the Future: Improving Infection Prevention and Control Education in Pediatric Infectious Diseases Fellowship

Abstract Background Infection prevention and control (IPC) is a potential area of career specialization for infectious diseases (ID) fellows. However, ID fellows are not consistently involved in IPC operations or content expertise. IPC education for ID fellows at Children’s Hospital of Philadelphia relied upon lectures, self-study, and some in-person shadowing. ID fellows had few experiences engaging in surveillance, working with data, or discussing approaches to common clinical IPC scenarios. We aimed to develop an IPC curriculum for pediatric ID fellows focusing on experiential learning relevant to clinical and operational practice as an ID physician. Methods We used the Kern model to systematically design a curriculum addressing identified gaps in IPC education. Areas of need included: aligning IPC curriculum content with the physician role, improving tracking of core IPC experiences (e.g. surveillance, bedside reviews), incorporating education on IPC operations, and enhancing connection between ID fellows and IPC non-physician team members. We partnered an ID fellow and an IPC program manager to lead development of the new IPC curriculum. The designed curriculum consists of 3 weeks separated throughout fellowship focusing on: 1) IPC core concepts, and 2) IPC operational skills. Weeks 1 and 2 are a primer on IPC as a field including emphasis on the multidisciplinary roles involved. Week 3 focuses on the role of IPC within overall hospital operations. An optional 4th week is available for those pursuing a career in IPC. Results We have implemented 2 weeks of the new curriculum. The post-implementation feedback is still in progress as only 2 of the 3 weeks has been implemented. Initial feedback highlighted the interactive nature of the curriculum and organized delivery. Additionally, feedback from IPC team members highlighted the improved communication with fellows and better understanding of a fellow’s role. IPC Curriculum Overview An overview of the newly developed IPC curriculum for pediatric ID fellows. Week 1 and 2 are focused on IPC fundamentals, Week 3 is dedicated to operational knowledge and skill, and an optional week 4 exists for those particularly interested in IPC as a career. IPC Foundations "Passport" This is an example of the passport tool for tracking experiences during the IPC rotation weeks. This is used by both the fellow and the IPC division to help create shared awareness of a fellow's experiences and better identify any gaps. Key Elements of Operations Week. This schematic illustrates the key components of week 3 (Operations) of the IPC curriculum. The 3 main elements include collaborating on an IPC-related project, didactics of IPC emergencies (with opportunity to answer IPC calls with infection preventionists and IPC medical directors), and a focus operational skills essential to being a leader within IPC. Conclusion Through collaboration between the ID fellowship program and IPC, we redesigned the IPC curriculum for fellows. While implementation of the curriculum is still in progress with ongoing plans for evaluation, we have demonstrated success in engaging a multidisciplinary team to develop a curriculum for ID fellows focused on an operational (rather than strictly content) field. Disclosures All Authors: No reported disclosures.

1415. Successful Model for Pharmacy Driven Harm Reduction Services to Link Veterans Who Inject Drugs Into Care

Abstract Background Substance abuse continues to be on the rise in the U.S. driven by the proliferation of fentanyl laced street drugs. Per the CDC, during May 2020 - April 2021, a 29% increase in over dose deaths was observed compared to the previous year. Harm reduction services play a major role in reducing overdose deaths, life-threatening infections and chronic diseases. Syringe service programs (SSPs) have proven to be an essential component of a broader focus on harm reduction; however, gaps remain in engaging Veterans into these programs. Figure 1.Contents of Standard SSP Kit Distributed to Veterans at the Orlando VA Methods A multimodal strategy was implemented to engage Veterans and VA staff into harm reduction services. A harm reduction short video series was developed and posted on social media channels. ICD-10 codes were utilized to identify Veterans with polysubstance use and harm reduction letters were mailed. A pre and post survey was developed to assess provider’s familiarity and level of comfort with SSPs before and after in-service education was provided by ID physicians. An ID pharmacy consult was developed for providers to request patient education or harm reduction kit dispensing. Upon completion of the quality improvement project, we expect to see an increase in the number of Veterans utilizing SSP. Figure 2.Orlando VA SSP Process MapFigure 3.Harm Reduction Letter Results Upon implementation of outreach strategies total SSP visits increased by 72%. A total of 2040 syringes and 24 Naloxone kits have been dispensed through the SSP. Survey data shows that employees' knowledge on SSPs have increased by 48%, their comfort on working with Veterans who inject drugs increased by 6%, providers confidence in the tools available to them to successfully help veterans with alcohol and substance use recovery increased by 17%, misconception that SSPs increase drug use decreased by 6%, and support of placing consults for medication assisted therapy increased by 4%. Data is notable given limitations like post survey participation. Figure 4.Pre and Post Education Survey Data Collection ComparisonFigure 5.Pre and Post Education Survey Data Collection ComparisonFigure 6.Pre and Post Education Survey Data Collection Comparison Conclusion The implementation of multimodal strategies to engage Veterans and VA staff has resulted in an increase of SSP utilization. Sustained efforts to continue to identify target patients and bring them into care will be undertaken in an effort to increase and normalize SSP utilization. The steps already taken can serve as a model for programs currently in development and moves us closer to ending the HIV epidemic by 2030. Figure 7.Outreach Strategies Summary Disclosures All Authors: No reported disclosures.

