Using the findings of this study, teachers will gain novel approaches to teaching patient education that specifically target instructing students in the practices of health literacy. These practices can ameliorate and mitigate problems many students encounter when addressing health literacy.

BackgroundMolecular-based automated systems for the rapid diagnosis of bacterial infections have potential to improve patient care. The Accelerate Pheno™ blood culture detection system (ACCEL) is an FDA approved platform that allows for identification (ID) and antimicrobial susceptibility testing (AST) 8 hours following growth in routine culture.MethodsThis is a single-center retrospective chart review of bacteremic adult inpatients before and after implementation of ACCEL. Laboratory and clinical data were collected February–March 2018 (intervention) and compared with a January–April 2017 historical cohort (standard of care). Standard of care ID and AST were performed using VITEK® MS (MALDI-TOF MS) and VITEK®2, respectively. An active antimicrobial stewardship program was in place during both study periods. Patients with polymicrobial cultures, off-panel isolates, previous positive culture, or who were discharged prior to final AST report were excluded. Primary outcome was length of stay (LOS). Secondary outcomes were inpatient antibiotic duration of therapy (DOT) and time to optimal therapy (TTOT). Nonparametric unadjusted analyses were performed due to non-normal distributions. Statistics were performed using SAS 9.4.ResultsOf the 143 positive cultures performed on ACCEL during intervention, 118 (83%) were identified as on-panel organisms. Seventy-five (64%) of these 118 cultures and 79 (70%) of 113 reviewed standard of care cultures met inclusion criteria. Patient comorbidities (P = NS), MEWS severity score (P = 0.10), source of bacteremia (P = NS), and pathogen detected (P = 0.30) were similar between cohorts. Time from collection to ID (28.2 ± 12.7 hours vs. 53.8 ± 20.9 hours; P < 0.001) and AST (31.9 ± 11 hours vs. 71.8 ± 20 hours; P < 0.001) were shorter in the intervention arm.Clinical OutcomesStandard of Care (Mean ± SD) N = 79Intervention (Mean ± SD), N = 75 P-valueLOS (days)12.1 (11.9)9.1 (7.6)0.03TTOT (hours)73.5 (50.2)37.5 (32.7)<0.001Total antibiotic DOT (days)9.0 (7.5)7.0 (4.6)0.05Meropenem DOT (days)6.6 (3.7)3.7 (2.1)0.03ConclusionCompared with standard of care, ACCEL shortens laboratory turn-around-time and improves clinical outcomes. The use of this system has resulted in decreased mean antibiotic DOT, TTOT, and LOS. Further studies are needed to verify these findings.Disclosures All authors: No reported disclosures.

Background Clostridium difficile infection (CDI) remains a major health problem in the United States. The IDSA guidelines recommend using stool toxin assay as part of a multistep algorithm rather than nucleic acid amplification test (NAAT) alone. However, the clinical significance of toxin negative tests remains a subject of debate. We performed a prospective study in our institution to describe clinical outcomes of CDI based on the results of the stool toxin assay.MethodsOur laboratory utilizes a 2-step algorithm, using glutamate dehydrogenase plus detection of toxin B by enzyme immunoassay (EIA) arbitrated by NAAT for testing stool samples submitted for C. difficile testing. The study was conducted between January and December 2017. Patients diagnosed with CDI based on laboratory results were divided into two groups based on toxin B assay results. Shotgun metagenomics was performed directly on stool specimens using Illumina NextSeq in a subset of patients. Chart reviews were performed to assess clinical outcomes. Our primary outcome was incidence of severe CDI and 30-day mortality.ResultsA total of 2,823 samples were submitted to the laboratory for testing for suspected CDI. Three hundred thirty-eight samples in 290 discrete patients were considered positive using the two step algorithm. Whole genome sequencing was performed on samples from 57 patients (Figure 1). Clinical outcome data were available for 53 patients. Thirty percent were on active chemotherapy. Thirty-four patients were toxin B positive (group 1), 19 were toxin B negative (group 2) by EIA. Hospital onset disease was seen in 10 (27%) of patients in group 1 vs. 7 (37%) in group 2 (P = 0.57). Thirty-day mortality was 3% in toxin positive vs. 5% in toxin negative groups (P = 0.67). Severe CDI was seen in 14 (41%) in group 1 vs. 8 (42%) in group 2 (P = 0.94). NAP 1 strain was detected in 10.5% of patients in group 2. Percentage of C. difficile reads on sequencing in fecal samples in group 1 (0.17%) was not significantly different from group 2 (0.24%) (P = 0.70, Figure 2).ConclusionIn our cohort, detection of C. difficile toxin in stool samples was not associated with increased severity of disease. Our cohort has a higher prevalence of patients on active chemotherapy than previously studied cohorts.Bioburden of C. difficile was not significantly different in toxin positive and negative disease. Disclosures All authors: No reported disclosures.