bluuebunny/crossref_metadata_2025 huggingface dataset:
P-1609. Provider and Nursing Perspectives on "Panculture": Opportunities for Innovative Diagnostic Stewardship Interventions
Authors: Gibas Kevin , Mermel Leonard
Published: January 2025

Background

Overutilization of diagnostic tests results in inappropriate antibiotic use, increased hospital length of stay, higher healthcare costs, overdiagnosis of healthcare-associated infections, and antimicrobial resistance.

Table 1

Participant Characteristics

Methods

From January 3 – February 26, 2024, we conducted two prospective surveys focused on the evaluation of febrile inpatients at Rhode Island Hospital. One survey was of medical providers trained in internal medicine, surgery, pediatrics, emergency medicine, and neurology and the other was of nursing staff in inpatient areas and the emergency department (ED).

Results

70 providers (9%) and 178 nursing staff (12%) completed their respective surveys. When asked about evaluating febrile inpatients, 64% of providers (n=43) reported “always” or “often” ordering full fever workups or ‘panculturing’ and 67% of providers (n=47) reported “always” or “often” physically evaluating febrile patients at the bedside (Table 2). In contrast, only 45% of nursing staff (n=80) reported that providers “always” or “often” evaluate febrile patients in person. 76% of nursing staff (n=135) responded providers “always” or “often” order full fever workups. When asked about hand-off practices for febrile patients, 71% of providers (n=50) reported “always” or “often” receiving written hand-offs. 86% of providers (n=60) reported the hand-offs are “always” or “often” accurate; however, only 17% of providers responded these were “always” accurate. 77% of providers (n=54) reported “always” or “often” following hand-off instructions to obtain a full fever workup if a patient becomes febrile, regardless of a patient’s clinical status. Responses differed significantly by nursing unit type (Table 3) and by provider specialty and position (Tables 3 & 4).

Table 3

Nursing Staff Responses by Unit Type

Conclusion

This study elucidates drivers of inefficient and excessive utilization of diagnostic studies at RIH and identifies potential targets for diagnostic stewardship interventions.

Table 4

Provider Responses by Specialty and Position

Disclosures

Leonard Mermel, DO, ScM, Citius Pharmaceuticals: Advisor/Consultant|CorMedix Pharma: Advisor/Consultant|Destiny Pharma: Advisor/Consultant|Lightline Medical: Advisor/Consultant|Lightline Medical: Stocks/Bonds (Private Company)|Pristine Access Technologies: Advisor/Consultant|Pristine Access Technologies: Stocks/Bonds (Private Company)
583. Increasing Diversity, Equity, and Inclusion in the Antimicrobial Stewardship Workforce through the SIDP Certificate Program
Authors: Eudaley Sarah , Johnson Melissa D , Jeffres Meghan N , Lawrence Kenneth , Bergman Scott J , Elizabeth Hermsen D , Zembles Tracy N
Published: January 2025

Background

A diverse workforce provides opportunities for patients to be served by healthcare practitioners sharing a common race, ethnicity, culture, language, or disability. The Society of Infectious Disease Pharmacists (SIDP) aims to increase engagement in an Antimicrobial Stewardship Certificate Program (ASCP) among clinicians identifying with underrepresented minoritized (URM) groups to increase workforce diversity, equity and inclusion; reduce antimicrobial resistance; and improve outcomes.

Methods

SIDP updated and redesigned its long-standing ASCP in May 2023. Healthcare professionals identifying as URM were invited to apply for a scholarship to complete the ASCP, with planned enrollment of 130 participants over 3 years. Baseline data collection included demographics, motivation for training, anticipated challenges in completing the ASCP, and confidence in stewardship activities (Likert scale 1-5, with 5 as the highest level). Demographic data prior to May 2023 was not available.

Results

To date, 97 individuals received a scholarship and were enrolled. Most were pharmacists (65%), with allied health professionals comprising the remainder. Participants most commonly identified as Black or African American (29%), Hispanic or Latin descent (21%), and Asian (18%) (Table 1). Considering non-scholarship enrollments (among those reporting race/ethnicity) over the same time-period (n=385), the scholarship increased the proportion of total participants in the program identifying as Black or African American (11% v 6%), Hispanic or Latin descent (9% v 6%), and Middle East or North African (2% v 0%). Among scholarship recipients who started the program and received an entrance survey (n=45), 80% (n=36) responded. The most anticipated challenge for successfully completing the program was knowledge to design a quality improvement project (Figure1). Respondents reported the least confidence in ability to establish an antimicrobial stewardship program (Figure 2).

Conclusion

The scholarship program has increased the proportion of URM clinicians in the ASCP, resulting in a potentially more diverse workforce. Identifying and mitigating barriers to completion and assessing participant confidence in stewardship activities will inform additional program development.

