bluuebunny/crossref_metadata_2025 huggingface dataset:
908. Impact of Antimicrobial Stewardship Protocol Mandating Infectious Diseases Consultation Post 72 Hours of Meropenem Usage
Authors: Nguyen Nhi , Britt Rachel S , Reynoso David , Ferren Scott
Published: December 2022

Background

Carbapenem use correlates with the development of carbapenem-resistant organisms, prompting our antimicrobial stewardship program (ASP) to develop a policy mandating infectious diseases (ID) consultation after 72 hours of meropenem use. Our objective was to evaluate the impact of this policy on meropenem utilization and associated clinical outcomes.

Methods

This quasi-experimental, observational study evaluated the impact of the new ASP policy in adult patients across four campuses. Administered meropenem orders were retrieved retrospectively six months before (11/2020-4/2021) and after (6/2021-11/2021) policy implementation. The primary outcome was meropenem days of therapy per 1000 patient-days (DOTs). Secondary outcomes included DOTs of select broad-spectrum antimicrobials, 30-day all-cause mortality, hospital length of stay (LOS), and Clostridioides difficile (C. difficile) infection incidence. All outcomes were assessed in pre- and post-intervention periods.

Results

There were 1493 and 1404 meropenem orders in the pre- and post-intervention periods, respectively. Pre-intervention group patients had slightly higher modified Charlson Comorbidity Index scores (2.1 vs 1.9, p=0.02). Pre-intervention group had more patients with penicillin allergies but less patients with sulfa allergies (p=0.007 and p=0.03, respectively). The most common meropenem indications were bloodstream, respiratory, abdominal, and urinary tract infections. The incidence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales and cefepime-resistant Pseudomonas spp. was similar in both groups (p=0.7 and p=0.1, respectively). ID consultation increased after policy implementation (44.1% vs 51.7%, p=0.001). Meropenem DOTs decreased significantly after intervention (50.3 vs 35.5, p=0.0003). We observed increases in ceftriaxone and cefepime DOTs (94 vs 103.8, p=0.006 and 39 vs 58.5, p=0.0005, respectively). An increase in C. difficile incidence was seen. Hospital LOS was similar pre- and post-intervention (mean 18.5 days, p=0.9).

Conclusion

The ASP policy mandating ID consultation after 72 hours of meropenem use helped decrease meropenem DOT and encouraged use of antimicrobial agents with narrower spectrum.

Disclosures

All Authors: No reported disclosures.
911. Impact of Intensified Clindamycin Stewardship Initiatives in Three Phases: A Quasi-Experimental Study
Authors: Gamble Kelly C , Rose Dusten T T , Mondy Kristin , Thyagarajan Rama , Jaso Theresa , Coats Leslie , Reveles Kelly R
Published: December 2022

Background

Clindamycin utilization has provoked gram-positive and anaerobic bacterial resistance and is associated with Clostridioides difficile infections (CDI). The purpose of this study was to evaluate if implementing local clindamycin-focused stewardship initiatives impacts clindamycin utilization and outcome metrics.

Methods

This multicenter, retrospective quasi-experimental study was conducted in adult hospitalized patients who received clindamycin from 2018 to 2020. Outcomes were compared in three phases between an intervention and control group (Figure 1). The primary outcome was inappropriate utilization: a resistant pathogen, concurrent antibiotic(s) with pathogen activity, a non-necrotizing infection, an alternative agent was preferred, or alternative reasons per expert discretion. Secondary outcomes included clindamycin duration of therapy per 1000 patient hospital days (DOT/1000 PD), 30-day CDI, 30-day readmission, and in-hospital mortality. Outcomes were compared between groups using the chi-square, Fisher’s exact, or Kruskal-Wallis tests as appropriate. Figure 1.Study DesignID: infectious diseases, I: intervention group, C: control group

Results

The study included 481 patients (Table 1). Inappropriate clindamycin use in the intervention group was highest in Phase 1 (94%), then decreased in Phase 2 (72%) and Phase 3 (74%) (p< 0.01). Comparing Phase 1, Phase 2, and Phase 3 between the intervention and control groups, respectively, the primary outcome occurred in 94% vs 93% (p=0.80), 72% vs 88% (p=0.02), and 74% vs 89% (p=0.03). The DOT/1000 PD was 10 in Phase 1, 9.2 in Phase 2, and 6.2 in Phase 3. Initiatives were not associated with significant reductions in 30-day CDI (1% in Phase 1, 0% in Phase 2, 0% in Phase 3, p=0.64), 30-day readmission (18% in Phase 1, 31% in Phase 2, 22% in Phase 3, p=0.13), or in-hospital mortality (0% in Phase 1, 2% in Phase 2, 0% in Phase 3, p=0.33). Table 1.OutcomesI: intervention group, C: control group, DOT/1000 PD: days of therapy per 1000 patient days, CDI: Clostridioides difficile infection

Conclusion

Clindamycin-focused stewardship initiatives reduced inappropriate prescribing patterns by approximately 20% but still remained high in Phase 3. Clindamycin was primarily ordered in the emergency department (ED). Additional initiatives may include formal criteria for use and removing clindamycin from automated dispensing cabinets in the ED. Our initiatives may serve as a model for other institutions to reduce clindamycin utilization and its associated complications.

Disclosures

All Authors: No reported disclosures.
914. Implementation and User Experience with a Mobile Stewardship App: Phase One of a Study on Guideline Concordant Prescribing
Authors: Thumann Alexis , Wankum Michael , Gens Krista
Published: December 2022

Background

The development of facility-specific antibiotic guides to promote the appropriate use of antibiotics is strongly encouraged; however, the inability to access these resources quickly and easily can be a barrier to optimal antimicrobial prescribing. This study phase aims to determine whether providing guidelines in an easy-to-use mobile app increases access to and awareness of these resources available to providers.

Methods

In phase one of this study, our team: migrated facility guidelines over to the Sanford Guide Stewardship AssistTM application, provided education, launched the app (March 14, 2022), and sent out a voluntary pre- and one-month post-implementation REDcap provider survey. Phase two of this study will evaluate antibiotic prescribing for limited indications pre-post app implementation and will include a six-month follow-up survey to assess continued trends in guideline awareness and accessibility. The primary endpoint for phase one is to evaluate the usefulness and effect of the app on provider guideline awareness.

Results

As of May 3, 2022, 409 downloads of the app occurred since launch, with the facility-specific antibiogram being the most viewed page. Thirty-five participants completed the pre-implementation survey, and twenty-three completed the one-month follow-up survey. Respondents included medicine residents (54.3%), hospitalists (17.1%), primary care (11.4%), infectious disease (8.6%), internal medicine (5.7%), and others (2.9%). Statistically significant increases pre-post app implementation for strongly agree/agree responses were seen for the statements, “I feel confident in using an antibiogram” (71.4% vs. 95.7%, p=0.02) and “I can easily access our facility-specific antibiotic guidelines when needed” (68.6% vs. 95.7%, p=0.01). At one month, 73.9% and 91.3% of providers agreed with the statements “I would consider myself a better steward of antibiotics because of the app implementation” and “The app is useful to my practice,” respectively.

Pre-implementation Survey Responses

One-month Post-survey Responses: General

One-month Post-survey Responses: App-specific

Conclusion

Implementing an antimicrobial stewardship app at a large, non-academic health system promoted accessibility to facility-specific guidelines, reinforced antimicrobial stewardship ideals, and was a valuable resource for prescribers.

Disclosures

All Authors: No reported disclosures.
929. A Nationwide Survey on the Role of Antimicrobial Stewardship Programs during the COVID-19 Pandemic: What is restricted and who decides?
Authors: Mena Lora Alfredo J , Herald Fischer , Lindsey Brenna , Burgos Rodrigo M , Borgetti Scott , Chaisson Lelia H , Bleasdale Susan C
Published: December 2022

Background

During the COVID-19 pandemic, evolving literature and emerging therapies have led to significant controversies on what constitutes optimal therapy for hospitalized patients with COVID-19. In addition, multiple guidelines emerged exhibiting variable recommendations in key areas of therapeutic management. Thus, interpreting emerging data and deploying novel therapeutics during the pandemic has been challenging. Antimicrobial stewardship programs (ASP) have been proven to help promote evidence-based practices and are now common the United States (US). We seek to further understand the role of ASP during the COVID-19 pandemic.

Methods

A survey was developed and disseminated through Infectious Diseases Society of America (IDSA) IDea network, IDSA Antimicrobial Stewardship Centers for Excellence and the Society for Healthcare Epidemiology messaging boards. Data collected included city, hospital size, facility type, and existence of active ASP. COVID-19 therapeutic restrictions and type of provider who decides on treatment allocation was surveyed.

Results

A total of 92 surveys were completed, representing wide geographic reach within the United States (Figure 1). Hospital size by beds were 14% less than 200 (13), 18.5% 201-300 beds (17), 15.2% 301-400 beds (14), and 52.2% over 400 beds (48). Community hospitals accounted for 31.5% (29), county/public hospital 3.3% (3, 3.3%), University-affiliated Community-Based Teaching Hospitals 10.9% (10), University-based Teaching Hospital 45.7% (42), and 8.7% selected other. ASP were present in 97.2% of hospitals. COVID-19 therapeutic restrictions were common (Figure 2). Infectious diseases (ID) approval was required in 87.9% of facilities (Figure 3). Figure 1Geographic distribution of hospitals represented in the survey

Figure 2. Restricted COVID-19 therapies by medication type (%)

Figure 3 Specialties or providers that are able to order or approve restricted COVID-19 therapies (%)

Conclusion

COVID-19 therapeutics were commonly restricted during the COVID-19 pandemic. Approval by ID clinicians was required almost universally (87.9%). The role of other specialties was significantly lower, representing less than 45% of hospitals. ID clinicians have played a vital role in guiding therapy and supporting ASP during the COVID-19 pandemic. This survey highlights the value of ID clinicians to healthcare systems in allocating resources and promoting evidence-based practices through ASP.

Disclosures

All Authors: No reported disclosures.
932. Analysis of Seasonal Variation of Antibiotic Prescribing for Respiratory Tract Diagnoses in Primary Care Practices
Authors: Serletti Lacey M , Dutcher Lauren , Degnan Kathleen , Cressman Leigh , David Michael Z , Szymczak Julia E , Glassman Lindsay W , Cluzet Valerie , Hamilton Keith W
Published: December 2022

Background

Seasonal fluctuations in antibiotic prescribing for respiratory tract diagnoses (RTDs) have been identified, but characteristics and appropriateness of these variations have not been well described. The objectives of this study were to describe seasonal variations for RTDs and to determine whether seasonal variation in prescribing is associated with inappropriate use.

