bluuebunny/crossref_metadata_2025 huggingface dataset:
P-1243. Evaluation of Single and Multiple Dose Safety and Pharmacokinetics of Ledaborbactam Etzadroxil and Ceftibuten-Ledaborbactam Etzadroxil in Healthy Volunteers
Authors: de Oliveira Carlos Fernando , Dorr Mary Beth , Lowe Kathryn , Winchell Gregory A , McGovern Paul
Published: January 2025

Background

Ledaborbactam etzadroxil (LED-E), a novel oral prodrug that converts to the active β-lactamase inhibitor ledaborbactam (LED), is being developed in combination with ceftibuten (CTB) to address the urgent need for new oral (PO) treatments against drug-resistant gram-negative infections.

Methods

In part 1, healthy participants (PT) received single (100mg to 1000mg) or multiple (75mg to 500mg q8h for 10 days) PO doses of LED-E or matching placebo (PBO); PTs in Part 2 received single doses of LED-E 500mg, CBT 400mg, and LED-E+CTB 500mg+400mg; Part 3 PT received LED-E+CTB 300mg+400mg, LED-E+CTB 500mg+400mg or PBO q8h for 10 days. Serial blood and urine samples were obtained to determine single dose and steady-state plasma PK of CTB, LED-E, and LED. Safety was assessed by recording adverse events (AE), and changes in laboratory, vital signs, and ECGs.

Results

AUC of LED-E was ≤ 2% of exposures of LED across the dose range tested, suggesting extensive conversion of the prodrug to the active drug. LED exposures increased in a generally dose proportional manner across single LED-E doses from 100mg to 1000mg and multiple doses from 75mg to 500mg q8h. The terminal half-life of LED in plasma is approximately 11-12 h, with 30-35% accumulation of LED following q8h dosing of LED-E. Excretion in urine of LED-E derived material was 84.4% over the 8-hour dosing interval at steady state. No clinically relevant changes in the pharmacokinetics of CTB, LED, or LED-E occurred when CTB and LED-E were co-administered compared to each administered alone (Table 1).

The number of participants with treatment-emergent AEs (TEAE) was similar in the LED-E (+/- CTB) (81.7%) and PBO (77.8%) groups. Headache and nausea were the most frequently reported TEAEs in LED-E dosed PTs (Table 2). Most events were mild and only 1 TEAE led to drug discontinuation. No serious adverse events or deaths occurred. No clinical relevant changes were noted in clinical labs, ECGs, or vital signs

Conclusion

LED exposure increased in a dose proportional manner. No clinically relevant drug-drug interaction was observed between LED and CTB When LED-E and CTB are co-administered. LED-E was safe and well tolerated when given with CTB at multiple doses up to 1500mg daily for 10 days.

Disclosures

Carlos Fernando de Oliveira, MD, PhD, MS, Venatorx Pharmaceuticals: Stocks/Bonds (Private Company) Mary Beth Dorr, PhD, Merck: Stocks/Bonds (Public Company)|Pfizer: Stocks/Bonds (Public Company)|Venatorx: Stocks/Bonds (Private Company) Kathryn Lowe, MS, Venatorx Pharmaceuticals: Stocks/Bonds (Private Company) Gregory A. Winchell, PhD, Certara: Advisor/Consultant|Merck: Advisor/Consultant|Venatorx: Advisor/Consultant Paul McGovern, MD, Venatorx Pharmaceuticals, Inc.: employee|Venatorx Pharmaceuticals, Inc.: Stocks/Bonds (Private Company)
P-1389. Portrayal of Sexually Transmitted Infections in Popular Films
Authors: Deaney Michael A , McClure Kinsey , Jeffres Meghan N
Published: January 2025

Background

Stigmatization of sexually transmitted infections (STIs) threatens provider-patient relationships and leads to the underutilization of STI services. Media can shape public attitudes toward healthcare topics by perpetuating or reducing stigma. Considering the prevalence of STIs and the widespread consumption of media, healthcare providers must be cognizant of factors influencing societal perceptions of STIs. This study aims to analyze the representation and accuracy of STIs in popular narrative films.

Characteristics of Films and Characters Portraying Sexually Transmitted Infections.

a Other STIs featured in films include HSV (n=11), gonorrhea (n=6), syphilis (n=8), pubic lice (n=4), unspecified STI (n=3), chlamydia (n=2), HPV (n=1), trichomoniasis (n=0).

b Other STIs featured in characters include HSV (n=13), gonorrhea (n=8), syphilis (n=8), pubic lice (n=5), unspecified STI (n=4), chlamydia (n=3), HPV (n=1), trichomoniasis (n=0).

Methods

This study is a descriptive analysis of popular films depicting STIs. Full-length, English-language, narrative films featuring characters with confirmed or suspected STIs were gathered through a keyword search from the Internet Movie Database. Descriptive statistics were used to determine the proportion of characters with accurately portrayed STI clinical variables of symptoms, transmission, diagnosis, and treatment.

Stacked bar graph displaying proportion of accurate (blue) and inaccurate (orange) STIs in individual characters by clinical variable (symptoms, transmission, diagnosis, and treatment). Character counts are presented as data labels within their respective colors.

