bluuebunny/crossref_metadata_2025 huggingface dataset:
P-1646. Assessing Antibiotic Adverse Drug Events from Walk-In Clinics at an Academic Healthcare System
Authors: Patel Nishant , Zou Michael , Staub Milner , Nardone Emily W , Thomas Retha B , Zuill Angela , Shackelford Claude E , Zhang Jim , Onguti Sharon
Published: January 2025

Background

Outpatient antibiotic adverse drug event (ADE) rates are largely unknown. This project aimed to evaluate methods for collecting data on antibiotic ADEs and report antibiotic ADE data from 8 walk-in clinics (WICs) at Vanderbilt University Medical Center (VUMC), which represents a high-volume antibiotic prescribing outpatient setting.

Methods

We attempted retrospective data collection of antibiotic ADE billing codes. After multiple trials, we recognized a need to understand how ADEs are documented (Tables 1 and 2) versus billed. To examine this, we conducted a retrospective chart review of patients prescribed antibiotics in selected WICs from 8/1/23 - 10/31/23 with WIC, primary care, or emergency department visits within 14 days after. We reviewed visit notes for antibiotic ADEs. If present, visit billing codes were collected and analyzed. To evaluate potential new antibiotic ADE data collection methods, especially ADEs reported via calls without a visit, we conducted prospective collection of antibiotic ADE calls or return visits within 14 days from patients prescribed antibiotics at selected WICs from 11/1/23-4/30/24 via voluntary REDCap survey reports by WIC providers. We used manual chart review to assess antibiotic appropriateness.

Results

From 8/1/23-10/31/23, we extracted 1059 unique visits with antibiotic prescriptions; 69 (6.5%) had antibiotic ADEs documented in subsequent visits. ADEs were secondary complaints in 30/69 (43.5%) visits. ADE billing codes were present in 17/69 (24.6%) visits (Figure 1).

From 11/1/2023-4/30/2024, 16,274 WIC visits had antibiotic prescriptions. Providers logged 45 calls and 3 return visits (48/16274, 0.3%); 6/48 (12.5%) antibiotics were unnecessary. When antibiotics were indicated, choice, dose, or duration was inappropriate in 13/42 (31.0%).Table 2:ICD-10 codes classified by organ system

Conclusion

This project showed outpatient antibiotic ADEs occur routinely. Utilizing voluntary reporting led to increased capture of antibiotic ADE patient calls but was not comprehensive. Additionally, ADE billing codes are currently underutilized, resulting in inaccurate estimates of antibiotic ADEs. Future studies are needed to determine an optimal approach to identify and extract antibiotic ADE data from electronic medical records.

Disclosures

Milner Staub, MD, MPH, Gilead: Stocks/Bonds (Public Company)|Johnson & Johnson: Stocks/Bonds (Public Company)
P-1648. Impact of Provider Education Versus Prospective Audit and Feedback on Outpatient Antibiotic Durations for Endodontic Infections at an Urban Veteran’s Affairs Medical Center
Authors: Kuhn Ryan , Dhar Sorabh , Natesan Suganthini Krishnan
Published: January 2025

Background

Despite evidence-based practice guidelines published by the American Dental Association, data indicates that antibiotic prescribing by dentists is often inappropriate. Optimal antimicrobial stewardship (AS) strategies to ensure appropriate antibiotic durations of therapy for endodontic infections are not well defined.

Methods

This single center, retrospective review evaluated the impact of provider education alone versus pharmacist-directed prospective audit and feedback (PAF) on outpatient antibiotic durations for endodontic infections. For the first phase of the intervention, staff dentists were educated regarding indications for antibiotic therapy and the recommended duration of therapy (3-7 days) for treatment of endodontic infections. For the second phase of the intervention, the Clinical Pharmacist used real-time electronic medical record alerts to perform PAF of antibiotic prescriptions for endodontic infections. The mean duration of antibiotic therapy and the number of antibiotic courses with a duration of 10 days or longer were collected. Data from the pre-intervention period (12/1/2018 to 11/31/2019), post-intervention period 1 (1/1/2022 to 12/31/2022) and post-intervention period 2 (4/1/2023 to 12/31/2023) were compared.

Results

Compared to the pre-intervention period, the mean duration of antibiotic therapy decreased from 7.8 days to 7.4 days and the number of treatment courses of 10 days or longer decreased by 40% (pre-intervention period, 22.5% [64/284]; post-intervention period 1,13.5% [52/384]; P =.003) in post-intervention period 1. Compared to post-intervention period 1, the mean duration of antibiotic therapy decreased from 7.4 days to 6.5 days and the number of treatment courses of 10 days or longer decreased by 84% (post-intervention period 1,13.5% [52/384]; post-intervention period 2, 2.2% [4/182]; P < .001) in post-intervention period 2.

Conclusion

While provider education and pharmacist-directed PAF were both effective strategies to decrease inappropriate antibiotic durations of therapy for endodontic infections, PAF was the optimal AS strategy in this setting. Clinical Pharmacists play an essential role in outpatient AS programs and should be engaged with dental clinics to help to improve antibiotic prescribing.