Methods

From July 1, 2016 through June 30, 2017, antibiotic prescribing was analyzed for 31 primary care practices comparing winter (October-March) and summer (April-September) months. ICD-10 codes for RTDs were described as tier 1, 2, or 3 based on whether antibiotics are almost always, sometimes, or almost never indicated, respectively. Twenty visits from each of 60 providers were randomly selected and manually reviewed to determine a gold standard of antibiotic appropriateness in order to characterize the appropriateness of these seasonal variations. Associations between season and diagnosis tier, season and appropriateness, and individual provider seasonal changes in antibiotic prescribing and provider characteristics were determined.

Results

There was a lower proportion of visits with tier 3 diagnoses in winter months (68% v. 74%, p< 0.01), but a greater proportion of tier 2 diagnoses (29% v. 23%, p< 0.01). There were greater proportions of visits in which an antibiotic was prescribed for both tier 2 (80% vs 74%, p< 0.01) and tier 3 diagnoses (23% v. 16%, p< 0.01) in winter months. Using medical record review, inappropriate antibiotics were prescribed more frequently for RTDs in winter compared to summer months (73% v. 64%, p< 0.01). Greater individual provider difference in proportion of RTD visits in which an antibiotic was prescribed from summer to winter was associated with family medicine v. internal medicine specialty (8.2% v. 5.1%, p< 0.01), nonteaching v. teaching practice (8.1% v. 2.9%, p< 0.01), and nonurban v. urban setting (9.1% v. 3.9%, p< 0.01).

Conclusion

Although there was a greater proportion of tier 2 compared to tier 3 RTDs in winter months, winter months were associated with more inappropriate prescribing than in summer months. More investigation is needed to understand the drivers for seasonal variations in RTDs and inappropriate prescribing.

Disclosures

Kathleen Degnan, MD, Gilead: Grant/Research Support Michael Z. David, MD PhD, Contrafect: Grant/Research Support|GSK: Advisor/Consultant|Johnson and Johnson: Advisor/Consultant.
939. Barriers and facilitators in the implementation of ASP in Mexico and the impact of COVID-19
Authors: Cortés-Ortíz María Alejandra , Dreser Anahí , Hegewisch-Taylor Jennifer , Romero-Mónico Julián , Quiroz Jorge
Published: December 2022

Background

Hospital antimicrobial stewardship programs (ASP) involve a continuous effort by health institutions to monitor and optimize the use of antimicrobials. In this study, we aimed to explore barriers and opportunities in the implementation of ASP perceived by personnel of Mexican hospitals, as well as their views on the impact of COVID-19 in ASP activities.

Methods

An online survey was applied to a purposive sample of 40 hospitals that perform regular antimicrobial stewardship activities in Mexico, during the last trimester of 2021.

Results

A total of 40 hospitals (62.5% public and 37.5% private) in 13 states in Mexico responded to the survey. Regarding the perception of barriers, they identified the overload of activities (73%), hospital reconversion due to COVID-19 (65%), the scarcity of human resources, and resistance of personnel to new procedures (63% each). The main perceived facilitators were the support by hospital authorities (60%) and the commitment by the ASP team and health professionals in the implementation of ASP (48%). Only 15% of hospitals reported that support by health authorities or other hospitals were factors favoring implementation. The main reported changes due to COVID-19 were: temporary suspension of ASP activities (60%); greater workload due to increased prescription of antimicrobials (33%); involvement in interventions (such as education and guidelines) directed to improve antimicrobial use in COVID-19 patients (18%), as well as implementation of new protocols in pharmacy (44%) and microbiology laboratory (51%). 18% reported no changes in ASP.

Conclusion

Implementation of ASP in Mexican Hospitals could be strengthened by the inclusion of sufficient human resources with protected time for ASP activities, the active involvement of hospital authorities, as well as encouraging the training and leadership of ASP teams. The impact of COVID-19 was two-way: the stagnation of the program in some hospitals, as well as the active participation in the response to the emergency, in other hospitals.

Disclosures

Anahí Dreser, PhD, MSD: Grant/Research Support.
943. Cross-Sectional Survey of Antibiotic Stewardship Activities Across Kansas Healthcare Settings including Hospitals, Ambulatory Centers and Long-Term Care Facilities
Authors: Jegede Olujimi , Wark Kellie , Kimball Joanna
Published: December 2022

Background

Kansas ranks as the second-worst state nationally for inpatient antibiotic stewardship core element implementation. Based on the Center for Disease Control and Prevention's 2020 National Healthcare Safety Network (NHSN) Annual Survey, Kansas hospitals reporting at 17% below the national average. We sought to investigate and characterize the stewardship activities healthcare facilities including hospitals, ambulatory centers, long-term care settings, among others, are engaging in, regardless of whether a formal stewardship program exists or not.

Methods

A survey was drafted based on the NHSN Annual Facility Survey for hospitals and long-term care settings. The survey was distributed to antibiotic stewardship experts and revised based on input. Surveys were distributed electronically from December 2021 through April 2022 via direct communication through Kansas Department of Health and Environment contacts, and partner organization dissemination.

