bluuebunny/crossref_metadata_2025 huggingface dataset:
P-1606. Utilizing Diagnostic Stewardship to Help Increase the Yield and Clinical Value of Broad Range PCR Testing at a Tertiary Children’s Hospital
Authors: Fortna Sarah , Alali Muayad , Prabhudas-Strycker Kirsten , Mellencamp Kagan A , Boyd LaKeisha , Goings Michael , Khan Haseeba , Fahey Mackenzie , Samaro Matthew , Schneider Jack G
Published: January 2025

Background

Broad range PCR testing (BR-PCR) in various clinical samples has the ability to provide timely diagnoses that cannot always be made through conventional testing (CT), yet its diagnostic yield and clinical impact have been variable, especially by specimen type. As such, we developed an ID-physician led diagnostic stewardship approval protocol to help optimize test usage.

Methods

We conducted a single-center, retrospective pre/post study to assess the impact of an ID-led diagnostic stewardship approval protocol for BR-PCR testing. All clinical specimen types obtained for BR-PCR at Riley Hospital for Children were evaluated between 10/1/2019 to 4/30/2022 (pre-intervention) and 5/1/2022-12/31/2023 (post-intervention). Clinical relevancy of BR-PCR results was determined after review from two ID physician experts and compared between the two time periods, along with clinical impact and overall cost savings.

Results

A total of 931 BR-PCR tests were sent from 238 specimens collected from 175 patients in the pre-intervention period, while 208 BR-PCR tests were sent from 65 specimens collected from 65 patients in the post-intervention period. Clinical relevancy of results was determined to be 30.7% and 56.9% for pre-and post-intervention periods, respectively (p< 0.001). 23.1% of post intervention results led to a change in clinical management, compared to 12.6% in the pre-intervention period (p=0.035). Bronchial lavage (BAL) was the most common specimen type with 52.9% of results being clinically relevant post-intervention, compared to 29.6% in the pre-intervention period; p=0.068). Results that led to a clinical change in management were also slightly higher but non-significant for BALs post-intervention (11.8% vs 9.9% pre intervention; p=0.816). Overall cost savings post-intervention was estimated to be $200,000.

Conclusion

Use of an ID-physician led diagnostic stewardship approval protocol led to an overall improvement in clinical utility for BR-PCR testing at our institution and was influenced by specimen type. Prospective, multi-center studies are needed to determine which specimen types, diagnoses, and potential diagnostic stewardship measures will help increase the yield and clinical value of BR-PCR testing.

Disclosures

Jack G. Schneider, MD, MiraVista Diagnostics: Advisor/Consultant
P-1624. Are Follow-Up Blood Cultures Necessary in Children with Gram-Negative Rod Bacteremia?
Authors: Doshi Shreya M , Jadhav Shamily , Rueda Altez Maria Susana , Ansusinha Emily , Hamdy Rana F , Hamdy Rana F
Published: January 2025

Background

The utility of follow-up blood cultures (FUBCs) in children with a gram-negative rod (GNR) bacteremia is unclear. A prior pediatric study showed that FUBC positivity rate was 21%. Many adult studies have demonstrated that a FUBC is not always necessary in the setting of a UTI. Primary objectives were to determine 1. the rate of positivity in follow up blood cultures in children with gram negative bacteremia 2. To understand the clinical risk factors associated with positivity in follow up blood cultures in children with gram-negative rod bacteremia.Figure 1Flowchart depicting chart analysis

Methods

A retrospective cohort study in patients < 21 years of age at Children’s National Hospital that had a positive blood culture for gram negative rods from 01/2013 to 06/2023. FUBC was defined as a subsequent blood culture collected at least 24 hours after and < 7 days from the time of collection of the initial positive blood culture. Structured chart review was performed to collect clinical features, source of bacteremia, time to positivity, and FUBC positivity and contamination rate . Univariate analysis of each risk factor with FUBC positivity and multi-variable logistic regression model for association of each risk factor with FUBC positivity will be performed. Figure 1 - Flowchart depicting chart analysis.Table 1.Demographics and Clinical Characteristics of patients

Results

In an analysis of 35 patients, rate of FUBC positivity was 23% (n=9), contamination rate in the FUBC was 11% (n=1). Clinical factors of and outcomes are depicted in Table 1 and 2. E.coli was the most common organism found in the initial blood culture depicted in Figure 2.Table 2.Blood culture data and outcomes

Conclusion

Preliminary results for this ongoing study demonstrate that FUBC positivity was 22% in children with gram negative bacteremia, which is higher than what has been reported in adult studies. More data and subset analysis required for immunocompromised patients and patients with a central line.Figure 2Microbiologic distribution by percentage for initial and follow-up blood culture

Disclosures

All Authors: No reported disclosures
P-1627. The Impact of Microbiology Diagnosis Process Optimization on Clinical Outcomes and Health Economics in Hospitalized Bloodstream Infection Patients in China
Authors: AI Genwei , ZHAO Lu , LI Zhi , GUO Kunshan , ZHANG Ying , JIA Erjuan , XIA Yijun
Published: January 2025

Background

Bloodstream infection (BSI) is one of the leading causes of morbidity and mortality worldwide. Early identification of bacteria is essential for antimicrobial stewardship and the key to improve outcomes. The aim of this study was to evaluate the impact of an optimized microbiology lab process on turnaround times, antibiotics use and economics in adult hospitalized BSI patients.Figure 1:Gram stain, ID and AST reporting times between pre- and post-optimization groups.

Methods

Since Oct-2021, the microbiology laboratory in Xuchang Central Hospital, Henan, China had implemented a series of improvements, including the utility of BacT/Alert Virtuo blood culture (BC) system, the new resin anaerobic/aerobic BC bottles, VITEK MS (bioMérieux), and an optimized sample reception process. Patients with positive BC results in ICU, general surgery, respiratory, hematology and emergency wards from Oct-2020 to Sep-2021 and Oct-2021 to Sep-2022 were grouped into the pre-optimization (pre-op) and the post-optimization (post-op) groups, respectively.Table 1:The impact of optimized microbiology lab process

Results

A total of 134 patients were included in the pre-op group, 79 patients were included in the post-op group. There were no differences in baseline characteristics. Compared to pre-op group, the Gram stain reporting time of post-op group decreased significantly (37.27 vs 45.88h, p=0.001). The use of VITEK MS allowed a faster ID report, which significantly reduced the ID reporting time (48.18 vs 70.14h, p< 0.001) compared to pre-op group (Figure 1). These faster reports resulted in rapid targeted antibiotics use. The time from blood sample collection to targeted antibiotic therapy within 48h of each report (Gram stain, ID and AST) was much shorter in post-op group (Table 1). In post-op group, although the decreases of total antibiotics days and length of hospital stay didn’t show significance, the total antibiotics fee was significantly reduced (5902.80 vs 9791.85 RMB, p=0.022). Such fee saving possibly contributed in the saving of total hospitalization cost in post-op group (53816.67 vs 66991.58, P=0.243).

Conclusion

Optimization of the microbiology lab process resulted in significant decreases in reporting time and ensured faster targeted antibiotic therapy in hospitalized BSI patients. Such improvements might potentially bring positive impact on antimicrobial stewardship, clinical outcomes and health economics.

Disclosures

All Authors: No reported disclosures
P-1630. Retrospective Evaluation of Urinalysis to Urine Culture Reflex Frequency and Criteria
Authors: Zheng Dina , Hirsch Elizabeth B , Hamid Lina , Bixby Morgan L , Bixby Morgan L
Published: January 2025

Background

Patients with asymptomatic bacteriuria (ASB) often receive inappropriate treatment despite IDSA guidelines recommendation against antimicrobial treatment of ASB in the majority of adults. Emphasis on laboratory results rather than symptoms often triggers ASB treatment. At our institution, a urinalysis (UA) positive for ≥ 1 criteria ( > 10 WBC / HPF, leukocyte esterase (LE), or nitrites) results in a reflex to urine culture (UC). The objective of this study was to assess the frequency of UC reflex orders and the specific criteria driving reflex to identify opportunities for diagnostic stewardship and treatment guidance.

Methods

Retrospective data were provided by the Best Practices Integrated Informatics Core for hospitalized adults with an ICD-10 diagnosis of urinary tract infection (UTI) or related condition and a UA +/- UC order within 72 hours between 11/1/2022 and 4/30/2023 at a large academic medical center. Number and frequency of UA to UC reflex and UA criteria driving UC reflex were assessed. LE results were considered positive if “moderate” or “large” and negative if “small”, “trace”, or “negative”. RStudio (version 2023.06.0) was utilized to perform logistic regression analyses with univariable and multivariable models to calculate odds ratios for reflex to UC.

Results

This cohort comprised 2007 unique patients with a total of 3193 UA orders. Of 3193 UA orders, 1016 (31.8%) reflexed to UC. The highest frequency of UC reflex was with 2 of 3 UA criteria positive (43.2%), followed by 1 of 3 criteria positive (39.0%), then 3 of 3 criteria positive (9.5%), and lastly, the remaining 8.3% of patients had UC reflexed for unknown reasons that need to be further investigated (Table 1). All 3 criteria when positive had increased odds for triggering UC reflex (Table 2). In the multivariable model, LE had the highest odds of triggering UC reflex (OR 1.73, 95% CI: 1.68-1.78).

Conclusion

Despite frequent UA orders, only 31.8% reflexed to UC. Following these results, retrospective chart review will be completed to characterize patients with symptomatic UTI vs. ASB based on review of progress notes. These data will identify whether certain UA criteria are more highly correlated with symptomatic UTI and will help inform the need for revised UA and UC diagnostics.

Disclosures

Elizabeth B. Hirsch, PharmD, FCCP, FIDSA, GSK: Advisor/Consultant|GSK: Honoraria
P-1641. Comparing Traditional and Weighted Incidence Combined Syndromic Antibiograms in Nursing Homes
Authors: Taylor Lindsay , Jolles Sally , Bej Taissa A , Kowal Corinne , Hicks Oteshia , Gangnon Ronald , Furuno Jon P , Nace David A , Jump Robin , Crnich Christopher J
Published: January 2025

Background

Aggregate susceptibility reports, commonly referred to as antibiograms, may assist empiric antibiotic decisions. Creating traditional antibiograms (TAs) is hampered by the limited number of cultures collected in NHs. A weighted incidence syndromic combined antibiogram (WISCA) is an alternative method of representing susceptibility data. We compared TAs and WISCAs in a sample of NHs from three U.S. regions.

Table: Success Rate of Creating a TA and WISCA Using One Year of Culture Data in 75 Nursing Homes

Methods

Data on urine cultures collected in 75 NHs in Ohio, Oregon, and Pennsylvania (2018-2021) were obtained from their reference laboratories. Clinical & Laboratory Standards Institute (CLSI) breakpoints were used to normalize susceptibility interpretations across laboratories. We attempted to create a TA and WISCA for each study NH using the 3 most prevalent uropathogens (Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae) and susceptibilities to 5 commonly prescribed antibiotics. Sensitivity analyses using different isolate number thresholds (10 & 30) and years of culture data (1 & 2) were conducted.Figure:Success Rate of Creating a TA and WISCA Using Two Years of Culture Data in 75 Nursing Homes

Results

15,238 unique urine cultures obtained from 7,703 residents were obtained from reference laboratories. The final sample was 12,789 cultures after excluding duplicate isolates obtained from the same resident within 3 monthsof an index urine culture. A TA could be constructed for ∼5% (1.5% - 5.1%) of NHs using a single year of culture data and an isolate number threshold of 10 (Table). This increased to ∼11% when combining two years of culture data (Figure). A 1- or 2-year TA could not be constructed for any of the NHs using the CLSI recommended isolate threshold of 30. We were able to construct a WISCA for most of the study NHs (63% - 80%) using a 10-isolate threshold and this improved slightlyby combining two years of culture data. We were only able to construct a 1-year WISCA for a third of NHs (29% - 34%) using a 30-isolate threshold but this improved to 57% of NHs when combining 2 years of culture data.

Conclusion

A facility-specific urinary antibiogram can be produced for the majority of NHs by using a WISCA approach and combining more than one year of culture data. Additional study to examine the effects of pooling facility culture results on WISCA success rates and effects on susceptibility estimates are needed.

Disclosures

Jon P. Furuno, PhD, Merck & Co., Inc: Grant/Research Support Robin Jump, MD, PhD, Abacus: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support
P-1685. Knowledge, Attitudes, and Practice of Healthcare Providers Regarding Oral Antibiotic Use in a Health System
Authors: Gammill Emily , Shephard Emily , Bhagat Hita , Chan Dominic
Published: January 2025

Background

Treating infections with oral (PO) antibiotics is associated with reduced risk for catheter associated infections, costs, and length of stay. However, barriers in appropriate transition to PO antibiotics exist.

Intravenous versus oral antibiotics by treatment indication

The most common treatment indications were pneumonia, cellulitis, bacteremia, and urinary tract infection. A lower proportion of patients with cystitis and bacteremia were transitioned to oral antibiotics compared to other indications.

Methods

This study aims to understand the knowledge, attitudes, and practice of healthcare providers regarding PO antibiotics. This is a cross-sectional, descriptive survey followed by a multi-center, retrospective chart review. A web-based questionnaire was distributed electronically and promoted during meetings to healthcare providers. The retrospective chart review included admitted adult patients who were administered antibiotics for targeted infections. Patients that were pregnant, incarcerated, had inadequate PO absorption, or lack of source control were excluded. The primary outcome was to identify areas for antimicrobial stewardship intervention. This was done by identifying discordances between provider knowledge or attitudes and prescribing practices. Descriptive statistics and regression analyses were conducted.

Results

The survey collected 119 total responses from pharmacists (47.1%), physicians (36.1%), medical residents (5.9%), and advanced practice providers (5%). Providers were most comfortable using PO antibiotics for cellulitis (88.2%), cystitis (86.6%), and community acquired pneumonia (82.4%), and were least comfortable using PO antibiotics for osteomyelitis (26.1%), prosthetic joint infection (16.8%), and endocarditis (14.3%). The most common barrier was the concern that PO antibiotics are not as effective (86.6%). The retrospective chart review included 224 patients, of which 164 were transitioned to PO antibiotics at any point. A lower proportion of patients with cystitis (60%) and bacteremia (57.7%) were transitioned to PO. The largest discordance between comfort using PO antibiotics and actual prescribing practices occurred with cystitis. Average duration of intravenous (IV) antibiotics were 4.2 days for pneumonia, 4.2 days for cellulitis, and 3.3 days for cystitis.

Conclusion

Antimicrobial stewardship initiatives can be targeted at education on oral antibiotic options that have high efficacy, improving IV to PO conversion rates for cystitis, and implementing criteria for early transition to PO antibiotics.

Disclosures

All Authors: No reported disclosures
P-1713. Impact of an Evidence-Based Order Panel on Antimicrobial Prescribing in Ambulatory Patients with Complicated and Uncomplicated Cystitis
Authors: Neumann Matt , Jensen Kelsey L , Stevens Ryan W W , Ilges Dan , Virk Abinash , Vergidis Paschalis , Mara Kristin
Published: January 2025

Background

Optimizing antimicrobial prescribing for urinary tract infections (UTI) represents an area of opportunity for ambulatory antimicrobial stewardship programs. A pre-populated, ambulatory antibiotic order panel for UTI was implemented in the Mayo Clinic Enterprise on 5/16/2022. The order panel provides antimicrobial regimens which align with both institutional and national treatment guidelines based on patient comorbidities, complicating factors, and beta-lactam allergy status. We aimed to assess the impact of panel use on antibiotic prescribing for complicated and uncomplicated cystitis in the ambulatory setting.

Methods

This retrospective review included ambulatory encounters from the Mayo Clinic Enterprise in 2022 and 2023. Eligible encounters were randomly selected and included those with a primary ICD-10 code of cystitis performed by primary care or urgent care clinicians. Encounters were excluded if patients had symptoms indicative of pyelonephritis, underwent urinary instrumentation within 30 days, or had a urinary pathogen isolated within 90 days. The primary outcome was concordance with institutional guidelines. Secondary outcomes included repeat healthcare contact and therapy duration. Outcomes were analyzed with Pearson's chi-squared and Wilcoxon rank sum tests (α level = 0.05).

Results

793 encounters (397 panel vs. 396 non-panel) were included. Prescribing was guideline concordant in 79.3% and 64.9% (p< 0.001) of panel and non-panel encounters, respectively. Inappropriate duration was the most common reason for non-concordance in the panel use cohort. There was no difference between groups for repeat healthcare contact incidence. Antimicrobials prescribed differed between panel and no-panel groups (Table 1), with higher use of sulfamethoxazole/trimethoprim and lower use of cefdinir in the panel cohort. Numerically shorter durations were seen in the panel group, with more 3- and 5-day regimens than the no-panel group.

Conclusion

Use of a pre-populated antimicrobial order panel for outpatient cystitis encounters resulted in greater adherence to institutional guideline recommendations, particularly in terms of antimicrobial selection, without adversely impacting repeat healthcare contact.

Disclosures

Paschalis Vergidis, MD, MSc, AbbVie: Advisor/Consultant|Ansun Biopharma: Grant/Research Support|Cidara Therapeutics: Grant/Research Support|F2G: Grant/Research Support|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support
P-1719. Promoting antibiotic stewardship for commercial poultry production in Bangladesh: using social and behavioral change communication approach
Authors: Murshid Hasan S M
Published: January 2025

Background

Bangladesh has a high prevalence of antimicrobial resistance due to extensive antibiotic use in humans and animals. This study aimed to develop social and behavioral change communication (SBCC) strategies to promote antibiotic stewardship in commercial poultry production in Bangladesh.

Methods

In 2022, we used formative research findings to explore contextual factors of antibiotic sale, prescribing, promotion, and use among four groups in Narsingdi, Bangladesh: 1) poultry farmers, 2) pharmacy shop employees, 3) veterinarians, and 4) pharmaceutical representatives. We conducted multiple intervention design workshops to select target behaviors and develop SBCC messaging. We used the behavior change wheel model to analyze the data and summarize the findings.

Results

Participants identified their behaviors considered to be changed and assisted in developing SBCC for all four stakeholder groups. Poultry farmers had two behaviors to change: not following infection control measures and irrational antibiotic use. SBCC target behaviors included taking appropriate infection control measures, seeking registered veterinarian consultations, and rational antibiotic use. Pharmacy shop employees had one behavior to change: unnecessary antibiotic dispensing practices. SBCC target behaviors included asking farmers for prescriptions and referring them to registered veterinarians. Registered veterinarians had one behavior to change: unnecessary antibiotic prescribing practices. SBCC target behaviors included appropriate antibiotic prescribing practices and increasing farmer awareness for rational antibiotic use. Pharmaceutical sales representatives had one behavior to change: unethical antibiotic promotion. SBCC target behaviors included appropriate antibiotic promotion.

Conclusion

We identified stakeholders considered behavior change and SBCC intervention delivery to them to promote antibiotic stewardship for commercial poultry production, including improved health-seeking behaviors, and improved health literacy on antibiotic transactions. The study findings may contribute to developing health communication materials to promote antibiotic stewardship among stakeholders in commercial poultry production in Bangladesh.

Disclosures

All Authors: No reported disclosures
P-1721. Antibiotic Prescribing in Oregon, an Analysis of Outpatient Prescribing Patterns for Acute Respiratory Tract Infections Using Oregon’s All Payer All Claims Database
Authors: Gilbreath Terran , Iguchi Lisa , Breitenstein Elizabeth , Zhang Alexia Y , Cieslak Paul R , Tran Dat
Published: January 2025

Background

Acute respiratory tract infections (ARTIs) often lead to antibiotic prescriptions in outpatient settings, many of which are unnecessary. Inappropriate prescribing of antibiotics contributes to the emergence of antibiotic resistance. Antibiotic surveillance related to ARTIs is important for identifying diagnoses and populations for which stewardship efforts are needed. The purpose of this study was to describe antibiotic prescribing trends for ARTIs in outpatient settings in Oregon, both before and during the COVID-19 public health emergency.

Methods

We queried medical and pharmacy claims during 2018–2022 in Oregon’s All Payer All Claims (APAC) database. Medical claims were restricted to index ARTI visits in outpatient settings. Antibiotic pharmacy claims were matched to ARTI claims using a unique person identifier. We defined “antibiotic use” as ARTI claims that filled an antibiotic prescription within three days of the ARTI visit.

Results

Antibiotic use was observed in 41% of ARTI visits during 2018–2022. Antibiotic use followed approximately 45% of visits in both 2018 and 2019, 37% in 2020, 30% in 2021, and 41% in 2022. Acute otitis media (AOM) had the highest antibiotic use at 81% of visits, followed by sinusitis (69%), bronchitis (56%), pharyngitis (28%), and upper respiratory infections (URI) (11%). Antibiotic use decreased with age for AOM, pharyngitis, and sinusitis - and increased with age for URIs. During 2020-2022, lower antibiotic use for ARTIs was observed, and telehealth use increased. Approximately 27% of ARTI telehealth visits, largely observed in 2020 and 2021, received antibiotics.

