bluuebunny/crossref_metadata_2025 huggingface dataset:
P-1524. Clinical Characteristics and Outcomes of Patients with Candida auris at RUHS
Authors: Chiu Chiao An , Hong Maily , Aravagiri-Do Arunmozhi , Nguyen Rebecca , Mulligan Nikki , Sutjita Made , Weng Bruce
Published: January 2025

Background

Invasive Candidiasis Clinical Associations

*: Immunocompromised status including patients on chemotherapy, status post organ transplant, HIV positive, etc.

Methods

We conducted a retrospective chart review of C. auris fungemia cases in adult hospitalized patients at RUHS between January 2022 to December 2023. Demographic data, clinical associations, antifungal susceptibility and clinical outcomes were noted using descriptive statistics.

Antifungal Susceptibility

Results

Nine patients (n = 9) were identified. 8/9 (89%) presented from a long-term care facility. 5/9 (56%) patients were male gender averaging 65 years old (range 45-86yo). Charlson comorbidity index was 8.11. Clinical associations: invasive devices (9/9, 100%), long-term care residence (8/9, 89%), hospitalization within 90 days (7/9, 78%), IV antibiotic within 90 days (8/9, 89%), and surgery (5/9, 56%). All patients were treated with micafungin. Despite 100% susceptibility to echinocandins, fungemia duration was long (mean 242.1 hours; range 39.13-1431.75 hours) and 4/9 (44%) patients required a dose increase of micafungin (mean dose 194 mg; range 100-300 mg). Cases were further characterized by prolonged ICU length of stay (LOS (mean 15d, range 3-41d)), prolonged hospital LOS (mean 39.3d, range 9-65d), and high mortality (4/9, 44%). 2/5 (40%) survivors versus 0/4 (0%) deceased patients had source control. The majority of survivors 4/5 (80%) had a primary line-associated fungemia. 2/5 survivors (40%) were readmitted within 6 months.

Mortality in Relation to Source Control

Conclusion

Patients from long-term care facility with additional clinical associations appear to have high risk for C. auris infection and complications. Consideration of higher initial dose echinocandins should be considered in management of patients presenting with C.auris fungemia. Aggressive source control of fungemia etiology should be pursued when possible.

Disclosures

All Authors: No reported disclosures
P-1525. Real-World Efficacy of Fosfomycin for Treatment of Cystitis Caused by E. coli Versus Non-E. coli Gram Negatives With High Rates of FosA
Authors: McCormick Ryan C , Randazza Olivia , DeWitt Michael E , Banoub Mary , Taylor Alex D , Luther Vera P , Cook Julia Christine , Williamson John C
Published: January 2025

Background

Fosfomycin is an appealing cystitis treatment; however, guidelines recommend against fosfomycin for non-E. coli gram negatives due to reduced in vitro activity associated with FosA, an enzyme that hydrolyzes fosfomycin but does not always result in full resistance. These concerns have yet to be corroborated in efficacy studies. The purpose of this study was to determine if fosfomycin is an acceptable treatment for cystitis caused by non-E. coli gram negatives with high rates of FosA.

Methods

This was a single-center, retrospective, cohort study evaluating the efficacy of fosfomycin for cystitis caused by E. coli versus non-E. coli gram negatives with high rates of FosA, including K. pneumoniae, P. aeruginosa, K. aerogenes, K. oxytoca, M. morganii, and E. cloacae. Patients with an inpatient or outpatient fosfomycin order to treat cystitis caused by these bacteria were included. Patients were excluded if there was a lack of cystitis symptoms, evidence of pyelonephritis, polymicrobial culture, or ≥ 48 hours of antimicrobial therapy prior to fosfomycin. The primary outcome was 30-day treatment failure defined as persistence or recurrence of cystitis symptoms with either a positive culture (same bacteria) or antibiotic re-treatment.

Results

104 cases of cystitis were included in the study, 53 in the E. coli group and 51 in the non-E. coli group. Patient characteristics are presented in Table 1. The E. coli group had a higher median BMI; 26 (49%) vs 13 (25%) were obese (p=0.013). With 32 (63%) cases, K. pneumoniae was the most common non-E.coli and all but 10 cases were Enterobacterales. Treatment failure occurred in 17 (32%) of the E. coli group and 18 (35%) of the non-E. coli group (p=0.73) (Table 2). Among the failures, about half had a repeat positive culture, all failures received re-treatment, and median time to failure was 10 days for E. coli vs 7 days for non-E. coli. Figure 1 shows time to failure within groups, and Figure 2 shows failures by species.

Conclusion

These data suggest failure rates for fosfomycin are relatively high in all cases of gram negative cystitis, regardless of FosA. Presence of FosA may not be as clinically relevant as guidelines suggest when deciding to use fosfomycin for cystitis. Additional studies are needed to validate these findings.

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-1548. Risk Factors for Escherichia Coli Resistance to First-line Antibiotics in Urinary Isolations in Children
Authors: Guglielmo María Cecilia , Guedes Veronica
Published: January 2025

Background

There is concern about the increase in antibiotic resistance to Sulfamethoxazole/trimethoprim (SMX/TMP) in urinary tract infections (UTI) in children. There is limited evidence on whether there are associated risk factors for this resistance. The Objective of our investigation is to evaluate if there is an association between E. Coli resistance to (SMX/TMP) and previous episodes of UTI, prophylaxis or antibiotic treatment, hospitalizations, urinary tract disorders, age and sex.