Results

This study examined 128 characters from 77 films. Human immunodeficiency virus (HIV) was the most commonly portrayed STI in 42 films (55%). HIV was most commonly featured in dramas (62%). Herpes simplex virus, gonorrhea, syphilis, pubic lice, chlamydia, and human papillomavirus were most frequently portrayed in comedies (40%). Other characteristics are displayed in Table 1. Characters with STIs were primarily adult (93%), non-Hispanic White (78%), and male (75%). Figure 1 shows the rates of clinical variable depiction and accuracy by character. Accuracy of each clinical variable was 92% for symptoms, 89% for transmission, 84% for diagnosis, and 85% for treatment. Four (3%) characters represented all clinical variables, 2 (50%) of which were accurately portrayed. Death occurred in 39 characters (30%), with HIV contributing to the majority of deaths (82%).

Conclusion

Films commonly represent accurate symptoms, transmission, diagnosis, and treatment of STIs. However, the frequency of death secondary to STIs is exaggerated and may contribute to STI stigmatization. Understanding the portrayal of STIs in popular films can provide valuable insights for clinicians, enabling them to address patient misconceptions and knowledge gaps.

Disclosures

All Authors: No reported disclosures
P-1393. TikTok Fact or Fiction: Dissecting Misinformation about STIs in the Digital Landscape
Authors: Nicolas Marissa , Pavia Jonathan E , Hornak Joseph Patrik
Published: January 2025

Background

With over 1 billion TikTok users, the platform has seen an unprecedented influx of content. Studies have noted a significant shift in TikTok's role as a source of medical information. While some creators utilize the platform to disseminate scientifically supported content, others unintentionally or deliberately propagate misinformation. Thus, navigating the misinformation surrounding sexually transmitted infections (STIs) becomes crucial for effective infection control.

Methods

Forty TikTok's were analyzed covering the CDC’s eight most common STIs: Gonorrhea, Chlamydia, Syphilis, HIV, Hepatitis B, Trichomonas, HSV, and HPV. Inclusion criteria required English-language videos with >10K likes posted after 2020. Exclusions comprised content from medical professionals, pharmaceutical companies, and non-educational videos. Two graders assessed video accuracy on a scale from 0 being completely accurate to 4 being completely inaccurate using CDC guidelines as reference. A weighted Cohen's kappa score was calculated to determine inter-rater agreement. The two grades for each video were averaged and used to calculate the results.

Results

The forty videos analyzed had an average like-and-share count of 139K and 7.5K, respectively. The average TikTok score was 1.325 indicating that in general, content was not free of inaccuracies. In fact, 65% of the TikTok's analyzed contained at least one inaccuracy and about 28% were graded as mostly inaccurate (score > 2). The top three topics covered were STI transmission, symptoms, and treatment. Among these, 78% of treatment and 69% of transmission videos contained inaccurate information. Further, 44% of videos regarding STI treatment obtained a score of 4 indicating complete inaccuracy. The kappa coefficient was 0.555 indicating moderate agreement between graders.

Conclusion

Today access to educational content is as easy as opening TikTok. Expanding access to STI education has potential to improve public health, but viewers must proceed with caution. Our study found that misinformation is common on TikTok, especially surrounding STI treatment and transmission. Misinformation can fuel stigmas on this sensitive topic, create barriers to those seeking proper care for STIs, and ultimately can lead to poor public health outcomes.

Disclosures

Joseph Patrik Hornak, MD, Innoviva Specialty Therapeutics: Advisor/Consultant|Innoviva Specialty Therapeutics: Advisor/Consultant
572. The Burden of RSV Infections Among Nursing Home Residents, Monroe County, NY, October 2022 to April 2023
Authors: Popham Kevin , St George Katherine , Felsen Christina B , Dumyati Ghinwa , Tesini Brenda L
Published: January 2025

Background

RSV causes significant morbidity and mortality in older adults. Outbreaks are common in nursing home (NH) residents, but little is known about the burden of disease in this vulnerable population. We analyzed population-based data on laboratory-confirmed RSV infections and hospitalizations from the CDC Respiratory Syncytial Virus Hospitalization Surveillance Network to understand the burden of RSV on the NH population compared to community-dwelling older adults.

Weekly Number of Positive RSV Tests Reported by Nursing Homes in Monroe County, NY, October 2022 to April 2023

Methods

We reviewed positive RSV tests from all clinical labs utilized by Monroe County, NY residents from October 2022 to April 2023. Cases in patients ≥65 years of age were attributed to a NH or the community through medical chart review. RSV rates were calculated in NH residents using occupied bed census averaged over the season and in community-dwelling residents using county population data. Incidence and outcomes including hospitalization, ICU admission and in-hospital mortality were calculated weekly and across the season.

Healthcare utilization among nursing home residents with laboratory-confirmed RSV hospitalizations in Monroe County, NY, October 2022 to April 2023

Results

Of 766 laboratory-confirmed RSV cases in patients ≥65 years of age, 134 were among NH residents. Incidence per NH ranged from 25.5 to 3,163.1 per 10,000 residents. NH cases often clustered in time (Figure 1), with a peak weekly attack rate of 17.7% in one facility. Three NHs had a seasonal attack rate >20%.

Of 170 hospitalizations in patients ≥65 years, 24 occurred in NH residents; 18% (24/134) of all NH residents with RSV were hospitalized. NH residents accounted for 295 hospital days (Table 1). Four NH residents required ICU admission, utilizing 20 ICU days, and 6 died in the hospital. NH residents were hospitalized at a rate 5.6 times greater than community dwelling older adults (Table 2).

Rates of laboratory-confirmed RSV infection and hospitalization among adults ≥65 years of age in Monroe County, NY, October 2022 to April 2023

Conclusion

Our data emphasize that NH residents are particularly vulnerable to RSV infection and complications. The tight clustering of laboratory-confirmed cases within facilities likely represents within-facility transmission, the magnitude of which may be underestimated due to NH testing practices. Early recognition of infection and swift implementation of appropriate infection control precautions are needed to limit outbreaks. Additional preventive measures including resident vaccination and policies discouraging working or visiting while ill should be prioritized.

Disclosures

Brenda L. Tesini, MD, Merck: Honoraria
P-1568. Reevaluating Our Urine Culture Clinical Support Tool: Do I Really Need “Other” as an Option?
Authors: Said Mina , Kung Vanessa , Beck Abigail , Nagaro Kristin , Snyder Graham M , Martin Elise , Buehrle Deanna
Published: January 2025

Background

One strategy to reduce non-indicated urine cultures and asymptomatic bacteriuria is an electronic health record tool requiring providers to select an indication, but limited data exist on such tool’s optimal indications and if “other” is a necessary option.Figure 1:Urine culture clinical decision support tool with indication selection at time of ordering.

Methods

In 1/2023, our VA facility developed a urine reflex/culture ordering clinical decision support (CDS) tool requiring an approved indication selection with each order (Figure 1), and audit/feedback emails for non-indicated orders were added in 7/2023. We performed a quality improvement evaluation of the CDS tool’s selected indications to understand ordering trends including appropriate orders (medically indicated with matched chart reviewed clinical scenario), wrong selection (medically indicated but selected indication did not match chart reviewed clinical scenario), non-indicated (no appropriate indication on chart review), and all “other”. We performed a chart review of 1063 orders (44%) from 1/17/23 - 12/30/23 and compared the CDS tool selections to chart review. We analyzed the percentage and distribution of appropriate, wrong selection, and non-indicated orders, and separately analyzed all “other” selections.Table 1:Proportion of selected indications deemed appropriate, wrong selection, and non-indicated, with the most common reasons for each.

UTI: Urinary tract infection, SPC: Suprapubic catheter

Results

Of all urine reflex/culture orders audited, 43% were appropriately ordered, wrong selections were detected in 35%, while 22% were medically non-indicated (Table 1). The indication “other” was selected 357 times (33% of all orders) and only 1 “other” selection was considered appropriate (Table 2). 67% of “other” were selected instead of a medically indicated choice available on the order set. 33% of “other” were selected when a urine culture was not medically indicated, such as leukocytosis (16%), altered mental status without infectious symptoms (14%), or fever without urinary symptoms (11%). “Other” was also selected in 14 patients when ordering providers wanted a different urine test and did not need a culture.Table 2:Assessment of indications when the ordering provider selected “other” for a urine culture or a urinalysis with reflex to culture.

UTI: Urinary tract infection, AKI: Acute kidney injury, DKA: Diabetic keto-acidosis

Conclusion

While CDS tools may be effective in reducing non-indicated urine cultures, wrong selection and bypassing the order tool were common at our facility. Selecting “other” was a common source of bypassing the tool and for medically non-indicated urine cultures. Further research is necessary on whether removing “other” helps to reduce non-indicated urine reflex/cultures.

Disclosures

Graham M. Snyder, MD, SM, Infectious Diseases Connect: Advisor/Consultant
P-1571. Risk Factors for Infections after Urological Procedures among Patients with Negative Urine Culture Screening
Authors: Tantiwattanapaibul Nutnicha , Apisarnthanarak Anucha , Noppakulsatit Patranuch , Liwrotsap Chatchawet , Tangpaitoon Teerayut , Swatesutipun Valeerat , Vanichkarn Dollacha , Tangkaew Natthapitch , Jantarathaneewat Kittiya , Suwantarat Nuntra
Published: January 2025

Background

The increased demand for urological procedures had become significant complications and correlating with an elevated prevalence of multidrug-resistant organisms (MDROs) infections, prolonged hospital stay, and the cost of treatment.

Table 1

Multivariate analysis of risk factors for infection after urological procedures among patients with negative urine culture screening

Methods

We conducted a retrospective cohort study to identify the risks for infections after urological procedures among patients with negative urine culture screening. The patients underwent transrectal ultrasound (TRUS) and biopsy of the prostate, transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HoLEP), percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), retrograde intrarenal surgery (RIRS), and transurethral resection of bladder tumor (TURBT) between 2021 and 2023, at Thammasat University Hospital, Thailand.

Results

A total of 441 patients had the procedures. There were 55 patients (12.5%) developed infections including urinary tract infections (UTIs) (55/55; 100%) and sepsis (9/55; 16%). The significant risks of infections were chronic kidney disease (CKD) stage III-V (P=0.005), history of previous UTI within 3 months (P< 0.05), Revised Cardiac Risk Index (RCRI) for preoperative risk > 2 (P=0.002), and PCNL (P< 0.05). The patients received antibiotic prophylaxis with levofloxacin (26.5%) for TRUS and biopsy of the prostate and cefoxitin (73.5%) for other procedures. The most common causative pathogens of UTIs after the procedures were Escherichia coli (27/55; 49%), Pseudomonas aeruginosa (9/55; 16.4%) and Klebsiella pneumoniae (7/55; 12.7%). MDROs were identified including extended-spectrum cephalosporinase (24/55; 43.6%) and fluoroquinolone-resistant Gram-negative bacteria (12/55; 21.8%). The median hospital stay was 12 days (IQR 10-15) VS 3 days (IQR 3-4) for infection VS non-infection.

