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

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

scholarly journals 1043. Evaluation of Early Clinical Failure Criteria for Gram-Negative Bloodstream Infections

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S311-S312
Author(s):  
Hana Rac ◽  
Alyssa Gould ◽  
P Brandon Bookstaver ◽  
Julie Ann Justo ◽  
Joseph Kohn ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antimicrobial Therapy ◽  
Bloodstream Infections ◽  
Failure Criteria ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Clinical Failure ◽  
Gram Negative ◽  
Additional Criterion ◽  
Prolonged Hospitalization

Abstract Background Early identification of patients at high risk of morbidity and mortality following Gram-negative bloodstream infections (GN-BSI) based on initial clinical course may prompt adjustments to optimize diagnostic and treatment plans. This retrospective cohort study aims to develop early clinical failure criteria (ECFC) to predict unfavorable outcomes in patients with GN-BSI. Methods Adults with community-onset GN-BSI who survived hospitalization for at least 96 hours at Palmetto Health hospitals in Columbia, SC, USA from January 1, 2010 to June 30, 2015 were identified. Multivariate logistic regression was used to examine association between clinical variables within 72–96 hours of BSI and unfavorable outcomes (28-day mortality or hospital length of stay >14 days). Results Among 766 patients with GN-BSI, 225 (29%) had unfavorable outcomes. After adjustments for Charlson Comorbidity Index and appropriateness of empirical antimicrobial therapy in multivariate model, predictors of unfavorable outcomes included systolic blood pressure <100 mmHg or vasopressor use (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.1–2.5), heart rate >100/minute (aOR 1.7, 95% CI 1.1–2.5), respiratory rate ≥22/minute or mechanical ventilation (aOR 2.1, 95% CI 1.4–3.3), altered mental status (aOR 4.5, 95% CI 2.8–7.1), and peripheral WBC count >12 × 103/mm3 (aOR 2.7, 95% CI 1.8–4.1) at 72–96 hours from index BSI. Area under receiver operating characteristic curve of ECFC model in predicting unfavorable outcomes was 0.77 (0.84 and 0.71 in predicting 28-day mortality and prolonged hospitalization separately, respectively). Predicted 28-day mortality increased from 1% in patients with no ECFC to 3%, 7%, 16%, 32%, and 54% in presence of each additional criterion (P < 0.001). Predicted hospital length of stay was 7.5 days in patients without any ECFC and increased by 4.0 days (95% CI 3.1–4.9, P < 0.001) in presence of each additional criterion. Conclusion Risk of 28-day mortality or prolonged hospitalization can be estimated within 72–96 hours of GN-BSI using ECFC. These criteria may have utility in future clinical research in assessing response to antimicrobial therapy based on a standard evidence-based definition of early clinical failure. Disclosures P. B. Bookstaver, CutisPharma: Scientific Advisor, <$1,000. Melinta Therapeutics: Speaker’s Bureau, <$1,000.

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

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

scholarly journals Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach

2021 ◽  
Vol 10 (1) ◽  
pp. e001120
Author(s):  
Brendan Joseph McMullan ◽  
Michelle Mahony ◽  
Lolita Java ◽  
Mona Mostaghim ◽  
Michael Plaister ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Audit And Feedback ◽  
Hospital Length Of Stay ◽  
Oral Antibiotic ◽  
Intravenous Therapy ◽  
Paediatric Hospital ◽  
Inpatient Settings ◽  
Surgical Teams

Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here, we describe a quality improvement approach to implement a guideline, with team-based education, audit and feedback, for timely, safe switch from intravenous-to-oral antibiotics in hospitalised children. Eligibility for switch was based on evidence-based guidelines and supported by education and feedback. The project was conducted over 12 months in a tertiary paediatric hospital. Primary outcomes assessed were the proportion of eligible children admitted under paediatric and surgical teams switched within 24 hours, and switch timing prior to and after guideline launch. Secondary outcomes were hospital length of stay, recommencement of intravenous therapy or readmission. The percentage of children switched within 24 hours of eligibility significantly increased from 32/50 (64%) at baseline to 203/249 (82%) post-implementation (p=0.006). The median time to switch fell from 15 hours 42 min to 4 hours 20 min (p=0.0006). In addition, there was a 14-hour median reduction in hospital length of stay (p=0.008). Readmission to hospital and recommencement of intravenous therapy did not significantly change postimplementation. This education, audit and feedback approach improved timely intravenous-to-oral switch in children and also allowed for more timely discharge from hospital. The study demonstrates proof of concept for this implementation with a methodology that can be readily adapted to other paediatric inpatient settings.

scholarly journals Intravenous versus Oral Step-Down for the Treatment of Staphylococcus aureus Bacteremia in a Pediatric Population

Pharmacy ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 16
Author(s):  
Sarah Grace Gunter ◽  
Mary Joyce B. Wingler ◽  
David A. Cretella ◽  
Jamie L. Wagner ◽  
Katie E. Barber ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Length Of Stay ◽  
Therapy Group ◽  
Pediatric Population ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Limited Data ◽  
Staphylococcus Aureus Bacteremia ◽  
Secondary Endpoints ◽  
Step Down

Limited data are available regarding optimal antimicrobial therapy for Staphylococcus aureus bacteremia (SAB) in pediatric patients. The purpose of this study was to assess clinical characteristics and outcomes associated with intravenous (IV) versus oral step-down treatment of pediatric SAB. This study evaluated patients aged 3 months to 18 years that received at least 72 h of inpatient treatment for SAB. The primary endpoint was 30-day readmission. Secondary endpoints included hospital length of stay and inpatient mortality. One hundred and one patients were included in this study. The median age was 7.9 years. Patients who underwent oral step-down were less likely to be immunocompromised and more likely to have community-acquired SAB from osteomyelitis or skin and soft tissue infection (SSTI). More patients in the IV therapy group had a 30-day readmission (10 (25.6%) vs. 3 (5.3%), p = 0.006). Mortality was low (5 (5%)) and not statistically different between groups. Length of stay was greater in patients receiving IV therapy only (11 vs. 7 days, p = 0.001). In this study, over half of the patients received oral step-down therapy and 30-day readmission was low for this group. Oral therapy appears to be safe and effective for patients with SAB from osteomyelitis or SSTIs.

scholarly journals 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

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.

Abstract 15580: The Impact of Sex and Gender-related Factors on Length-of-stay Following NSTEMI: A Multicountry Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Uri Bender ◽  
Colleen M Norris ◽  
Valeria Raparelli ◽  
Tadiri Christina ◽  
Louise Pilote
Keyword(s):  
Length Of Stay ◽  
Cardiac Risk ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Bivariate Analysis ◽  
P Value ◽  
Sex And Gender ◽  
Related Factors ◽  
And Gender ◽  
The Impact

Introduction: Gender refers to psycho-socio-cultural characteristics typically ascribed to men, women and gender-diverse individuals and has been shown to be associated with adverse clinical outcomes in AMI independent of sex. Substantial heterogeneity in hospital length of stay exists among patients admitted with NSTEMI. Whether sex and gender-based differences contribute to length-of-stay (LOS) among patients with NSTEMI remains unknown. Methods: To examine the relationship between sex, gender-related factors and LOS in adults hospitalized for NSTEMI, data from the GENESIS-PRAXY (n=1,210, Canada, U.S. and Switzerland), EVA (n=430, Italy) and VIRGO (n=3,572, U.S., Spain and Australia) studies of adults hospitalized for AMI were combined and analyzed. A best-fit linear regression model was selected through incremental analysis by stepwise addition of gender-related variables thought to be different in either impact or distribution between men and women. Results: Among the overall cohort (n=5,212), 2,218 participants with a diagnosis of NSTEMI were included in the final cohort (66% women, mean age 48.5 years, 67.8% U.S.). Half of the patients had a LOS of longer than 4 days (n=1,124) and were more likely to be white and have a clustering of cardiac risk factors in comparison to those with shorter LOS. No association between sex and LOS was observed in the bivariate analysis (p=0.87). In the multivariable model adjusted for sex, age, country of hospitalization, level of education, marital status, employment status, income, and social support, age (0.062 days/year, p=0.0002), being employed (-0.63 days in workers, p=0.01) and the treatment country relative to Canada (Italy=4.1 days; Spain=1.7 days; and the U.S.=-1.0 days, all p-value<0.001) were significant predictors of LOS. Conclusions: Employed individuals are more likely to experience a shorter LOS following NSTEMI. Variation in LOS exists across different countries and is likely due to institutional policy, resource allocation, and differences in cultural and psychosocial influences.

