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BackgroundThere is limited literature evaluating the effect of antibiotic stewardship programmes (ASPs) in hospitalized geriatric patients, who are at higher risk for readmissions, developing Clostridioides difficile infection (CDI) or other adverse outcomes secondary to antibiotic treatments.MethodsIn this cohort study we compare the rates of 30 day hospital readmissions because of reinfection or development of CDI in patients 65 years and older who received ASP interventions between January and June 2017. We also assessed their mortality rates and length of stay. Patients were included if they received antibiotics for pneumonia, urinary tract infection, acute bacterial skin and skin structure infection or complicated intra-abdominal infection. The ASP team reviewed patients on antibiotics daily. ASP interventions included de-escalation of empirical or definitive therapy, change in duration of therapy or discontinuation of therapy. Treatment failure was defined as readmission because of reinfection or a new infection. A control group of patients 65 years and older who received antibiotics between January and June 2015 (pre-ASP) was analysed for comparison.ResultsWe demonstrated that the 30 day hospital readmission rate for all infection types decreased during the ASP intervention period from 24.9% to 9.3%, P ConclusionsRigorous de-escalation and curtailing of antibiotic therapies were beneficial and without risk for the hospitalized patients 65 years and over.

Background Antimicrobial Stewardship Programs (ASP) aim to ensure the appropriate use of antibiotics. There is limited literature evaluating ASP outcomes in hospitalized geriatric patients who are at higher risk for developing Clostridium difficile infection (CDI) or other adverse outcomes. The primary objective of this study was to determine if ASP efforts in this age group decreases the rate of 30-day hospital readmissions due to reinfection or development of CDI, hospital length of stay (LOS) and mortality. Methods A retrospective chart review was performed to compare the rates of 30-day hospital readmissions because of reinfection or development of CDI in patients 65 years and older who received ASP interventions between January and June 2017. A control group of patients 65 years and older who received antibiotics between January and June 2015 (pre-ASP) was analyzed for comparison. We also assessed their mortality rate and LOS. Patients were included if they received antibiotics for pneumonia (PNA), urinary tract infection (UTI), acute bacterial skin and skin structure infection (ABSSSI) and complicated intra-abdominal infection (cIAI). The ASP team consisted of an infectious diseases physician and a clinical pharmacist who met daily to review patients on broad spectrum antibiotics. ASP interventions consisted of de-escalation of empiric or definitive therapy, change in duration of therapy or discontinuation of therapy. Results Overall, 834 patients (540 control; 294 intervention) were included. The 30-day hospital readmission rate for all infection types decreased during the intervention period (19.6% vs 4.8%, P=0.0001). Both the development of CDI during hospital stay and 30-day readmission due to CDI during the intervention period decreased (2.6% vs 0.34%, P=0.019). There was no statistically significant decrease in 30-day hospital readmissions in the PNA (58.5% vs. 35.7%, P=0.11), UTI (18.9% vs. 35.7%, P=0.15), ABSSSI (12.3% vs. 21.4%, P=0.34) or cIAI (10.4% vs 7.1%, P=0.14) arms. There was no statically significant change in LOS (7.50 days vs 7.26 days, P=0.48) or mortality (9.6% vs 6.5%, P=0.12). Conclusion Multidisciplinary ASP efforts significantly reduced 30-day hospital readmission rates and development of CDI in hospitalized patients 65 years and older. Disclosures All Authors: No reported disclosures

Geosmin and C-8 hydrocarbons are among the major volatile organic compounds (VOC) responsible for the distinctive, musty odor of filamentous fungi. In this study, we developed a plant bioassay for testing the possible toxicity of these compounds, as well as four air freshener products sometimes used to mask their odor. Seeds and vegetative plants of Arabidopsis thaliana were exposed to 1 ppm of 14 different volatile treatments (both single compounds and mixtures) for 72 h and monitored for germination rate, seedling formation, vegetative plant vigor and chlorophyll concentration. All VOCs tested had some inhibitory effect on seed germination or seedling formation; 1-octen-3-one was the most active, giving almost complete inhibition of germination. Geosmin did not prevent germination (radicle protrusion) but seedling formation was arrested 90 %. Of solvents and fragrance products tested, only the scented oil product was as active as the C-8 biogenic compounds in inhibiting seed germination and seedling formation. Two-week-old plants exposed to 1 ppm of individual fungal VOCs for 72 h all exhibited some degree of stress symptoms including smaller leaf size and weight, discoloration, leaf curling, small necrotic lesions, and reduced chlorophyll concentration. Two-week-old vegetative plants exposed to solvents and air freshener products were generally smaller in size. The single most phytotoxic compound tested was 1-octen-3-one which almost completely inhibited seed germination and was lethal to vegetative phase plants. Formaldehyde at 1 ppm killed 2-week-old seedlings but had little effect on seed germination. In conclusion, the A. thaliana bioassay provides an inexpensive approach for testing the toxicity of gas phase molecules.

Background There is limited literature evaluating ASP outcomes in patients 65 years and older. The primary objective of this study was to show that ASP efforts to deescalate and/or discontinue antimicrobial therapy in older patients did not lead to an increased rate of 30-day hospital readmissions due to treatment failure. The secondary objective was to show a decrease in antimicrobial expenditure per adjusted patient day (APD). Methods A retrospective chart review was performed to compare the rates of 30-day readmissions of patients 65 years and older who received ASP interventions between January and June 2017 with a control sample who received antibiotics between January and June 2015 (pre-ASP). Patients were included if they received antibiotics for pneumonia (PNA), urinary tract infection (UTI), acute bacterial skin and skin structure infection (ABSSSI) and complicated intra-abdominal infection (cIAI). The ASP team met daily to review patients identified by the clinical pharmacist. ASP interventions consisted of de-escalation of empiric or definitive therapy, change in the duration of therapy or discontinuation of therapy. Treatment failure was defined as readmission due to re-infection or a new infection (e.g., Clostridium difficile). Results Overall, 461 patients (150 control; 311 intervention) were included. The 30-day readmission rate for all infections decreased during the intervention period (10.7% vs. 3.9%, P = 0.004). There was a statistically significant decrease in 30-day readmissions in the PNA subgroup (9.8% vs. 2.9%, P = 0.038), a marginally significant decrease among UTI patients (12.5% vs. 4.7%, P = 0.097), and no statistically significant change in the ABSSSI (5.6% vs. 8.6%, P = 0.694) and cIAI (20.8% vs. 6.7%, P = 0.233, CI) subgroups. The total APD was 16,267 (control) and 15,487 (intervention). Total antimicrobial expenditure during the control period was $379,643 ($23.33/APD) vs. $67,721 ($4.37/APD) during the intervention period. Conclusion ASP efforts did not lead to an increase rate of 30-day readmissions due to treatment failure. Furthermore, there was a statistically significant decrease in readmission rates in the intervention group as well as a large decrease in antimicrobial expenditure per APD. Disclosures All authors: No reported disclosures.

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