P-44. Trend of Palliative Care Consult Among Patients with Staphylococcus aureus Bacteremia at a Mid-west Referral Center Between 2016 and 2018

Abstract Background Staphylococcus aureus bacteremia (SAB) remains a leading cause of bloodstream infection in both community and healthcare settings, with reported mortality rates ranging from 10% to 30%. This study aimed to characterize the frequency, predictors, and clinical impact of palliative care consultation (PCC) in hospitalized patients with SAB.Figure 1.Distribution of Palliative Care Consults in hospitalized Staphylococcus aureus bacteremia patientsFigure 2.Distribution of Staphylococcus aureus bacteremia patients during hospitalization Methods We conducted a retrospective cohort study of adult and pediatric inpatients with SAB, defined by ≥1 positive blood culture for S. aureus, between January 1, 2016, and December 31, 2018. Baseline characteristics were compared between patients who did and did not receive PCC using chi-square, Fisher’s exact, and Wilcoxon rank-sum tests. Temporal trends, predictors of PCC, and associated outcomes were assessed using multivariable regression models. Survival was analyzed using Kaplan-Meier methods. Results Among 479 patients with SAB, 89 (18.6%) received PCC. Although PCC use increased over time, the trend was not statistically significant. Goals-of-care (GoC) discussions were the most common indication. Independent predictors of PCC included older age (adjusted odds ratio [aOR], 1.03 per year; 95% CI, 1.02–1.05; P< 0.001) and prolonged bacteremia (aOR, 1.10 per day; 95% CI, 1.00–1.21; P=0.042). Female sex (aOR, 0.54; 95% CI, 0.29–0.97; P=0.043) and musculoskeletal/soft tissue source of infection (aOR, 0.35; 95% CI, 0.14–0.83; P=0.021) were associated with lower odds of PCC. PCC was associated with shorter antibiotic duration (aOR, 0.58; 95% CI, 0.55–0.61; P< 0.001), increased GoC documentation (aOR, 1369.48; 95% CI, 257.29–25,917.74; P< 0.001), and higher rates of transition to comfort care (aOR, 42.40; 95% CI, 19.96–98.50; P< 0.001) and hospice (aOR, 164.34; 95% CI, 26.55–360.32; P< 0.001). Median time from consultation to discharge was 4 days (IQR, 1–10), and was shorter among those who died in-hospital (2 vs. 8 days; P< 0.0001). Conclusion PCC was infrequently utilized among patients with SAB but strongly associated with care transitions and antimicrobial stewardship outcomes. A substantial proportion of patients died without PCC involvement. These findings highlight the need for earlier integration of palliative care in the management of SAB to support patient-centered care. Disclosures Paul G. Auwaerter, MD, Capricor: Board Member|Capricor: Stocks/Bonds (Public Company)|Johnson and Johnson: Stocks/Bonds (Public Company)|Pfizer: Grant/Research Support|Shionogi: Advisor/Consultant