bluuebunny/crossref_metadata_2025 huggingface dataset:
P-1695. Antimicrobial prescribing differences for urinary tract infections between advanced practice practitioners and physicians at a safety-net community hospital
Authors: Hua Jessica , Balaji Aakash , Pomerantz Ben , Huber Dylan , Sanchez Lawrence , Ali Mirza , Mena Lora Alfredo J
Published: January 2025

Background

Advanced practice practitioners (APPs) are increasingly working in inptient settings as hospitalists. Despite these trends, there's a paucity of data on APP antimicrobial prescribing practices. Antimicrobial stewardship programs (ASPs) can reduce antimicrobial overuse and misuse. One of the most common infections in the inpatient setting is urinary tract infections (UTIs). We examine antibiotic prescribing practices of APPs and physicians for treatment ofUTIs. Understanding prescribing practices can highlihgt stewardship gaps and help guide ASP efforts.

Figure 1

UTI severity and empiric antimicrobial selection by physicians and APPs

Methods

A retrospective analysis of antimicrobial prescriptions was conducted at a 151-bed community hospital. ASP prospective audit and feedback (PAF) data for UTIs from July 2022 to June 2023 was reviewed, including initial antimicrobial selection, duration, and guideline concordance for APPs and physicians. Guideline adherence, antimicrobial effectiveness based on local antibiogram, and days of therapy (DOT) per 1000 patient days was compared between APPs and physicians.

Figure 2

Empiric antimicrobial selection by physicians and APPs

Results

A total of 209 initial PAF events for UTIs were reviewed, of which, 161 were physicians and 48were APPs. Physicians’ initial empiric choice was 9% (15) guideline discordant and ineffective. APP initial choice was 17% (8) guideline discordant and ineffective. TMP-SMX was more commonly used by APPs (Figure 1). Total DOT/1000 was 145. DOT/1000 was 44 for physicians, of which 11% were anti-pseudomonal beta lactams (APBLs) and 34% non-APBLs. DOT/1000 was 21 for APPs, of which 19% were APBLs and 27% non-APBLs (Figure 2). DOT/1000 was 44 for physicians, of which 11% were anti-pseudomonal beta lactams (APBLs) and 34% non-APBLs. DOT/1000 was 21 for APPs, of which 19% were anti-pseudomonal beta lactams (APBLs) and 27% non-APBLs (Figure 2).

Conclusion

APPs more commonly chose guideline discordant or ineffective initial empiric choices for UTIs compared to physicians. Empiric selection of ineffective agents according to local antibiogramswas higher for APPs. This underscores the importance of targeted ASP education on UTI guidelines and local antibiogram interpretation to improve antibiotic prescribing practices among APPs.

Disclosures

All Authors: No reported disclosures
P-1699. Antimicrobial Administration and 30-Day Outcomes in Patients Hospitalized with MRSA-Related Infections who Self-Discharge
Authors: Lewis Julia , Nechodom Kevin , Jones Makoto M
Published: January 2025

Background

Management of serious infectious diseases typically includes hospitalization and IV antibiotics, particularly where methicillin-resistant Staphylococcus aureus (MRSA) is the causative organism. When patients with these infections decide to self-discharge, it presents a challenging clinical decision for their providers. Here we describe antimicrobial prescribing practices for patients hospitalized with different infectious disease diagnoses and their 30-day outcomes.

Methods

This retrospective cohort study included patients 18 years and older admitted between January 1, 2010, and December 31, 2019, with admission blood cultures growing MRSA. Veterans Affairs (VA) electronic health data was extracted from the Veterans Informatics and Computing Infrastructure, microbiology data, inpatient antibiotic administration, discharge antibiotic prescriptions, ICD-9- and ICD-10-CM coded infectious disease discharge diagnoses, discharge type (self-discharge or regular discharge), as well as 30-day all-cause mortality and readmission. Descriptive statistics were used to compare antibiotic prescribing for specific infectious diseases between self- and regular discharges.

Results

While hospitalizations with patients self-discharging were lower for each infectious disease, their total antibiotic days were similar for most listed MRSA-related infections. However, for 30-day readmission rates, there was a higher rate among self-discharged patients for most all infections except cardiovascular. Conversely, 30-day mortality appeared to be higher among regular discharges for most infectious disease diagnoses except central nervous system and bloodstream infections.

Conclusion

While this analysis is preliminary, there is a concerning trend towards higher 30-day readmissions for patients with MRSA infections who self-discharge, despite similar durations of MRSA-directed antibiotic prescribing. This suggests additional factor(s) than antibiotic administration that play a role in readmissions for this patient population. Further research is needed to elucidate what factors contribute to readmission for patients who self-discharge from hospitalization for serious MRSA-related infections.

Disclosures

All Authors: No reported disclosures
P-1702. Evaluation of Prescribing Practices and Treatment Failure in Obese Patients Diagnosed with Purulent Skin and Soft Tissue Infections in Outpatient Settings Across Michigan
Authors: Miller Mackenzie , Hughson Destiny , Blower Noah , Jameson Andrew , Dumkow Lisa E
Published: January 2025

Background

Obesity has been associated with increased risk of antibiotic treatment failure in skin and soft tissue infections (SSTI), however optimal treatment of SSTIs in obesity is unclear with limited data available. The goal of this analysis was to assess prescribing practices and risk factors for treatment failure in obese patients treated for purulent SSTI with oral antibiotics in the outpatient setting.