Characteristics of children with SMZ-TMP-resistant E. Coli isolates compared to the control group

Methods

retrospective study that evaluated 117 medical records from Nephrology service of Elizalde Hospital, in Buenos Aires , Argentina from 1/1/2018 to 12/31/2018. The sample was divided into two groups. A control group (68 patients) with E. coli sensitive to SMX/TMP in urine isolations and a group of cases (49 patients) with resistant isolates. Risk factors were considered and association was evaluated by Chi test, OR calculation

with 95% confidence intervals. Binary logistic regression was performed . Significance 0.05. Age was dichotomized into older and younger than 2 years old

Results

Sex showed no association with resistant insulation. Patients older than 2 years old, were associated with resistant isolates (p = 0.01). Patients with hospitalizations were 3 times more likely to have a resistant insulation (p = 0.001). Alterations in the urinary tract increased 3.9 times the risk of resistant isolates (p < 0.0001). Greater resistance was observed in those with recurrence of infection (p < 0.0001). The multivariate analysis indicated that those patients with prophylaxis had an 83 times greater risk of presenting isolates resistant to SMX/TMP than patients without this risk factor (OR 83.47, 95% CI 12.6 – 552.21)

Conclusion

Prolonged use of antibiotics and receiving antibiotic prophylaxis were the only

factors independently associated with the finding of SMX/TMP-resistant E. Coli

Disclosures

All Authors: No reported disclosures
P-1561. Use of BacterioScan 216Dx to Reduce Antibiotic Use for Suspected Urinary Tract Infection in the Emergency Department
Authors: Gao Kelly , Kumar Vishak H , Divinagracia Giovanni , Kaye Keith S , Azim Ahmed Abdul , Kirn Thomas , Berla Bert M
Published: January 2025

Background

Urinary tract infections (UTI) are often empirically treated in the emergency department (ED) before urine culture (UCx) results are available. 20-40% of suspected UTIs yield negative UCx and therefore are, by definition, not UTIs. BacterioScan 216Dx is an FDA cleared device that allows for point of care analysis of urine samples for bacteria in 3 hours as opposed to UCx which can take up to 48 hours. The BacterioScan system uses the trend of optical density of a urine sample mixed with bacterial growth media to identify UTI positive samples containing ≥50,000 colony forming units (CFU)/mL of a uropathogen. We describe the potential impact of a negative BacterioScan test result on antibiotic use prior to UCx results becoming available.

Table

Urinalysis Positive, BacterioScan Negative, and Urine Culture Negative Patients Treated for Urinary Tract Infection: Antibiotics Used and Duration

Methods

We performed a retrospective review of ED patients from 12/1/2023 to 4/8/2024 with a positive UA (WBC >5 cells/hpf or leukocyte esterase or nitrite +) that reflexed to culture. Concurrently, the samples were tested using BacterioScan, but results were not released to treating clinicians. BacterioScan and UCx results were recorded along with patient demographics, antibiotics received, and duration of treatment. This analysis focused on UA positive, BacterioScan negative patients.

Results

600 patients had a positive UA that reflexed to culture. BacterioScan was negative in 100 of these patients. These patients had a mean age of 47.67 (SD 20.67). 66% were female. 36% identified as White, 16% African American, 4% Asian, and 44% other/prefer not to respond. 33% identified as Hispanic.

83 of 100 patients were Bacterioscan and UCx negative. Of these 83 patients, 8 (9.64%) were treated with median antibiotic duration of 5.5 days (Table).

17 patients had Bacterioscan negative/UCx positive results.13 of 17 had a mix of different bacterial species with CFUs ranging from < 10,000 to 50,000. 4 UCx were positive for potential pathogens- Streptococcus agalactiae (2), Proteus mirabilis, and Klebsiella pneumoniae. Of these 4, 3 had < 50,000 CFU and 1 had ≥100,000 CFU.

Conclusion

Appoximately 10% of patients of patients with UA positive/BacterioScan negative/UCx negative results could have avoided antibiotic treatment if BacterioScan results had been available to clinicians in real time. In urgent care settings, BacterioScan can help reduce unnecessary antibiotic use.

Disclosures

Keith S. Kaye, MD, MPH, Allecra: Advisor/Consultant|CARB-X: Advisor/Consultant|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Shionogi: Advisor/Consultant|Spero: Advisor/Consultant Thomas Kirn, MD PhD, Selux Diagnostics: Advisor/Consultant|Selux Diagnostics: Honoraria Bert M. Berla, PhD, Bacterioscan, Inc.: Ownership Interest|Bacterioscan, Inc.: Stocks/Bonds (Private Company)
P-1579. Prediction of Prognosis of Visceral and Subcutaneous Fat Areas in Pyelonephritis
Authors: Kitazawa Takatoshi , Nakayama Shin , Wakabayashi Yoshitaka
Published: January 2025

Background

Visceral fat accumulation has been regarded as a poor prognostic factor for coronary artery disease. Moderate overweight and mild obesity are associated with a lower mortality in patients with several infectious diseases on intensive care units, and this phenomenon is referred to as the obesity paradox. Pyelonephritis is one of the common infectious diseases, and although computed tomography (CT) imaging is frequently used in its localization, its prognostic value is limited. In this study, we analyze the relationship between the visceral and subcutaneous fat areas in CT scans and prognosis of patients with pyelonephritis.Fig. 1ROC curves using subcutaneous and visceral fat area to discriminating surviving pyelonephritis patients from deceased pyelonephritis patientsThe black line shows the curve using subcutaneous fat area and the gray line shows the curve using visceral fat area.

