bluuebunny/crossref_metadata_2025 huggingface dataset:
P-1622. Decreasing Cellulitis Length of Stay with Implementation of Rapid Diagnostic Test
Authors: Shah Rishita , Grohmann Stephen , Hart Catherine
Published: January 2025

Background

Skin and soft tissue infections (SSTIs) have been an increasing burden in the recent years. Rapid diagnostic tests can be useful to rule out Staphylococcus aureus as a pathogen. Northwestern Lake Forest Hospital (NLFH) did not have MRSA purulent wound PCR onsite and was sent out to another hospital. It was noticed that patients had longer length of stay (LOS) in our system compared to cohorts with patients diagnosed with cellulitis. We evaluated patients with cellulitis without major complications (DRG 603) and found an average LOS of 0.86. The goal was to reduce LOS of patients with cellulitis without major complications with the addition of a rapid diagnostic tool in our lab.

Length of Stay Run Chart

Shows LOS prior to project and after interventions

Methods

NLFH was under-utilizing rapid diagnostic testing to quickly identify if Staphylococcus aureus was an organism for SSTI. We also analyzed turnaround times (TAT) of send out testing compared to on-site testing with regards to observed to expected LOS. We used a multi-modal and phased approach with education, upgrades to our electronic health record (EHR), creation of an updated SSTI Clinical Pathway, and implementation of onsite MRSA purulent wound PCR (Table 1). Our primary goal was to reduce LOS. Another goal was to reduce TAT of testing.

Interventions were applied January to June of 2022 and post intervention data was collected May – July 2023. Education was done to emphasize ordering in the ED. Providers were informed on EHR updates in Epic and best practice alerts were implemented as a reminder to place a picture in the EHR and order correct tests.

Summary of Interventions

Results

Baseline data was collected and observed over expected length of stay was 0.89. Among other NM hospitals across our system, we were in the 79th percentile for cellulitis without major complications. TAT for testing results was also elevated in the pre-intervention timeframe to an average of 21 hours. We found a reduction in LOS with implementation of MRSA purulent wound PCR and education to 0.65. NLFH ranked in the 90th percentile across our system during the post analysis period. When we evaluated TAT during our post intervention period, the time decreased to an average of 6 hours.

MRSA purulent wound PCT Turn Around Times

Shows pre and post interventions TAT for testing

Conclusion

Implementation of a MRSA purulent wound PCR at NLFH helped improve TAT to identification of Staphylococcus aureus. Next steps would be to evaluate the impact on vancomycin utilization.

Disclosures

All Authors: No reported disclosures
P-1623. Implementation of MRSA Nasal PCR Pharmacy Protocol on Vancomycin Use for SSTI
Authors: Withers Sarah , Lipe Abigale , Jozefczyk Caroline , Faulkner-Fennell Carmen M , Eskens Danielle
Published: January 2025

Background

Recent published literature has shown that methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) nasal swabs have similar utility for skin and soft tissue infections (SSTI) to well-established pneumonia data with a specificity ranging from 92.2-94% and negative predictive value ranging from 92-94%. The purpose of this study was to evaluate the effect of implementing a pilot pharmacy-led protocol for ordering MRSA PCR nasal swabs in vancomycin-treated SSTI.

Methods

A single-center, pre- and post-implementation observational study was conducted on adult floor patients admitted to a single institution between March 2023 to January 2024 who were on vancomycin for only the indication of SSTI. Exclusion criteria included Gram positive organism in blood culture, admission to any ICU, or if the suspected infection was a deep surgical site infection, necrotizing fasciitis, osteomyelitis, or a vascular graft infection. The primary outcome of duration of vancomycin therapy was compared between pre- and post-implementation groups. Secondary outcomes included length of hospitalization, acceptance rate of de-escalation, total duration of antibiotic therapy, SSTI-related readmissions within 30 days, and MRSA PCR statistics.

Results

A total of 229 patients were included in the study with 160 patients in the pre-protocol group and 70 patients in the post-protocol group. 52.4% of patients were male and 78.2% of patients were white with majority of SSTI being lower extremity cellulitis. There was an increase in MRSA PCR collection from 14.4% to 48.6% in the post-protocol group and in MRSA PCR pharmacy interventions from 0.6% to 28.6%. Duration of vancomycin therapy was similar between both groups and the average total duration of antibiotic therapy was longer than current guideline recommendations for SSTI.

Conclusion

While there was an increase in MRSA PCR nasal swab usage after piloting a new MRSA PCR protocol, the PCR results did not have a significant change on antibiotic utilization for skin and soft tissue infections. As a result of this study, alternative stewardship efforts have been identified for skin and soft tissue infection management.

Disclosures

All Authors: No reported disclosures
P-1626. Impact of Repeat Blood Cultures Among Adult Cancer Patients with Gram-Negative Bacilli Bacteremia on Patient-Oriented Outcomes
Authors: Tang Wesley , Vuong Nancy N , Jiang Ying , Dailey Garnes Natalie J
Published: January 2025

Background

Gram-negative bacilli (GNB) bacteremia is a common and often fatal infection with mortality rates estimated to be 14-34%. Follow-up blood cultures (FUBCs) are blood cultures that are repeated after an initial positive culture. FUBCs are used to assess the appropriateness and duration of antimicrobial therapy. Currently, no guidelines exist regarding the use of FUBC for GNB bacteremia, and the utility is not well-studied in adults living with cancer. We aimed to characterize the impact of FUBC in GNB bacteremia on patient-centered outcomes in patients with cancer.

