Background An internal quality assurance review at AtlantiCare Regional Medical Center (ARMC) revealed that patients admitted with skin and soft tissue infections (SSTIs) remained in hospital post-resolution of acute symptoms and demonstrated a delayed transition to step-down oral antibiotic therapy. A non-mandatory institutional pathway was developed and implemented in 2016 to expedite hospital discharge in hemodynamically stable SSTI patients by utilizing oritavancin. Objective To describe the outcomes associated with use of single-dose oritavancin therapy to expedite hospital discharge in hemodynamically stable inpatients with SSTIs. Methods A retrospective, descriptive cohort was evaluated for outcomes of patients with SSTIs who received either oritavancin to expedite discharge or were discharged on oral step-down antibiotics. Patients were included in this analysis if they were: ≥ 18 years old; hospitalized; received empiric vancomycin; not pregnant or nursing; hemodynamically stable at the time of assessment; and received either oritavancin or oral step-down antibiotics to facilitate discharge. The primary outcomes were index hospital length of stay (LOS), 30-day SSTI-related readmissions, and 30-day SSTI progression. Results Overall, 199 patients met the study criteria (oritavancin = 99 and oral step-down antibiotics = 100). Groups were well matched at baseline. Patients who received oritavancin had a shorter mean index hospital LOS than those in the oral step-down antibiotic group (3.5 days vs. 5.6 days). Patients receiving oritavancin also had lower SSTI 30-day readmission and SSTI-progression rates. Conclusions An institutional pathway that used oritavancin to expedite hospital discharge of hemodynamically stable SSTI patients resulted in shorter hospital LOS, less 30-day SSTI-related hospital readmissions, and decreased SSTI progression relative to those discharged on conventional oral step-down therapy.

BackgroundAcute bacterial skin and skin structure infections (ABSSSI) have a high economic burden secondary to prolonged hospitalizations and high rates of recurrent infections. Utilizing oritavancin rather than vancomycin, select inpatients may be discharged earlier in their hospitalization with anticipated decreased infection recurrences and cost avoidance.MethodsAll inpatients administered oritavancin to expedite discharge and/or vancomycin for the treatment of ABSSSI between May 2017 and January 2018 were included in this retrospective evaluation. The primary endpoint was to determine the 30-day ABSSSI recurrence rate between treatment arms. The secondary endpoints were to evaluate financial expenditures associated with utilization of oritavancin when compared with vancomycin, and to assess for potential risk factors associated with poor outcomes. A financial analysis was performed for patients based on their DRG (diagnosis-related group) applying hospital-specific expenditures provided by the finance department. Data were analyzed using Fisher’s exact test, χ2 test, or t-test as appropriate.ResultsA total of 51 patients receiving oritavancin and 50 patients receiving vancomycin were identified as meeting inclusion criteria. Nine of 50 patients (18%) returned for recurrent infections in the vancomycin arm while only 2 of 51 (4%) returned in the oritavancin arm (P = 0.0279). Out of the 11 patients with recurrent infections, 6 were current intravenous drug users (55%), 3 left against medical advice at their initial visit (27%) and 7 had an emergency department visit in the prior 30 days for the same infection (64%). Overall, there were 111.7 hospitalization days avoided in 51 patients receiving oritavancin, resulting in an estimated cost avoidance of $217,206 compared with conventional treatment with vancomycin.ConclusionUtilizing oritavancin to expedite discharge in hospitalized patients appears to be an effective and financially beneficial treatment for ABSSSI.Disclosures All authors: No reported disclosures.

Background Antimicrobial stewardship is a priority for hospitals and utilizing generated reports can enhance stewardship activities. At our institution, a software program was used to help optimize antimicrobial therapy by providing a drug-bug mismatch (DBM) alert which identifies patients with culture susceptibilities not covered by their current antimicrobial therapy. The purpose of this study was to evaluate the utility of this alert feature and determine whether or not an intervention was needed for patients identified. Methods From August 2019 to March 2020 the DBM alerts were reviewed by a pharmacist and interventions pursued when appropriate. Data collection included the patient’s culture results and source, indication for current antibiotics, and potential for intervention. Alerts were stratified into different groups based on the type of culture, including urine, blood, sputum, bone or bodily fluid, wound or tissues, and stool. Those mismatches not resulting in an intervention were categorized as a contamination, colonization, or inappropriate. This study was approved by the institutional review board. Results A total of 105 DBM alerts were analyzed from various sources, including 51 (47.6%) urine, 17 (16.2%) sputum, 16 (15.2%) wound or tissue, 14 (13.3%) blood, 6 (5.7%) bone or bodily fluid, and 1 stool culture. Overall, 48 of 105 (45.7%) of alerts resulted in an intervention. Urine and sputum culture alerts required interventions at the lowest rate with treatment interventions in 12 of 51 (23.5%) and 5 of 17 (29.4%) of those cases respectively. Blood culture alerts were the most successful as 9 of 14 (64.3%) alerts required an intervention. Alerts with wound or tissue cultures identified gaps in therapy as 9 of 16 (56.3%) cases required intervention. Colonization or contamination appeared to be the major cause of alerts that did not result in intervention. Conclusion The DBM alert can be a beneficial tool for pharmacists participating in antimicrobial stewardship activities. However, the alerts had varying value depending on the culture source. The DBM alert can identify real-time patient issues regarding appropriate antimicrobial therapy. Further modifications to our process in utilizing this DBM report are warranted to enhance value and allocate time accordingly. Disclosures All Authors: No reported disclosures