bluuebunny/crossref_metadata_2025 huggingface dataset:
657. Evaluating Clinical Outcomes of Bacteremic Patients Treated with AmpC-Inducing Versus -Stable Agents
Authors: Barsoum Barbara , Karkenny Gabriel , Donaghy Henry , Doan Thien-Ly
Published: December 2022

Background

AmpC enzymes are β-lactamases that can rapidly hydrolyze penicillins, cephalosporins, and monobactams. When in the presence of β-lactams, inducible pathogens can become derepressed and lead to an overproduction of AmpC. Because of this induction potential, agents that appear susceptible may quickly become resistant, complicating the treatment choices for these infections. The purpose of this study is to assess clinical outcomes in bacteremic patients with an AmpC producing organism based on the antimicrobial agent used.

Methods

This retrospective chart review is approved by Northwell Health IRB and evaluated patients admitted with a positive blood culture from July 2017 to January 2022. The primary objective is outcome of infection (treatment success or failure). Secondary objectives include 30-day readmission related to infection, microbiologic relapse, and in-hospital mortality. Patients were included if they had a positive blood culture demonstrating E. cloacae, E. aerogenes, or C. freundii, cefoxitin resistance, and were treated with a β-lactam antibiotic for at least 72 hours. Patients were excluded if they had polymicrobial cultures or if a resistance gene was detected.

Results

A total of 71 patients were included in analysis, with 40 patients in the carbapenem or cefepime group (Group A), 18 patients in the piperacillin/tazobactam group (Group B), and 13 patients in the ceftriaxone or aztreonam group (Group C). The most frequently isolated pathogen was E. cloacae and the most common source of infection was genitourinary. Treatment failure was seen in 16.7% of Group B patients, 15.4% of Group C patients, and 12.5% of Group A patients (p=0.901). Microbiologic relapse was experienced in 5.6% of patients in Group B and 2.5% of patients in Group A (p=0.686). In Group C, 15.4% of patients were readmitted within 30 days related to infection, compared to 11.1% in Group B and 2.5% in the Group A (p=0.23). In-hospital mortality was 16.7% in Group B, compared to 15% in Group A (p=0.341).

Conclusion

Although not statistically significant, patients who received piperacillin/tazobactam had numerically more treatment failure, microbiologic relapse, and 30-day readmission related to infection when compared to the patients who received a carbapenem or cefepime.

Disclosures

All Authors: No reported disclosures.
667. Real-world Experience of Cefiderocol with Pseudomonas aeruginosa in the PROVE (Retrospective Cefiderocol Chart Review) Study
Authors: Marcella Stephen , Carr Amy L , Kobic Emir , Nguyen Sean , Zhou Anan
Published: December 2022

Background

Gram-negative (GN) bacterial resistance is an urgent global health problem. Cefiderocol (CFDC) is active against many resistant GN pathogens, including Pseudomonas aeruginosa (PA). PROVE is an ongoing international, retrospective study assessment of CFDC use for Gram-negative infections (GNI).

Methods

Patients were eligible if they received ≥ 72 hours of CFDC. Patient and pathogen characteristics, hospital course, and antibiotic treatment patterns were described. All-cause mortality (ACM) at 14 and 30 days and clinical cure were examined as outcomes, overall, and by key characteristics such as pathogen susceptibility (determined at the local level), patient demographics, infection site, and severity of illness. Serious adverse drug reactions (SADR) were recorded.

Results

To date, 123 patients treated with CFDC at 12 sites were included. Sixty-five patients had PA as a pathogen, either alone (N=45) or in combination with another pathogen (N=20) attributed to starting CFDC. The median age was 54 years; 68% were male. The most prevalent comorbidity was diabetes with end stage organ damage (N=15, 23%). CFDC was given in an ICU setting in 54 (82%) patients. Vasopressors and mechanical ventilation were required in 42% and 62%, respectively. Most (91%) PA were carbapenem resistant. The median time from a positive culture to start of CFDC was 6 days. CFDC monotherapy was used in 75%. The most common GN antibiotic class used concurrently with CFDC was aminoglycosides (N=7). Targeted therapy with CFDC against pathogens of known susceptibility with or without prior GN antibiotics accounted for 80% of use. The remainder was used for salvage (15%) or empirically (2%). Susceptibility testing to CFDC, available for 54 cultures (54 patients), showed 94% (51/54) were susceptible. Post-CFDC initiation 14- and 30-day all-cause mortality (ACM) was 9% (95% CI: 3%-19%) and 23% (95% CI: 14%-35%) respectively. Clinical resolution was achieved in 66% (95% CI: 53% -77%). Thirty-day ACM for susceptible pathogens was 25% (13/51).

Cefiderocol Use Patterns in Pseudomonas aeruginosa

Conclusion

Real-world use of CFDC for PA demonstrated that most patients had multiple comorbidities and were severely ill. These data suggest that CFDC is being used appropriately with little empirical use in patients with few treatment options.