Methods

This retrospective, multicenter cohort study evaluated patients treated for purulent SSTI from February 1, 2020 - August 31, 2023, at Michigan outpatient locations within a health system. Patients ≥ 18 years with a body mass index (BMI) ≥ 30 kg/m2 and creatinine clearance ≥ 30 mL/min who received a ≥ 5-day course of oral antibiotics for purulent SSTI were included. Key exclusion criteria were chronic infections, antibiotic treatment within the past 30 days, and those requiring hospital admission. The primary endpoint was to describe prescribing practices. Secondary endpoints included comparing risk factors for treatment failure, revisit, or admission within 30 days between patients with treatment success (Tx-S) and treatment failure (Tx-F). Treatment failure was defined as a recurrence of infection or need for re-treatment within 30 days.

Results

200 patients were included (Tx-S, n = 100; Tx-F, n = 100). Baseline characteristics were similar between groups. Patients received 11 different antibiotic regimens with 26 dosing variations. Cephalexin monotherapy was most commonly prescribed (30%); 67% of patients received MRSA-active therapy, however, no patient received linezolid. Treatment failure was similar between those appropriately dosed (46.4%) vs. under-dosed (54.4%) (p=0.256), those who received 5-7 days of therapy (47.1%) vs. 10-14 days (54.4%) (p=0.311), and those who received MRSA-active therapy (52.2%) vs. no MRSA therapy (45.5%) (p=0.367). Patients treated with clindamycin were more likely to experience treatment failure (73.7% vs 47.5%, p=0.030) and had a higher rate of 30-day revisit (68.4% vs 47%, p=0.075).

Conclusion

Antimicrobial prescribing for outpatient treatment of purulent SSTIs in obese patients was heterogenous across a Michigan health system. Opportunities exist to optimize agent selection, dosing, and duration of therapy in this population.

Disclosures

All Authors: No reported disclosures
P-1704. Impact of an Empiric Antibiotic Pocket Guide on Rates of Guideline-concordant Empiric Regimens for Inpatient Community-acquired Pneumonia at a Community Hospital
Authors: Bernauer Elizabeth , Brenneman Martin , Johnson Taylor H
Published: January 2025

Background

Community-acquired pneumonia (CAP) is a common cause of hospital admissions and studies have shown concordance with guideline recommendations improves outcomes. Antibiotic pocket guides (PG) have been shown to increase use of preferred agents in urinary tract and intra-abdominal infections, but their impact on inpatient CAP treatment has not yet been evaluated. This study sought to evaluate the impact of a newly introduced empiric antibiotic PG (introduced May 2023) on rates of guideline-concordant empiric CAP regimens within 24 hours of admission.

Methods

This retrospective, pre-post, quasi-experimental study conducted at a 300-bed community hospital included adult inpatients initiated on antibiotics with order indication of pneumonia (+/- sepsis) within 24 hours. Patients were excluded if other indications were selected, if they had severe β-lactam allergies precluding use of all recommended agents, or if initiated on azithromycin or doxycycline alone. Included patients were randomly stratified 1:1 from pre-PG (Jul–Sep 2022) and post-PG (Jul–Sep 2023). The primary outcome was the rate of guideline-concordant empiric antibiotic selection for CAP between the two time periods. Secondary outcomes included total duration of therapy and C. difficile rate within 60 days of admission. Length of stay and all-cause mortality within 30 days of discharge were exploratory safety outcomes.

Results

300 patients were included,150 per group. Baseline demographics and risk factors were similar between groups except for higher rates of ICU-admission and recent hospitalization with IV antibiotics in the pre-PG group (Table 1). Patients received a guideline-concordant regimen more frequently post-PG than pre-PG, but this did not reach statistical significance (44.7% vs 35.3%, p = 0.099). No difference in appropriate duration was observed. 30-day all-cause mortality was significantly higher in the pre-PG group (p = 0.015). Other details on management and outcomes can be seen in Table 2 and Figures 1-2.

Conclusion

Introduction of an antibiotic pocket-guide did not result in a significant change in guideline-concordant empiric CAP treatment in this study. Though no evidence of harm was observed, other interventions may be needed to improve guideline-concordant inpatient CAP treatment.Figure 2.Hospital Length of Stay

Disclosures

Martin Brenneman, PharmD, BCIDP, Cardinal Health, Inc.: Stocks/Bonds (Public Company)|Dexcom, Inc: Stocks/Bonds (Public Company)|Insulet Corp.: Stocks/Bonds (Public Company)|Johnson & Johnson: Stocks/Bonds (Public Company)|Medtronic Plc: Stocks/Bonds (Public Company)
P-1705. Infectious Diseases Pharmacist Curbsides: Questions Infectious Diseases Providers Ask Infectious Diseases Pharmacists
Authors: Davis Matthew , Kufel Julia , Kufel Wesley D , Ross Jennifer , Oleksiuk Louise-Marie , Ours Rachael , Smith Ethan A , Pham Christine , Trisler Michael J , Tverdek Frank
Published: January 2025

Background

Infectious Diseases (ID) consult services, typically led by ID physicians, benefit significantly from the support of ID pharmacists. These pharmacists, with specialized training in ID pharmacotherapy through post-graduate residencies or fellowships, play a crucial role in advising on the selection, dosing, duration, and monitoring of antimicrobials. While the contribution of ID pharmacists to antimicrobial stewardship programs is well described, their impact in supporting ID consult services remains underdocumented. This report explores the clinical inquiries made by ID physicians and advanced practice providers (APP) to ID pharmacists on consult services, detailing how these interactions influence patient treatment and monitoring plans.Figure 1ID Pharmacist Curbside Question Categories (Categories with 2+ Submissions)

