654. Clinical efficacy and safety of high dose Ampicillin sulbactam among patients with CRAB infections: A case series

Abstract Background CRAB continues to threaten the healthcare facilities in developing nations and is one among the commonest causes of hospital acquired infections in our hospital. In December 2021, the IDSA published the AMR guidance 2.0, that stated Ampicillin- sulbactam as the first choice for treating CRAB infections. We review the clinical outcomes with adherence to this guideline in our setting. Methods A descriptive study from India (January 2022 to April 2022), of in-patients who have received ampicillin sulbactam monotherapy or combination for CRAB infections. A standard treatment guideline for the identification and management of CRAB infections was introduced to the clinicians based on the AMR guidance 2.0 of IDSA. CRAB infections were classified as mild to severe based on clinical and radiological parameters. We collected the data on patients who were started on ampicillin sulbactam, given in a high dose (27g per day or renally adjusted) as a 4-hour infusion either alone or as combination with other antibiotics for the indication of CRAB infections. Results Ampicillin-Sulbactam was started for 12 patients with CRAB infection. 2 of these patients were discharged while on treatment and hence, excluded. 6 out of the 10 patients were being treated for CRAB associated hospital acquired pneumonia, whereas the other indications included urinary tract infection, post neurosurgical meningitis and skin and soft tissue infections. Susceptibility testing to Ampicillin-Sulbactum was not possible in our setting. All the patients survived from 14 days of starting the therapy and 9 out of 10 patients improved clinically (in terms of defervescence or symptomatic relief) by day 7. No adverse effects were noted either in clinical symptoms or Laboratory parameters during the course of treatment. Conclusion High dose Ampicillin-Sulbactum is effective and safe for CRAB infections with varying clinical syndromes and severity. All patients in this case series were treated with Colistin sparing regimens when combination therapy was required. Disclosures All Authors: No reported disclosures.