Disclosures

Stephen Marcella, MD, MPH, Shionogi: Shionogi employee|Shionogi, Inc: Employee Amy L. Carr, PharmD, BCIDP, Shionogi: Advisory Board Sean Nguyen, n/a, Shionogi: Employee Anan Zhou, MPH, Shionogi, Inc: contracting work for Shionogi, Inc.
668. Presence of the Narrow-Spectrum OXA-1 Beta-Lactamase Enzyme is not Associated with Elevated Ceftolozane-Tazobactam MIC Values among ESBL-Producing Escherichia coli Clinical Isolates (CANWARD, 2011-2018)
Authors: Walkty Andrew , Karlowsky James , Golden Alyssa , Lagace-Wiens Philippe , Baxter Melanie , Denisuik Andrew , McCracken Melissa , Mulvey Michael , Adam Heather , Zhanel George
Published: December 2022

Background

Beta-lactam-beta-lactamase inhibitor combinations have been proposed as an alternative to carbapenems for the treatment of infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli as an antimicrobial stewardship initiative. However, in a recent randomized trial evaluating patients with bacteremia, presence of the narrow spectrum OXA-1 beta-lactamase enzyme among ESBL-producing Enterobacterales was associated with higher piperacillin-tazobactam MICs, and in turn excess mortality among patients treated with piperacillin-tazobactam relative to meropenem. The purpose of this study was to determine whether the in vitro activity of ceftolozane-tazobactam versus ESBL-producing E. coli is similarly compromised by the presence of OXA-1.

Methods

E. coli clinical isolates were obtained from patients evaluated at hospitals across Canada (January 2011 to December 2018) as part of an ongoing national surveillance study (CANWARD). ESBL production was confirmed using the Clinical and Laboratory Standards Institute phenotypic method. Susceptibility testing was carried out using custom broth microdilution panels, and all isolates underwent whole genome sequencing for beta-lactamase gene detection.

Results

In total, 485 ESBL-producing E. coli identified as part of the CANWARD study were included. The majority of isolates (91.3%; 443/485) harbored a CTX-M ESBL enzyme. OXA-1 was present in 39.6% (192/485) of isolates. OXA-1 was detected in 62.5% (187/299) of isolates with a CTX-M-15 ESBL enzyme versus only 2.7% (5/186) of isolates with other ESBL enzyme types. Ceftolozane-tazobactam MIC50 and MIC90 values were identical (0.25 µg/mL and 1 µg/mL, respectively) for the isolate subsets with and without OXA-1. Overall, 97.4% and 96.9% of isolates with and without OXA-1 remained susceptible (CLSI breakpoint) to ceftolozane-tazobactam.

Conclusion

The presence of OXA-1 among ESBL-producing E. coli clinical isolates was not associated with an elevation in MIC values for ceftolozane-tazobactam. These data support further evaluation of ceftolozane-tazobactam as an alternative to carbapenems for the treatment of infections caused by ESBL-producing E. coli, as is being done with the MERINO-3 trial.

Disclosures

George Zhanel, PhD, Merck: Grant/Research Support.
670. Real-life Experience of Imipenem-cilistatin-relebactam for the Treatment of Extensively Drug-resistant and Difficult-to-treat Pseudomonas Infections
Authors: Vu Christine A , Bec Elizabeth , Deronde Kailynn , Rosa Rossana , Abbo Lilian M
Published: December 2022

Background

Imipenem-cilistatin-relebactam (Recarbrio) is recommended to treat extensively drug-resistant (XDR) and difficult-to-treat (DTR) Pseudomonas aeruginosa (PA). Since approval in 2019, there remains limited literature describing real-world use. We describe our experience and evaluate the efficacy and safety of Imipenem-cilistatin-relebactam for the treatment of XDR and DTR Pseudomonas infections.

Methods

This was a retrospective, observational study at a 1,550 licensed-bed academic hospital. Adults receiving ≥72 hours of Imipenem-cilistatin-relebactam for Pseudomonas infections between January 2020-February 2022 were included. The primary outcome was clinical success. Secondary outcomes included 30-day all-cause mortality, 30-day recurrence, 60-day infection-related hospital readmission, and adverse effects. Descriptive statistics were used to analyze our findings.

Results

Ten patients were included, with 60% being male and a median age of 63 years (range 31-85). The median duration of treatment was 7 days (range 4-14). Sources of infection included ventilator-associated pneumonia (70%), empyema (20%), and bacteremia (20%). Two isolates were XDR, and seven DTR, including an isolate positive for Verona-integron-borne Metallo-β-lactamase (VIM). At the time of index culture, the median APACHE II score was 25.5 and 60% had at least one concomitant infection. For our primary outcome, 7 patients (70%) achieved clinical success. All-cause mortality at 30 days was 30% and 3 out of 8 patients had recurrent infection within 30 days.

Conclusion

Our study demonstrates the real-life use of Imipenem-cilistatin-relebactam for the treatment of XDR and DTR Pseudomonas infections. While the majority of patients achieved clinical success, a high mortality and recurrence rate was still observed. Larger studies are needed to validate our initial findings.

Disclosures

All Authors: No reported disclosures.
680. Utility of Cefoxitin for the Treatment of ESBL-producing E. coli Urinary Tract Infections
Authors: Nathan Ramesh V , Tran Diem
Published: December 2022

Background

Carbapenems are regarded as first-line agents for the treatment of ESBL-producing bacterial infections, even when in vitro activity to other beta lactams is demonstrated. However, overuse is associated with the selection of beta-lactamases that can hydrolyze carbapenems. Patients with isolated urinary tract infections due to ESBL–producing E. coli potentially have a lower burden of infection ("low inoculum"). These patients are frequently less ill and may benefit from non-carbapenem therapy. Cephamycins have in vitro activity against ESBL–producing Enterobacterales, and may be useful in the treatment of ESBL E. coli urinary tract infections as a carbapenem sparing agent.