951. Implementation and Rapid Uptake of an Antimicrobial Stewardship Clinical Decision Support System Across 19 UPMC Hospitals

Abstract Background UPMC Antimicrobial stewardship (AS) includes independently functioning AS programs and a central tele antimicrobial stewardship (TASP) (1 ID pharmacist and 1 ID physician) that supports smaller hospitals with few on-site AS resources. We describe implementation of an AS clinical decision support system (CDSS) at 19 UPMC hospitals (12-695 staffed beds). Figure 1 is an example of the CDSS. Figure 1Representative Example of CDSS Patient Overview Page (not real patient data) Methods The CDSS extracts clinical data to provide real-time alerts to AS teams. It also supports asynchronous communications between AS team members, including between a local AS and our TASP. CDSS utilization and intervention data from Oct 21 to Mar 22 are reported. Figure 2 shows hospital locations and the timeline for CDSS implementation. Table 1 shows implementation steps. Figure 2:Implementation Timeline and Geographic Location of HospitalsTable 1:Implementation Steps Results Table 2 summarizes category alerts provided by the CDSS. Category 1 alerts were independently reviewed by local pharmacists. Category 2 alerts were reviewed either by local pharmacists or central TASP team. Figure 3 shows high CDSS usage over time with numerous unique users and frequent logins. Most users were pharmacists. CDSS usage was steady and increased in the final month included here. Communications between users were frequent and increased 46%. On average, 7033 CDSS generated alerts per month (70-798 per hospital) were reviewed from Oct 21 to Mar22. Table 3 groups the alerts into successful, unsuccessful, or nonactionable interventions. 93% of actionable alerts (959 of 1029 per month) produced a successful outcome. Table 2:CDSS Alert CategoriesFigure 3:CDSS Utilization SummaryTable 3:Summary and Alert Statuses and Intervention Outcomes Conclusion After a rapid 5-month deployment across 19 hospitals this CDSS was successfully adopted as evidenced by sustained monthly use, increasing communications, and a high rate of accepted interventions on actionable alerts. A high rate of nonactionable alerts in the first 6 months was a limitation. Although this did not appear to limit CDSS use, sites implementing a CDSS should monitor for nonactionable alerts during early utilization and adjust as needed. CDSS has the potential to improve efficiency and consistency of AS within a health system. After a successful implementation, evaluation of impact on antimicrobial usage and clinical outcomes are important future metrics. Disclosures J Ryan Bariola, MD, Infectious Disease Connect: Salary support|Merck: Grant/Research Support Tina Khadem, PharmD, Infectious Disease Connect: Salary support|Merck: Grant/Research Support Caley Yakemowicz, n/a, Infectious Disease Connect: Employee Courtney Simonick, n/a, Infectious Disease Connect: Stocks/Bonds Erin K. McCreary, PharmD, AbbVie: Advisor/Consultant|Cidara: Advisor/Consultant|Entasis: Advisor/Consultant|Ferring: Advisor/Consultant|Merck: Advisor/Consultant|Shionogi: Advisor/Consultant|Summit: Advisor/Consultant Christina Andrzejewski, n/a, Melinta Therapeutics: employee 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.

937. Appropriateness of using a Mobile Application for Choosing Antibiotic Therapy in Hospitalized Patients at Siriraj Hospital

Abstract Background Development of facility-specific clinical practice guidelines and incorporation of computerized clinical decision support have been recommended as the effective antimicrobial stewardship strategies. The DigitalAMSTM is a mobile-based application used to guide choosing empirical antibiotics. Before the hospital-wide implementation of DigitalAMSTM, the appropriateness and limitation of such an application needs to be evaluated. Methods A retrospective cross-sectional study of hospitalized adult patients who received at least one dose of antibiotic and had at least one documented site of infection were enrolled between 1 Jan and 31 Jun 2018. All necessary data was obtained via chart review. The antibiotic regimen that was prescribed by the ward physician (WARD), the regimen recommended by the DigitalAMSTM (APP), the regimen recommended by the independent infectious disease (ID) physicians before and after knowing the culture results (Emp-ID and Def-ID) were compared. Results A total of 401 patients of the targeted infections i.e. 98 subjects with pneumonia, 103 subjects with urinary tract infection (UTI), 98 subjects with bacteremia and 102 subjects with skin and soft tissue infection (SSTI) were enrolled. The percent agreement between the APP and the WARD was less than half in all sites of infection. The APP regimen provided approximately 80% agreement with the Emp-ID regimen among subjects with UTI (78.6%), bacteremia (85.7%) and SSSI (85.2%), while the percent agreement of the WARD regimen and the Emp-ID was approximately half in all sites of infection. The lowest percent agreement between the APP regimen and the Emp-ID regimen was found among subjects with pneumonia (59.1%). Univariate analysis did not reveal any association between subjects who received the antibiotic regimen matching to the APP recommendation and the 28-day mortality. Conclusion Our study confirmed that the DigitalAMSTM application could improve appropriateness of antibiotic regimens for empirical therapy for four common infections among adult hospitalized patients at Siriraj Hospital. However, some revisions need to be done to improve the appropriateness of antibiotic regimens in the APP, especially for subjects with pneumonia. Disclosures All Authors: No reported disclosures.

