Allergy assessments and penicillin skin testing have emerged as a vital intervention for Antimicrobial Stewardship Programs (ASPs). Investment and involvement in such programs by ASPs, however, are often limited due to resources, time, and personnel constraints. Harnessing an underutilized resource, 4th-year advanced pharmacy practice experience (APPE) students, allows for expanded ASP involvement and scope of practice. We aim to outline and provide insight on how 4th-year APPE students serve as an asset to an ASP. Through our novel longitudinal rotation experience, APPE students complete penicillin allergy assessments, patient education, and work alongside a clinical pharmacist to refer patients for penicillin skin testing if appropriate. Students also achieve many of the education standards required by the Accreditation Counsel for Pharmacy Education (ACPE) for graduation within the Doctor of Pharmacy degree while developing a strong foundation in antimicrobial stewardship and gaining invaluable knowledge for their future. The addition of APPE pharmacy students to our ASP has also enabled our program to achieve its goals and expand involvement and reach within our facility.

BackgroundNontuberculous mycobacterial (NTM) pulmonary infections are increasingly common and associated with significant morbidity and mortality. Treatment is challenging given high rates of antimicrobial resistance, the need for prolonged therapy with multiple agents, and poor medication tolerability. Clofazimine (CFZ), an antimicrobial available under an investigational new drug (IND) program, has excellent in vitro activity but limited clinical data. We present an 18-month experience of clofazimine as part of a multidrug regimen as salvage therapy for NTM pulmonary infections at the James A. Haley Veterans’ Affairs Hospital in Tampa, FL.MethodsWe conducted a single-center, retrospective review of the medical records of 11 patients with NTM pulmonary infections who were approved for treatment with CFZ-containing regimens between September 2017 and February 2019. Basic demographics, clinical characteristics, as well as symptomatic, radiologic, and microbiologic responses to therapy were evaluated.ResultsApproval for the IND program took approximately 15 months. We then treated 8 patients with pulmonary NTM infection with CFZ-containing regimens. Of these, 88% had cavitary disease, 63% were active smokers, and all had underlying pulmonary disease. The most common etiologic organisms were Mycobacterium avium complex and Mycobacterium abscessus. All patients were required to follow up every 3 months while on therapy. For patients who had at least 3 months of follow up, 100% reported symptomatic improvement. 50% achieved negative cultures with an average time to clearance of 25 weeks. All had stable or improved imaging. CFZ was well tolerated with no significant adverse effects.ConclusionOnce available, CFZ-containing regimens were moderately effective in treating NTM pulmonary infections with minimal adverse effects. Close patient follow up was necessary to assess response to treatment.Disclosures All authors: No reported disclosures.

BackgroundUrinary tract infection (UTI) is one of the most common infectious diagnoses and in 2007 accounted for 10.5 million primary care visits in the US Advancing age and comorbidities, such as chronic kidney disease (CKD) and diabetes, affect antimicrobial prescribing habits. Sulfamethoxazole/trimethoprim (SMX-TMP), nitrofurantoin, and fosfomycin are first-line recommendations for uncomplicated cystitis. In an aging male population with potential allergies or contraindications to the above, fosfomycin is a potential option for treatment.MethodsA retrospective chart review of fosfomycin prescribing habits at a large VA academic medical center. Patients were selected based on fosfomycin prescription in both inpatient and outpatient settings from January 1, 2004 to December 5, 2017. Data reviewed included indication, organism(s), susceptibility, duration of treatment, CKD, and clinical success. Treatment success was defined as no representation with UTI symptoms for 30 days.Results117 cases of UTI in which fosfomycin was used were identified with a median patient age of 70 years old and 90% male. Twenty-five were uncomplicated cystitis, 49 complicated cystitis, and 34 catheter associated infections. Treatment success was obtained in 92% of the uncomplicated cystitis cases, 76% in complicated cystitis cases, and 67% in catheter associated UTIs. In half of all the cases an ESBL bacterium was isolated and 79% were successfully treated with fosfomycin. The most common pathogen identified was E. coli 58/118 (49%), followed by Klebsiella 25/118 (21%).ConclusionFosfomycin is an antibiotic recommended for simple cystitis due to its safety profile, less collateral damage (gut flora disturbance), and low resistance as currently known. This review displays the largest ESBL cohort identified in the literature and uniquely used in a predominant male population. These findings suggest that ESBL producing bacteria can be treated successfully with fosfomycin in a male population as well as uncomplicated cystitis. However, caution should be used with catheterized patients as treatment was less effective regardless of isolated bacteria.Disclosures All authors: No reported disclosures.