1124. Impact of a Best Practice Advisory for Pediatric Patients with Staphylococcus aureus Bloodstream Infection

BACKGROUND: Infectious diseases (ID) consultation and use of optimal antibiotic therapy have been shown to improve outcomes of patients with Staphylococcus aureus bloodstream infection (SA-BSI). We investigated the ability of an electronic medical record (EMR)-based best practice advisory (BPA) to enhance adherence to these practices for pediatric patients with SA-BSI. METHODS: An EMR-based BPA for SA-BSI (Figure 1) was implemented on 8/1/2017, recommending ID consultation and optimal therapy based on mecA gene rapid testing (vancomycin if mecA-positive; cefazolin or nafcillin if mecA-negative). We conducted a quasi-experimental pre/post study to evaluate impact of the BPA. Patients <21 years old admitted to C.S. Mott Children’s Hospital with SA-BSI during the pre- (1/2015 – 7/2017) and post-intervention (8/2017 – December 2018) periods were included. Demographic and clinical data were collected via chart review. Receipt of ID consult and optimal therapy before and after intervention were compared using interrupted time series (ITS) analysis with segmented regression. Time to optimal therapy was compared with segmented Cox regression. RESULTS: We included 99 SA-BSI episodes (70.7% pre-intervention and 29.3% post-intervention). Pre-intervention, 68.6% of patients received an ID consult compared with 93.1% post-intervention, but this was not significant with ITS analysis (Figure 2). The proportion of patients receiving optimal therapy did not significantly increase following the intervention, but time to optimal therapy significantly decreased (Figure 3). The median time to optimal therapy decreased from 26.1 hours to 5.5 hours. Cox regression showed both an immediate decrease in time to optimal therapy (HR 3.9, P = 0.009), followed by a continued decrease over time. CONCLUSION: Following implementation of a novel EMR-based intervention, ID consultation for SA-BSI increased, although this was not statistically significant due to a pre-existing trend of increasing ID consults over time. Implementation of the BPA was associated with a significant decrease in time to optimal therapy, likely due to a combination of increasing ID consultation and antibiotic guidance provided by the BPA. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures