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Background Despite multiple studies indicating a low prevalence of bacterial coinfection in coronavirus disease 2019 (COVID-19) patients, the majority of hospitalized COVID-19 patients receive one or more antibiotics. Patients with coinfection usually have multiple risk factors and poor clinical outcomes. Methods A retrospective case control study was conducted comparing clinical characteristics and antimicrobial use in hospitalized adult COVID-19 patients with bacterial co-infections vs. randomly selected patients without co-infections (matched on month of admission). The study was conducted at three hospitals within the Montefiore Medical Center, Bronx, NY between March 1, 2020 and October 31, 2020. A multivariable logistic regression model was developed to assess the relationship of each predictor variable with coinfection status. Secondary outcomes included hospital mortality, antibiotic days of therapy (DOT), and C. difficile infection. Results A total of 150 patients with coinfection and 150 patients without co-infection were included in the analysis. Table 1 summarized baseline characteristics and risk factors. The multivariable logistic regression model indicated that presence of a central line (OR=5.4, 95% CI: 2.7-11.1), prior antibiotic exposure within 30 days (OR=5.3, 95% CI: 2.8-10.0), prior ICU admission (OR=3.6, 95% CI: 1.7-7.6), steroid use (OR=2.7, 95% CI: 1.4-4.9), and any comorbid condition (OR=2.7, 95% CI: 1.4-5.2) were significantly associated with the development of coinfection (table 2). Mortality was higher in patients with coinfection (56% vs. 11%, p < 0.0001) (table 3). Average antibiotic DOT was 10.5 in coinfected patients compared to 4 in non-coinfected patients, (p < 0.0001). Forty-one percent of coinfected patients had a multidrug resistant organism isolated. C. difficile rate was higher in coinfected patients (4% vs. 0%, p=0.03). Conclusion As the healthcare community contends with a 3rd year of COVID-19 pandemic, understanding risk factors most predictive of bacterial coinfection can guide empiric antimicrobial therapy and targeted stewardship interventions. Ideally, co-infection risk scores are developed which may be useful for future inpatient surges. Disclosures Yi Guo, PharmD, BCIDP, Merck: Grant/Research Support Kelsie Cowman, MPH, Merck: Grant/Research Support.

Background Antibiograms are important stewardship tools for empiric antibiotic prescribing. Appropriate therapy is particularly important in patients with hematologic malignancies and bone marrow transplants being treated for febrile neutropenia. These patients are at high risk for multi-drug resistance based on extensive prior antibiotic and hospital exposures, and therefore, hospital-wide antibiograms may not reliably reflect resistance patterns for this population. We created a unit-specific antibiogram for a closed hematology/oncology unit and hypothesized there would be decreased antibiotic susceptibilities compared to the hospital-wide antibiogram. Methods All positive cultures with antimicrobial susceptibilities on a closed 32-bed hematology-oncology unit from 7/2016-6/2019 were obtained from the microbiology laboratory. Based on recommendations by the Clinical and Laboratory Standards Institute (CLSI), only organisms with > 30 isolates were included in antibiogram analysis. Susceptibilities were compared to those reported in our hospital-wide antibiograms from the same time period using Fisher’s exact test. Results Two organisms met CLSI criteria: Escherichia coli (n=83) and Klebsiella pneumoniae (n=31). Unit Escherichia coli isolates were significantly more resistant to almost all commonly tested antibiotics (Table 1). Klebsiella pneumoniae unit susceptibilities were significantly lower for many antibiotics, including aztreonam, ceftriaxone, cefepime, levofloxacin, piperacillin-tazobactam and tobramycin (Table 1). Table 1: Percentage of Escherichia coli and Klebsiella pneumoniae isolates susceptible to reported antibiotic agents Conclusion Our hematology-oncology antibiogram showed significantly lower antibiotic susceptibilities in Escherichia Coli and Klebsiella pneumoniae compared with the hospital-wide antibiogram. These findings can help guide prescribers toward appropriate broad-spectrum empiric therapy. Additionally, results suggest a need for intensified stewardship measures to prevent multi-drug resistance in this population. Disclosures All Authors: No reported disclosures

We engaged medical students with antimicrobial stewardship (AS) and resistance (AMR) through patient stories and a panel on AMR advocacy with experts from the Centers for Disease Control and Prevention and the Infectious Diseases Society of America. Students were surveyed on their perceptions about AS and AMR (response rate=139/166, 84%).

Burnout is pervasive in academic medicine. We administered the Maslach Burnout Inventory and an Infectious Diseases (ID) job description survey to our ID faculty. Respondents’ burnout (>50%) and job satisfaction (>90%) were each high. Although burnout may be balanced by job satisfaction, the relationship between the 2 deserves further study.