Disclosures

Melissa D. Johnson, PharmD MHS AAHIVP, Biomeme: Licensed Technology|Scynexis, Inc: Grant/Research Support|UpToDate: Author Royalties Kenneth Lawrence, BS, PharmD, Seres Therapeutics: Employee Hermsen D. Elizabeth, PharmD, MBA, Pfizer, Inc.: Employee|Pfizer, Inc.: Stocks/Bonds (Public Company)
P-1628. Impact of the BioFire® FilmArray® BCID2 Panel and Antimicrobial Stewardship on Clinical Outcomes in Patients with Antimicrobial Resistant Bacteremia
Authors: Li Yihan , Dubrovskaya Yanina , Siegfried Justin , Decano Arnold , Mazo Dana , Zacharioudakis Ioannis , Marsh Kassandra
Published: January 2025

Background

Bloodstream infections (BSIs) carry high rates of morbidity and mortality, with delays in appropriate therapy associated with worse outcomes. Given limited available literature, our objective was to describe the impact of BioFire® FilmArray® Blood Culture Identification 2 (BCID2) panel implementation on clinical outcomes in patients with organisms not covered by empiric regimens.

Methods

This was a retrospective review comparing adults with extended-spectrum β-lactamase (ESBL), carbapenemase (CRE), or AmpC-producing Enterobacterales, Acinetobacter baumannii, Stenotrophomonas maltophilia, or Enterococcus species BSIs pre- (7/2020–12/2021) and post- (7/2022–12/2023) BCID2 implementation. Patients were excluded if the initial positive blood culture (BCX) was from an outside facility, had organisms not on the BCID2 panel, or if they died or were discharged prior to BCX results. The primary outcome was time from BCX positivity to initiation of effective therapy. Process measures included pharmacist interventions. Clinical outcomes included recurrence, resistance development, readmission, Clostridioides difficile infection, and mortality.

Results

319 patients were included (pre-BCID2 n=128; post-BCID2 n=191), with a median age of 69 years (57-81). The most common infecting organisms were Enterococcus spp. (44%) and ESBL Enterobacterales (41%), and the majority were from urinary (35%) or intra-abdominal (28%) sources. Time to effective therapy was significantly shorter post-BCID2 (7 v. 4 hours, p=0.011), particularly among those with ESBL (40 v. 5 hours, p< 0.001), high-risk AmpC-producing organism (41 v. 6 hours, p=0.174), and E. faecium infections (17 v. 5 hours, p=0.067). Antimicrobial stewardship pharmacists performed more interventions post-BCID2 (34% v. 49%, p=0.006) with a higher number of interventions performed pre-MALDI-TOF speciation (22% v. 39%, p=0.002). Given low event rates, we were unable to demonstrate clinically meaningful differences in secondary endpoints between groups.Figure 1.Primary Outcome: Time to Effective Therapy

Conclusion

Implementation of BCID2 in conjunction with antimicrobial stewardship was associated with shorter time to effective therapy. Further studies are needed to understand the impact of this on patient-related outcomes.

Disclosures

All Authors: No reported disclosures
P-1655. Impact of an Educational Leaflet on Urinary Tract Infections, Asymptomatic Bacteriuria, and Antibiotics for Adults ≥65 years
Authors: Thorpe Alistair , Lee Rachael A , Szymczak Julia E , Farrell Madeline C , Fong Karen , Muller Brandi M , White Andrea T , Fagerlin Angela , Vaughn Valerie
Published: January 2025

Background

Adults ≥65yrs are at high risk of harm from antibiotic overuse due to misdiagnosis of asymptomatic bacteriuria (ASB) as urinary tract infection (UTI). Alongside strategies to improve clinician prescribing, patients should be educated on ASB and empowered to discuss harms and benefits of antibiotic treatment. Previously, we used a user-centered design process to develop a patient-focused educational leaflet on UTI, ASB, and antibiotic use (Figure 1). Here, we tested whether the leaflet improved patients’ knowledge about ASB and willingness to avoid unnecessary antibiotics.Figure 1.A three-page antibiotic education designed with patients, caregivers, and clinicians.

Methods

In an online survey experiment of US adults ≥65yrs, respondents read a scenario of themselves as an asymptomatic patient with a positive urine test during prescreening for non-urologic surgery. Respondents were randomized to one of four experimental conditions which varied educational leaflet provision and the surgeons’ treatment recommendation (Figure 2). Outcome measures included whether respondents thought they (as the patient described in the case) had a UTI, how comfortable they would be not taking antibiotics, and their knowledge about UTIs, ASB, and antibiotics

Results

Figure 2 shows characteristics of the 504 study respondents [completion=89%].

Compared to those not provided the educational leaflet, respondents shown the educational leaflet were less likely to believe they had UTI (p< .001), were more comfortable not taking antibiotics (p< .001), and answered more knowledge questions correctly (p< .001) (Figures 3&4).

Conversely, respondents who were told the surgeon recommends antibiotics were more likely to believe they had UTI (p< .001) and less comfortable with not taking antibiotics (p=.013) but did not differ in their knowledge (p=.096).

Conclusion

A patient-centered educational leaflet, designed with patients, caregivers, and clinicians, was effective in aligning antibiotic treatment preferences with clinical guidelines and improving knowledge about UTI, ASB, and antibiotics. Findings offer important preliminary evidence on the potential for patient/caregiver-focused education to help prepare patients/caregivers to engage in treatment decisions and contribute to reducing antibiotic overuse and its associated harms.