1002. Complex Outpatient Antimicrobial Therapy (COpAT) Program at a Rural Academic Medical Center: Evaluation of First 100 Patients

Abstract Background Literature shows early intravenous (IV) to oral (PO) antimicrobial transition for infective endocarditis (IE) and bone and joint infection (BJI) is noninferior to prolonged IV antimicrobial therapy. COVID-19 pandemic peaks resulted in critical shortages of staffed hospital beds spurring innovation. Outpatient parenteral antimicrobial therapy (OPAT), a well-established program using prolonged IV antimicrobials, faces challenges such as infusion resource needs and social circumstance limitations. Complex outpatient antimicrobial therapy (COpAT) uses PO in place of IV antimicrobials. We hypothesized rapid adoption of COpAT would decrease hospital length of stay and open beds while retaining satisfactory clinical outcomes. Methods COpAT protocols (Image 1) and guidelines by infection type and isolated organism (Image 2) were created. Hospitalized patients including persons who inject drugs (PWID) were evaluated for IV to PO antimicrobial transition by an infectious diseases (ID) physician and then followed by an ID physician-pharmacist team. Demographic, ID, and clinical outcome data for the first 100 COpAT patients between December 2020 and February 2022 were obtained by retrospective chart review. Image 1.COpAT Inpatient and Outpatient Protocols Image 2. COpAT Guidelines by Infection Type and Isolated Organism MSSA = methicillin-susceptible Staphylococcus aureus; MRSA = methicillin-resistant Staphylococcus aureus; spp. = species; TMP/SMX = trimethoprim-sulfamethoxazole; DS = double strength; SSTI = skin and soft tissue infection; CAP = community-acquired pneumonia Results PWID accounted for 78% of COpAT patients. BJI followed by mixed infection (IE and BJI) was most prevalent (Image 3) with bacteremia in 53% of cases. Staphylococcus aureus was most frequently isolated (Image 4). Oral linezolid and fluoroquinolones, often in combination, were most commonly used. IV and PO antimicrobials were taken for a median 28 and 14 days, respectively. The COpAT program saved 1425 IV antimicrobial and 1363 hospital days. Assuming daily inpatient cost of $2050, cost avoided was $2,794,150. COpAT patients participated in ID follow-up and adhered to PO antimicrobials with low 30-day readmission rates (Image 5). Image 3.Infection TypeImage 4.Isolated Organism CoNS = coagulase-negative staphylococci Image 5.Clinical Outcomes Conclusion In a sample of 100 COpAT patients including PWID, IV to PO antimicrobial transition safely saved hospital days and mitigated critical bed shortages during pandemic peaks. A successful COpAT program requires a multidisciplinary group: close ID physician-pharmacist collaboration extending to OPAT and antimicrobial stewardship teams. With a COpAT program in place, even earlier IV to PO antimicrobial transitions should be studied. Disclosures All Authors: No reported disclosures.

1108. Feasibility and Impact of a Monoclonal Antibody Infusion Program in Reaching Vulnerable Underserved Communities

Abstract Background Monoclonal antibodies (mAbs) against SARS-CoV-2 are potent therapeutics that prevent progression of disease in high-risk patients. Deploying mAb infusion programs and reaching communities in need remains challenging. We established a mAb infusion program centered in the emergency department (ED) fast-track. We seek to assess the feasibility and impact of our mAb infusion program in reaching vulnerable underserved communities. Methods The ED fast-track was repurposed for mAb infusions. Indications and protocols were created by the infectious disease (ID) physician and antimicrobial stewardship program (ASP). Test to treat was deployed in the ED and a referral program connected patients from telehealth and providers in the community to the infusion program (Figure 1). Data on mAb use from November 2020 to February 2022 was reviewed. To assess the reach of the program in vulnerable communities, the COVID-19 Community Vulnerability Index (CCVI) map by zip code was used. The CCVI identifies communities at risk by using variables such as sociodemographic variables, occupational factors, cumulative COVID-19 burden, vaccine uptake and other factors. Figure 1.Monoclonal antibody infusion test-to-treat and referral process in the ED fast track Results mAbs were successfully deployed and sustained throughout the pandemic, increasing its use in each COVID-19 surge by >103% (Figure 2). A total of 267 patients were treated, with an average age of 52 years, of which 55% (147) were female. Ethnicity was 46% Hispanic and Race was 54% White, 28% Black, 1.4% Asian, 1.8% Multiracial and 14% Other. Zip codes by CCVI were 64% high, 18% medium, and 3% low CCVI index. 15% were outside of city limits without CCVI index (Figure 3). Figure 2.COVID-19 Community Vulnerability Index (CCVI) of patients who received monoclonal antibodies at our program Figure 3 Monoclonal antibody infusions by COVID-19 Community Vulnerability Index (CCVI) and Zip codes Conclusion A mAb infusion program with test to treat and referrals from the community was successfully deployed in an ED fast track. The ED space and staff can be leveraged for mAbs during surges amid clinic staffing challenges. The program adopted novel mAbs as new COVID-19 variants emerged. Uptake increased with each wave, likely reflecting awareness of mAbs and the infusion program by patients and providers in the community. The majority of patients served (82%) were of high and medium CCVI. Thus, this mAb infusion program led by ID and ASP successfully reached predominantly underserved vulnerable populations. Disclosures All Authors: No reported disclosures.

