bluuebunny/crossref_metadata_2025 huggingface dataset:
P-1649. Nursing Home Clinician Rationales Underlying Antibiotic Decision-Making for Suspected Urinary Tract Infection
Authors: Jolles Sally , Crnich Christopher J , Taylor Lindsay , Jump Robin , Bej Taissa A , Kowal Corinne , Hicks Oteshia , Wilson Brigid , Langenstroer Madeline C , Jacob Deepthi
Published: January 2025

Background

The factors underlying antibiotic decision-making in nursing homes (NHs) remains poorly understood. We conducted an analysis of discrete and free text responses from a mixed-methods survey presenting NH clinicians with two patient clinical vignettes on asymptomatic bacteriuria (ASB) and cystitis (CYS) designed to assess clinicians’ treatment (TX) threshold.Table 1:Clinical Vignettes

Methods

NH clinicians were recruited nationally via professional organizations from December 2021 to April 2022. A web-based survey tool was used to administer the vignettes (Table 1) to participants who were asked to document their TX decision and justification. Treater (TRT) and non-treater (NTRT) responses were stratified by vignette and textual responses were uploaded to NVivo. A hybrid directed and conventional content approach was utilized to develop a codebook using the constant comparison technique.Table 2:Factors Contributing to Clinicians’ Treatment Decisions by Vignette and Treatment Choice

Results

Among 298 survey respondents; 10.4% treated ASB while 61.1% treated CYS. Seven factors contributing to clinicians’ TX decisions were identified (Table 2). For the ASB vignette (Table 3), TRTs framed the patient’s positive test results as infection (84%) while NTRTs framed it as contamination (79%). TRTs were less likely than NTRTs (26% vs 91%) to note the absence of signs and symptoms (S/S). Both groups cited the patient’s comorbidities and/or medical history (42% vs. 54%) in their TX decision. In the CYS vignette (Table 4), TRTs focused on positive patient S/S (91%) while NTRT did not feel there were sufficient frequency or severity of symptoms to justify immediate therapy (77%). TRTs were more likely to rely on positive test results (59%) and have more concern for patients’ comorbidities and/or medical history (18%).Table 3:Asymptomatic Bacteriuria Vignette Illustrative Quotes

Conclusion

Both TRTs and NTRTs use urine diagnostics in their decision-making, with TRTs having more confidence in the positive predictive value of urine diagnostics. NTRTs highlighted the lack of S/S as a justification for withholding therapy in both vignettes. TRTs accurately identified S/S for CYS, however, TRTs for ASB expressed concern that S/S might be underreported. This study shows how TRTs and NTRTs justify their rationales, however the next steps involve understanding how these decision-making patterns are amenable to education, information framing and/or risk management interventions.Table 4:Cystitis Vignette Illustrative Quotes

Disclosures

Robin Jump, MD, PhD, Abacus: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support
P-1662. Antifungal Prophylaxis in Liver Transplants: Navigating the Optimal Duration
Authors: Dammann Fabian , Anjan Shweta , Vega Ana , Natori Yoichiro , Selvaggi Gennaro , Vianna Rodrigo , Abbo Lilian M , Vu Christine A
Published: January 2025

Background

Invasive candidiasis (IC) is associated with a high mortality rate following liver transplantation (LT). Data on ideal duration of antifungal prophylaxis post-LT is limited. We investigated the effect of decreasing antifungal prophylaxis duration on the incidence of IC in LT recipients.

Methods

Single-center, retrospective study was performed comparing two prophylaxis strategies in adult LT recipients at a large transplant center. In 2021, a stewardship intervention was made to decrease the duration of antifungal prophylaxis. In pre-intervention group (Jan 1 - Dec 31, 2020), patients received no prophylaxis (low risk), fluconazole for 14 days (intermediate risk), or micafungin for 14 days (high risk). For the post-intervention group (Jan 1 to Dec 31, 2022), this was decreased to fluconazole for 5 days (intermediate risk) or micafungin for 7 days (high risk). Primary outcome was incidence of IC, defined as isolation of Candida spp. from a sterile site. For risk factor assessment, Chi-square and Mann-Whitney U test were conducted as univariate analysis. Multivariate logistic regression model was developed based on univariate analysis. Log-rank test was utilized to compare the incidence between pre- and post- intervention era.

Results

Of the 176 LT recipients included, 53 (30%) in the pre-intervention group and 123 (70%) in the post-intervention group (Table 1), 2 (3.8%) versus 9 (7.3%) patients developed IC respectively (p=0.37). Five (45.5%) patients developed IC while on prophylaxis. Overall mortality was 16 (9.0%), with one death related to IC (Table 2). In a univariate analysis, prolonged mechanical ventilation (p=0.002), re-opening of abdomen (p=0.023), ICU stay prior to transplant (p=0.036), prior antifungals (p=0.021), prior antibiotics (p=0.016), MELD > 30 (p=0.004) were associated with increased risk for IC in both groups. After a multivariate analysis, MELD > 30 (p=0.039, OR 3.94, 95%CI 1.07-14.49) and prolonged mechanical ventilation (p=0.020, OR 4.84, 95%CI 1.29-18.18) was associated with increased risk for IC.

Conclusion

Decreasing the duration of antifungal prophylaxis in LT recipients did not significantly impact the incidence of IC. Further research is needed to refine antifungal stewardship strategies in this high risk patient population.