Disclosures

All Authors: No reported disclosures
P-1650. Clinical Outcomes among Patients Prescribed Suboptimal Antibiotic Therapy on Discharge to Nursing Homes
Authors: Short Emily K , Noble Brie , Crnich Christopher J , Chan Dominic , Hildebrand Andrea , Nguyen Thuan , Zhou Michelle H , Santos Evita T , Ham YoungYoon , Shephard Emily , McGregor Jessina C , Jolles Sally , McCracken Caitlin M , Bearden David T , Izumi Seiko , Furuno Jon P
Published: January 2025

Background

Little is known regarding outcomes for patients prescribed antibiotics on discharge from the hospital to nursing homes (NHs). We quantified the association between suboptimal antibiotic prescribing and clinical outcomes at discharge to NHs.

Methods

This was a multicenter, retrospective cohort study of adult (age >18 years) patients prescribed systemic antibiotics on discharge from 9 acute care hospitals in Oregon, Washington, and Wisconsin to a NH from 2016 – 2018. Study data were electronically extracted from hospital and NH electronic health records and supplemented with chart review. Suboptimal antibiotic therapy was determined by an infectious disease pharmacist or physician using clinical information (e.g., antibiotic regimen, indication, and culture results) available at discharge. Outcomes included emergency department (ED) visits, hospital readmissions, or Clostridioides difficile infection (CDI) within 30 days of hospital discharge. Comparison of outcomes between patients with suboptimal and non-suboptimal antibiotic therapy were tested by chi-squared tests.

Results

Among 280 included patients, mean (SD) age was 76.0 (11.5) years, 35.7% (n=100) were male, and median (IQR) inpatient length of stay was 6 (4-9) days. The most prevalent antibiotic indications were urinary tract infections (n =109, 38.9%), lung indications (n=60, 21.4%), and prophylaxis (n=29, 10.4%). Among 317 antibiotic prescriptions, the most frequently prescribed antibiotic classes were cephalosporins (n=83, 29.6%), fluoroquinolones (n=57, 20.4%), and beta-lactam/beta-lactamase-inhibitors (n=40, 14.3%). Fifty-eight patients (20.7%) were prescribed suboptimal antibiotic therapy on hospital discharge. There were no significant differences in the frequency of 30-day ED visits (14% vs 11%, p=0.76) or hospital readmission (19% vs 18%, p=0.94) between patients prescribed and not prescribed suboptimal antibiotics; however, suboptimal antibiotics were significantly associated with CDI within 30 days of discharge (10% vs 2%, p=0.01).

Conclusion

Suboptimal antibiotic prescribing on discharge to NHs was associated with increased risk of CDI within 30 days of discharge. This finding may inform interventions to improve antibiotic prescribing on discharge to NHs.

Disclosures

YoungYoon Ham, PharmD, Gilead: Honoraria Jon P. Furuno, PhD, Merck & Co., Inc: Grant/Research Support
P-1652. Geographical factors associated with antibiotic use for non-bacterial upper respiratory infections using nationwide Japanese data
Authors: Kitano Taito , Tsuzuki Shinya , Koizumi Ryuji , Aoyagi Kensuke , Asai Yusuke , Kusama Yoshiki , Ohmagari Norio
Published: January 2025

Background

The large number of antibiotic prescriptions for non-bacterial upper respiratory infections has been reported globally. The reduction of unnecessary antibiotic use for non-bacterial upper respiratory infections is critical. Elucidating geographical factors associated with antibiotic use for non-bacterial upper respiratory infections using nationwide data may guide national policy regarding antibiotic stewardship.

Methods

This study evaluated geographical factors regarding antibiotic use for patients with sole diagnosis of upper respiratory infections using health insurance claims data across all Japanese prefectures. A multivariable negative binomial regression analysis was implemented for the outcome of the defined daily doses per 1,000 habitants per day by prefecture with patient- and physician-level variables. Total and sub-class antibiotic use were analyzed.

Results

In 2019, 116,174,509 defined daily doses of antibiotic use for non-bacterial upper respiratory infections were included from all 47 prefectures. The annual number of diagnoses related with upper respiratory infections per 1,000 inhabitants per day (adjusted rate ratio [aRR] 1.001, [95% confidence interval 1.000-1.001], p=0.001) were significantly correlated with total antibiotic use. The mean age of physician (aRR 1.059 [1.009-1.113], p=0.019) for third generation cephalosporins and aRR 1.065 [1.011-1.122], p=0.016) for fluoroquinolones and the proportion of children age under 15 years (aRR 0.920 [0.876-0.966], p< 0.001) for third generation cephalosporins and aRR 0.926 [0.879-0.977], p=0.002 for fluoroquinolones) was also associated with the consumption of third generation cephalosporins and fluoroquinolones.

Conclusion

This ecological study demonstrated that the proportion of children and the mean age of physicians were associated with the use of third generation cephalosporins and quinolones for non-bacterial upper respiratory infections. The results may contribute to the further development of the national stewardship strategies to reduce unnecessary antibiotic use for upper respiratory infections.

Disclosures

All Authors: No reported disclosures
P-1667. Effect of Penicillin Allergy on Common Urinary Tract Pathogens within a Community Health-System Antibiogram
Authors: Weller Katherine , Bland Christopher M , Bradley Logan C , Smith Susan E , Jones Bruce M
Published: January 2025

Background

A penicillin allergy label promotes use of broad-spectrum and alternative antibiotics, which can cause an increase in resistance. Urinary tract infections are commonly encountered in health systems and few studies have shown how a documented penicillin allergy affects resistance on a yearly antibiogram for these isolates.

