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Background There is variability in the duration of peri-operative antibiotic prophylaxis for free flap reconstructions (FFRs) of the head and neck. Complications of FFRs such as surgical site infections (SSIs), can be devastating and lead to vessel thrombosis and flap loss. Infection rates for head and neck free flap reconstructions have been reported to be as high as 20–50% of cases.1 Despite recommendations from ASHP, IDSA and CDC, postoperative antibiotics are often prolonged at the clinician’s discretion, with many clinicians administering &amp;gt;24 hours of prophylactic antibiotics in cases of FFRs. Methods The departments of infectious disease, otorhinolaryngology and antimicrobial stewardship, developed a pathway for perioperative antibiotics for adult patients undergoing FFRs. Patients with criteria that put them at high risk for SSIs post-operatively, were given up to 72 hours of antibiotics. Patients without these risk factors, were allowed a maximum of 24 hours of antibiotics post-operatively. Next, dissemination and education of the pathway occurred. Our group then collected post –intervention data on antibiotic duration of therapy, C. difficile infections and SSIs in these patients. We collected data over a 6 month period (10/1/2018 to 3/31/2019) for patients undergoing FFRs who received ampicillin/sulbactam (n=33) and compared it to our baseline/pre-intervention data. Perioperative Antibiotic Recommendations for Adult Facial Reconstructive Surgery Pathway Results The mean duration of ampicillin-sulbactam usage decreased from 6.82 days to 4.24 days (p=0.0039). The hospital acquired C.difficile rate decreased from 6.06% to 0% (p=0.4923). The rate of SSIs increased from 3.13% pre-intervention to 9.09%, but this did not reach statistical significance (p=0.6132). One patient in the pre- intervention group and one patient in the post intervention group required a return to the operating room due to SSIs. Conclusion In conclusion, through the development of a pathway for perioperative antibiotics for adult patients undergoing FFRs, the duration of postoperative antibiotic therapy decreased significantly. The rates of SSIs increased after the pathway was introduced, but this was not statistically significant. The rates of C.difficile infections decreased, but this did not reach statistical significance. Disclosures All Authors: No reported disclosures

open forum infectious diseases

41. Impact of the Development of a Perioperative Antibiotic Pathway on Antibiotic Duration of Therapy, <i>C.difficile</i> Infection Rates and Surgical Site Infection Rates in the Adult Facial Reconstruction Population

41. Impact of the Development of a Perioperative Antibiotic Pathway on Antibiotic Duration of Therapy, C.difficile Infection Rates and Surgical Site Infection Rates in the Adult Facial Reconstruction Population