Hospital-level high-risk antibiotic use in relation to hospital-associated Clostridioides difficile infections: Retrospective analysis of 2016–2017 data from US hospitals

2019 ◽  
Vol 40 (11) ◽  
pp. 1229-1235 ◽  
Author(s):  
Ying P. Tabak ◽  
Arjun Srinivasan ◽  
Kalvin C. Yu ◽  
Stephen G. Kurtz ◽  
Vikas Gupta ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Setting ◽  
Antibiotic Use ◽  
The United States ◽  
Fourth Generation ◽  
Teaching Hospitals ◽  
Clostridioides Difficile ◽  
Positive Stool ◽  
Days Of Therapy ◽  
Assay Result

AbstractObjective:Antibiotics are widely used by all specialties in the hospital setting. We evaluated previously defined high-risk antibiotic use in relation to Clostridioides difficile infections (CDIs).Methods:We analyzed 2016–2017 data from 171 hospitals. High-risk antibiotics included second-, third-, and fourth-generation cephalosporins, fluoroquinolones, carbapenems, and lincosamides. A CDI case was a positive stool C. difficile toxin or molecular assay result from a patient without a positive result in the previous 8 weeks. Hospital-associated (HA) CDI cases included specimens collected >3 calendar days after admission or ≤3 calendar days from a patient with a prior same-hospital discharge within 28 days. We used the multivariable Poisson regression model to estimate the relative risk (RR) of high-risk antibiotic use on HA CDI, controlling for confounders.Results:The median days of therapy for high-risk antibiotic use was 241.2 (interquartile range [IQR], 192.6–295.2) per 1,000 days present; the overall HA CDI rate was 33 (IQR, 24–43) per 10,000 admissions. The overall correlation of high-risk antibiotic use and HA CDI was 0.22 (P = .003), and higher correlation was observed in teaching hospitals (0.38; P = .002). For every 100-day (per 1,000 days present) increase in high-risk antibiotic therapy, there was a 12% increase in HA CDI (RR, 1.12; 95% CI, 1.04–1.21; P = .002) after adjusting for confounders.Conclusions:High-risk antibiotic use is an independent predictor of HA CDI. This assessment of poststewardship implementation in the United States highlights the importance of tracking trends of antimicrobial use over time as it relates to CDI.

scholarly journals Association of Hospital-Onset Clostridium difficile Infection Rates and Antibiotic Use in US Acute Care Hospitals, 2006–2012: An Ecologic Analysis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S1-S1 ◽  
Author(s):  
Sophia Kazakova ◽  
James Baggs ◽  
Lawrence McDonald ◽  
Sarah Yi ◽  
Kelly Hatfield ◽  
...  
Keyword(s):  
Acute Care ◽  
Inpatient Treatment ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Estimating Equation ◽  
The United States ◽  
Fourth Generation ◽  
Days Of Therapy ◽  
Facility Level ◽  
Hospital Characteristics

Abstract Background This study investigated the association between facility-level rates of hospital-onset CDI (HO-CDI) and inpatient antibiotic use (AU) in a large group of U.S. acute care hospitals over a 7-year period. Methods We used adult discharge and antibiotic use data from 552 acute care hospitals participating in the Truven Health MarketScan Hospital Database from January 1, 2006 to December 31, 2012 to determine facility-level CDI rates and AU. HO-CDI was defined as a discharge with a secondary ICD-9-CM diagnosis code for CDI (008.45) and inpatient treatment with metronidazole or oral vancomycin. The relationship between facility-level HO-CDI (HO-CDI per 10,000 patient-days (PD)) and AU (days of therapy (DOT) per 1,000 PD) was examined through multivariate general estimating equation models that accounted for the correlation between annual HO-CDI rates within a hospital. The models controlled for hospital characteristics and a facility-level rate of community-onset CDI (CO-CDI), defined as a discharge with a primary ICD-9-CM code for CDI and inpatient treatment. Results During 2006 to 2012, the mean HO-CDI rate was 11 per 10,000 PD (interquartile range (IQR): 5.7–14.7) and mean AU was 811 DOT/1,000 PD (IQR: 710–932). After controlling for facility-level CO-CDI and other hospital characteristics, overall AU was significantly associated with facility-level HO-CDI rate; for every 50 DOT/1,000 PD increase in AU, there was a 4.4% increase in the HO-CDI rate. Similarly, the only antibiotic classes significantly associated with HO-CDI were third- and fourth-generation cephalosporins (P < 0.0001) and carbapenems (P = 0.0011) with respective increases of 2.1% and 2.4% of HO-CDI per 10 DOT/1,000 PD increase. Fluoroquinolones and β-lactam/β-lactamase inhibitor combinations were not significantly associated with HO-CDI. Conclusion In this ecologic analysis of over 500 hospitals, overall antibiotic use was associated with increased rates of HO-CDI. In contrast to recent patient-level analyses in the United States and national observations in England, only third- and fourth-generation cephalosporins and carbapenems were associated with HO-CDI. Disclosures All authors: No reported disclosures.