Urinary Antibiogram for Penicillin and Non-penicillin Allergic PatientsTable 1lists Gram negative isolates for penicillin and non-penicillin allergic patients and Table 2 lists the Gram positive isolates

Methods

This was a retrospective, observational chart review of patients admitted in 2022 within a two-hospital community health-system. Using a query language server and third-party software, patients with a first positive bacterial culture were compared with those with a penicillin allergy to create distinct antibiograms. Data collected included culture site and organism, antibiotic susceptibility, and presence of an infectious diseases (ID) consultation. The primary outcome was percentage of susceptible and non-susceptible isolates of E. coli, P. mirabilis, K. pneumoniae, P. aeruginosa, and E. faecalis in penicillin allergic and non-penicillin allergic patients. A secondary outcome was to determine if ID consultation was different between subgroups. Chi-squared and student's t-test were used for categorical and continuous variables, respectively.

Results

Of 3,757 patients meeting inclusion criteria, 12.8% (n=484) were penicillin allergic with results in Table 1&2. E. coli had a significantly lower susceptibility rate for ciprofloxacin (p < 0.001), levofloxacin (p < 0.001), and trim/sulfa (p=0.002) in penicillin allergic patients. P. mirabilis had a significantly lower susceptibility rate for cefepime (p=0.015), gentamicin (p=0.006), levofloxacin (p=0.025), ciprofloxacin (p=0.023), and pip/tazo (p=0.012). K. pneumoniae showed higher susceptibility rates for multiple antibiotics in the penicillin allergic group. P. aeruginosa and E. faecalis did not show any statistically significant differences. There was ID consultation on 137/484 (28.3%) of penicillin allergic patients and 899/3273 (27.5%) of non-penicillin allergic patients, which was not statistically different (p=0.7719).

Conclusion

Labeled penicillin allergic patients demonstrated increased resistance in E. coli and P. mirabilis, while K. pneumoniae had higher resistance rates in non-allergic patients. Both groups had similarly high rates of ID consultation.

Disclosures

Christopher M. Bland, PharmD, FCCP, FIDSA, BCPS, Merck: Honoraria|Nestle/Seres: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria Bruce M. Jones, Pharm.D., FIDSA, BCPS, AbbVie: Advisor/Consultant|AbbVie: Honoraria|Ferring: Honoraria|Innoviva: Honoraria|Paratek: Honoraria
P-1686. Appropriateness of Antibiotic Prescribing in Urgent Care Centers in Chicago, 2019-2022
Authors: Li Linda F , Cervantes Estrella , Walblay Kelly , Black Stephanie R , Kim Do Young
Published: January 2025

Background

Urgent care centers (UCC) face unique challenges such as high patient volume and turnover, contributing to increased overall antibiotic prescriptions and inappropriate prescribing. The Chicago Department of Public Health (CDPH) obtained the IQVIA Longitudinal Prescription and Medical Claims dataset to evaluate antibiotic prescribing trends between 2019-2022 in Chicago UCC, including appropriateness.

Methods

We analyzed IQVIA data from 2019-2022, restricted to encounters with Chicago UCC providers. Claims data were linked to prescription data using a unique patient identifier. Using previously published methodology, antibiotic appropriateness was assessed by assigning ICD-10 codes to three tiers: tier 1 conditions, for which antibiotics are almost always indicated; tier 2, antibiotics may be indicated; and tier 3, antibiotics are almost never indicated.

Results

There were 24,776 antibiotic prescriptions with matched diagnosis codes attributed to Chicago UCC providers between 2019-2022, representing 19,809 unique patients. Tier 3 conditions accounted for 44.6% of prescriptions, followed by tier 2 (37.0%) and tier 1 (18.4%) conditions . The most common tier 3 diagnosis codes were respiratory infections (43.2%), including viral upper respiratory infections (40.4%), bronchitis/bronchiolitis (11.9%), and other respiratory conditions (37.7%). Inappropriate prescribing was lowest in 2019 and highest in 2021, with 40.1% and 48.3% of prescriptions matched to a tier 3 condition, respectively. The three most frequently prescribed antibiotics following an encounter for a tier 3 condition were azithromycin (25.2%), amoxicillin (12.3%), and amoxicillin/clavulanate (11.4%). Nurse practitioners (29.1%) were the most frequent tier 3 prescribers followed by family medicine (25.4%) and internal medicine (24.0%) physicians.

Conclusion

Nearly half of antibiotics prescribed in Chicago UCC from 2019-2022 were associated with a condition where antibiotics are almost never indicated, and this trend increased during the COVID-19 pandemic. Antibiotic stewardship efforts should target unnecessary antibiotic treatment for respiratory infections, and stewardship education should prioritize nurse practitioners, and family medicine and internal medicine physicians.

Disclosures

All Authors: No reported disclosures
P-1726. Antibiotics Prescribing Practices for Skin and Soft Tissue Infections in an Urban Urgent Care Setting
Authors: Xie Chuman , Devlin Amanda , Koshy Sanjana , Eiting Erick , Hedvat Jason
Published: January 2025

Background

Skin and soft tissue infections (SSTIs) are amongst the most common bacterial infections in the ambulatory care setting. Initial antibiotic treatment should consider anticipated pathogens, severity, patient-specific considerations, and local antibiogram data. This study evaluated the alignment of antibiotic prescription practices for SSTIs with IDSA guidelines to identify opportunities to improve antibiotic prescribing at a single urgent care (UC) center.

