Dirofilariasis is a filarial infection of domestic and sylvatic vertebrates such as canines, felines, raccoons, and bears (the definitive hosts) and is transmitted mostly by mosquitoes (the vector) with the exception being Dirofilaria ursi that is transmitted by the black fly. At least 60 cases of subcutaneous dirofilariasis in humans have been reported; however, the overall incidence of dirofilarial infection has increased, and dirofilariasis is considered an emerging zoonosis. Here, we present a case of subcutaneous Dirofilaria in an otherwise healthy woman in her sixth decade who presented with a painless, mobile, nonerythematous pea-sized nodule of the right upper extremity of 1 month's duration. Evaluation regarding possible disseminated infection, microfilaremia, filarial serology, pulmonary, and central nervous system involvement was negative. She reported no travel outside of South Carolina. Her only risk factor was exposure to mosquitoes 5 months prior in her backyard, composed primarily of wetlands, a common habitat in coastal southeastern United States. No antihelminthics were given. She had complete resolution of the lesion after surgical excision, with no sequelae. This is the second case reported in Charleston, South Carolina.

BackgroundA multidisciplinary approach using pre-authorization and/or prospective audit and feedback combined with institutional guidelines, personnel education, and intervention monitoring is essential for successful antimicrobial stewardship programs (ASP). Assessing the impact of ASPs can be process-based and/or outcome-based. Electronic medical record-based clinical decision support (CDS) tools can be used to prioritize stewardship interventions.MethodsThe Medical University of South Carolina (MUSC) transitioned from Theradoc® to Epic® for ASP surveillance and data collection in 2018. The ASP team developed a scoring algorithm with integral rules to identify and analyze inpatients who might require ASP interventions. The dynamic list captures and scores patients based on key infection-related data and prioritizes interventions. Additionally, we created a smart form flowsheet to streamline stewardship efforts for use by physicians and pharmacists. Accuracy of event capture was assessed during the buildout and via daily comparisons between Theradoc® and Epic®. Our goals are to optimize the treatment of potentially fatal infections (e.g., bacteremia) and delay emerging resistance.ResultsOur ASP module utilizes a scoring algorithm to identify and prioritize patients with positive blood or central nervous system cultures, other positive critical diagnostic tests, and high-risk antimicrobial use. Additional rules identify “bug-drug” mismatches, multiple positive cultures, and de-escalation opportunities. For example, the rules assign a high priority to patients with positive blood cultures and no prescribed antibiotics, but a lower priority score to restricted antimicrobial orders. We created a smart form flowsheet to document microorganism, presumed source, anti-infective use, ASP intervention, and acceptance of recommendations, allowing for multidisciplinary documentation outside of Epic® I-vents. Finally, we created a Reporting Workbench report which allows for monthly compilation and analysis of ASP interventions.ConclusionThe MUSC Epic® ASP platform build showcases a CDS system that allows for streamlined, multidisciplinary communication, documentation, and analysis of outcomes.Disclosures All authors: No reported disclosures.