Methods

Ten ID residency- or fellowship-trained clinical pharmacists practicing in various practice settings documented questions they received from ID providers (attendings, fellows, and APPs) for patients on their respective ID consult service over a 6-month period. The impact of the conversations was documented if the pharmacist recommending a new drug, dose, duration, or monitoring plan which resulted in a change in care. Additional information was captured on the time spent answering questions, category of question, and pertinent microbiology or organism phenotype to describe areas of highest need for ID pharmacist support.Figure 2Questions Leading to Therapeutic Change

Results

Over the first three months of documentation, 782 questions were asked by ID providers to ID pharmacists. Total direct time spent answering questions was 8,937 minutes. The top three question categories were gram-negative resistance, antifungal therapy, and antimicrobial allergies. Seven hundred and three (89.8%) questions resulted in a clinical change in management as recommended by the ID pharmacist. The most common clinical change category was recommending a new dose which occurred in 57.4% of questions followed by new antimicrobial 50.4%, new monitoring plan 24.2% and new duration of therapy 8.8%.

Conclusion

ID pharmacists offer critical support that frequently changes management on ID consult services. Integrating their expertise into a multidisciplinary ID team is essential for achieving optimal patient safety and treatment outcomes.

Disclosures

Wesley D. Kufel, Pharm.D., BCPS, BCIDP, Merck & Co.: Grant/Research Support|Shionogi, Inc: Grant/Research Support Jennifer Ross, PharmD, BCIDP, Shionogi Inc.: Advisor/Consultant Frank Tverdek, PharmD, Merck: Advisor/Consultant
P-1706. Understanding Facility Bed Size Changes in NHSN over the COVID-19 Public Health Emergency
Authors: Arar Olivia , Iguchi Lisa , Breitenstein Elizabeth , Zhang Alexia Y , Tallman Gregory B , Tran Dat , McGregor Jessina C
Published: January 2025

Background

Antimicrobial use surveillance data within National Healthcare Safety Network (NHSN) uses patient care location mapping data to define locations and inform risk adjustment. During the COVID-19 public health emergency, many hospitals changed how beds were utilized. This study compares location mapping changes over time within a statewide hospital antimicrobial stewardship collaborative during the COVID-19 public health emergency.Figure 1.Frequency of Facilities by Change in Total Beds from 2019

In this analysis, each facility's change in total bed count was subtracted from the 2019 value to classify the change as an increase, decrease, or no change in each year of analysis. The figure demonstrates that total bed counts varied in the direction of change; there was no significant difference in the direction of change across years (p=0.63) .

Methods

We utilized facility survey data from facilities who submitted data from 2019-2022 to the Oregon Antimicrobial Stewardship Network (ORASN) NHSN group. Annual total bed and ICU bed counts were compared to 2019 data for each facility. Changes in bed counts were also categorized as increases, decreases, and no change and compared using the Fisher’s exact test.Figure 2.Frequency of Facilities by Change in ICU Beds from 2019

In this analysis, each facility's change in ICU bed count was subtracted from the 2019 value to classify the change as an increase, decrease, or no change in each year of analysis. The figure demonstrates that ICU bed counts increased in all years; there was no significant difference in the direction of change across years (p>0.99) .

Results

Nineteen hospital facilities contributed sufficient data and were included in analysis. Overall, there was a mean decrease in total bed count in 2020 (-8.16 ± 26.68) and 2021 (-4.16 ± 29.3) but an increase in 2022 (27.89 ± 68.39) when compared to 2019 baseline total bed counts at each facility. The total bed counts decreased in 8.77% of facilities in 2020 and 8.77% in 2021; while increases were observed among 21.05% in 2022 (p = .63; see Figure 1). There was a mean increase in the total number of ICU beds in 2020 (3.95 ± 9.51), 2021 (4.47 ± 10.89), and 2022 (4.63 ± 10.05) when compared to 2019 baseline data. The ICU bed counts increased in 8.77% of facilities in 2020, 8.77% in 2021, and 10.53% of facilities in 2022 (p > .99; see Figure 2).

Conclusion

The data suggest that location mapping changed meaningfully across the COVID-19 public health emergency with no clear trend. Interpretation of the antimicrobial use data over time and risk adjusted metrics must consider these shifts. Further efforts are needed to understand NHSN location mapping changes in the context of actual historical bed utilization during this time frame.

Disclosures

All Authors: No reported disclosures
P-1707. A Comparative Analysis of Clindamycin versus Linezolid as Adjunctive Anti-toxin Therapy for Invasive Group A Streptococcal Infections
Authors: Jagannathan Megha , Jordan Tamara , Kinsey Daniel , Kenney Rachel M , Veve Michael , Shallal Anita , Suleyman Geehan
Published: January 2025

Background

Group A Streptococcus (GAS) is an important pathogen that can cause life-threatening disease. Clindamycin (DA) and linezolid (LZD) have been used as adjunctive antitoxin (AT) therapy in high-inoculum GAS infections to inhibit bacterial protein synthesis. However, there is concern about DA efficacy in the era of increasing DA resistance, where LZD may have a role. We evaluated outcomes of patients with invasive GAS infection who received DA or LZD.Table 1.Comorbidities and clinical syndromes of patients receiving Clindamycin vs. Linezolid (n=158)