Methods

This was a retrospective study conducted at the UC in an urban academic health system of adult patients with SSTI diagnosis receiving at least one antibiotic prescription from July 1, 2022, to August 31, 2023. The primary outcome was the proportion of patients with antibiotic prescriptions deviated from IDSA guidelines, considering individual patient factors and local antibiogram data. Secondary outcomes included evaluating the use of clindamycin when better alternatives were available, combination therapy when monotherapy would have been sufficient, deviations from guideline-recommended dosage regimen, and bug-drug mismatch rates. Descriptive statistics were used for outcome analysis.

Results

141 patients were included in the final analysis; 80 patients with purulent SSTIs and 61 patients with nonpurulent SSTIs. Incision and drainage occurred in 70% of patients with purulent SSTIs, but only 11% of patients had cultures obtained. The most common antibiotics prescribed were cephalexin (41%), trimethoprim-sulfamethoxazole (TMP/SMX) (40%), and doxycycline (20%) for purulent SSTIs, and cephalexin (56%) and TMP/SMX (25%) for nonpurulent SSTIs. 50% of patients received antibiotic prescriptions not aligned with guidelines, accounting for individual patient factors and local antibiogram data. 8% of patients were prescribed clindamycin when a better alternative existed. Combination antibiotic therapy was used in 12% of patients where monotherapy would suffice. 10% of patients with purulent SSTIs and 15% with nonpurulent SSTIs received antibiotics without a guideline-recommended dosage regimen.

Conclusion

This study demonstrated that there is room for improvement to align with IDSA guidelines at the UC. Additional provider education on appropriate antibiotic prescribing for SSTIs is warranted.

Disclosures

All Authors: No reported disclosures
P-1728. Let's Settle the "Score": Implementation of a Prioritization Tool into an Antimicrobial Stewardship Prospective Audit and Feedback Program
Authors: Cain Alexander R , Claeys Kimberly C , Dunning Megan , Heil Emily L , Noval Mandee , Lapin Jonathan S , Lee Sara , Tripathi Ravi , Bork Jacqueline T
Published: January 2025

Background

Prospective audit and feedback (PAF) remains the backbone of antimicrobial stewardship (AS) action. However, PAF is time consuming and does not always result in intervention. A prioritization scoring tool is a proposed solution to improve AS efficiency. We sought to assess the impact of a scoring tool (‘score’) on the efficiency of our AS program.Figure 1.Interrupted Time Series Analysis of Intervention Rate Pre-Post Score Implementation

Methods

A pre-post evaluation of AS PAF at an academic medical center was performed. The pre-score period (November 2022 – June 2023) consisted of standard PAF (largely 48-hour review). The post-score period (July 2023 – March 2024) included standard PAF in addition to the score. The scoring tool is embedded within the AS surveillance system in the electronic medical record and is used to readily identify patients with opportunities for antimicrobial optimization. It consists of pre-defined “points” for each programmed alert (e.g. bug-drug mismatch=10) which are reported in real-time as a prioritized list (higher score = higher priority). An interrupted time series was conducted to compare the intervention rate pre- and post-score implementation. A subgroup analysis was conducted on the post-score period comparing the reviews triggered by the score versus the 48-hour review. A univariate logistic regression was carried out to determine the association of the score with AS intervention.Table 1.Comparison of Score Interventions vs 48-hour Review during the Post-Period

Results

There were 5801 AS reviews in total, 2927 pre-score and 2874 post-score (92 missing outcome data). The mean intervention rate pre- and post-score was 46.2% and 52.3%, respectively (p< 0.001), with a +2.2% difference per month (p=0.036) as illustrated by Figure 1. The change was gradual without any significant, immediate level change. The score subgroup consisted of 312 reviews and were compared to 1180 48-hour reviews during the same period. Table 1 compares the two groups demonstrating overall high intervention rate in the score group (52.6% vs 40.9%, p < 0.0001); however, notable characteristics were different. An AS intervention was 1.6 times more likely when using the score approach (OR 1.6, 95% CI 1.3 – 2.0).

Conclusion

Implementation of an antimicrobial scoring tool may improve PAF efficiency by better predicting patients for antimicrobial optimization than standard 48-hour review. The scoring tool can be an impactful method when performing PAF.

Disclosures

Kimberly C. Claeys, PharmD, PhD, bioMérieux: Advisor/Consultant|bioMérieux: Honoraria
P-1756. Impact of order set implementation on appropriate treatment of community acquired pneumonia (CAP)
Authors: Pham Han , Stein Mitchell , Worden Lacy
Published: January 2025

Background

The overuse and misuse of antibiotics can lead to adverse events, antibiotic resistance, and increased healthcare costs. In 2022, Ascension Borgess Hospital implemented a community acquired pneumonia (CAP) order set to help guide appropriate antimicrobial prescribing.The orderset included guideline-concordant agents and durations of therapy for CAP as well as comments empowering pharmacists to adjust total duration of therapy to account for antimicrobial doses received in the emergency department. The purpose of this study is to evaluate appropriate antimicrobial prescribing after implementing a pneumonia order set.

