Background The use of extracorporeal membrane oxygenation (ECMO) in critically ill adults is increasing. There are currently no guidelines for antimicrobial prophylaxis. We analyzed 7 years of prophylactic antimicrobial use across three time series for patients on ECMO at our institution in the development, improvement, and streamlining of our ECMO antimicrobial prophylaxis protocol. Study design and Methods In this quasi-experimental interrupted time series analysis, we evaluated the impact of an initial ECMO antimicrobial prophylaxis protocol, implemented in 2014, on antimicrobial use and NHSN reportable infection rates. Then, following a revision and streamlining of the protocol in November 2018, we re-evaluated the same metrics. Results Our study population included 338 ICU patients who received ECMO between July 2011 and November 2019. After implementation of the first version of the protocol we did not observe significant changes in antimicrobial use or infection rates in these patients; however, following revision and streamlining of the protocol, we demonstrated a significant reduction in broad spectrum antimicrobial use for prophylaxis in patients on ECMO without any evidence of a compensatory increase in infection rates. Conclusion Our final protocol significantly reduces broad spectrum antimicrobial use for prophylaxis in patients on ECMO. We propose a standard antimicrobial prophylaxis regimen for patients on ECMO based on current evidence and our experience.

Despite growing literature, there is still limited understanding of factors that can predict outcomes in coronavirus disease 2019 (COVID-19) patients who require intensive care. ObjectiveTo evaluate the characteristics of COVID-19 patients admitted to the intensive care unit (ICU) and identify their associations with outcomes.

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BackgroundBronchoalveolar lavage (BAL) is a widely used procedure in the diagnosis of pneumonia in critically ill and immunocompromised hosts. Fungal smears and cultures are commonly performed on these samples. We evaluated the yield of various fungi, including but not limited to Candida species, Aspergillus species, Penicillium species, isolated from BAL specimens at our institution to determine the yield of this test and its impact on decision making.MethodsWe identified adult immunocompromised patients who underwent “Bronchoscopy with Immunocompromised Host Protocol (ICH),” which consists of an exhaustive list of diagnostic tests for various pathogenic organisms, over a one year period from January 1, 2017 to December 31, 2017. We reviewed if positive fungal cultures led to a change in management and if this was appropriate.Results582 patients underwent bronchoscopy with ICH protocol. There were 285/582 (48.9%) positive fungal cultures of which 177 (62%) grew Candida species. The most common species was Candida albicans (142/177, 80%). 53(18%) were Aspergillus species of which Aspergillus fumigatus was the most common (26/53). 16/285 (5.6%) patients underwent intervention based on the results, 14(87.5%) of which were appropriate. 176/177 (99.4%) patients with Candida species in BAL cultures were not treated.10/53 (18. 8%) patients with Aspergillus species in BAL cultures were treated of which 80% were appropriate interventions based on proven/probable invasive fungal infections criteria as were rest of the 6/16 patients with other fungal organisms (Table 4). Patients with Aspergillus species in BAL cultures are 8 times more likely to have an intervention (OR: 8. 7, P = < 0. 0001) while patients with Candida species in BAL cultures are not likely to be intervened upon (OR: 0. 26, P = 0. 0098) (Table 3).ConclusionAlthough Candida species is commonly isolated in BAL cultures its clinical significance is minimal in the absence of disseminated disease even in immunosuppressed hosts. Evaluating the way that Candida cultures are communicated for respiratory specimens, along with diagnostic stewardship may be a route for antimicrobial stewardship. Consulting ID service early on is essential in assessing the significance of fungal culture data thereby resulting in appropriate changes in management. Disclosures All authors: No reported disclosures.