2212. Improving Sexually Transmitted Infection Co-testing in a Large Urgent Care Network

Abstract Background Sexually transmitted infections (STIs) remain a serious public health concern. The state of Utah has the lowest percentage of adults 18-64 years-old ever tested for HIV (26.5%) and the lowest percentage tested for HIV in the previous 12 months (6.5%). Increasing HIV testing in Utah is of the utmost importance. Delayed diagnoses and missed testing opportunities for HIV and other STIs exist. Encounters for evaluation of possible gonorrhea (GC) or chlamydia (CT) infection is a critical opportunity to co-test for HIV and syphilis. With continued growth, urgent care (UC) sites are well-positioned to increase STI diagnosis and treatment. We aimed to develop a multi-faceted quality improvement (QI) bundle to increase STI testing in our UC centers. Methods Intermountain Healthcare (IH) is a vertically integrated healthcare network predominantly in Utah and operates a network of 35 UC clinics across the state. In 2020, qualitative interviews to evaluate barriers to STI testing were performed with UC clinicians. Based on these interviews a QI initiative was designed and implemented throughout 2021. The bundle included clinician education, electronic health record (EHR) improvements, and automatic referral for patients with a new diagnosis of HIV to an Infectious Diseases (ID) physician (Methods Image 1). We compared co-testing rates before (July 2018 – December 2020) and after the intervention began (March 2021 – April 2022). Methods Table 1 The quality improvement (QI) initiative began in 2021 and consisted of multiple components as detailed below. Results 13,715 and 5,628 UC encounters were associated with GC/CT testing during the pre-intervention and intervention periods, respectively. HIV co-testing was performed in 2,784 (20.3%) GC/CT testing encounters in the pre-intervention period and in 1,674 (29.7%) encounters during the intervention, a relative increase of 37.6%. HIV/syphilis co-testing was performed in 2,304 (16.8%) GC/CT testing encounters and 1,225 (21.8%) encounters during the pre-intervention and intervention phases, respectively. From January 1 2022 – April 1 2022 3 new outpatient HIV diagnoses were identified. The average time from diagnosis to contact with an ID provider was 30.0 hours. Results Image 1 Co-testing rates for GC/CT UC encounters are presented for HIV (blue), syphilis (green), and HIV/syphilis (orange). Testing reagent quality issues in early 2022 lead to an abrupt decline in syphilis co-testing and once these issues were resolved co-testing trends returned to similar rates prior to the reagent quality issue and testing limitation. Conclusion Multi-modal QI initiatives may increase STI testing rates within UC centers of integrated healthcare systems. Further study is needed to optimize STI screening, diagnosis, and care in UC centers. Disclosures Kimberly D. Brunisholz, PhD, MST, Johnson and Johnson: Advisor/Consultant.

1347. @Women_in_ID : A Social Media Platform for Advocacy and Amplification of Women in Infectious Diseases

Abstract Background In 2015, 39.7% of active infectious diseases (ID) physicians in USA were women. This calculation does not include the many other women professionals in ID such as Advanced Practice Providers, ID pharmacists, researchers in ID and Infection Preventionists. There is no dedicated national platform for women in ID and no Twitter representation of groups dedicated to women in ID. Women in Infectious Disease (WIID) with twitter handle @Women_in_ID was created April 22nd 2021, for women providers in ID to collaborate, promote, and advocate for each other through a social media platform; and to highlight significant issues like gender pay gap, inequity in career advancement and leadership, research funding etc. We sought to explore the social media impact of this account over the last year. Methods A descriptive content analysis of this account from April 2021 to May 1st, 2022 was done to reflect on lessons learned, plan future directions, and highlight some real-world changes that happened after creation of WIID. Twitter analytics were used, and manual review of followers’ accounts and tweet activities were done to assess engagement. Results In 12 months, this account has gained 1709 followers (Image 1). Out of the followers, 109 are twitter accounts of organizations, such as fellowship programs, ID societies and their foundations, ID divisions, and journals. The rest appear to be individuals. Since demographics of followers are not revealed in twitter accounts, this could not be assessed. Table 1 provides detailed twitter analytics and content that got the most engagement each month. During the month of September, the account highlighted 20 nominated profiles (including women from other countries), and several other women in ID with significant historical contributions (Image 2). This content resulted in our highest engagement and new members. Some previously unnoticed women in history had Wikipedia pages created after their work was amplified. Image 1:Women in ID (WIID) twitter profile pageImage 2:Women in Medicine Month call for nominations created to amplify women in ID Conclusion @Women_in_ID is the first and only twitter platform dedicated for women in ID. This platform is accessible to every woman in ID with a twitter account, hence networking, amplification and collaboration transcends local or institutional boundaries. In future, social media work must translate to real life changes to have meaningful impact. Disclosures All Authors: No reported disclosures.

