O’Horo, John C.

Abstract Babesiosis is an emerging health risk, and clinicians need to be aware of its different clinical manifestations. In our cohort of 38 patients, almost half did not recall a tick bite, and diagnosis was delayed due to the nonspecific nature of symptoms. Sixty-eight percent of patients required hospitalization, with 21% requiring intensive care unit stay. Coinfection with Lyme, anaplasma, or both Lyme and anaplasma was seen in 24%, 5%, and 8% of the patients, respectively. None of the patients in our cohort died from their disease.

Abstract Background Limited data exist to evaluate safety-related outcomes in Outpatient Parenteral Antimicrobial Therapy (OPAT) patients treated with antimicrobial agents for Gram-positive infections. Methods This retrospective, single-center study enrolled Mayo Clinic OPAT patients between 2013 and 2017. The primary objective of the study compared rates of therapy modification due to drug-related toxicity for staphylococcal infections treated with ceftriaxone, cefazolin, nafcillin, oxacillin, vancomycin, daptomycin, ceftaroline, linezolid, or ertapenem. Secondary objectives included determination of the frequency and type of adverse drug events (ADEs) attributed to OPAT and rate of readmission due to ADEs attributed to OPAT. Results One hundred seventy-two patients were identified (cefazolin n = 54, ceftriaxone n = 49, vancomycin n = 30, daptomycin n = 16, nafcillin n = 9, ertapenem n = 6, ceftaroline n = 4, oxacillin n = 3, linezolid n = 1). The overall treatment completion rates were high (153/172, 89.0%). Patients completed an average of 35.3 days (7 to 95) of therapy with their original antibiotic. Fourteen patients required change to a different antibiotic due to antimicrobial toxicity (ceftriaxone=5; vancomycin=2; cefazolin = 2; daptomycin = 2; ceftaroline = 1; nafcillin = 1; oxacillin = 1) and five patients experienced treatment failure required an additional agent (ceftriaxone = 2; nafcillin = 2; linezolid = 1). Adverse drug events (ADEs) were the most common reason for antimicrobial adjustment (14/19, 73.7%). The most common ADEs were hypokalemia (28/172, 16.3%) and diarrhea (25/172, 14.5%). There were only two cases of Clostridium difficile. Thirty-day readmissions due to antimicrobial therapy were low with 11 patients. Conclusion OPAT with Gram-positive agents used for staphylococcal infections is effective, but antimicrobial modifications still occur. Clinicians should be aware of the risk of ADEs and readmissions in OPAT patients. A multidisciplinary approach may enhance management of ADEs and possibly preventing readmissions Disclosures All authors: No reported disclosures.

Abstract Background Patients dismissed from the hospital on oral or intravenous antibiotics frequently need follow-up appointments with the Division of Infectious Diseases (ID). Follow-up appointments may be inappropriately scheduled with respect to timing and indication. Suboptimal transitions of care may lead to increased no-shows and ultimately poor patient outcomes. Methods The baseline sample included 102 patients seen by the inpatient ID services at Mayo Clinic’s Rochester Methodist and Saint Mary’s Hospitals between January 1, 2017 and June 30, 2017. Defects in transitions of care were categorized as those pertaining to sign-off templates, sign-off labels, follow-up priority, and timing. The current transfer of care system from our institution is outlined in Figure 1. Results Out of 102 patients, 75 (74%) had at least one defect identified. Root cause analysis revealed multiple factors contributing to this performance gap (Figure 2). Patients often have variable health literacy and social or financial difficulties. There are often multiple ID providers with inadequate time to properly orchestrate follow-up. There are undefined checkpoints and triaging in the department’s scheduling policies. Interventions involved reformatting the ID sign-off template and clarifying the roles of providers in the transitions-of-care process. Analysis after 6 months of implementation revealed improvement of communication among teams, decline in improper sign off by 13% and decrease in antibiotic prescription errors by 2%. Conclusion This study demonstrates that well-designed sign-off templates can help with effective communication of the final treatment plan among providers and possibly improve patient outcomes. The target goal is to reduce the number of improper sign-offs by 50% within 1 year. Disclosures All authors: No reported disclosures.