Conclusion

Our study emphasized the novel significance of CKD and RCRI scores as risk factors and severity indices for preoperative risk assessment, correlating with postoperative infections following urological proceOur study emphasized the novel significance of CKD and RCRI scores as risk factors and severity indices for preoperative risk assessment, correlating with postoperative infections following urological procedures.

Disclosures

All Authors: No reported disclosures
P-1574. Asymptomatic Bacteriuria Not a Predictor of Clinical Failure in Uncomplicated Urinary Tract Infections (uUTI): A Prospective Analysis of Women Treated for uUTI from the REASSURE Trial
Authors: Aronin Steven I , Dunne Michael , Puttagunta Sailaja
Published: January 2025

Background

Per FDA Guidance, the primary efficacy endpoint for trials evaluating antimicrobials for treatment of UTI is a combined clinical/microbiologic response. Overall success requires both resolution of UTI symptoms and demonstration that the causative uropathogen is reduced to < 103 CFU/mL at a fixed time point after randomization, regardless of whether the patient is asymptomatic. Previously, we retrospectively evaluated the impact of post treatment asymptomatic bacteriuria (ASB) for Phase 3 clinical trial patients with UTI and found that ASB was not a predictor of subsequent clinical failure. In this study, we prospectively assessed the impact of post treatment ASB on subsequent clinical response for adult women with uUTI.

Methods

Study IT001-310 was a Phase 3 randomized, double-blind, double-dummy, active controlled trial to evaluate the safety and efficacy of sulopenem/probenecid (SUL) versus amoxicillin/clavulanate (AMC) for the treatment of uncomplicated UTI (uUTI). Adult women were randomized to receive SUL or AMC, both bid for 5 days. The primary efficacy outcome was overall success (combined clinical/microbiologic success) at the Test of Cure (TOC) visit in the mMITT population. ASB at TOC was prespecified as an additional efficacy endpoint to be assessed, and the presence of ASB at the End of Treatment (EOT) and TOC visit was evaluated to see if it impacted clinical response at the following visit.

Results

2,222 women were randomized; 990 (44.6%) were in the mMITT population. ASB was the reason for nonresponse in 74 (14.2%) and 93 (19.9%) patients treated with SUL and AMC, respectively. As shown in the table, for both treatment arms, the presence of ASB at the EOT and TOC visit did not lead to clinical failure at the following visit.

Conclusion

SUL and AMC, both β-lactams, appear to have similar effects on the frequency of post treatment ASB. For patients in both treatment arms, the presence of ASB a week after completing UTI therapy was not a marker of subsequent clinical failure. The inclusion of ASB as part of the primary endpoint for studies of UTI should be reconsidered. Inclusion of microbiologic results from asymptomatic patients after complete resolution of uUTI symptoms is a practice inconsistent with available treatment recommendations.

Disclosures

Steven I. Aronin, MD, Iterum Therapeutics: Employee|Iterum Therapeutics: Employee|Iterum Therapeutics: Stocks/Bonds (Public Company)|Iterum Therapeutics: Stocks/Bonds (Public Company) Michael Dunne, MD, Iterum Therapeutics: Advisor/Consultant|Iterum Therapeutics: Board Member|Iterum Therapeutics: Stocks/Bonds (Public Company) Sailaja Puttagunta, MD, Iterum Therapeutics: Employee|Iterum Therapeutics: Employee|Iterum Therapeutics: Stocks/Bonds (Public Company)|Iterum Therapeutics: Stocks/Bonds (Public Company)
P-1640. Antibiotic prescribing guideline-concordance for sinusitis in adult and pediatric primary care practices
Authors: Dutcher Lauren , Gonzalez-Hernandez Graciela , Rendell Sara , Serletti Lacey M , Boustany Mickael , O’Connor Karen , Weissenbacher Davy , Cressman Leigh , Gerber Jeffrey S , Grundmeier Robert , Hamilton Keith W
Published: January 2025

Background

Antibiotics are only sometimes indicated for acute sinusitis, a commonly diagnosed infection in the ambulatory setting and an important target for antibiotic stewardship. However, assessment of the appropriateness of antibiotic use for sinusitis is based on clinical signs and symptoms, and therefore requires manual chart abstraction. We present a study assessing the appropriateness of antibiotic prescribing in adult and pediatric sinusitis visits.

Methods

Outpatient encounters for sinusitis in adult and pediatric primary care practices within two health systems with an antibiotic prescribed from July 1, 2017 through June 30, 2021 were identified by ICD-10 code (J01 and J32). Of these, 600 encounters were randomly selected for review (300 from adult practices; 300 from pediatric practices). Five trained physician annotators reviewed prescriber notes from these encounters and identified relevant signs/symptoms, duration of illness, and disease trend and severity; annotators used these findings to assess overall guideline concordance of antibiotic prescribing using definitions adapted from clinical guidelines (table 1). Two physicians performed adjudication for disagreements (LD, KWH).

