188. Outcomes After Implementing the OPTIONS-DC Multidisciplinary Care Conference for Patients with Substance Use Disorders and Severe Bacterial Infections

Abstract Background Hospitalizations for patients with severe bacterial infections (SBI) and substance use disorders (SUDs) are increasing. To address the unique treatment challenges for these patients and balance appropriate medical therapy with patient goals, we implemented the OPTIONS-DC, a structured multidisciplinary discharge planning conference. All patients with SBI and SUD at our institution qualify for an OPTIONS-DC. Methods We performed a retrospective case-control study to evaluate differences and describe outcomes in patients who received an OPTIONS-DC compared to those who did not. Admissions were included if the patient was diagnosed with a SUD, a SBI requiring at least 2 weeks of antibiotics, consultation by infectious diseases and addiction medicine, and who were admitted between February 2018 and March 2020 (following implementation of OPTIONS-DC conferences). Patients were excluded for infected prosthetic material, pregnancy, or non-bacterial infection. Results 173 admissions qualified for inclusion and 73 had at least one OPTIONS-DC. Unstable housing and psychiatric disease were common (table 1). Opioid and methamphetamine use disorders were most common and almost all SUDs were severe. Patients who received an OPTIONS-DC had less medical comorbidities, less unstable housing, and were more likely to have an opioid use disorder, use more than one substance, start MAT while inpatient, and have vertebral osteomyelitis or epidural abscess (table 2). Patients who had a conference had similar proportions of unexpected discharges (13.7% vs 17%), but a higher proportion of treatment completion (83.6% vs 69%), more days of antibiotic therapy remaining after discharge (13.9 vs 9.8 days), were more likely to discharge to an outpatient setting with family or medical support (30% vs 9%), and more likely to complete their antibiotic course with a long-acting injectable (27.4% vs 9%)(table 3). Conclusion Not all eligible patients received an OPTIONS-DC and there were significant differences in substances used, housing status and type of infections between those groups. Descriptive data suggest that OPTIONS-DC may reduce the duration of inpatient antibiotic treatment and increase likelihood of completion of antibiotic therapy, however this requires further study. Disclosures Amber C. Streifel, PharmD, BCPS, Melinta (Advisor or Review Panel member) Monica K. Sikka, MD, FG2 (Scientific Research Study Investigator)

duration of inpatient antibiotic treatment and increase likelihood of completion of antibiotic therapy, however this requires further study.

Bacteremia among COVID-19 and Non-Covid-19 Patients Admitted in the ICU
paraskeui chra, MD 1 ; Evdokia Gavrielatou, MD 2 ; prodromos Temperikidis, MD 2 ; Michalis Tsimaras, MD 2 ; eleni magira, MD PhD 3 ; 1 Evanelismos Hospital, Athens, Attiki, Greece; 2 National Kapodistrian University of Athens, Athens, Attiki, Greece; 3 University of Athens Medical School, athens 15235, Attiki, Greece eleni magira Session: P-10. Bacteremia Background. The aim of this work were to investigate the rate and aetiology of bloodstream infection collected from COVID and non-COVID patients admitted in the ICU Methods. A retrospective cohort study was conducted on PCR Covid-19 positive patients admitted in the ICU from 20th March to 30 th April 2020. Corresponding data from the same period in 2019 collected of all consecutive patients admitted in the same ICU were retrospectively reviewed for the presence of microbiologically documented bloodstream infections at least 8 hours after admission. All patients in the cohort study were on mechanical ventilation, or at some point during their ICU admission required mechanical ventilation.
Conclusion. Our findings emphasize that although the incidence of BSI in CoVID-19 positive ICU admitted patients slightly increased their impact on overall outcome was significantly worse. Consequently, it is important to pay attention to bacterial superinfections in critical patients positive for COVID-19.
Disclosures. Background. Monotherapy with vancomycin (VAN) or daptomycin (DAP) remains the guideline-driven standard of care for methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B) despite concerns regarding efficacy. While combination therapy is often utilized as salvage treatment for persistent MRSA-B, growing data suggest a potential benefit of combination therapy with ceftaroline as initial therapy for MRSA-B. In light of these data, we updated practice guidance at our institution for management of MRSA-B in March 2020 to favor initial combination therapy with ceftaroline. Herein, we present an assessment of outcomes of patients with MRSA-B initiated on early combination therapy.
Methods. This was a single-center, retrospective, cohort study of adult patients admitted to the University of Virginia with MRSA-B between July 1, 2018 and February 28, 2021. Patients were considered to have received combination therapy if they received VAN or DAP plus ceftaroline (CPT) within 5 days of index blood culture, and monotherapy if during that period they received VAN and/or DAP alone. The primary outcome was a composite of persistent bacteremia, 30-day allcause mortality, and 30-day bacteremia recurrence. Time to microbiological cure and safety outcomes were also assessed. A propensity score-weighted logistic regression was conducted. A post-hoc analysis of the primary composite outcome was performed in which patients were only deemed to have received combination therapy if it was started within 72 hours.
Conclusion. In this retrospective study, there was no clear benefit or harm of early initiation of combination therapy for MRSA-B. Additional study of initial combination therapy with ceftaroline is warranted given the small number of subjects in the study presented.
Disclosures. All Authors: No reported disclosures