Paradox of trimethylamine-N-oxide, the impact of malnutrition on microbiota-derived metabolites and septic patients

Abstract Background Trimethylamine N-oxide (TMAO) is a microbiota-derived metabolite, which is linked to vascular inflammation and atherosclerosis in cardiovascular (CV) diseases. But its effect in infectious diseases remains unclear. We conducted a single-center prospective study to investigate association of TMAO with in-hospital mortality in septic patients admitted to an intensive care unit (ICU). Methods Totally 95 septic, mechanically ventilated patients were enrolled. Blood samples were obtained within 24 h after ICU admission, and plasma TMAO concentrations were determined. Septic patients were grouped into tertiles according to TMAO concentration. The primary outcome was in-hospital death, which further classified as CV and non-CV death. Besides, we also compared the TMAO concentrations of septic patients with 129 non-septic patients who were admitted for elective coronary angiography (CAG). Results Septic patients had significantly lower plasma TMAO levels than did subjects admitted for CAG (1.0 vs. 3.0 μmol/L, p < 0.001). Septic patients in the lowest TMAO tertile (< 0.4 μmol/L) had poorer nutrition status and were given longer antibiotic courses before ICU admission. Circulating TMAO levels correlated positively with daily energy intake, the albumin and prealbumin concentration. Compared with those in the highest TMAO tertile, septic patients in the lowest TMAO tertile were at greater risk of non-CV death (hazard ratio 2.51, 95% confidence interval 1.21–5.24, p = 0.014). However, TMAO concentration was no longer an independent predictor for non-CV death after adjustment for disease severity and nutritional status. Conclusion Plasma TMAO concentration was inversely associated with non-CV death among extremely ill septic patients, which could be characterized as TMAO paradox. For septic patients, the impact of malnutrition reflected by circulating TMAO levels was greater than its pro-inflammatory nature.

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764. Will the Addition of Probiotics to Patients Receiving Intravenous Antimicrobial Therapy Reduce the Incidence of Healthcare Facility-Onset Clostridium difficile Infection?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.961 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S479-S479

Author(s):

Punit Shah ◽

Jessica Kay ◽

Adanma Akogun ◽

Silvia Wise ◽

Sarfraz Aly ◽

...

Keyword(s):

Logistic Regression ◽

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Primary Outcome ◽

Standard Of Care ◽

Healthcare Facility ◽

Polymerase Chain Reaction Test ◽

Multiple Logistic Regression ◽

Icu Admission ◽

The Impact

Abstract Background Exposure to antimicrobials is a known risk factor for Clostridium difficile infection (CDI). Antimicrobials cause collateral damage by disrupting the natural intestinal microbiota allowing for C.difficile to thrive and production of C.difficile toxins. Probiotics could modulate the onset and course of CDI. However, the data on probiotics for the prevention of CDI is conflicting. Methods We conducted an IRB approved retrospective cohort study at a 340-bed community hospital. All hospitalized patients from August 1, 2017 through July 31, 2020 were evaluated for enrollment. Patients were included if they received at least one dose of intravenous (IV) antibiotic and had a length of stay of at least 3 days. Patients were excluded if they were younger than 18 years, or if they had a positive C.difficile polymerase chain reaction test before antibiotics were started. The primary outcome was the incidence of healthcare facility-onset Clostridium difficile infection (HO-CDI). Descriptive statistics were used to analyze demographics data, and the primary outcome of HO-CDI was analyzed using Fisher’s exact test and multiple logistic regression. Results A total of 20,257 patients received IV antibiotics during the study time frame. Of these, 2,659 patients received probiotics. Primary outcome of HO-CDI occurred in 46 patients in the IV antibiotics alone cohort (0.26%) and 5 patients in the probiotics plus IV antibiotics cohort (0.19%). The difference in HO-CDI between these two groups was not statistically significant, p=0.677. A multiple logistic regression was performed to see the impact of proton pump inhibitor use, age, ICU admission, Charlson Comorbidity Index, probiotic use and CDI in the past 12 months on the primary outcome. C.difficile infection in prior 12 months [OR 3.37, 95%CI 1.04-10.97] and ICU admission [OR 1.81, 95%CI 1.02-3.19] were associated with higher CDI. The addition of probiotics to patients on IV antibiotics did not exhibit a protective effect [OR 0.72, 95% CI 0.28-1.81]. Conclusion The addition of probiotics to standard of care was not beneficial in the prevention of HO-CDI. We endorse robust antibiotic stewardship practices as part of the standard of care bundle that institutions should employ to decrease the incidence of HO-CDI. Disclosures All Authors: No reported disclosures

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Evaluating the Impact of Ventilator-Associated Parameters on Ventilation Free Days of non-ARDS Patients in ICU.