scholarly journals 558. Evaluating Length of Stay Data for Use in Targeting Prevention of Methicillin-Resistant Staphylococcus aureus (MRSA) Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S265-S265
Author(s):  
Katryna Gouin ◽  
Kelly M Hatfield ◽  
Sarah H Yi ◽  
Sujan Reddy ◽  
Hannah Wolford ◽  
...  
Keyword(s):  
New York ◽  
Length Of Stay ◽  
Blood Culture ◽  
Large Fraction ◽  
Bloodstream Infections ◽  
Hospital Length ◽  
Blood Cultures ◽  
Hospital Length Of Stay ◽  
Birth Date ◽  
Post Discharge

Abstract Background Evidence suggests that interventions such as MRSA decolonization are useful in the prevention of MRSA bloodstream infections (BSI) both during hospitalization and post-discharge. However, decolonization may be costly and have diminishing effectiveness when used on all inpatients. Hospital length of stay (LOS) is a known risk factor for MRSA BSI. To determine whether LOS could be useful in prioritizing patients for intervention, we aimed to evaluate (i) distribution of time from admission to hospital-onset (HO) MRSA BSI, and (ii) frequency and LOS of hospitalizations that preceded community-onset (CO) MRSA BSI. Methods MRSA-positive blood cultures among adults admitted to New York hospitals from 2013 to 20s16 were identified in the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN). We linked these data to admissions in New York’s hospital discharge dataset, the Statewide Planning and Research Cooperative System (SPARCS), where the NHSN blood culture collection date was between a patient’s SPARCS admission and discharge dates and there was an exact match for birth date, gender and facility. Time to MRSA BSI was defined as the number of days from admission (day 1) to collection of a blood culture positive for MRSA. We defined positive blood cultures collected on days 1–3 as CO, and those collected ≥day 4 as HO. Results We linked 10,425 (79%) MRSA BSIs from NHSN to SPARCS. 78% (8,147) of MRSA BSIs were CO and 22% (2,278) were HO. The median time to HO MRSA BSI was 10 days (IQR 6–21) (Figure 1), in contrast to the median LOS for all hospitalizations of 4 days (IQR 3–7). By definition, 35% of all hospitalizations were never at risk of HO MRSA BSI because their LOS was < 4 days. Among CO MRSA BSI, 48% were discharged from a hospital in the 90 days preceding their BSI (Figure 2). The median LOS of these prior hospitalizations was 8 days (IQR 5–14), and 87% were at least 4 days in length. Conclusion Over half of HO MRSA BSI occur on or after day 10 of hospitalization and a large fraction of CO MRSA BSI had a lengthy hospitalization shortly before their BSI diagnosis. Our results suggest that patients likely to have a long LOS could be evaluated as potential targets for prevention strategies (e.g., decolonization) to reduce both HO and CO MRSA BSI. Disclosures All authors: No reported disclosures.

Does the Degree of Platelet Adenosine Diphosphate and Arachidonic Acid Receptor Inhibition Correlate With the Severity of Injury in Non-Brain-Injured Trauma Patients?

