602. Intravenous Push Versus Intravenous Piggyback Administration of Cephalosporin Antibiotics: Impact on Safety, Workflow, and Cost

Abstract Background IV piggyback (IVPB) infusion has been the standard method of administration of IV antibiotics since the 1970s. Literature has demonstrated that the IV push (IVP) method has similar pharmacokinetic exposures and risk for complications as short infusion IVPB, and may have potential benefits. The primary objective is to evaluate the incidence of infusion-related complications in patients receiving cefazolin, ceftriaxone, and cefepime administered via IVP versus short infusion IVPB at the Veteran Affairs Long Beach Healthcare System. The secondary objectives include evaluating the time-to-onset of complications, time-to-first-dose combination vancomycin in the emergency department (ED), cost, and nursing and pharmacy staff preference between IVP and IVPB. Methods This is a retrospective, single-center cohort study. Patients who received ceftriaxone, cefepime, or cefazolin between April 1st, 2019 – December 31st, 2019, and April 1st, 2020 – December 31st, 2020 were included. Patients who received the study antibiotics via IVPB during the IVP period were excluded. Statistical analyses were performed using the chi-square, fisher’s exact, Mann-Whitney U, and unpaired t-tests where appropriate. Complications associated with IVP or IVPB administration were assessed via chart review of electronic health records. Surveys to nursing and pharmacy staff were distributed using Microsoft Forms. Results 366 treatment episodes were evaluated for 355 unique patients. Complications occurred in 13 out of 183 (7.1%) treatment episodes in the IVP group compared to 18 out of 183 (9.8%) treatment episodes in the IVPB group (P = 0.35). The median time to complications was 2 days for both groups. IVP cefepime and ceftriaxone reduced the median time-to-first-dose vancomycin in the ED by 25 minutes. The use of cefazolin, ceftriaxone, and cefepime as IVP yielded a quarterly cost savings of &38,890.04. 55% of nursing staff and 85% of pharmacy staff prefer IVP administration for cefazolin, ceftriaxone, and cefepime. Conclusion Cefazolin, ceftriaxone, and cefepime given as IVP were observed to be as safe as IVPB while reducing time-to-first dose vancomycin in the ED and cost, and is the preferred method of administration among nursing and pharmacy staff. Disclosures All Authors: No reported disclosures


The Effect of Medication-Assisted Treatment on Completion Rates of Outpatient Parenteral Antibiotic Therapy
Background. Injection drug use is a nationwide epidemic associated with an increased risk of invasive Staphylococcus aureus (S. aureus) infections. Medicationassisted treatment (MAT) is effective in reducing substance use and increasing adherence to inpatient medical therapy in persons with injection drug use (PWID). Studies assessing the impact MAT has on completion of outpatient parenteral antibiotic therapy (OPAT) are limited.
Methods. This was a single-center, retrospective, cohort study at The Ohio State University Wexner Medical Center in patients admitted from 12/1/2017 to 12/1/2019 with a diagnosis of S. aureus bacteremia who were identified as PWID either by ICD-9 or 10 code or chart review. A formal MAT program was established on 11/30/2018. Patients were assigned to the pre-MAT group if they were discharged prior to 11/30/2018 and to the MAT group with treatment after 11/30/2018. We evaluated a composite outcome of failure to complete OPAT, recurrence of S. aureus bacteremia during the OPAT period and readmission within 30 days. A multivariable logistic regression analysis was performed to examine the association between MAT therapy and the primary composite outcome, while adjusting for proven confounders.
Results. A total of 700 patients were identified with 644 patients omitted based on exclusion criteria. The study population included 27 in the Pre-MAT group and 17 in the MAT. Median age was 37 years (IQR 30.6 -46.1). There was a higher number of females in the MAT therapy group compared to the pre-MAT group (82% vs. 33%, p=0.002). Patients in the pre-MAT group had a significantly longer length of stay (25 days vs. 17 days, p=0.01). The primary composite outcome was met if a patient did not complete their OPAT, if they had a recurrence of S. aureus bacteremia during their OPAT or if they were readmitted to the hospital within 30 days. In the pre-MAT group 14/27 (52%) met the composite outcome versus 6/17 (35%) of the MAT group (p=0.28).