444. Effect of multidisciplinary management of CKD on proteinuria in people with HIV

Abstract Background Optimizing management of chronic kidney disease in people with HIV has become a more pressing priority both to minimize morbidity and preserve HIV antiretroviral options. Part of standard care is employing the beneficial effects of angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB) in patients with clinically significant proteinuria. Our analysis looks at the proteinuria outcomes of PWH with CKD co-managed by a multidisciplinary team of infectious disease and nephrology physicians nested in a Ryan White-funded clinic in New Orleans. Methods Patients with HIV and at least grade 3 CKD or with significant proteinuria were referred to the multidisciplinary clinic. Patients were evaluated by an HIV specialist and nephrologist at the initial visit for a jointly developed management plan. Renal function and proteinuria were measured at baseline and longitudinally per standard of care. Change in proteinuria and GFR over time were calculated. Patients were also assessed for whether they were prescribed ACE/ARB therapy, if appropriate. Patients included in this analysis were evaluated between January 1, 2021 and March 31, 2022. Results During the analysis period, 46 patients with at least CKD 3 or proteinuria were evaluated. 35 patients were Black non-Hispanic, 9 were White non-Hispanic, and 2 were Hispanic. 39 were male, and 7 were female. 35 had a previous diagnosis of hypertension, and 10 had diabetes mellitus. Of the 42 with a recorded baseline urine protein measurement, 24 were found to have clinically significant proteinuria. Of those with proteinuria, 16 were on an ACE or ARB at their baseline evaluation. 20 were on ACE/ARB’s the end of the analysis period (p=0.058). Average baseline proteinuria was 1,158 mg/g, while average final was 938 mg/g, which was less but not significantly different (p=0.54). Mean baseline GFR was not significantly different from final GFR (50.8 mL/min vs 50.5 mL/min, p=0.67). Conclusion A multidisciplinary model of managing CKD among people with HIV may improve adherence with management guidelines and limit progression of proteinuria and decrease in GFR. In general, the natural history of kidney disease with proteinuria is to worsen over time, so while not significant, proteinuria in this cohort did decrease over time Disclosures All Authors: No reported disclosures.

936. Antimicrobial Stewardship Assessments in De-labeling Beta-lactam Allergies

Abstract Background Unnecessary use of broad-spectrum antibiotics due to false antibiotic allergy labels leads to an increase in drug resistant and health care associated infections. Therefore, allergy assessments to de-label patients not truly allergic is an important antimicrobial stewardship (AMS) tool. The purpose of this study was to assess the effectiveness of a pharmacy-led questionnaire and AMS rounds in improving the accuracy of beta-lactam allergy labels (BLA). Methods AMS piloted BLA de-labeling rounds three times a week from November 1, 2021 to April 1, 2022. Rounds consisted of an infectious disease physician and an AMS pharmacist that reviewed allergy questionnaires conducted by trained pharmacy personnel. The questionnaire was provided to patients 18 years or older with a documented BLA and an admission stay of two or more nights. Patients were excluded if unable to participate or did not have a representative available for interview. The primary outcomes evaluated were: (i) direct de-labelling (ii) future de-labeling upon patient consent (iii) allergy profile changes. The secondary outcomes were potential days of therapy (DOTs) saved for anti-MRSA agents (vancomycin, linezolid, clindamycin) and fluoroquinolones (ciprofloxacin, levofloxacin) and PEN-FAST scores for those with a penicillin-specific allergy. Results 93 of 96 patients interviewed (96.9%) had their allergy profile updated to include type, severity, or timing of reaction. 82 of 96 patients (85.4%) were classified as low-risk allergies in which 11 patients (13.4%) were successfully de-labeled and 18 patients (22.0%) were eligible for de-labeling upon patient consent. The remaining patients were eligible for further interrogation with an oral challenge (Figure 1). Potential DOTs saved were 131 and 67 days for anti-MRSA agents and fluoroquinolones, respectively. Average PEN-FAST scores for those de-labeled and eligible for oral challenge was 0.5 (SD 0.85) and 1.08 (SD 1.20), respectively. Conclusion AMS BLA assessments can decrease the prevalence of false BLA labels and prescribing of unnecessary broad-spectrum agents. PEN-FAST scores less than 2 suggests that allergy assessments help identify patients with low-risk penicillin allergies. Disclosures All Authors: No reported disclosures.