Disclosures

Yoichiro Natori, MD, Eurofin/Viracor: Honoraria|Nobel Pharma: Advisor/Consultant
588. The Association Between Contact Precautions for Methicillin-resistant Staphylococcus aureus (MRSA) Colonization and MRSA Bloodstream Infection (BSI) Rates in Los Angeles County Hospitals: Results of a Countywide Survey
Authors: Lee Pam , OYong Kelsey , Rubin Zachary A , Miller Loren G , Kupferwasser Deborah
Published: January 2025

Background

Contact precautions are frequently used to prevent in-facility transmission of MRSA, but their efficacy has been questioned. We hypothesized that contact precautions use would not correlate with MRSA bloodstream infection (BSI) rates in LA County hospitals.

Methods

The LA County Department of Public Health conducted a survey of LA County acute care hospitals’ use of contact precautions for MRSA colonization, history of MRSA infection/colonization, and active MRSA infection with or without uncontained purulence. We modeled National Healthcare Safety Network (NHSN) reported healthcare-associated MRSA BSI rates from 2022-23 via a negative binomial multivariable regression model. We controlled for hospital type (general acute care hospitals vs. long-term acute care hospitals (LTACHs)), number of intensive care unit (ICU) beds, and MRSA BSI admission prevalence rates.

Results

Of the 82 acute care hospitals in LA County, 69 completed the survey (84% response rate). MRSA contact precaution use was stratified into three groups: Least strict (no contact precautions or contact precautions only for active infection with uncontained purulence, 24% of hospitals), intermediate (contact precautions for any active infection, 32% of hospitals), and most strict (contact precautions for >2 reasons, 44% of hospitals).

We found higher MRSA BSI in LTACHs vs. hospitals (Incidence rate ratio [IRR] 3.50, 95% CL 1.80-6.80, p = 0.0002), but no relationship with ICU beds (IRR 1.00, 95% CL 0.99-1.01, p = 0.15), MRSA BSI admission prevalence rates (IRR = 4.40, 95% CL 0.30-63.10, p = 0.27), or contact precaution use (IRR 0.80, 95% CL 0.50-1.30, p = 0.29 for the least strict group; IRR 1.40, 95% CL 0.89-2.20, p = 0.14 for the intermediate group, both in comparison to the most strict group).

Conclusion

Our survey of hospitals across LA County, which has a population of ∼10 million, found no significant association between stringency of MRSA contact precaution use and healthcare-associated MRSA BSI rate. Our findings support other data that fail to find clinical benefit to contact precautions for MRSA colonization/infection. Considering potential downsides of contact precautions for MRSA, the assumption that MRSA requires contact precautions may need to be reconsidered.

Disclosures

Loren G. Miller, MD MPH, Armata: Grant/Research Support|Contrafect: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Paratek: Grant/Research Support
P-1668. Perioperative Antibiotic Use for Heart Transplantation at Children’s Hospitals in the United States
Authors: Inagaki Kengo , Tribble Alison C
Published: January 2025

Background

Data on perioperative antibiotic use for pediatric heart transplantation are scarce, although such information can inform the optimal approaches for perioperative antibiotic prophylaxis.

Methods

We identified children undergoing heart transplantation in the Pediatric Health Information System database. The primary outcomes of interest were perioperative antibiotics other than cefazolin single therapy and prolonged duration (defined as more than 1 postoperative calendar days) of postoperative antibiotics.Figure 1.Rate of the Use of Cefazolin Single Therapy at the Time of Transplantation Surgery in Children’s Hospitals by Transplantation VolumeHospitals that performed 50 or more transplantations were included in this FigureThe hospital with the rate of 0% (#28) was a 4th-quartile transplantation volume hospital

Results

Cefazolin was used predominantly (i.e. > 50% of cases) as part of the perioperative antibiotic regimen at 22 of 28 (78.6%) hospitals, while only 12 of 28 hospitals (42.9%) predominantly used cefazolin as a single therapy. The predominant use of two or more antibiotics (with or without cefazolin) perioperatively was seen in 12 of 28 hospitals (42.9%). The median postoperative duration of antibiotics was 2 calendar days (interquartile range: 1-3). Patients undergoing transplantation at higher transplantation volume hospitals were less likely to receive antibiotics other than cefazolin single therapy or to receive prolonged duration (odds ratio, OR: 0.45 [95% confidence interval, CI: 0.38-0.53], and OR: 0.76 [95%CI: 0.63-0.91], respectively, for the 4th quartile hospitals).Figure 2.Factors Associated with the Use of Perioperative Antibiotic Other Than Cefazolin Single Therapy among Children Undergoing Heart Transplantationa obtained using multivariable logistic regressionAbbreviations: CI, confidence interval; ECMO, extracorporeal membrane oxygenationHospitals that performed 50 or more transplantations were included

Conclusion

Perioperative antibiotic use for heart transplantation varies substantially across children’s hospitals. Higher transplantation volume hospitals were more likely to use cefazolin single therapy and shorter durations of antibiotics although there remain rooms for improvement. Careful review of the best available evidence should be incorporated in developing institutional perioperative antibiotic approaches for heart transplantation, particularly at low-volume hospitals.Figure 3:Factors Associated with Postoperative Duration of Antibiotics More Than 1 Calendar Daysa obtained using multivariable logistic regressionAbbreviations: CI, confidence interval; ECMO, extracorporeal membrane oxygenationHospitals that performed 50 or more transplantations were included

Disclosures

Kengo Inagaki, MD, AstraZeneka: Grant/Research Support
P-1672. Novel Software and Web Application to Facilitate and Simplify Antibiotic Stewardship to Improve Antibiotic Days of Therapy (DOT) and Cost Savings with Evidenced-Based Algorithms in Long Term and Post Acute Care Facilities (LTPAC)
Authors: Williams Steve J
Published: January 2025

