296. IV-to-PO Antibiotic Step-down Therapy for Treatment of Uncomplicated Streptococcal Bloodstream Infections

Abstract Background Beta-lactams are the drug of choice for uncomplicated Streptococcal bloodstream infections (BSIs). However, due to the low bioavailability of oral beta-lactams, it’s unclear whether de-escalation from IV to PO therapy is safe and effective. Our objective was to compare the efficacy and safety of step-down IV-to-PO antibiotic therapy to IV-only treatment of uncomplicated Streptococcal BSIs. Methods This was a retrospective study at a level-1, academic medical center in New Mexico of patients ≥ 18 years of age treated for uncomplicated Streptococcal BSI between January 2017 and December 2019. The primary outcome was clinical failure in patients receiving IV-only therapy compared to IV-to-PO step-down therapy. Clinical failure was defined as having at least one of the following: persistent bacteremia, 30-day reinfection at any site or new-onset sepsis, 30-day BSI recurrence, or 30-day all-cause mortality. Secondary outcomes include 30-day all-cause readmission, 30-day antibiotic-related side effects, 30-day C. difficile-associated diarrhea and hospital length of stay (HLOS). Results A total of 98 patients were included: 51 in the IV-to-PO group and 47 in the IV-only therapy group. The median age for both groups was 61 years; 65% patients were male, and 72% were Caucasian. BSIs were predominantly associated with respiratory infections (24.5%). Streptococcus pneumoniae (29.6%) was the most common pathogen. Nine patients (19.1%) in the IV-only group and none in the IV-to PO group experienced a clinical failure. 30-day reinfection at any site or new-onset sepsis (88.9%) was the primary cause of clinical failures. Fourteen patients (14.3%) were readmitted due to any cause within 30 days, 6 patients (11.8%) from the IV-to-PO and 8 (17%) from the IV-only group. Patients in the IV-to-PO group had a shorter duration of therapy than patients in the IV-only group (13 vs. 15 days, p=0.001), and decreased HLOS (5 vs. 12 days, p< 0.001). Clinical failure was not statistically different when assessed for co-morbidities, source of infection, Pitt bacteremia score, documented BSI clearance, ICU admission or pathogen. Conclusion IV-to-PO step-down therapy appears to be a safe and effective alternative for treating uncomplicated Streptococcal BSIs in patients who are otherwise clinical stable. Disclosures Keenan L. Ryan, PharmD, PhC, Theravance (Advisor or Review Panel member)

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159. Comparing Clinical Cure and Patient Outcomes Between Intravenous Therapy and Intravenous (IV)-to-Oral (PO) Step-down Therapy for Treatment of Gram-Negative Bloodstream Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.234 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S105-S105

Author(s):

Kelsey Williams ◽

Riane Ghamrawi ◽

Sheila Takieddine ◽

Peter Grubbs ◽

Maggie Powers-Fletcher ◽

...

Keyword(s):