Methods

Patients 18 years of age and older, hemodynamically stable with negative blood cultures and who demonstrated signs and symptoms of a urinary tract infection with a urine culture showing ESBL E. coli, were eligible to participate. Patients were started on initial antimicrobial therapy at the discretion of the admitting physician, and if the urine culture showed ESBL E. coli with an MIC of less than 8, the antimicrobial stewardship team requested to switch the patient to Cefoxitin 2 g intravenously every 6 hours, via extended infusion. The dose was renally adjusted as appropriate, and patients with beta-lactam allergies were excluded.

Results

46 patients were evaluated between May 2017-April 2022. Patients received antibiotics for 2.6+1 day before the switch to Cefoxitin. The mean duration of therapy with Cefoxitin was 4.5+2.2 days. All 46 patients had resolution of fever and dysuria. Six patients were readmitted within 30 days, but none were due to a urinary tract infection. 30 patients had a repeat urinalysis at 48 hours, and all demonstrated reduction in pyuria. 39 patients had a repeat urine culture following completion of therapy, and 36 had converted to culture-negative status.

Conclusion

Cefoxitin is a useful agent for the treatment of ESBL E. coli urinary tract infections. The optimal dose appears to be 2 g intravenously every 6 hours, via extended infusion, in patients with normal creatinine clearance. Further larger studies, involving patients with pyelonephritis, are needed to validate these findings.

Disclosures

Ramesh V. Nathan, MD, Eli Lilly: Grant/Research Support|PPD: Grant/Research Support.
888. A Predictive Model for Subtherapeutic Vancomycin Troughs in Adults
Authors: Crisp Sarah , Shrestha Nabin K , Pallotta Andrea , Wu Janet , Ahrens Christine , Cerrato Pooja
Published: December 2022

Background

Vancomycin is a first line agent in the treatment of methicillin-resistant Staphylococcus aureus infections. The ability to predict sub-therapeutic troughs would limit potential for development of resistance. The purpose of this study was to develop a predictive model for sub-therapeutic vancomycin troughs in adults.

Methods

This retrospective cohort study included adults 18 years and older ordered a pharmacy to dose vancomycin consult. Exclusion criteria included patients with cystic fibrosis, pregnancy, no steady-state trough, or required dialysis during therapy. Patients with sub-therapeutic vancomycin troughs (< 10 mg/L) were compared to patients with therapeutic troughs (10-20 mg/L). A K-nearest neighbors (KNN) regression model to predict an initial sub-therapeutic vancomycin level based on age, gender, race, BMI, loading dose, frequency, creatinine clearance, and institutional vancomycin dosing guideline adherence was developed and validated using 10-fold cross validation. The association of vancomycin dosing guideline adherence with initial sub-therapeutic vancomycin trough was evaluated in a multivariable logistic regression model adjusted for age and creatinine clearance.

Results

A total of 1,615 subjects were included; 494 (30.5%) subjects experienced a sub-therapeutic trough. A KNN regression model to predict an initial sub-therapeutic vancomycin level had an area under the ROC curve of 0.82, and an accuracy of 0.77 (95% CI 0.75-0.79, baseline accuracy 0.69). After adjusting for age and creatinine clearance, guideline dosing adherence was associated with significantly lower odds of an initial sub-therapeutic vancomycin level compared to guideline dosing non-adherence (OR 0.37, 95% CI 0.20-0.66, p-value 0.001).

Conclusion

A predictive model, based on readily available data points, for an initial sub-therapeutic vancomycin level was reasonably accurate. Adherence to the institutional vancomycin dosing guideline was associated with greater than 60% lower odds of an initial sub-therapeutic vancomycin level.

Disclosures

All Authors: No reported disclosures.
904. Impact of a Pharmacist-driven Antimicrobial Stewardship Program on Prescribing Practices by Intensive Care Physicians in a Latin American Hospital.
Authors: Díaz-Madriz José Pablo , Zavaleta-Monestel Esteban , Chaverri-Fernandez José Miguel , Arguedas-Chacón Sebastián , Arguedas-Herrera Raquel , Leiva-Montero Brayan , Vásquez-Mendoza Ana Fernanda , Muñoz-Gutierrez Gabriel
Published: December 2022

Background

In a recent report from Latin American hospitals, only 59.7% of the prescriptions of patients admitted to the ICU followed treatment guidelines. Implementation of antimicrobial stewardship programs (AMS) have proven to be an effective tool for the rational use of antimicrobials, but their implementation has been a challenge in this region due to resources limitations. One significant barrier is the lack of clinical pharmacists with specialized training in infectious diseases. This study aims to determine the impact of a pharmacy driven AMS on the optimal prophylactic and empirical therapy prescription by intensive care physicians (ICP) in a Latin American hospital.

Methods

A retrospective observational study that compared the optimal selection and the consumption (DOTs/1000 ICP patient days) of antibiotics in patients treated by intensive care physicians before and after the implementation of the AMS at Clínica Biblica Hospital, Costa Rica. The comparison was made from January to December 2014 (preAMS) and from January 2020 to March 2021 (postAMS). Bacterial resistance patterns before and after AMS implementation were also compared.