Background

According to the Centers for Disease Control (CDC), 4.1 million Americans are admitted to reside in LTPAC during a year, 70% of those receive antibiotics, and only 25% are used correctly prompting a 2017 mandate for Antimicrobial Stewardship by the Center for Medicare and Medicaid Services (CMS). Most facility programs miss many of the seven core elements as outlined by CDC (Fig 1) lacking the expertise and oversight to improve antibiotic use, decrease days of therapy, and reduce resistant organisms and adverse outcomes.Figure 1.Core Elements of LTPAC Antibiotic Stewardship Programs

Methods

A stewardship software system was developed for LTPAC at www.idsteward.com. Six facilities were evaluated for 2023. Entries were categorized as facility-acquired infections and other-acquired infections. Newly diagnosed facility infections were primarily analyzed and subject to 2020 updated McGeer screening criteria. Entries were reviewed for length of therapy, diagnosis, and substitutions (Fig 2), and released back as a reviewed “stewardship recommendation(s)” in real-time, indicating neutral, agree, disagree, modify, or disagree with proposed therapy. Cost was estimated as the mean for each antibiotic through Lexidrug. DOT and costs were calculated for both the provider and the “Steward”. Providers of facilities were compared to the Steward and received feedback in real-time per facility discretion as well as quarterly.Figure 2.Sample algorithm

Results

Six Facilities were evaluated via the software for 2023. A total of 14320 days of therapy were observed by the providers (Fig 3). A total of 13666 antibiotic days were realized by the steward with a total 654 DOT saved, or a 4.6% decrease (Fig 4). Cost savings for those DOT saved and antibiotic substitutions were estimated at $34692 total ($5782 average).Figure 3.Days of Therapy Analysis

Conclusion

Antimicrobial stewardship in LTPAC poses many obstacles given their challenges with staffing, lack of resources to antibiotic expertise, and provider oversight and education. Antibiotic usage by a facility can be supervised with a software-based automated algorithm that can recommend real-time changes to antibiotic length of therapy based on standardized screening criteria such as McGeer, resulting in saved DOT and cost.Figure 4.Days of Therapy Saved and Cost Saved

Disclosures

All Authors: No reported disclosures
P-1673. Antibiotic Stewardship in a palliative care setting reduces antimicrobial consumption and is cost-effective
Authors: Dörr Tamara K , Buschor-Bichsel Miriam , Thompson Lora , Rüfenacht Susanne , Eberhard-Kuhn Nadia , Cipriani Michela , Kuster Stefan , Kohler Philipp
Published: January 2025

Background

More than 50% of patients in palliative care (PC) receive antibiotics in the final days of their life. While infection commonly occurs in this heterogenic population, clinical signs such as fever, malaise and elevation of inflammatory markers may also be attributable to the underlying disease. We evaluated the impact of a PC antimicrobial stewardship (ASP) intervention on antimicrobial consumption and cost effectiveness.

Methods

Starting 08/2022, the ASP and PC team of our tertiary care hospital in Switzerland conducted an interdisciplinary stewardship intervention. During weekly visits, the ASP team provided review and feedback on cases selected by the PC physicians, recommendations made were contextualized with the patient’s superordinate goals. In added teaching sequences, general stewardship principles were explained to the PC team.

Cases were documented prospectively, gathering patient characteristics (i.e. age, sex, diagnoses), the ASP recommendation made regarding antimicrobials (i.e. none, start, continuation, oral switch, stop), its acceptance by the PC team (defined as realization within 48h) and hospitalization markers (i.e. length of stay (LOS), discharge location). Impact of the intervention on LOS and days of antimicrobials were estimated independently by two members of the ASP; disagreements were resolved by an arbiter.

Descriptive analysis was performed, associated cost savings were calculated and offset with ASP operational costs.

Proportions of recommendations made by ASP team

Results

Between 08/2022 and 12/2023, 96 interventions were made in 90 patients (median age 72 years), malignancy was present in 61 (68%) (Table). The most frequent recommendation was to stop antimicrobials (45%), in 17% the initiation of antimicrobials was discouraged (Figure). Overall, 96% of recommendations were accepted by the PC team, leading to an overall saving of 63 hospitalization days and 177 days of parenteral antimicrobials. Calculating the net economic effect of the ASP intervention, savings of 140’314 USD were offset by 9767 USD operational cost, resulting in overall savings of 130’547 USD.

Conclusion

Weekly interdisciplinary case discussions between the ASP and the PC team reduces antimicrobial consumption and hospitalization days and can be cost-effective.

Disclosures

All Authors: No reported disclosures
P-1677. Assessing An Institution’s Approach to Management of Gram-Negative Bacteremia in High-Risk Populations
Authors: Mostaghim Anahita , Hashem Nehal G , Pathan Sabina , Han Alison
Published: January 2025

Background

Immunocompromised populations present unique antimicrobial management and stewardship challenges. These challenges can persist despite existing stewardship policies. This study examined management of gram-negative bacteremia (GN-BSI) in a diverse immunocompromised population at the National Institutes of Health Clinical Center (NIH CC).

Methods

Episodes of GN-BSI admitted to the NIHCC from January 1 to December 31, 2023 were identified through positive blood culture results. Charts were abstracted for baseline demographics, episode-specific data, antimicrobial prescribing, and clinical outcomes.