Methods

We included hospitalized patients with pyelonephritis who underwent computed tomography of the abdomen. Clinical data were obtained from the medical records. Subcutaneous and visceral fat aeras were analyzed at the umbilical level using the abdominal analysis (2D) function of the 3D image analysis system volume analyzer.

Results

505 patients were included in the study. There were 497 survivors and 8 non-survivors, with both subcutaneous and visceral fat areas being lower in the non-survivors than in the survivors (subcutaneous fat area 49.3 ± 73.9 cm2 vs 123.7 ± 85.3 cm2, p=0.012; visceral fat area 42.2 ± 29.2 cm2 vs 98.4 ± 69.1 cm2, p< 0.01, respectively. ROC analysis using subcutaneous and visceral fat areas to discriminate survival and death showed that the areas under the curve of subcutaneous and visceral fat areas were 0.794 (p=0.002) and 0.770 (p< 0.001), respectively (Fig.1).

Conclusion

Patients with poor prognosis of pyelonephritis tended to have lower subcutaneous and visceral fat area at onset than patients with improved prognosis. The results suggest that both subcutaneous and visceral fat area using CT may have prognostic value for pyelonephritis.

Disclosures

All Authors: No reported disclosures
P-1612. Does the Use of Diagnostic Testing Vary by Race and Social Vulnerability for those Seen in the Emergency Department or Admitted to the Hospital? A Retrospective Analysis in a Large Healthcare System
Authors: Mupanomunda Maria , Cosimi Reese , Garrett-Ray Stacy D , Daragjati Florian , Ghosh Subhangi , Masoudi Frederick , Bollinger Allison , Aloia Thomas , Fogel Richard , Fakih Mohamad G
Published: January 2025

Background

Diagnostic stewardship complements antimicrobial stewardship by promoting appropriate use of diagnostic tools. While disparities have been reported in antibiotic prescribing and hospital-acquired infections, data are limited on diagnostic test utilization. We evaluated the association of race and social vulnerability index (SVI) on ordering of diagnostic testing in a large diverse health system.Table 1:Diagnostic Test Utilization by Race and SVI Inpatient and Observation encounters

Methods

Retrospective analysis of tests ordered for all Inpatient and Emergency Department (ED) encounters of 85 hospitals in a large health system between January 1, 2023 to December 31, 2023. The primary clinical outcome was diagnostic test utilization defined as the number of tests ordered per 100 encounters for the following: blood cultures, urinalysis (UA), urine cultures, Clostridioides difficile (C. diff), complete blood count (CBC), comprehensive and basic metabolic panels (CMP/BMP), and COVID-Influenza-RSV panel. Data were stratified across patient race and SVI.

Results

A total of 751,638 Inpatient (70% White, 18% Black/African American (AA)) and 2,440,769 ED (60% White, 27% Black/AA) encounters were included in the analysis. Inpatient White patients had higher rates of diagnostic testing for C. diff than Black/AA patients (relative difference, 16%; p< 0.001) while UA, CBC, CMP/BMP, blood culture, and COVID-Influenza-RSV panel ordering was lower in White patients (relative difference, -6, -5, -5, -38; p< 0.001, respectively). In the ED, test ordering was higher in White patients in all test panels except for COVID Flu RSV. Similar differences seen by race were observed by SVI, with Low/Medium-Low SVI mirroring testing in White patients and High/Medium-High SVI mirroring testing in Black/AA patients.

Conclusion

Differences were identified in diagnostic test utilization by race and SVI in the inpatient and ED settings. Additional factors such as age, diagnosis, and regional variability may need to be further examined in future analyses. Although these disparities were observed, our internal mortality data shows no differences by race. Further investigation is warranted to determine appropriateness of diagnostic test ordering in each population to better interpret the disparities identified in this study.

Disclosures

All Authors: No reported disclosures
P-1644. Antimicrobial Stewardship Opportunities for Urine Cultures Resulting After Patient Discharge
Authors: Harris Natalie , Shroba Jenny , Burrows Joshua , Deri Connor R , Erkanli Alaattin , Funaro Jason , Lee Hui-Jie , Moehring Rebekah W , Yarrington Michael E , Wrenn Rebekah
Published: January 2025

Background

Urinary tract infections (UTIs) constitute 3 million emergency department visits (ED) annually and 15% of outpatient antibiotic prescriptions. The outpatient setting is the highest volume of antimicrobial prescribing in the United States, however, is generally a neglected practice area for antimicrobial stewardship (AS) programs. This study sought to evaluate need for AS with an existing ED feedback system for ambulatory patients.

Primary Outcome

Methods

This multi-center, retrospective study included adults > 18 years old and admitted inpatient or visited the emergency department from August 1, 2022 to February 1, 2023. Patients were included if prescribed antibiotics at discharge or within 72 hours of discharge and had a significant update to urine culture results post discharge up to 14 days. Patients were excluded if prescribed non-urinary indication antibiotic, deceased prior to final culture result, or discharged to hospice. A random 10% convenience sample was analyzed. Descriptive statistics were used to summarize patient characteristics and primary and secondary objectives.

Secondary Outcomes

Results

From a cohort of 1,362 patients, 137 encounters were screened and 111 met the inclusion criteria. Over 70% of encounters had at least one AS opportunity. Misdiagnosis attributed to 42% of all opportunities for intervention. Additionally, 20 (18%) patients received longer duration of antibiotics than indicated, and upon culture review, 14 (12.6%) patients received antibiotics post-discharge despite initial diagnosis of asymptomatic bacteriuria.