scholarly journals Corticosteroids Do Not Increase the Likelihood of Primary Clostridioides difficile Infection in the Setting of Broad-spectrum Antibiotic Use

2021 ◽  
Author(s):  
Travis J Carlson ◽  
Anne J Gonzales-Luna ◽  
Melissa F Wilcox ◽  
Sarah G Theriault ◽  
Faris S Alnezary ◽  
...  
Keyword(s):  
High Risk ◽  
Antibiotic Use ◽  
Primary Study ◽  
Relative Reduction ◽  
Study Cohort ◽  
Clostridioides Difficile ◽  
Final Study ◽  
Days Of Therapy ◽  
Clostridioides Difficile Infection ◽  
Anti Inflammatory

Abstract Objectives The pathogenesis of Clostridioides difficile infection (CDI) involves a significant host immune response. Generally, corticosteroids act by suppressing the host inflammatory response, and their anti-inflammatory effects are used to treat gastrointestinal disorders. Although previous investigations have demonstrated mixed results regarding the effect of corticosteroids on CDI, we hypothesized that the anti-inflammatory effect of corticosteroids would decrease the risk of CDI in hospitalized patients. Methods This was a case-control study of hospitalized adults. The case population included patients diagnosed with primary CDI who received at least one dose of a high-risk antibiotic (cefepime, meropenem, or piperacillin-tazobactam) in the 90 days prior to CDI diagnosis. The control population included patients who received at least one dose of the same high-risk antibiotic but did not develop CDI in the 90 days following their first dose of antibiotic. The primary study outcome was the development of CDI based on receipt of corticosteroids. Results The final study cohort consisted of 104 cases and 153 controls. Those who received corticosteroids had a lower odds of CDI after adjusting for age, proton-pump inhibitor use, and antibiotic days of therapy (OR, 0.54; 95% CI, 0.30 to 0.97; P=0.04). We did not observe an association between corticosteroid dose or duration and CDI. Conclusions We demonstrated a 46% relative reduction in the odds of developing CDI in patients who received corticosteroids in the past 90 days. We believe that our results provide the best clinical evidence to further support mechanistic studies underlying this phenomenon.

scholarly journals Association Between Antibiotic Use and Hospital-onset Clostridioides difficile Infection in US Acute Care Hospitals, 2006–2012: An Ecologic Analysis

2019 ◽  
Vol 70 (1) ◽  
pp. 11-18 ◽  
Author(s):  
Sophia V Kazakova ◽  
James Baggs ◽  
L Clifford McDonald ◽  
Sarah H Yi ◽  
Kelly M Hatfield ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Fourth Generation ◽  
Cross Sectional ◽  
Clostridioides Difficile ◽  
Days Of Therapy ◽  
Clostridioides Difficile Infection ◽  
The Impact