Clinical Cure ◽

Medical Center ◽

Univariate Analysis ◽

Bloodstream Infections ◽

Hospital Length Of Stay ◽

Oral Antibiotic ◽

Oral Antibiotics ◽

Gram Negative ◽

Step Down ◽

Cure Rates

Abstract Background There is a paucity of evidence surrounding optimal prescribing practices for the treatment of Gram-negative bloodstream infections (GNBSI). This study aimed to assess the appropriateness of IV-to-PO step-down therapy in the treatment of GNBSI. Methods A retrospective cohort study was conducted at the University of Cincinnati Medical Center and West Chest Hospital and included subject’s ≥18 years of age with GNBSI caused by Enterobacteriaceae spp. or Pseudomonas aeruginosa. The primary objective was to compare clinical cure rates between IV-only and IV-to-PO therapy, and to further assess differences in clinical cure rates amongst oral antibiotics of high, moderate, and low bioavailability. The study also aimed to identify factors associated with clinical cure, hospital length of stay, and emergence of multi-drug-resistant organisms (MDRO). Results Amongst 215 subjects screened, 99 subjects were included and 64 subjects met criteria for clinical cure. In the univariate analysis, the IV-to-PO group had a higher percentage of clinical cure than IV only therapy (82% vs. 48%, P = 0.001). Of note, the two study groups were significantly different in regards to intensive care status, Pitt bacteremia score, and primary site of infection. Upon further analysis, data from the multivariate logistic regression revealed that critical illness was the only significant factor that negatively impacted clinical cure (OR = 0.208; 95% CI 0.04–0.99; P = 0.049). A total of 49 subjects received oral antibiotics. Majority of patients (82%) in the IV-to-PO group received a moderately bioavailable oral antibiotic. No difference in respect to clinical cure rate was found between the three PO antibiotic bioavailability groups (P = 0.346). The median duration of hospital stay was shorter in the IV-to-PO compared with IV alone group (4 days vs. 9.5 days, respectively, P ≤ 0.001). There was a trend in emergence of MDROs with IV therapy compared with IV-to-PO therapy (10% vs. 2%, P = 0.204). Conclusion IV-to-PO stepdown therapy compared with IV therapy alone was noninferior in clinical cure rates in the treatment of GNBSI and may result in fewer hospital days and less emergence of multidrug-resistant organisms. These conclusions are limited by significant differences in severity of illness between groups in this study. Disclosures All authors: No reported disclosures.

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PT Achievement in Public Hospitals and Its Effect on Outcomes

Geriatrics ◽

10.3390/geriatrics4040058 ◽

2019 ◽

Vol 4 (4) ◽

pp. 58

Author(s):

Jessica S. Morton ◽

Alex Tang ◽

Michael J. Moses ◽

Dustin Hamilton ◽

Neville Crick ◽

...

Keyword(s):

Physical Therapy ◽

Length Of Stay ◽

Medical Center ◽

Therapy Group ◽

Academic Medical Center ◽

Early Mobilization ◽

The United States ◽

Public Hospitals ◽

Hospital Length Of Stay ◽

Discharge Disposition

The demand for TKA continues to rise within the United States, while increasing quality measures and cost containment became the basis of reimbursement for hospital systems. Length of stay is a major driver in the cost of TKA. Early mobilization with physical therapy has been shown to increase range of motion and decrease complications, but with mixed results in regards to length of stay. We postulate that initiating physical therapy on post-operative day zero will decrease length of stay in an urban public hospital. Retrospective chart review was performed at a large, urban, public academic medical center to identify patients who have had a primary TKA over the course of a 3-year period. Groups who underwent post-operative day zero therapy were compared with those who initiated physical therapy on post-operative day one. Length of stay was the primary outcome. Patient demographic characteristics and discharge disposition were also collected. There were 98 patients in the post-operative day-one physical therapy cohort and 58 in the post-operative day zero physical therapy group. Hospital length of stay was significantly decreased in the post-operative day zero physical therapy group. (p < 0.01) There was no difference in discharge disposition between the two groups.

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1010. Effectiveness of Oral Antibiotics for Definitive Therapy of Gram-Positive Bloodstream Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.847 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S300-S301

Author(s):