Conclusion

These data are likely confounded by the COVID-19 public health emergency, making comparison to previous analyses difficult. Trends in prescribing for bronchitis, pharyngitis, and URIs showed decreasing antibiotic use from 2018 to 2022. Prescribing trends for sinusitis and bronchitis, where antibiotic use is often unnecessary, indicated these ARTIs as possible targets for stewardship interventions. More broadly, claims data allows public health to monitor prescribing for diagnoses that often do not require antibiotics. Monitoring antibiotic use for ARTIs is important to identify conditions and populations for which stewardship efforts may be needed.

Disclosures

All Authors: No reported disclosures
P-1723. Comparison of Antibiotic Prescribing for Urinary Tract Infections (UTI), Sinusitis, Group A Streptococcal Pharyngitis, and Pyelonephritis by Prescriber Type
Authors: Vanhouten Brianna , Eckardt Owen , Sohn Minji , Pontefract Benjamin , Klepser Michael
Published: January 2025

Background

Introduction: Currently, 25%-40% of all outpatient visits are with physician's assistants (PAs) or nurse practitioners (NPs)1 . PAs and NPs receive less formal education on diagnosis and pharmacology than physicians. The goal of this study was to determine if there is a difference in prescribing patterns between physicians and PAs/NPs for selected infectious diseases.

Methods

Design: This was a cross-sectional study utilizing the CHARM (Collaboration to Harmonize Antimicrobial Registry Measures) database.

Methods

The CHARM database is a Michigan multi-system registry containing archival data previously collected from the medical records of partnering health systems regarding outpatient antibiotic prescribing. This project evaluated antibiotic prescribing data from July 2021 to June 2023 available through CHARM. Antibiotic prescriptions were identified and associated with ICD-10 codes for acute sinusitis, chronic sinusitis, group A streptococcal pharyngitis, UTI, and pyelonephritis. Guideline concordance between prescriber types was compared using chi-square tests.

Results

137,960 prescriptions were included in the study. Of those, 63.7% were written by PAs and NPs, and 36.3% were written by physicians. Compared to physicians, PAs and NPs, prescribed concordant antibiotics more often for acute sinusitis, chronic sinusitis, group A streptococcal pharyngitis, and pyelonephritis (P < 0.01). There was no significant difference between groups for uncomplicated UTIs (P= 0.10).

Conclusion

Our data suggests PAs and NPs prescribe antibiotics at a higher rate of guideline concordance than physicians.

Disclosures

Minji Sohn, PhD, Emergent BioSolutions, Inc.: Grant/Research Support
P-1730. Implementation of Pharmacist-Led Intervention on Oral Antibiotic Prescribing within Hospital Discharge Medication Reconciliation
Authors: Patel Amolee R , Gavaghan Victoria , Dilworth Thomas J
Published: January 2025

Background

Inappropriate antibiotic exposure places patients at risk for collateral damage. Hospital discharge presents an opportunity to ensure antibiotic regimens represent an appropriate continuation of inpatient therapy and adhere to evidence-based activity spectrum and therapy duration recommendations. We sought to determine the impact of a pharmacist-led antibiotic stewardship intervention on oral antibiotic prescribing at hospital discharge, informed by institutional guidelines and targeted pharmacist education.

Methods

This was a quasi-experimental study in which an antibiotic stewardship intervention was implemented within a 27-hospital, integrated health-system for patients discharging on oral antibiotics. Data following systemwide implementation (Jan-March 2023; POST) were compared to retrospective data without intervention (Aug-Sept 2022; PRE). The primary outcome measure was institutional guideline-discordant discharge regimens (agent, dose, duration of therapy). Secondary outcomes included treatment associated adverse-events, 30-day readmissions and treatment failure.

Results

A total of 560 patients were included, 300 (53.6%) in PRE and 260 (46.4%) in POST. The most common antibiotic indications were community-acquired pneumonia (13.7%), urinary tract infection (26.8%) and skin and soft tissue infection (31.1%). The most frequent discordances included extended durations of therapy (47.7%), inappropriate targeted or empiric coverage (11.4%) and fluoroquinolone use in the setting of available alternatives (7.9%). Outcome results shown in Table 1. Pharmacists intervened upon 63 (24.2%) patients in POST with an 81.0% intervention acceptance rate. Rates of guideline-discordant regimens and treatment-associated adverse events were significantly lower in POST. Both median outpatient duration of therapy and total duration of therapy were significantly lower in POST as seen in Table 2.

Conclusion

Hospital discharge is an important opportunity for antimicrobial stewardship programs. A pharmacist-led antibiotic stewardship initiative resulted in intervention on and optimization of guideline-discordant regimens. This initiative was also associated with both decreased antibiotic exposure and treatment-associated adverse events.

Disclosures

All Authors: No reported disclosures
595. The Effect of Herpes Zoster Vaccination on New Diagnoses of Dementia: A Quasi-randomized Study in Australia
Authors: Pomirchy Michael , Bommer Christian , Geldsetzer Pascal
Published: January 2025

Background

We have recently provided evidence from a quasi-randomized study in Wales that herpes zoster (HZ) vaccination reduced the incidence of new dementia diagnoses. This study used a similar quasi-randomization in Australia to determine the effect of HZ vaccination on new dementia diagnoses over 7.5 years.Figure 1:Eligibility for a free herpes zoster (HZ) vaccine reduces dementia diagnosesIn panel (a), a regression discontinuity is plotted, where the forcing variable is the number of weeks from the cutoff (November 2, 1936) and the outcome is dementia diagnoses (in percentages). The triangular dots indicate dementia diagnoses for the comparison group, scaled up by the intercept for the main cohort. Panel (b) describes this effect for different follow-up periods, and panel (c) shows the effect for different grace periods.