Methods

Retrospective cohort study comparing patients with positive blood cultures (BC) for GAS from June 2013-Dec 2023 treated with DA or LZD ≥ 48 hours. We identified patients using a data query for positive BC for GAS through Microsoft SQL. Patients aged < 18 years, or those with polymicrobial bacteremia, receipt of both AT therapies, incomplete data, or enrolled in hospice/died within 48-hours of admission were excluded. Collected variables included: demographics, infection characteristics, microbiologic data, adjunct therapy (surgical, immunoglobulin), and clinical outcomes (treatment-associated adverse events, 30-day all-cause mortality and infection-related readmission).Table 2.Severity of illness and adjunctive therapies of patients receiving Clindamycin vs Linezolid (n=158)

Results

158 patients were included; 117 patients received DA and 41 patients LZD. Baseline characteristics were similar among groups except for chronic kidney disease, which was more common in the LZD group (Table 1). The most common clinical syndrome accompanying bacteremia in both groups was abscess/cellulitis; bone and joint infection was more prevalent in the LZD group. 55 (33.5%) of GAS isolates were DA resistant. There was no significant difference in severity of illness, surgical interventions, or duration of therapy between the two groups (Table 2). Duration of bacteremia was significantly longer in the LZD group. There was no significant difference in readmission (10.3% vs 12.2%, p=0.77) or all-cause mortality within 30 days (17.1% vs 7.3%, p=0.13) in the DA versus LZD groups. Treatment-associated adverse events were low across both groups [Figure 1].

Conclusion

Despite increasing DA resistance at our facility, there was no significant difference in outcomes between patients treated with LZD vs DA plus standard therapy, consistent with prior literature. Further studies are needed to determine optimal therapy for invasive GAS.

Disclosures

Rachel M. Kenney, PharmD, BCIDP, Medtronic Inc: Spouse is an employee, stockholder
593. Randomized, Double-Blinded, Placebo-Controlled, Phase 1 Study of the Safety of BPL-1357, A BPL-Inactivated, Whole-Virus, Universal Influenza Vaccine
Authors: Tudor Giurgea Luca , Han Alison , Czajkowski Lindsay , Ann Baus Holly , Mak Gregory , Adao Kimberly , Bellayr Ian , Cervantes-Medina Adriana , Gouzoulis Monica , Sherry Jenna , Athota Rani , Callier Viviane , Hunsberger Sally , Park Jaekeun , Taubenberger Jeffery , Memoli Matthew J
Published: January 2025

Background

Better influenza vaccines are needed, not just for seasonal strains but for future pandemic viruses. BPL-1357 is a whole-virus, β-propiolactone-inactivated vaccine containing four wild-type, low-pathogenicity avian influenza viruses (H1N9, H3N8, H5N1, and H7N3). In mice and ferrets, BPL-1357 provided robust protection against challenge with a diverse set of influenza A viruses, including completely heterosubtypic strains.

Methods

A phase 1, randomized, placebo-controlled, double-blinded, study was performed in volunteers 18 to 55 years of age using a single dose-level of vaccine given twice 28-days apart, either intramuscularly (IM) or intranasally (IN). Forty-five participants were block randomized (1:1:1) to receive IM BPL-1357 and IN placebo (IM group), IM placebo and IN BPL-1357 (IN group), or IM placebo and IN placebo (placebo group). Adverse events (AEs) were solicited using a questionnaire for 7 days after each vaccination and volunteers had medical follow-up for 182 days after the second vaccine (V2D182). Solicited AEs were presented visually as proportions. AEs were compared using tests of proportions at day 28 (V2D28) and V2D182.

Results

Forty-five participants were enrolled between June 27, 2022 and November 9, 2022 and randomized into each group (n=15,15,15). Two participants (placebo group) delayed or missed their second dose because they developed COVID-19. No serious AEs were observed. Most AEs were mild. Injection site pain was the most common AE, which occurred in 87%/67% of the IM group after each vaccine dose respectively, but only in 33%/0% of the IN group, and 13%/21% of the placebo group. Other AEs, such as fatigue and headache, were similarly observed across the three groups. There was a severe AE possibly related to the IN vaccine (fever 39-40°C) which occurred after the first dose, but not the second. When comparing intervention-related AEs, only injection site pain was found to occur more frequently in the combined IM+IN group relative to placebo.

Conclusion

BPL-1357 was safe and well-tolerated. Pain at the injection site was commonly seen in the IM group, though was mostly mild. Other AEs were similar in frequency between vaccine and placebo groups. Further work to determine the immunogenicity and efficacy of BPL-1357 is underway.

Disclosures

All Authors: No reported disclosures
P-1715. Antibiotic Stewardship based on the usage of Non- FDA Approved Fixed Dose Combination of Antibiotics in a Secondary Care Hospital South India
Authors: Nitheeshwar C , Dorairajan Suresh Kumar
Published: January 2025

Background

In developing countries, the widespread use of non-FDA (Food and Drug Administration) approved fixed-dose combinations of antibiotics in secondary care hospitals is a concern. Despite cautions from infectious disease specialists, comprehensive studies on this practice are lacking. Our research aims to investigate indications for prescribing these combinations in a South Indian secondary care hospital and develop stewardship strategies to reduce the use of it.TABLE 1:Indication for the Usage of non FDA Approved Fixed Combination of Antibiotics

Methods

The study conducted was a Prospective observational study at a secondary care hospital in South India over a 4-month period from December 2023 to March 2024. Data collection utilized a validated audit tool capturing details of non-FDA approved fixed dose antibiotic combinations prescribed to patients. Statistical analysis was conducted using MS Excel, employing simple descriptive statistics.

Results

CIPROFLOXACIN (500mg) + TINIDAZOLE (600mg) and CEFEXIME (200mg) + OFLOXACIN (200mg) are commonly prescribed for various conditions such as acute gastroenteritis, ear pain, and other ailments like fissures, cysts, and vaginal white discharge. However, these combinations lack FDA approval and randomized controlled trials (RCTs) to support their efficacy in treating conditions like otitis media and loose stools. The addition of antiparasitic agents in these combinations lacks evidence of effectiveness. Therefore, caution is advised in their prescription until further scientific validation is available.

Conclusion

In conclusion, our antibiotic stewardship efforts led to the removal of CIPROFLOXACIN (500mg) + TINIDAZOLE (600mg) and CEFEXIME (200mg) + OFLOXACIN (200mg) from our hospital formulary. Physicians were informed that these combinations lack scientific rationale for treating specific conditions. This action aligns with evidence-based prescribing practices to optimize patient care and combat antimicrobial resistance.

Disclosures

All Authors: No reported disclosures
P-1727. Impact of Four-Day Automatic-Stop Orders on the Duration of Antibiotic Treatment
Authors: Oliver Aaron , Quinn Andrea , Ries Amanda , Weslander Erin , Malkowicz Katarzyna
Published: January 2025

Background

Implementation of automatic antibiotic stop orders is an antimicrobial stewardship intervention that encourages timely antibiotic order re-evaluation for potential discontinuation, spectrum de-escalation, transition to oral therapy, or spectrum escalation if warranted based on emerging diagnostic results. This pre-post study was designed to evaluate the impact of a four-day automatic-stop order on antibacterial orders for patients admitted at a single community hospital site.

Methods

A single-center, retrospective pre-post study was conducted to compare outcomes following the re-introduction of a four-day automatic-stop order on antibacterial orders. The primary outcomes were hospital length of stay and median duration of antibiotic therapy. Secondary outcomes included hospital readmission within 30 days and the occurrence of C. difficile infections within 30 days. Data was compared between 2 non-consecutive weeks in the pre-implementation of the automatic-stop order policy with data from 2 non-consecutive weeks in the post-implementation of the automatic-stop order policy to ensure prescriber variability and prescribing practices. Patients admitted for fewer than 4 days, or who had orders with indications for meningitis, bacteremia, prosthetic material infection, bone and joint infections, endocarditis, C. difficile treatment, prophylaxis, or documented uncontrolled source were excluded to align with exclusions in the policy.

Results

The study included 362 patients in total, 167 in the pre-implementation group and 195 in the post-implementation group. The median hospital length of stay was 8.2 days in the pre-implementation group and 7.1 days in the post-implementation group (p=0.536). The median total treatment duration of antibiotic therapy was 6.2 days in the pre-implementation group and 5 days in the post-implementation group (p=0.02). Incidence of c. difficile was 3% in the pre-implementation group, compared to 1% in the post-implementation group (p=0.256).

Conclusion

An antimicrobial automatic stop policy of four days was associated with decreased antimicrobial days of therapy per patient, without differences in hospital length of stay. There were no safety concerns identified with this intervention.

Disclosures

All Authors: No reported disclosures
P-1732. Evaluating the Impact of a Gram-Negative Bacteremia Treatment Guideline Combined with Antimicrobial Stewardship Pharmacist Intervention
Authors: Peterson-Weber Alex , Donohoe Kendall , Chapin Ryan W , Al Lawati Hawra J , Lee Matthew S , McCoy Christopher
Published: January 2025

Background

Gram-negative rod (GNR) bloodstream infections (BSIs) in hospitalized patients are associated with significant morbidity and mortality if not treated appropriately. By contrast, use of overly broad antibiotics or long durations of therapy for GNR BSIs may increase risk for antimicrobial resistance and C. difficile infection. The purpose of this study was to evaluate outcomes of GNR BSI treatment before and after implementation of an institutional practice guideline paired with real-time antimicrobial stewardship (AS) review.

Methods

A before-and-after quasi-experimental study was performed at our large academic medical center. Patients were identified for inclusion using a third-party pharmacovigilance platform based on presence of at least one blood culture with GNRs. Exclusion criteria included age less than 18 years, identified source of the GNR BSI was an infection requiring a prolonged duration of therapy (e.g., osteomyelitis, endovascular infection, etc.), or if the patient expired or was placed on comfort measures prior to BSI treatment completion. The primary endpoint was time to directed therapy, defined as susceptibility-directed tailoring of therapy. Secondary endpoints included time to optimal therapy (TOT), defined as narrowest effective therapy or step down to oral therapy, total duration of therapy, rate of step down to oral therapy, and acceptance of AS interventions.

Results

A total of 175 patients met inclusion criteria between November 2022 and April 2024. Eighty-four patients in the pre-guideline group and 91 patients in the post-guideline with AS review group were included. Baseline characteristics are described in table 1. The median time to directed therapy was 46.9 hours (IQR; 0, 72) in the pre-guideline group and 36.9 hours (IQR; 0, 58.9) in the post-guideline group. Additional endpoints are described in table 2.

Conclusion

The GNR BSI guideline with AS review led to faster tailoring of therapy but no change in TOT. A high prevalence of Infectious Diseases consults was observed in this population, thus AS interventions were mostly directed at patients without formal Infectious Diseases consultation. Additionally, ability to make timely AS interventions was limited by the resources available to our AS program.