Danya Roshdy ◽

Nick Quinn ◽

Jamie Sebaaly ◽

Megan Templin ◽

David Weinrib

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Bloodstream Infections ◽

Definitive Treatment ◽

Common Source ◽

Clinical Failure ◽

Gram Positive ◽

Definitive Therapy ◽

Significant Difference ◽

Antibiotic Group

Abstract Background Transition from intravenous (IV) to oral (PO) antibiotics is common practice in patients with Gram-positive bloodstream infections (GP-BSI); however, clinical data evaluating IV to PO switch options are lacking. The objective of this study was to examine effectiveness of PO antibiotics for definitive treatment GP-BSI, with a focus on bioavailability (BA). Methods This was a single-center, retrospective cohort study of adult inpatients admitted to an 874-bed academic medical center in Charlotte, NC between September 1, 2014 and August 31, 2017. Patients with a GP-BSI who received appropriate antibiotic therapy with at least one third of their total course administered PO were included. Patients with GP-BSI caused by staphylococcal species were excluded. The primary endpoint was clinical failure in patients receiving high (≥90%) vs. low (<90%) BA agents. Secondary endpoints included clinical failure stratified by antibiotic group, bactericidal vs. bacteriostatic agents, and organism. Chi-square and Fisher’s exact tests were used to examine clinical failure. Results One hundred three patients were included, 26 in the high BA group, and 77 in the low BA group. The median age was 58, 51% were women, 74.8% of patients had streptococcal bacteremia (26.2% S. pneumoniae), with pulmonary being the most common source (30.1%). There were no major differences in baseline demographic and clinical characteristics between groups. The median treatment duration with IV antibiotics was 4 and 5 days in the high and low BA groups, respectively (P = 0.12). There was no statistically significant difference in clinical failure in the high vs. low BA groups (19% vs. 23%, P = 0.66, respectively). Clinical failure stratified by antibiotic group, bacteriostatic vs. bactericidal agent (OR 1.43, CI 0.26–7.90), and organism also did not yield statistically significant differences. Conclusion These data demonstrate similar rates of clinical failure among patients definitively treated with high or low BA agents for GP-BSI. High BA agents such as fluoroquinolones may not be needed for all patients with GP-BSI, where more targeted β-lactam therapies may be appropriate. Additional prospective studies with larger sample sizes are needed to further validate these conclusions. Disclosures All authors: No reported disclosures.

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205. Evaluating the Time to Oral Step-Down Therapy for Gram-Negative Bloodstream Infections Associated with a Genitourinary Source

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.407 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S211-S211

Author(s):

Nicole Mulvey ◽

Thien-Ly Doan ◽

Lemar Nadi

Keyword(s):

Length Of Stay ◽

Therapy Group ◽

Bloodstream Infections ◽

Clinical Failure ◽

Oral Antibiotics ◽

Oral Agent ◽

Gram Negative ◽

Duration Of Therapy ◽

Day Range ◽

Step Down

Abstract Background The transition to oral antibiotics in gram-negative bloodstream infections (BSI) can decrease length of stay, avoid central line access, and improve patient convenience. Some studies suggest that the bioavailability of the oral agent selected can impact outcomes. The purpose of this study was to determine when the most appropriate time to oral step-down is, and assess if the bioavailability of the agent selected impacts outcomes. Methods This retrospective observational chart review evaluated adult patients admitted to Long Island Jewish Medical Center during the study period of January 2019 – December 2019 with a gram-negative BSI from a genitourinary source. The primary objective was to assess if the time to oral step-down therapy impacts clinical success. Secondary objectives included assessment of if continued IV therapy or oral step-down impacts outcome measures including clinical failure, length of stay, and duration of therapy, and to compare high versus low bioavailability agents on treatment outcomes. Results A total of 130 patients were included, with 88 patients in the oral step-down group and 42 patients in the IV therapy only group. Clinical failure occurred in 10 patients in the oral step-down group, with 2 de-escalated in the 1-3 day range and 8 de-escalated in the 4-6 day range (p=0.29). There was no difference in clinical failure when the oral step-down group was compared to the IV therapy group (11 vs. 17%; p=0.41). The length of stay was significantly shorter in the oral step-down group (p< 0.0001), while the duration of therapy was shorter in the IV therapy group (p=0.0015). When comparing high and low bioavailability agents, there was no difference in the rate of treatment failure (p=0.74), length of stay (p=0.08), or duration of therapy (p=0.02). Conclusion There was no significant difference in outcomes if patients were de-escalated to oral therapy early versus late in their treatment course. Step-down to oral antibiotics led to decreased length of stay, and the bioavailability of the oral agent selected did not impact outcomes. This study demonstrates the safety and efficacy of prompt oral step-down for gram-negative bacteremia secondary to a genitourinary source which can have positive impacts on patient care. Disclosures All Authors: No reported disclosures