Results

A total of 95 programs responded to the survey. Facilities from 55 of 106 counties responded. 52 of the 95 responses were from critical access hospitals. The facility representation is shown in Fig 1. 33% facilities reported not having a formal ASP. Thirty-five percent of those with formal ASP have had it for 2 years or less. 53% of respondents found it challenging to establish an ASP. About 58% of respondents felt their facility leadership was committed to improving antibiotic use. Accountability amongst all respondents was poor with only 55% reporting a physician/surgeon/dentist leader responsible for ASP activities. The most common activities implemented were clinical decision pathways and audit, and feedback (19% each), followed by guidelines (15%), dosing or duration optimization strategies (13%), with the least implemented being peer comparison (8%), prophylactic guidelines (5.5%) and pre-authorization (5.5%) as seen in figure 2. Figure 1- Number of responses per facility typeFigure 2:Actions reported (all healthcare facilities)

Conclusion

There have been ongoing endeavors to start ASPs, but these appear to have been hampered by the COVID-19 pandemic, lack of adequate support from facility leadership and lack of leadership representation in antibiotic stewardship. Further efforts are needed in developing and supporting antibiotic stewardship activities across facilities in Kansas.

Disclosures

All Authors: No reported disclosures.
947. Evaluating the Outcomes of Infectious Diseases Consultation on methicillin susceptible Staphylococcus aureus Bacteremia
Authors: Viteri Alina , Tucker Natalie , Barnstable Sara
Published: December 2022

Background

In 2014, an institutional project was completed assessing outcomes of beta-lactams versus vancomycin in patients with MSSA bacteremia. This research led to the development and implementation of a new standard of care for Staphylococcus aureus bacteremia using a bundle set that included ID consultation. The purpose of this research is to evaluate the impact mandatory ID consultation had on patient outcomes since this bundle set was implemented at our institution.

Methods

This was a quasi-experimental, single center study of adults with MSSA bacteremia admitted from April 1, 2018 to August 31, 2021. In the instance of patients with multiple admissions with MSSA bacteremia, data from only the first admission was included in the final analysis. Patients were excluded if they had polymicrobial bacteremia or expired within 48 hours of admission. Patients were identified by utilizing reports generated from the pharmacy clinical decision support software of patients with at least one blood culture positive for MSSA. Patients in this list were further screened through manual chart review for inclusion and exclusion criteria. The primary endpoint of this study is inpatient mortality in the setting of MSSA bacteremia with and without an ID consultation. Inpatient mortality was defined as death by any cause during hospital admission. Secondary endpoints included time to bacterial clearance, ID consultation, and mortality.

Results

Of the patients included, only 42 percent of patients in the pre-bundle set group were treated with MSSA targeted therapy (beta-lactam), in comparison to 86 percent in the post-bundle set group. The difference in secondary outcomes was not statistically significant. For the primary outcome of inpatient all-cause mortality, a 10 percent difference was found between the pre and post-bundle set groups, 18% vs. 8% (p = 0.01). The multivariate regression analysis also confirmed that the presence of an ID consult had a significant relationship with decreased mortality (p = 0.01).

Conclusion

The all-cause mortality rate of adult patients with MSSA bacteremia significantly decreased after implementation of the Staphylococcus aureus bacteremia bundle set requiring an ID consultation.

Disclosures

All Authors: No reported disclosures.
949. Impact of Antimicrobial Stewardship Pharmacist Participation in Pediatric Infectious Diseases Rounds on Prospective Audit and Feedback Recommendations
Authors: Bio Laura , Puckett Lauren M , Joerger Torsten , Schwenk Hayden T
Published: December 2022

Background

Prospective audit and feedback (PAF) is a core strategy of antimicrobial stewardship programs (ASPs). To improve communication of PAF recommendations to the inpatient pediatric infectious diseases (ID) consult service, the ASP pharmacists at our hospital were integrated into ID rounds. The purpose of this study was to assess the impact of ASP pharmacy participation in ID rounds on the rate of ASP recommendations.

Methods

Prior to implementation of the ASP pharmacist rounding service, the ASP pharmacist did not routinely attend rounds or communicate PAF recommendations directly to the ID consult service. Starting 1/3/22, the ASP pharmacists had daily (M-F) in-person discussions with the ID team regarding their patients’ antimicrobials. Audits performed between 1/4/21-12/30/21 and 1/3/22-4/29/22 on patients with an ID consult were included in the non-rounding cohort (NRC) and rounding cohort (RC), respectively. We compared PAF recommendation rates, characteristics, and acceptance rates between the two cohorts.

Results

There was an increase in PAF recommendation rate in the RC compared to NRC (188/485 [39%] vs 359/1234 [29%], p < 0.001). Antibiotics were the antimicrobial category mostly likely to have a recommendation and the rate of antibiotic PAF recommendations was higher in the RC compared to the NRC (132/341 [39%] vs. 271/934 [29%], p = 0.001) (Table 1). The most common recommendation types in both cohorts were to optimize the antimicrobial dose and antimicrobial discontinuation. Recommendations were more frequently communicated to the ID team in the RC compared to NRC (125/188 [66%] vs. 107/359 [30%], p < 0.001). The recommendation acceptance rate was similar between the two cohorts (159/188 [85%] RC vs. 290/359 [81%] NRC, p = 0.29).

CNS: Central nervous system; IV: Intravenous; NRC: Non-rounding cohort; PAF: Prospective audit and feedback; PO: Per os, oral; RC: Rounding cohort; SSTI: Skin and soft tissue infection; UTI: Urinary tract infection.

Conclusion

Implementation of a pediatric ASP pharmacist rounding service increased the PAF recommendation rate and improved recommendation communication with the pediatric ID consult service. Participation in rounds may better inform ASP pharmacist PAF recommendations. Future studies describing the potential benefit to the ID team by having an ASP pharmacist present on rounds are warranted. ASPs should consider formal integration of ASP pharmacists as part of the ID consult service to further improve the quality of antimicrobial prescribing.

