122. Impact of Infectious Diseases Consultation in Patients with Candidemia at a Large Multi-site Healthcare System Providing Telemedicine Services

Background Candida species are the most common cause of fungemia and are associated with high mortality. Management concordant with the Infectious Diseases Society of America guidelines and infectious diseases consultation (IDC) have been shown to lower mortality in patients with candidemia. The purpose of this study was to compare in-hospital mortality at a large multi-site healthcare system, including sites providing IDC via telemedicine services, in patients with candidemia with and without IDC. Methods This was a retrospective, observational cohort study completed at ten sites of Legacy Atrium Health in Charlotte Metro, NC, USA; at five sites, IDC is performed via telemedicine. Adult hospitalized patients identified with candidemia were enrolled May 2018-June 2019. The primary outcome was in-hospital mortality of IDC and non-IDC patients. Secondary outcomes included obtainment of repeat blood cultures, receipt of antifungal treatment, duration of therapy, removal of central venous lines (CVC) when present, and ophthalmological examination. Fisher’s exact, Chi-Square, or two-tailed Student’s t-test were used for demographics, primary and secondary outcomes as appropriate. Results A total of 126 patients were enrolled: 103 (82%) in the IDC group and 23 (18%) in the non-IDC group (Table 1). Mortality was significantly lower, and rates of repeat blood culture obtainment and receipt of antifungal treatment were significantly higher in patients with IDC (Table 2). Other outcomes including duration of therapy, removal of CVC, repeat cultures within 48 hours, and ophthalmological examination were not statistically different between groups. Conclusion This study is the first multi-site healthcare system providing telemedicine services to evaluate the impact of IDC on candidemia mortality. Ophthalmological examination rates were low in both groups, highlighting a potential area for improvement. IDC had significantly lower mortality, higher rates of antifungal treatment, and higher rates of repeat blood culture obtainment. IDC should be strongly considered in all patients with candidemia. Disclosures All Authors: No reported disclosures

The Utility of Repeat Blood Cultures for Bacteremic Urinary Tract Infections and Associated Durations of Therapy

Background Urinary tract infections (UTIs) are common among hospitalized patients with 10–40% of cases complicated by bacteremia. Recent literature suggests limited utility in repeating blood cultures for non-Staphylococcus aureus bacteremia; however, clinicians often repeat blood cultures to document clearance prior to selecting definitive therapy for bacteremias. Additionally, comparative data evaluating treatment duration for bacteremic UTIs are lacking and clinical practice guidelines do not address optimal duration for bacteremic UTIs. We aimed to evaluate local practice patterns and utility of repeat blood cultures and their influence on treatment durations for bacteremic UTIs. Methods We identified patients with bacteremia from a urinary source at the Salt Lake City Veterans Affairs (VA) hospital from a previously compiled cohort of inpatients with bacteremia from any source between November 2013 and October 2015. Demographic and clinical information including presence of comorbidities, source of infection, number of repeat blood cultures collected, repeat blood culture positivity, planned duration of antibiotic therapy and recurrent bacteremia with the same organism within 30 days of discharge were collected by manual chart review. Results Fifty-three bacteremic UTIs were included during the study period. Ninety-four percent of patients were male with a median age of 77. Repeat blood cultures were drawn in 77% (41/53) of cases; however, only 7% (3/41) of repeats were positive, all with Enterococcus faecalis. Median duration of therapy was 14 days (IQR 14, 15), with a longer mean duration in patients with repeat blood cultures as compared with not (15 vs.. 12 days, P = 0.03). Two patients had recurrent bacteremia with the same organism within 30 days; both with negative repeat blood cultures at the time of initial bacteremia and undetected metastatic complications. Conclusion Patients with bacteremic UTIs are at low risk of persistent bacteremia. Repeat blood cultures are of low utility, specifically with Gram-negative organisms, and may lead to prolonged durations of therapy. The impact of reducing repeat blood culture collection on outcomes, length of stay, and antibiotic durations warrants further evaluation. Disclosures All authors: No reported disclosures.