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198. Evaluation of Oral Step-down versus Continued Intravenous Antimicrobial Therapy in Immunocompromised Patients Hospitalized with Gram-Negative Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.400 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S207-S207

Author(s):

Heather Savage ◽

Catherine H Vu ◽

DeMaurian Mitchner ◽

Amir Zaki

Keyword(s):

Length Of Stay ◽

Academic Medical Center ◽

The United States ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Immunocompromised Patients ◽

Clinical Failure ◽

Gram Negative ◽

Gram Negative Bacteremia ◽

Step Down

Abstract Background Bloodstream infections are associated with considerable morbidity and mortality in the United States. Most patients initially receive parenteral antibiotics for gram-negative bacteremia, and more data is emerging supporting de-escalation to oral (PO) antibiotics to complete treatment. Previous studies evaluating PO antibiotics for gram-negative bacteremia often exclude or have underrepresented immunocompromised patients. This study evaluated clinical failure in immunocompromised patients receiving intravenous (IV) antibiotics compared to patients transitioned to PO antibiotics for gram-negative bacteremia. Methods A single center, retrospective cohort study was conducted at 446-bed academic medical center. Patients were included if they were immunocompromised and admitted with a positive blood culture for E. coli, Klebsiella spp., Citrobacter spp., Serratia spp., Enterobacter spp., Proteus spp., P. aeruginosa. between November 4, 2017 to November 4, 2020. Patients were excluded from this study if they had polymicrobial bacteremia, no source control within the first 5 days, or an indication for prolonged duration of treatment. The primary endpoint of this study was clinical failure defined as an escalation from PO to IV antibiotics, worsening clinical status, or readmission for the same infection within 30 days of discharge. The secondary endpoints included 30-day mortality, 90-day mortality, 30-day readmission, and time to microbiologic clearance. Results A total of 31 immunocompromised patients were included in the study with 26 patients receiving PO step-down therapy and 5 patients being continued on IV treatment for gram-negative bacteremia. There was no difference in the primary outcome of clinical failure between the PO step-down group versus the IV therapy group (15.4% vs 20%; p = 0.613). The most common immunocompromised state in both groups was being HIV positive. Patients in the PO step-down group had a significantly shorter hospital length of stay (7.4 days vs. 13.6 days; p = 0.016). Conclusion Oral step-down therapy for gram-negative bacteremia showed similar clinical failure rates to continuous IV therapy in the immunocompromised patient population and may be an option to shorten hospital length of stay. Disclosures All Authors: No reported disclosures

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191. Oral Antibiotic Step-Down Therapy for Non-Staphylococcal Gram-Positive Bloodstream Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.393 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S203-S203

Author(s):

Kelvin Gandhi ◽

Magdalena Wrzesinski ◽

Kristen Bunnell ◽

Ashley Long ◽

Vanessa Hutzley ◽

...

Keyword(s):

Length Of Stay ◽

Bloodstream Infections ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Bivariate Analysis ◽