10.21203/rs.2.21795/v1 ◽

2020 ◽

Author(s):

Na Liu ◽

Jingxuan Ren ◽

Lina Yu ◽

Junran Xie

Keyword(s):

Mechanical Ventilation ◽

Primary Outcome ◽

Prognostic Significance ◽

Length Of Hospital Stay ◽

Multivariate Regression Analysis ◽

Parameter Setting ◽

Learning Models ◽

Mechanically Ventilated ◽

Ventilation Parameter ◽

The Impact

Abstract Background: Critically ill patients are not only mechanically ventilated because of ARDS, what kind of ventilation parameter setting is the optimal ventilation strategy for non-ARDS ICU patients?Methods: A retrospective cohort study for non-ARDS patients who received mechanical ventilation (MV), performed univariate, multivariate regression analysis, covariate balancing propensity score and inverse–probability–of–treatment weighting, and machines learning models to predict different outcomes. The included predicted factors are four parameters of mechanical ventilation (Driving pressure (DP) and its mediation of tidal volumes (VT) and positive end-expiratory pressure (PEEP), mechanical power (MP)), and the primary outcome was the ventilator-free days (VFD) at day 28.Results: The study included 2932 patients, low DP, low PEEP and low MP for non-ARDS patients could prolong VFD at day 28, reduce in-hospital mortality and length of hospital stay. However, the VT has no prognostic significance for the population. Among machine learning models with VFD, the randomforest had the best prediction.Conclusions: For non-ARDS patients who receive invasive ventilation for at least 48 hours, low DP, low PEEP and low MP are beneficial to the population. However, the effect of VT is inconclusive.

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Predictors of specialized pediatric palliative care involvement and impact on patterns of end-of-life care in children with cancer: A population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.10573 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 10573-10573

Author(s):

Sumit Gupta ◽

Rinku Sutradhar ◽

Adam Rapoport ◽

Katherine Nelson ◽

Ying Liu ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Population Based ◽

Small Sample ◽

Pediatric Palliative Care ◽

Income Quintile ◽

Hospital Death ◽

Children With Cancer ◽

Icu Admission ◽

The Impact

10573 Background: Children with cancer are at risk of receiving high-intensity (HI) care at the end-of-life (EOL) and associated high symptom burden. The impact of palliative care (PC) delivered by generalists or of specialized pediatric palliative care (SPPC) on patterns of EOL care is unknown, with previous studies limited by small sample sizes or low response rates. Methods: Using a provincial registry, we assembled a retrospective cohort of Ontario children with cancer who died between 2000-2012 and who received care through a pediatric institution with a SPPC team and a clinical PC database. Patients were linked to population-based healthcare data capturing inpatient, outpatient, and emergency visits. Clinical PC databases were used to identify patients receiving SPPC. Remaining patients were categorized as having received either general PC (GPC) or no PC depending on the presence of PC associated physician billing or inpatient codes. We determined predictors of SPPC involvement, and whether either SPPC or GPC was associated with HI-EOL outcomes: ICU admission < 30 days from death, mechanical ventilation < 14 days from death, or in hospital death. Sensitivity analyses excluded treatment-related mortality (TRM) cases. Results: 572 patients met inclusion criteria. Children less likely to receive SPPC services included those with hematologic cancers [odds ratio (OR) 0.33, 95th confidence interval (CI) 0.30-0.37; p < 0.001)], in the lowest income quintile (OR 0.44, 95CI 0.23-0.81; p = 0.009), and living at increased distance from the treatment center (OR 0.46, 95CI 0.40-0.52; p < 0.0001). In multivariate analysis, SPPC was associated with a 3-fold decrease in the odds of an EOL ICU admission (OR 0.32, 95CI 0.18-0.57), while GPC had no impact. Similar associations were seen with all other HI-EOL indicators. Excluding TRM had little impact. Conclusions: SPPC, but not GPC, is associated with lower intensity care at EOL. Access to such care however remains uneven. In the absence of randomized trials, these results provide the strongest evidence to date supporting the creation of SPPC teams. These results can be used to support PC advocacy and policy efforts.