Results

A total of 333 patients met the inclusion criteria (52% preAMS and 48% postAMS). After a five-year intervention, the optimal antibiotic selection prescribed by ICP was 43.1% (n=75) in the preAMS period and 86.8% (n=138) in the postAMS period (43.7% absolute improvement, p < 0.001). The prescription of most antibiotics showed an improvement (Fig 1), such as ertapenem in 45% (p< 0.001) and levofloxacin in 59% (p< 0.001). Similarly, there was a trend towards improvement of the prescription by diagnosis (Fig 2), including an increase of 32% (p< 0.001) in CAP. There was a reduction of the consumption of most antimicrobials (Fig 3) including a decrease of 66.9% (p =0.017) for vancomycin and 64.7% (p =0.033) for meropenem. Regarding bacterial resistance, there was found a decrease of 11% (p=0.048) of P. aeruginosa resistant to meropenem and a reduction in the detection of ESBL in E. coli (11% decrease; p=0.007).

Conclusion

The AMS implementation showed an overall positive impact on antibiotics selection and consumption. In addition, is thought that the intervention could had a positive effect on antibiotic resistance.

Disclosures

José Pablo Díaz-Madriz, PharmD, MSc, Eli Lilly: Stocks/Bonds|Pfizer: Advisor/Consultant.
907. Impact of Antimicrobial Stewardship Prospective Audit and Feedback on Antibiotic Utilization in Hospitalized COVID-19 Patients
Authors: Shafiq Ashfaq , Hori Taylor , Pham Selena
Published: December 2022

Background

Studies have consistently shown a high proportion of antimicrobial usage in hospitalized COVID-19 patients despite low prevalence of bacterial co-infection. Improving antibiotic utilization is one of the main goals of antimicrobial stewardship program (ASP). This study aimed to determine the impact of prospective audit and feedback intervention (PAF) performed by ASP pharmacists on antibiotic utilization in hospitalized COVID-19 patients.

Methods

A retrospective chart review was conducted at a 90-bed Veteran Affairs hospital. This study included patients who were admitted to the hospital due to laboratory confirmed COVID-19 infection from November 1, 2020 to January 31, 2021. The primary outcome of this study was to evaluate the impact of ASP PAF on avoiding the unnecessary use of antibiotics in hospitalized patients with acute COVID-19. The secondary outcomes included the prevalence of bacterial co-infection in hospitalized COVID-19 patients and the clinical outcomes.

Results

A total of 199 patients were included in this study. Sixty-one patients (30.7%) had antibiotics started empirically upon hospital admission. Fifty (82%) out of 61 patients had antibiotics discontinued due to the lack of indication for antibiotics during their hospital admission, with 47 (94%) was done by ASP team versus 3 of them (6%) was done by Internal Medicine. Fifty-eight of these patients were followed by ASP team, with 28 patients (48.3%) met SIRS criteria upon admission and 25 (43.1%) with elevated procalcitonin level. The overall readmission rate was 5.8%, with readmission rate of the intervention group to be 6.4% and the non-intervention group to be 5.6% (p = 0.29). The overall mortality rate was 13.1% in hospitalized COVID-19 patients, with 19% reported in the intervention group and 10.1% in the non-intervention group (p = 0.09). Overall, only 5 patients (2.5%) had laboratory-confirmed bacterial co-infection upon admission. Sixteen patients (8%) were found to have microbiologically confirmed nosocomial infection.

Conclusion

The findings suggested that ASP PAF safely and effectively avoided the unnecessary use of antibiotics in hospitalized patients with acute COVID-19 infection. In addition, low prevalence of microbiologically confirmed bacterial co-infection was observed.

Disclosures

All Authors: No reported disclosures.
915. Implementation of Face-to-Face Antimicrobial Stewardship Rounding at a Veterans Affairs Hospital
Authors: Malepsy Jon , Atluri Vidya
Published: December 2022

Background

The Veterans Affairs Central California Healthcare System (VACCHCS) antimicrobial stewardship program primarily utilizes prospective audit-feedback. Initially, antimicrobial recommendations were communicated to medicine and surgery teams exclusively through chart notes. Beginning September 2021, a new process was initiated whereby all antibiotic recommendations were communicated to care teams during daily face-to-face rounds. This pre-post cohort study is an assessment of the changes in antimicrobial use, inpatient mortality and 30-day readmissions that occurred with the intervention.

Methods

Both pre- and post- intervention, all admitted patients with active antibiotic orders were reviewed for antibiotic optimization by an ID team and a chart note was written to document recommendations. Post-intervention, recommendations were communicated via daily face-to-face rounds with medicine and surgery services. Total antibiotic use was collected from the National Healthcare Safety Network’s Antimicrobial Use and Resistance (NHSN-AUR) Module as antibiotic days-of-therapy per 1000 patient days (DOT/1000). Monthly in-hospital mortality and 30-day readmission data were collected from the VA’s Corporate Data Warehouse. Median monthly amounts of each measure were compared pre- and post-intervention. Antibiotic use was compared monthly for 2 years prior and 3 months post intervention, whereas mortality and readmission outcomes included 2 years prior and 6 months post-intervention.

Results

Pre and post-intervention median monthly antibiotic use was 728 and 741 DOT/1000, respectively. Median monthly mortality was seven deaths pre-intervention and six post-intervention. Median monthly 30-day readmissions were 48 pre-intervention and 36 post-intervention.

