RATIONALE: Intravenous penicillin is the antibiotic of choice for streptococcal bacteremia, which results in up to 48% mortality. The impact of reported penicillin allergy remains unclear in this patient population. Our study compares the clinical outcomes of streptococcal bacteremia in matched patients with (exposed) versus without (unexposed) reported penicillin allergy. METHODS: Retrospective cohort study comparing exposed to unexposed adult patients admitted to Einstein Medical Center Philadelphia from 1/1/2014 to 12/31/2015. RESULTS: In the cohort (n5331), the prevalence of reported penicillin allergy was 12%. We compared 15 exposed to 16 unexposed patients with matching demographics and clinical presentation. The exposed group more frequently reported allergy to other antibiotics than the unexposed group (33% vs 0%, p50.02); were treated with more antibiotic classes (median of 3 versus 2 classes, p50.05), had a shorter mean duration of antibiotic treatment (10 versus 20 days, p50.04), developed more acute kidney injury (46.7% versus 31.3%, P > 0.05), and had more complications of infection (including endocarditis, metastatic infection, septic shock; 60% versus 43.8%; P > 0.05). CONCLUSIONS: Our results suggest that patients who report penicillin allergy are more likely to report concurrent allergies to other drug(s) and receive more classes of antibiotics. The reduced duration of antibiotic treatment may indicate more cautious prescribing behavior in this group. The study is currently underpowered to detect differences in other clinical outcomes.Abstracts AB29 SATURDAY

BackgroundAztreonam (AZT) is an alternative antibiotic for Gram-negative infections requiring IV therapy and anti-pseudomonal coverage in patients with an IgE mediated penicillin allergy. However, many reported allergic reactions to penicillins are either unknown or mis-categorized. In 2012, significant use of AZT was observed at our institution coupled with a 29% resistance rate for Pseudomonas aeruginosa (PA) to AZT. The aim of this study was to track and assess AZT use during a 5-year period during which antimicrobial stewardship interventions along with a hospital-wide allergy guideline were implemented to optimize antibiotic use.MethodsA retrospective review of AZT use was conducted at RUSH University Medical Center from January 2012 to December 2017. September of 2012, AZT was restricted for use in patients with an immediate type-1 hypersensitivity reaction to a β-lactam (BL) with approval from the infectious diseases (ID) consult service. January 2015, a hospital-wide BL allergy guideline, including a clinical pathway for BL graded challenges, was implemented. November 2015 and April 2017, computerized order-sets for BL graded challenges and in-patient penicillin skin tests were executed, respectively. AZT usage was tracked yearly and stratified by the number of patient cases, total number of doses and average days of therapy (DOT) to assess for differences. AZT cost, PA susceptibility, BL graded challenges and ID consultations for approval were also tracked for assessment.ResultsPatient cases using AZT decreased by 76% in 2017. The total number of doses decreased by 84%. The mean DOT for AZT declined from 5.5 days in 2012 to 3.4 days in 2017. The expenditure of AZT reduced by 86%. Hospital-wide resistance rates for PA to AZT declined to 22% in 2017. Compliance with the BL allergy guideline improved post implementation as the number of BL graded challenges rose to a mean of 30 orders with an 82% decrease in ID consults in 2017.20122017% Decrease P valuePatient cases (n)2596276<0.0001Doses (n)3,11249784<0.0001DOT (mean days)5.53.438<0.0001AZT expenditure ($)157,35421,55086<0.0001ID consults (n)1713082<0.0001ConclusionMultiple stewardship interventions, including restrictions and guidelines, can significantly decrease use of AZT and improve susceptibility of PA to AZT.Disclosures All authors: No reported disclosures.

While sleep medications can improve sleep for those suffering from insomnia, other medications, particularly antidepressants and antipsychotics, can significantly reduce sleep quality. The mechanism by which this occurs is often indirect and variable, and it is not entirely understood. In this chapter, the authors examine how these drugs affect various sleep parameters as evidenced by polysomnography and which phase of the sleep cycle is most impacted as a result of their actions. This chapter also discusses the risks and downsides associated with long-term use of prescription and nonprescription insomnia agents, as well as important age considerations with their use.