249. Frequency of Antimicrobial Complications Following Initiation of Palliative Chemotherapy in Advanced Cancer Patients

BACKGROUND: Evaluating antimicrobial complications in advanced cancer patients on palliative chemotherapy may guide clinical care and stewardship efforts. METHODS: We identified advanced cancer patients aged ≥65 years started on palliative chemotherapy from January 2016 to September 2017 at Yale New Haven Hospital. Complications with and without antimicrobials were assessed during first hospitalizations until death or March 2018. We compared differences with χ(2) tests. RESULTS: Of 2,680 patients started on palliative chemotherapy, 1181 had ≥1 hospitalization. Median age was 74 years (range 65–98), and 856 (72%) had solid tumors. Median time to hospitalization from starting palliative chemotherapy was 77 days (range 1–580) and length of stay was 4 days (range 1–50). During first hospitalization, 158 (13%) died or were discharged to hospice. Overall, 493 (42%) died. Palliative chemotherapy often included FOLFIRINOX (n = 257), FOLFOX (n = 239), or pembrolizumab (n = 210). During first hospitalizations, patients given antimicrobials more likely incurred nephrotoxicity, hepatotoxicity, or C. difficile infection within 7 days of use than patients not given antimicrobials (Table 1). CONCLUSION: Antimicrobial complications are common in advanced cancer patients on palliative chemotherapy. Increased stewardship and alignment of infection treatment with goals of care are needed. DISCLOSURES: M. Juthani-Mehta, Iterum Therapeutics: Scientific Advisor, Consulting fee