We describe the proportion of pharmacist representation among current and corresponding prior editions of Infectious Diseases Society of America (IDSA) clinical practice guidelines (CPGs). Pharmacist representation was 13% and 21% in previous and current editions, respectively, increasing significantly since 2011. We advocate for continued collaborations between IDSA and pharmacy organizations to enhance multidisciplinary representation in CPGs.

Background Bacteremia is a life-threatening illness. Delayed treatment increases patient morbidity and healthcare costs. Accelerate Pheno™ Blood Culture Detection System (AXDX) is a novel diagnostic technology for rapid detection of gram-negative bacteremia. Studies have shown accurate and faster time to speciation and sensitivity (TTSS) by AXDX compared to conventional modality. Our unique study examined the direct impact of AXDX on clinical outcomes and cost. Methods This retrospective study consisted of 213 patients aged 18 years and older admitted to our academic institution with gram-negative bacteremia. The pre-AXDX group had 109 patients admitted in 2019 and the post-AXDX group had 104 patients admitted in 2021. Demographics, microbes, TTSS, time to de-escalation of therapy (TTDeT), length of stay (LOS), readmissions, mortality rates, and Clostridioides difficile infection (CDI) rates were recorded. Results The pre-AXDX group had 51.4% females, mean age of 60.3 years, mean Charlson Comorbidity Index (CCMI) of 2.2, mean LOS of 21.2 days, and mean Pitt Bacteremia Score (PBS) of 2.4. The post-AXDX group had 52.0% females, mean age of 63.7 years, mean CCMI of 3.0, mean LOS of 15.0 days, and mean PBS of 2.7. Both groups’ top 2 sources of bacteremia were urinary and gastrointestinal and top 2 microbes were Escherichia coli and Klebsiella pneumoniae. Pre-AXDX's mean TTSS was 71.9 hours and 23.6 hours for post-AXDX. Pre-AXDX's mean TTDeT was 74.0 hours and 43.9 hours for post-AXDX. The pre-AXDX cohort had 7.4% more related readmissions, 5.5% more CDI, and 0.3% more inpatient mortality than post-AXDX group. Conclusion In addition to faster TTSS with AXDX as seen with previous studies, our study shows clinical advantages with AXDX use. Both groups were comparable in bacteremia sources and microbes. The post-AXDX group had higher CCMI and PBS scores, indicating they were more ill. Despite this, the pre-AXDX group had 30.05 hours longer TTDeT, 6.17 days longer mean LOS, 5.45% more CDI, 7.12% more readmissions, and 0.26% higher mortality. The pre-AXDX group also reported adverse reactions to antibiotics, while post-AXDX did not. Our data shows AXDX use improves clinical outcomes with reduced adverse effects, mortality and CDI rate and lower costs with less LOS and readmission rates. Disclosures All Authors: No reported disclosures.

Background Current treatment guidelines for invasive candidiasis (IC) largely recommend an echinocandin as initial therapy. Echinocandins have demonstrated non-inferiority to previously utilized agents for the treatment of IC with low toxicity, few drug-drug interactions, and activity against azole-resistant Candida species. Although echinocandins are suggested empirically when IC is suspected, recommendations for empiric therapy based upon IC risk factors do not exist. The primary objective is to develop a risk score to predict probability of IC to help triage when empiric therapy with an echinocandin is likely warranted. Methods This evaluation is a retrospective, case-control design of hospitalized adults that received at least one dose of micafungin between July 1, 2020 and June 30, 2021 for proven or suspected IC at a large academic medical center. Descriptive statistics were used to describe all variables collected. A multivariable logistic regression analysis was used to determine the predictability of identified risk factors on IC. The predictability of the model was quantified using a nomogram which sums the odds of experiencing IC based on the presence of selected predictors. The sum is correlated to a linear predictor which corresponds to the log odds of experiencing IC. The exponential on the log odds gives the predicted probability of IC. Results Three hundred eighteen patients that received at least one dose of micafungin during the time frame for proven or suspected IC were included. IC was confirmed in 105 patients (33%) with endovascular source being the most common (56.2%). The most common Candida species isolated was C. albicans (47.6%). Independent risk factors for development of IC included anti-anaerobic antimicrobial therapy (adjusted odds ratio [aOR], 0.4611; 95% confidence interval [CI], 0.232, 0.914), parenteral nutrition (aOR, 2.115; 95% CI, 1.019, 4.388), and critical illness (aOR, 0.511; 95% CI, 0.315, 0.829). Patients with prediction scores of greater than 50 had an estimated probability of IC greater than 20%. Conclusion A prediction score can be a useful tool to estimate the patient-specific risk of IC development. Integration of a risk score for IC into clinical workflow may improve empiric antifungal prescribing and reduce echinocandin utilization. Disclosures All Authors: No reported disclosures.