Methods

This retrospective cohort study was conducted at a 450-bed community teaching hospital. The primary objective of this study was a composite outcome of appropriate empiric antimicrobial selection, dosing, and duration in accordance with the national guidelines. Secondary outcomes include length of hospital stay (LOS), readmission rates, mortality rates and Clostridium difficile infection rates. An exploratory outcome was pre-determined to evaluate pharmacists' intervention on duration of therapy, and utilization of the order-set to prescribe antibiotics. Patients were eligible for inclusion if they were 18 years or older and treated for CAP between 10/1/2021 and 8/1/2023

Results

A total of 236 patients were included (118 patients per group). Significantly more patients in the post-implementation group received guideline-concordant therapy for CAP (5.9% vs 35.6%, p< 0.001). Results were heavily influenced by improvements in appropriate durations of therapy (pre- 6.8% vs post 39.9%, p< 0.001). There were no significant differences observed for LOS, 30 day readmission rates, C. difficile infections within 30 days, or mortality rates between groups. For exploratory endpoints, the orderset was utilized in 66.1% of patients included in the post-implementation group. Additionally, pharmacists were more likely to intervene following implementation of the orderset (22.9% v 43.2%, p < 0.001), as a result of order comments and increased awareness.

Conclusion

Implementing a guideline concordant orderset significantly improved inpatient antibiotic prescribing for CAP with no difference in clinical or safety outcomes.

Disclosures

All Authors: No reported disclosures
627. Outcomes of Military Blood Donors Screening Positive for Trypanosoma cruzi
Authors: Wells Michael , Casleton Brian , Rivera Glorimar , Phelps Megan , Casey Theresa , Osuna Angela , Gella Melita , Jung Ga O , Winkler Erin , Yun Heather , Marcus Joseph
Published: January 2025

Background

First time blood donors at the Armed Service Blood Bank-San Antonio are screened for Trypanosoma cruzi infection with a chemiluminescent microparticle immunoassay (CMIA) followed by a confirmatory enzyme strip assay (ESA). In military populations, T. cruzi positivity on a screening test accounts for the fourth most common reason for post-donation deferral. With concerns for low positive predictive value in a low prevalence disease, this study evaluated the clinical outcomes and diagnostic work-up of blood donors who screened positive on T. cruzi CMIA testing.Table 1:Workup of 49 blood donors who screened positive for Trypanosoma cruzi infection

Methods

All blood donors from 2017-2022 were screened for T. cruzi antibodies with CMIA and deferred indefinitely if screening was positive, regardless of ESA result. All donors that initially screened positive for T. cruzi infection were evaluated to determine diagnostic work-up, further testing, specialty appointments seen, and final diagnosis of each case following their initial positive blood donation screen.Table 2:Clinical outcomes of 4 blood donors with positive T. cruzi screening test and confirmatory test

Results

Of 89,459 blood donors during the study period, 49 (57.3 per 100k donors) screened positive for Chagas disease on initial blood donation. Of those individuals, 4 (8%) had positive, 18 (36%) had indeterminate, and 30 (61%) had negative confirmatory tests. The evaluation varied significantly depending on the results of ESA testing, however there were no blood donors who met criteria for Chagas disease (Table 1). Evaluation of four donors with positive CMIA and ESA showed only one with repeat positivity on one assay, but all were ultimately deemed negative (Table 2).

Conclusion

While positive T. cruzi antibodies were a common reason for post-donation deferral in this cohort, there were no confirmed cases of Chagas disease, despite most patients receiving an extensive work-up. Patients with positive or indeterminate ESA received more specialty care and more confirmatory testing than those with a negative confirmatory test. This study demonstrates the need for higher specificity screening and confirmatory tests for T. cruzi in blood donors in low prevalence settings.

Disclosures

All Authors: No reported disclosures
P-1757. Standardizing the Penicillin Allergy Documentation Program and Optimizing the Use of Beta Lactam Antibiotics In a Tertiary Care Hospital
Authors: Kuriakose Linta Susan
Published: January 2025

Background

The adoption of standardized penicillin allergy assessment protocols and the optimization of beta-lactam antibiotic usage have been advocated by international guidelines on Antibiotic Stewardship Programs (ASPs). However, the precise effects of conducting these assessments on allergy documentation and antibiotic prescription practices remain inadequately characterized.

Methods

A retrospective quasi-experimental study was devised to assess the repercussions of implementing a standardized penicillin allergy assessment initiative led by the Antimicrobial Stewardship Team, comprising Infectious Disease (ID) Physicians, clinical pharmacists, and nurses. Commencing January 2022, nursing personnel conducted comprehensive evaluations of hospitalized patients with documented penicillin allergies, with subsequent review by clinical pharmacists. The pre-intervention phase encompassed randomly selected adult patients with reported penicillin allergies admitted between January 2019 and December 2021. The principal study endpoint was the accurate delineation of penicillin allergies in the electronic health record (EHR), encompassing clarification of allergic reactions and removal of erroneously labelled allergies. Secondary endpoint was beta-lactam antibiotic utilization within 90 days of hospitalization.

Results

A total of 360 patients were enrolled, comprising 140 during the intervention phase and 220 during the pre-intervention phase. The proportion of patients with updated allergy information surged from 22% to 53% post-implementation of the program (P < 0.0001), with inappropriate allergy designations rectified in 18 (5%) patients. Notably, the program's implementation did not alter the proportion of patients receiving beta-lactam antibiotics (22% vs. 25%; P = 0.51).

Conclusion

The adoption of a standardized penicillin allergy assessment initiative exerted a significant influence on allergy documentation within the EHR, without imposing excessive burdens on clinical team. This initiative facilitated the updating of allergy information for the majority of patients and rectified inaccurately labelled penicillin allergies.