Methods

We conducted a single-center, retrospective study in patients ≥18 years, hospitalized during 2022, living with cancer, and with laboratory-confirmed GNB bacteremia. FUBC was defined as a blood culture performed within 7 days of initial positive blood culture. We gathered information on the source of bacteremia, identified organisms, presence of antimicrobial resistance, and comorbidities. Categorical variables were compared using Chi-square or Fisher’s exact test. Independent predictors of length of hospital stay were obtained via generalized linear model analysis. Logistic regression analysis was used to identify predictors of unplanned hospital readmission and mortality.

Results

Overall 94% (590/626) of patients with GNB bacteremia had a FUBC at our institution. Among those with FUBC, the majority were without growth (73%). 116/590 (20%) of patients had persistent GNB bacteremia. Patients with persistent or alternative growth on FUBC had higher mortality compared to those with negative FUBC (41% and 53% vs 17%, p< 0.001). Patients with a new organism on FUBC had longer length of stay compared to those with no growth on FUBC (aOR 1.55, 95% CI [1.09-2.20]). Patients with a single organism on repeat culture had a higher rate of mortality.

Conclusion

The majority of patients with FUBC did not show growth. We observed that patients who underwent FUBC had lower mortality than those without FUBC. Patients with new organisms identified on FUBC were associated with longer length of stay. Patients with positive FUBC may be characterized as high risk for mortality. Despite the majority of FUBC without growth, there may be a mortality benefit in identifying those patients with positive FUBC in patients living with cancer.

Disclosures

Natalie J Dailey Garnes, MD, MPH, MS, AlloVir: Grant/Research Support
P-1633. Evaluating an Urgent Care Antibiotic Stewardship Intervention: A Multi-Network Collaborative Effort
Authors: Roberts Annie , Park Daniel E , Balthrop Sabrina , Hamdy Rana F , Hamdy Rana F , Dolan Patrick , Liu Cindy
Published: January 2025

Background

Urgent care centers (UCCs) have previously been associated with high rates of inappropriate antibiotic prescribing without supporting appropriate diagnoses. Prior antibiotic stewardship studies in urgent care settings have generally been limited to pediatric clinics and diagnoses or conducted within single urgent care networks. Broadly generalizable stewardship efforts targeting common diagnoses across ages are needed.

Methods

This quality improvement study's participants were UCC clinicians from a national collaborative of 49 UCCs in 27 networks across 18 states within the United States. Stewardship interventions included signing of a commitment statement, and a choice of intervention options to implement during two plan-do-study-act (PDSA) cycles during the intervention period. The primary outcome was the percent of urgent care encounters (from randomly selected patient charts) for viral illness or bronchitis diagnoses with inappropriate antibiotic prescribing, stratified by whether the clinician was a direct participant in the quality improvement study and by diagnosis. A 3-month baseline and 9-month intervention period were compared using an interrupted time series with a generalized estimating equation model.

Results

15,588 patient encounters were included with a diagnosis of bronchitis or viral illness. The intervention was associated with a 39% relative decrease in inappropriate antibiotic prescribing (aOR=0.61, 95%CI 0.48-0.77) among participating clinicians compared to baseline. The intervention did not result in a significant change in inappropriate antibiotic prescribing (aOR=1.08, p=0.54) for clinicians who did not directly participate.

Conclusion

This antibiotic stewardship intervention was associated with significant reductions in inappropriate prescribing among clinicians who directly participated. Implementing stewardship interventions in UCCs may reduce inappropriate antibiotic prescriptions for common diagnoses; however, direct clinician participation may be necessary, especially in settings with high rates of clinician turnover.

Disclosures

All Authors: No reported disclosures
P-1638. Prevalence and Correlates of Inappropriate Antibiotic Prescribing in Japanese Primary Care Settings
Authors: Miyawaki Atsushi , Ladines-Lim Joseph B , Chua Kao-Ping , Tsugawa Yusuke
Published: January 2025

Background

Since the release of its 2016 National Action Plan on Antimicrobial Resistance (AMR), Japan has promoted antimicrobial stewardship in various ways (e.g. AMR awareness campaigns) but remains short of meeting benchmarks, e.g. reduction of antibiotic use per capita by one-third by 2020 versus 2013 (decreased only by 4.4% as of 2019). Effective stewardship interventions require comprehensive assessment of antibiotic prescribing appropriateness, with the most recent national-level data from 2012–2015. To fill this knowledge gap, we evaluated antibiotic prescribing appropriateness in Japanese outpatient primary care visits using nationally representative data.

Characteristics of patients who received ≥1 antibiotic prescription and visits in which physicians wrote antibiotic prescriptions from October 2022 to September 2023, JAMDAS

Methods

In a cross-sectional analysis of 2,809 primary care clinics, we analyzed all antibiotic prescriptions from October 1, 2022, to September 30, 2023. We adapted an established ICD-10-based classification scheme (Chua et al, BMJ, 2019) to the Japanese context, classifying prescriptions as “appropriate” (associated with ≥1 “always” code), “potentially appropriate” (associated with ≥1 “sometimes” code but no “always” codes), “inappropriate” (associated only with “never” codes), or “not associated with recent diagnoses.” We used regression to examine the association between prevalence of inappropriate antibiotic prescriptions and patient, clinic, and visit characteristics, adjusting for month indicators.