Disclosures

All Authors: No reported disclosures
P-1661. Characteristics and Outcomes Associated with Treatment of Asymptomatic Bacteriuria Among Patients with Neurogenic Bladder in a Statewide Hospital Database
Authors: Amenta Eva , Trautner Barbara , Horowitz Jennifer , McLaughlin Elizabeth , Czilok Tawny , Bernstein Steven J , Nielsen Daniel , Ratz David , Gupta Ashwin , Malani Anurag , Gandhi Tejal N , Petty Lindsay A , Flanders Scott A , Vaughn Valerie
Published: January 2025

Background

Inappropriate treatment of asymptomatic bacteriuria (ASB) among hospitalized patients leads to longer length of stay (LOS) without improving outcomes. ASB is common in individuals with neurogenic bladder (NB); however, little is known about the epidemiology, treatment, and outcomes of inpatients with NB and ASB.

Methods

Between 1/1/2017-12/31/2023, abstractors collected deidentified data—including signs/symptoms of urinary tract infections (UTI) and 30-day outcomes—from inpatients with a positive urine culture (UC) at 46 hospitals. Due to poor documentation of NB, we defined NB using surrogates (Table 1). Patients without signs or symptoms of UTI were classified as ASB. Characteristics of patients a) with vs. without NB and b) with NB and ASB who were treated vs. untreated were compared using t or chi-squared tests. Finally, we compared 30-day outcomes of patients with NB and ASB treated vs. untreated using general estimating equation models adjusting for variables known to be associated with the outcomes via inverse probability of treatment weighting.

Results

Of 45,800 inpatients with a positive UC, 6% (2,769) had NB (Table 2). Compared to patients without NB, patients with NB were more often male (59% vs. 29% p< 0.001), younger (median age 69 vs. 76 p< 0.001), less likely to be white (64.6% vs. 77% p< 0.001) and more likely to use a catheter (76% vs. 17% p< 0.001). While ASB rates (25.7% vs. 25.2%, p=0.62) were similar, bacteremia from a presumed urinary source (4.6% vs. 7.2%, p< 0.001) was less common in patients with NB. 85.1% (605/711) of patients with NB with ASB received antibiotic therapy. Similar to patients without NB, altered mental status (AMS) was the main predictor of ASB treatment (23.8% vs. 13.3% p=0.017; Table 3). LOS after UC was longer among those with NB and ASB who were treated vs. untreated (4 vs. 3 days, aIRR: 1.538, 95% CI: 1.33-1.77 p< 0.001; Table 4).

Conclusion

Among inpatients with NB in a statewide dataset, ASB was common, more frequently treated with antibiotics, and treatment was associated with longer LOS. AMS was the main predictor of ASB treatment. Bacteremia was lower among patients with NB, suggesting UC overuse.

Disclosures

Barbara Trautner, MD, PhD, Abbott Laboratories: Stocks/Bonds (Public Company)|AbbVie: Stocks/Bonds (Public Company)|Bristol Myers Squibb: Stocks/Bonds (Public Company)|Pfizer: Stocks/Bonds (Public Company)|Phiogen Pharma: Advisor/Consultant Elizabeth McLaughlin, MS, RN, Blue Cross Blue Shield of Michigan: Salary Support
P-1665. Predictors of Antibiotic Prescription for Upper Respiratory Tract Infections in Cancer Patients
Authors: Jang Hyeon Mu , Boumiza Aida , Lin I Hsin , Cohen Nina , Shah Krishna , Majeed Jibran , Groeger Jeffrey , Seo Susan K
Published: January 2025

Background

Antibiotic stewardship efforts are ongoing to improve antibiotic prescribing in the outpatient setting for patients with acute upper respiratory infection (URI). Limited data regarding predictors of antibiotic prescription for acute URI are available for ambulatory patients with cancer.

Methods

Adult cancer patients with URI who presented to the Urgent Care Center (UCC) or Symptom Care Clinic (SCC) at Memorial Sloan Kettering Cancer Center and underwent respiratory pathogen panel (RPP) between September 1, 2019, and March 11, 2020, prior to the start of the Coronavirus Disease 2019 pandemic were evaluated. Study population was dichotomized by receipt of antibiotic prescription (yes vs. no). Demographics, cancer treatment, URI characteristics, and URI management were compared by the Student's t test or Mann Whitney Wilcoxon test and Chi-square or Fisher's exact test as appropriate. Logistic regression was performed to evaluate the predictors of antibiotic prescription.

Results

Of 552 patients, 343 (62.1%) had a solid tumor, 384 (69.6%) received cancer treatment within 30 days of the URI, and 377 (68.3%) had a positive RPP result. Antibiotics were prescribed in 156 (28.3%) patients. Only 16.7% (26/156) were appropriate based on the Centers for Disease Control’s Adult Outpatient Treatment Recommendations. Multivariable logistic regression showed that predictors of antibiotic prescribing included SCC visit location (odds ratio (OR) 2.09, 95% confidence interval (CI) 1.30-3.38), symptom duration > 7 days (OR 2.29, 95% CI 1.26-4.17), earache (OR 9.30, 95% CI 3.47-24.93), sinus pain/headache (OR 2.64, 95% CI 1.53-4.56), negative RPP result (OR 1.88, 95% CI 1.18-2.98), and negative RPP result for influenza (OR 3.31, 95% CI 1.53-7.16). Cancer therapy within 30 days of URI diagnosis and pharyngitis were insignificantly associated with antibiotic prescriptions.