Conclusion

The majority of patients prescribed antibiotics with pending urine culture data receive unnecessary exposure in our system. Given the high frequency of misdiagnosis of UTI’s and errors in antibiotic prescribing found in this cohort, it is ripe for AS intervention and is uniquely structured with existing culture review systems as present in many EDs. Provision of decision support and provider education to reduce risks of unnecessary antibiotic therapy is needed.

Disclosures

Rebekah W. Moehring, MD, MPH, FIDSA, FSHEA, UpToDate, Inc.: Author Royalties
P-1654. Factors affecting vancomycin and piperacillin/tazobactam-induced nephrotoxicity
Authors: Munshi Ruhul , VanNatta Mollie , Khan Muhammad Haris , Alam Mohammad , Malek Alexandre E
Published: January 2025

Background

The concomitant use of vancomycin (Vanc) and piperacillin-tazobactam (Pip/Tazo) is one of the most common combinations utilized in infectious disease field. But, studies have hinted at an increased risk of nephrotoxicity. However, the specific factors leading to the development of acute kidney injury (AKI) remain uncertain. In this study, we sought to elucidate the potential factors contributing to AKI in pts who received both Vanc and Pip/Tazo

Methods

We performed a retrospective study of adult pts admitted at the Ochsner LSU Health Shreveport - Academic Medical Center between May 2019 and March 2023 who received at least 48h of Vanc and Pip/Tazo combination. Exclusion criteria and number of eligible pts are outlined in the flow chart. Demographics, calculation of Vanc levels and AUCs, and information on the treated infectious syndromes were all collected. AKI was defined according to RIFLE and AKIN criteria. We then compared pts who developed AKI versus those who did not.

Results

Of 1153 pts, we included 350 pts who met the inclusion criteria. Pts were divided into AKI group (n=89, 25.4%) and non-AKI group (n=261, 74.6%). Pts’ demographics at baseline were comparable between the two groups, except obesity was more prevalent in pts in the AKI vs non-AKI groups, with mean BMI of 31.52 vs 27.35, respectively, p=value < 0.001 (Table 1). There were no statistically significant differences between the two groups in terms of concomitant use of potentially nephrotoxic agents, except the use of IV contrast was significantly higher in the AKI group (31.5%) compared to the non-AKI group (18.0%) with p=0.008 (Table 2). On the univariate analysis, the mean duration of combination therapy was higher in the AKI group vs non-AKI group, 4.65 vs 4.04, respectively, p=0.01. Vanc loading and maintenance doses, AUCs, and trough levels were significantly higher in the AKI group (Table 3). However, logistic regression analysis showed that IV contrast was an independent risk factor for AKI (OR=2.4, 95% CI=1.14-5.03, p=0.02).

Conclusion

Our data demonstrated that IV contrast is significantly associated with an increased risk of nephrotoxicity in pts receiving Vanc and Pip/Tazo combination therapy. The data support that the combination of vanc and Pip/Tazo is not as nephrotoxic as initially thought.

Disclosures

All Authors: No reported disclosures
P-1657. Antibiotics in hospice and the patients who receive them
Authors: Crowley Patrick , Whelan Francis , Siegel Leslie , Challener Douglas
Published: January 2025

Background

At the time of hospice enrollment, patients are asked whether they would potentially want antibiotics. This is little information regarding which patients are more likely to receive these antibiotics or the impact on comfort or longevity. To help guide discussions with patients and families and target future stewardship interventions, we sought to characterize the use of antibiotics in the outpatient hospice setting.

Methods

We performed a retrospective review of patients enrolled in hospice with the Mayo Clinic Health System -Midwest from 1/1/2017 through 1/1/2023. For those with documented Hospice Qualifying Condition (HQC), we assessed age at enrollment, gender, survival time (ST), and Charleston Comorbidity Index (CCI). We documented which antibiotics were prescribed and compared the rate of prescription based on the above characteristics.

Results

We identified 6452 patients with identifiable HQC. Of these, 1281 patients (19.8%) received 4173 antibiotic prescriptions. After removing refilled prescriptions, there were 2037 new prescriptions. Cephalosporins were the most common class of antibiotics prescribed (24.4% of antibiotics prescribed), followed by fluoroquinolones (19.9%), penicillin derivatives (14.4%), and trimethoprim (10.4%) (fig 1). Pulmonary (28.6%) and GI (31.9%) HQCs were most likely to receive antibiotics, neurologic was least likely (fig 2). There was no difference of age for those receiving antibiotics (80.6 yr) vs those not receiving (80.3 yr [p=0.53]), or for gender (male vs female OR 0.97 [0.86-1.10). CCI was higher in those patients who received antibiotics (4.3) than those not receiving (3.93, p< 0.001). Patients were more likely to receive antibiotics the longer they survived on hospice (4.7% surviving < 7d, 47.7% surviving >6mo – fig 3).

Conclusion

Antibiotics are an important pharmaceutical tool in the hospice setting. Nearly 20% of patients in hospice will receive antibiotics during their hospice course, with higher chance in those surviving longer periods and those enrolled for GI or pulmonary reasons. Discussions of antibiotic are crucial for these groups, and antimicrobial steward efforts should consider focusing on these patients.