Conclusion.
Patients in the MAT group met the composite outcome 17% less than those in the pre-Mat group which is suggestive of the impact MAT has on completion of OPAT therapy; however, this study did not reach statistical significance as it was underpowered. Further longitudinal evaluation with greater sample size is needed to fully evaluate this intervention. Background. At our facility a collaborative team of nurse and pharmacist manage patients receiving outpatient parenteral antimicrobial therapy (OPAT). This project aims to characterize this collaboration and assess the effectiveness by reviewing interventions made by the nurse and pharmacist, and assessing patient outcomes such as OPAT or infection related hospital admissions or ED visits, infection clearance, and mortality.
Methods. A retrospective cohort study was performed on patients started on OPAT between 1/1/19 and 12/31/20. This time period was split into three: Period 1 where the clinic only included the PharmD and they saw patients for in-person appointments, Period 2 where the clinic included both the OPAT RN and PharmD and the PharmD performed in-person appointments, and Period 3 where the clinic included both but due to COVID the in-person PharmD appointments were on hold. OPAT or infection related hospital admissions, ED visits, infection clearance, and death were compared for each period.
Results. A total of 388 patients were included in the review. There were 158 (40.7%) and 148 (38.1%) OPAT-related phone calls from the PharmD and RN, respectively. The two most common reasons for both PharmD and RN phone calls were a medication stop order/confirmation, and weekly lab obtainment. The third most common reason for the PharmD was dose change, and for the RN it was patient education. During Periods 1 and 2 the PharmD had in-person appointments with 28.9% of patients. The overall OPAT/infection related hospital admission and ED visit rates were 7.7% and 5.4%, respectively. Periods 2 and 3, which utilized the combined efforts of RN and PharmD, had consistently lower hospital admissions related to OPAT/infection (46-50% vs 62% Period 1), and ED visits due to OPAT/infection (33-36% vs 47% for Period 1). Clearance of infection was high for all 3 periods (89-95%), and mean mortality was low (2.1%).
Conclusion. Collaborative management allowed for the nurse and pharmacist to function as substitutes for each other without losing the specific focus of their specialties, with the RN performing more patient education, and the PharmD performing more medication dosing. The collaboration had positive effects on OPAT patient outcomes.
Disclosures. Background. IV piggyback (IVPB) infusion has been the standard method of administration of IV antibiotics since the 1970s. Literature has demonstrated that the IV push (IVP) method has similar pharmacokinetic exposures and risk for complications as short infusion IVPB, and may have potential benefits. The primary objective is to evaluate the incidence of infusion-related complications in patients receiving cefazolin, ceftriaxone, and cefepime administered via IVP versus short infusion IVPB at the Veteran Affairs Long Beach Healthcare System. The secondary objectives include evaluating the time-to-onset of complications, time-to-first-dose combination vancomycin in the emergency department (ED), cost, and nursing and pharmacy staff preference between IVP and IVPB.
Methods. This is a retrospective, single-center cohort study. Patients who received ceftriaxone, cefepime, or cefazolin between April 1 st , 2019 -December 31 st , 2019, and April 1 st , 2020 -December 31 st , 2020 were included. Patients who received the study antibiotics via IVPB during the IVP period were excluded. Statistical analyses were performed using the chi-square, fisher's exact, Mann-Whitney U, and unpaired t-tests where appropriate. Complications associated with IVP or IVPB administration were assessed via chart review of electronic health records. Surveys to nursing and pharmacy staff were distributed using Microsoft Forms.
Results. 366 treatment episodes were evaluated for 355 unique patients. Complications occurred in 13 out of 183 (7.1%) treatment episodes in the IVP group compared to 18 out of 183 (9.8%) treatment episodes in the IVPB group (P = 0.35). The median time to complications was 2 days for both groups. IVP cefepime and ceftriaxone reduced the median time-to-first-dose vancomycin in the ED by 25 minutes. The use of cefazolin, ceftriaxone, and cefepime as IVP yielded a quarterly cost savings of $38,890.04. 55% of nursing staff and 85% of pharmacy staff prefer IVP administration for cefazolin, ceftriaxone, and cefepime.
Conclusion. Cefazolin, ceftriaxone, and cefepime given as IVP were observed to be as safe as IVPB while reducing time-to-first dose vancomycin in the ED and cost, and is the preferred method of administration among nursing and pharmacy staff.
Disclosures. All Authors: No reported disclosures Background. Confusion and controversy surround various aspects of Lyme Disease (LD) including diagnosis. Typically, the diagnosis of LD is based on tick exposure, clinical history, exam, and laboratory testing. Laboratory testing and interpretation can be confusing, difficult, and a source of misdiagnosis.

Misdiagnosis of Lyme Disease in Patients Referred to an Academic Lyme
Methods. One hundred and fifteen records of patients referred to the Integrated Lyme Program at University of Maryland for evaluation of LD were analyzed. All patients underwent initial evaluation by Infectious Disease (ID) physician who made a determination regarding Lyme diagnosis based on history, exam, epidemiologic risk factors and laboratory test results. Pt were determined to have one of the following diagnoses: 1) Acute LD 2) Past LD 3) Post Treatment Lyme Disease Syndrome (PTLDS) 4) Misdiagnosed LD. Data was also collected on reasons for misdiagnosis based on record review, referral information and patient reported information.
Results. We evaluated 115 patient records from our Lyme Program Registry. There were 78 female (68%) and 37 males (32%). The mean age was 46 years (range 19 to 83). Of the 115 records analyzed, there were 8 (7%) patients with acute Lyme disease; 38 (33%) patients with past Lyme disease , 3 (2.6%) patients with PTLDS and 93 (81%) of patients who were misdiagnosed with LD. Patients were misdiagnosed for multiple reasons and by different people. Twenty three percent (21/93) were misdiagnosed based on false positive IGM Western Blot; 16% (15/93) were misdiagnosed based on misread IGG Western Blot and 14% (13/93) were misdiagnosed based on unconventional Lyme test. The remainder were misdiagnosed based on symptoms. Forty two percent (39/93) were misdiagnosed by PCP; 4.3%(3/93) were misdiagnosed by Urgent/Emergent care physician and 31% (29/93) were misdiagnosed by physicians' self-referred as Lyme Literate Medical Doctor. The remainder were incorrectly self-diagnosed by patients based on symptoms.
Conclusion. Misdiagnosis of patients referred to Lyme Center is common and due to various reasons including misinterpretation of laboratory Lyme testing by healthcare providers and misinterpretation of symptoms by patients.
Disclosures. Background. The COVID-19 pandemic has led to changes in clinical practice, including a significant increase in the use of telehealth (TH). We sought to assess the impact of the pandemic on the use and perceptions of TH by pediatric infectious diseases (PID) clinicians. Methods. The PIDS* Telehealth Working Group developed a 26-question online survey to assess telehealth practices among PID clinicians. The survey was available via Survey Monkey® from 12/6/2020-2/26/2021 to members of PIDS, PICNIC*, AAMI and AAP*. Clinicians in active practice in North America were included in the analysis.