2020 ◽  
pp. 000313482095483
Author(s):  
Grant Woodruff ◽  
Dustin Price ◽  
Aparna Sodhi ◽  
Andrew Kerwin ◽  
Marie Crandall
Keyword(s):  
Arachidonic Acid ◽  
Linear Regression ◽  
Length Of Stay ◽  
Injury Severity ◽  
Adenosine Diphosphate ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Bivariate Analysis ◽  
Receptor Inhibition ◽  
Severity Of Injury

Background Direct correlations between platelet adenosine diphosphate (ADP) and arachidonic acid (AA) receptor inhibition have been described in the traumatic brain injury (TBI) population. Our goal was to evaluate the percent inhibition of ADP receptor inhibition (ADPri) and AA receptor inhibition (AAri) receptors in non-TBI patients and correlate injury severity and outcomes. Methods We performed a retrospective review of non-TBI patients admitted to our trauma center, who received thromboelastography with platelet mapping prior to blood transfusion. Exclusion criteria included patients younger than 18 years, current antiplatelet therapy, or history of renal failure. Univariate descriptive statistics and bivariate comparisons were performed on patient demographic and outcomes. Multivariable linear regression models were constructed to quantify any association between ADPri and AAri with injury outcomes. High ADP inhibition was defined >20% and high AA inhibition >7%. Results 117 patients met inclusion criteria. Mean age was 53 years with 61% male. Mean ADPri was 64% and AAri 42%. On bivariate analysis, no statistically significant differences with respect to injury severity measures or outcomes were identified. On multivariable linear regression, AAri was associated with longer hospital length of stay. Discussion There was a high degree of platelet dysfunction in this cohort of severely injured patients without TBI. Despite this, the only correlation identified between injury severity and outcomes was AAri correlating with hospital length of stay. Irrespective of injury severity or outcomes, these patients’ results were far from reported “normal” values. Further, research is needed to determine the significance and clinical implications of thromboelastography with platelet mapping use in trauma care.

scholarly journals 254. Review of Clinical Outcomes in Patients Treated with Beta-lactam vs Non-beta-lactam Therapy for AmpC Producing Bacterial Bloodstream Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S126-S126
Author(s):  
Mary L Staicu ◽  
Tyler Baumeister ◽  
Maryrose R Laguio-Vila
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Bloodstream Infections ◽  
Hospital Length ◽  
Primary Objective ◽  
Hospital Length Of Stay ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Fluoroquinolone Antibiotics ◽  
Significant Difference

Abstract Background AmpC beta-lactamase producing organisms are traditionally treated with carbapenem or fluoroquinolone antibiotics. Recent studies, however, describe similar clinical outcomes in patients that receive cefepime or piperacillin/tazobactam. We sought to assess outcomes in patients with bloodstream infections caused by AmpC-producing organisms that received beta-lactams compared non-beta-lactam therapy. Methods Data was obtained retrospectively from the electronic health record (EHR) from January 2012 to February 2020. The primary objective was 30-day mortality from the day of first positive blood cultures with Enterobacter spp., Citrobacter spp., or Serratia spp. in patients who received non-beta-lactam therapy (carbapenem, fluoroquinolone, trimethoprim/sulfamethoxazole) to those who received beta-lactam therapy (cefepime, piperacillin/tazobactam). Secondary objectives included 30-day recurrence of bacteremia, pathogen isolated, source of bacteremia, hospital length of stay, and duration of antimicrobial therapy. Results A total of 90 patients were included, 50 in the non-beta lactam group and 40 in the beta-lactam group. Demographics were similar between groups. Thirty-day mortality was significantly higher in the beta-lactam group (20% vs 2%, p=0.009). Enterobacter spp. was the most frequently identified pathogen (67%), most commonly isolated from a urinary (31%) or intra-abdominal source (22%). The average duration of antibiotic therapy was significantly higher in the non-beta lactam group (18 vs 12 days, p=0.001). In contrast, there was no significant difference found in hospital length of stay, recurrence of bacteremia, pathogen isolated or source of bacteremia between groups. Conclusion Beta-lactam therapy for the treatment of bloodstream infections caused by Amp-C producing organisms was associated with significantly greater 30-day mortality compared to patients that received non-beta-lactam therapy. Disclosures All Authors: No reported disclosures

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