Disclosures

All Authors: No reported disclosures.
956. Improving Understanding and Utilization of the Antibiogram among Medical Residents
Authors: Cooper Stephen J , Vivekanandan Renuga , Destache Christopher
Published: December 2022

Background

The antibiogram is a powerful tool for providers when selecting empiric antibiotic coverage. Its use is recommended by the Infectious Disease Society of America, Center for Disease Control, and clinical decision support resources to aid in antibiotic stewardship and patient care. Antibiograms are a key component of antimicrobial stewardship programs. A quality improvement project was implemented for the family medicine, internal medicine, and surgery residency programs at Creighton University to assess and improve early trainees' comfort with, utilization of, and understanding regarding antibiograms.

Methods

Forty-two first year residents making up 100% of the post graduate year one classes of the family medicine, internal medicine, and surgery residency programs at a Midwest Academic institution were interviewed in April 2021. Questions collected data regarding the function of, knowledge regarding, comfort and personal experience with antibiograms, as well as past exposure to infectious disease training. Antibiogram training lectures, informational posters, and new methods of accessing the antibiogram were implemented in July 2021. Post implementation of these interventions thirty-seven second year residents and forty first year residents, consisting of 100% of the respective classes of the three residency programs, were interviewed in January 2022.

Survey Questionnaire

Nine-question survey to gather data regarding residents knowledge and use of antibiograms.

Educational Poster

Information about how to use an antibiogram and quick response codes to access institutions antibiogram. Posters were displayed in all residency team rooms.

Results

Our efforts resulted in statistically significant increase in resident reported understanding, utilization, and comfort with the antibiogram. A total of 24/42 of the 2021 residents and 69/77 of the 2022 residents surveyed reported correct understanding of the antibiogram (p < 0.001). Residents who reported knowing how to access the antibiogram increased from 24% to 78% (p < 0.01) and use of the antibiogram in patient care increased by 19% (p = 0.027). The average reported comfort level increased from 2.3 to 4.2 out of 5 (p < 0.01).

Conclusion

Previous literature documents that many residents are not comfortable with using antibiogram data. This quality improvement project demonstrates that simple inexpensive measures can improve physician's comfort, access, and utilization of the antibiogram.

Disclosures

Renuga Vivekanandan, MD, MDstewardship: Ownership Interest Christopher Destache, Pharm D, Shionogi Inc: Honoraria.
958. Is Dalbavancin a Reliable Treatment Option in Socially Challenged Populations?
Authors: Askar Wajih , Bedoya Federico Palacio , Liao Siyun
Published: December 2022

Background

Dalbavancin (DAL) is a lipoglycopeptide antibacterial that was granted full FDA approval for the treatment of acute bacterial skin and skin structure infections (ABSSSI) in 2014. Due to its long terminal half-life of 14.4 days, DAL has been used off-label to treat infections that require a prolonged duration of treatment, especially in patients with challenging social situations. We aimed to evaluate the differences in outcomes and clinical effectiveness of DAL, primarily in deep-seated infections in an academic health system.

Methods

We performed a retrospective review of all the adult patients ( >18 years old) with DAL orders within our health care system between January 1st, 2016, and July 16th, 2021. Baseline characteristics were collected, including age, gender, race, history of illicit drug use disorder (IDUD), diagnosis, and recommended DAL regimen. Follow-up data, including completion of treatment, outpatient visits to infectious diseases clinic, and recurrence of infection within six months, were also collected.

Results

A total of 50 patients were identified during the study time frame. The median age was 45.5 years, 62% were male, 82% were white, and 62% had a history of IDUD (Table 1). DAL was used predominantly to treat bone and joint infections (e.g., osteomyelitis, septic arthritis), followed by bacteremia, endocarditis, and ABSSSI (Table 1). The most common regimen used is 1500 mg weekly for two doses. Patients with a history of IDUD are less likely to complete the recommended treatment regimen (64.5% vs. 100%; p=0.003), and less likely to follow in the infectious disease clinic (16.1% vs. 52.6%, p=0.016) when compared to patients with no history of IDUD. Twelve patients had either objective evidence or clinical suspicion for recurrence within six months. Although there was a trend for higher recurrence among patients with IDUD (29% vs. 16%), there was no statistical difference with a p-value of 0.332 (Table 2). In addition, DAL was well-tolerated among most patients. Table 1.Baseline characteristics of the study population.

Table 2. Outcomes of patients with dalbavancin orders.

Conclusion

Although DAL is a safe and convenient antimicrobial option, more efforts should be made to establish consistent treatment regimens for its off-label use. Those with social barriers such as IDUD might benefit from additional measures to ensure treatment completion and proper follow-up.

Disclosures

All Authors: No reported disclosures.
960. Optimizing the report of antimicrobial resistance in Mexican hospitals: An unfinished business.
Authors: Hegewisch-Taylor Jennifer , Dreser Anahí , Alejandra Cortés-Ortíz María , Romero-Mónico Julián
Published: December 2022

Background

One of the aims of antimicrobial stewardship programs (ASP) in hospitals is to make an efficient use of the available infrastructure to enhance surveillance and antimicrobial resistance (AMR) reporting. In this study, we aimed to explore specific AMR reporting mechanisms in ASPs in Mexican hospitals in order to highlight potential areas of improvement.

Methods

An online survey was applied to a purposive sample of 40 hospitals who performed regular antimicrobial stewardship activities in Mexico. Answers regarding a subset of questions on antimicrobial susceptibility monitoring and reporting practices were provided by ASP professionals.