Conclusion

Almost one-third of outpatients at a single cancer center were prescribed antibiotics for URI with only 16.7% being appropriate. Getting real-time RPP results can be helpful to optimize antibiotic prescribing. Understanding risk factors for antibiotic prescribing in ambulatory cancer patients with URI may better direct antimicrobial stewardship efforts.

Disclosures

Susan K. Seo, MD, Merck: Grant/Research Support
P-1670. Digital Five-Step Tool Enhances Standard Perioperative Prophylaxis by Delabeling Surgical Patients from Allergy to Beta-Lactam Antibiotics
Authors: Röder Daniel , Eichhorn Kathrin , Meybohm Patrick , Stoevesandt Johanna , Surat Güzin
Published: January 2025

Background

Up to 90% of patient-reported allergy to one or more beta-lactam antibiotics (BLA) are misdiagnosed, underscoring the widespread issue of incorrect allergy identification. The Infectious Diseases Society of America (IDSA) guidelines and local Antimicrobial Stewardship Programs advocate for the delabeling of self-reported BLA allergies in preoperative settings to facilitate the administration of BLAs, the standard for perioperative antibiotic prophylaxis (PAP). This study evaluates the safety of a novel, digitally-based questionnaire designed to delabel surgical patients from BLA allergies, promoting the use of standard PAP.

Digital five-step tool to delabel surgical patients from allergy to beta-lactam antibiotics

Workflow of the digital delabeling tool as published by Schrüfer (2022) Allergy, Asthma & Clinical Immunology, 18(1), 26.

Methods

A single-center retrospective observational study was conducted from September 2020 to October 2022, analyzing surgical patients who reported BLA allergies during preoperative assessments. A digital tool integrated into the patients’ electronic health records assessed the risk of a genuine allergy using five specific questions and then provided recommendations for or against the use of standard PAP (Figure 1). Subsequent allergic reactions to PAP were monitored for 24 hours.

Results

Of the 983 patients reporting BLA allergy, 322 (32.7%) did not require PAP. Among the remaining 661 patients, the questionnaire targeted 420 (63.5%) for delabeling. Within this group, 262 patients (62.4%) received standard BLAs and reported two allergic reactions (0.8%), while 158 (37.6%) were administered alternative antibiotics, experiencing two allergic reactions (1.3%). The tool’s negative predictive value was 99.2%. Conversely, of the 241 patients advised to maintain the BLA allergy label, 197 (81.7%) received alternative antibiotics with four allergic reactions (2.0%), and 44 (18.3%) were administered BLAs contrary to the tool’s advice, yet experienced no allergic reactions.

Conclusion

The use of a novel, digitally-based five-step questionnaire in the preoperative setting successfully delabeled reported BLA allergies in over 60% of patients. This tool proved straightforward and safe, substantially enhancing the use of standard first-line antibiotics and thereby adhering to best practice guidelines.

Disclosures

Daniel Röder, MBA, Biotest AG: Honoraria
589. Late Onset Invasive Group B Streptococcal Disease Outbreak in a Neonatal Intensive Care Unit Identified Through Whole Genome Sequencing — Connecticut, 2020–2024
Authors: Lambert Matthew C , Jones Sydney , Mueller Kelly , Maloney Meghan , Perera Neranjan , Incekara Kutluhan , Petit Susan , Ramachandran Veena , Grossman Marissa , Valderrama Amy , Chochua Sopio , McGee Lesley , Metcalf Benjamin , Schrag Stephanie , Sosa Lynn
Published: January 2025

Background

Group B Streptococcus (GBS) is a major cause of neonatal sepsis. Outbreaks of GBS late-onset disease (LOD), defined as infection during the first 7–89 days of life, are uncommon. In September 2023, 4 GBS LOD cases were reported by a neonatal intensive care unit (NICU) to the Connecticut Department of Public Health (DPH). We investigated to characterize the outbreak and guide response.

Methods

We identified patients with invasive (i.e., GBS isolated from a sterile site) LOD hospitalized in the NICU through review of data from DPH’s Active Bacterial Core Surveillance Program during January 2019–April 2024. We distinguished outbreak cases through whole-genome sequencing (WGS) of associated bacterial isolates. Single nucleotide polymorphism (SNP) analysis with a cutoff of ≤12 SNPs defined a case as outbreak-related. We abstracted medical records to collect case data. We performed 3 on-site assessments of infection prevention and control (IPC) practices and policies. To monitor response effectiveness, we performed weekly GBS colonization screening (aural, oropharyngeal, rectal sites) of infants admitted to the NICU during December 2023–April 2024. We performed WGS on GBS isolates associated with each colonization.

Results

We identified 12 outbreak-related cases during January 2020–April 2024 based on WGS. Median case interval, time between illness onset, was 85 days but ranged from three days to 458 days; 3 outbreak-patients died. Chart abstraction and on-site assessments indicated the milk room as an area for potential transmission. Variability was noted in adherence to appropriate hand hygiene, personal protective equipment use, and environmental cleaning throughout the NICU. Screening identified 7 colonized infants; GBS isolates from 3 infants matched the outbreak, and 1 colonized infant developed LOD. We recommended addressing IPC gaps and continuing GBS colonization screening to monitor for ongoing transmission.

