Assessing antibiotic therapy for Acinetobacter baumannii infections in an academic medical center

Abstract Background Procalcitonin testing has been adopted by antimicrobial stewardship programs as a means of reducing inappropriate antibiotic use, including within intensive care units (ICUs). However, concerns regarding procalcitonin’s sensitivity exist. The purpose of this study is to calculate the sensitivity of procalcitonin for bacteremia among hospitalized patients. Methods This was a retrospective cohort study of adult patients admitted to an academic medical center between July 1, 2018, and June 30, 2019, with ≥1 positive blood culture within 24 hours of admission and procalcitonin testing within 48 hours. Low procalcitonin was defined as <0.5 µg/L. Results A total of 332 patients were included. The sensitivity of procalcitonin for bacteremia was 62% at the sepsis threshold of 0.5 µg/L, 76% at a threshold of 0.25 µg/L, and 92% at a threshold of 0.1 µg/L. Of the 125 patients with low procalcitonin, 14% were initially admitted to the ICU and 9% required the use of vasopressors. In that same group, the top 3 organisms isolated were Staphylococcus aureus (39%), Escherichia coli (17%), and Klebsiella spp. (7%). Compared with those patients with elevated procalcitonin, patients with low procalcitonin were significantly more likely to have >24-hour delayed receipt of antibiotic therapy (3% vs 8%; P = .04), including among patients admitted to the ICU (1% vs 18%; P = .02). Conclusions The sensitivity of procalcitonin for bacteremia is unacceptably low for a rule-out test. Antimicrobial stewardship programs should use caution before promoting the withholding of antibiotic therapy for patients with low initial procalcitonin values.

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1930. Developing an Electronic Medical Record System to Monitor Patients on Outpatient Parenteral Antibiotic Therapy at an Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1586 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S556-S556

Author(s):

Joseph Canterino ◽

Marjorie Golden ◽

Maricar Malinis

Keyword(s):

Antibiotic Therapy ◽

Medical Record ◽

Electronic Medical Record ◽

Medical Center ◽

Academic Medical Center ◽

Electronic Medical Record System ◽

Record System ◽

Parenteral Antibiotic ◽

Academic Medical ◽

Medical Record System

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1050. Oral Antibiotics for the Treatment of Gram-Negative Bloodstream Infections: Prescribing Practices and Outcomes at a Large Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.887 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S313-S314

Author(s):

Kimberly Claeys ◽

Nora Loughry ◽

Sanjay Chainani ◽

Surbhi Leekha ◽

Emily Heil

Keyword(s):

Antibiotic Therapy ◽

Medical Center ◽

Academic Medical Center ◽

Bloodstream Infections ◽

Antibiotic Use ◽

Optimal Time ◽

Oral Antibiotics ◽

Prescribing Practices ◽

Gram Negative ◽

Academic Medical

Abstract Background There is limited data to guide the use of oral (PO) antibiotics for the treatment of Gram-negative (GN) bloodstream infection (BSI). The objective of this study was to describe the characteristics and outcomes at a large academic medical center. Methods Retrospective observational cohort of adult patients (age ≥18 years) with at least one blood culture positive for aerobic Gram-negative organism(s) treated with antibiotic therapy (IV or oral [PO]) at University of Medical Center from November 2015 to May 2017. Oral antibiotics were described based on bioavailability. The primary outcome of interest was 30-day infection-related readmission. Secondary objectives included evaluation of patient characteristics associated with PO antibiotic use. Results During the defined study period 310 patients met inclusion; 113 (36.5%) were switched to PO antibiotic therapy for the treatment of GN BSI within a median of 5 (IQR 3–11) days. Oral antibiotics were initiated at discharge for 50 (44%) of patients switched. Patients switched to PO were less likely to have has a stay in the ICU (24.8% vs. 47.7%, P < 0.0001) and were less likely to have an ID consult (57.5% vs. 71.1%, P = 0.034). There was no difference in median Charlson Comorbidity Score (2, IQR 0–4). The most common sources of infection among those switched to PO agents were urinary (50, 44.2%) and intra-abdominal (25, 22.1%). The majority of patients were placed on a PO agent with high bioavailability (61, 54%), which included levofloxacin and moxifloxacin. There was a slightly higher proportion of use of high (vs. low) bioavailable antibiotics in patients with ID consult compared with those without (59% vs. 41%, P = 0.053). PO antibiotics were more frequently prescribed for patients discharged home (78, 69%) compared with patients discharged to Rehab/Short-term facility (28, 24.8%). Thirty-day hospital readmission was more common among the patients treated with PO antibiotics (18.6 vs. 8.1%, P = 0.006); however, ID-related readmission was rare (0.9% vs. 1%, P = 0.91). Conclusion Urinary and intra-abdominal sources and home discharge were common among those with PO antibiotic use. ID-related outcomes were similar among those treated with IV vs. PO agents. More research is necessary to determine optimal time to PO antibiotic switch. Disclosures K. Claeys, Nabriva: Scientific Advisor, Consulting fee. Melinta: Scientific Advisor, Consulting fee. E. Heil, ALK-Abelló: Grant Investigator, Research grant.

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