Methods

In Australia, starting on November 1 2016, live-attenuated HZ vaccination was provided for free to individuals aged 70 to 79 years of age. Thus, those whose 80th birthday was just a few days prior to November 1 2016 never became eligible, whereas those whose 80th birthday was a few days later were eligible for one year. There is no reason to expect that these population groups who differ in their age by only a minute degree should differ in any of their dementia-related characteristics. We used detailed primary healthcare records (provided by PenCS) with week-of-birth information from 65 general practices across Australia. We analyzed our data using a comparative regression discontinuity design, with dementia diagnoses from older birth cohorts serving as a comparison group.

Results

Of 108,670 patients in our data, 15,297 were born between November 2 1928 and November 2 1944. At baseline, patients were well-balanced across the date-of-birth eligibility threshold (November 2 1936) for HZ vaccination in their preventive health services uptake and chronic disease diagnoses. There was an abrupt increase of 13.2 (95% CI: [8.7, 17.6], p = 0.001) percentage points in the probability of ever receiving HZ vaccination between patients born shortly before versus shortly after the eligibility threshold. Eligibility for a free HZ vaccination caused a 3.9 percentage point (95% CI: [1.7, 6.1], p = 0.001) decrease in the probability of receiving a new dementia diagnosis over 7.5 years. Being eligible for HZ vaccination did not affect the probability of taking up other preventive health services (including other vaccinations) nor do we find consistent evidence that it affected the probability of receiving any of the twenty most common disease diagnoses in our data.

Conclusion

In conjunction with our findings from Wales, these results from Australia constitute robust evidence that live-attenuated HZ vaccination may delay or prevent dementia.

Disclosures

All Authors: No reported disclosures
P-1739. Impact of a Urinary Tract Infection Treatment Algorithm on Antimicrobial Prescribing at a Small Rural Hospital without Formally Trained Infectious Disease Team Members
Authors: West Daniel , Becker Shane , McClew Nancy
Published: January 2025

Background

Small, rural community hospitals lack certified infectious disease (ID) staff, which can make antimicrobial stewardship (AMS) interventions challenging. At our Critical Access Hospital, we developed a treatment algorithm for urinary tract infections (UTIs) and assessed appropriate duration of therapy (DOT), and appropriate antimicrobial selection in cases before and after implementation of our algorithm.

Figure 1.

Methods

In this retrospective observational study, the AMS team published a treatment algorithm for UTIs (Figure 1) in Q1 2023. Implementation of the algorithm focused on physician exposure, buy-in, and follow-up. A webpage was created to house the algorithm. Buy-in was obtained from key physicians. Antimicrobial prescribing was reviewed at quarterly AMS meetings and physician leaders took this information back to their teams for review. A retrospective review was performed after 2 quarters of interventions.

We obtained prescribing data via electronic health records. Baseline characteristics are in Table 1. Each UTI case was manually reviewed for DOT and appropriateness of antibiotic choice as defined by agreement with our algorithm.

Results

The study included in-patients who were treated for UTI between 10/1/21 through 3/31/22, and 10/1/23 through 3/31/24. Exclusion criteria included concomitant infections, inability to follow-up, and expiration. A t-test was performed to compare antibiotic DOT for UTI treatment. The distribution of DOT is presented in Figure 2. There was a decrease in DOT after our intervention (M=3.84, SD 1.95) compared to baseline (M=4.95, SD=2.64); t(2.2491), P=0.0271. Appropriateness of therapy was assessed (Figure 3). A Chi-square test showed association between the intervention and appropriate choice of therapy, χ2 (1, N= 88)= 12.90, p=0.0003.

Figure 2.

Antibiotic days for the treatment of UTI. Antibiotic days calculated to include discharge medications.

Conclusion

The development of a treatment algorithm for UTI, paired with stakeholder buy-in, exposure, and follow-up, led to shifts in prescribing habits. We found a reduction in DOT, as well as better adherence to guideline driven antibiotic selection. This study, which included discharge prescribing, is unique in that it follows our cases through the continuum of care. We show that rural hospitals without certified ID staff can effectively implement AMS best practices and affect meaningful change.

Figure 3.

Retrospective contingency table summarizing number of appropriate and inappropriately treated UTIs. Appropriateness determined by AMS team by comparing antibiotic selection to our UTI algorithm.