Conclusion

This investigation highlights the integration of WGS with classic epidemiology to distinguish outbreak-related cases with long intervals between identification. In LOD GBS outbreaks where IPC gaps appear to contribute to transmission, colonization screening and WGS can evaluate effectiveness of implementation of protocols to address IPC gaps.

Disclosures

Meghan Maloney, MPH, Pfizer Global R&D: Former employee, separated in 2009. I do have a retirement entitlement which I do not actively manage/no stock options. PGRD offers periodic buy outs
P-1676. Retrospective Evaluation of the Impact of Infectious Diseases Consultation on Prescribing Patterns and Clinical Outcomes among Patients with Gram-negative Bacteremia in the Community Hospital Setting
Authors: Warehall Rowan , Gothard David , Fabian Amy
Published: January 2025

Background

Gram-negative bloodstream infections (BSI) are concerning due to high mortality rates reporting up to 30%; however, infectious diseases (ID) consultation has been associated with reduced mortality. According to consensus statement recommendations, fluoroquinolones (FQ) or trimethoprim-sulfamethoxazole (TMP/SMZ) are first-line oral treatment options and high bioavailable beta-lactams (HBBL) are alternatives for the treatment of Gram-negative BSI. The objective of this study is to evaluate differences in oral antibiotic prescribing patterns and outcomes between ID and non-ID providers among patients with Enterobacterales BSI in a community hospital setting.

Methods

This is a multi-centered, retrospective cohort. Adult patients who received treatment for confirmed Enterobacterales BSI between January 1, 2022 and June 30, 2023 were included. Patients who completed treatment with only IV antibiotics, were greater than 89 years of age, elected palliative or hospice care before completion of treatment, died prior to receiving oral antibiotics, or with polymicrobial blood cultures were excluded. The primary outcome was the proportion of patients ordered FQ, TMP/SMZ, HBBL, or low-moderate bioavailable beta-lactam (LBBL) as oral stepdown. Secondary outcomes included length of stay, IV, oral, and total length of therapy (LOT), 30-day readmission, Clostridioides difficile infection (CDI), and all-cause mortality. The primary outcome was analyzed using a chi-square test with post hoc Bonferroni adjusted z tests to determine specific categorical differences.

Results

In the ID consult group (n=95) 72.6% of patients received a FQ, 6.3% TMP/SMZ, 16.8% HBBL, and 4.2% LBBL whereas in the non-ID consult group (n=77) 50.6% received a FQ, 5.2% TMP/SMZ, 39% HBBL, and 5.2% LBBL (p=0.009; Bonferroni z test p< 0.0125 for FQ and HBBL). Secondary outcomes did not differ significantly between the two groups.

Conclusion

FQ were more likely to be prescribed for oral stepdown in the ID consult group whereas HBBL were more likely to be prescribed in the non-ID consult group. Overall, among either group rates of prescribing were low for both TMP/SMZ and LBBL.

Disclosures

All Authors: No reported disclosures
P-1679. Discrepancies in antibiotic prescribing: revealing inappropriate use patterns
Authors: Silva-Pereira Andrea P , Arias-Ariza Anderson F , Ochoa-Vera Miguel , Luna-Gonzalez Maria L , Bernal-Garcia Edgar
Published: January 2025

Background

Inappropriate antibiotic prescribing fuels antimicrobial resistance (AMR) and compromises patient outcomes. This study aimed to elucidate the prevalence and factors associated with inappropriate antibiotic use across various agents and antibiotic groups.Table 1.Assessment of Inappropriate Antibiotic Prescribing Patterns by Antibiotic Type

Methods

A retrospective analysis of 1647 cases evaluated antibiotic prescribing patterns. We assessed both prescription rates and prevalence ratios (PR) to examine the appropriateness of antibiotic choice within and across groups.Table 2.Comparative analysis of prevalence factors for various antimicrobial groups

Results

Prescription rates indicated higher rates of inappropriate use for meropenem (22.8%) and carbapenems (20%) compared to other agents and groups. Conversely, PR analysis revealed a significantly lower likelihood of inappropriate prescribing for cephalosporins compared to carbapenems (adjusted PR: 0.43, 95%CI 0.29-0.66, p < 0.001). Glycylcyclines exhibited a markedly higher risk of inappropriate use (adjusted PR: 3.00, 95%CI 1.44-6.24, p=0.003), while glucopeptides also demonstrated a propensity for inappropriate prescribing (adjusted PR: 1.46, 95%CI: 1.12-1.89, p=0.004).

Conclusion

our study reveals notable discrepancies in the appropriateness of antibiotic prescriptions across different agents and antibiotic groups. While the analysis based on prescription rates demonstrated higher rates of inappropriate use for meropenem and carbapenems overall, prevalence ratio analysis highlighted specific trends within antibiotic classes. Cefalosporins consistently demonstrated a lower likelihood of inappropriate prescribing compared to carbapenems, suggesting their preferential use in clinical practice. However, caution is warranted with glicylcyclines, which exhibited a higher risk of inappropriate prescription. These findings underscore the importance of tailored interventions to optimize antibiotic prescribing practices, mitigate antimicrobial resistance, and improve patient outcomes.

