Background In an ideal state, the stewardship of antimicrobial agents would happen at the point of order entry. In June 2018, Eskenazi Health implemented a series of clinical decision support tools in the electronic health record (EHR), including required fields on all inpatient antimicrobial orders for indication, type of therapy (empiric or definitive), and duration. When empiric therapy is selected, providers receive a Best Practice Advisory (BPA) at 48 hours to re-evaluate therapy. Additionally, a side bar table was added to all antimicrobials orders that included drug-specific duration of therapy recommendations for common indications. Methods This is a single-center, retrospective, observational chart review that includes adult inpatients prescribed antibiotics for the treatment of CAP or UTI from July 2017 to December 2018. The primary outcome is the overall length of therapy between pre- and post-intervention groups for CAP and UTI. Secondary outcomes include duration of empiric/broad-spectrum therapy, duration of definitive therapy, time to de-escalation, length of hospital stay, C. difficile infections, 30-day readmission, and cost of antimicrobial therapy. Results A total of 541 orders were included for analysis. The composite overall duration of therapy decreased from 7 days to 5 days in the post-intervention group (p< 0.001). For CAP, the duration of therapy (5 days) was not different between groups. For UTI, the duration of therapy decreased from 11 days to 7 days in the post-intervention group (p< 0.001). The duration of empiric therapy decreased from 3 days to 2 days (p< 0.001) and the duration of definitive therapy decreased from 4 days to 3 days (p< 0.001). There was a 1 day longer length of stay for patients in the post-intervention group (p=0.038); however, there was a lower 30-day readmission rate in the post-intervention group (p=0.003). The rate of hospital-acquired C. difficile infections did not differ between groups (p=1.000). It was found that action was taken from the BPA 55.4% of the time after implementation. Conclusion The duration of therapy overall was shortened by 2 days, which was driven by the difference in duration for UTI. Incorporating antimicrobial stewardship principles at the point of order entry can result in fewer days of unnecessary therapy. Disclosures All Authors: No reported disclosures.

Objective: To determine if race-ethnicity is correlated with case-fatality rates among low-income patients hospitalized for COVID-19.Research Design: Observational cohort study using electronic health record data.Patients: All patients assessed for COVID-19 from March 2020 to January 2021 at one safety net health system.Measures: Patient demographic and clinical characteristics, and hospital care processes and outcomes.Results: Among 25,253 patients as­sessed for COVID-19, 6,357 (25.2%) were COVID-19 positive: 1,480 (23.3%) hospitalized; 334 (22.6%) required intensive care; and 106 (7.3%) died. More His­panic patients tested positive (51.8%) than non-Hispanic Black (31.4%) and White patients (16.7%, P<.001]. Hospitalized Hispanic patients were younger, more often uninsured, and less likely to have comorbid conditions. Non-Hispanic Black patients had significantly more diabetes, hyperten­sion, obesity, chronic kidney disease, and asthma (P<.05). Non-Hispanic White patients were older and had more cigarette smoking history, COPD, and cancer. Non- Hispanic White patients were more likely to receive intensive care (29.6% vs 21.1% vs 20.8%, P=.007) and more likely to die (12% vs 7.3% vs 3.5%, P<.001) compared with non-Hispanic Black and Hispanic patients, respectively. Length of stay was similar for all groups. In logistic regres­sion models, Medicaid insurance status independently correlated with hospitaliza­tion (OR 3.67, P<.001) while only age (OR 1.076, P<.001) and cerebrovascular disease independently correlated with in-hospital mortality (OR 2.887, P=.002).Conclusions: Observed COVID-19 in-hospital mortality rate was lower than most published rates. Age, but not race-ethnicity, was independently correlated with in-hospital mortality. Safety net health systems are foundational in the care of vulnerable patients suffering from COVID-19, including patients from under-represented and low-income groups. Ethn Dis. 2022;32(2):113- 122;doi:10.18865/ed.32.2.113

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Introduction Antibiograms display susceptibilities based on bacterial growth in response to systemic agents, utilizing automated systems performing bacterial identification and susceptibility testing. There is a paucity of literature regarding burn-specific antibiograms or susceptibility testing of organisms isolated from wound cultures against topical antimicrobials. Our goal was to create an institutional topical antimicrobial antibiogram in burn and dermatologic disorder patients. Methods Institutional topical antimicrobial agent susceptibilities were retrospectively reviewed from 1/1/18-12/31/18. Quantitative biopsies or swabs collected from patients were cultured. Susceptibility plates were prepared by wells aseptically punched into an agar plate and inoculated with antimicrobial creams. Bacterial isolates were then inoculated in melted agar, overlaid onto the susceptibility dish, and incubated. Zones of inhibition (ZOI) were reported in mm; susceptible being any measurable zone and resistant defined as a zone of 0 mm. Isolated organisms were grouped as Gram-positive cocci (GPC), Gram-negative rods (GNR), or yeast-like fungi (YLF). Results In 2018, 21 organisms were tested for susceptibility in 19 patients with positive cultures. Overall susceptibilities of isolates were 71–91%. Overall, susceptibility rates were: gentamicin 71%, mupirocin 77%, silver sulfadiazine 77%, and mafenide 91%. All C. albicans isolates were susceptible to nystatin. Excluding resistant isolates, the median (IQR) ZOI measurements were: gentamicin 10.0 (7.0, 15.0), mupirocin 12.0 (7.5, 27.0), silver sulfadiazine 8.0 (7.0, 10.5), and mafenide 14.5 (10.3, 19.8). Of organisms reported, there were 10 GNR (45%), 8 GPC (36%), and 4 YLF (18%), with P. aeruginosa, MRSA, and C. albicans being most common. For GPC, susceptibility rates were 63–88% and median (IQR) ZOI measurements were: gentamicin 16.0 (8.0, 30.0), mupirocin 27.0 (9.8, 35.5), silver sulfadiazine 10.0 (8.5, 19.0), and mafenide 15.0 (10.0, 22.0). For GNR, susceptibility rates were 70–90% and median (IQR) ZOI measurements were: gentamicin 10.0 (6.0, 11.0), mupirocin 12.0 (7.0, 18.0), silver sulfadiazine 7.5 (7.0, 9.5), and mafenide 15.0 (13.0, 19.0). Conclusions Based on susceptibility profiles of isolated organisms, mafenide appears to be an appropriate first-line empiric agent with an overall susceptibility rate greater than 90% and the largest ZOI amongst topical agents tested. When examining GPC, mupirocin demonstrated the largest ZOI and may be a more appropriate empiric choice if Gram-stain results are available. Applicability of Research to Practice To our knowledge, no previously published studies exist in burn patients examining susceptibilities to topical antimicrobials. These antibiogram-level data provide direction for empiric treatment of wound infections utilizing local susceptibilities for targeted topical coverage.