Results

Seventy-five episodes of GN-BSI were identified. Thirty-six (48%) were undergoing cellular therapy and 54 (58.7%) were neutropenic. About 50.7% identified translocation as etiology of infection. Eleven (14.7%) were ESBL-positive by BCID2 panel. Seventy-two (96%) involved infectious disease (ID) consultation. Empiric choice of gram-negative antibiotics included ceftazidime/avibactam in 9 (12%) episodes, meropenem in 38 (50.7%) episodes, piperacillin/tazobactam in 15 (20%) episodes, and an anti-pseudomonal cephalosporin in 32 (42.7%). Twenty (26.7%) received 2+ empiric anti-pseudomonal antibiotics. After 72 hours, 37 (49.3%) still received meropenem with most isolates susceptible to narrower spectrum (Table 1). Similar results were seen with final ID recommendations (Table 2). Seven (10%) had transitioned to an oral agent by the seventh day. Comparing 72-hour antibiotic (Meropenem vs anti-pseudomonal cephalosporin), ICU admission (32.4% v 25%, p=0.62) and 30-day mortality (5.4% v 6.3%, p=0.87) were similar. Median therapy duration was 14 days (IQR 14-18.5). Of the 65 episodes with indwelling central venous access (CVAD), only 16 had removal of all CVADs. Those with CVAD removal had lower 30-d mortality (0% v 11.9%, p=0.22) though not statistically significant.

Conclusion

In a high-risk immunocompromised population, there is a low rate of narrowing gram-negative coverage at 72 hours although options for narrowing exist. Choice of empiric antimicrobial and targeted therapy for these GN-BSI episodes are the two major areas of improvement in our population. Primary teams and ID consultants should be involved in ongoing stewardship interventions.

Disclosures

All Authors: No reported disclosures
P-1678. Post Implementation Analysis of Inpatient Review by Infectious Diseases Pharmacists of Outpatient Parenteral Antimicrobial Therapy (OPAT) Prior to Discharge
Authors: Skillings Anna , Hart Delaney , Herstine Emily , Gens Krista
Published: January 2025

Background

The Infectious Diseases Society of America OPAT guidelines recommend all patients should have ID expert review prior to initiation of OPAT. Prior to 2020, no formal OPAT program existed at this hospital system and prescribing was not limited to any specialty. However, in February 2020, the Outpatient Parenteral Antimicrobial Therapy - Inpatient Review (OPAIR) program was created in response to pre-implementation data showing only 16% of patients were discharged on appropriate therapy per IDSA OPAT guidelines.

Figure 1.

Outpatient Parenteral Antimicrobial Therapy Inpatient Review (OPAIR) program process

Methods

This retrospective, observational chart review identified patients for data collection if they had pharmacist documentation of OPAIR review during their index hospital stay. Patients were included in the pre-implementation group if prescribed OPAT and admitted between January 1, 2017, and December 31, 2017, in the health system. Patients were included in the post-implementation group if 18 years and older, prescribed OPAT, and admitted between February 2, 2020, to August 1, 2023, at Abbott Northwestern, New Ulm, Owatonna, Faribault, or River Falls Hospitals. Exclusion criteria include OPAT prescribed by an Infectious Disease (ID) provider or prior to index hospitalization. Chi squared tests were performed for all outcomes.

Figure 2.

Primary outcome of OPAT appropriateness. Appropriateness defined as a composite outcome: appropriate monitoring or follow up​, indication​, antibiotic selection​, antibiotic dose/frequency/duration, and recommended laboratory monitoring.

Results

There were 101 patients included in the pre and 79 in the post-implementation analysis. Internal Medicine was the most common prescriber in both the pre and post-implementation groups (60% vs 67%). OPAT appropriateness was significantly higher in the post-implementation group than in the pre-implementation group (52% (n=41/79) vs 16% (n=16/101), p< 0.001). The most common cause of inappropriate OPAT prescribing was a lack of monitoring or follow up (n=8/79). Complication rates were similar between pre and post groups (12% vs 18%, p=0.19) as was the 30-day readmission rate (17% vs 23%, p=0.32). Actual cost savings totaled $33,600 and maximum potential cost savings totaled to $214,200. The rates of midline utilization increased by 62% (p< 0.001).

Figure 3.

Secondary outcome of complication rate.

Conclusion

The OPAIR program at this health system significantly increased non-ID provider OPAT prescribing appropriateness. These results support the creation of a new workflow and expansion of the OPAIR program.

Figure 4.

Secondary outcome of cost avoidance.

Disclosures

All Authors: No reported disclosures
P-1683. Evaluation of Outpatient Clindamycin Prescriptions Across a Large Military Healthcare Network
Authors: Derasmo Mark , Scheps Kayla R , Marcus Joseph
Published: January 2025

Background

Introduction: While clindamycin has broad Gram-positive and anaerobic activity, its use has been limited by toxicity and increasing resistance. Multiple clinical practice guidelines (CPGs) at Joint Base San Antonio recommend against clindamycin usage due to poor coverage of Gram-positive bacteria in local antibiograms. Despite this recommendation, a significant number of clindamycin outpatient prescriptions are ordered each year. The driver of these prescriptions is unknown. This study describes prescriber, diagnostic, and patient factors contributing to outpatient clindamycin usage at a large military medical system.Table 1Characteristics of 882 Patients Who Received an Outpatient Clindamycin Prescription at Joint Base San Antonio, 2023

Methods

Outpatient clindamycin prescriptions from January-December 2023 filled at pharmacies on Joint Base San Antonio were evaluated to determine prescription duration, diagnostic indication, age, antibiotic allergies, prescriber, and prescribing clinic. Antibiotic indication was compared between those with beta-lactam allergies to those without beta-lactam allergies by Chi-squared.Table 2Prescriptions by Diagnostic Group and Beta-Lactam Allergy Status of Patient