Disclosures

All Authors: No reported disclosures
P-1687. Antibiotic Prophylaxis before Dental Procedures to Prevent Prosthetic Joint Infections
Authors: Raheem Mariam , Kuhn Ryan , Natesan Suganthini Krishnan , Dhar Sorabh
Published: January 2025

Background

Antibiotic prophylaxis before invasive dental procedures (IDP) to reduce the risk of late prosthetic joint infections (PJI) is a controversial, yet common practice despite lack of supporting evidence. Antibiotics are no longer recommended, except for certain high-risk populations, highlighted in dental and orthopedic guidelines. To assist providers, the American Academy of Orthopedics (AAOS) has developed an algorithmic clinical decision support tool (CDS) “appropriate use criteria” matrix. However, uptake of these criteria for dental prophylaxis and antibiotic prescribing in routine dental care of patients with prosthetic joints remains unclear.

Methods

This retrospective review at a Veterans Affairs hospital evaluated use of amoxicillin and clindamycin over 16 months for prophylaxis prior to high risk dental procedures in patients with prosthetic joints. Clinical data was reviewed for 5 indications defined by the AAOS including: 1) Invasive dental procedure (manipulation of the gingiva or periapical tissues), 2) Immunocompromised status, 3) Diabetic glycemic control (as defined by hemoglobin A1C ≥ 8 or blood glucose ≥ 200), 4)previous history of (PJI), and 5)timing of the joint replacement (≥ 1 year). The use of the antibiotic was categorized into 3 groups per AAOS guidance: 1). Appropriate, 2). Maybe Appropriate, 3). Rarely appropriate. Records were also reviewed for subsequent joint infection, antibiotic adverse events, and development of Clostridioides difficile infection (CDI).

Results

Indications for dental prophylaxis among the 36 cases reviewed are shown in table 1. Of the records reviewed, 0 (0%) were deemed “appropriate”, 2 (5.6%) “maybe appropriate”, and 34 (94.4%) “rarely appropriate.” No joint infections, adverse antibiotic events, CDI were noted in the subsequent 90 days.

Conclusion

Despite the availability of a clinical decision support tool for prescribing prophylactic antibiotics to patients with prosthetic joints, 95% of antibiotics were found to be unnecessary per current AAOS guidelines. Provider feedback and updated evidence-based recommendations are needed to promote appropriate antibiotic use.

Disclosures

All Authors: No reported disclosures
P-1708. Frontline Febrile Neutropenia Antibiotic Treatment Across Institution Types: A Multicenter Survey Study
Authors: Castillo Maia , Gross Derick , Harding Stephanie
Published: January 2025

Background

American Society of Clinical Oncology febrile neutropenia guidelines highlight the importance of quick empiric antipseudomonal coverage, and use of gram-positive active agents only in special circumstances. Despite this, first line vancomycin use increased over the years, thus, our study hoped to gain information on how institutions treat febrile neutropenia and if any patterns emerge between institution types.

Methods

A survey was distributed via email to IDSA and ACCP listservs. A survey tool was used for survey questions and to collect responses pertaining to febrile neutropenia management, institution demographics, and routine antibiotics used. Descriptive statistics, chi-squared tests and Mann-Whitney U tests were used to analyze the data as indicated.

Results

Eighty-four survey results were included in the analysis. When comparing academic medical centers (AMC) to non-AMCs there was more initial oncology responsibility for treatment (50.9% vs 22.6%; p-value = 0.047) and less empiric MRSA coverage (p-value = 0.039). When comparing institutions with > 500 beds to those with < = 500 beds similar results were seen with more initial oncology responsibility (53.2% vs 25%; p-value = 0.047), and more primary oncology responsibility in larger locations (70.2% vs 36.1%; p-value = 0.039), and less empiric MRSA coverage (p-value = 0.02). When comparing institutions with internal protocols versus without, there was less empiric MRSA coverage with a protocol (p-value = 0.006). No statistically significant difference in percentage of patients treated with MRSA or pseudomonal coverage were found when comparing service lines responsible for febrile neutropenia treatment.

Conclusion

Institution size or academic affiliation does not directly impact adherence to guidelines, internally published FN guidelines can increase adherence to IDSA/ASCO guidelines and are a modification that any institution can implement. Having a small sample size with perception-based data was a large limitation of this study, therefore future studies with larger sample sizes and concrete usage data could be pursued in the future to better understand febrile neutropenia treatment guideline adherence.

Disclosures

All Authors: No reported disclosures
P-1709. Factors Associated with Anti-Methicillin-Resistant Staphylococcus aureus and Anti-Pseudomonas aeruginosa Therapy in Critically Ill Patients with Community-Acquired Pneumonia: A Single-Center Experience
Authors: Trujillo Nalea , Diep Calvin , Garcia Ariadna , Holubar Marisa , Ha David R
Published: January 2025

Background

Current American Thoracic Society and Infectious Diseases Society of America community-acquired pneumonia (CAP) guidelines recommend empiric antibiotic therapy against methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa (P. aeruginosa) in individuals with major risk factors: (1) MRSA or P. aeruginosa growth in respiratory cultures within the past year or (2) severe CAP with prior hospitalization and receipt of parenteral antibiotics within the preceding 90 days. The objective of this study was to describe factors associated with empiric antibiotic therapy against MRSA and P. aeruginosa in critically ill patients with CAP.