Results

A total of 39 hospitals (14 private and 25 public hospitals) in 13 states in Mexico answered the subset of the survey. Thirty-three of those (85%) expressed that their databases allowed periodically monitoring of changes in susceptibility and resistance patterns for specific pathogens. As many as 17 hospitals (44%) reported to two external national academic networks and none reported to international ones. Only 10 reported to the National Hospital Network for Epidemiological Surveillance (RHOVE) in charge of AMR data (29%). Thirty hospitals (77%) declared reporting their AMR consolidated results internally to either the epidemiology department, an ASP leader, or other hospital committee. Twenty percent of the surveyed hospitals issued AMR reports to two entities, an additional 10% of them to 3 entities and 5% more to 4 different entities; reporting to >3 entities was observed only in public hospitals. Two hospitals (5%) declared not submitting AMR reports at all.

Conclusion

The adoption of reporting commitments without guiding national AMR policies derives into the duplicity of processes (reporting to different networks or entities) requiring additional human and financial resources. It also reflects the unavailability of a functional national reporting system allowing all hospitals to monitor and access the reported information nationally or internationally (GLASS). Optimizing AMR surveillance and reporting in Mexico must incorporate the simplification and standardization of reporting processes into an articulated system in line with the National Strategy against AMR.

Disclosures

Anahí Dreser, PhD, MSD: Grant/Research Support.
962. Pediatric Antimicrobial Stewardship at Colorado Hospitals
Authors: Parker Sarah K , Kronman Matthew , Czaja Christopher A , Matteson Caleb , Ziniel Sonja I , Dodson Daniel S
Published: December 2022

Background

Although antibiotics are essential to pediatric care, many pediatric antimicrobial prescriptions are inappropriate. Antimicrobial stewardship programs (ASPs) are implemented to mitigate these instances of inappropriate prescription, but little is known about how these programs are applied to pediatric care. To better understand extension of ASP to pediatric patients, barriers to pediatric stewardship, and desired resources for pediatric stewardship, we assessed stewardship practices as applied to pediatric patients and identified barriers to including this vulnerable population across Colorado hospitals.

Methods

We conducted a mixed-methods evaluation including a survey and semi-structured interviews with the objective of characterizing and assisting Colorado ASPs. Forty-one hospitals responded to the survey and 24 programs were interviewed, of 103 possible hospitals.

Results

Of the 41 hospitals responding to the survey and 23 hospitals interviewed, 35 (85%) and 23 (90%) cared for pediatric patients respectively. Of hospitals caring for neonatal and general pediatric patients, only 17% and 14% employed rigorous stewardship practices for the action, tracking, and reporting stewardship core elements for these populations (compared to 50% and 31% for their adult patients).

Notably, we found many programs inaptly combined adult and pediatric ASP efforts (18 hospitals, 81%), including frequent combining of adult and pediatric antibiotic use data, versus separating these patient populations (3 hospitals, 14%).

Barriers to priority pediatric stewardship included lack of pediatric expertise and perceived low priority for pediatric stewardship due to lower volumes. The most desired pediatric resources were clinical care guidelines and pediatric stewardship education.

Conclusion

Though most hospitals in Colorado care for pediatric patients, priority stewardship in pediatrics is rare. Resources to assist pediatric ASP are uncommon, and incentive to develop such resources may be low. Public health departments and pediatric hospitals can help combat antimicrobial resistance and improve pediatric care in community settings by providing easier access to pediatric expertise.

Disclosures

All Authors: No reported disclosures.
963. Perceived Antimicrobial Stewardship Roles of Pharmacists and Residents in US Intensive Care Units
Authors: Uttla Kruthika , Rynkiewich Katharina , Hojat Leila S
Published: December 2022

Background

Antimicrobial stewardship programs (ASPs) were developed as a way of addressing antibiotic resistance by promoting the judicious use of antibiotics. Pharmacist and resident perspectives of their own roles within antimicrobial stewardship are relatively unknown. An ethnographic study of intensive care units (ICU) was conducted to understand the perceptions and attitudes surrounding pharmacist and resident roles relative to stewardship.

Methods

A research assistant with medical anthropology training performed semi-structured interviews with intensive care pharmacy specialists and residents at a medical center in Cleveland, Ohio, USA between June 2021 and August 2021. Data analysis centered on the understandings of ASPs and antibiotic prescribing present in multidisciplinary groups where certain members are not primary antibiotic decision-makers. The data were analyzed using thematic coding aided by NVivo qualitative analysis software.

Results

Intensive care pharmacy specialists (N=5) and residents (N=6) were interviewed, accruing > 518 minutes of semi-structured interview data. Pharmacy specialists described their contributing role as serving stewardship goals such as “decreasing mortality” and believed that they should have input in antibiotic decision making. Residents also emphasized the importance of consulting pharmacists before antibiotic decisions were made. Both groups felt limited in their ability to contribute to final antibiotic decisions. Pharmacists regularly referred to their input as a “recommendation” and described their actions as “suggestions”. Residents expressed that physicians were better suited to make decisions due to the residents’ limited experience, acknowledging that they “don’t know everything.” Table 1.Key Themes and Perceived Roles in Intensive Care

Conclusion

This study found that ICU pharmacists and residents have an awareness of stewardship that might aid in antimicrobial prescribing. Both groups expressed an appreciation for stewardship goals despite being bounded by hierarchies of medical practice. Providing these groups with greater autonomy over prescribing practices might improve ASP effectiveness. Future studies may focus on analysis on the social dynamics of hospital spaces and the corresponding impact on decision-making and expert practices.