Conclusion

Total antibiotic use slightly increased after the intervention. Further post-intervention observation is needed in order to better characterize impact on antimicrobial use. Monthly in-hospital mortality and 30-day readmission data were decreasing prior to our intervention and continued to decrease post-intervention.

Disclosures

All Authors: No reported disclosures.
918. Influence of a hospital-based antimicrobial stewardship program on clinical and economic outcomes. The experience from a referral center in Mexico.
Authors: Molina-Jaimes Aaron , del Carmen Gonzalez-Sanchez M , Molina Mariana
Published: December 2022

Background

Antibiotic stewardship programs (ASP) are relatively new in Mexico. It was until May 2018 that it was established as a public health policy in the country. Few hospitals have acknowledged the mandate and started an ASP despite the efforts. Besides, little has been done to evaluate the efficacy of the program in terms of antibiotic expenditure and the incidence of associated infections. Therefore, the main objective was to evaluate antibiotic expenditure before and after the ASP in a third-level hospital in Mexico. As a secondary analysis, the relationship with Clostridioides difficile infections was explored.

Methods

This is a retrospective and descriptive study from January 2017 to February 2020 (pre-COVID-19 pandemic). First, the mean antibiotic expenditure (adjusting for DDD/patient days-costs in USD) was evaluated before and after (June 2018 as the first month of implementation) the ASP. Statistical difference of the means was evaluated. It was also performed an exploratory analysis between the prescription of Clindamycin and Levofloxacin with the number of cases and deaths related to C. difficile infection.

Results

The average antibiotic expenditure before ASP was US$13,468 ± 3,267, and US$8,193 ± 2,574 (p< 0.001) after. Graph 1 presents the changes in trend. Specifically, caspofungin, ciprofloxacin, clindamycin, fluconazole, levofloxacin, linezolid, piperacillin/tazobactam, and tigecycline showed statistically significant reduction after June 2018. Graph 2 displays the descriptive relationship between the prescription of levofloxacin and clindamycin, the cases of C. difficile infection, and the elimination of all associated mortality.

Graph 1.

Antibiotic expenditure. Before and after AMS

Graph 2.

Relationship between monthly consumption of clindamycin and levofloxacin and the number of cases/deaths secondary to Clostridioides difficile infections, before and after ASP.

Conclusion

The ASP has significantly reduced the antibiotic expenditure in the hospital. Besides reducing the prescription of associated antibiotics, a possible reduction in C. difficile infections and associated deaths were observed.

Disclosures

All Authors: No reported disclosures.
926. Shorter. Safer. Better. Pledge Campaign to Increase Uptake of Shortest Effective Durations of Antimicrobial Therapy
Authors: Doughman Danielle , Marx Ashley H , Mavrogiorgos Nikolaos
Published: December 2022

Background

Patients often receive longer-than-needed antimicrobial treatment for common infections, when a shorter duration would be equally effective. To promote use of evidence-based durations, the University of North Carolina Medical Center’s (MC) Carolina Antimicrobial Stewardship Program (CASP) developed best practices (BPs) in 2020 to inform prescribing. CASP conducted a signature pledge campaign to encourage nurses, pharmacists, prescribers, and allies to know, use, and share BPs.

Methods

CASP developed a pledge form on a password-protected MC intranet site. Participants selected way(s) to “action” their pledge from a pre-filled list. CASP delivered coordinated messages to nurses, pharmacists, prescribers, and allied groups using multiple platforms: tiered safety huddles, leadership meetings, MC news, email, social media, and the CASP website over a 35-day campaign period that culminated with Antibiotics Awareness Week.

Measures of campaign effectiveness included number of pledgers, intranet views of BPs, reported awareness and use of BPs by pledgers at the time of pledge and in a 90-days post-campaign electronic survey, and pledge actions fulfilled.

Survey responses were cross-tabulated and analyzed using descriptive statistics.

Results

238 MC staff signed the pledge; nurses comprised 21%, pharmacists 24%, prescribers 48%, and allies 7%. At time of pledge, 39% reported prior awareness of BPs (Figure 1); 39% reported prior use of BPs. 99% selected at least one action at time of pledge. 116 (49%) responded to the 90-day post campaign survey. 84% reported taking at least one action. The most common action reported among nurses was patient education (36%); among pharmacists, identifying too-long durations for query (78%); among prescribers, BP use and patient education were tied at 60%. The BPs page was viewed 323 times during campaign, compared to 153 total pre-campaign views. Prescribers’ BP use increased 66% from time of pledge.

90 days post-pledge, all groups except allies reported increased use of BPs since pledging (Figure 2).

Awareness of CASP Best Practices for Durations of Therapy resource among pledgers at time of signature.

Reported use of CASP Best Practices for Duration of Therapy resource at the time of pledge and at time of survey, 90-days post campaign.

Conclusion

A pledge campaign to increase awareness and uptake of shortest effective durations was effective except among allies. Further analysis is needed to determine if durations for common infections are similar to the BP ranges post-campaign.