Methods

This was a single-center retrospective study including adult patients admitted to the intensive care unit (ICU) with a diagnosis of pneumonia and who received systemic antibiotics solely for CAP from January 2022 to December 2023. The primary outcome was factors associated with empiric anti-MRSA and anti-P. aeruginosa therapy. Secondary outcomes included empiric antibiotic use relative to guideline-stated risk factors.

Results

169 patients were included in the final analysis. No risk factors were associated with empiric anti-MRSA therapy. Multivariate regression analysis showed that the following were associated with empiric anti-P. aeruginosa therapy: presence of guideline-stated risk factors for P. aeruginosa (OR 12, 95% CI 1.31-109, p< 0.05) and prior immunosuppression (OR 3.67, 95% CI 1.47-9.17, p< 0.01). Prevalence of MRSA CAP was 1.8% and prevalence of P. aeruginosa CAP was 2.4%. Of the 79 patients who received empiric anti-MRSA therapy, 68 (86.1%) did not have guideline-stated risk factors. Of the 105 patients who received empiric anti-P. aeruginosa therapy, 88 (83.8%) did not have guideline-stated risk factors.

Conclusion

Presence of guideline-stated P. aeruginosa risk factors as well as prior immunosuppression were associated with empiric anti-P. aeruginosa therapy and no factors were associated with empiric anti-MRSA therapy. Despite low incidence of MRSA and P. aeruginosa CAP, use of broad-spectrum antibiotics was frequent. Development of a protocol to guide empiric anti-MRSA and anti-P. aeruginosa therapy may help reduce unnecessary use of broad-spectrum antibiotics.

Disclosures

All Authors: No reported disclosures
P-1724. Knowledge, Attitude, and Practices (KAP) on Appropriate Antibiotic Use among Healthcare Providers in Qatar - A cross-sectional study
Authors: Shams Sherin , Nafady-Hego Hanaa , Al Nuaimi Asma Ali , Saleem Samah , Aziz Maryan Hassan , Seyam Naheel Ismail , Aziz Kamran , Kandil Dalia , Malik Aimon , Thomas Anil G , Al-Kuwari Mohamed Ghaith , Saeed Wael Ezzeldin , Al Abdulla Samya Ahmad , Krishnan Jeyaram Illiayaraja , Semaan Sandy , Abou-Samra Abdul-Badi , Butt Adeel A
Published: January 2025

Background

There has been growing awareness of antibiotic resistance as a significant public health issue, notably a widespread prescription of antibiotics for upper respiratory tract infections (URTIs).

Understanding the knowledge, attitude, and practices (KAP) of healthcare providers is crucial in designing interventions to reduce inappropriate antibiotics use. Our aim was to determine the KAP of primary care physicians towards antibiotics prescriptions in the outpatient setting to develop strategies to improve appropriate antibiotics use.

Physician responses to KAP Survey.

Methods

We employed a cross-sectional survey to determine the KAP of physicians at 4 Primary Healthcare Centers (PHCCs) in Qatar. The KAP questionnaire was structured into three main sections: evaluating physicians' knowledge regarding Upper Respiratory Infections (URIs) and antibiotics, examining attitudes encompassing beliefs or perspectives on antibiotic usage for URIs, and investigating practices to understand how physicians implement their knowledge and attitudes in their actions. A 5-point Likert scale was used for the questions.

Results

A total of 141 physicians were surveyed and 96% responded. Nearly 80% were >40 years old, approximately half were women and 69% had ≥10 years of clinical experience. A majority of physicians (97.8%) agreed that inappropriate antibiotic use contributes to the rise of antibiotic resistance, 80.8% expressed disagreement with prescribing antibiotics for fever alone, and 40.4% admitted to experiencing patient pressure to prescribe antibiotics even when unnecessary. Conversely, 13.4% admitted to frequently prescribing antibiotics solely due to patient requests, and 37.6% confirmed encountering patient complaints or patient migration to other doctors if antibiotics were not prescribed.

Conclusion

Primary care physicians are knowledgeable about the role and risks associated with antibiotics, but frequently felt pressured by the patients/families to prescribe antibiotics. Intervention strategies to educate the public and empower the physicians are needed to address the inappropriate use of antibiotics.

Disclosures

Adeel A. Butt, MD, MS, Gilead Sciences: Grant/Research Support
P-1725. A Cluster Randomized Trial of Bundled Interventions to Reduce Inappropriate Antibiotic Use in the Outpatient Setting
Authors: Shams Sherin , Al Nuaimi Asma Ali , Krishnan Jeyaram Illiayaraja , Saleem Samah , Aziz Maryan Hassan , Seyam Naheel Ismail , Aziz Kamran , Kandil Dalia , Malik Aimon , Thomas Anil G , Nafady-Hego Hanaa , Saeed Wael Ezzeldin , Semaan Sandy , Al Abdulla Samya Ahmad , Al-Kuwari Mohamed Ghaith , Abou-Samra Abdul-Badi , Butt Adeel A
Published: January 2025

Background

Antibiotics are often inappropriately prescribed in the outpatient settings. Among the most common reasons for inappropriate antibiotic prescriptions are upper respiratory tract infections (URI) which are known or highly likely to be viral in origin. Our aim was to test a bundle of complementary interventions to reduce inappropriate antibiotic prescriptions in the outpatient setting for patients presenting with various URIs. Here we present preliminary data from the cluster randomized trial using pre-intervention baseline data (August to October 2023) and after implementation of interventions (December 2023 to March 2024).Figure 1.Comparison of inappropriate antibiotic prescriptions for URTIs between the intervention and control groups during the pre-intervention (Aug 2023 – Oct 2023) and post-intervention phases (Dec 2023 - Mar 2024).