Disclosures

All Authors: No reported disclosures
P-1762. Assessing the Clinical Impact of Carbapenem Pre-authorization in a High ESBL Prevalence Setting: A Focus on the Middle East
Authors: Nuaman Amna , El Lababidi Rania M , El Nekidy Wasim S , Abidi Emna
Published: January 2025

Background

Hospitals commonly employ preauthorization as a strategy to optimize carbapenems utilization. However, there is paucity of data regarding carbapenem restriction in environments with a high prevalence of extended-spectrum beta-lactamase (ESBL) organisms. This study aims to assess the impact of implementing a preauthorization policy for carbapenems on patient clinical outcomes and appropriateness of use.

Methods

An observational retrospective cohort study comparing data collected for patients from pre-restriction period between December 2021 and May 2022, and post-restriction period between June 2022 and December 2023 who were prescribed carbapenems including ertapenem or meropenem. The restriction policy was implemented in June 2022. We included adult patients ( > 18 years old) with active infections in acute care units (ACU).

Results

A total of 244 patient were included in the study with 131 in pre implementation period and 113 in post implementation period. The appropriate indication of carbapenems use was significantly higher in the post-restriction group 69.9% (79) vs the pre-restriction group 55.7% (73) (P=0.025). No significant difference was found between the two groups in terms of appropriateness of treatment duration (P=0.425). Antibiotic de-escalation was significantly higher in the pre-restriction group 60.3% (79) vs the post-restriction group 35.4% (40) (P< 0.001). The 30-day all cause mortality was significantly lower in the post-restriction group 7.1% (8) vs the pre-restriction group 19.8% (26) (P=0.005). Length of hospital stay (LOS) was significantly lower in the post-restriction group compared to the pre-restriction group; 6 vs 9 days (P=0.002). Furthermore, the 30-day readmission rate was 32.1% (42) of patients in the pre-restriction group vs 20.4% (23) in the post-restriction group (P=0.043).

Table 2

Conclusion

Despite ESBL high prevalence, preauthorization policy for carbapenems prescription showed efficacy to optimize their use in terms of, both, appropriateness, and duration. Lower 30-day mortality, LOS and readmissions within ACU patients also confirmed better clinical outcomes. Larger studies are needed to corroborate these findings.

Disclosures

All Authors: No reported disclosures
P-1767. Understanding Antibiotic Prescribing Practices by utilizing WHO's AWaRe Criteria in a tertiary care hospital in South India: A Prospective Observational study
Authors: Dorairajan Suresh Kumar , Roshni M , Hassan Suhail , Dharan Rithik , Narayanan Sathya , Angel jenifer F
Published: January 2025

Background

Antibiotic resistance is a significant threat globally and the inappropriate use of antibiotics leads to subsequent rise in the antimicrobial resistance causing challenge in antimicrobial stewardship programs [AMS]. Assessment of Antimicrobial use by using World health organization [WHO] categorization of Antibiotics into ACCESS, WATCH, RESERVE [AWaRe].

Methods

The prospective Observational study was conducted in a tertiary care hospital in the period of one month APRIL [01.04.24 -30.04.24] using a tool containing patient’s demographic data, AWaRe classification, their indications, culture reports and prescribing practices in hospitalized patients

Results

out of 1236 hospitalized patients 246 patient receive antibiotics. The results of the collected data in the following table

ANTIBIOTIC CATEGORY- ACCESS – (33.3%)WATCH – (63.4 %)RESERVE – (3.25%)DoxycyclineMetronidazole6.9%2.1%CeftriaxoneCefuroximePiperacillin - TazobactumCefoperazone – SulbactumMeropenem28.1%24.8%22.4%13.8%7.3%FosfomycinTigecyclineLinezolid0.81%0.4%0.4%ID REFERENCEYes26.3%No74.6%INDICATIONSEmpirical30.5%Definitive16.3%Prophylaxis48.9%Empirical to Definitive6

Conclusion

The data indicates a predominance use of antibiotics in the "Watch" category, with Ceftriaxone (28.1%), Cefuroxime (24.8%), and Piperacillin-Tazobactam (22.4%) being the most commonly used antibiotics and most of the antibiotics are given Empirically (30.5%) . A quarter of antibiotics are referenced in Infectious Disease. This highlights the importance of careful antibiotic stewardship to combat antimicrobial resistance and ensure effective treatment.

Disclosures

All Authors: No reported disclosures
P-1769. Improving Surgical Prophylaxis for Patients with Penicillin Allergy Label
Authors: Sharara Sima L , Dzintars Kate , Klein Eili , Fabre Valeria , Cosgrove Sara E
Published: January 2025

Background

Patients with a penicillin allergy label (PAL) have an increased risk of surgical site infection when receiving a β-lactam alternative for surgical prophylaxis. The updated 2022 Drug Allergy Parameters support the use of cefazolin for patients with a penicillin allergy history including anaphylaxis. We evaluated antibiotic use for surgical prophylaxis in a large academic center.

Methods

We performed a quality improvement intervention to decrease inappropriate use of non-β-lactam antibiotic surgical prophylaxis in patients with PAL at a 1091-bed tertiary hospital. Beginning in 10/2018, we provided education at anesthesia grand rounds and surgical safety meetings regarding preferential use of cefazolin in patients without severe PAL. In 12/2023, we updated institutional guidelines to recommend cefazolin use in all patients except those with history of anaphylaxis to cephalosporins, isolated hives to cefazolin, and β-lactam-associated severe cutaneous drug reactions. This was communicated to anesthesia and surgery stakeholders. Peri-operative antibiotic prophylaxis alert cards were hung in the operating rooms (Figure 1) and clindamycin and gentamicin were removed from OR medication-dispensing machines (ORMD).

