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Background Staphylococcus aureus is a common pathogen that is implicated with both community and healthcare-associated infections. S. aureus infections lead to sepsis and bacteremia, and are associated with considerable morbidity and mortality despite available antimicrobial therapy. Methods Utilizing a clinical decision support system, patients with the presence of at least 1 positive blood culture for S. aureus were identified from April 2018 to March 2019, in 58 hospitals from a single health system. Patients were then matched in the outcomes measures database to obtain the following outcome measures: mortality, complications rate, length-of-stay (LOS), and cost. The S. aureus bacteremia (SAB) outcome measures were compared between community-onset (CO), and hospital-onset (HO). Results There were 2,700 SAB cases within the system identified during that time period. Baseline characteristics were similar between patients with CO-SAB and HO-SAB. CO-SAB accounted for 89.4% (2,413/2,700) of the overall cases, while 10.6% (287/2,700) of the cases were HO-SAB. For overall SAB, the observed mortality rate was 11.9% (321/2,700), complications rate was 35%, observed LOS was 11.97 days, and mean observed cost per admission was $29,114. There is a statistically significant higher observed absolute mortality rate (14.8%, 95% CI 9.61, 19.93), complications rate (53.3%), LOS (11.06 days), and cost per admission ($33,285) for HO-SAB, compared with CO-SAB. Conclusion HO-SAB is associated with more than twice the mortality, complication rate, LOS, and cost compared with CO-SAB. Structured efforts to reduce the risk for HO SAB and optimizing management of SAB are essential to improve patient outcomes. Disclosures All authors: No reported disclosures.

open forum infectious diseases

157. Hospital-Onset Staphylococcus aureus Bacteremia Is Associated with More Than Twice the Mortality Compared with Community-Onset: Evaluation of 58 Hospitals