Results

Demographics and characteristics of included encounters are reported in Table 2. In adults, 19 encounters were excluded after review due to a note being unrelated to the sinusitis encounter; of the remaining 281, 37 (13.2%) were considered guideline concordant, 157 (55.9%) were considered not guideline-concordant, and 87 (31.0%) were potentially guideline concordant but with insufficient information. In pediatrics, 184 (61.3%) were considered guideline concordant, 99 (33.0%) were considered not guideline-concordant, and 17 (5.7%) were potentially guideline concordant but with insufficient information. Common reasons for guideline non-concordance are described in Table 3.

Conclusion

Antibiotic prescribing forsinusitis was frequently not concordant with guidelines. Prescribing was more frequently concordant in pediatric compared to adult-care settings. In both groups, duration of symptoms was frequently documented as fewer than 10 days, suggesting a potential target for antibiotic stewardship interventions.

Disclosures

All Authors: No reported disclosures
P-1651. Utilizing Electronic Medical Record (EMR) Based Tools to Shorten Duration of Therapy for Community Acquired Pneumonia in the Ambulatory Setting
Authors: Upadhyayula Shankar , Williamson Kelly
Published: January 2025

Background

Community acquired pneumonia (CAP) is a commonly encountered diagnosis is the pediatric outpatient setting. Short durations of antimicrobial therapy of 5-7 days are considered adequate for uncomplicated CAP. We wanted to utilize Electronic medical record (EMR) based tools to standardize treatment durations for CAP. Akron children’s hospital is a large pediatric health care provider in Northeast Ohio and offers pediatric care through more than 30 pediatric offices in the community. This extensive network of primary care offices affords unique opportunities to use the EMR based tools for care standardization.

Counts of antibiotic orders based on duration.

Methods

The antimicrobial stewardship committee developed a guideline for diagnosing and managing community acquired pneumonia and distributed it to all primary care providers. A standardized smart set provided clinical decision support regarding choice of antibiotics and duration of therapy. A visit diagnosis of Community acquired pneumonia prompted the use of the smart set. Smart set usage and duration of therapy (7 days or less vs 8 days or more) were monitored. Baseline data for one year prior and 3 years post-introduction were tracked to measure impact and monitor sustainability of change.

Percentage of antibiotic orders based on duration.

Results

The smart set went live in January 2020. Data review from January 2019 to December 2023 showed the percentage of orders with antibiotic prescriptions of 8 days or more decreased from 97% to 34% while 7 days or less increased from 3% to 66% (Figures 1,2). This change is associated with a high utilization of the pneumonia smart set of > 70 percent (Figure 3). Even though the project is in its maintenance phase the gains have sustained over time.

Smart set usage for antibiotic orders

Conclusion

Utilizing EMR based tools can help shorten antibiotic duration for community acquired pneumonia in a sustainable fashion. This approach holds promise as it can be easily utilized to standardize care for other common outpatient conditions. Expectedly the strategy would be most applicable to health care networks with a wide outreach. It also requires intensive education of providers at the outset, but this can be accomplished by using interested primary care providers to partner with antimicrobial stewardship teams.

Disclosures

All Authors: No reported disclosures
P-1663. Evaluating Peripartum Antimicrobial Use in Intraamniotic Infection Patients
Authors: Pazienza Grace , Schacht Lance , Thomas Mattie Jo , Palomo Jennifer , Stuart Sean , Withers Sarah , Crockett Amy H , Bailey Pamela
Published: January 2025

Background

Intraamniotic infections (IAI, e.g. chorioamnionitis) require urgent antimicrobial administration. These patients may also require group B Streptococcus (GBS) prophylaxis (ppx) or surgical site infection (SSI) ppx. Many of these patients may receive duplicative antimicrobial coverage due to multiple clinical scenarios. We sought to characterize antimicrobial use in these patients, particularly after a clindamycin shortage generated a change to cefoxitin at our institution in June 2023. We sought to characterize the impact of our transition to cefoxitin monotherapy on overall antimicrobial use in patients diagnosed with IAI.Table 1.Exposure to Antimicrobials

Methods

A retrospective cohort study was performed. Patients were identified by ICD diagnoses, from February 2016 through October 2023. All charts were reviewed for medication administration as well as appropriate indications. Comparisons were made between the traditional regimen prior to our clindamycin shortage and the revised regimen after cefoxtin was recommended using chi square testing.

Results

We identified 301 patients who received antimicrobials for IAI. 19 patients (6.3%) received antimicrobials for all three indications of IAI, GBS ppx, and SSI ppx.

After cefoxitin-based guidelines implementation, there was a significant difference in the number of antimicrobials to which patients were exposed (p< 0.01, Table 1). There was a significant difference in patients receiving two cephalosporins in the traditional (n=1, 2.8%) and revised (n=34, 97.1%) groups (p< 0.001), and in those receiving two types of penicillin coverage (traditional, n=26, 86.7%) vs revised (n=4, 14.3%) (p=0.008).

Rates of SSI ppx were high for patients with cesarean delivery (n=105/113). A prescribing error was noted with 5 patients undergoing unlabored caesarean deliveries receiving azithromycin. Appropriate prescribing for GBS ppx was also high (n=43/49).

Conclusion

Pregnant persons with IAI are being exposed to significant amounts of antimicrobials during labor and delivery, which was streamlined by our transition to cefoxitin monotherapy for IAI. Many patients received antimicrobials for multiple indications, which should be addressed in guidelines when antimicrobials have overlapping spectrums of activity.