Results

There was a significant decrease in clindamycin use from 11.2% in the pre-education period to 6.2% after education, further reduced to 1.7% since updating institutional guidelines and removing clindamycin and gentamicin from ORMD. Concurrently, cefazolin use increased from 9.0% to 26.0% to 39.5% in the same periods (Figure 2). This was seen across surgical services (Figure 3). Decreases were also seen in gentamicin use. There was no significant change IV vancomycin use as an alternative for patient with PAL. There was no increase in episodes of perioperative anaphylaxis related to these interventions.

Conclusion

There remains significant opportunity to optimize surgical prophylaxis for patients with PAL. QI efforts such as acquiring stakeholder support and development and dissemination of teaching materials were effective in reducing suboptimal perioperative antibiotic prophylaxis. Informative posters at point of care and removal of clindamycin and gentamicin from OMRD further reduced inappropriate surgical prophylaxis in patients with PAL.

Disclosures

All Authors: No reported disclosures
P-1770. Antimicrobial Stewardship: Usage of AWaRe Classification for justification of antibiotic therapy in a tertiary care hospital in South India
Authors: Hassan Suhail , Roshni M , Dharan Rithik , Narayanan Sathya
Published: January 2025

Background

Antibiotic resistance, a consequence of the overuse and inappropriate use of antibiotics, poses a significant global health threat, endangering our ability to effectively treat bacterial infection. Utilizing the WHO,s categorization of antibiotics into Access, Watch, and Reserve (AWaRe) for justification provides a structured approach for assessing antimicrobial use, thereby facilitating the identification of areas for improvement and the implementation of effective antimicrobial stewardship programs (AMS).

Methods

This Prospective Observational study was conducted in a Tertiary care hospital in South India in the month of APRIL 2024 using a tool containing patient’s demographic data, drug chart , indications, culture reports and justification column.

Results

Out of 1046 patients 246 patient were receiving antibiotics in which the study revealed that a majority of antibiotics fell into the WATCH (63.4%), followed by ACCESS (33.3%) and RESERVE (3.25%) categories. Among the antibiotics prescribed, Ceftriaxone (28.1%), Cefuroxime (24.8%) and Piperacillin-Tazobactam (22.4%) were most frequently used. Conversely, Fosfomycin, Tigecycline, and Linezolid were prescribed less frequently, each constituting less than 1% of prescriptions. Analysis showed that 164 patients (66.6%) received antibiotics without justification, while 84 patients (33.4%) received justified therapy. Regarding patient referral, 26.3% were referred with an ID reference, while the majority (74.6%) were not. Indications for antibiotic use varied, with empirical treatment being the most common (30.5%), followed by prophylaxis (48.9%), and definitive treatment (16.3%). A smaller percentage of cases transitioned from empirical to definitive treatment (6.2%).

Conclusion

In summary, the majority of prescriptions fell under the WATCH category (63.4%), with common antibiotics like Ceftriaxone and Cefuroxime being frequently prescribed. A significant portion (66.6%) of prescriptions lacked justification, highlighting the need for improved antimicrobial stewardship. The low rate of infectious disease referrals suggests potential gaps in consultation. Targeted interventions are necessary to rationalize prescribing practices and address the threat of antimicrobial resistance.

Disclosures

All Authors: No reported disclosures
630. Sustained reduction of meropenem use in a tertiary-care pediatric service in Medellín, Colombia
Authors: Diaz Diaz Alejandro , Echavarria-Gil Adriana M , Jimenez Carolina , Gonzalo Mesa-Monsalve Juan
Published: January 2025

Background

Carbapenems are the widest spectrum antibiotics, categorized as a Watch group in the AWaRe classification tool by the World Health Organization, which recommends limiting its use only to certain specific infections. In settings where circulation of multidrug resistant Gram-negative organisms is common, overuse of carbapenems might occur which leads to additional costs and harm. Antibiotic stewardship programs (ASP) have demonstrated impact on antibiotic use in the hospital setting. We describe the impact of the ASP in meropenem use in children at a large public hospital.

P: period; DOT: days of therapy

Methods

Single-center (largest regional public hospital: 450-bed (110 pediatric (55 NICU + neonatal ward – 55 PICU + pediatric ward), retrospective observational study. ASP was established in late 2014. Initial strategies included weekly hand-shake antibiotic rounds led by a pediatric infectious disease physician. Multimodal ASP was implemented hospital-wide in 2016. During 2017 to 2019 a surge in resistant Enterobacter spp invasive infections occured in the NICU, which affected antibiotic treatment temporarily. Hence, we divided Observation period from 2015 – 2023 in four periods (P): P1 2015-2017: ASP establishment; P2 2017-2019: increase in invasive infections caused by Enterobacter spp resistant to cephalosporins; P3 2020: COVID-19 pandemic; P4 2021-2023: post-pandemic (figure 1). Meropenem consumption was measured with days of therapy (DOT). We used descriptive statistics for analysis.

Results

Meropenem use increased significantly during P1 (DOT 9.05 [5.8-16] and P2 (DOT 19.5 [15.2-24.3]; p< 0.01). Reinforcement of infection control measures and updated antibiotic guidelines with restricted meropenem indications with pre-authorization by the ID team led to sustained decrease of meropenem use after P2. This trend was not affected by COVID-19 pandemic (P3 DOT 10.7 [6.8-12-8] and P4 DOT 1.1 [0-3]; p ≤ 0.01). The number of highly resistant Enterobacter isolates also decreased over time while ESBL rates remained unchanged (Figure 2 & 3).