Results

During the study period there were 941 prescriptions in 882 patients. The cohort was predominately female (52%) with a median age of 51 [IQR 40-68] (Table 1). Of these scripts, 229 (24%) were written by clinicians outside the military facility. The clinics with the most prescriptions were the Emergency Department (33%), Dental clinics (21%), Primary Care (16%), and Surgical clinics (14%). Patients with beta-lactam allergies were significantly more likely to have a dental indication (39.7% vs. 16.9%, p=< 0.0001) and those without beta-lactam allergies were more likely to have a skin and soft tissue infection (49.8% vs. 22.2%, p=< 0.0001) (Table 2). While there were 491 prescribers in this study, ten (2%) clinicians (six from the Emergency Department) prescribed 18% of all clindamycin prescriptions, 67% of which were in the absence of a beta-lactam allergy.

Conclusion

Patterns of outpatient clindamycin use across large health systems have not been well described. This study identifies potential areas for local stewardship interventions that have not previously been considered, including focused CPGs for emergency room clinicians as well as penicillin allergy de-labeling in outpatient dental clinics.

Disclosures

All Authors: No reported disclosures
P-1689. Impact of Antibiotic Usage on Antimicrobial Resistance Rates among Gram-Negatives at a COVID-Care Facility
Authors: Aguirre-García Gloria Mayela , Baylon-Valdez Victor , Gonzalez-Gonzalez Luisa F , Medina-Hernandez Rodolfo , Guajardo-Lara Claudia E , Martínez-Reséndez Michel F , Disease Infectious , Aleman-Bocanegra Mary C
Published: January 2025

Background

Antimicrobial resistance is directly associated with antimicrobial use and abuse, becoming an important public health problem in modern practice. Unchecked prescriptions, noncompliance with antimicrobial stewardship programs, pandemics, and outbreaks contribute to this issue. This study aims to analyze the antimicrobial resistance patterns over the years in a tertiary-level facility compared to antibiotic usage.

E. coli antimicrobial resistance rates and antibiotic usage

Methods

A retrospective single-center study from 2019 to 2022 was conducted at the Intensive Care Unit of Hospital San Jose, Monterrey, Mexico. Antibiotic usage was calculated using a defined daily dose (DDD) in g/100 beds for Cefepime, Ceftazidime, Ceftriaxone, Ertapenem, Levofloxacin, Meropenem, and Piperacillin/tazobactam. Antimicrobial resistance rates to these antibiotics by Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa isolates from ICU were calculated and compared against antibiotic usage over the years.

P. aeruginosa antimicrobial resistance rates and antibiotic usage

Results

During COVID-19 pandemic in 2020, there was an increased resistance rate of E. coli to cephalosporins (ceftriaxone 80%, ceftazidime 80% and cefepime 80%) in comparison to 2019 and the following years. Klebsiella pneumoniae had a similar behavior, with high resistance rates to cephalosporins (60% each). Pseudomonas aeruginosa isolates also presented a higher resistance rate in 2020 to cefepime (49.6%), ceftazidime (41.6%), meropenem(57.4%) and piperacillin-tazobactam(31.2%) during 2020. During the same year, high DDDs were observed for ceftriaxone (53.3) and meropenem (32.79). Nonetheless, resistance rates to meropenem by P. aeruginosa in 2019 and 2020 (60, 57.4%), E. coli (5.6, 4.4%) and K. pneumoniae (26.3, 7.4%) were not influenced by overuse of meropenem, neither during COVID-19 or the following years.

K. pneumoniae antimicrobial resistance rates and antibiotic usage

Conclusion

Besides overuse of Beta-lactam antibiotics such as ceftriaxone and meropenem during the COVID-19 pandemic, surpassing importantly recommended DDDs by the WHO, resistance rates to these antibiotics in the following years was not affected. Multidisciplinary teams including an infectious disease specialist were fundamental for antimicrobial stewardship during the pandemic, positively impacting resistance rates of Gram-negatives.

Disclosures

All Authors: No reported disclosures
P-1691. Palliative medicine consultation does not reduce antimicrobial use during end-of-life care
Authors: Akalu Hanna Y , DeWitt Michael E , Bantikassegn Amlak , Brooten Justin , Maves Ryan C
Published: January 2025

Background

The role of antimicrobial drugs in end-of-life (EOL) care is uncertain, with the potential palliative benefit of antimicrobials in some settings being outweighed by potential limited benefit and added toxicity. In this study, we aimed to analyze the roles of palliative care consultation and code status change on antimicrobial prescribing practices at the EOL. We hypothesized that palliative medicine consultation (PMC) reduces antimicrobial use in patients receiving EOL care.

Methods

This was a retrospective cohort study conducted on adult patients who were admitted to Wake Forest Baptist Health facilities between January-December 2019 and who were either transitioned to comfort care or discharged to hospice. Patients were stratified based on the presence or absence of PMC during their hospitalization. The primary outcome was the mean days of therapy (DOT) per patient before and after EOL care. DOTs were defined as a calendar day when a single systemic antimicrobial was administered. Antimicrobials given topically or prescribed solely for Pneumocystis or herpesvirus prophylaxis were excluded.

