Small modifications in hospital routines, especially in the timing of vital signs and routine medication administration, can significantly reduce sedative use in unselected hospital patients.

The bioavailability of linezolid is not impaired by RYGBS. The serum exposure of linezolid is more than 50% lower in obese compared with non-obese subjects, suggesting that dose modification may be needed.

Bell's palsy is one of the most common neurologic disorders affecting the seventh cranial nerve. Several disease states have been associated with facial paralysis. Drugs, however, have been rarely implicated as an etiology. We describe a 49-year-old man who developed peripheral facial paralysis after 3 weeks of linezolid therapy, along with recurrence of symptoms on rechallenge. He had insulin-dependent diabetes mellitus and a longstanding history of bilateral diabetes-related foot problems. After hospitalization, debridement, and vancomycin therapy for methicillin-resistant Staphylococcus aureus osteomyelitis, the patient was discharged to home with oral linezolid therapy. On day 23 of linezolid therapy, he developed signs and symptoms that were consistent with Bell's palsy. Linezolid was discontinued; the Bell's palsy gradually improved, with complete resolution occurring at month 3. On rechallenge with linezolid for recurrent osteomyelitis, the patient developed a second episode of Bell's palsy within a similar time frame as in the first episode. Assessment of causality using the Naranjo adverse drug reaction probability scale revealed a probable relationship between this adverse drug event and linezolid therapy. Clinicians should be aware that Bell's palsy may be another neuropathic adverse effect associated with linezolid.

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BackgroundIn patients with bacteremia, delay in appropriate therapy is associated with higher morbidity and mortality. Matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) reduces the time to identification (ID) to approximately 30 minutes. Previously published studies show rapid diagnostics need to be coupled with antibiotic stewardship intervention for maximal benefit.MethodsRetrospective, observational review at Cambridge and Everett Hospitals, two inpatient community, teaching hospitals that are part of Cambridge Health Alliance. The purpose is to evaluate the impact of MALDI-TOF by reviewing data in three phases: Microscan ID (January 1 to November 30, 2017), MALDI-TOF alone (December 1, 2017 to December 9, 2018), and MALDI-TOF coupled antimicrobial stewardship (December 10, 2018 to April 30, 2019). The laboratory batches all positive blood cultures to be run via MALDI-TOF mid-morning. In phase 3, a pharmacy resident is notified of the result via an automatic page. The resident determines appropriate empiric therapy using an algorithm developed by the Antimicrobial Stewardship Team and contacts the primary team. Data were collected via a laboratory report and chart review. The primary outcome is time to targeted antimicrobial therapy after ID. Secondary outcomes include time to ID, time to susceptibilities, duration of therapy for blood culture contaminants, and number of pharmacy interventions in phase 3.ResultsPreliminary data indicate mean time targeted antibiotic therapy was 41:45, 35:58, and 27:39 hours:minutes in phases 1, 2, and 3, respectively. Mean time to ID and final susceptibilities was also reduced in phases 2 and 3. The duration of therapy for blood culture contaminants decreased from 53:50 in phase 1 to 32:48 hours:minutes in phase 2. Pharmacy residents in phase 3 successfully implemented 47 total interventions, 24 (51%) after identification.ConclusionImplementation of MALDI-TOF with and without stewardship intervention successfully decreased time to targeted antibiotic therapy in two community hospitals. Future directions include adding an evening MALDI-TOF run and simplifying pharmacy resident standard operating procedure.Disclosures All authors: No reported disclosures.