Prevalence of antibiotic prescriptions in each appropriateness category, JAMDAS

Results

Table 1 shows characteristics for patients who received ≥1 antibiotic prescription and visits in the sample. Among 2,058,021 prescriptions to 1,267,708 patients, 17.9% were inappropriate (Table 2). The adjusted prevalence of inappropriate antibiotic prescriptions was higher for children (< 18 years), patients with comorbidities (sourced from the Charlson Comorbidity Index), older physicians, physicians with higher antibiotic prescription volumes, and telehealth visits versus office visits (Figure 1). There were no differences by patient or physician sex, total patient volume, region, or regular versus after hours.

Association of patient, clinic, and visit characteristics with prevalence of inappropriate antibiotic prescriptions

Conclusion

Antibiotic stewardship initiatives in Japanese primary care targeting children, patients with more comorbidities, older physicians, physicians with high antibiotic prescription volumes, and telehealth settings may be warranted.

Disclosures

Atsushi Miyawaki, MD, PhD, M3, Inc.: Advisor/Consultant
P-1639. Assessing Disparities in Inappropriate Outpatient Antibiotic Prescriptions in Tennessee
Authors: Thure Katie A , Mutamba Glodi , Kirtz Erika , Evans Christopher D
Published: January 2025

Background

The Centers for Disease Control and Prevention (CDC) estimates almost 47 million antibiotics are prescribed each year for indications that do not warrant antibiotic use. Identifying populations that are inappropriately prescribed antibiotics is imperative to address health inequities and prevent antimicrobial resistance. Tennessee Department of Health (TDH) evaluated disparities in outpatient antibiotic prescriptions in patients of different age groups, gender, geographical location, and insurance type.

Methods

The IQVIA Medical Claims and Longitudinal Prescription Claims databases were used to perform a cross-sectional study to evaluate the appropriateness of all outpatient antibiotics dispensed from retail pharmacies in TN from January 1–December 31, 2022. Data were categorized using a tiered system utilizing ICD-10 codes. Logistic regression was performed to predict whether age, gender, insurance type, and residence were associated with receiving an antibiotic in encounters for which antibiotics are rarely indicated (tier 3).

Results

In 2022, 2,017,863 prescribed antibiotics were linked to the medical claims database. Over half of these antibiotics were classified as a tier 3 encounter. Females were prescribed more antibiotics (62.0%). For tier 3 encounters specifically: 41.0% of antibiotics were prescribed to patients 65 and older. Residence in low and high socially vulnerable index (SVI) counties accounted for 27.9% and 24.9% of antibiotics, respectively. 37.2%, 16.5%, and 44.5% of antibiotics prescribed were billed to third-party payers (e.g., private health insurance), Medicaid, and Medicare Part D, respectively. Logistic regression showed female gender, younger age, and residence in low SVI had significantly higher odds of receiving an antibiotic for a tier 3 encounter; whereas prescriptions filled with Medicaid and Medicare were less likely to be associated with tier 3 encounters.

Conclusion

Previously TDH had not explored outpatient antibiotic use through a health equity lens. While the study provided basic demographic information about patients, there is a need to continue exploring disparities within various populations to aid in targeting inventions that drive appropriate antimicrobial use in ambulatory clinical settings.

Disclosures

All Authors: No reported disclosures
P-1653. Current Prescribing Practices and Guideline Concordance for the Treatment of Community-Acquired Bacterial Pneumonia (CABP) across Outpatient and Urgent Care Visits
Authors: Asempa Tomefa E , Ackley Tyler , Linder Kristin E , Nicolau David P
Published: January 2025

Background

Resources and support for antibiotic stewardship programs (ASP) have focused on hospitalized patients and there is minimal prescribing data and interventions among outpatients. We aimed to assess the treatment of CABP in adults in order to develop interventions to improve antibiotic utilization.

Methods

This retrospective study (2022-2022) included patients within a large healthcare system presenting to outpatient clinics (n=120) and affiliated Urgent Care Centers (n=24) across Connecticut. Patient encounters were identified via CABP ICD-10 codes and IDSA relevant patient comorbidities (chronic heart, lung, liver, or renal disease; diabetes; alcoholism; malignancy; asplenia) were extracted from patient problem lists. Primary outcome was to describe the proportion of patients receiving concordant therapy (antibiotic choice and prescription of monotherapy or combination therapy depending on presence of comorbidity) per IDSA guideline and local antibiogram.

Results

Patient characteristics are listed in Table 1. Overall guideline concordance rate was 36.6% (1,468/4,011 antibiotic orders). Among orders in patients with comorbidities (n=2,212), a large proportion received discordant therapy (n=1,417; 64.1%) via monotherapy particularly doxycycline (DOX) or azithromycin (AZM). Among appropriate combination therapy orders (n=370) in patients with comorbidities, the most common pairings were amoxicillin-clavulanate plus AZM (160/370; 43.2%) followed by amoxicillin-clavulanate plus DOX (86/370; 23.2%). 10.5% (232/2,212) received a guideline concordant respiratory fluoroquinolone monotherapy.

Among antibiotic orders in patients with no comorbidity (n=1,799), 1,126 (62.6%), orders were discordant largely due to inappropriate monotherapies (742/1,126; 65.9%) in particular AZM monotherapy (352/1,126; 31.3%) despite local pneumococcal resistance rates >25%.