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Impact of Renin-Angiotensin-Aldosterone System Inhibition on Mortality in Critically Ill COVID-19 Patients with Pre-Existing Hypertension: A Prospective Cohort Study

10.21203/rs.3.rs-898264/v1 ◽

2021 ◽

Author(s):

Kei Sato ◽

Nicole White ◽

Jonathon P. Fanning ◽

Nchafatso Obonyo ◽

Michael H. Yamashita ◽

...

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Hospital Stay ◽

Critically Ill ◽

Length Of Hospital Stay ◽

Hospital Death ◽

Renin Angiotensin Aldosterone System ◽

Renin Angiotensin ◽

Icu Admission ◽

The Impact

Abstract BackgroundThe influence of renin-angiotensin-aldosterone system (RAAS) inhibitors on the critically ill COVID-19 patients with pre-existing hypertension remains uncertain. This study examined the impact of previous use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on the critically ill COVID-19 patients.MethodsData from an international, prospective, observational cohort study involving 354 hospitals spanning 54 countries were included. A cohort of 746 COVID-19 patients with pre-existing hypertension admitted to intensive care units (ICUs) in 2020 were targeted. Multi-state survival analysis was performed to evaluate in-hospital mortality and hospital length of stay up to 90 days following ICU admission.ResultsA total of 746 patients were included - 543 (73%) with pre-existing hypertension had received ACEi/ARBs before ICU admission, while 203 (27%) had not. Cox proportional hazards model showed that previous ACEi/ARB use was associated with a decreased hazard of in-hospital death (HR, 0.73, 95% CI, 0.58 to 0.93). Sensitivity analysis adjusted for propensity scores showed similar results for hazards of death. The average length of hospital stay was longer in ACEi/ARB group with 21.4 days (95% CI: 19.9 to 23.0 days) in ICU and 6.7 days (5.9 to 7.6 days) in general ward compared to non-ACEi/ARB group with 16.2 days (14.1 to 18.5 days) and 6.3 days (5.0 to 7.7 days), respectively. When analysed separately, there was insufficient evidence of differential effects between ACEi and ARB use on the hazards of death and discharge.ConclusionsIn critically ill COVID-19 patients with comorbid hypertension, use of ACEi/ARBs prior to ICU admission was associated with a reduced risk of in-hospital mortality following adjustment for baseline characteristics although patients with ACEi/ARB showed longer length of hospital stay.

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Hyperoxaemia and hypoxaemia are associated with harm in patients with ARDS

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01648-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Andrew J. Boyle ◽

David N. Holmes ◽

Jonathan Hackett ◽

Susanna Gilliland ◽

Michael McCloskey ◽

...

Keyword(s):

Hospital Mortality ◽

Primary Outcome ◽

Multivariable Analysis ◽

Final Analysis ◽

Arterial Oxygen ◽

Icu Mortality ◽

Mechanically Ventilated ◽

Predicted Probability ◽

Definition Of ◽

The Impact

Abstract Background Oxygen therapy is routinely administered to mechanically ventilated patients. However, there remains uncertainty about the optimal oxygen titration target in patients with the acute respiratory distress syndrome (ARDS). Methods Prospectively identified adult patients meeting the Berlin definition of ARDS between 1st January 2014 and 13th December 2016 were analyzed. Oxygen exposure variables were collected at 6-hourly intervals. The primary exposure was the average time-weighted partial pressure of arterial oxygen (PaO2) calculated over a maximum of 7 days from meeting ARDS criteria. The primary outcome was ICU mortality. Univariable and multivariable logistic regression analyses were performed to assess the impact of exposure variables on clinical outcomes. Results are presented as odds ratio [95% confidence interval]. Results 202 patients were included in the final analysis. Overall ICU mortality was 31%. The average time-weighted PaO2 during the first 7 days of ARDS was similar between non-survivors and survivors (11.3 kPa [10.2, 12.5] (84.8 mmHg [76.5, 93.8]) vs. 11.9 kPa [10.9, 12.6] (89.3 mmHg [81.8, 94.5]); p = 0.08). In univariable and multivariable analysis, average time-weighted PaO2 demonstrated a U-shaped relationship with ICU mortality. There was a similar relationship identified with hospital mortality. Conclusions In patients with ARDS, the predicted probability of both ICU and hospital mortality was lowest when the average time-weighted PaO2 was between 12.5 and 14 kPa (93.8–105.0 mmHg), suggesting this is a reasonable oxygenation target for clinicians to aim for.