Disclosures

All Authors: No reported disclosures.
928. The Cost-effectiveness of the Pediatric Antimicrobial Stewardship Program in a Non-Freestanding Children’s Hospital
Authors: Lien Tsung-Chi , Ip Alice , Covarrubias Laurie , Husted Harlan , Sidhom Alexander , Doctor Medical , Rongkavilit Chokechai , Doctor Medical
Published: December 2022

Background

Improper utilization of antimicrobials has impacted clinical outcomes in patient care and economical costs. Pediatric antimicrobial stewardship (Ped ASP) lowers healthcare costs by promoting efficient and judicious use of antimicrobials which improves patient outcomes and amends resource utilization. The objective of this study is to evaluate the cost-effectiveness of a Ped ASP in a non-freestanding children’s hospital within an adult-centered tertiary hospital.

Methods

We conducted a cost-effective analysis of our Ped ASP within a 685-bed, adult-centered medical center. Impacted by the COVID pandemic, the pediatric services reduced from 21 to 14 beds with 10 general pediatrics (PED) and 4 pediatric intensive care (PICU) beds. Our Ped ASP activities include thrice-weekly chart reviews followed by handshake rounds and quarterly reviews of documented interventions. The preset values of antimicrobial-specific interventions in the Electronic Medical Record system were utilized. An average cost savings of $732 (range: $2.5 - $2,640) per patient as determined by previous studies was used to calculate the annual cost savings.

Results

During years 2020 to 2021, antibiotic days of therapy per 1000 patient days (DOT) decreased from 290.4 to 100.2 in PED but increased from 433 to 569.1 in PICU. The ratio of broad to narrow-spectrum antibiotics decreased from 0.46 to 0.20 in PED and 0.69 to 0.63 in PICU. In 2020, 286 reviews were completed of 155 patients which projected an average cost savings of $113,460 (range: $387.5 - $409,200). In 2021, 256 reviews of 116 patients projected an average cost savings of $84,912 (range $290 - $306,240). An estimated overall annual cost-savings was $99,186. The total number of ASP-specific interventions in 2020 and 2021 were 172 and 146 with projected pharmacy intervention values of $26,354 and $19,170 respectively.

Conclusion

Our Ped ASP effectively reduces the usage of broad-spectrum antibiotics in both PED and PICU demonstrating cost savings. Implementing antibiotic time-out reports on specific broad-spectrum antibiotics based on local susceptibility data may further enhance the safety and appropriateness of antimicrobial therapy.

Disclosures

All Authors: No reported disclosures.
936. Antimicrobial Stewardship Assessments in De-labeling Beta-lactam Allergies
Authors: Fahmy Nicole , Morado Faiza , Nanda Neha
Published: December 2022

Background

Unnecessary use of broad-spectrum antibiotics due to false antibiotic allergy labels leads to an increase in drug resistant and health care associated infections. Therefore, allergy assessments to de-label patients not truly allergic is an important antimicrobial stewardship (AMS) tool. The purpose of this study was to assess the effectiveness of a pharmacy-led questionnaire and AMS rounds in improving the accuracy of beta-lactam allergy labels (BLA).

Methods

AMS piloted BLA de-labeling rounds three times a week from November 1, 2021 to April 1, 2022. Rounds consisted of an infectious disease physician and an AMS pharmacist that reviewed allergy questionnaires conducted by trained pharmacy personnel. The questionnaire was provided to patients 18 years or older with a documented BLA and an admission stay of two or more nights. Patients were excluded if unable to participate or did not have a representative available for interview. The primary outcomes evaluated were: (i) direct de-labelling (ii) future de-labeling upon patient consent (iii) allergy profile changes. The secondary outcomes were potential days of therapy (DOTs) saved for anti-MRSA agents (vancomycin, linezolid, clindamycin) and fluoroquinolones (ciprofloxacin, levofloxacin) and PEN-FAST scores for those with a penicillin-specific allergy.

Results

93 of 96 patients interviewed (96.9%) had their allergy profile updated to include type, severity, or timing of reaction. 82 of 96 patients (85.4%) were classified as low-risk allergies in which 11 patients (13.4%) were successfully de-labeled and 18 patients (22.0%) were eligible for de-labeling upon patient consent. The remaining patients were eligible for further interrogation with an oral challenge (Figure 1). Potential DOTs saved were 131 and 67 days for anti-MRSA agents and fluoroquinolones, respectively. Average PEN-FAST scores for those de-labeled and eligible for oral challenge was 0.5 (SD 0.85) and 1.08 (SD 1.20), respectively.

Conclusion

AMS BLA assessments can decrease the prevalence of false BLA labels and prescribing of unnecessary broad-spectrum agents. PEN-FAST scores less than 2 suggests that allergy assessments help identify patients with low-risk penicillin allergies.

Disclosures

All Authors: No reported disclosures.
937. Appropriateness of using a Mobile Application for Choosing Antibiotic Therapy in Hospitalized Patients at Siriraj Hospital
Authors: Chaloernnpoj Kanthon , Wangchinda Walaiporn , Koomanachai Pornpan , Thamlikitkul Visanu , Rattanaumpawan Pinyo
Published: December 2022

Background

Development of facility-specific clinical practice guidelines and incorporation of computerized clinical decision support have been recommended as the effective antimicrobial stewardship strategies. The DigitalAMSTM is a mobile-based application used to guide choosing empirical antibiotics. Before the hospital-wide implementation of DigitalAMSTM, the appropriateness and limitation of such an application needs to be evaluated.