Conclusion

Guideline concordance was low, primarily due to lack of combination therapy in patients with comorbidities, as well as use of AZM monotherapy despite high resistance rates. Overall, these data will be instrumental in our current efforts to initiate an outpatient ASP and deploy interventions to improve care across the continuum of care.

Disclosures

Tomefa E. Asempa, PharmD, FDA/CDER: Grant/Research Support|Paratek: Grant/Research Support|Shionogi: Grant/Research Support|Spero: Grant/Research Support|VenatoRx: Grant/Research Support David P. Nicolau, PharmD, CARB-X: Grant/Research Support|Innoviva: Grant/Research Support|Innoviva: Honoraria|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Shionogi: Honoraria|Venatorx: Grant/Research Support
P-1656. Different Drugs for Different Bugs? A Comparison of a Solid Organ Transplant Population-specific Antibiogram with the Hospital-wide Antibiogram
Authors: Borgetti Scott , Ali Arzina Aziz , Gross Alan E , Mena Lora Alfredo J , Knodle Ryan D , Ismail Nahed , Ali Taha
Published: January 2025

Background

Solid organ transplant (SOT) recipients are vulnerable to infections with multi-drug resistant organisms. Studies have shown that SOT patients often do not receive adequate empiric antimicrobials for serious Gram-negative infections. Knowledge of epidemiologic differences in resistance rates in this population may help guide empiric antibiotic choices for SOT patients.

Cohort A

Methods

We performed a retrospective cohort study comparing antibiotic susceptibility rates of Gram-negative sepsis in SOT patients (cohort A) between 1/1/2021 and 4/30/2023 to the hospital-wide inpatient antibiogram for 2021-2022 (Cohort B). Using resistance rates from Cohort A, we developed a weighted-incidence syndromic combination antibiogram (WISCA) comparing SOT population specific empiric antibiotic therapy to the institutional empiric antibiotic recommendations for non-SOT patients with sepsis (figure 3).

Cohort B

Results

Cohort A had 90 Gram-negative isolates compared to 1328 in cohort B. Pseudomonas (27%) and E.coli (31%) were the most common isolates in cohorts A and B respectively. Pseudomonas isolates in cohort A were less likely to be susceptible to common anti-pseudomonal beta-lactams compared to cohort B, including piperacillin-tazobactam (46% vs 72% susceptible; OR 0.33, 95%CI 0.13-0.83), imipenem (33% vs 70% susceptible; OR 0.21, 95%CI 0.08-0.56), and cefepime (42% vs 70% susceptible; OR 0.31, 95%CI 0.12-0.80). E. coli isolates in cohort A were less likely to be piperacillin-tazobactam (50% vs 78% susceptible; OR 0.28, 95%CI 0.09-0.89) susceptible than isolates in cohort B, but not significantly less likely to be susceptible to imipenem (94% vs 100% susceptible; OR 0, 95%CI 0-1.53) or cefepime (75% vs 84% susceptible; OR 0.57, 95%CI 0.17-2.5). WISCA analysis of Gram-negative sepsis for SOT patients yielded imipenem (62% of isolates covered) as the optimal beta-lactam as opposed to the institutional recommendation of piperacillin-tazobactam (only covered 39% of SOT isolates).

Conclusion

Antimicrobial resistance rates were higher in SOT patients with Gram-negative sepsis compared to the non-SOT hospital population. Imipenem was a more active empiric Gram-negative antimicrobial for sepsis in the SOT patients compared to the institutional recommendation of piperacillin-tazobactam.

Disclosures

Scott Borgetti, MD, GSK: Grant/Research Support Alan E. Gross, PharmD, Becton Dickinson Co: Advisor/Consultant
P-1659. Clinical and Safety Outcomes of Uniform Thrice-Weekly Daptomycin Dosing Based on Adjusted Body Weight in Patients Receiving Intermittent Hemodialysis
Authors: Adams David T , Kaur Satwinder S
Published: January 2025

Background

Limited evidence exists on optimal dosing of daptomycin (DAP) in patients receiving intermittent dialysis (HD). Current labeling recommends every 48 hour (q48h) dosing which often causes additional DAP doses to be given throughout the week when the schedules become unaligned. Alternatively, current recommendations for thrice weekly dosing suggest a larger dose for the 72-hour interdialytic interval, which makes operationalization difficult within current inpatient electronic systems.

Methods

A retrospective observational cohort study comparing clinical and safety outcomes of adult patients receiving DAP with HD was performed between 01/2021 and 04/2024. Updated dosing recommendations for DAP with HD was modified on 1/2023 to indication based uniform adjusted body weight (AdjBW) dosing with each HD session compared to the previous recommendation of q48h based on total body weight. Clinical outcomes included microbiologic recurrence and escalation of dose or antibiotic therapy. Safety outcomes included CK elevation and development of rhabdomyolysis. Patients were excluded if they were on DAP prior to admission or received < 2 DAP doses.