Results

A total of 2242 patients were identified, of whom 621 received PM consultation during their hospitalization. Among those receiving PMC, there were a total of 3301 days of hospitalization and 4560 DOTs prior to the transition to EOL care, for a mean DOT/hospital day of 1.38 (95% CI 1.34-1.42). There were 6,563 hospital days and 11,466 DOTs among the non-PMC group, for a mean DOT/hospital day of 1.75 (1.72-1.78). Following transition to EOL care, antimicrobial use decreased rapidly, with 0.087 DOTs/hospital day in the PMC group (0.077-0.097) and 0.051 DOTs/hospital day (0.044-0.056) in the non-PMC group.

Conclusion

In this observational study, antimicrobial drug use decreased markedly in patients transitioning to EOL care. However, the rate of antimicrobial use in EOL patients was not reduced by PMC and was greater than in those patients not receiving PMC, although this difference was not clinically substantial. Antimicrobial use was infrequent in EOL patients in our cohort. Future studies should evaluate the palliative benefit of antimicrobials in specific subgroups of patients receiving EOL care.

Disclosures

Ryan C. Maves, MD, AiCuris: Grant/Research Support|Biotest: Grant/Research Support|GeoVax: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria|Sound Pharmaceuticals: Grant/Research Support
P-1697. Antibiotic prescribing patterns among outpatients with acute sinusitis in Michigan
Authors: Wangchinda Walaiporn , Haddad Anne , Stier Elisia , Brennan Brenda M , Malani Anurag , Pogue Jason M
Published: January 2025

Background

Acute sinusitis is a common presenting illness in the outpatient setting. While antibiotics are often prescribed, they are infrequently indicated in adults. Limited data are available assessing prescribing practices. This study aimed to describe statewide antibiotic prescribing for sinusitis among outpatients in Michigan to identify opportunities for antimicrobial stewardship (AMS) interventions for clinical and public health partners.Figure 1:Outpatient antibiotic prescribing practices for sinusitis in Michigan, 2019-2021

Methods

The Michigan Department of Health and Human Services received medical and pharmacy claims data from IQVIA from 2019 – 2021. Outpatients with medical claims data with a diagnosis code (J01) for acute sinusitis were included, while those with concomitant upper respiratory tract, urinary tract, or skin and soft tissue infectious diagnoses codes were excluded. Patients with a J01 diagnosis in their medical claims were linked to their corresponding antibiotic prescriptions from pharmacy claims based on patient identifier, prescription date, ordering provider, and antibiotic utilized. Prescribing patterns of antibiotics (frequency of prescription, agent selection, and duration of therapy) were analyzed for the overall cohort and stratified by place of service, provider specialty, year of service, patient zip code, age, and gender.Figure 2:Frequency of acute sinusitis encounters with an antibiotic prescription by 3-digit zip code

Results

From 2019 - 2021 there were 560,255 unique encounters from 424,684 patients for acute sinusitis in Michigan within the IQVIA medical claims database. Antibiotics were prescribed in 66% of these cases. Amoxicillin-clavulanic acid (33%), azithromycin (25%), and amoxicillin (20%) were the most prescribed antibiotics, with median durations of 10 days, 5 days, and 10 days, respectively. The prescription patterns among different groups are shown in Figures 1 and 2. Prescription rates, agent selection, and durations were remarkably consistent across calendar year, age group, sex, place of service, provider specialty, and patient zip code.

Conclusion

The study revealed a concerning pattern of high antibiotic prescription rates, inappropriate antibiotic selection, and prolonged durations of therapy in the outpatient management of acute sinusitis in Michigan. These findings were consistent in all subgroups analyzed and emphasize the need to prioritize outpatient AMS practices for sinusitis.

Disclosures

jason M. Pogue, PharmD, Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Venatorx: Advisor/Consultant
P-1700. Benchmarking Clinical Outcomes by Antimicrobial Spectrum in Patients with Community-Acquired Pneumonia
Authors: Beaulac Kirthana , Mentler Philippe , Nagel Jerod , Postelnick Michael , Patel Pratish C , McCoy Christopher , Kinn Patrick M , Casaus Danielle , Smith Ethan A
Published: January 2025

Background

Antimicrobial benchmarking provides insight into practice variation relative to peers and outcomes relative to projections. Incorporation of patient-level risk-adjustment amplifies the validity and utility of data generated. The Vizient Clinical Data Base (CDB) is a healthcare analytics platform incorporating granular patient-level data from over 1,100 US hospitals and can be used to benchmark patient outcomes. The CDB’s multi-variate 2023 Academic Medical Center Risk Model is validated to produce reliable estimates for patient outcomes.

Methods

The CDB evaluated length of stay (LOS) and mortality for hospital admissions for community-acquired pneumonia (CAP). Admissions in CY2023 were included when labeled with a principal ICD-10 code for bacterial pneumonia, adjudicated as present on admission, and when the admission source was an outpatient location. Compared to the observed LOS, the risk model computed expected LOS (eLOS) and produced an observed to expected (O:E) index; a similar O:E index was created for mortality. Those who received narrow-spectrum (NS) antimicrobials, defined as ceftriaxone plus either azithromycin (CA) or doxycycline (CD), or levofloxacin or moxifloxacin (FLQ) monotherapy, were compared to patients who received broad-spectrum (BS) therapy, defined as vancomycin plus either piperacillin/tazobactam (VPT) or cefepime (VCP). Admissions attributed to the NS cohort did not receive any doses of a BS (VPT/VCP) antimicrobial and vice versa. Admissions were limited to those with eLOS of 3-7 days to balance medical complexity between NS and BS cohorts and limit confounding amongst eLOS, morality estimates, and antimicrobial prescribing.