Disclosures

All Authors: No reported disclosures
P-1666. Hematology-Oncology Unit-Specific Antibiogram: A Decade of Experience at a Large Academic Medical Center
Authors: Clement Josh , Rivera Christina G , Cole Nicolynn , Schuetz Audrey N , Estes Lynn L
Published: January 2025

Background

Antibiograms are an important stewardship tool that can inform optimal empiric therapy; most antibiograms are hospital-wide. Unit-specific antibiogram data for unique patient populations including intensive care unit and pediatrics is robust; however, published experience with unit-specific antibiograms in the hematology-oncology (heme-onc) population is limited. These patients are unique because of the common use of antimicrobial prophylaxis, prolonged broad-spectrum antibiotics, and an immunocompromised state. We sought to examine the trends in antibiogram antimicrobial susceptibility over time.

Methods

This retrospective quality initiative included microbiology results (first isolates per patient per timeframe) from Mayo Clinic Rochester from 2012 to 2022. Eligible cultures were those identified as being obtained from one of 8 hematology, oncology, or bone marrow transplant inpatient units. Agar dilution susceptibility testing and Clinical and Laboratory Standards Institute (CLSI) breakpoints were used. Screening PCRs (eg, VRE PCR) were excluded. Culture and susceptibilities were identified by an EMR based report, compiled annually, and reported for two-year periods. Susceptibility rates were compared using the Chi-square test and Chi-square analysis for trends.

Results

There were 4 gram-negative and 5 gram-positive organism groups that met CLSI antibiogram criteria of ≥ 30 isolates and were included (tables 1-4). There were several significant differences in comparison to the hospital-wide antibiogram, with lower antibiotic susceptibility rates in the heme-onc units for multiple organisms, notably fluoroquinolones to E.coli and P. aeruginosa and several cephalosporins to Enterobacterales as well as penicillin and levofloxacin to Viridans group Streptococcus and vancomycin to E. faecium (tables 1&2). Over the period of 2012-2013 to 2021-2022, susceptibility rates remained stable among the heme-onc antibiogram, with few significant changes (tables 3&4).

Conclusion

Heme-onc antibiograms illustrated susceptibility rate differences compared to our hospital-wide antibiograms, particularly for antimicrobials used as prophylaxis. Through population-specific antibiograms, providers may be able to improve empiric antibiotic selection.

Disclosures

Christina G. Rivera (O'Connor), Pharm.D, Gilead Sciences: Board Member
P-1736. Examining the Impact of Eliminating a Transitions of Care Pharmacist Program on Antimicrobial Use
Authors: Godsey Mary , Duenn Angela , Collins Curtis D
Published: January 2025

Background

Antimicrobial stewardship interventions during transitions of care (TOC) have increased guideline concordant prescribing at hospital discharge. A TOC pharmacy program targeting discharging patients at the high risk for mortality was established at our community teaching hospital in 2016. A previous program analysis reported 14.4% of all pharmacist interventions made involved antimicrobials. The TOC pharmacy program was eliminated in 2022. The purpose of this study was to assess the impact of program elimination on appropriate and optimal antimicrobial prescribing.

Methods

This retrospective, single center, pre-post cohort study investigated the impact of the elimination of the TOC program on appropriate and optimal antimicrobial prescribing. Adult inpatients with the highest risk of 30-day mortality receiving an antimicrobial at discharge between September - November 2021 (TOC pharmacist program cohort) and September - November 2022 (post-TOC cohort) were included. Appropriate antimicrobial use was defined as prescribing of indication-based effective and safe therapy. Optimal prescribing was defined as adherence to institutional guideline-based antimicrobial stewardship recommendations.

Results

Six-hundred twenty-six patients were included with 313 patients in each cohort. Baseline characteristics between cohorts were generally similar with significant differences in the number of patients treated for community-acquired pneumonia (20.4% vs. 28.4%; P = 0.026) and bacteremias (11.5% vs. 5.1%; P = 0.004). There were no differences in appropriate (90.4% vs. 90.1%; P = 0.893), or optimal prescribing (80.8% vs. 78%; P = 0.374) between cohorts. There were no differences in incidence of non-optimal antimicrobial dosing (6.4% vs. 5.8%; P = 0.738), or non-optimal antimicrobial selection (1.3% vs. 2.9%; P = 0.161); however, the incidence of non-optimal duration decreased in the post-TOC cohort (22% vs. 15%; P = 0.024).

Conclusion

The elimination of the TOC pharmacy program did not impact appropriate or optimal antimicrobial prescribing. Relatively high appropriate and optimal prescribing were noted in both cohorts and additional ongoing stewardship interventions may have confounded results.

Disclosures

All Authors: No reported disclosures
P-1802. Assessing the Effectiveness and Essentialness of Antimicrobial Stewardship Practices in Multiple States
Authors: Thure Katie A , Patel Dipen , Biehle Lauren , Evans Christopher D
Published: January 2025

Background

Acute Care Hospitals (ACH) self-report on implementation of the Core Elements of Antimicrobial Stewardship through the National Healthcare Safety Network’s (NHSN) Annual Facility Survey. By 2022, a majority of ACHs in Tennessee (TN), Colorado (CO), and Virginia (VA) reported achieving all seven core elements. To gain better insight into their stewardship practices, the Healthcare-Associated Infection Programs from TN, CO, and VA developed a survey assessing the value of specific antimicrobial stewardship practices.Table 1.Ratings of how essential and effective interventions are to antibiotic stewardship.