Abstract Background Unnecessary antibiotic use (AU) contributes to increased rates of Clostridioides difficile infection (CDI). The impact of antibiotic restriction on hospital-onset CDI (HO-CDI) has not been assessed in a large group of US acute care hospitals (ACHs). Methods We examined cross-sectional and temporal associations between rates of hospital-level AU and HO-CDI using data from 549 ACHs. HO-CDI was defined as a discharge with a secondary International Classification of Diseases, Ninth Revision, Clinical Modification code for CDI (008.45), and treatment with metronidazole or oral vancomycin > 3 days after admission. Analyses were performed using multivariable generalized estimating equation models adjusting for patient and hospital characteristics. Results During 2006–2012, the unadjusted annual rates of HO-CDI and total AU were 7.3 per 10 000 patient-days (PD) (95% confidence interval [CI], 7.1–7.5) and 811 days of therapy (DOT)/1000 PD (95% CI, 803–820), respectively. In the cross-sectional analysis, for every 50 DOT/1000 PD increase in total AU, there was a 4.4% increase in HO-CDI. For every 10 DOT/1000 PD increase in use of third- and fourth-generation cephalosporins or carbapenems, there was a 2.1% and 2.9% increase in HO-CDI, respectively. In the time-series analysis, the 6 ACHs with a ≥30% decrease in total AU had a 33% decrease in HO-CDI (rate ratio, 0.67 [95% CI, .47–.96]); ACHs with a ≥20% decrease in fluoroquinolone or third- and fourth-generation cephalosporin use had a corresponding decrease in HO-CDI of 8% and 13%, respectively. Conclusions At an ecologic level, reductions in total AU, use of fluoroquinolones, and use of third- and fourth-generation cephalosporins were each associated with decreased HO-CDI rates.

scholarly journals Significant Regional Differences in Antibiotic Use Across 576 US Hospitals and 11 701 326 Adult Admissions, 2016–2017

2020 ◽  
Author(s):  
Katherine E Goodman ◽  
Sara E Cosgrove ◽  
Lisa Pineles ◽  
Laurence S Magder ◽  
Deverick J Anderson ◽  
...  
Keyword(s):  
Regional Differences ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Antibiotic Use ◽  
Fourth Generation ◽  
Teaching Hospitals ◽  
Antibiotic Prescribing ◽  
Healthcare Database ◽  
Days Of Therapy ◽  
Adult Inpatient

Abstract Background Quantifying the amount and diversity of antibiotic use in United States hospitals assists antibiotic stewardship efforts but is hampered by limited national surveillance. Our study aimed to address this knowledge gap by examining adult antibiotic use across 576 hospitals and nearly 12 million encounters in 2016–2017. Methods We conducted a retrospective study of patients aged ≥ 18 years discharged from hospitals in the Premier Healthcare Database between 1 January 2016 and 31 December 2017. Using daily antibiotic charge data, we mapped antibiotics to mutually exclusive classes and to spectrum of activity categories. We evaluated relationships between facility and case-mix characteristics and antibiotic use in negative binomial regression models. Results The study included 11 701 326 admissions, totaling 64 064 632 patient-days, across 576 hospitals. Overall, patients received antibiotics in 65% of hospitalizations, at a crude rate of 870 days of therapy (DOT) per 1000 patient-days. By class, use was highest among β-lactam/β-lactamase inhibitor combinations, third- and fourth-generation cephalosporins, and glycopeptides. Teaching hospitals averaged lower rates of total antibiotic use than nonteaching hospitals (834 vs 957 DOT per 1000 patient-days; P < .001). In adjusted models, teaching hospitals remained associated with lower use of third- and fourth-generation cephalosporins and antipseudomonal agents (adjusted incidence rate ratio [95% confidence interval], 0.92 [.86–.97] and 0.91 [.85–.98], respectively). Significant regional differences in total and class-specific antibiotic use also persisted in adjusted models. Conclusions Adult inpatient antibiotic use remains high, driven predominantly by broad-spectrum agents. Better understanding reasons for interhospital usage differences, including by region and teaching status, may inform efforts to reduce inappropriate antibiotic prescribing.

scholarly journals 2378. Corticosteroid Use Prevents Primary Clostridioides difficile Infection in the Setting of Broad-Spectrum Antibiotic Use Among Hospitalized Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S820-S820
Author(s):  
Travis J Carlson ◽  
Melissa F Wilcox ◽  
Sarah G Theriault ◽  
Faris S Alnezary ◽  
Anne J Gonzales-Luna ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Use ◽  
The United States ◽  
Case Control ◽  
Hospitalized Patients ◽  
Primary Study ◽  
Care Hospital ◽  
Clostridioides Difficile ◽  
Days Of Therapy ◽  
History Of