Results

A principal diagnosis of CAP was assigned to 46,585 admissions. The LOS index was < 1 for NS regimens, but > 1 for those receiving BS therapy (Table 1). All deviations were statistically significant. The mortality index was < 1 for all antimicrobial combinations; however, it was significantly lower than expected (p < 0.01) for NS regimens (CA 0.36; CD 0.27; FLQ 0.52), but not for VPT 0.81 or VCP 0.95 (p > 0.05).

Conclusion

After risk-adjusting for patient-level confounders impacting LOS and mortality, the use of NS antimicrobials for the treatment of CAP was associated with better outcomes than BS antimicrobials.

Disclosures

Kirthana Beaulac, PharmD, Abbvie: Honoraria Pratish C. Patel, PharmD, BCIDP, AAHIVP, VBI Vaccines: Stocks/Bonds (Public Company)
P-1737. A pilot intervention trial to reduce the use of post-procedural antimicrobials after common endoscopic urologic surgeries
Authors: Livorsi Daniel J , Shi Qianyi , Alberding Steven , Carter Knute , Steinberg Ryan
Published: January 2025

Background

Post-procedural antimicrobial prophylaxis is not recommended by professional guidelines but is still commonly prescribed and can lead to patient harm. The goal of this multicenter pilot intervention trial was to encourage less frequent use of post-procedural antimicrobials after common endoscopic urologic procedures.Table 1.Characteristics of patients across the 3 participating hospitals during both the baseline and intervention periods

Methods

We evaluated a bundled intervention using a pre-post, quasi-experimental design at three Veterans Affairs medical centers that performed common endoscopic urologic procedures: ureteroscopy and transurethral resection of a bladder tumor or prostate. There was a 2-year baseline, 1-month implementation, and 12-month intervention period. The intervention consisted of education, local champion(s), and audit-and-feedback of data, aggregated to the hospital-level, on the frequency of post-procedural antimicrobial use with comparisons to other facilities. The primary outcome was antimicrobial use on post-procedural day 1 and was evaluated using a logistic regression model for each site. Secondary outcomes were a) unplanned visits (i.e., Emergency Department visits and/or hospital readmissions within 30 days of the procedure) as well as b) late antimicrobial prescriptions (i.e., antimicrobials prescribed within 7-30 days after the procedure).Figure 1.Probability of post-procedural antimicrobial use after common urologic procedures across the 3 participating hospitals during the baseline and intervention periods

Results

There were 1,272 procedures performed across all sites at baseline compared to 525 during the intervention period (Table 1). During the baseline period, 644 (50.6%) patients received post-procedural antimicrobials compared to 216 (41.1%) during the intervention period. There was no change in the use of post-procedural antimicrobials at sites 1 and 2 between the two periods (Figure 1). At site 3, the odds of prescribing a post-procedural antimicrobial significantly decreased during the intervention period relative to the baseline time trend (0.089; 95% CI 0.016-0.445). There was no significant increase in unplanned visits or late antimicrobial prescriptions at any of the sites.

Conclusion

Implementation of a bundled intervention was associated with reduced post-procedural antimicrobial use after urologic procedures at 1 of the 3 participating sites. These mixed findings support the safety and also the difficulty of implementing guidelines on surgical antimicrobial prophylaxis.

Disclosures

Daniel J. Livorsi, MD, Merck: Grant/Research Support
P-1744. Impact of a Multimodal Antimicrobial Stewardship Intervention on Fluoroquinolone Usage for Antimicrobial Prophylaxis before Urologic Procedures at South Texas Veterans Health Care System
Authors: Kinyua Gertrude , Harb Gaielle , Hopkins Teri L , Frei Christopher R , Mendoza Vidal M , Cadena-Zuluaga Jose , Walter Elizabeth
Published: January 2025

Background

Fluoroquinolones (FQ) are frequently prescribed for urologic procedure prophylaxis, despite being associated with a myriad of adverse events and increasing rates of resistant bacteria. The purpose of this project was to evaluate the impact of a multimodal antimicrobial stewardship intervention on FQ usage for antimicrobial prophylaxis in urologic procedures in an outpatient setting.

Methods

This was a single-center, retrospective, cohort study of patients at the South Texas VA who underwent urologic procedures from December 1, 2020 to February 28, 2024. Initiatives conducted during this period included academic detailing, generation of provider specific FQ usage reports for review by the chief of urology, and prospective reviews of preoperative urine cultures followed by feedback on pathogen-directed therapy. The study was composed of a pre-intervention cohort and 3 post-intervention cohorts. The primary outcome was FQ days of therapy (DOT). Secondary outcomes included number of ≥3-day versus 1-2-day supply prescriptions, percentage of inappropriate prescriptions, rate of 30-day postoperative urinary tract infection (UTI), surgical site infection (SSI) and blood stream infection (BSI), emergence of FQ resistance within 1 year after procedure, and Clostridioides difficile infection (CDI) 30 days after completion of antimicrobial prophylaxis.

Results

Data from 548 patients were included for analysis (150 PRE; 139 POST2021; 168 POST2022; 91 POST2023). The majority of patients were male (94.5%), with a median age of 67 (IQR, 59-74) years. Antimicrobial and microbiological characteristics are described in Table 1. A significant decrease in pre-operative FQ DOT/100 procedures was observed between the pre- and post-intervention groups (Fig 1). This decrease was driven by a reduction of pre-operative IV FQ usage (Fig 3) with minimal impact observed with pre-operative PO FQ usage (Fig 2). No difference was observed in percentage of inappropriate prescriptions which was entirely driven by inappropriate day supply. No significant differences were observed in the secondary outcomes assessed.