Methods

A retrospective cross-sectional study of hospitalized adult patients who received at least one dose of antibiotic and had at least one documented site of infection were enrolled between 1 Jan and 31 Jun 2018. All necessary data was obtained via chart review. The antibiotic regimen that was prescribed by the ward physician (WARD), the regimen recommended by the DigitalAMSTM (APP), the regimen recommended by the independent infectious disease (ID) physicians before and after knowing the culture results (Emp-ID and Def-ID) were compared.

Results

A total of 401 patients of the targeted infections i.e. 98 subjects with pneumonia, 103 subjects with urinary tract infection (UTI), 98 subjects with bacteremia and 102 subjects with skin and soft tissue infection (SSTI) were enrolled. The percent agreement between the APP and the WARD was less than half in all sites of infection. The APP regimen provided approximately 80% agreement with the Emp-ID regimen among subjects with UTI (78.6%), bacteremia (85.7%) and SSSI (85.2%), while the percent agreement of the WARD regimen and the Emp-ID was approximately half in all sites of infection. The lowest percent agreement between the APP regimen and the Emp-ID regimen was found among subjects with pneumonia (59.1%). Univariate analysis did not reveal any association between subjects who received the antibiotic regimen matching to the APP recommendation and the 28-day mortality.

Conclusion

Our study confirmed that the DigitalAMSTM application could improve appropriateness of antibiotic regimens for empirical therapy for four common infections among adult hospitalized patients at Siriraj Hospital. However, some revisions need to be done to improve the appropriateness of antibiotic regimens in the APP, especially for subjects with pneumonia.

Disclosures

All Authors: No reported disclosures.
941. Clinical Outcomes of Vancomycin Area-Under-the-Curve Monitoring: A Quasi-Experimental Study Interim Analysis
Authors: Flynn Ryan , Tucker Natalie , Foreman Jena K
Published: December 2022

Background

The 2020 Infectious Diseases Society of America vancomycin guidelines recommend the use of area-under-the-curve (AUC) monitoring instead of trough concentration monitoring. These guidelines changed due to evidence showing decreased rates of nephrotoxicity and lack of correlation between vancomycin troughs and patient treatment outcomes. Two common methodologies of calculating AUC exist in clinical practice, including two level kinetic calculations and Bayesian software programs. Previous studies used two levels for calculating the AUC. The purpose of this study is to evaluate if the same reduction in acute kidney injury (AKI) is achieved while using a Bayesian software program.

Methods

This retrospective quasi-experiment was performed at two sites within the same health system. The primary objective of this study was to assess the rate of AKI, as defined by the Acute Kidney Injury Network (AKIN) criteria, between patients receiving vancomycin dosed by trough monitoring as compared to AUC monitoring. Secondary objectives include mean daily dose of vancomycin, number of vancomycin levels, and severity of AKI. Patients were included in the study if they were 18 years or older, with at least one vancomycin concentration drawn. Patients were excluded if they had a baseline serum creatine greater than 2 mg/dL, received renal replacement therapy of any type, or received > 1 doses of vancomycin prior to admission. After screening for inclusion criteria, patients were matched 1:1 based on APACHE II score and vancomycin indication.

Results

One hundred and thirty patients met inclusion criteria at the interim analysis. Overall, baseline characteristics were similar between groups. No statistical difference was detected regarding the rate of acute kidney injury between the vancomycin trough group and AUC group (12% vs 14% p=0.971). The mean total daily doses of vancomycin were 1642 mg per day in the AUC group and 1838 mg per day in the trough group (p=0.08).

Conclusion

No statistical difference in rates of AKI were detected at the interim analysis, likely due to small sample size. Further data collection is ongoing to meet power and full results will be presented.

Disclosures

All Authors: No reported disclosures.
942. Comparison of Antibiotic Susceptibility Across Minnesota Hospitals in 2019 and 2020 Using a New Statewide Antibiogram
Authors: Anderson Jadyn C , Hirsch Elizabeth B , Rivers Jennifer , Beaudoin Amanda , Spaulding Alicen B
Published: December 2022

Background

Surveillance is imperative to successful antibiotic stewardship, but active surveillance is resource-intensive. Regional antibiograms provide a supplementary method of surveillance while conserving resources. We developed the first statewide antibiograms to track susceptibility across the state of Minnesota and compared 2019 and 2020 data.

Methods

Hospital antibiograms for 2019 and 2020 were submitted to the Minnesota Department of Health in January 2022. Twelve organisms (Enterococcus faecalis, Enterococcus faecium, methicillin-resistant Staphylococcus aureus, methicillin-susceptible S. aureus, S. aureus, Acinetobacter spp., Enterobacter spp., Escherichia coli, Klebsiella aerogenes, K. oxytoca, K. pneumoniae, and Pseudomonas aeruginosa) were selected for analysis against 32 drugs, leading to a total of 142 unique organism/agent combinations. The number of isolates and percent susceptibility from each antibiogram were used to calculate a weighted average percent susceptibility as the state-level susceptibility. Chi-square analysis compared the proportion of susceptible to non-susceptible isolates between the years.

Results

Submitted antibiograms (n=40) represented 30% of Minnesota hospitals. The total number of isolates reported decreased by 5% from 2019 (n=85,010) to 2020 (n=80,781), with E. coli having the greatest proportion (2019=41.7%, 2020=39.5%) of the total isolates. Significant changes in susceptibility proportions occurred in 33% of analyzed organism/agent combinations, with 68% of these showing increased susceptibility in 2020 compared to 2019. All antibiotics tested against P. aeruginosa demonstrated a statistical increase in susceptibility from 2019 to 2020 (Figure 1). Figure 1

Statewide susceptibility profile of P. aeruginosa in Minnesota, 2019 and 2020. Antimicrobial agents grouped by class from narrow spectrum to broad spectrum, cephalosporins ordered by generation. *denotes statistical significance (p<0.05).