Disclosures

All Authors: No reported disclosures
P-1733. Effectiveness of a Clinical Pharmacist-Led Electronic Medical Record-Based Antimicrobial Stewardship Intervention in Reducing the Overuse of Meropenem During Transition of Care: Evidence from a Tertiary Care Hospital in India
Authors: Nair Aravind R
Published: January 2025

Background

In tertiary care hospitals, the overuse of broad-spectrum antibiotics like meropenem contributes to the rise of antimicrobial resistance, posing a significant public health concern, particularly in countries like India. Addressing this issue, this study evaluates the effectiveness of a clinical pharmacist-led electronic medical record-based antimicrobial stewardship intervention in curbing meropenem overuse during transitions of care at a tertiary care hospital in India.

Methods

A prospective interventional study was conducted over six months at the tertiary care hospital. Trained clinical pharmacists led the intervention. Upon patients' transition from intensive care units (ICUs) to medical/surgical units, an active meropenem order triggered an alert in the EMR system. Pharmacists reviewed the order and liaised with the primary medical team for approval to continue meropenem therapy, documenting all communications and actions in the patient's EMR. Data on meropenem days of therapy (DOT) and related outcomes were collected pre- and post-intervention. Statistical analysis was performed to assess the impact of the intervention.

Results

Out of 280 patients, 130 were in the pre-intervention group and 150 in the post-intervention group, with similar baseline characteristics. Pre-intervention, median meropenem DOT after transition was 4 days (IQR: 3-6), decreasing to 2 days post-intervention (IQR: 1-3) (p < 0.001), a 50% reduction. Median doses decreased from 8 (IQR: 6-10) to 5 (IQR: 3-7) post-intervention (p < 0.001). Total meropenem DOT significantly decreased post-intervention, from 600 to 375 days (p < 0.001). Furthermore, the acceptance rate of recommendations for de-escalation or discontinuation of meropenem therapy increased post-intervention, with 70% acceptance compared to 45% pre-intervention.

Conclusion

In conclusion, the clinical pharmacist-led electronic medical record-based antimicrobial stewardship intervention effectively mitigated meropenem overuse during care transitions, highlighting its potential to optimize antibiotic utilization and combat antimicrobial resistance in Indian tertiary care settings.

Disclosures

All Authors: No reported disclosures
P-1734. Pharmacist-Led Antibiotic Deprescribing for Negative Urine Cultures in the Emergency Department
Authors: Teter Ashley , Hurley Evan
Published: January 2025

Background

Inappropriate antibiotic use in EDs, often due to empiric prescribing before urine culture results are available, poses significant challenges. This study evaluates the impact of a pharmacist-led intervention to deprescribe antibiotics for patients with negative urine culture results.

Intervention

Methods

Conducted from May 1, 2023, to March 31, 2024, this study employed a two-phase approach involving a retrospective review and a prospective intervention. Inclusion criteria were patients prescribed antibiotics for a UTI with subsequent negative urine culture results during an ED visit. Exclusion criteria included patients admitted for inpatient treatment or transferred to other healthcare facilities. In Phase I (May to July 2023), a clinical pharmacist in the ED adjusted antibiotic therapy based on culture susceptibility results on weekdays. Phase II (January to March 2024) expanded to include antibiotic deprescribing in patients with negative results. The primary outcome was the number of ED readmissions within 30 days after antibiotic discontinuation for UTI symptoms or serious infection. Secondary outcomes included total antibiotic days saved, antibiotic days prescribed per patient at ED discharge, and post-intervention antibiotic days per patient. Statistical analyses utilized the Fisher Exact Test and Mann-Whitney U Test.

Patient Characteristics

Results

The study included 78 patients: 27 in the retrospective phase and 51 in the prospective phase. Among the initial 51 patients, follow-ups with 17 revealed no continued UTI symptoms. There were no readmissions in our prospective intervention group compared to two in the retrospective group (P=0.117). Antibiotic days were significantly reduced from a pre-intervention average of 7.2 to 5.2 days per patient post-intervention (P=0.000468), saving a total of 82 antibiotic days.

Results

Conclusion

Pharmacist-led deprescribing of antibiotics in patients with negative urine cultures significantly reduced total antibiotic days per patient without increasing ED readmissions for urinary tract infection symptoms. These findings demonstrate the feasibility and safety of deprescribing in a clinical ED setting and suggest potential changes in clinical practice, advocating for the expansion of pharmacist roles in antibiotic stewardship programs.

Results Continued

Disclosures

All Authors: No reported disclosures
P-1738. Effectiveness of Clinical Pharmacist-Driven Antimicrobial Stewardship (ASP) in Bacteremic Patients in India
Authors: Kumar Prasanna , Rupali Priscilla , Jose J Franklin , Selvakumar J
Published: January 2025

Background

Antimicrobial resistance is a prevalent problem, especially in low-middle-income countries. Infectious disease physicians are a scarce commodity and are unable to fully shoulder the complete responsibility of antimicrobial stewardship implementation in a health care setting. Thus, we set out to assess the utility of a Clinical pharmacist-led ASP in optimising antimicrobial use in bacteremic patients.

SOURCE OF INFECTION

Methods

This is a prospective audit and feedback of bacteremic patients led by a clinical pharmacist with minimal input and sign-off from an ID specialist. A month of observation (July 2023) was followed by a 3-month intervention period from August to October 2023 in the medical and surgical speciality departments of a large tertiary care hospital in Southern India.