Conclusion

A multimodal stewardship initiative decreased overall FQ usage prior to urologic procedures.

Disclosures

Christopher R. Frei, PharmD, FCCP, BCPS, AstraZeneca: Grant/Research Support
P-1752. Antimicrobial Stewardship Initiative on Prescribing at Discharge from a Community Medical Center
Authors: Adenkar Gargi , Raja Karan , Chen Brandon , Patel Mitesh , Philips Mona
Published: January 2025

Background

Inappropriate antimicrobial prescribing and overuse propagates multi-drug resistant organisms and increases risk of adverse drug events. Antimicrobial stewardship programs (ASP) focus a majority of interventions on hospital inpatients, but efforts at discharge remain limited. A recent gap analysis at our institution found that 53% of antimicrobial regimens prescribed at discharge were inappropriate in drug choice, dosing, and/or duration. Therefore, a multifaceted ASP initiative focusing on discharge antimicrobial regimens was implemented at our institution. The study objective was to assess program impact on prescription appropriateness.

Overall Appropriateness of Antimicrobial Prescriptions

Methods

Components of the stewardship initiative included development of an institution-specific prescribing guideline, clinician education, and pharmacist prospective audit and feedback at discharge. This IRB-approved study evaluated oral antimicrobial regimens prescribed to adults patients upon discharge from a community medical center. Patients were randomized irrespective of encounter type or discharge destination. Pregnant and post-partum patients were excluded. The validated National Antimicrobial Prescribing Survey (NAPS) tool was used to categorize antimicrobial appropriateness as appropriate (optimal or adequate), inappropriate (suboptimal or inadequate), or not assessable. Hospital-specific treatment guidelines, literature references, and patient-specific factors were used to determine appropriateness. The primary outcome was the proportion of appropriate discharge antimicrobial regimens before versus after initiative implementation.

Proportion of Each NAPS Category

Results

One hundred antimicrobial regimens were analyzed in each cohort. The proportion of appropriate antimicrobial regimens increased by 15% after program implementation (47% vs. 62%, p = 0.03). Exploratory outcome analyses indicated an increase in optimal regimens (26% vs. 44%) and a decrease in suboptimal (33% vs. 26%) and inadequate (20% vs 12%) therapy as categorized by the NAPS tool.

Conclusion

ASP initiative implementation increased the proportion of appropriate discharge antimicrobial regimens. Study results highlight the positive impact of a multidisciplinary approach in improving discharge antimicrobial prescribing.

Disclosures

All Authors: No reported disclosures
P-1759. Antibiotic De-Escalation in Neutropenic Fever
Authors: Evans Michelle , Tremblay Douglas , Rana Meenakshi M , Jacobs Samantha E , Fuller Risa
Published: January 2025

Background

Cancer patients with neutropenic fever are frequently continued on broad-spectrum empiric antimicrobial therapy (EAT) until neutrophil recovery, but recent randomized trials demonstrate that EAT de-escalation prior to neutrophil recovery is safe in certain subgroups. We evaluated outcomes of EAT de-escalation based on clinical criteria in patients with neutropenic fever at our institution.

Methods

We retrospectively reviewed charts of 49 patients with acute myeloid leukemia (AML) or hematologic stem cell transplantation (HSCT) and neutropenic fever following revisions to Standard of Practice (SOP) institutional guidelines (hereafter “SOP” group) allowing for antibiotic de-escalation using a clinical approach in comparison to a historic cohort of 60 patients. The revised SOP recommended antibiotic de-escalation to levofloxacin prophylaxis in patients who received ≥ 72 hours of EAT, were afebrile and clinically stable for 48 hours, and did not have a clinically or microbiologically documented infection. The primary endpoint was the EAT duration. Secondary end points included incidence of recurrent fever, infections, vasopressor support and/or intensive care unit (ICU) stay, and in-hospital mortality.

Results

Baseline characteristics were similar between both groups, with differences including a larger proportion of males in the SOP group compared to the control group (59% vs. 35%) and the primary underlying malignancy of multiple myeloma in the SOP group compared to AML in the control group. The median duration of EAT prior to de-escalation was shorter in the SOP group compared to the historic cohort (5.0 [IQR 4.0, 6.0] vs. 7.0 days [IQR 5.0, 10.2], p< 0001). There was no difference in incidence of recurrent fever (20% vs. 30%, p=0.3) or secondary infection (10% vs. 12%, p=0.8). Incidence of vasopressor support and/or ICU stay(10% vs. 3.3%, p=0.2) and in-hospital mortality (2.0% vs. 3.3 %, p >0.9) were also similar between both groups.

Conclusion

Our study indicates that our new institutional guidelines successfully lead to reduced broad spectrum antimicrobial exposure without increased infections, ICU stays, or mortality. Thus, de-escalation of EAT based on clinical criteria is safe in this high risk patient population.

Disclosures

Douglas Tremblay, MD, AbbVie: Advisor/Consultant|Astellas: Grant/Research Support|Cogent Biosciences: Advisor/Consultant|Cogent Biosciences: Grant/Research Support|Gilead: Grant/Research Support|GSK: Advisor/Consultant|Novartis: Advisor/Consultant|Sierra Oncology: Advisor/Consultant|Sobi: Advisor/Consultant|Sobi: Grant/Research Support|Sobi: Patent for use of pacritinib and azacitidine in CMML|Sumitomo: Grant/Research Support Samantha E. Jacobs, MD, MS, Ansun Biopharma: Advisor/Consultant|Eurofins, Viracor, LLC.: Grant/Research Support