Oral Antibiotic ◽

Clinical Failure ◽

Oral Group ◽

Step Down ◽

Primary Composite Outcome

Abstract Background Bloodstream infections are traditionally treated with intravenous (IV) antimicrobial therapy, which may increase length of stay and healthcare costs. The purpose of this study is to evaluate if oral antibiotic step-down therapy for non-staphylococcal gram-positive bloodstream infections (GP-BSIs) is non-inferior to IV antibiotics. Methods This single-center, retrospective cohort study included patients with a non-Staphylococcus aureus, non-Staphylococcus lugdunensis GP-BSI from January 2017 to December 2019. Patients were excluded if they fit any of the following criteria: organism identified as contaminant, polymicrobial BSI, recurrent BSI within the past 90 days, or receipt of an effective antibiotic for a duration longer than what is indicated for BSI treatment. Patients were categorized into those who received an IV antibiotic for the total duration of therapy and those who received an oral step-down antibiotic for at least one-third of the treatment course. The primary composite outcome was the incidence of 90-day clinical failure consisting of 90-day all-cause mortality, change in therapy due to inadequate clinical response, and 90-day BSI recurrence. The secondary outcomes included the individual components of the primary composite outcome, line-related complications, and hospital length of stay. Bivariate analysis was conducted to assess for predictors of 90-day clinical failure. Results A total of 308 patients were included (oral group, n=94; IV group, n=214). Pitt Bacteremia Scores were low overall, but higher in the IV group (0 vs 1, p=0.045). The oral group had a higher proportion of GP-BSI caused by streptococcal species (76% vs 61%, p< 0.001). The oral group had a lower incidence of 90-day clinical failure and was found to be noninferior to the IV group (9% vs 14%; mean difference -5%, 90% CI -12.7 to 2.6). The IV group had a longer hospital length of stay (4 vs 6 days, p< 0.001), however there were no other significant differences in secondary outcomes. Bivariate analysis found no significant predictors of 90-day clinical failure. Conclusion Oral antibiotic step-down therapy was found to be non-inferior to IV antibiotic therapy, and thus may be an alternative option for the treatment of non-staphylococcal GP-BSIs. Disclosures All Authors: No reported disclosures

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Impact of Critical Care Consultation Requests for Avoidable Central Venous Catheters on Medical-Surgical Units

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.822 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s258-s258

Author(s):

Madhuri Tirumandas ◽

Theresa Madaline ◽

Gregory David Weston ◽

Ruchika Jain ◽

Jamie Figueredo

Keyword(s):

Critical Care ◽

High Risk ◽

Medical Center ◽

Academic Medical Center ◽

Retrospective Chart Review ◽

Bloodstream Infections ◽

Central Line ◽

Central Venous Catheters ◽

High Risk Population ◽

Central Venous

Background: Although central-line–associated bloodstream infections (CLABSI) in US hospitals have improved in the last decade, ~30,100 CLABSIs occur annually.1,2 Central venous catheters (CVC) carry a high risk of infections and should be limited to appropriate clinical indications.6,7 Montefiore Medical Center, a large, urban, academic medical center in the Bronx, serves a high-risk population with multiple comobidities.8–11 Despite this, the critical care medicine (CCM) team is often consulted to place a CVC when a peripheral intravenous line (PIV) cannot be obtained by nurses or primary providers. We evaluated the volume of CCM consultation requests for avoidable CVCs and related CLABSIs. Methods: Retrospective chart review was performed for patients with CCM consultation requests for CVC placement between July and October 2019. The indication for CVC, type of catheter inserted or recommended, and NHSN data were used to identify CLABSIs. CVCs were considered avoidable if a PIV was used for the stated indication and duration of therapy, with no anatomical contraindications to PIV in nonemergencies, according to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).6Results: Of 229 total CCM consults, 4 (18%) requests were for CVC placement; 21 consultations (9%) were requested for avoidable CVCs. Of 40 CVC requests, 18 (45%) resulted in CVC placement by the CCM team, 4 (10%) were deferred for nonurgent PICC by interventional radiology, and 18 (45%) were deferred in favor of PIV or no IV. Indications for CVC insertion included emergent chemotherapy (n = 8, 44%) and dialysis (n = 3, 16%), vasopressors (n = 3, 16%), antibiotics (n = 2, 11%) and blood transfusion (n = 2, 11%). Of 18 CVCs, 9 (50%) were potentially avoidable: 2 short-term antibiotics and rest for nonemergent indications; 2 blood transfusions, 1 dialysis, 2 chemotherapy and 2 vasopressors. Between July and October 2019, 6 CLABSIs occurred in CVCs placed by the CCM team; in 3 of 6 CLABSI events (50%), the CVC was avoidable. Conclusions: More than half of consultation requests to the CCM team for CVCs are avoidable, and they disproportionately contribute to CLABSI events. Alternatives for intravenous access could potentially avoid 9% of CCM consultations and 50% of CLABSIs in CCM-inserted CVCs on medical-surgical wards.Funding: NoneDisclosures: None

