Advanced microbiology technologies such as multiplex molecular assays (i.e. syndromic diagnostic tests) are a novel approach to the rapid diagnosis of common infectious diseases. As the global burden of antimicrobial resistance continues to rise, the judicious use of antimicrobials is of utmost importance. Syndromic panels are now being recognized in some clinical practice guidelines as a ‘game-changer’ in the diagnosis of infectious diseases. These syndromic panels, if implemented thoughtfully and interpreted carefully, have the potential to improve patient outcomes through improved clinical decision making, optimized laboratory workflow, and enhanced antimicrobial stewardship. This paper reviews the potential benefits of and considerations regarding various infectious diseases syndromic panels, and highlights how to maximize impact through collaboration between clinical microbiology laboratory and antimicrobial stewardship programmes.

Background In the outpatient setting, IDSA guidelines recommend a 3-day course of highly bioavailable oral antibiotics (abx) for treatment of uncomplicated urinary tract infections(uUTI); however, hospitalized patients often receive IV abx and longer durations. Ceftriaxone (CRO) is well tolerated and has a favorable spectrum of activity making it an ideal antibiotic for inpatient uUTI treatment. The purpose of this study was to compare a short, 3-day course of ceftriaxone with longer durations of therapy for inpatients with uUTI. Methods This retrospective cohort study included adult inpatients receiving abx for symptomatic uUTI with a positive urine culture between July 1, 2015 and June 30, 2021. The primary objective was to compare clinical cure between patients treated with 3-days of CRO (CRO 3-day) vs longer durations of abx therapy (Longer DOT). Clinical cure was defined as resolution of uUTI symptoms at completion of abx and no new documented symptoms within 24 hours following completion. Secondary outcomes included comparing hospital length of stay (LOS), 30-day return visit due to UTI, and development of Clostridiodes difficile within 30 days of abx treatment. Patients empirically treated with an anti-pseudomonal abx, microbiological resistance to CRO, co-infection, or complicated UTI were excluded. Results A total of 100 patients were included in the study (CRO 3-days, n=51; Longer DOT, n=49). Baseline characteristics were similar between groups. There was no difference in the primary endpoint between groups as all patients in the sample population achieved clinical cure (p=1.0). Additionally, no differences in median hospital LOS (5 [4-7] vs 4 [3-6.5] days, p=0.372), 30-day return visit due to UTI (13.7% vs 6.1%, p=0.319), or development of C. difficile within 30 days of treatment (2% vs 6.1%, p=0.357) were observed between the CRO 3-days vs Longer DOT groups, respectively. Conclusion There were no differences in efficacy or safety endpoints between short-course CRO and longer durations of therapy. Short-course IV CRO is likely an effective treatment strategy for inpatient treatment of uUTI and may limit prolonged antibiotic durations. Disclosures All Authors: No reported disclosures.

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Background Antipseudomonal antibiotics are often used to treat community-acquired intra-abdominal infections (CA-IAIs) despite common causative pathogens being susceptible to more narrow-spectrum agents. The purpose of this study was to compare treatment-associated complications in adult patients treated for CA-IAI with antipseudomonal versus narrow-spectrum regimens. Methods This retrospective cohort study included patients >18 years admitted for CA-IAI treated with antibiotics. The primary objective of this study was to compare 90-day treatment-associated complications between patients treated empirically with antipseudomonal versus narrow-spectrum regimens. Secondary objectives were to compare infection and treatment characteristics along with patient outcomes. Subgroup analyses were planned to compare outcomes of patients with low-risk and high-risk CA-IAIs and patients requiring surgical intervention versus medically managed. Results A total of 350 patients were included: antipseudomonal, n=204; narrow spectrum, n=146. There were no differences in 90-day treatment-associated complications between groups (antipseudomonal 15.1% vs narrow spectrum 11.3%, P=.296). In addition, no differences were observed in hospital length of stay, 90-day readmission, Clostridiodes difficile, or mortality. In multivariate logistic regression, treatment with a narrow-spectrum regimen (odds ratio [OR], 0.75; 95% confidence interval, 0.39–1.45) was not independently associated with the primary outcome. No differences were observed in 90-day treatment-associated complications for (1) patients with low-risk (antipseudomonal 15% vs narrow spectrum 9.6%, P=.154) or high-risk CA-IAI (antipseudomonal 15.8% vs narrow spectrum 22.2%, P=.588) or (2) those who were surgically (antipseudomonal 8.5% vs narrow spectrum 9.2%, P=.877) or medically managed (antipseudomonal 23.1 vs narrow spectrum 14.5, P=.178). Conclusions Treatment-associated complications were similar among patients treated with antipseudomonal and narrow-spectrum antibiotics. Antipseudomonal therapy is likely unnecessary for most patients with CA-IAI.

Background Antipseudomonal antibiotic regiments are often used to treat community-acquired intra-abdominal infections (CA-IAI) despite common causative pathogens being susceptible to more narrow-spectrum agents. The purpose of this study was to compare post-infection complications in adult patients treated for CA-IAI with antipseudomonal or narrow-spectrum regimens Methods This retrospective cohort study included patients ≥18 years admitted for CA-IAI treated with antibiotics between January 1, 2013, and December 31, 2019. Patients who had bacteremia or peritonitis were excluded. The primary objective of this study was to compare post-infection complications within 90 days between patients treated empirically with antipseudomonal versus narrow-spectrum regimens. Post-infection complication was defined as post-operative infection, recurrence of diverticulitis, or mortality. Secondary objectives were to compare infection and treatment characteristics along with patient outcomes. Sub-group analyses were planned to compare outcomes of patients with low-risk and high-risk CA-IAI and patients who required surgical intervention versus who were medically managed Results A total of 350 patients were included: Antipseudomonal, n=204; Narrow-spectrum, n=146. There were no differences in 90-day post-infection complications between groups (Antipseudomonal 15.1% vs Narrow-spectrum 11.3%, p=0.296). Additionally, no differences were observed in hospital LOS, 90-day readmission, C. difficile, or mortality. Patients treated with Antipseudomonal regimens received longer durations of therapy (median 11 days [IQR 8-14] vs 9 days [IQR 5-12], p< 0.001). No differences were observed in 90-day post-infection complications for patient with low-risk (Antipseudomonal 15% vs Narrow-spectrum 9.6%, p=0.154) or high-risk CA-IAI (Antipseudomonal 15.8% vs Narrow-spectrum 22.2%, p=0.588), or those who were surgically (Antipseudomonal 8.5% vs Narrow-spectrum 9.2%, p=0.877) or medically managed (Antipseudomonal 17.5% vs Narrow-spectrum 13.1%, p=0.463). Conclusion Post-infection complication rates were similar among patients treated with antipseudomonal and narrow-spectrum antibiotics. Antipseudomonal therapy is likely unnecessary for most patients with CA-IAI Disclosures Lisa E. Dumkow, PharmD, BCIDP, Nothing to disclose