Results

In total, 79 patients met inclusion. BMI, acuity of infection, length of stay, and duration of therapy were similar between the q48h (n=42) and the with each HD groups (n=37). There was a significant reduction in total weekly AdjBW DAP received in the with each HD group (23.8mg/kg vs 28.8 mg/kg, p < .0001) despite a higher utilization of the 8 mg/kg strategy (64.9% vs 26.2%). There was no significant difference in the clinical failure (5.4% vs 4.8%, p = 0.90) or safety outcomes (0% vs 6.5%, p = 0.12) between the post- and pre-groups, including after propensity matching based on BMI, AdjBW dose received, and receipt of source control.

Conclusion

Utilizing uniform DAP doses with each HD compared to standard q48h frequency in patients receiving HD did not result in worse clinical or safety outcomes while reducing the overall weekly exposure to DAP. This strategy further supports the use of AdjBW as the preferred dosing weight for DAP, including in HD patients, who have been underrepresented in previous studies. This method could also be useful in the outpatient setting to help optimize DAP exposure.

Disclosures

All Authors: No reported disclosures
P-1674. Comparative study of advance practice providers and physician prescribing practices for complicated intra-abdominal infections in patients hospitalized at a safety-net community hospital
Authors: Balaji Aakash , Pomerantz Ben , Hua Jessica , Huber Dylan , Ali Mirza , Sanchez Lawrence , Mena Lora Alfredo J
Published: January 2025

Background

The expansion of advanced practice providers (APPs) in the inpatient setting warrants understanding of their antimicrobial prescribing practices in these settings to help adapt antimicrobial stewardship (ASP) strategies. Variability in APP training programs further complicates the landscape. This study aims to investigate disparities in antibiotic prescription practices for complicated intra-abdominal infections (cIAI) between APPs and physicians.

Figure 1

clAl severity and empiric antimicrobial selection by physicians and APPs

Methods

A retrospective review of antibiotic orders was conducted at a 151-bed community hospital. ASP prospective audit and feedback (PAF) data from July 2022 to June 2023 was reviewed, including initial antibiotic selection, duration, and guideline concordance for APPs and physicians. Guideline adherence, antimicrobial effectiveness, 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 175 initial empiric PAF entries for cIAI were reviewed, of which 145 were from physicians and 30 from APPs. Guideline non-adherence was 10% (14) for physicians and 20% (6) for APPs. Additionally, 3% (5) of physician and 7% (2) of APP prescriptions were ineffective. Critical illness was higher for physician cases (Figure 1). Physicians prescribed more antipseudomonal beta-lactam (APBLs) than APPs (52% vs 30%). APPs prescribed more quinolones (FQ) than physicians (33% vs 26%). Of the patients treated with FQs by APPs, 37% had allergies to beta-lactams, compared to 22% of patients treated by physicians. Total DOT/1000 during the study period 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 anti-pseudomonal beta lactams (APBLs) and 27% non-APBLs (Figure 2).

Conclusion

Empiric antimicrobial selection for cIAI differed between APPs and physicians, with APP showing higher quinolone use, a non-preferred agent, and almost double the level of non-adherence to guidelines. These findings underscore the need for tailored ASP education and interventions that address the unique practices and educational backgrounds of APPs, aiming to standardizing and optimizing antimicrobial use. APPs may require specific education for cIAI and ASP guidance.

Disclosures

All Authors: No reported disclosures
P-1675. Antibiotic Inertia Occurs Frequently in Patients Admitted from the Emergency Department on Guideline Non-Concordant Therapy
Authors: Creel Joseph , Elashker Adrianna , DeWitt Michael E , Beardsley James R , Ohl Christopher , Banoub Mary , Randazza Olivia , Taylor Alex D , Williamson John C , Hartis Charles , McCormick Ryan C , Luther Vera P
Published: January 2025

Background

Antibiotic (abx) inertia is when inpatient providers continue inappropriate empiric abx started in the emergency department (ED) rather than changing to an appropriate regimen. Studies using hypothetical case scenarios estimate that this occurs in 39% of cases, but the phenomenon has not been studied using actual prescribing data. The objective of this study is to evaluate abx inertia in real-world clinical practice.

Methods

This retrospective chart review of adult inpatients at an 885-bed tertiary care referral center from January - October 2022 evaluated whether guideline non-concordant (GNC) abx therapy started in the ED was continued upon admission to an inpatient team. Patients admitted with a diagnosis of acute uncomplicated cystitis, pyelonephritis, community-acquired pneumonia (PNA), or skin/soft tissue infection (SSTI) who received abx in the ED were eligible for inclusion. ICU admissions were excluded. Ten patients meeting study criteria were randomly chosen from each month. Abx regimens were compared to those listed in corresponding IDSA guidelines. The primary outcome was the continuation of empiric GNC abx by the inpatient team at the time of admission.

Results

Of the 100 patients evaluated, 56 were started on GNC abx therapy in the ED. Of these, 25 (45%) were continued on GNC regimens. Vancomycin and cefepime, prescribed in 18 (72%) and 10 (40%) cases, were the most commonly continued GNC abx. The majority [23 (92%)] of continued GNC regimens were broader than those listed in the guidelines; 17 (68%) continued an abx not listed in guidelines while also omitting a listed abx. It took a median of 63 hours (95% CI 48-80) for those started on GNC abx in the ED to receive guideline concordant abx (figure 1). There was no difference in age, comorbidities, admission diagnosis, change in diagnosis, prior infections or allergies in patients whose GNC abx were continued versus not. Patients admitted to a hospitalist service were more likely to have GNC abx continued (p < 0.05), table 1.