1350. Limited Opportunities for Student Involvement in Infectious Diseases in the Mountain West: How a New Group is Bridging the Gap

Abstract Background The documented lack of infectious disease physicians in the United States has motivated substantial research. A new student group, “InfectED”, was formed at the University of Utah with a particular focus on community and student education in infectious diseases. To explore the efforts of our peer clubs, this study characterized student groups focused on infectious diseases (ID), microbiology (M), or global/public health (GPH) in the Mountain West. Methods A list of undergraduate colleges, including associates/community colleges, with enrollments of 1,000+ students in eight Mountain West states was constructed. Enrollment was verified with the College Navigator service from the NCES. A second list of 26 schools providing either medical (MD & DO) and/or physician assistant degrees was also developed. Club constitutions, campus and social media webpages were consulted to determine club activities and goals. Results Of the 90 final undergraduate schools, 19 (21.2%) had at least one group. 14 M, 16 GPH, and one ID group were found. 4 (12.9%) groups were at private institutions, with the remainder (87.1%) at public universities; none were at associates/community colleges. 11 (35.5%) groups were chapters of either the American Society for Microbiology, GlobeMed, or Operation Outbreak. Of the professional schools, 1 (3.85%) had groups for M, 11 (42.3%) for GPH, and 2 (7.69%) for ID. Community service, student and community education, guest lectures, journal club, and social and enrichment events were frequently mentioned in club bylaws. Undergraduate Groups Found in the Mountain West Thirty-one groups for infectious diseases, microbiology, or global/public health were found in undergraduate universities in Utah, Idaho, Nevada, Colorado, Arizona, Montana, New Mexico, and Wyoming. The state of Montana has no groups, and no groups were found at associates and community colleges. Conclusion We demonstrate a need for ID-related student involvement opportunities. By developing chapters of ID organizations such as IDSA, students can be inspired to consider the field later on. A strong interest in global/public health is seen, which can be leveraged to attract interest in ID. The absence of any groups at associates/community colleges is also striking. To target this gap and increase interest, InfectED is directing education and enrichment efforts in both English and Spanish at local community centers, community colleges, and high schools with audiences reporting higher interest in both healthcare and ID afterward. A qualitative survey with an invitation to collaborate is currently collecting responses from our peer clubs. Audience Interest in ID Increases Answer to the question "this presentation influenced my decision to consider pursuing a career in microbiology and/or infectious disease" by community college and high school students across multiple InfectED presentations. Disclosures All Authors: No reported disclosures.

993. “I feel like they’re actually listening to me”: A Pilot Study of Hospital Discharge-Decision Making for Patients with Injection Drug Use-Associated Infections

Abstract Background Conversation guides have the potential to transform care for patients hospitalized with injection drug use (IDU)-associated infections. This study’s objectives were to 1) pilot a structured conversation guide for hospital discharge decision making in patients with IDU-associated infections 2) investigate the guide’s feasibility and acceptability and 3) examine patient and provider experiences, patient outcomes, and lessons learned. Methods We developed a conversation guide and conducted semi-structured interviews with physicians and patients at a tertiary care center in Maine. We interviewed physicians after each piloted the guide with two patients. We interviewed patients less than one week after the conversation and again after 4-6 weeks. Two analysts indexed transcriptions and used the framework method to identify and organize relevant information. We conducted retrospective chart review to corroborate and contextualize qualitative data. Results Eight patients and four infectious disease physicians piloted the conversation guide. All patients (N=8) completed antimicrobial treatment and 88% were discharged on medication for opioid use disorder (Table 1). All providers and most patients stated that the conversation guide was important for incorporating patient preferences and antimicrobial treatment options. Patients appreciated more autonomy and their voices being included in their care. Providers felt the guide facilitated their understanding of patient values. Values and preferences between patients and providers were aligned. Participants identified the length of the guide, discussion of pain management, and addressing post-discharge needs such as housing as areas for improvement (Table 2). Conclusion The use of a conversation guide to inform hospital discharge decision making for patients with IDU-associated infections incorporates patient preferences and values into treatment decisions. While we identified areas for improvement, overall patients and providers believed that this novel conversation guide helped to improve patient care and autonomy. Disclosures Kinna Thakarar, DO, MPH, Maine Medical Center: Board Member|NIH: Grant/Research Support|University of New England: Board Member Monica K. Sikka, MD, F2G: Site research investigator Ellen Eaton, MD, MSPH, Gilead: Grant/Research Support.

968. The Impact of Film Array Detection of High-risk and Resistant Pathogens on the Time to Optimal Antibiotic Therapy at a Community Health System