Methods

Key stewards at ACHs were identified and received the survey electronically. Respondents rated how essential each stewardship intervention in the NHSN Survey is to the success of their stewardship program and how effective each specific intervention is at driving antibiotic use at their facility. Respondents rated each intervention from 1 to 7 with 1 being non-essential/effective and 7 being absolutely essential/effective. The overall mean for each category was calculated by averaging the means of each intervention for that specific element.

Results

A total of sixty-four stewards responded to the survey. 82.8% of respondents were Pharmacists. Microbiology based interventions were rated to be the most essential NHSN Survey category with a mean of 5.9, while nurse-driven interventions were the least essential with a mean of 4.3. Pharmacy Interventions were deemed the most effective with a mean of 5.4, whereas Nurse Driven Interventions were also rated the least effective with a mean of 3.4 (Table 1).

Conclusion

Respondents considered all interventions essential. On average, ratings for effectiveness of each intervention were lower than those for essentialness. Microbiology based interventions were rated most essential. This could be attributed to items stewards are able to act on objective data. Even though Nursing Driven interventions had the lowest mean ratings for both essentialness and effectiveness, they also had the lowest number of interventions, which could skew the results. As evidenced by these data, not all stewardship interventions are perceived as equal in driving antimicrobial usage.

Disclosures

All Authors: No reported disclosures
P-1871. Surge Protector: Characterizing the Challenges of Fluctuating OPAT Volume
Authors: Schranz Asher J , Ponder Madison , Swartwood Michael , Kinlaw Alan C , Oosterwyk Teresa M , Perhac Angela , Marx Ashley H , Bowman Mary Catherine , Farel Claire E
Published: January 2025

Background

Outpatient parenteral antimicrobial therapy (OPAT) is often overseen by multidisciplinary teams in infectious diseases (ID) provider groups. OPAT programs serve an important role in health systems to decrease inpatient length of stay and ensure safe transitions of medically complex patients. The optimal composition and staffing needs of OPAT teams are not defined. To gauge challenges facing OPAT program administration and provide insights for those initiating an OPAT program, we described trajectories in patient volume throughout our OPAT program.

Methods

We included all UNC OPAT courses from inception in 2015 through 2023. The OPAT team mainly provides care for home infusion OPAT, providing lab monitoring, assessment of adverse events, and care coordination. The OPAT team does not cap enrollment and currently accepts patients seen by general ID providers who require >14 days parenteral antimicrobials. OPAT team staffing has varied since inception. It is currently primarily administered by a nurse and a pharmacist, with support from a scheduler and an ID physician. We calculated the average monthly census of patients followed by the OPAT team over time. Census was defined as the number of outpatients followed by the OPAT team at a time. To gain granular detail we also trended the average weekly OPAT census in 2022 and 2023.

Results

2,878 OPAT courses were cared for by the OPAT team. Median days on OPAT was 35. The most common diagnoses were osteomyelitis (43%), bacteremia (20%) and diabetic foot infection (12%). Average monthly OPAT census overall increased since inception (Fig 1) and demonstrated marked monthly variation across the entire period. In 2022-2023, the weekly census ranged from 32 to 60 patients, with a median weekly census of 45 patients (IQR, 41-50) (Fig 2).

Conclusion

We found our OPAT census underwent frequent, wide fluctuations in volume, which was met with adjustments in task prioritization and approach to accommodate surges. Of note, the OPAT team provides assessment and transition management for referred patients prior to discharge. These patients are not counted in census but are a key area to improve safety and stem readmission. Our results demonstrate that OPAT workload can be volatile and needs robust, expert staffing to meet unpredictable demands and patient needs.

Disclosures

Asher J. Schranz, MD, MPH, UpToDate: I receive fees for authorship of an UpToDate article.
P-1896. Comparing Clinical Diagnoses of Intraamniotic Infections to the Guideline Definitions
Authors: Pazienza Grace , Schacht Lance , Thomas Mattie Jo , Palomo Jennifer , Stuart Sean , Withers Sarah , Crockett Amy H , Bailey Pamela
Published: January 2025

Background

Intraamniotic infection (IAI) or chorioamnionitis is an intrapartum clinical diagnosis. Treatment delay for confirmatory test results can lead to maternal and fetal morbidity. The American College of Gynecology (ACOG) defines “suspected IAI” as persistently elevated temperatures plus findings of purulent cervical discharge, maternal leukocytosis, fundal tenderness, and maternal or fetal tachycardia. These variable and relatively complex diagnostic criteria may introduce clinical confusion and lead to overtreatment. We sought to evaluate compliance with ACOG guidelines in our hospital.Table 1:Diagnostic criteria for IAI including categories of maternal fever and clinical findings

Methods

A retrospective cohort study was planned. Patients with IAI were identified by ICD diagnoses, and screened for appropriateness. Manual chart abstraction was performed to identify diagnostic criteria for IAI per ACOG guidelines. Additionally, culture and pathology results were reviewed when available. Comparisons between groups were made using chi square.

Results

301 patients with IAI were identified between Feb 2016 and Oct 2023. Most (n=281, 93.4%) met ACOG diagnostic criteria but 20 (6.6%) did not have documented indications for initiation of treatment. There is no statistical significance between the number of symptoms and fevers (p=0.55) between groups (Table 1).