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The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms

Journal of Neurosurgery ◽

10.3171/2019.3.jns183500 ◽

2020 ◽

Vol 133 (1) ◽

pp. 182-189

Author(s):

Tae-Jin Song ◽

Seung-Hun Oh ◽

Jinkwon Kim

Keyword(s):

Statin Therapy ◽

Coil Embolization ◽

Primary Outcome ◽

Cox Regression ◽

Cerebral Aneurysms ◽

Time Dependent ◽

Lipid Lowering ◽

Surgical Clipping ◽

The Impact

OBJECTIVECerebral aneurysms represent the most common cause of spontaneous subarachnoid hemorrhage. Statins are lipid-lowering agents that may expert multiple pleiotropic vascular protective effects. The authors hypothesized that statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes.METHODSThis was a retrospective cohort study using the National Health Insurance Service–National Sample Cohort Database in Korea. Patients who underwent coil embolization or surgical clipping for cerebral aneurysm between 2002 and 2013 were included. Based on prescription claims, the authors calculated the proportion of days covered (PDC) by statins during follow-up as a marker of statin therapy. The primary outcome was a composite of the development of stroke, myocardial infarction, and all-cause death. Multivariate time-dependent Cox regression analyses were performed.RESULTSA total of 1381 patients who underwent coil embolization (n = 542) or surgical clipping (n = 839) of cerebral aneurysms were included in this study. During the mean (± SD) follow-up period of 3.83 ± 3.35 years, 335 (24.3%) patients experienced the primary outcome. Adjustments were performed for sex, age (as a continuous variable), treatment modality, aneurysm rupture status (ruptured or unruptured aneurysm), hypertension, diabetes mellitus, household income level, and prior history of ischemic stroke or intracerebral hemorrhage as time-independent variables and statin therapy during follow-up as a time-dependent variable. Consistent statin therapy (PDC > 80%) was significantly associated with a lower risk of the primary outcome (adjusted hazard ratio 0.34, 95% CI 0.14–0.85).CONCLUSIONSConsistent statin therapy was significantly associated with better prognosis after coil embolization or surgical clipping of cerebral aneurysms.

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The impact of a multi-domain intervention on cerebral glucose metabolism: analysis from the randomized ancillary FDG PET MAPT trial

Alzheimer s Research & Therapy ◽

10.1186/s13195-020-00683-6 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Julien Delrieu ◽

Thierry Voisin ◽

Laure Saint-Aubert ◽

Isabelle Carrie ◽

Christelle Cantet ◽

...

Keyword(s):