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Impact of Inactive Empiric Antimicrobial Therapy on Inpatient Mortality and Length of Stay

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00466-06 ◽

2006 ◽

Vol 50 (10) ◽

pp. 3355-3360 ◽

Cited By ~ 27

Author(s):

Kimberly K. Scarsi ◽

Joe M. Feinglass ◽

Marc H. Scheetz ◽

Michael J. Postelnick ◽

Maureen K. Bolon ◽

...

Keyword(s):

Length Of Stay ◽

Antimicrobial Therapy ◽

Medical Center ◽

Academic Medical Center ◽

Bloodstream Infections ◽

Empiric Therapy ◽

Inpatient Mortality ◽

In Vitro Susceptibility ◽

Empiric Antimicrobial Therapy

ABSTRACT The consequences of inactive empiric antimicrobial therapy are not well-described and may cause prolonged hospitalization or infection-related mortality. In vitro susceptibility results for 884 patients hospitalized at an academic medical center with gram-negative bloodstream infections (GNBI) from 2001 to 2003 were matched to antimicrobial orders within 24 h of culture. Clinical characteristics, organism, inpatient mortality, and length of stay after culture for patients with GNBI were compared between patients receiving active versus inactive empiric antimicrobial therapy. A total of 14.1% of patients with GNBI received inactive empiric therapy, defined as no antimicrobial therapy within 24 h of the culture active against the identified organism based on in vitro microbiology reports. Patients who received inactive therapy were more likely to be younger, to be infected with Pseudomonas aeruginosa, to have a nosocomial infection, and to receive antimicrobial monotherapy but less likely to be bacteremic with Escherichia coli or to have sepsis (P < 0.05). There were no significant differences in mortality between patients receiving active versus inactive empiric therapy (16.1% versus 13.6%, respectively) or in length of stay after positive culture (11.5 days versus 12.6 days, respectively). Only 45 patients had greater than 2 days of exposure to inactive therapy; however, 8/30 patients (26.7%) who never received active antimicrobial therapy died while in the hospital. Inactive empiric therapy was more common in healthier patients. Inactive antimicrobial therapy in the first 24 h did not significantly impact average outcomes for GNBI among hospitalized patients but may have caused harm to specific individuals.

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Static Ankle Dorsiflexion and Hip and Pelvis Kinematics During Forward Step-Down in Patients With Hip-Related Groin Pain

Journal of Sport Rehabilitation ◽

10.1123/jsr.2020-0140 ◽

2020 ◽

pp. 1-8

Author(s):

Stefanie N. Foster ◽

Michael D. Harris ◽

Mary K. Hastings ◽

Michael J. Mueller ◽

Gretchen B. Salsich ◽

...

Keyword(s):