Conclusion

Abx inertia occurred in almost half of patients started on GNC abx in the ED. Vancomycin and cefepime as well as a specific inpatient service were often associated with continued GNC abx. These observations offer potential targets for antimicrobial stewardship efforts.

Disclosures

John C. Williamson, PharmD, Armata Pharmaceuticals: Grant/Research Support|Blue Collar Vaccines and Therapeutics: Board Member|Blue Collar Vaccines and Therapeutics: Ownership Interest|Paratek Pharmaceuticals: Grant/Research Support|ST Pharm Co, Ltd: Grant/Research Support
P-1684. Characterization of Bacteremia and de-escalation practices among 13 public hospitals in Chile: Results from the 2022-2023 Chilean PPS
Authors: Benadof Dona , Acuña Mirta , Lichtenberger Paola , Herrera Tania ,   P , Bustos Mejia Jose Luis , Zamora Francisco , Rosales Ruth A , Lobos Maria Alejandra , Rojas Loreto , Orellana Rodrigo , Soto Ricardo J , Gutierrez Catalina C
Published: January 2025

Background

Antimicrobial resistance (AMR) is a global concern. Collecting data and implementing interventions to optimize antimicrobial (AM) use has significant potential to lower AMR.There is no information in Latin American Region on how prescribers are using data from positive blood culture results to de-escalate AM. We present a sub-analysis of the 2022-2023 Latin-PPS performed in Chile including the characterization of bacteriemia and de-escalation practices.

Antimicrobial distribution to treat bacteremia

Methods

13 public hospitals joined the Latin-PPS group. This PPS is based on the WHOPPS methodology. Each hospital conducted a survey in which everyday data from AM prescriptions was collected by ward. We include only patients that received AM related to documented bacteremia. The purpose of this study is to describe the etiological agents that caused bacteremia, AM use and compare the blood culture result with appropriate AM prescription.

Most common etiological agents and antimicrobials used.

Results

Chilean PPS included 3,342 beds, where 1302 AM treatments were given and 1,928 AM were administered to a national prevalence of 38.84%. Bacteremia is the 6th most common diagnosis related to AM use and corresponds to 3,76% . We found 49 bacteremia episodes, 9 occurred in ICU. The most common etiological agent was Staphylococcus aureus (16/49). Table 1 describes: most common etiological agents and AM used. The AM distribution to treat bacteremia is shown in graphic 1.

37/49 (75.5%) bacteremia had an organism that matched an appropriate AM. 10 of those missed an opportunity of de-escalation and 7 possibly represented contaminations in which AM could be stopped.

Conclusion

The AM prescription in hospitalized patients in Chile is lower compared to other LMIC. We found opportunities for AM optimization by de-escalating or stopping AM when blood culture results are available in bacteremia. We plan to recommend evidence-based strategies implementation aiming to de-escalate AM to a narrow more tailored regimen by audit and feedback supported with guidelines. Also to raise awareness about the possibility of contamination when blood cultures isolate coagulase negative staphylococcus as an opportunity to stop antimicrobials. PPS is an effective method to detect antimicrobial prescription habits and prioritize Antimicrobial Stewardship activities with local data.

Disclosures

Dona Benadof, MD, Biomerieux: Grant/Research Support Mirta Acuña, MD, Pfizer: Grant/Research Support P. , PharmD, Eli Lilly: Stocks/Bonds (Private Company)|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant Ruth A. Rosales, n/a, BECTON DICKINSON DE CHILE: Advisor/Consultant|BECTON DICKINSON DE CHILE: Speaker|Pfizer SA: Speaker
P-1690. The relationship of prescriber role and timing of prescribing to antibiotic prescribing appropriateness at a tertiary academic hospital
Authors: Greidanus Paul , LeBlanc Ryan , Kabbani Dima , Smith Stephanie W , Doucette Karen , Lau Cecilia , Bains Serena , Fong Karen G , Stewart Jackson J , Zeggil Teagan , Chen Justin
Published: January 2025

Background

There are limited studies examining antibiotic prescription appropriateness that compare trainees versus attending physicians or time of prescription in relation to working hours. Antimicrobial stewardship (AMS) prospective audit and feedback (PAF) was implemented in 2018 at a tertiary care centre targeting six restricted antibiotics (carbapenems, daptomycin, linezolid, and tigecycline). The agent, regimen, and duration were assessed by AMS pharmacists and/or physicians against institutional prescribing guidelines (expert opinion if not available) and recorded prospectively in the AMS quality improvement database. Real time written and verbal feedback were provided to the most responsible physician.

Table 1

Baseline prescription demographics.

Methods

We examined all prescriptions subjected to PAF from 2018 to 2023, with the primary objective to assess prescription appropriateness for medical trainees versus staff physicians. Secondary objectives were to evaluate whether other variables including time of day (working vs off hours), weekday vs weekend, and the COVID-19 pandemic period (Mar 2020-May 2022) impacted appropriateness. Multiple logistic regression was used to determine factors independently associated with optimal prescribing of antibiotics. Institutional ethics approval was obtained.

Figure 1

Odds ratios of prescription appropriateness for each independent variable (reference in parentheses).