Disclosures

All Authors: No reported disclosures
P-1743. Impact of a carbapenem centered antimicrobial stewardship program in the antibiotic consumption patterns and healthcare infections in a tertiary public hospital in Colombia
Authors: Muñeton Lopez Gerardo A , Amaya Maria Juliana , Suarez David , Vergara Hernan
Published: January 2025

Background

Antimicrobial stewardship programs (ASP) recommend the control of multiple antibiotics related to bacterial resistance in order to prevent the induction of ESBL, carbapenemases, and vancomycin resistance. Nevertheless, the control of all these antibiotics sometimes is not possible due to the limited workforce in the ASP team. In this study, we decided to limit all ASP interventions to the control of carbapenems, leaving the intervention of other antibiotics as a secondary task

Methods

A before and after study was conducted from July 2022 to July 2023, with a baseline period (July to December 2022) and an intervention period (January to July 2023). During the intervention, the ASP emphasized carbapenem prescription control while addressing other antibiotics as secondary concerns. Daily monitoring of meropenem and ertapenem prescriptions was prioritized, with other antibiotics monitored as resources allowed only when all carbapenem prescriptions were assessed. Selective reporting eliminated carbapenems from antibiograms in natural resistance patterns, and susceptibility testing for piperacillin-tazobactam was expanded to guide carbapenem-sparing therapies. Educational sessions focused on appropriate carbapenem use

Results

A decrease in the consumption of carbapenems was observed between the baseline period and the intervention period going from 13.52 (DDD/100 patient days) to 5.84 for meropenem and from 2.70 to 0.59 for ertapenem. Chart1. Additionally, a decrease in the infection rate was observed going from an average of 0.79 (cases/1000 patient days) in the baseline period to an average of 0.47 in the intervention period. Chart 2. The prevalence of carbapenemase producing enterobacterales did not change between the pre and post intervention period but the infection rate did. Chart 3. The non supervised use of other antibiotics was not related to an increase in their consumption. Chart 4.

Conclusion

ASP strategies can be directed toward a specific antimicrobial group in the pursuing of controlling specific problems such as carbapenem overuse and carbapenemase-producing-enterobacterales. These directed strategies can be implemented without an increase in the consumption of other antimicrobial groups.

Disclosures

All Authors: No reported disclosures
P-1746. Evaluating Microbiology Reporting on Time to Appropriate Therapy for Organisms Producing Extended-spectrum and AmpC β-lactamases
Authors: Samsel Alison , Kelly Jennifer , Harrington Nicole , Curran Kelly , Ing Julie , Borja Clint
Published: January 2025

Background

Our Antimicrobial Stewardship Program (ASP) implemented specific treatment recommendations and suppression of select susceptibility results for microbiology reports positive for extended-spectrum β-lactamases (ESBL) and AmpC producing organisms. These statements also recommend Infectious Diseases (ID) consult if needed. This change is in alignment with the Clinical and Laboratory Standards Institute (CLSI) recommendations.Figure 1:Microbiology lab reporting statementsA. ESBL organism statements. B. AmpC organism statements.

Methods

This study was a single-center, retrospective cohort of adult patients with monomicrobial infections due to organisms at high-risk for AmpC or ESBL production. The intervention was effective February 28th, 2023. See Figure 1. Data was collected by chart review for pre- and post-intervention groups from April 1st to September 30th, 2022, and April 1st to September 30th, 2023, respectively. The primary outcome was the time to appropriate definitive antibiotic administration. Appropriate antibiotic therapy was defined by the Infectious Diseases Society of America (IDSA) 2023 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections guidelines. Secondary outcomes included guideline-adherent antibiotic therapy, frequency of ID consultations, and inappropriate antibiotic de-escalation.

Results

Time to appropriate antibiotic administration was not significantly different between the pre- and post-intervention group (median time 8.6 hours vs. 8.3 hours, respectively). The frequency that patients received guideline-adherent therapy significantly increased between groups (pre- 67% vs post- 81%, p = 0.024). ID consultations also significantly increased (pre- 52% vs post- 77%, p = 0.005). Inappropriate de-escalation of therapy based on susceptibilities significantly decreased between groups (pre- 12% vs post- 2%, p = 0.047).

Conclusion

The implementation of microbiology reporting statements increased guideline-adherent definitive antibiotic therapy, increased ID consultations and decreased inappropriate antibiotic de-escalation.

Disclosures

All Authors: No reported disclosures
P-1749. Implementation of an Automatic 36-hour Stop Order on Empiric Meropenem Usage
Authors: Parker Connor , Schneider Jack G , Boyd LaKeisha , Kussin Michelle L
Published: January 2025

Background

Implementation of automatic stop orders (ASOs) for empiric antimicrobials have reduced antimicrobial use without negatively impacting patient outcomes. Given a recent increase in empiric meropenem use at our tertiary referral pediatric hospital, a 36-hour meropenem ASO option was implemented in the EMR for patients with sepsis requiring empiric antibiotics active against ESBL-producing organisms. We sought to evaluate the impact this initiative had on meropenem use and safety outcomes.

Methods

A 36-hour ASO for meropenem was implemented on October 12th, 2022. We conducted a single-center, retrospective pre/post evaluation of order set implementation of all patients admitted to Riley Hospital for Children and treated with meropenem between 9/01/2019–9/01/2021 (pre-intervention) and 10/13/2022–10/13/2023 (post-intervention). The primary outcome was meropenem utilization, as measured by the number of meropenem days and doses per admission. Secondary outcomes included total hospital and ICU mean length of stay (LOS), mortality within 30 days of meropenem exposure, and 30-day readmission rate.

Results

309 admissions during which meropenem was administered were included. Demographics between pre-ASO (147 patients; n = 193 admissions) and post-ASO (88 patients; n = 116 admissions) groups were similar. There was no difference in the number of meropenem days (pre and post-ASO: median = 4; p = 0.88) or the number of meropenem doses (pre-ASO: 11 vs. post-ASO: 10; p = 0.63). Secondary safety outcomes including death within 30 days of meropenem administration (8.7% vs. 8.7%; p = 0.99), hospital LOS (18 vs 15.5 days; p = 0.42), ICU admission, and 30-day readmission rate were not significantly different. The new ASO was utilized in 23.3% of admissions in the post-implementation period.