Disclosures

All Authors: No reported disclosures.
975. Dalbavancin for the Treatment of Vertebral Osteomyelitis
Authors: Streifel Amber C , Strnad Luke , Sukerman Ellie , Makadia Jina T , Lewis James S , Douglass Alyse H , Young Kathleen , Mayer Heather , Sikka Monica K
Published: December 2022

Background

Dalbavancin (DAL) provides an alternative to daily intravenous (IV) antibiotics for the treatment of infections when treatment in the outpatient setting is not practical. While clinical outcomes data for the treatment of osteomyelitis (OM) with dalbavancin has expanded, data specifically addressing vertebral OM remains limited.

Methods

We conducted a retrospective single center study to evaluate DAL use at our institution for patients with vertebral OM, including relevant treatment details and follow-up to 90 days post last DAL dose. All patients aged> 18 years who received at least one dose of DAL between 2015 and 2021 via medication records were included.

Results

Twenty-eight patients with vertebral OM (24 with native vertebral OM) were treated with DAL for at least a portion of a treatment course. The most commonly isolated organisms were methicillin-resistant Staphylococcus aureus (MRSA) (10; 35.7%) and methicillin-sensitive S. aureus (MSSA) (7; 25%). Cultures were negative for 7 patients (25%). Eight (28.5%) patients were bacteremic upon presentation, 5 (17.8%) with MRSA, 2 (7.1%) with MSSA, and 1 (3.6%) due to Enterococcus faecalis. All included patients had a history of substance use and 18 (64.2%) endorsed injection use. DAL was most commonly selected due to a history of injection drug use (19, 67.9%), lack of a safe home environment (6, 21.4%) or prior non-adherence to outpatient antibiotics (5, 17.9%). For the 11 patients who received one dose of 1500 mg, the mean duration of antibiotics prior to DAL was 29.3 days, 2 of these patients were intended for 2 dose regimens but did not complete a second dose. For the 17 patients who received 2 doses of 1500 mg, mean duration of antibiotics prior to DAL was 13.8 days. Adverse reactions were documented for 7 patients (25%), most commonly infusion reactions. Readmission for any reason at 30 days occurred for 1 patient (3.6%) and 2 patients (7.1%) at 90 days. Mortality at days 30 and 90 post-treatment were 0. Recurrence or relapse of infection at 30 and 90 days occurred for 1 (3.6%) patient each.

Conclusion

DAL appears to be safe and well-tolerated for the treatment of vertebral OM, although clinical data comparing it to standard of care regimens, especially for vertebral OM due to S. aureus is needed before it can be recommended as standard of care.

Disclosures

James S. Lewis, PharmD, FIDSA, Cidara: Advisor/Consultant|Merck: Advisor/Consultant|SeLux Diagnostics: Advisor/Consultant Monica K. Sikka, MD, F2G: Site research investigator.
976. E coli Periprosthetic Joint Infections: Poor Infection Clearance at One Year
Authors: Polascik Breanna A , Bethell Mikhail A , Briggs Damon V , Adu-Kwarteng Kwabena , Kim Billy I , Case Ayden , Prado Isabel P , Wixted Colleen M , Hendershot Edward F , Jiranek William A , Seidelman Jessica , Seyler Thorsten M
Published: December 2022

Background

Escherichia Coli (E coli) is a gram-negative rod that can cause devastating periprosthetic joint infections (PJIs) in patients with total hip and knee replacements (THA/TKA). Minimal literature exists on outcomes of E coli PJIs.

Methods

Retrospective review of our institution’s electronic medical record from 2009-2020 identified 21 patients that met MusculoSkeletal Infection Society criteria for E coli hip or knee PJI. Primary outcome was 1-year infection clearance - eradication of infection off antibiotics with no further surgeries for 1 year after completion of standard postoperative antibiotics. Minimum followup was 1 year.

Results

We analyzed 21 patients (mean age 66.6 yrs, 47.6% male, 23.8% nonWhite, 38.1% knee PJIs). There were 11 acute, 8 acute hematogenous (AH), and 2 chronic PJIs. Several patients had recent gastrointestinal/urinary tract surgery (14.3%), recurrent urinary tract infections (9.5%), or >1 E coli urine culture <1 mo pre-PJI (14.3%). Surgical treatments included DAIR (66.7%), 2-stage revision (14.3%), Girdlestone/Resection Arthroplasty (G/RA; 14.3%), and fusion (4.8%), with 7.1%, 100%, 66.7%, and 100% 1-year infection clearance, respectively, and 33.3% 1-year infection clearance overall (p=.001). Common reasons for treatment failure were reinfection requiring surgery (57.1%) and chronic antibiotics (38.1%). Patients clear at 1 year had a longer mean time from most recent surgery to index PJI surgery (48.7 vs 7mo;p=.043) and more AH than acute or chronic infections (54.6% vs 27.3% vs 18.2%;p=.0412). Patients who were not clear at 1 year had more acute infections (80% vs 20% AH;p=.0412). The E coli PJI persisted in 23.8% of patients. Outcomes at final followup included G/RA (28.6%), original prosthetic (28.6%), new prosthetic (19%), above knee amputation (9.5%), destination spacer (9.5%), and arthrodesis (4.8%).

Conclusion

E coli PJI 1-year infection clearance is poor, with DAIR being the most common yet least effective surgical treatment. Most E coli PJIs occurred postoperatively as opposed to hematogenously, as is sometimes assumed. This serves as a foundation for future studies evaluating E coli treatment outcomes.