RECOMMENDATION ACCEPTANCE RATE

Results

103 and 218 patients were noted to be bacteremic during baseline and intervention, respectively. The mean age was 48.2, and 66% were male. The majority of positive blood cultures were from Haematology (19%), Hepatology(15%), Nephrology(14%) and others (52%). The average length of stay was 19 days and 16.6 days in baseline and intervention phases, respectively. The predominant organisms were carbapenem-resistant and extended-spectrum beta-lactamase-producing enterbacteriaceae and coagulase-negative staphylococci (CoNS). The common sources of bacteremia were central line-associated bloodstream infection (CLABSI) and gut translocation during febrile neutropenia. (Table 1). The DOT in the observation phase was 1517/1000 Patient-Days (PD), and the intervention phase's average DOT was 1326/1000PD, and there was a significant reduction in antibiotic utilisation in the intervention (P=0.003). The length of therapy was 16.6 and 11.06 days, with in-hospital mortality of 13.6% and 8% in the observation and intervention phases, respectively. Clinical pharmacist recommendations were either fully or partially accepted in 75% of the cases in the intervention phase (Table 2).

Conclusion

A clinical pharmacist-led ASP showed a reduction in significant antimicrobial use with 75% acceptance of recommendation and no difference in mortality even in bacteremic patients.

Disclosures

All Authors: No reported disclosures
P-1745. Development and Use of a System Antimicrobial Stewardship Dashboard
Authors: Borkowski Jaime , Weslander Erin , Moore William Justin , McGuire Nicole , Tatti Megha , Postelnick Michael
Published: January 2025

Background

Obtaining data has been an ongoing challenge for antimicrobial stewardship programs. With the creation and recent update of the Joint Commission antimicrobial stewardship standards, an increased focus has been placed on acting on relevant data to improve antimicrobial use. We describe the development and use of a systemwide dashboard to help track meaningful outcomes and identify areas of opportunity for our Antimicrobial and Diagnostic Stewardship Program (ADSP).

Methods

A list of all potential pieces of data we may want to be able to compare was made, including demographic information, metrics, and important outcomes. Examples of dashboards already in use in our organization were reviewed to see what types of metrics were included and how they were displayed. The Enterprise Data Warehouse was used to pull data out of the electronic health records within Epic® and to house the dashboard.

Results

The dashboard contains three main views. The default view is the executive summary. This view contains performance and outcome metrics. These include adherence to guidelines, length of stay (LOS), 30-day readmission rate, and mortality rate. There is also a section below the overall summary that breaks out site-specific data. The second view includes population demographics and a breakdown of provider- and specialty-specific outcomes. The third view includes graphic representations of more granular detail broken out by treatment indication. In addition, we are able to filter each view by various details such as date, the ordering department, antimicrobial, treatment indication, and ADSP team intervention. One example of how we have used this dashboard so far is in the assessment of a systemwide initiative to improve empiric antibiotic prescribing for urinary tract infections. We were able to see increased guideline-consistent prescribing, decreased need for interventions, and no significant increase in LOS, readmission or mortality.

Conclusion

This dashboard allows us to obtain data that would have previously required much time to gather and analyze. The inclusion of important patient-centered outcomes allows us to see the impact of ADSP interventions on our patients. It also aids in obtaining multiple pieces of data that TJC has outlined in the Antimicrobial Stewardship Standard.

This graphic shows an example of how we are able to use our dashboard. Here we show a pre-post review of outcomes related to a systemwide initiative targeting empiric treatment of urinary tract infections. We saw an increase in guideline-consistent prescribing, a decreased need for ADSP intervention, and no significant increase in important outcomes including length of stay, readmission rate, or mortality (p>0.05 for readmission and mortality).

Disclosures

All Authors: No reported disclosures
P-1785. A nationwide survey of Antimicrobial Stewardship Infrastructure and CDC Core Elements in the Dominican Republic
Authors: Castillo Elianet , Ali Arzina Aziz , Rojas-Fermin Rita A , Reyes Yeison , Blanco Claudia , Villegas Antonio M , Mena Lora Alfredo J
Published: January 2025

Background

Antimicrobial resistance (AMR) poses a critical global health threat, escalating the need for widespread implementation of antimicrobial stewardship programs (ASPs) to monitor and promote appropriate use of antimicrobials. Despite the growing concern for AMR, particularly in low and middle-income countries, data on the implementation of ASPs in these regions remain scarce. This study aims to describe the presence and practices of ASPs in the Dominican Republic (DR).

Figure 1

Population density of the Dominican Republic and geographic distrubution of hospitals surveyed

Methods

We performed an anonymous survey of infectious diseases (ID) specialists in acute care hospitals in the DR. A survey based on the CDC Infection Control Assessment and Response (ICAR) tool for antimicrobial stewardship was distributed via professional society listervs between March 4 and April 24, 2024. Data was tabulated and descriptive statistics performed.

Figure 2

CDC Antimicrobial Stewardship Core Elements met by hospitals in the DR

Results

A total of 20 hospitals completed our survey, of which 16 were from Santo Domingo and 1 from La Romana, San Cristobal, San Pedro, and Santiago (Figure 1). Eighteen were tertiary centers. ASP was absent in 50% (10), present in 35% (7), and in the process of development in 15% (3). Compliance with CDC core elements for ASP varied, with accountability and action present in all hospitals with ASP, leadership commitment and tracking both at 85.7%, and education at 71.0% (Figure 2). Pharmacy expertise and reporting were 57.0% and 42.8% respectively. The most frequently adopted ASP interventions were 'Documentation of indication' and 'Center Specific Treatment guidelines', both present at 71% (5) of hospitals. PAF and 'Pre-authorization' were also common, each at 57% (4/7) (Figure 3). The less frequent interventions included 'Antibiotic timeout' and 'Assessing Penicillin allergy', both at 14% (1/7), and 'Review of outpatient parenteral antibiotic therapy' at 29% (2/7).