Glucose Metabolism ◽

Fdg Pet ◽

Primary Outcome ◽

Cognitive Stimulation ◽

Cerebral Glucose Metabolism ◽

Parahippocampal Gyrus ◽

Cerebral Magnetic Resonance Imaging ◽

Brain Glucose ◽

Brain Glucose Metabolism ◽

The Impact

Abstract Background The Multidomain Alzheimer Preventive Trial (MAPT) was designed to assess the efficacy of omega-3 fatty acid supplementation, multidomain intervention (MI), or a combination of both on cognition. Although the MAPT study was negative, an effect of MI in maintaining cognitive functions compared to placebo group was showed in positive amyloid subjects. A FDG PET study (MAPT-NI) was implemented to test the impact of MI on brain glucose metabolism. Methods MAPT-NI was a randomized, controlled parallel-group single-center study, exploring the effect of MI on brain glucose metabolism. Participants were non-demented and had memory complaints, limitation in one instrumental activity of daily living, or slow gait. Participants were randomly assigned (1:1) to “MI group” or “No MI group.” The MI consisted of group sessions focusing on 3 domains: cognitive stimulation, physical activity, nutrition, and a preventive consultation. [18F]FDG PET scans were performed at baseline, 6 months, and 12 months, and cerebral magnetic resonance imaging scans at baseline. The primary objective was to evaluate the MI effect on brain glucose metabolism assessed by [18F]FDG PET imaging at 6 months. The primary outcome was the quantification of regional metabolism rate for glucose in cerebral regions involved early in Alzheimer disease by relative semi-quantitative SUVr (FDG-based AD biomarker). An exploratory voxel-wise analysis was performed to assess the effect of MI on brain glucose metabolism without anatomical hypothesis. Results The intention-to-treat population included 67 subjects (34 in the MI group and 33 in the No MI group. No significant MI effect was observed on primary outcome at 6 months. In the exploratory voxel-wise analysis, we observed a difference in favor of MI group on the change of cerebral glucose metabolism in limbic lobe (right hippocampus, right posterior cingulate, left posterior parahippocampal gyrus) at 6 months. Conclusions MI failed to show an effect on metabolism in FDG-based AD biomarker, but exploratory analysis suggested positive effect on limbic system metabolism. This finding could suggest a delay effect of MI on AD progression. Trial registration ClinicalTrials.gov Identifier, NCT01513252.

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Characteristics, outcomes and risk factors for mortality of 522 167 patients hospitalised with COVID-19 in Brazil: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2021-049089 ◽

2021 ◽

Vol 11 (5) ◽

pp. e049089

Author(s):

Marcia C Castro ◽

Susie Gurzenda ◽

Eduardo Marques Macário ◽

Giovanny Vinícius A França

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cox Proportional Hazards ◽

Secondary Outcome ◽

Hospital Death ◽

Factors Associated ◽

Icu Admission ◽

Hospitalised Patients

ObjectiveTo provide a comprehensive description of demographic, clinical and radiographic characteristics; treatment and case outcomes; and risk factors associated with in-hospital death of patients hospitalised with COVID-19 in Brazil.DesignRetrospective cohort study of hospitalised patients diagnosed with COVID-19.SettingData from all hospitals across Brazil.Participants522 167 hospitalised patients in Brazil by 14 December 2020 with severe acute respiratory illness, and a confirmed diagnosis for COVID-19.Primary and secondary outcome measuresPrevalence of symptoms and comorbidities was compared by clinical outcomes and intensive care unit (ICU) admission status. Survival was assessed using Kaplan Meier survival estimates. Risk factors associated with in-hospital death were evaluated with multivariable Cox proportional hazards regression.ResultsOf the 522 167 patients included in this study, 56.7% were discharged, 0.002% died of other causes, 30.7% died of causes associated with COVID-19 and 10.2% remained hospitalised. The median age of patients was 61 years (IQR, 47–73), and of non-survivors 71 years (IQR, 60–80); 292 570 patients (56.0%) were men. At least one comorbidity was present in 64.5% of patients and in 76.8% of non-survivors. From illness onset, the median times to hospital and ICU admission were 6 days (IQR, 3–9) and 7 days (IQR, 3–10), respectively; 15 days (IQR, 9–24) to death and 15 days (IQR, 11–20) to hospital discharge. Risk factors for in-hospital death included old age, Black/Brown ethnoracial self-classification, ICU admission, being male, living in the North and Northeast regions and various comorbidities. Age had the highest HRs of 5.51 (95% CI: 4.91 to 6.18) for patients≥80, compared with those ≤20.ConclusionsCharacteristics of patients and risk factors for in-hospital mortality highlight inequities of COVID-19 outcomes in Brazil. As the pandemic continues to unfold, targeted policies that address those inequities are needed to mitigate the unequal burden of COVID-19.