Disclosures

William A. Jiranek, MD, Biomech Holdings LLC: Stocks/Bonds|DePuy, A Johnson & Johnson Company: IP royalties Thorsten M. Seyler, MD, PhD, Heraeus: Paid consultant|Pattern Health: IP royalties|Restor3d: IP royalties|Smith & Nephew: Paid consultant|Total Joint Orthopedics: Paid consultant|Zimmer: research.
984. Pediatric acute hematogenous osteoarticular infections in central Missouri
Authors: Andrade Heather J , Ohler Adrienne , Padhye Amruta
Published: December 2022

Background

Acute hematogenous osteoarticular infections (AOI), including osteomyelitis (OM) and/or septic arthritis (SA), are a frequent cause of hospitalization and morbidity in children. In this retrospective observational study, we aim to describe the epidemiology, presentation, and management of children diagnosed with AOI at a Midwest academic healthcare center in central Missouri.

Methods

Systematically reviewing medical records from July 2015 to March 2021, we identified 73 pediatric patients (age < 18 years) diagnosed with AOI. Cases related to trauma, surgery, or chronic recurrent multifocal osteomyelitis were excluded. Information was collected on clinical course and management, and a descriptive analysis was performed.

Results

Children meeting the inclusion criteria included 46 males (63%) and a median age at presentation of 6.9 years (IQR 2.8 – 11.9). Presenting symptoms included localized pain (n=72, 99%), refusal to move or bear weight (n=64, 88%) and fever (n=49, 63%); 42 (56%) had all three symptoms. 32 (44%) had OM, 17 (23%) had SA, and 24 (33%) had both; lower extremity long bones/joints were often involved. Definitive bacterial etiology was identified in 49 (67%) patients: 39 (76%) Staphylococcus aureus (16 methicillin resistant [MRSA], 23 methicillin susceptible [MSSA]), 4 (8%) Streptococcus pyogenes, and 3 (6%) Kingella kingae; and blood cultures identified an etiology in 29 of the 69 obtained (42%; 25 MSSA, 2 MRSA, 2 S pyogenes). Surgical management in an operating room was performed in 44 (60%). Median hospitalization was for 5 days (IQR 4-8), and 5 cases (7%) required intensive care, with no mortality. 62 were successfully transitioned from intravenous (IV) antibiotics to oral at discharge (85%) – 10 were discharged with IV antibiotics and one infant received full IV course in hospital. Definitive oral antibiotics used included cephalexin (35), clindamycin (24), and amoxicillin (3). 8 (11%) required hospital readmission for various reasons.

Conclusion

Our trends in AOI are comparable to those reported nationally – blood cultures remain key in identifying etiology and empiric therapy should continue to target S aureus. Most children can be successfully transitioned to oral antibiotics at discharge. This data will guide us in preparing a clinical pathway at our center.

Disclosures

All Authors: No reported disclosures.
994. A Novel Informatics Tool to Detect Antibiotic Allergies in Patients Undergoing CIED Procedures
Authors: Dassum Samira Reyes , Mull Hillary J , Golenbock Samuel , Lamkin Rebecca P , Epshtein Isabella , Shin Marlena , Strymish Judith , Blumenthal Kimberly G , Colborn Kathryn L , Branch-Elliman Westyn
Published: December 2022

Background

Antibiotics are one of the leading causes of emergency room visits for adverse drug events, yet surveillance for antimicrobial allergy adverse events is limited and identifying true cases is challenging. As part of a larger study to improve antimicrobial use, we sought to develop and validate a tool for near real-time measurement of antimicrobial allergy adverse events.

Methods

An existing cohort of patients undergoing cardiac device procedures with known antimicrobial exposure was split into a development and validation set. Candidate triggers for identifying allergic reactionswere identified a priori, using disease phenotype codes “phecodes”, allergy documentation on allergy module of the electronic medical record (EMR), and keyword searches applied to clinical notes (e.g., “anaphylaxis,” “rash”), medication administration (e.g, corticosteroids alone or with antihistamines) and administrative codes (ICD-10 codes and phecodes). Cases were reviewed for presence of a true event, and the tool was iteratively updated based on chart review findings. The tool was then applied to the validation cohort and a sample of trigger-flagged and unflagged cases underwent manual review. Data were analyzed in SAS and model triggers were selected using a LASSO technique.

Results

Among 34,703 patients, N=431 cases underwent manual review (350 development; 120 validation), and 104 true allergy adverse events were identified. Among chart reviewed cases, the most frequently detected flags were keywords in unstructured clinical notes (35%), phecodes (26%), corticosteroid administration (15%), observed allergy documentation in EMR (14%) and reported allergy documentation in EMR (13%). The final model contained 7 triggers and had an AUC of 0.95, and a positive predictive value of 67% (Figure). The strongest predictors of true adverse events were the allergy health factors (aOR 358, 95% CI 76.3-999) and specific Phecodes (Table1).

Conclusion

We developed an antibiotic allergy measurement tool using structured and unstructured data that can be applied to detect antimicrobial adverse events in near-real time. This model may be applied to provide near real-time feedback to clinicians about antimicrobial allergy adverse events and may be useful for antimicrobial stewardship programs.

Disclosures

Westyn Branch-Elliman, MD, MMSc, DLA Piper,LLC/Medtronic: Advisor/Consultant|Gilead Pharmaceuticals: Grant/Research Support.