Conclusion

Analysis of statewide antibiograms for 2019 and 2020 demonstrated overall stability in antimicrobial susceptibility, with two-thirds of organism/agent combinations showing no significant changes. In those with significant changes, the majority exhibited an increase in susceptibility. Susceptibility changed more frequently in gram-negative organisms than gram-positive organisms. Ongoing collection of antibiograms will be used to assess regional and statewide susceptibility trends across Minnesota.

Disclosures

Elizabeth B. Hirsch, PharmD, FCCP, FIDSA, Melinta: Advisor/Consultant|MeMed: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support.
945. Development of Antimicrobial Stewardship Programs in Central and South America
Authors: Fabre Valeria , Cosgrove Sara E , Lessa Fernanda C , Patel Twisha S , Patel Payal K , Quiros Rodolfo E
Published: December 2022

Background

There is a need to assess current development of hospital Antimicrobial Stewardship Programs (ASPs) in Latin America.

Methods

Cross-sectional evaluation of ASPs using a standardized and previously validated self-assessment tool derived from the Centers for Disease Control and Prevention Core Elements of Antibiotic Stewardship (AS). The assessment was deployed to 40 hospitals in Panama, Guatemala, Ecuador, Colombia, and Argentina in 3/2022 through a regional research network. The assessment included 94 questions, with each question including a graded response (meets criteria, partially meets criteria, does not meet criteria, and in some, not applicable).

Results

22 public and 16 private hospitals completed the assessment (95% response rate), 10% and 25% of which were small hospitals (< 110 beds), respectively. 82% were academic, and all have an Infection Prevention and Control program/committee. >70% of ASPs have a physician and pharmacist involved, although 65% reported no salary support for AS activities. Only 13% and 29% of AS pharmacists and physicians, respectively, met recommended full-time equivalent/bed ratios; and 76% lacked information and technology (IT) support. 50% indicated the AS committee did not meet regularly, and another 50% reported not including non-AS physicians in the committee. Most hospitals have implemented prior-authorization and post-prescription review and feedback, with much fewer reporting a process to alert of duplicate therapy and use of auto-stops. 89% reported regular access to new antibiotics. While most hospitals monitor antibiotic consumption, few evaluate trends and/or appropriateness of use. Treatment guidelines for most common infections were missing in up to 50% of hospitals, especially in public hospitals. Most respondents indicated their hospitals promote teamwork, and in the vast majority, recommendations from AS are valued. Stratification of results by private and public hospitals in Table. Table:Results of a self-assessment of antimicrobial stewardship activities at the facility level in 38 hospitals in Latin America.

Conclusion

We found several opportunities for improvement, which differed between private and public hospitals. Common barriers to both settings include access to IT support; better pharmacist and physician resource allocation, education, and monitoring of process and outcomes measures.

Disclosures

Sara E. Cosgrove, MD, Basilea: Member of Infection Adjudication Committee.
952. Implementation of Antimicrobial Stewardship Weekend Coverage within a Community Hospital with a PGY2 Infectious Diseases Pharmacy Resident
Authors: Worden Lacy , Dumkow Lisa E , Ryan Tomlin C , Egwuatu Nnaemeka
Published: December 2022

Background

Antibiotic use contributes to antibiotic resistance affecting individual patients and communities. Important antimicrobial stewardship program (ASP) strategies, such as prospective audit and feedback, may be limited to peak weekday hours in many institutions. Currently, a lack of data exists to support expansion of ASP beyond peak hours in community hospitals. The goal of this study was to describe the impact of expanding inpatient ASP weekend coverage with a newly established PGY2 infectious diseases pharmacy resident program.

Methods

This retrospective cohort study was approved by the Institutional Review Board and conducted using the pharmacist documentation function within the electronic health record of weekend interventions taking place between July 1, 2021 and December 31, 2022. The primary objective was to describe the impact of expanding weekend AMS coverage with a PGY2 ID pharmacy resident through quantification of inpatient antimicrobial stewardship interventions. Secondary endpoints included comparing the PGY2 resident’s weekend stewardship activities based on intervention quantity, type, and impact, to weekends without PGY2 ID resident coverage. Comparator groups included: 1) A single experienced clinical pharmacist, 2) Two new PGY1 pharmacy residents (first 6 months of residency), and 3) Two experienced PGY1 pharmacy residents (final 6 months of residency).

Results

8 weekends of interventions were collected for each group. Significantly more interventions, including low-, medium-, and high-impact interventions were made by an ID-PGY2 pharmacy resident compared to a clinical pharmacist and both PGY1 groups. The median number of interventions made by each group are outlined in Table 1. Additionally, significantly more interventions were made per protocol as well as interventions that required communication with providers.

Conclusion

Expansion of ASP services to include weekend clinical coverage with an ID PGY2 pharmacy resident significantly increased weekend ASP interventions in a community teaching hospital. Specialty pharmacy residency training programs may offer a high-value opportunity to expand ASP coverage.

Disclosures

All Authors: No reported disclosures.