Results

Overall, 3685 prescription audits were included in this study. Baseline prescription demographics are shown in Table 1. Of these, 1106 (32%) audited prescriptions were assessed by AMS PAF as not optimally prescribed requiring actionable AMS intervention. Prescriptions written by trainees were not less appropriate compared to staff (OR 1.27 [95%CI 0.97-1.66]). Off hours prescriptions had lower odds of being optimal (OR 0.81 [0.64-1.02], NS). Other secondary outcomes are reported in Figure 1. Prescriptions initiated by infectious disease (ID) had higher odds of being optimal (4.88 [3.68-6.55]).

Conclusion

In our cohort, we did not find a difference in appropriateness of restricted antibiotic prescriptions between trainees and staff, with a trend towards decline in optimal prescribing during off hours and weekends. ID had higher odds of optimally prescribing. Appropriateness improved over time and the COVID-19 pandemic did not have a negative effect at our center.

Disclosures

All Authors: No reported disclosures
P-1692. Evaluation of Antibiotic Appropriateness at Discharge in a Community Teaching Hospital
Authors: Patel Hinal , Poulsen Melissa
Published: January 2025

Background

Antimicrobial therapy is prescribed for approximately 20% of patients upon hospital discharge. The CDC and Joint Commission emphasize antimicrobial stewardship as a standard of care. While inpatient programs have processes in place to monitor and optimize antimicrobial therapy, monitoring and intervention during transitions of care is an unmet need for many hospital-based antimicrobial stewardship programs. We sought to evaluate antibiotic use at discharge at our institution to help develop potential strategies for monitoring and intervention.

Figure 1

Appropriateness of overall discharge antimicrobial therapy and breakdown by specific domains

Methods

This retrospective single center chart review evaluated adult patients discharged on oral antibiotics and diagnosed with pneumonia, skin and soft tissue infection, urinary tract infection, intra-abdominal infection, or bacteremia secondary to these infections. Exclusion criteria included pharmacist intervention on discharge orders, discharge parenteral antibiotics, and immunocompromised patients. The primary outcome was antibiotic appropriateness defined as right drug, dose, duration, and antibiotic-appropriate indication. Secondary outcomes included total duration of antibiotics, 30-day mortality, infection recurrence, and Clostridium difficile occurrence. Descriptive statistics were used for demographics and primary and secondary endpoints, and comparative statistics were used to evaluate the relationship between secondary outcomes and appropriateness.

Results

A total of 150 patients were included, of which 43/150 (28.7%) were prescribed appropriate antimicrobial therapy on discharge. Cefpodoxime was the most commonly prescribed antibiotic (45/150, 30%). The most common cause of inappropriate therapy was excess duration. The average excess duration of therapy was 4.4 days. The most common antibiotic indication was urinary tract infection, of which 33/52 (63.5%) cases were asymptomatic. Of note, the inappropriate use group had a statistically significant higher rate of 30-day readmission (12/107 versus 0/43, p = 0.022).

Conclusion

Inappropriate discharge antibiotics were common and associated with increased 30-day readmission rates, indicating a need for increased antimicrobial stewardship monitoring and intervention on hospital discharge.

Disclosures

Hinal Patel, PharmD, BCPS, BCIDP, Abbvie: Stocks/Bonds (Public Company)
P-1693. Comparison of Initial Treatment Strategies for Outpatients with Suspected Community Acquired-Pneumonia (CAP)
Authors: Munir Sheheryar , Iqra Soonha , Natesan Suganthini Krishnan , Kuhn Ryan , Dhar Sorabh
Published: January 2025

Background

Initial therapies for outpatient community acquired pneumonia (CAP) remain variable based on geographic location and resistance patterns. Infectious Diseases Society of America (IDSA) guidelines recommend either monotherapy for patients who lack comorbidities or risk factors for resistant organisms, or combination therapy for those at risk for severe pneumonia. Despite clinical guidance, it remains challenging for providers to prescribe guideline recommended therapies. Assessments of local practices and outcomes are essential for optimal CAP management.

Table 1

Community Acquired Pneumonia (CAP) Antibiotics Regimens and Patient Characteristics

Methods

A retrospective review of outpatient antibiotics prescribed from 1/2023 to 3/2024 for the indication of pneumonia was conducted at a Veterans Affairs Hospital. Clinical and antibiotic data were collected and analyzed to for comorbidities, risk factors, and outcomes, and assessed for indications for monotherapy or combination therapies in concordance with current IDSA guidelines. Antibiotics assessed included amoxicillin, doxycycline, azithromycin, amoxicillin/clavulanate either as monotherapy or combination therapy (beta-lactam antibiotic + azithromycin or doxycycline). Outcomes were compared between the 2 groups.

Table 2

Results

A total of 169 patients were reviewed of which 103 (60%) had comorbidities or risk factors for MRSA and pseudomonas. Most common antibiotics prescribed were amoxicillin/clavulanate + azithromycin in 81 (47.9%) and amoxicillin/clavulanate in 42 (24.9%) of patient (table 1). Monotherapy was prescribed in 40.8% of patients of whom 24 (34.8%) had no comorbidities or risk factors for resistance, while combination therapy prescribed in 100 (59.2%) patients of whom 58 (56.3%) possessed risk factors for resistance (p=0.4). There were no other differences noted in the clinical characteristics, risk factors, or outcomes between the monotherapy and combination therapy group.

Conclusion

Antibiotic prescribing for CAP was found to be variable with low concordance with guideline recommendations for monotherapy and combination therapies. Despite variability in regimens, no differences were noted in risk factors or outcomes suggesting that regional practices dictate CAP antibiotic selection. Appropriate prescribing patterns need to be assessed by stewardship programs.