Background Developing robust, multidisciplinary antimicrobial stewardship programs to combat drug resistance is a priority of healthcare institutions, in accordance with Joint Commission standards and national legislature. However, the involvement of nurses in stewardship programs has trailed behind that of physicians and pharmacists, despite their unique position as frontline providers. In particular, oncology nursing staff can play a key role in extending stewardship to their high acuity patients, who frequently require antimicrobials. We sought to conduct a survey study of oncology nursing providers on their understanding, perceptions, and attitudes about antimicrobial stewardship. Methods A voluntary and anonymous survey was emailed to oncology nursing staff on adult and pediatric oncology wards and clinics throughout our hospital system. We used an adapted 28-item Likert scale-based survey to assess understanding of antimicrobial stewardship attitudes and perceived barriers to greater involvement in stewardship programs. A survey reminder was emailed weekly for 8 weeks and completion was encouraged by nursing leadership in unit staff meetings. Results The survey was emailed to 281 nurses, of whom 39% (n=109) responded. 54.1% of nurses believed that an antibiotic stewardship program was very important in their healthcare setting. However, 56% of respondents were unfamiliar with the meaning of antibiotic stewardship, and 83.5% were not aware of how to contact the antimicrobial stewardship team with questions. More than 75% felt that nurses could help with antibiotic use, though 76% indicated wanting to know more about which antibiotics treat different infections and 74% wanted to know more about appropriate durations of antibiotics. Conclusion Oncology nurses have the potential to play a valuable role in antimicrobial stewardship. Barriers to nursing involvement include knowledge gaps on antibiotics and unfamiliarity with existing stewardship programs and their functions within hospital systems. Nursing education and orientation to available resources are key steps to involving nursing staff in antimicrobial stewardship programs, maximizing benefits for both patients and hospitals. Disclosures All Authors: No reported disclosures

Background Inappropriate IV vancomycin prescribing for febrile neutropenia (FN) is an excellent stewardship target given well-established guidelines specifying indications for its use. As a supplement to an educational initiative with institutional FN guidelines, we conducted methicillin-resistant Staphylococcus aureus (MRSA) colonization screening to estimate its prevalence on our hematology/oncology unit. We hypothesize that MRSA prevalence data can augment existing stewardship efforts to improve IV vancomycin use in FN. Methods (1) Pre-intervention: we conducted a retrospective chart review of vancomycin receipt for FN on a 32-bed Hematology/Oncology unit, November 2015–May 2016 (control group). (2) Intervention: in January 2017, we implemented an institutional FN guideline with recurring education to hematology/oncology providers emphasizing criteria for appropriate vancomycin initiation. Vancomycin audit was again conducted from February 2017–October 2017 (intervention group). The primary outcome was appropriateness of vancomycin use per guideline indications (chi-squared analysis). Use was considered inappropriate if no guideline indications were met. (3) MRSA screening: cultures were obtained from the nares, axilla and groin on admission and bimonthly for 6 weeks and plated on CHROMagar. Screened patients were followed for 5 months for the occurrence of clinical MRSA infection. Results Forty-three of 88 controls were started on vancomycin appropriately vs. 60 of 91 intervention group patients (49% vs. 66%, P = 0.02). Results of MRSA screening and follow-up for invasive infection are shown in Table 1. Conclusion Recurring, guideline-focused education can improve appropriateness of vancomycin for FN. High NPV in our study supports the hypothesis that MRSA screening can augment stewardship efforts to reduce vancomycin use when not indicated. Disclosures All authors: No reported disclosures.

Background A national assessment of antibiotic appropriateness in intensive care units (ICUs) with benchmarking was performed to assist antibiotic stewardship programs (ASPs) identify improvement opportunities. Methods A Centers for Disease Control and Prevention tool was adapted by an expert panel from the Partnership for Quality Care (PQC), a coalition dedicated to high quality care in US hospitals, to validate appropriate antibiotic use measurement via a point prevalence survey on a single day. Data were collected by ASP personnel at each hospital, de-identified and submitted in aggregate to PQC for benchmarking. Hospitals identified reasons for inappropriate antibiotic use by category and antibiotics misused. Results Forty-seven ICUs from 12 PQC hospitals participated: California (2), Florida (2), Massachusetts (3), Minnesota (1), and New York (4). Most hospitals identified as teaching (83%) with 252-1550 bed size (median: 563) and 20–270 licensed ICU beds (median: 70). All hospitals reported a formal ASP. On March 1, 2017, 362 (54%) of 667 patients in participating ICUs were on antibiotics (range: 8-81 patients); 1 patient was not assessed. Of the remaining 361 antibiotic regimens, 112 (31%) were identified as inappropriate from among all 12 hospitals (range: 9-82%) (figure). The table displays inappropriate antibiotic use by ICU type. Reasons for inappropriate use included unnecessarily broad spectrum of activity (29%), duration longer than necessary (21%), and treatment of a non-infectious syndrome (19%). The antibiotic most commonly misused was vancomycin in 7 (58%) hospitals. Conclusion Up to 80% of antibiotic use in some ICUs is inappropriate, underscoring the need for ASP interventions, standardized assessment tools and benchmarking. Strategies should focus on de-escalation of broad-spectrum antibiotics and reducing duration of therapy. Disclosures D. W. Kubiak, Shionogi: Consultant, Consulting fee. Astellas Pharma: Consultant, Consulting fee