2734. Evaluation of Empiric Antimicrobial Therapy for End-Stage Liver Disease Patients at an Academic Medical Center

BACKGROUND: Patients with end-stage liver disease (ESLD) are prone to decompensation secondary to infections, with an increasing prevalence of multidrug-resistant organisms (MDROs). These patients often receive broad-spectrum antimicrobials prior to transplant, pre-disposing them to resistant pathogens. Our study assessed institutional guideline adherence, antimicrobial prescribing, and the incidence of MDROs in this population. METHODS: This IRB-approved, retrospective chart review included pre-transplant inpatients with ESLD on the adult liver transplant service who received antimicrobials between 1/1/20 and 10/30/20. Patients were excluded if they started antimicrobials post-transplant or transferred from another institution on parenteral antimicrobials. Per institutional guidelines for empiric antimicrobials in suspected infection in ESLD, patients were categorized into three infectious risk categories: Floor/Non-High-Risk (F-NHR), Floor/High-Risk (F-HR), and ICU or MELD greater than 35 (ICU/M35). Antimicrobial prescribing in each group was evaluated for guideline adherence and microbiology data. Results were analyzed using descriptive statistics. RESULTS: We included 92 patients: 28 F-NHR, 50 F-HR, and 14 ICU/M35. Table 1 summarizes baseline characteristics. The frequency of guideline adherence for the F-NHR, F-HR, ICU/M35 groups, respectively, was 11 (39%), 4 (8%), and 4 (29%) patients. For the F-NHR group, ceftriaxone (CRO) was most prescribed (n=17, 61%). For the F-HR group, 18 (36%) received CRO; 16 (32%) received vancomycin and piperacillin-tazobactam. In the ICU/M35 group, 13 patients (93%) received meropenem plus linezolid, and 11 (79%) also received caspofungin. No methicillin-resistant Staphylococcus aureus or carbapenem-resistant Enterobacterales were isolated. Two patients (14%) in the ICU/M35 group experienced C. difficile infection within 30 days of antimicrobial initiation. [Figure: see text] CONCLUSION: Our study showcases opportunities to optimize internal ESLD antimicrobial protocols and curtail unnecessary antimicrobial exposure. Study limitations include a small cohort at a single center. Future directions include data dissemination and protocol updates. DISCLOSURES: David Quan, PharmD, Mallinckrodt Pharmaceuticals: Advisor/Consultant Sarah B. Doernberg, MD, MAS, Basilea: Clinical events committee/adjudication committee participation|F2G: Grant/Research Support|Genentech: Advisor/Consultant|Gilead: Grant/Research Support|Janssen/J+J: Advisor/Consultant|Pfizer: Grant/Research Support|Regeneron: Grant/Research Support|Shinogi: Clinical events committee/adjudication committee participation