Pelvic Tilt ◽

Groin Pain ◽

Medical Center ◽

Weight Bearing ◽

Academic Medical Center ◽

Ankle Dorsiflexion ◽

Future Research ◽

Cross Sectional ◽

Anterior Pelvic Tilt ◽

Step Down

Context: The authors hypothesized that in people with hip-related groin pain, less static ankle dorsiflexion could lead to compensatory hip adduction and contralateral pelvic drop during step-down. Ankle dorsiflexion may be a modifiable factor to improve ability in those with hip-related groin pain to decrease hip/pelvic motion during functional tasks and improve function. Objective: To determine whether smaller static ankle dorsiflexion angles were associated with altered ankle, hip, and pelvis kinematics during step-down in people with hip-related groin pain. Design: Cross-sectional Setting: Academic medical center. Patients: A total of 30 people with hip-related groin pain (12 males and 18 females; 28.7 [5.3] y) participated. Intervention: None. Main Outcome Measures: Weight-bearing static ankle dorsiflexion with knee flexed and knee extended were measured via digital inclinometer. Pelvis, hip, and ankle kinematics during forward step-down were measured via 3D motion capture. Static ankle dorsiflexion and kinematics were compared with bivariate correlations. Results: Smaller static ankle dorsiflexion angles were associated with smaller ankle dorsiflexion angles during the step-down for both the knee flexed and knee extended static measures. Among the total sample, smaller static ankle dorsiflexion angle with knee flexed was associated with greater anterior pelvic tilt and greater contralateral pelvic drop during the step-down. Among only those who did not require a lowered step for safety, smaller static ankle dorsiflexion angles with knee flexed and knee extended were associated with greater anterior pelvic tilt, greater contralateral pelvic drop, and greater hip flexion. Conclusions: Among those with hip-related groin pain, smaller static ankle dorsiflexion angles are associated with less ankle dorsiflexion motion and altered pelvis and hip kinematics during a step-down. Future research is needed to assess the effect of treating restricted ankle dorsiflexion on quality of motion and symptoms in patients with hip-related groin pain.

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301. Penicillin Versus Cefazolin or Anti-staphylococcal Penicillins for Penicillin-Susceptible Staphylococcus aureus Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.344 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S149-S149

Author(s):

Mohammed Aldhaeefi ◽

Jeffrey Pearson ◽

Sanjat Kanjilal ◽

Brandon Dionne

Keyword(s):

Staphylococcus Aureus ◽

Blood Culture ◽

Positive Blood Culture ◽

Medical Center ◽

Academic Medical Center ◽

Similar Distribution ◽

Clinical Failure ◽

Staphylococcus Aureus Bacteremia ◽

Definitive Therapy ◽

Significant Difference

Abstract Background Staphylococcus aureus bacteremia is a significant cause of mortality. Penicillin (PCN) may have a role in the treatment of penicillin-susceptible Staphylococcus aureus (PSSA) bacteremia as it has a narrower spectrum of activity than cefazolin and is better tolerated than antistaphylococcal penicillins (ASPs). The aim of this study is to evaluate the safety and effectiveness of PCN versus cefazolin or ASPs in the treatment of PSSA bacteremia. Methods This is a single-center, retrospective study at a tertiary academic medical center. All patients with a PSSA blood culture from January 1, 2012 to September 1, 2019 were screened. Patients were excluded if they were treated with a definitive antibiotic (defined as antimicrobial therapy received 72 hours after positive blood culture) other than the study comparators, or if they received combination antibiotic therapy >72 hours from the initial positive blood culture result. The primary outcome was 60-day clinical failure, which was a composite endpoint of change in antibiotic after 72 hours of definitive therapy, recurrence of PSSA bacteremia, infection-related readmission, or all-cause mortality. Results Of 277 patients with PSSA bacteremia, 101 patients were included in the study; 62 (61%) were male and 11 (11%) had a β-lactam allergy. At baseline, 40 patients (40%) had hardware, 25 (25%) had an intravenous line, 6 (6%) were on dialysis, and 4 (4%) had active IV drug use, with similar distribution across antibiotic groups. Penicillin was the most common antibiotic used (Table 1). There was a significant difference among groups with respect to the 60-day clinical failure (log-rank p=0.019). In terms of unadjusted 60-day clinical failure, penicillin had similar outcomes to cefazolin (95% CI -0.29 to 0.104, p=0.376), however, it had statistically significant better outcomes in comparison to the ASPs, nafcillin or oxacillin (95% CI 0.023 to 0.482, p=0.031) (Table 1). Table 1. 60-day outcomes of PSSA bacteremia Conclusion Penicillin is effective and safe in the treatment of PSSA bacteremia and may be preferable to antistaphylococcal penicillins Disclosures All Authors: No reported disclosures

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