Conclusion

Use of the new ASO was not widely adopted, making evaluation of impact difficult. No significant difference in meropenem use nor clinical outcomes were identified after implementation, which has informed the next Plan-Do-Study-Act (PDSA) cycle for quality improvement at our center, likely with a focus on EMR modifications and education.

Disclosures

Jack G. Schneider, MD, MiraVista Diagnostics: Advisor/Consultant
P-1753. Impact of a Microbiology Reporting Change on Treatment Selection and Clinical Outcomes for Organisms at Low-Risk for Significant AmpC Production
Authors: Hodapp Ellie , Kinn Patrick M , Ford Bradley A , Auerbach Sarah , Weiner Lukasz , Ince Dilek , Percival Kelly M
Published: January 2025

Background

AmpC β-lactamase production can be induced after exposure to beta lactam antimicrobials, most notably ceftriaxone (CRO), leading to development of resistance on therapy. New guidance from IDSA indicates that the risk of AmpC enzyme production is not equal among all Enterobacterales and those deemed low-risk may be treated with CRO. The purpose of this study was to evaluate the impact of a microbiology reporting change made in collaboration with our antimicrobial stewardship program (ASP) to guide antibiotic selection for low-risk AmpC organisms.

Methods

This was a pre-test, post-test quasi-experimental study with data collected by chart review. A microbiology comment warning against the potential for inducible resistance on therapy with CRO was present pre-test and was removed in the post-test period. A didactic education session was given by ASP to medicine services. The study enrolled hospitalized patients ≥1 month old treated for infection with a low-risk AmpC organism (Serratia marcescens, Morganella morganii, Proteus vulgaris, and Providencia spp.) pre- (3/21-2/22) and post-intervention (8/22-7/23). Further inclusion and exclusion criteria are in table 1. The primary outcome was rate of carbapenem-sparing definitive treatment. Secondary outcomes were rate of CRO definitive therapy along with 30-day readmission, retreatment, mortality, and development of CRO resistance.

Results

73 patients were included: 36 (49%) pre- and 37 (51%) post-intervention. Patient, infection, and treatment characteristics are described in table 2.Serratia marcescens was the most common organism isolated with the most frequent sources being respiratory and urinary. There was no significant difference in the rate of carbapenem-sparing therapy between the pre- (83%) and post-(81%) intervention, p=0.59. No difference was found in CRO as definitive therapy in either group (25% vs. 33%, p=0.49) as well. No difference was seen in secondary clinical outcomes (table 3). For those with repeat positive cultures within 30 days, none developed CRO resistance.

Conclusion

The combination of changing microbiology reporting and a single ASP education session did not change antibiotic selection for low-risk AmpC producing organisms. Despite updated guidance the uptake in practice is slow.

Disclosures

All Authors: No reported disclosures
P-1754. An Antimicrobial Stewardship Program (ASP) Without Antibiotic Restrictions - Performance Update
Authors: Leuthner Kimberly D
Published: January 2025

Background

In 2011, University Medical Center of Southern Nevada (UMC) in Las Vegas presented introductory results of a simple, yet effective ASP program with the unique strategy of not restricting antibiotics. Since this time, ASP has continued to strive towards appropriate antimicrobial use in an attempt to improve patient care and minimize development of resistance. This project is an update of the progress of this ASP program in terms of resistance, antibiotic use and costs.

Methods

ASP started January 2008 with minimal resources. Baseline activities included targeted medication use evaluation (MUE), duration regulation, expansion of infection prevention and education. In contrast to many ASP programs our program did not restrict antibiotics – formulary agents were available for any practitioner. Over time activities were adjusted, reporting technologies advanced although personnel resources remained limited. ASP modifications:Added MUE agentsTiered sensitivity reportingReduce duration to 7 daysExpand service to 6 days per week

Deviating from initial procedures, in 2015 we implemented restriction of 5 “last-line” antimicrobials to UMC employed Infectious Disease Physicians (table 1) using the EHR. Markers of ASP progress was monitored by rates of organism isolation per 1000 patient days and antimicrobial in days of therapy per 1000 patient days. Financial implications were based on antibiotic expenditures per adult patient day.

Results

Monitored bacterial pathogens decreased 65 – 94% (table 2). The largest reduction was with Acinetobacter sp. followed by carbapenem resistant P. aeruginosa. Antibiotic use also improved (table 3). Overall use was decreased 71.3 ± 14.7% with the largest changes with fluoroquinolones and piperacillin/tazobactam. Of note, not all antibiotics reported are MUE, and use of these agents still improved. Despite expanding formulary, and cost monitoring activities, antibiotic expenditures decreased 47% per adult patient day.

Conclusion

ASP at UMC has demonstrated that simple programs, with limited resources, can decrease the use of unnecessary antimicrobial agents and isolation of specific bacterial pathogens. Additional benefits include a decrease in hospital costs without requiring significant restriction of antimicrobial agents.

Disclosures

Kimberly D. Leuthner, PharmD, FIDSA, AbbVie Inc.: Advisor/Consultant|AbbVie Inc.: Honoraria|Basilea Pharamceutica: Advisor/Consultant|La Jolla Pharmaceutical Company: Honoraria|Merck: Advisor/Consultant|Merck: Honoraria|Shionogi, Inc: Honoraria