P-819. You get a nudge, and you get a nudge! The impact of a microbiology comment on the treatment of Streptococcus pneumoniae bloodstream infections

Abstract Background Bloodstream infection (BSI) occurs in 25-30% of pneumococcal disease. For nonmeningeal S. pneumoniae infections, ampicillin or penicillin demonstrate 97% susceptibility on local antibiograms but are not commonly prescribed. The study purpose was to assess the impact of a microbiology nudge comment on narrow-spectrum antibiotic use in patients with S. pneumoniae BSI.Variables associated with de-escalation to narrow-spectrum at 48-hrs in patients with Streptococcus pneumoniae BSI. Methods This was an IRB-approved, single pre-, post-test, quasi-experiment conducted at a five-hospital health system from 10/1/2022 to 9/26/2023 (pre-nudge) and 0/1/2023 to 9/26/2024 (post-nudge). On 9/27/2023, a microbiology nudge was appended to rapid blood polymerase chain reaction (PCR) results: "Drugs of choice = Ampicillin IV or Penicillin IV. For meningitis, use max dose Ceftriaxone IV plus Vancomycin IV until susceptibilities known". Inclusion: hospitalized adults >18 years with confirmed S. pneumoniae BSI. Exclusion: IgE-mediated or severe cutaneous β-lactam allergy, polymicrobial infection, comfort/hospice care, death