Abstract Background The importance of effective antibiotic therapy for the treatment of bloodstream infections has been well described. Rapid diagnostic testing platforms like the BioFire® FilmArray® blood culture identification (BCID) have the potential to decrease time to effective antibiotics when acted on appropriately. The Cone Health stewardship team has collaborated with clinical pharmacists and infectious diseases physicians to define a process to optimize antibiotic therapy. This process involves microbiology calling a pharmacist with newly positive blood cultures, and the pharmacist notifies the attending physician with the results and evidence-based treatment recommendations. We transitioned from BCID to BCID2 in August, 2021. As CTX-M (marker for extended spectrum beta-lactamase production) was not a target on BCID, we were interested in how the addition of this marker could improve care in this subset of patients. Procedure for Positive Blood Culture Workup and Notification Treatment Recommendations for Selected Organisms Methods From August 2021 - March 2022, the times to administration of effective and optimal antibiotics were evaluated in patients with the following BCID2 organism and resistance gene targets identified: S. aureus, P. aeruginosa, CTX-M, KPC, OXA-48 like, IMP, VIM, NDM, and vancomycin resistant enterococci. An effective antibiotic was defined as an antibiotic with in vitro activity to the organism, and an optimal antibiotic was defined as the preferred agent based on institutional guidelines. For CTX-M isolates, we compared effective and optimal times to a historical control of ceftriaxone resistant enterobacterales and analyzed by student’s t-test. Results The combined mean time from BCID2 to administration of effective antibiotics = 1.2 hours (range 0-7.9 hours) and to optimal therapy =7.6 hours (range 0 – 113.8 hours). Prior to the BCID2 transition, patients found to be growing ceftriaxone resistant enterobacterales had an average time to optimal antibiotic administration of 17.7 hours, which improved to 2.8 hours after BCID2 implementation (p=0.0041). Time to Effective and Optimal Antibiotics after implementation of BCID2 (August 2021 – March 2022) Time to Effective and Optimal Antibiotics for Ceftriaxone Resistant Enterobacterales Prior to BCID2 Implementation (January 2021 - July 2021) Conclusion BioFire® FilmArray® coupled with antibiotic stewardship team support can help optimize time to effective and optimal antibiotic therapy in bloodstream infection. The addition of the CTX-M target to BCID2 was a helpful addition to the panel which allowed for decreased time to optimal antibiotic therapy. Disclosures All Authors: No reported disclosures.

896. Cost-Avoidance Associated with Active Stewardship of Remdesivir

Abstract Background The COVID pandemic shifted antimicrobial stewardship resources at community hospitals. One reason for this shift was new COVID treatments, the first of which was remdesivir, which received initial emergency use authorization (EUA) for the treatment of COVID-19 in May 2020. The UNC Health Southeastern (UNC SEH) pharmacy director stewarded remdesivir by reviewing patients to ensure they met emergency use authorization (EUA) and guideline-based appropriateness criteria. The infectious diseases physician resolved any disputes regarding patient candidacy for remdesivir. The goal of remdesivir stewardship was to optimize care; however, the shift in workflow presented an unrecognized opportunity for stewards to reduce remdesivir costs. Methods The percentage of COVID patient admissions receiving remdesivir at UNC SEH for calendar years 2020 and 2021 was benchmarked against 32 community hospitals in the Duke Antimicrobial Stewardship Outreach Network (DASON) (Figure 1). UNC SEH purchasing data were used to calculate remdesivir expenditures for 2020 and 2021. Next, the anticipated cost if the hospital had prescribed remdesivir to the same percentage of admissions as the DASON mean was calculated. The difference was calculated to determine the cost avoidance achieved by having below average use of remdesivir (Table 1). Results At UNC SEH, 28.1% of COVID admissions received remdesivir in 2020 and annual remdesivir expenditures were $693,680. In 2021, 47.45% of COVID-19 admissions received remdesivir and drug expenditures were $1,248,000. The DASON mean % of COVID admissions receiving remdesivir in 2020 was 44.08% and 60.07% in 2021. A total cost avoidance of $726,407 was calculated based on the hospital’s below-benchmark use of remdesivir (Table 1). Conclusion UNC SEH achieved significant cost-savings in 2020 and 2021 due to active remdesivir stewardship. The team created a patient-centered model that focused on using drugs for the right patients and the organization realized cost-savings while ensuring that patients received therapy in accordance with remdesivir EUAs and published guidelines. Disclosures All Authors: No reported disclosures.

944. Development & Implementation of a Biomarker-based Remotely-delivered Antimicrobial Stewardship (AMS) Strategy during the COVID-19 Pandemic

