342. Time to Antimicrobial De-escalation/Discontinuation After Implementation of Cerebrospinal Fluid Polymerase Chain Reaction Tool

BACKGROUND: Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) technology can be used as a rapid diagnostic tool that has the potential to more rapidly facilitate targeted antimicrobial therapy and reduce overall time to de-escalation and/or discontinuation of inappropriate antimicrobial usage in patients with suspected meningitis/encephalitis. METHODS: This was a single-center, retrospective cohort analysis with a primary objective focusing on time to de-escalation or discontinuation of inappropriate antimicrobials before and after implementation of a rapid diagnostic meningitis/encephalitis (ME) panel (BioFire FilmArray®). The pre-implementation group, containing 84 patients, examined individuals who had CSF cultures performed in the 6-months prior to implementation. The post-implementation group, containing 88 patients, examined individuals who had an ME panel done in the 6 months following a transitionary 1-month period following implementation. Categorical data analysis was performed using χ(2) or Fisher’s exact test and continuous data was analyzed using the Mann–Whitney U test. RESULTS: Time to de-escalation/discontinuation of inappropriate ampicillin reported in median hours (IQR) was 47.5 (55) for pre-PCR group compared with 39.5 (23.5) in post-PCR group (P = 0.004). Time to de-escalation/discontinuation of Cefotaxime for pre-PCR group was 50.5 (42) compared with 45 (10) for post-PCR (P = 0.027). Using a subgroup analysis based on age, the results for ampicillin and cefotaxime were mirrored in the pediatric population; however, results were insignificant in the adult population. Subgroup analysis of the adult population showed significance in terms of de-escalation/discontinuation of acyclovir reported (in median hours) as 49 (68) in pre-PCR and 19 (18) in post-PCR group (P = 0.002). CONCLUSION: Time to de-escalation and/or discontinuation of ampicillin and cefotaxime was significantly reduced after implementation of the ME panel suggesting clinical significance in high-risk populations such as neonates. Time to de-escalation and/or discontinuation of acyclovir was significantly reduced in the adult population. DISCLOSURES: All authors: No reported disclosures.