P-858. Impact of Infectious Diseases Consultation on the Management of Staphylococcus Aureus Bacteremia in a Large, Predominately Rural, Health System

Abstract Background Staphylococcus Aureus Bacteremia(SAB) is associated with high morbidity and mortality. Infectious Diseases (ID)consultation has been associated with a decrease in mortality. The WVU Medicine Health System (WVUM) serves as a predominantly rural population and includes 24 hospitals (9 of which are critical access hospitals). Access to ID consultations is limited across the system and region. Methods We generated a list of patients with SAB who presented to WVUM hospitals between 6/1/22 to 5/30/2023. A subset of patient charts were selected for review. We manually reviewed patient records and recorded key information and assessed whether patients met IDSA guidelines criteria for complicated versus uncomplicated SAB. Results Please see Table 1 Table 1.Management of SAB for Patients With and Without ID ConsultationVariablePatients with ID Consult (143)Patients without ID Consult (93)P-valueDiagnostic ImagingMRI C-spine: 27/143 (19%)MRI C-spine: 2/93 (2%)< 0.001MRI T-spine: 32/143 (22%)MRI T-spine: 4/93 (4%)< 0.001MRI LS spine: 41/143 (29%)MRI LS spine: 3/93 (3%)< 0.001TTE: 129/143 (90%)TTE: 38/93 (41%)< 0.001TEE: 62/143 (43%)TEE: 3/93 (3%)< 0.001Metastatic Infection48/143 (34%)5/93 (5%)< 0.001Complicated139/143 (97%)93/93 (100%)0.1557Antibiotic duration< 2 weeks: 0/143 (0%)< 2 weeks: 52/93 (56%)< 0.0012 weeks 10/143 (7%)2 weeks 16/93 (17%)0.0254 weeks 24/143 (17%)4 weeks 2/93 (2%)< 0.0016 weeks 95/143 (66%)6 weeks 10/93 (11%)< 0.001Died within 72 hours of presentation0/143 (0%)16/93 (17%)< 0.00130 Day re-admission*30/143 (21%)26/77 (34%)0.30130-Day mortality*10/143 (7%)11/77 (14%)< 0.001*Excluding people who died within 72 hours of presentation Conclusion We found major differences in the work up of SAB and in clinical outcomes for patients receiving ID consultation and those who did not. Patients who received ID consultation were more likely to receive guidelines compliant evaluation and treatment, and were less likely to be re-admitted and die. When patients who died within 72 hours of presentation were excluded from analysis , patients without ID consults were still significantly more likely to die. These data will inform efforts to expand access to ID consultation for patients with SAB across our health system. Disclosures All Authors: No reported disclosures