Disclosures

All Authors: No reported disclosures
P-1680. Retrospective Review of Adherence to Institutional Pneumonia Antimicrobial Guidelines at Hospital Admission
Authors: Burnette Bailey , Thompson Jesse M , Reece Becky , Burnette Jordan R , Howard Catessa A
Published: January 2025

Background

Literature supports the importance for institutions to have antimicrobial guidance accessible for providers in order to improve patient outcomes and antimicrobial stewardship (AMS). However, guideline adherence when prescribing for community acquired infections tends to be poor and includes more broad-spectrum antibiotics than required. We performed a review to assess adherence to our institutional pneumonia guidelines.

Methods

A retrospective chart review was conducted on all adult patients admitted to a Medicine or Hospitalist team at WVU Hospitals with an admission diagnosis of community acquired pneumonia (CAP)/pneumonia between January – June 2023. Demographic and clinical characteristics were collected as well as outcomes of interest: empiric antimicrobials and adherence to our institutional pneumonia guidelines. Data was collected and analyzed via WVU REDCap.

Results

We identified 154 patients with admission diagnosis of CAP to internal medicine services; however, 37 were excluded, as they were transfers from the ICU or outside facilities. Demographics showed 49.4% of the patients were female and median age was 69 years. 30% received antibiotics in preceding 90 days, with 77% of these for prior pneumonia. Identified comorbidities included: COPD (51.5%), Type II Diabetes (31.7%), CHF (43.6%), active malignancy (23.8%) and immunosuppressed (35.6%) (Figure 1). The median Patient Severity Index score was 91 (26-277). Adherence to institutional guidelines was 59% and of those non-adherent, 81% were over treated (Figure 2). Frequency of appropriate antibiotic use included: 24.8% ampicillin/sulbactam, 52.1% doxycycline, 33.3% ceftriaxone, and 12.8% azithromycin. Most common inappropriate antibiotic use included cefepime 28.2% and vancomycin 23.9%.

Conclusion

At 59% adherence to our pneumonia guidelines, this data shows there is a need for education and increased accessibility to institutional guidelines. Our QI intervention will include educational sessions on AMS guidelines and our CAP order panel, how to access the guidelines (via AMS app or webpage) and placement of guideline links within antibiotic orders. This study will also serve as a basis for assessing empiric treatment of other common infections and adherence to institutional AMS guidelines.

Disclosures

All Authors: No reported disclosures
P-1681. Determining Appropriateness of Pneumonia Treatment in Long-Term Care Facilities Pilot Project
Authors: Adre Cullen , Patel Dipen , Wren Callyn , Dao Quynh Nhu , Wilson Christopher , Evans Christopher D
Published: January 2025

Background

In 2019 IDSA updated the guidelines for community-acquired pneumonia (CAP). To date there are limited AU data in long-term care facilities (LTCFs). The Antimicrobial Appropriateness for Pneumonia in LTCFs (AAPL) Project was developed to determine which antibiotics are most used and their appropriateness in treating pneumonia (PNA) in TN LTCFs using a modified National Antimicrobial Prescribing Survey (NAPS) tool.

Methods

We recruited five LTCFs to collect retrospective PNA data from January 2023 to February 2023. Pharmacy students collected data for residents meeting a proposed PNA surveillance definition or with a written PNA diagnosis and entered into a REDCap database. Cases were reviewed and scored by two independent reviewers with an appropriateness score based on the NAPS tool (5 = not assessable, 3/4 = inappropriate, and 1/2 = appropriate). Descriptive statistics were used to analyze AAPL data and analyses performed on SAS Version 9.4.

Results

Thirteen cases were identified and reviewed; two were excluded due to no antibiotics received in the LTCF. Every chart had a written PNA diagnosis with 54.6% CAP and 18.2% HAP. 17.7% of cases had positive chest X-ray, 15.7% had acute decline in at least one daily living activity, and 11.8% had leukocytosis. 84.6% of cases (n=10) had MRSA risk factors). The most common antibiotics used were amoxicillin/clavulanate, ceftriaxone, and levofloxacin. The average duration of therapy was 7 days. 54.5% of antibiotics were appropriate (n=6), 36.4% were inappropriate (n=4), and 9% were not assessable (n=1). Nine cases had agreement on appropriateness, while two cases needed a third adjudicator to review.

Conclusion

The most common antibiotics used reflect current PNA guidelines, however only 54.5% were labeled as appropriate. Average duration was found to be longer than 2019 guideline recommendations (5 days of treatment with clinical stability). The data and experience from the pilot can be used to focus stewardship efforts on shorter durations with clinical stability, improve the survey tool, and build facility specific reports to improve prescribing practices with current PNA guidelines.

Disclosures

All Authors: No reported disclosures
P-1696. Antibiotic consumption and resistance among admitted patients with urinary tract infection in the Philippines: Results from a longitudinal Global Point Prevalence Survey
Authors: De los Reyes Mari Rose Aplasca , Garcia Jemelyn , Pauwels Ines , Versporten Ann , Bo Rhenalyn V , Vlieghe Erika
Published: January 2025

Background

Urinary Tract Infection (UTI) is a common diagnosis among hospitalized patients for which Escherichia coli (E.coli) is the most common etiologic agent. Recently, increasing antimicrobial resistance of E. coli to common antibiotics has been reported in the Philippines. We describe the prevalence of antimicrobial use for UTI in Philippine hospitals from 2017-2022 and compare this with the antimicrobial resistance pattern of urinary E. coli generated by the Department of Health, Antimicrobial Resistance Surveillance Program.