Figure 3

Antimicrobial steewardship interventions by hospitals in the DR

Conclusion

Our survey provides a snapshot of the current state of ASP in the DR. While there has been notable progress in implementing ASPs, half of the hospitals still lack such programs, underscoring the urgent need for broader implementation. Additionally, adherence to the CDC’s core elements among existing programs varies, highlighting specific gaps and areas for improvement. It is crucial to address these deficiencies to enhance ASP effectiveness and combat the growing threat of AMR.

Disclosures

Rita A. Rojas-Fermin, MD,FIDSA, Gilead: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria
P-1789. Implementation of Pathogen Independent Model Informed Precision AUC-based Dosing of Vancomycin at University Hospital Wuerzburg (UKW)
Authors: Gundlach Laura C , Surat Güzin , Kunkel Mareike , Scherf-Clavel Oliver
Published: January 2025

Background

The IDSA guideline concerning monitoring vancomycin in MRSA infections, published in March 2020, recommends model informed precision AUC based dosing for vancomycin. The application of pharmacometrics software with Bayesian calculating is recommended. The summary of product characteristics of vancomycin, issued by EMA (European Medicines Agency), includes also details regarding model informed precision dosing for vancomycin therapies, irrespective of targeted or identified pathogens. Due to the low prevalence of MRSA infections at UKW, model informed precision AUC-based dosing has been instituted for all parenteral vancomycin therapies.

Methods

The target for vancomycin AUC/MIC (minimum inhibitory concentration) is a range of 400 – 600 mg*h/L over 24 hours. Individual patient covariates, personal dosing information and vancomycin concentrations were converted into dosing recommendations with InsightRX. In order to record the effect of the intervention, the target attainment and the occurrence of AKI (acute kidney injury, defined as an increase in serum creatinine of ≥ 0.3 mg/dL within 48 h) is recorded 18 months before and 12 months after the implementation of the new dosing strategy.

Results

Since October 2022, a workflow for model informed AUC-based dosing has been launched across 12 wards - mainly intensive care units - encompassing 215 beds. In the conventional dosing strategy according to trough dosing, AKI occurred in 60 of 216 therapies, while AKI was detected in 8 out of 57 AUC-guided vancomycin therapies resulting in an odds ratio of 2.32 [CI 95 % 1.08 – 5.59]. Significantly more AUC guided therapies were in the therapeutic range of 400 – 600 mg*h/L after 120 hours than trough-based vancomycin therapies reached the target [55.1 % vs 70.2 %, OR 0.52, CI 95 % 0.27 – 0.97]. Additionally, more trough-based therapies were in a supratherapeutic range than AUC guided therapies [24.5 % vs 8.8 %, OR 3.23, CI 95 % 1.35 – 9.98]

Conclusion

The unique concept of pathogen independent model-informed AUC-based dosing of vancomycin was successfully integrated into the clinical routine work. Early dose individualization due to AUC-based dosing can contribute to increase drug therapy safety and improved patient safety for vancomycin therapies.

Disclosures

All Authors: No reported disclosures
P-1799. Impact of coronavirus disease 2019 on infectious disease treatment and infection control: Multicenter study in Japan
Authors: Kakeya Hiroshi , Kakuno Shigeki , Imoto Waki , Shintani Ayumi
Published: January 2025

Background

The coronavirus disease 2019 (COVID-19) pandemic impacted infection control practices such as hand hygiene and antimicrobial use, but its specific effects remain unclear. Thus, in this multicenter study, we aimed to determine the pandemic's effect on these factors by comparing pre- and post-COVID-19 periods.

(A) The number of inpatients by month during the study period. (B) The amount of hand sanitizer used per inpatient by month during the study period.

The two solid lines show the regression lines in the pre- and post-COVID-19 periods. The dashed line in the post-COVID-19 period is an extension of the regression line in the pre-COVID-19 period.

Methods

Data on hand sanitizer use, antimicrobial use, positive blood cultures, and antimicrobial-resistant (AMR) organism detections were collected monthly from April 2015 to March 2023 at four Japanese hospitals. The pre-COVID-19 period data (April 2015 to March 2020) were compared to the post-COVID-19 period data (April 2020 to March 2023).

Results

Compared to pre-COVID-19, hand sanitizer use per inpatient and antimicrobial use, particularly broad-spectrum antimicrobials, increased significantly post-COVID-19. The proportion of positive blood cultures increased, but AMR organism detections remained unchanged, suggesting increased contamination rather than infection.

Conclusion

Ongoing antimicrobial use monitoring, hand hygiene education, and promotion of effective infection control and antimicrobial stewardship by infection control teams are crucial for prevention of future pandemics.

(A) Total DOT (combined with all antimicrobials extracted in this study) by month. (B–F) DOT of individual antimicrobial agents by month.

The two solid lines show the regression lines in the pre- and post-COVID-19 periods. Other antimicrobial agents are shown in Appendix Figure A.1.

Abbreviations: CFPM, cefepime; CI, confidence interval; CTRX, ceftriaxone; DOT, days of therapy; MEPM, meropenem; SBT/ABPC, sulbactam/ampicillin; TAZ/PIPC, tazobactam/piperacillin.

Disclosures

Hiroshi Kakeya, MD, PhD, Asahikasei Phrma: Honoraria|GSK: Honoraria|MSD: Honoraria|Pfizer: Honoraria|Shionogi: Honoraria|Sumitomo Parma: Honoraria