Abstract Background Clostridioides difficile is the most common pathogen causing healthcare-associated infections in the United States and a Centers for Disease Control and Prevention urgent threat-level pathogen. The pathophysiology of C. difficile infection (CDI) involves neutrophil invasion of the colon associated with an inflammatory response. Previous case–control studies investigating an anti-inflammatory corticosteroid (CS) effect on CDI risk demonstrated conflicting results but were unable to control for antibiotic use. We hypothesized that CS use would decrease the risk of CDI in a well-matched, high-risk population. Methods This nested case–control study included hospitalized patients admitted to a single quaternary care hospital in the Texas Medical Center. The case population included adults who were diagnosed with CDI and received at least one dose of an antibiotic of interest (piperacillin–tazobactam, cefepime, or meropenem) in the 90 days prior to CDI diagnosis. The control population included hospitalized adults who received one of the same antibiotics during their hospital stay but did not develop CDI in the 90 days following their first dose. Patients were excluded if they had a documented history of CDI. CS use was defined as ≥ 20 mg prednisone or equivalent administered in the 48 hours prior to CDI diagnosis (cases) or antibiotic start (controls). The primary study outcome was the development of CDI. A logistic regression model was developed modeling CDI diagnosis as a function of available patient covariates. Results A total of 321 patients met the inclusion criteria; 56 patients had a history of CDI, leaving a final study cohort of 265 patients (104 cases and 161 controls). Antibiotic days of therapy were significantly higher in the control group (8 vs. 6 days; P = 0.02). The odds of CDI diagnosis were lower among patients administered CS (OR, 0.17; 95% CI, 0.08–0.38; P < 0.001), which remained protective in the multivariable model after adjusting for age, gender, and invasive GI surgery within 6 months. Conclusion We observed an association between CS use and decreased risk of developing primary CDI in hospitalized patients receiving broad-spectrum antibiotics. Future studies are needed to delineate the dose and duration of CS needed to realize this effect. Disclosures All authors: No reported disclosures.

scholarly journals Awareness of Antimicrobial Stewardship Interventions Within a Community Hospital Network

2020 ◽  
Vol 41 (S1) ◽  
pp. s136-s136
Author(s):  
Cindy Hou ◽  
Nikunj Vyas ◽  
Marianne Kraemer ◽  
David Condoluci
Keyword(s):  
Intensive Care ◽  
High Risk ◽  
Antimicrobial Stewardship ◽  
Wide Distribution ◽  
Frontline Staff ◽  
Clostridioides Difficile ◽  
Days Of Therapy ◽  
Share Data ◽  
Antibiotics Use ◽  
Lack Of Knowledge

Background: A system of 3 community hospitals in New Jersey has actively engaged in antimicrobial stewardship since November 2014. Consultations with infectious diseases specialists are mandatory for patients with sepsis, severe sepsis, septic shock, patients on 3 or more antibiotics, and for those diagnosed with Clostridioides difficile infection (CDI). A multidisciplinary team meets monthly and has begun to improve the appropriateness of antibiotics use and to reduce antibiotic days of therapy per 1,000 patient days. Recently, we participated in a targeted assessment program (TAP) for CDI, and we identified areas of opportunity for antimicrobial stewardship. Methods: The TAP survey was emailed to a wide distribution of employees in the hospital, primarily nurses, physicians, and others with a variable range of experience and for those working in the intensive care units and on the wards. Ultimately, the numbers of responses were 60 in hospital A, 88 in hospital B, and 124 in hospital C. Results: In hospital A, most respondents were nurses or nurse assistants or technicians (63%), and most of the total individuals surveyed worked outside the intensive care unit setting. In hospital B, nurses or nurse assistants or technicians comprised 69% of all responses. Hospital C had the highest percentage of physicians who responded (31%). One theme for all hospitals was that a little more than half of those surveyed felt that for patients with new or recent CDI infections, antibiotics prescribed for infections were reviewed by clinicians. Less than half of respondents believed that education was being given to patients and families about the risks of CDI from antibiotics. With regard to high-risk CDI antibiotics, there was a general lack of knowledge that these were being monitored. For example, survey respondents felt that this was always monitored on clindamycin by only 33% of respondents in hospital A, 40% in hospital B, and 42% in hospital C. With regard to strategies to reduce the unnecessary use of fluoroquinolones, the response of “always” ranged from 35% to 47% of the time. Conclusions: Even though hospitals may have robust antimicrobial stewardship programs, it is important to survey frontline staff. Although all of the antimicrobial stewardship interventions, such as monitoring high-risk-CDI antibiotics, reducing high-risk CDI antibiotics, among others, are performed, there may be lack of knowledge that these initiatives are even being implemented. In this TAP against CDI, we found opportunities to share data with respondents to increase awareness of antimicrobial stewardship to further combat hospital-acquired infections.Funding: NoneDisclosures: None

scholarly journals Performance Evaluation of the Luminex Aries C. difficile Assay in Comparison to Two Other Molecular Assays within a Multihospital Health Care Center