Methods

Since 2017, the Philippines has been conducting point prevalence surveys (PPS) on antimicrobial consumption using the standardized and validated methodology of the Global-PPS. All admitted patients on antimicrobials at 8 AM on the day of the survey were included. Type of infections and their corresponding antimicrobial prescriptions were recorded.

Results

Data were collected in 62 hospitals in the Philippines. Overall, three percent (N= 2242; 3.3%) of patients admitted in Philippine hospitals on the day of the PPS were treated with antimicrobials for UTI (lower UTI: 1,8%, upper UTI:1.5%). Ceftriaxone, cefuroxime, piperacillin-tazobactam, ciprofloxacin and meropenem were the top five antibiotics used (table 1), all of which are classified under the WATCH list of the WHO AWaRe classification. Seventy-seven percent of all antibiotics were prescribed empirically. Based on the antimicrobial surveillance data of the Department of Health, the resistance rates of E. coli to these antibiotics were high with on average more than 40% resistance to cefuroxime, ceftriaxone and ciprofloxacin (figure 1).

Conclusion

There is an opportunity to strengthen hospital antimicrobial stewardship programs, with particular emphasis on pre-authorization and audit and feedback strategies. Consideration may be given to placing ceftriaxone, cefuroxime, and ciprofloxacin under restricted categories requiring approval by the AMS clinician prior to empiric use. Importantly, local antibiograms should be reviewed on a regular basis and should be used as a basis for empiric antimicrobial recommendations in hospitals. Repeated point prevalence surveys are needed to measure the impact of interventions implemented by hospital AMS committees.

Disclosures

All Authors: No reported disclosures
P-1701. Impact of a Clinical Pharmacist-Led Antimicrobial Stewardship Program on Antibiotic Utilization and Resistance Patterns in a Medical Intensive Care Unit: A Cohort Study
Authors: James Leena
Published: January 2025

Background

Antimicrobial resistance presents a formidable challenge in medical intensive care units (MICUs), where the overuse of broad-spectrum antibiotics is closely associated with the rise of drug-resistant bacteria. This study aimed to evaluate the impact of implementing a robust Antimicrobial Stewardship (AMS) program in a medical ICU setting.

Methods

From February 2022, an AMS program was initiated in the medical ICU which involved consistent involvement from both a clinical pharmacist and an infectious disease physician who conducted ongoing assessments and offered feedback. To gauge the effectiveness of the AMS program, outcomes were compared between the AMS period and the six months preceding its implementation (pre-AMS period). Primary metrics included the utilization of antibacterial agents, such as broad-spectrum beta-lactam antibiotics effective against Pseudomonas aeruginosa.

Results

The study included a total of 275 patients during both the AMS and pre-AMS periods, ensuring a balanced comparison. There were no significant disparities between the groups regarding disease severity and mortality rates. Noteworthy findings during the AMS period included a substantial decrease in the empirical use of broad-spectrum beta-lactam antibiotics targeting Pseudomonas aeruginosa (42.18% during AMS vs. 63.27% pre-AMS, p < 0.001) and in multi-drug resistant organism (MDRO) infections (10.18% during AMS vs. 17.82% pre-AMS, p < 0.001). Additionally, there was notable improvement in appropriate antimicrobial de-escalation for MDRO-positive patients during the AMS period (37.45% during AMS vs. 20.36% pre-AMS, p = 0.001). The utilization of polymyxin also decreased during the AMS period (17.09% during AMS vs. 34.55% pre-AMS, p = 0.034). Furthermore, there was a significant increase in the susceptibility of Gram-negative Bacilli isolates to broad-spectrum beta-lactam antibiotics effective against Pseudomonas aeruginosa during the AMS period.

Conclusion

The implementation of a comprehensive clinical pharmacist-led AMS program resulted in a substantial reduction in antibacterial agent utilization within a medical ICU setting.

Disclosures

All Authors: No reported disclosures
P-1703. Evaluation of Antibiotic Use for Dental Infections in Dental Clinics Associated with an Academic Safety Net Institution
Authors: Deaney Michael A , Cooper Margaret M , Jenkins Timothy C , Meyers Kimberly A , Shihadeh Katherine C
Published: January 2025

Background

In 2019, the American Dental Association (ADA) issued guidance on diagnostic criteria and appropriate antibiotic regimens for dental pain and swelling. Limited data exists on adherence to these guidelines. This study aimed to evaluate adherence to these guidelines within outpatient dental clinics.

Figure 1

A flowchart for assessing antibiotic indication, selection, dose and duration adapted from the 2019 American Dental Association (ADA) guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling

Methods

We electronically identified all antibiotic prescriptions written by dentists in seven outpatient dental clinics in Denver Health, an integrated academic safety net institution, from July 2022 to November 2023. Detailed medical record review was performed for 200 randomly selected patients who were prescribed an antibiotic to examine antibiotic indication, selection, dose, and duration. Assessment of whether the prescribed regimens adhered to guidelines was conducted using a flowchart adapted from the ADA guidance (Figure 1).

Results

Forty-nine dentists dispensed a total of 1,874 prescriptions at 114,231 clinic visits (1.6% of visits). In the 200 patients whose medical records were reviewed, common prescription indications were irreversible pulpitis (15.8%), pulp necrosis with apical abscess (14.3%), caries (14.3%), and concern for post-operative infection (12.8%). Pain was noted in 85.2% of cases, with a median pain scale score of six. Due to incomplete documentation, 46.9% of prescriptions were deemed as "indeterminate" for guideline-directed indication. Only 5.6% of the documented cases met full indication criteria for antibiotic use per ADA guidance. Antibiotic selection was consistent with ADA guidance in 81.6% of cases; amoxicillin was the most prescribed antibiotic (79% of cases), followed by clindamycin (9.5%) and amoxicillin-clavulanate (8%). Durations of therapy were longer than recommended in ADA guidance in 23% of cases. In total, only 3.1% of prescriptions adhered to ADA guideline-directed antibiotic indication, selection, dose, and duration.