Few (n=59, 19.6%%) patients had cultures collected, and of these 35.5% (n=21) were positive including placenta (n=10, 47.6%) and blood (n=2, 9.5%). There was not a difference in patients with positive cultures compared to patients with negative or no cultures in fevers (p=0.77) or number of suspected IAI signs (p=0.11).

Conclusion

The diagnostic criteria for IAI should be refined or reevaluated, particularly in light of their complexity in accurately diagnosing IAI. This is especially important in light of antimicrobial stewardship initiatives in an effort to improve patient care, as well as an introduction of rapid diagnostics improving earlier identification of organisms in blood cultures which could significantly impact organism identification earlier than traditional microbiology.

Disclosures

All Authors: No reported disclosures
P-1900. Temporal Course and Risk Factors of Coinfections in Patients Hospitalized for COVID-19
Authors: Vilkas James L , Akmal Ali , Sarwar Akmal , Lei Yuxiu , Liesching Timothy N
Published: January 2025

Background

Studies about the distinction between coinfections acquired prior to admission and hospital-acquired coinfections and risk factors at different time point are limited.

Methods

We reviewed microbiology laboratory data of patients hospitalized for COVID-19 viral infection during January 1, 2024 to March 13, 2024.

Results

We collected data on 75 patients. The temporal course of coinfection rate was: 9.3% on the same day of hospital admission (Day 1); 10.7% on Day 2 to Day 4; 2.7% on Day 5 to Day 9; 14.7% after Day 9 . At any time point prior to or during the hospitalization or rehospitalization, 23 (30.7%) patients acquired infection of at least one organism.

Univariate analysis showed younger age (69 years vs. 78 years, p=0.025), lower proportion of diabetic patients (17.4% vs. 44.2%, p=0.036), lower proportion of chronic kidney disease (17.4% vs. 40.4%, p=0.065), higher proportion of indwelling catheter (17.4% vs. 1.9%, p=0.029), higher proportion of cancer (34.8% vs.13.5%, p=0.057), similar prior antibiotics (43.5% vs. 36.5%, p=0.6), and significant higher proportion of prior corticosteroids (21.7% vs. 3.9%, p=0.025) in coinfected group than not-coinfected group. Multivariate analysis indicated that indwelling catheter at baseline (OR=45.8, 95%CI: 3.2-652.8, p=0.005) and prior corticosteroids (OR=17.1, 95%CI: 0.99-296.4, p=0.051) are the two independent risk factors for coinfection at admission. Younger age (OR=0.96, 95%CI: 0.918-1.000, p=0.0495) and prior corticosteroids (OR=52.6, 95%CI: 3.11-891.3, p=0.006) are the two independent risk factors for hospital-acquired coinfection.

Conclusion

About 10% of patients hospitalized for COVID-19 infection had coinfection(s) at admission, with Escherichia coli being the most common. The coinfections at admission were eradicated within eight days. The second wave of coinfection(s) acquired during hospitalization rose to about 15% after eight days, with Klebsiella being the most common. Patients with indwelling catheter or prior corticosteroids use are in much greater risk to be coinfected with COVID-19 before hospital admission. Patients with prior corticosteroids are at fifty-time higher risk for hospital-acquired coinfections.

Disclosures

All Authors: No reported disclosures
P-1901. Statin Use and Severe/Critical/Fatal Outcomes in Individuals with COVID-19
Authors: Butt Adeel A , Yan Peng , Shaikh Obaid
Published: January 2025

Background

There are conflicting results regarding the effects of statins upon outcomes in individuals with COVID-19. Several studies demonstrated a beneficial effect on survival, with others failing to demonstrate a beneficial effect, or even a higher risk of mortality, need for mechanical ventilation, and intensive care unit admissions among those who received statins.

Statins in COVID_Fig 1

Methods

We identified all individuals in the VA COVID-19 database with confirmed COVID-19. We excluded those with HIV, organ transplantation, cancer diagnosis, and any hospitalization within preceding 30 days. Among those, we created a pool of potential cases who had received a statin within +/- 7 days, and controls with no statins in the previous 365 days and up to 28 days after the index positive test date. Using an inverse probability of treatment weights (IPTW) based approach, we determined the rates of moderate/severe/critical disease within 28 days of the index COVID-19 diagnosis among statin-recipients and controls. Absolute risk differences (ARD) and Kaplan-Meier curves were generated for cases and controls.

Statins in COVID_Fig 2

Results

In IPTW-weighted matched analysis including 10,544 statin-recipients and 94,185 controls, statin-recipients were more likely to have an unfavorable outcome compared with controls (ARD 0.21 (95% CI 0.08,0.35) overall. In subgroup analyses, statin-recipients >60 years old and those with diabetes, cardiovascular disease, or chronic lung or kidney disease had more favorable outcomes compared with controls.

Conclusion

Individuals with COVID-19 who received statins were more likely to have poorer outcomes compared with controls not receiving statins. Subgroup analyses demonstrating a benefit among those at high risk of cardiovascular outcomes may be reflection of the beneficial effects of statins on the underlying comorbidities rather than a direct benefit against COVID-19.

Disclosures

Adeel A. Butt, MD, MS, Gilead Sciences: Grant/Research Support