P-838. The effect of transesophageal echocardiogram on clinical decision making for patients with Staphylococcus aureus blood stream infection

Abstract Background Staphylococcus aureus can lead to severe infections, including bloodstream infections, which are associated with high mortality. Infective endocarditis (IE) is a concerning complication of S. aureus bloodstream infections (SABSIs), which is ruled out by transesophageal echocardiogram (TEE). The COVID-19 pandemic led to a decrease in TEEs at the University of Mississippi Medical Center (UMMC) for patients with SABSIs. This study explores the impact of reduced TEE rates on clinical decisions for SABSI patients. Methods This retrospective observational study assessed adult SABSI patients at UMMC, categorizing them into pre-COVID (admitted between 3/1/2018-3/11/2020) and COVID (admitted between 3/12/2020-3/1/2022) groups. A VIRSTA score, indicating IE risk and advocating TEE for high-risk patients (score ≥3), was calculated for patients. Primary outcomes included the rate of confirmed IE and antibiotic duration in pre-COVID and COVID groups. Secondary outcomes included hospital stay, correlation between VIRSTA score and TEE, 90-day mortality, and 60-day re-admission. Results Among 214 patients, baseline characteristics were comparable between groups. The rate of confirmed IE (9.4% pre-COVID vs. 12.1% COVID; p = 0.66) and median antibiotic duration (28 days in both groups) showed no significant differences. However, mortality was more likely in the COVID group (22.2% vs 10.4%; p=0.019). Notably, high VIRSTA score patients were less likely to undergo TEE COVID (3.8% vs 18.5%; p = 0.008). There were no differences in other secondary outcomes. Conclusion This retrospective study highlights the impact of reduced transesophageal TEE utilization during the COVID-19 pandemic on clinical decision-making for patients with SABSIs, including challenges in risk stratification based on VIRSTA score. Despite a decrease in TEE, there were no differences in confirmed IE diagnosis or duration of antibiotics, but mortality was higher in the COVID-19 group. Based on this study there is an opportunity to provide education related to VIRSTA score utility for risk stratification, which may preserve healthcare resources in select patients. Disclosures All Authors: No reported disclosures