Conclusion

An antibiotic was prescribed in < 2% of dental clinic visits; while this rate aligns with previous literature, there is opportunity to improve adherence to ADA guideline-directed therapy for dental infections. Evaluation of effective stewardship interventions reinforcing these guidelines is warranted.

Disclosures

All Authors: No reported disclosures
592. Immunogenicity and Safety of High-dose versus Double-dose Quadrivalent Inactivated Influenza Vaccine in Adult Kidney Transplant Recipients: A Randomized Controlled Trial
Authors: Arayanumas Thanachote , Boonnak Kobporn , Kantachuvesiri Surasak , Boongird Sarinya , Kiertiburanakul Sasisopin , Bruminhent Jackrapong
Published: January 2025

Background

Both high-dose and double-dose inactivated influenza vaccines have been shown to better elicit a greater immune response compared to standard-dose influenza vaccine in solid organ transplant (SOT) recipients. However, a direct comparison between high-dose (HD) and double-dose (DD) quadrivalent inactivated influenza vaccine (QIIV) has not been explored.

Methods

From June to December 2023, we conducted an open-label randomized controlled trial to compare the immunogenicity and safety of the 2023 southern hemisphere HD QIIV at 60 ug (Effluelda, Sanofi) versus double standard-dose QIIV at 30 ug (Fluarix tetra, Sanofi) in adult kidney transplant (KT) recipients. Pre-immunization and 4-week post-immunization sera underwent strain-specific hemagglutination inhibition assays, and safety profiles were assessed.

Results

Eighty-four eligible KT recipients were randomly assigned to receive either HD QIIV or DD QIIV (42 each). Among them, 50 (59.5%) were male, with a mean age (SD) of 46 (11) years old, and 50 (60.7%) participants received kidneys from deceased donors. Common immunosuppressive regimens included mycophenolate mofetil (65.5%), tacrolimus (77.1%), and prednisolone (100%). SC to at least 1 strain was significantly greater in the HD QIIV group (95.2%) compared to the DD QIIV group (69%) (P = 0.006). The SC rate for A/H1N1, A/H3N2, B/Victoria, and B/Yamagata strains was higher in the HD QIIV group compared to the DD QIIV group, with the following percentages: 69.1% vs 52.4%, 52.4% vs 38.1%, 52.4% vs 42.9%, and 61.9% vs 40.5% (P = 0.118, P = 0.188, P = 0.382, and P = 0.049, respectively). In multivariate analysis, SC to at least 1 vaccine strain was significantly associated with the use of HD vaccine (OR 17.59, 95% CI [2.10, 147.22], P=0.008) and receiving the vaccine after 1-year post-KT (OR 34.76; 95% CI [2.59–454.45], P=0.007). There were significantly fewer occurrences of pain at the injection site and muscle ache in the HD QIIV group compared to the DD QIIV group, with the following percentages: 4.8% vs 19.0%, and 0% vs 9.5% (P = 0.040 and P = 0.043, respectively).

Conclusion

HD QIIV could marginally elicit a more pronounced immune response, alongside a comparatively reduced occurrence of adverse reactions, in adult SOT recipients when compared with DD QIIV. TCTR20230510005.

Disclosures

All Authors: No reported disclosures
P-1716. Assessing Appropriateness of Cephalosporins Prescription in a Tertiary Care Hospital in South India
Authors: Dharan Rithik , Dorairajan Suresh Kumar , Hassan Suhail , Roshni M
Published: January 2025

Background

Cephalosporins plays a vital role in empirical therapy. Unfortunately the misuse & underuse of 3rd Generation Cephalosporins (3GCs) has triggered a concerning rise in ESBL-producing Enterobacterales, with resistance rates as high as 80-85% in India. If this ongoing misuse continues, it poses a serious threat to the efficacy of these vital antibiotics. This cross-sectional study aims to evaluate the appropriateness and utilization of Cephalosporins in a tertiary care hospital in South India.Table 1:Factors for the initiation of Cephalosporins

Methods

In April 2024, a cross-sectional study was conducted by Pharm D interns assisted with Infectious Disease Specialists. Patients admitted as IP who received Cephalosporins until discharge are included. Patients receiving other than Cephalosporins are excluded from the study. Therapy appropriateness was determined using the Sanford Antimicrobial Guide 2022. Simple statistics are done in Excel for analysis.Table 2:Assessment of the initiated Cephalosporins

Results

Of 1376 patients, 428 (31.1%) patients received antimicrobial therapy of that Cephalosporins were prescribed to 226 patients (52.8%) for various indications. The most commonly prescribed was Ceftriaxone 139 (61.5%) prescriptions, followed by Cefuroxime 67 (29.6%), Cefixime 5 (2.2%), Cefazolin 5 (2.2%) & others 10 (4.4%). Reasons for initiating cephalosporins and analysis are given in Table 1 & Table 2. 3GCs are the most frequently used empirical antibiotic. A significant proportion (37.6%) of cephalosporin prescriptions lacked clinical infections. Empirical therapy continued beyond the 5th day 5.8 ± days following negative cultures, Duration of surgical prophylaxis exceeded than the recommended guidelines.

