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Background Infectious diseases (ID) consultation improves SAB readmission rates, compliance with care bundles and mortality. Small community hospitals (SCHs) (which comprise 70% of US hospitals) often lack access to on-site ID physicians. IDt is one way to overcome this barrier, but it is unknown if IDt provides similar clinical benefits to traditional ID consultation. Our study aims to evaluate the impact of IDt on patient outcomes at 15 SCHs (bed range: 16–146) within the Intermountain Healthcare system in Utah. Methods Baseline demographics, Charlson Comorbidity Index (CCI), hospital length of stay (LOS), and mortality (in-hospital, 30- and 90-day) were collected using an electronic health record database and health department vital records on all patients with a positive S. aureus blood culture from January 1, 2009 through December 31, 2018. Data from January 2014 through Sep 2016 were excluded to avoid potential influence of a concurrent antimicrobial stewardship study. Starting in October 2016 an IDt program (staffed by an ID physician and pharmacist) provided consultation for SCH providers and patients using electronic consultation and encrypted two-way audiovisual communication.Statistical analyses were performed using Fisher’s exact test or χ 2 test for categorical variables and Mann–Whitney U test for nonparametric continuous data. Results In total, 625 patients with SAB were identified: 127 (20%) received IDt and 498 (80%) did not (non-IDt). The two groups (IDt vs. non-IDt) were similar in median age (66 vs. 62 years; P = 0.76), percent male (62% vs. 58%; P = 0.35), and median baseline CCI (4 vs. 4; P = 0.54). There were no statistically significant differences in median LOS (5 vs. 5 days; P = 0.93) or in-hospital mortality (2% in both groups). The IDt group had a lower 30-day (9% vs. 15%; P = 0.049) and 90-day mortality (13% vs. 21%; P = 0.034). Conclusion IDt consultation was associated with a decrease in 30- and 90-day mortality for SCH SAB cases. Early transfer of critically ill patients might have affected LOS and in-hospital mortality. Post-discharge care factors might also contribute to 30- and 90-day mortality. While more work is needed to identify other factors associated with the effect of IDt on SAB, these data support the use of IDt to increase access to care and improve SAB outcomes in SCHs. Disclosures All Authors: No reported Disclosures.

Febrile respiratory illness (FRI) due to adenovirus (Ad) has been a leading cause of morbidity in basic military trainees for >60 years [1]. For the purpose of respiratory disease surveillance in the military training population, FRI has been defined as a fever (typically, a temperature ≥100.4oF) and the presence of at least 1 respiratory symptom [2, 3]. Historically, adenovirus-associated FRIs have been associated with mild upper or lower respiratory tract disease, lost training time, high respiratory disease transmission rates and outbreaks [1, 4–6]. Ad-associated fatalities in military trainees and civilians are well documented in the literature [7–13]; however, the incidence of severe or fatal adenovirus infections in young, healthy military trainees has remained low, despite high attack rates. In 2005, Ad-14 (a B subtype, respiratory Ad) emerged at Lackland Air Force Base (AFB), Texas, and elsewhere in the United States as a novel cause of FRI, pneumonia, and death in military and civilian populations [3, 14–20]. Ad-14 was not known to be a common adult respiratory pathogen in the United States before these reports but had been previously identified as a cause of nonfatal respiratory disease outbreaks in European military populations [21, 22]. Molecular studies have shown the emergent Ad-14 virus to be a new genome type, with all recent US Ad-14 strains identified as the same viral strain [3]. Since the emergence of Ad-14 in the United States, several studies have suggested an association of greater morbidity and mortality with Ad-14 infection [15–18]. Although these studies demonstrate associations with severe disease in older individuals and those with underlying chronic medical conditions, it is not known whether Ad-14 is a cause of more severe disease in young, healthy patients, compared with other respiratory pathogens. An observational, descriptive clinical report on 9 of the Ad-14–positive pneumonia cases from this study was published elsewhere [23]; however, no comparative studies have been conducted to discern whether there were true differences in clinical, laboratory, or radiographic abnormalities based on Ad-14 infection status. The objectives of this study were to assess clinical, laboratory, and radiographic factors in US Air Force trainees with pneumonia to determine whether Ad-14 infection is associated with increased morbidity or mortality and whether specific clinical variables are associated with Ad-14 infection.