405. Trend in blood culture results in Washington DC during and prior to Pandemic COVID-19

Abstract Background The rate of bacterial and/or fungal infections among COVID-19 cases is reportedly low. Antimicrobial Stewardship Programs (ASPs) provide continuous surveillance of blood cultures to secure appropriate choice and duration of therapy. Comparing to historic data, we characterize our ASP experience in bacteremic surveillance during the COVID-19 pandemic. Methods Consecutive blood cultures at the Washington DC VA Medical Center were captured in an ASP-driven decision support software system (TheraDoc, Premier/DSS Inc) between Jan 1st 2018-May 31st 2020. In the setting of an established ASP, the organism positive cultures were reviewed over the first five months (Jan-May) of each of the three years collected. Results of cultures were characterized as either pathogenic gram positive (MSSA/MRSA/Enterococci/PSSP/PRSP/Strep sp.), pathogenic aerobic and anaerobic gram negative organisms and a skin contaminant-category (GPRs/skin flora/CNS). Results Over 3 yrs, 528 patients had 1464 positive cultures from among 8727 admissions, 83638 inpatient-days. The proportion of pathogenic GP bacteria and pathogenic GN bacteria were not statistically significantly different 38% (2018) vs 37% (2019) vs 39% (2020) and 33%, 31%, 27% respectively. There was slight trend in the increase of pathogenic GP 9.6 vs 9.5 vs 11.7 per 1,000 inpatient days and skin contaminant-category with 12.0 vs 11.0 vs. 14.1 per 1,000 patient days from 2019 to 2020. We noted a dramatic shift in culture surveillance report during the peak COVID-infection rates (March-April), notable for several weeks of few to no culture positive results. When broken down by month, variability was noted (data not shown). COVID-19 infected patients represented 9.0% (7/78) of positive blood culture results in 2020 Jan-May, only 5.1% (4/78) were treated as non-contaminants and were related to indwelling catheters or urosepsis. Conclusion Overall and adjusted rates of the blood cultures sent during the pandemic months in 2020 were comparable to the comparative years. Surveillance revealed short term changes in patterns which may have reflected the pandemic induced changes to admissions. COVID-19 infected patients rarely experienced line and hospital acquired bactermia/fungemia, most during the recovery period. Disclosures All Authors: No reported disclosures