ESBL: Extended spectrum beta-lactamase

Conclusion

ASP and infection control policies led to a significant and sustained decrease in meropenem use in our pediatric service. Leadership, administrative support, teamwork, and continued education are important to achieve goals in antibiotic consumption.

Disclosures

All Authors: No reported disclosures
P-1794. Evaluating the Impact of a Pharmacy Technician in an Antimicrobial Stewardship Program
Authors: Onsrud Jennifer , Hammer Katie Lynn , Kelly Susan , Davidson Lisa , Pasquale Tim , Bear Susan
Published: January 2025

Background

The use of a Certified Pharmacy Technician (CPhT) in clinical roles can optimize and expand pharmacy services. Across our integrated health care system, ceftriaxone is the most utilized inpatient antibiotic. Traditional antibiotic stewardship program (ASP) pharmacists focus on more broad-spectrum agents. To increase review of ceftriaxone, we implemented a novel ASP workflow with a CPhT conducting prospective audit of ceftriaxone.

Methods

The CPhT underwent training for ceftriaxone audits, documentation, and communication. Daily chart audits of ceftriaxone were completed with a clinical checklist (Figure 1) and eligible patients were sent to an ASP pharmacist who completed prospective audit and feedback. The primary outcome measure was inpatient administrations of ceftriaxone in days of therapy per 1,000 patient days present (DOT). The secondary outcomes were monthly CPhT audits, audits sent to a pharmacist, related interventions, and total interventions.

Figure 2

Results

The primary outcome is seen in Figure 2. Although not statistically significant, prior to intervention ceftriaxone use was rising and after intervention, rate of utilization stabilized. Secondary outcomes of monthly CPhT audits, audits sent to a pharmacist, and related interventions can be seen in Figure 3. The monthly average of 452 CPhT audits sent to a pharmacist resulted in 185 related interventions Total interventions in the ASP program during this one-year timeframe were 25,704, which is an 45% increase from the year prior. Using a conservative assumption of 5 mins of pharmacist time avoided per audit by using a CPhT, 62 hours of pharmacist time was saved each month.

Figure 3

Conclusion

Inclusion of a CPhT into a clinical role in ASP resulted in an increase in prospective audit and feedback of ceftriaxone and total interventions. The use of a CPhT optimized workflow and promoted stewardship of resources. In our experience, a CPhT can be a valuable member of an ASP team and may represent a new clinical role for further consideration. Further evaluation will focus on how this role can be expanded to further optimize stewardship metrics.

Figure 4

Disclosures

All Authors: No reported disclosures
P-1795. Antimicrobial Stewardship Knowledge, Attitudes, and Practices (KAP) Among Health Care Providers in a Community Hospital Network
Authors: Bouchard Jeannette , Dyer April , Johnson Melissa D , Davis Angelina , Anderson Deverick J , Ashley Elizabeth Dodds
Published: January 2025

Background

Drivers of inappropriate antimicrobial use (AU) and antimicrobial resistance (AMR) can be linked to deficiencies in prescribers’ knowledge, attitude, and practice (KAP) regarding antibiotics. Currently, KAP information in community hospitals throughout the United States (US) is not well known, and survey information is not standardized. Understanding clinicians’ KAP regarding AU and AMR may provide valuable information for improving antimicrobial stewardship (AS) efforts.Figure 1

Methods

Prescribers, pharmacists, nurses, and administrators at 40 community hospitals within the Duke Antimicrobial Stewardship Outreach Network (DASON) were invited to take an anonymous, voluntary, 41-question web-based IRB-approved AS KAP survey. This survey is an internationally validated tool translated for use in the US (www.oucru.org/wp-content/uploads/2023/10/KAP_tool.pdf). Responses were collected via REDCap from Feb – Apr 2024.Figure 2

Results

A total of 167 survey responses were received from 24 hospitals; 77 (46%) were pharmacists, 62 (37%) were nurses, and 16 (10%) were physicians. Respondents had a median of 15 years (15.3) of experience in their current healthcare profession and 8.5 years (14.3) in their current institution. Most respondents were familiar with AS (74.3%), strongly agree that antimicrobial overuse can cause harm (79.6%), and that appropriate antibiotic use can reduce AMR (74.3%) (Fig 1). More than half of the respondents who prescribe antibiotics agreed that education and feedback via peer comparison or direct feedback would improve their prescribing (Fig 2). Prescribing respondents also agreed that AS teams impact their antibiotic decisions (87.5%). 63% of prescribers and 46% of non-prescribers agreed antibiotics are overused at their institution. Providers were the most likely to agree AMR is a problem at their institutions (Fig 3).Figure 3

Conclusion

Healthcare workers within DASON were aware of the importance of AS and its effect on AMR and patient outcomes. Prescriber feedback was seen as a valuable educational tool, as most prescribers valued AS feedback and agreed feedback would improve antibiotic selection.

Disclosures

Melissa D. Johnson, PharmD MHS AAHIVP, Biomeme: Licensed Technology|Scynexis, Inc: Grant/Research Support|UpToDate: Author Royalties Elizabeth Dodds Ashley, PharmD, MHS, HealthtrackRx: Advisor/Consultant|UpToDate: Royalties