2019 ◽  
Vol 57 (11) ◽  
Author(s):  
Stefan Juretschko ◽  
Ryhana Manji ◽  
Reeti Khare ◽  
Shubhagata Das ◽  
Sherry Dunbar
Keyword(s):  
Care Center ◽  
Hospital Setting ◽  
The United States ◽  
Turnaround Time ◽  
Sample Number ◽  
Content Type ◽  
Health Care Center ◽  
Clostridioides Difficile ◽  
Comparison Results ◽  
Hands On

ABSTRACT Clostridioides difficile infection (CDI) remain a serious issue in the United States. Fast and accurate diagnosis of CDI is paramount to achieve immediate infection control initiation, triaging, and isolation, as well as appropriate antibiotic treatment. However, both, over- and underdiagnosis can lead to adverse patient outcomes, such as unnecessary administration of antibiotics or unwanted spread of spores in any hospital setting, respectively. In this prospective study, we evaluated the FDA-cleared Aries C. difficile assay and compared its performance and workflow characteristics to those of the BD Max Cdiff and Xpert C. difficile/Epi assays. Out of 302 samples tested, 55 (18.2%) samples were positive, and 234 (77.5%) samples were negative for C. difficile by all three testing methods. Comparison results showed a positive and negative percent agreement (PPA and NPA, respectively) between the Aries and Xpert assays of 95.2% (59/62) and 99.2% (238/240), respectively. The PPA and NPA between the Aries and BD Max assays were 91.8% (56/61) and 96.6% (230/238), respectively. Invalid result rates were determined to be 2.6% for the BD Max assay, 1.0% for the Aries assay, and 0% for the Xpert assay. Hands-on time (HoT) and total turnaround time (TAT) varied considerably depending on the sample number and instrument throughput. The HoT ranged from 1.2 to 3.5 min per sample, and the TAT was 1 to 2.3 h. Overall, the results demonstrated that the Aries assay is a rapid and sensitive method for the diagnosis of CDI in clinical laboratories.

scholarly journals Associations of facility-level antibiotic use and hospital-onset Clostridioides difficile infection in US acute-care hospitals, 2012–2018

2021 ◽  
pp. 1-3
Author(s):  
Sophia V. Kazakova ◽  
James Baggs ◽  
Sarah H. Yi ◽  
Sujan C. Reddy ◽  
Kelly M. Hatfield ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Fourth Generation ◽  
Third Generation ◽  
Hospital Level ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Facility Level

Abstract Previously reported associations between hospital-level antibiotic use and hospital-onset Clostridioides difficile infection (HO-CDI) were reexamined using 2012–2018 data from a new cohort of US acute-care hospitals. This analysis revealed significant positive associations between total, third-generation, and fourth-generation cephalosporin, fluoroquinolone, carbapenem, and piperacillin-tazobactam use and HO-CDI rates, confirming previous findings.

scholarly journals 2404. Molecular Epidemiology of Clostridioides difficile in the United States, 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S830-S830 ◽  
Author(s):  
Ashley Paulick ◽  
Michelle Adamczyk ◽  
Lauren C Korhonen ◽  
Alice Guh ◽  
Amy Gargis ◽  
...  
Keyword(s):  
United States ◽  
Molecular Epidemiology ◽  
The United States ◽  
Emerging Infections ◽  
Convenience Sample ◽  
Clostridioides Difficile ◽  
Positive Stool ◽  
Control And Prevention ◽  
Clostridioides Difficile Infection ◽  
Healthcare Associated

