Due to the increased incidence and recurrence of Clostridium difficile infection, health care providers are seeking new and alternative treatments to the standard antibiotic therapy. The objective of this article is to present a review on the background, microbiologic efficacy, clinical efficacy, and safety of fecal microbiota transplantation and to provide an overview of emerging treatment options currently under investigation. Emerging treatment options discussed include the use of monoclonal antibodies directed against toxins A and B, C difficile vaccination, and transplantation of nontoxigenic C difficile strains.

Given the complexity of antimicrobial resistance and the dire implications of misusing antimicrobials, it is imperative to identify accurate and meaningful ways to understand and communicate the realities, challenges, and opportunities associated with antimicrobial utilization and measurement in all sectors, including in animal agriculture. The objectives of this paper are to i) describe how antimicrobials are regulated and used in U.S. animal agriculture and ii) highlight realities, challenges, and opportunities to foster multidisciplinary understanding of the common goal of responsible antimicrobial use. Recognition of the realities of medicine, practice, and policy in the agricultural setting is critical to identify realistic opportunities for improvement and collaboration.

Background Home Hospital (HH) is a unique and rapidly expanding care model that allows patients to receive medical therapy and monitoring through telehealth communication and nursing visits, and there are currently no published studies evaluating antimicrobial stewardship interventions in the HH setting. The goal of this study is to evaluate the impact of a pharmacist-driven antimicrobial stewardship pilot for the HH program. Methods This was a pre-post quasi-experimental study of adult patients enrolled in HH program between January through March in 2021 (control cohort) and in 2022 (intervention cohort), who received antibiotics (oral/intravenous) during their HH admission. Patients on long-term prophylactic antimicrobials, antifungals, external antimicrobials, or mycobacterial treatment were excluded. The antimicrobial stewardship pharmacist performed prospective audit and feedback and provided recommendations to clinicians through the electronic medical record. The primary endpoint was antibiotic use (days of therapy per 1000 patient-days). Secondary endpoints included broad-spectrum antibiotic usage; appropriateness of antibiotic indication, dosing, and duration; compliance with the institution’s outpatient antibiotic reference guide or outpatient intravenous antibiotic therapy (OPAT) monitoring; treatment failure; antibiotic-associated adverse effects; and cost of antibiotic therapy. Results The study included 73 and 127 patients in the control and intervention group, respectively (Figure 1). On average, the pharmacist reviewed 8 eligible patients/day. Interventions were generally well received by HH providers (Figure 2). There was no significant difference in the primary outcome. More inappropriate antibiotic indication was identified in the intervention group (46 [36%] vs. 15 [19%], p=0.01), associated with post-surgical infection prophylaxis after orthopedic procedures (Figure 3). Other secondary outcomes did not vary significantly between the groups. Figure 1:Study inclusion flowchartFigure 2:Intervention breakdownFigure 3:Infection types Conclusion The pilot allows for better understanding of outpatient and HH antibiotic prescribing practices to provide targeted interventions, and suggests the need for additional antimicrobial stewardship involvement to optimize antibiotic therapy in this novel care setting. Disclosures Elizabeth B. Hirsch, PharmD, FCCP, FIDSA, Melinta: Advisor/Consultant|MeMed: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support.

Background The Infectious Diseases Society of America OPAT (outpatient parenteral antimicrobial therapy) guidelines state that effective OPAT programs require a multidisciplinary team1. Currently within the health system, there is no formal OPAT program in place, and OPAT prescribing is not limited to any specialty. This project aimed to pilot a pharmacist-driven program across five hospitals. Methods Adult patients with OPAT ordered between February 1 and May 1, 2020 were included. Patients were excluded if the OPAT was prescribed by infectious diseases (ID) providers or if patients were on OPAT prior to hospital admission. An alert was generated in the electronic health record (EHR) when an order for an intravenous catheter was placed for patients with concomitant antimicrobials. Follow up was performed and documented via a progress note in the EHR as appropriate. Data was collected via retrospective chart review and statistical analysis was performed using Chi-squared test with Yates’ correction. Results 101 pre- and 7 patients post-implementation were included in this study. There were a total of 51 patients pre-implementation that received inappropriate OPAT care per the IDSA OPAT guidelines, and post-implementation 2 patients (50.5% vs 28.6%, p=0.47). The secondary outcomes of 30-day readmission rates were 17% and 0% (p=0.52); and complications related to OPAT (e.g. central-line associated blood stream infections) were 12% and 0% (p=0.73), respectively. 2 midline catheters were recommended by the OPAT team, and a cost savings of up to $6,796 was calculated. Conclusion This pilot showed a trend towards decreased inappropriate OPAT prescribing and cost avoidance of an ID pharmacist-driven review of OPAT prior to patient hospital discharge. Limitations to this pilot included being underpowered due to the limited time-frame of the post-implementation period, and an inability for follow up with patients discharged utilizing an alternative home infusion service. Disclosures All Authors: No reported disclosures

BackgroundBloodstream infection is associated with 12% to 32% mortality. The FilmArray® BCID panel is a multiplex polymerase chain reaction assay (PCR) that can rapidly identify the most common bacterial pathogens in the blood and three antimicrobial resistance genes. In April 2015, Abbott Northwestern Hospital (ANW) implemented the multiplex PCR panel and a pharmacist-driven process to assist with antibiotic tailoring. In August 2017, a standardized algorithm was approved providing first-line and second-line antimicrobial options for each microbial pathogen included in the multiplex PCR panel. The objective of this study was to compare the time from the multiplex PCR panel result to final appropriate antibiotic therapy (as defined by the standardized algorithm or when clinical decision was indicated) between pre- and post-algorithm implementation in hospitalized patients with bacteremia.MethodsRetrospective chart review was performed in 93 randomly selected adult patients with ≥1 positive blood culture in November 2016–February 2017 (pre-algorithm) vs. 93 patients in November 2017–February 2018 (post-algorithm) at ANW.ResultsThe two groups did not differ significantly in terms of age (average ~60 years), sex (45% female), intensive care unit admission on day 1 of bacteremia (~41%), infectious diseases (ID) consult within 72 hours of bacteremia (average 72%), bacteremia source, or etiologic bacteria. The median time to final appropriate antibiotic therapy in response to the multiplex PCR result was 19 hours (interquartile range, IQR 4–38 hours) pre-algorithm and 18 hours (IQR 4–31 hours) post-algorithm (P = 0.34).ConclusionThe median time from the multiplex PCR result to final appropriate antibiotic therapy was ~19 hours pre- and post-algorithm. Previous studies showed a median of 21 hours to first appropriate de-escalation. Therefore, ANW performs very well in de-escalating antimicrobial therapy promptly. However, most of the rapidity in antibiotic change was driven by ID providers, who treated >70% of patients. Opportunities for improvement exist for non-ID providers in tailoring antimicrobial therapy and for pharmacists in engaging and providing recommendations in a timely manner.Disclosures All authors: No reported disclosures.