Conclusion

From the findings, Ceftriaxone dominated 61% of prescriptions for various indications, with one-third administered inappropriately via parenteral till discharge, mean duration 5.8 ± days. 37.6 % of the 3GC administered have been inappropriate also which has added additional costs to the patient. A knowledge gap among clinicians in discontinuation should be addressed by educational interventions with clinical pharmacists actively engaging to de-escalate cephalosporins. This single-centric study suggests the need for RCTs providing alternatives to cephalosporins for infections to prevent the risk of increasing ESBL resistance in India.

Disclosures

All Authors: No reported disclosures
P-1731. Assessing The Impact of an Electronic Health Record Embedded Treatment Algorithm and Order Set on Antipseudomonal Antibiotic Use in Diabetic Foot Infections
Authors: Acbo Antoinette M , McSweeney Terrence D , Bao Hongkai , Cowman Kelsie , Nori Priya , Guo Yi , Chang Mei H
Published: January 2025

Background

An opportunity to improve diabetic foot infection (DFI) management was identified based on institution-specific epidemiology and antibiotic use (AU) data. Pseudomonas aeruginosa prevalence was < 15% upon review of 6,749 unique DFI cultures. However, skin and soft tissue infections were a leading indication for antipseudomonal antibiotics at our institution, driven by DFI. In response, a multidisciplinary team implemented an electronic health record (EHR)-embedded treatment algorithm and order set for DFI treatment.

Methods

This multicenter, quasi-experimental study was conducted at an urban, academic healthcare system in the Bronx, NY. Patients were included if they were 18 years of age or older on antibiotics for DFI admitted to vascular surgery or medical floors. Exclusion criteria included duplicate patients, concomitant infection, or transfer from outside hospital. The primary outcome was antipseudomonal AU rate defined as days of therapy (DOT) per 1000 days present. Secondary outcomes included empiric antipseudomonal use, length of stay (LOS), 30-day readmission, 30-day mortality, amputation rates, and C. difficile infection (CDI).

Results

The pre-intervention group included 70 patients, while the post-algorithm and post-order set groups included 35 patients each. Baseline characteristics are listed in Table 1. Antipseudomonal AU was significantly lower in the EHR-embedded treatment algorithm group compared to the pre-intervention group (333 vs 503, p < 0.001); the post-order set group had the lowest antipseudomonal use (289 vs 503, p < 0.001). Empiric antipseudomonal use decreased from 85.7% pre-intervention to 62.9% post-algorithm and 65.7% post-order set (Table 2). Hospital LOS, 30-day mortality, and amputation within 30 days were similar between groups. No CDI occurred. The most frequently isolated bacteria from DFI cultures were Staphylococcus aureus and Streptococcal species (Figure 1).

Conclusion

EHR-embedded clinical decision-making tools can effectively reduce antipseudomonal AU for the treatment of DFI without increased risk of 30-day mortality or amputation.

Disclosures

All Authors: No reported disclosures
P-1741. The CArbapenem Sparing Antimicrobial Stewardship (CASAS) Project: an innovative approach to reduce carbapenem consumption in low-users hospital settings
Authors: Bongiovanni Marco , Barda Beatrice , Di Benedetto Caroline , Elzi Luigia , Mombelli Matteo , Ramponi Niccolò , Bernasconi Enos
Published: January 2025

Background

One of the main objective of the Antimicrobial Stewardship programmes (ASp) is the optimization of antibiotic use, reducing the use of broad spectrum antibiotics when unnecessary. In this context, the close monitoring of carbapenem consumption is mandatory.

Methods

The CASAS Project started in January 2024 in 4 public Hospitals (for a total of approximately 1000 beds) in Southern Switzerland, a region with a low prevalence of multi-drug-resistant bacteria (MDR) and with a low use of carbapenem treatments (CAR-T). An electronic alert was sent to the Infectious Diseases (ID) Team after 96 hours of continuous CAR-T; at that point, an ID specialist review was performed in order to confirm or not the CAR-T. For patients who continued CAR-T ID consultation was repeated every 72 hours until stopping. Parameters included in the consultation were: empiric or targeted treatment, type of carbapenem (meropenem, imipenem or ertapenem) and duration, outcome (confirm CAR-T, stop or switch to other drug), microbiological results, septic shock, admission to ICU, hospitalization in the previous 3 months, source of infection and known colonization with MDR. A descriptive analysis of these parameters was performed and finally we compare the Defined Daily Dose (DDD) of each carbapenem in the first trimester of 2023 and 2024.

Results

A total of 290 consultations were performed between Jan 1 and Mar 31, 2024 (184 first and 106 follow-up visits). Meropenem was the most used CAR-T (n=151) for a median duration of 13 days (4-14). Table 1 summarizes the other parameters considered in the analysis. An overall reduction of DDD for carbapenems was observed (overall DDD: 2023: 2372.6; 2024: 2026.5, -14.6%). When splitting the results for the single carbapenem, the main reduction was observed for meropenem (DDD 2023: 1563.7; 2024: 1236.4, -20.9%); the reduction for imipenem and ertapenem was -2.3% and -2.4%, respectively.

Conclusion

ASp should include a close monitoring of wide-spectrum antibiotic treatment, including carbapenems. In our setting, the CASAS Project was associated with a rapid reduction in CAR-T also in low-users hospitals. The long-term implementation of similar projects could have a beneficial impact on the prevalence of multi-drug resistance infections.

Disclosures

All Authors: No reported disclosures