Abstract Background In 2009, the Centers for Disease Control and Prevention (CDC) implemented Clostridioides difficile infection (CDI) surveillance through the Emerging Infections Program (EIP) to monitor the incidence and evolving epidemiology of CDI in the United States. Since 2012, ribotypes (RTs) 027, 106, 002, 014, and 020 have constituted the top five strain types among both US community- and healthcare-associated isolates. Here we describe the changes in molecular epidemiology of C. difficile isolates collected in the United States in 2017. Methods In 2017, CDI surveillance was conducted at 10 EIP sites (CA, CO, CT, GA, MD, MN, NM, NY, OR, and TN). A convenience sample of clinical laboratories across EIP sites submitted C. difficile-positive stool specimens to the MN Department of Health Public Health Laboratory and Hines VA Hospital (IL) for culture. Isolates were forwarded to CDC and characterized by capillary-based PCR-ribotyping and PCR detection of tcdA, tcdB, cdtA, cdtB, and deletions in tcdC. Results In 2017, 1,051 C. difficile isolates were submitted; the total number of isolates received from each site ranged from 11 to 286 with a median of 85.5. In total, 143 RTs were observed, with the majority of isolates harboring toxin genes tcdA and tcdB (95%) and a wild-type tcdC sequence (71%). Among 556 healthcare-associated isolates, RT 027 was the most prevalent and the top RT at 5 sites (CA, GA, MD, NM, TN). Ribotype 106 was the most prevalent among 495 community-associated CA isolates and the top RT at 6 sites (CO, CT, GA, MD, MN, TN). Ribotype 027 significantly decreased from 2012 to 2017 among both healthcare-associated (21% vs 15%; p = 0.02) and community-associated isolates (17% vs 6%; P < 0.0001). Among healthcare-associated isolates, RT 076, which was observed in 8 EIP sites, increased from 2% in 2016 to 5% in 2017 (p = 0.05) and replaced RT 020 as one of the top 5 healthcare-associated RTs in 2017. Conclusion Despite an overall decline since 2012, RT 027 remained the most prevalent RT among healthcare-associated isolates submitted in 2017. The increased frequency of RT 076 among healthcare-associated isolates submitted in 2017 highlights the evolving molecular epidemiology of C. difficile and the need for continued surveillance to monitor potential emerging strains. Disclosures All authors: No reported disclosures.

scholarly journals 144. Antifungal Use Trends in Hospitalized Adults in the United States, 2016-2020

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S184-S185
Author(s):  
Emily A Kaip ◽  
Ernie Shippey ◽  
Conan MacDougall
Keyword(s):  
United States ◽  
Fungal Infection ◽  
Negative Binomial ◽  
Hematologic Malignancy ◽  
Organ Transplant ◽  
The United States ◽  
Teaching Hospitals ◽  
Solid Organ ◽  
Days Of Therapy ◽  
Clinical Resource

Abstract Background Surveillance of antimicrobial use is a cornerstone of antimicrobial stewardship, though antifungal (AF) use is less frequently characterized. AFs are a major driver of inpatient costs and their use both reflects and drives changes in fungal susceptibility patterns. We report on trends in AF use in a large sample of United States hospitals over time including predictors of AF use. Methods We performed a retrospective analysis of adult inpatient visits between 2016 and 2020 at hospitals contributing data to the Vizient Clinical Database/Clinical Resource Manager (www.vizientinc.com). Inpatient use of systemically administered AFs was investigated as a function of study quarter, diagnosis code, and underlying immunosuppressive condition. Changes in AF use were modeled using logistic and negative binomial regression. Results We examined over 23 million admissions across 470 hospitals, 43% of which were classified as teaching hospitals and 54% of which performed solid organ transplants. During the study period, 4.03% (951,284/23,565,493) of admissions were billed for one or more of the study AFs. Among admissions receiving AFs, 86% received an azole, with the most frequently used agent being fluconazole, which accounted for for 46% of total AF days. Likelihood of AF receipt during admission increased by quarter (OR 1.012, p&lt; 0.001), controlling for length of stay, presence of fungal infection, hematologic malignancy (HM), or solid organ transplant (SOT). Odds of any receipt and days of therapy (DOT) of fluconazole, isavuconazole, posaconazole, and echinocandins increased over the study period while those of voriconazole, itraconazole, and flucytosine decreased; odds of receipt of amphotericin products increased while DOT decreased; flucytosine receipt odds increased while DOT did not change. Only 30% of admissions with AF use were associated with a documented fungal infection, with 93% of these episodes documented as candidiasis. Admissions associated with SOT or HM represented 2% and 3% of all patient-days, but 11% and 25% of total AF days, respectively. Antifungal Utilization Conclusion AF use increased significantly over the study period, with changes across agents and classes. Most AF use occurred in the absence of administratively documented infection and was more common among SOT and HM patients. Disclosures All Authors: No reported disclosures

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