Abstract Background Increased antibiotic usage during the COVID-19 pandemic and resultant infection control measures derailed the existing antimicrobial stewardship program which involved in person post prescription review and feedback. We performed a time series analysis using Procalcitonin as a tool for a remotely delivered antimicrobial stewardship program by a clinical pharmacist. Methods This study was conducted in a tertiary care 3500 bedded teaching hospital in southern India. In the baseline phase, all COVID-19 in-patients receiving antibiotics > 48 hours were screened via the electronic records by a pharmacist and antimicrobial consumption indices like days of therapy (DOT) and length of therapy (LOT) were measured. In the intervention phase, if a patient was on antimicrobials, then a PCT was sent. An alert was sent to the treating team based on the procalcitonin levels and a screening of electronic records by a clinical pharmacist to either continue/ de-escalate or discontinue an antibiotic under supervision of an Infectious Diseases physician. Figure 1Guideline for continuing or stopping antibiotics based on procalcitonin levelsFigure 2Guideline for continuing or stopping antibiotics based on procalcitonin levelsStudy Flow Results About 481 patients were enrolled in the pre intervention phase of the study from July to October 2020 (peak of the pandemic) and 90 patients in the intervention phase December 2020 - March 2021 (decline of the pandemic. The baseline characteristics are shown in Figure3. The DOT/1000 patient days (PD) for all antibiotics was 9269 (DOT-6915) in the baseline and 2032 (DOT-886) in the intervention arm. The total length of therapy (LOT) for antimicrobial consumption significantly reduced from 3779 in the pre-intervention phase to 657 in the intervention phase (Figure 4). Out of the 90 recommendations given in the intervention phase, 82 (91.1%) were accepted by the treating team. For Azithromycin and Doxycycline, DOT significantly reduced from 3319 to 486 per 1000 PD and 602 to 158 per 1000 PD respectively. The DOT of the reserve antibiotics according to the WHO AWaRe classification like Polymyxins and Carbapenems decreased from 323 to 67 and 777 to 443 per 1000 PD days in the intervention phase. Figure 3Baseline Characteristics comparing Pre- intervention and Intervention Phase Figure 4 Comparison of LOT (Length of therapy) and DOT (Days of therapy) in the Pre-intervention and Intervention Phase Figure 5 Comparison of the DOT per 1000 PD in the Pre-Intervention and Intervention phase of frequently used antibiotics in Covid- 19 infection Conclusion This study demonstrated the utility of a novel biomarker driven antimicrobial stewardship strategy by clinical pharmacists during the COVID pandemic when access to patients was restricted to both infection control physicians and pharmacists. Disclosures Priscilla Rupali, MD, DTM&H, PFIZER: Grant/Research Support|PFIZER: Grant/Research Support.

526. Antimicrobial Selection Based on Precision Metagenomics Compared with Standard Urine Culture/Susceptibility: A Reliability and Inter-rater Agreement Analysis for Application in Patients with Urinary Tract Infections

Abstract Background Management of urinary tract infections (UTIs) is highly variable and ∼50% of affected women may receive inappropriate antimicrobials. Precision Metagenomics-based detection of pathogens and antimicrobial resistance (AMR) markers can inform antimicrobial selection in support of stewardship practices. We investigated inter-physician agreement of culture and metagenomic results in a retrospective analysis. Methods We used de-identified urine samples with results of urine culture & antimicrobial susceptibility testing (AST, n=25, 76% culture-positive) and the Explify® Urinary Pathogen ID/AMR Panel (UPIP, IDbyDNA Inc). UPIP is a Precision Metagenomics method to detect >170 uropathogens and >2,000 AMR markers. Four physicians reviewed culture/AST and UPIP results independently to assess if and how they would treat based on each set of results in a middle-aged, female patient with uncomplicated UTI (no comorbidities or medication allergies). Consensus was defined by simple majority; treatment decisions and antimicrobial choice were adjudicated by an infectious disease trained pharmacist. Inter-rater agreement (Fleiss’ kappa) and reliability for accurate case management (reference: adjudicator) were estimated for each method. Results Analytical agreement for uropathogen identification between the two methods was 72% with 95% positive agreement for common uropathogens. Consensus on whether or not to treat was reached for 96% (24/25) of cases for both culture/AST and UPIP; decisions were concordant between methods for 88% of cases (22/25). Inter-rater agreement was high (culture: k=0.73, UPIP: k=0.68; p< 0.05). Physicians were more likely to decide to treat based on culture results (17/25, 68%) than UPIP (15/25, 60%). UPIP detected additional organism(s) and/or AMR marker(s) compared with culture/AST alone that were informative for stewardship-guided treatment decisions in 28% (7/25) of samples. Figure 1: Physician Consensus Treatment Decisions Based on Results of Urine Sample Analysis by Precision Metagenomics or Urine Culture/AST Four infectious disease physicians independently reviewed paired results from analysis of a set of 25 clinical remnant urine samples by an investigational Precision Metagenomics method (UPIP) and by standard urine culture/AST and determined whether or not treatment would be warranted. Figure 2:Summary of Changes in Antimicrobial Selection based on Interpretation of Precision Metagenomics vs Culture/AST Results An infectious disease pharmacist reviewed and adjudicated hypothetical antimicrobial selections. All antimicrobial selections based on the results of the Precision Metagenomics method (UPIP) were found to be appropriate; in 7/15 cases, hypothetical treatment based on UPIP results would have resulted in a change in management that was evaluated to be consistent with stewardship practices. Conclusion Physician agreement on hypothetical treatment recommendations was comparable between the investigational method (UPIP) and the reference method (urine culture/AST). In no case was there inappropriate consensus to treat based on UPIP results alone. The findings from this pilot analysis support the feasibility of metagenomics-guided management of UTIs. Disclosures Benjamin Briggs, MD, PhD, CloudCath: Advisor/Consultant|CosmosID: Employee Benjamin Briggs, MD, PhD, CloudCath: Advisor/Consultant|CosmosID: Employee Robert Schlaberg, MD, MPH, IDBYDNA INC: Board Member|IDBYDNA INC: Explify-related IP|IDBYDNA INC: Employee|IDBYDNA INC: Stocks/Bonds.