Disclosures

All Authors: No reported disclosures
591. The Agency for Healthcare Research and Quality (AHRQ) Safety Program for MRSA Prevention: Impact of an Educational and Implementation Project in United States (US) Hospitals
Authors: Maragakis Lisa L , Miller Melissa A , Lin Leyi , Ahn Roy , Speck Kathleen , Gao Yue , Titus Jennifer , Dullabh Prashila
Published: January 2025

Background

The AHRQ Safety Program for MRSA Prevention utilizes evidence-based infection prevention interventions and the Comprehensive Unit-based Safety Program (CUSP) framework to decrease invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in intensive care units (ICUs), non-ICUs, surgical services, and long-term care facilities. We report the program's effect on hospital-onset MRSA bacteremia rates (HOB-MRSA) in 106 ICUs and 87 non-ICUs from 94 US hospitals.Table 1.Educational Toolkit Content for the AHRQ Safety Program for MRSA Prevention

Methods

The ICU/non-ICU Safety Program for MRSA Prevention was implemented from April 2022 to September 2023. The Safety Program aimed to decrease invasive MRSA infections through education, technical support, reinforcement of safety culture, and implementation of evidence-based infection prevention practices. Chlorhexidine bathing and nasal decolonization were major foci of the intervention, along with disinfection of the environment and practices to prevent person-based MRSA transmission and device-related infections. The project team provided 22 live webinars, supporting materials, and other tools to assist units with MRSA prevention (Table 1). Units were also assigned an implementation adviser who provided support through monthly coaching calls.

Units submitted monthly data for HOB-MRSA per 10,000 patient days (PD) as well as data regarding process measures. Linear mixed effects models were employed to calculate pre-post intervention changes in HOB-MRSA events.

Results

106 ICUs and 87 non-ICUs from 94 hospitals completed the Safety Program, including 31 (33%) academic medical centers (AMC), 37 (39%) non-AMC teaching hospitals, and 26 (28%) non-teaching community/other hospitals. From July-September 2021 to July-September 2023, HOB-MRSA events declined from 5.7 to 1.5 per 10,000 PD among ICUs (p< 0.001)(Figure 1) and from 3.4 to 0.2 for non-ICUs (p< 0.001) (Figure 2).

Similar results were found in comparisons among other pre-program vs, end-of-program quarters.

Conclusion

The AHRQ Safety Program for MRSA Prevention supported implementation of evidence-based infection prevention practices, including decolonization, and was associated with reduced HOB-MRSA rates across participating ICUs and non-ICUs.

Disclosures

All Authors: No reported disclosures
P-1694. Estimating the Use of Newer Beta-lactam Gram-negative Targeted Antibiotics Across Greater than 700 Hospitals in the United States
Authors: Harris Anthony , Goodman Katherine E , Pineles Lisa , Walker Morgan , Bork Jacqueline T , Heil Emily L , Claeys Kimberly C , Brooks Justin , Kadri Sameer S , Maron Brad , Baghdadi Jonathan
Published: January 2025

Background

Newer broad-spectrum beta-lactam antibiotics (cefiderocol, ceftazidime-avibactam, ceftolozane-tazobactam, imipenem-relebactam, meropenem-vaborbactam) have been introduced. Ceftazidime-avibactam and ceftolozane-tazobactam predominated newer antibiotic use through 2021; however, less is known about current use patterns and for what clinical indications, in inpatient settings. The aim of this study was to describe the use of these newer antibiotics across a large national cohort.

Methods

We performed a retrospective cohort study of adults discharged from June 2022 through May 2023 among hospitals in the Premier Healthcare Database. Antibiotic utilization was ascertained from daily charge data, and clinical indication(s) were inferred from ICD-10 diagnosis codes. A stratified analysis was performed among patients receiving >3 days of antibiotic therapy to understand when these antibiotics are being used as definitive therapy.

Results

Across 832 hospitals, 3,890,557 admissions (61.9% of all admissions) included receipt of antibiotics. In 8,655 admissions (0.2% of antibiotic-prescribing admissions), newer antibiotics were prescribed (see Table 1 for patient demographic distribution). Ceftolozane-tazobactam was prescribed in 4157 (48%), 3660 (42.3%) ceftazidime-avibactam, 1060 (12.2%) cefiderocol, 456 (5.3%) meropenem-vaborbactam, and 99 (1.1%) imipenem-relebactam. Most patients who received newer antibiotics (69%, n=5,998) received them for greater than 3 days. Of these, ceftolozane-tazobactam was prescribed in 2607 admissions (43.5%), 2505 (41.7%) ceftazidime-avibactam, 832 (13.9%) cefiderocol, 332 (5.5%)meropenem-vaborbactam, and 68 (1.1%) imipenem-relebactam for greater than 3 days. Sepsis was the most common clinical indication for receipt of newer agents, followed by urinary tract infection (Table 2).

Conclusion

Ceftazidime-avibactam and ceftolozane-tazobactam remain the most frequently prescribed new antibiotics, with uptake of subsequently approved agents trailing. Most of the prescribing of these antibiotics are for sepsis.

Disclosures

Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor Kimberly C. Claeys, PharmD, PhD, bioMérieux: Advisor/Consultant|bioMérieux: Honoraria