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The Impact of Time Interval between Hepatic Resection and Liver Transplantation on Clinical Outcome in Patients with Hepatocellular Carcinoma

Cancers ◽

10.3390/cancers13102398 ◽

2021 ◽

Vol 13 (10) ◽

pp. 2398

Author(s):

Matteo Serenari ◽

Enrico Prosperi ◽

Marc-Antoine Allard ◽

Michele Paterno ◽

Nicolas Golse ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Hepatic Resection ◽

Primary Outcome ◽

Polynomial Regression ◽

Secondary Outcome ◽

Time Interval ◽

Comprehensive Complication Index ◽

Fractional Polynomial ◽

The Impact

Hepatic resection (HR) for hepatocellular carcinoma (HCC) may require secondary liver transplantation (SLT). However, a previous HR is supposed to worsen post-SLT outcomes. Data of patients treated by SLT between 2000 and 2018 at two tertiary referral centers were analyzed. The primary outcome of the study was to analyze the impact of HR on post-LT complications. A Comprehensive Complication Index ≥ 29.6 was chosen as cutoff. The secondary outcome was HCC-related death by means of competing-risk regression analysis. In the study period, 140 patients were included. Patients were transplanted in a median of 23 months after HR (IQR 14–41). Among all the features analyzed regarding the prior HR, only time interval between HR and SLT (time HR-SLT) was an independent predictor of severe complications after LT (OR = 0.98, p < 0.001). According to fractional polynomial regression, the probability of severe complications increased up to 15 months after HR (43%), then slowly decreased over time (OR = 0.88, p < 0.001). There was no significant association between HCC-related death and time HR-SLT at the multivariable competing risks regression model (SHR, 1.06; 95% CI: 0.69–1.62, p = 0.796). This study showed that time HR-SLT was key in predicting complications after LT, without affecting HCC-related death.

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141. Implementation of Veterans Affairs Outpatient Antimicrobial Stewardship Interventions for Asymptomatic Bacteriuria and Acute Respiratory Infections, a Stepped Wedge Randomized Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.186 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S81-S82

Author(s):

Grace Mortrude ◽

Mary Rehs ◽

Katherine Sherman ◽

Nathan Gundacker ◽

Claire Dysart

Keyword(s):

Patient Satisfaction ◽

Primary Outcome ◽

Respiratory Infections ◽

Asymptomatic Bacteriuria ◽

Educational Interventions ◽

Antibiotic Prescribing ◽

Acute Respiratory Infections ◽

Stepped Wedge ◽

Post Intervention ◽

The Impact

Abstract Background Outpatient antimicrobial prescribing is an important target for antimicrobial stewardship (AMS) interventions to decrease antimicrobial resistance in the United States. The objective of this study was to design, implement and evaluate the impact of AMS interventions focused on asymptomatic bacteriuria (ASB) and acute respiratory infections (ARIs) in the outpatient setting. Methods This randomized, stepped-wedge trial evaluated the impact of educational interventions to providers on adult patients presenting to primary care (PC) clinics for ARIs and ASB from 10/1/19 to 1/31/20. Data was collected by retrospective chart review. An antibiotic prescribing report card was provided to PC providers, then an educational session was delivered at each PC clinic. Patient education materials were distributed to PC clinics. Interventions were made in a step-wise (figure 1) fashion. The primary outcome was percentage of overall antibiotic prescriptions as a composite of prescriptions for ASB, acute bronchitis, upper-respiratory infection otherwise unspecified, uncomplicated sinusitis, and uncomplicated pharyngitis. Secondary outcomes included individual components of the primary outcome, a composite safety endpoint of related hospital, emergency department or primary care visit within 4 weeks, antibiotic appropriateness, and patient satisfaction surveys. Figure 1 Results There were 887 patients included for analysis (405 pre-intervention, 482 post-intervention). Baseline characteristics are summarized in table 1. After controlling for type 1 error using a Bonferroni correction the primary outcome was not significantly different between groups (56% vs 49%). There was a statistically significant decrease in prescriptions for bronchitis (20.99% vs 12.66%; p=0.0003). Appropriateness of prescriptions for sinusitis (OR 4.96; CI 1.79–13.75; p=0.0021) and pharyngitis (OR 5.36; CI 1.93 – 14.90; p=0.0013) was improved in the post-intervention group. The composite safety outcome and patient satisfaction survey ratings did not differ between groups. Table 1 Conclusion Multifaceted educational interventions targeting providers can improve antibiotic prescribing for indications rarely requiring antimicrobials without increasing re-visit or patient satisfaction surveys. Disclosures All Authors: No reported disclosures

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