Methods

We randomly assigned 2 Primary Healthcare Centers (PHCC) in Qatar to receive a 4 component intervention: 1) extensive provider education; 2) providing an algorithm driven decision support tool based on professional society recommendations for appropriate use of antibiotics for various URIs; 3) option for deferred prescription; and 4) monthly feedback to all physicians regarding their prescription patterns including anonymized comparison with their peers. Two PHCCs in the control group received a single intervention which was randomly chosen. For this study, we identified 4 common URIs for which professional society guidelines do not recommend use of antibiotics (acute bronchitis, acute laryngitis, common cold, influenza without mention of pneumonia). Prescriptions written and corresponding diagnoses were retrieved from the electronic medical records. Children < 2 years of age, and individuals with any immune compromising condition or medications were excluded.Table. 1Appropriate and Inappropriate use of antibiotics in URTIs

Results

A total of 7,246 antibiotic prescriptions were written for 4 included URIs during the study period. The percentage of inappropriate prescriptions in the intervention group decreased from 67.7% to 62% in the first 4 months after the intervention (p-value >0.05). The proportion of inappropriate prescriptions in the control groups remained steady at 70% before and after the intervention.

Conclusion

While not statistically significant in this early stage, our preliminary results indicate a trend in reduction in inappropriate prescriptions of antibiotics for URIS in the outpatient setting.

Disclosures

Adeel A. Butt, MD, MS, Gilead Sciences: Grant/Research Support
P-1761. Safety and Efficacy of Antimicrobial Optimization based on Negative Results from BioFire FilmArray Pneumonia Panel
Authors: Yoo Noah , Cheng Xian Jie , Chung Juri , Chawla Shalinee , Zacharioudakis Ioannis , Dubrovskaya Yanina
Published: January 2025

Background

The BioFire FilmArray Pneumonia (BFP) panel is a multiplexed nucleic acid test intended for detection of multiple respiratory viral and bacterial specimens from sputum or bronchoalveolar lavage (BAL) specimens, with high specificity and turnaround time. Efficacy and safety of de-escalation strategies in patients with negative BFP have not been adequately described.

Methods

This was a multi-center, retrospective analysis of adult patients with suspected pneumonia and sputum or BAL samples that tested negative on BFP. Patients for whom antibiotic therapy was discontinued (ATDC Group) were compared to patients who had their antibiotic therapy continued (ATC Group). Outcomes included in-hospital mortality, 30-day readmission, and hospital and ICU length of stay. Impact on the total number of days on antibiotics and the safety of the intervention were also assessed.

Results

Out of 500 patients with negative BFP assay, a total of 185 patients were included in the final analysis (59 ATDC Group vs. 126 ATC Group). 67.6% of samples were sputum and 32.4% were BAL in the entire cohort. The groups were generally well-balanced in baseline characteristics, but more patients in ATC Group had community-acquired pneumonia (59% vs 79%, p = 0.006), higher initial white blood cell count (10 vs 13, p = 0.038), and higher quick Pitt Bacteremia Score (1 [IQR 0-1] vs 1 [IQR 0-3], p = 0.020). The ATDC Group had significantly shorter days of total antibiotic therapy (1.0 days vs 10.6 days, p < 0.001). 30-day readmission rates (16.95% vs 15.87%, p = 0.853) and the hospital length of stay (8.34 days vs 7.75, p = 0.960) did not differ. The ATDC Group experienced fewer AKI (8% vs 37%, p = 0.004).

Duration of Antibiotics

Conclusion

Antibiotic discontinuation based on BFP was associated with significant reduction in the number of total days on antibiotics. Discontinuation was not associated with increases in in-hospital mortality, length of stay, or readmission, but was associated with a significant reduction in acute kidney injury.

Disclosures

All Authors: No reported disclosures
P-1771. Impact of a Multistep Urinary Tract Infection-Focused Disease State Stewardship Initiative on the Treatment of Asymptomatic Urinary Presentations
Authors: Tyler Pitcock C , Casaus Danielle , Cotner Sarah , Ruf Kathryn , Burgess David S , Burgess Donna R , VanHoose Jeremy , Mynatt Ryan P , Mansoor Armaghan-E Rehman , Van Sickels Nicholas , Maskey Mitu , Myint Thein , Wallace Katie L
Published: January 2025

Background

Asymptomatic bacteriuria (ASB) is often overtreated, risking patient harm through unnecessary antimicrobial use and fostering antimicrobial resistance. This study assessed the impact of a multistep urinary tract infection (UTI)-focused stewardship intervention by comparing the incidence of asymptomatic urinary presentation (AUP) treatment before and after implementation.

Methods

This retrospective quasi-experimental study included patients > 18 years at University of Kentucky HealthCare who received antimicrobial therapy with a urinalysis (UA) and/or urine culture (UC) collected for a presumed UTI between January 2023 to March 2023 (pre-implementation) and January 2024 to March 2024 (post-implementation). The steps implemented sequentially as part of the initiative included order set optimization with removal of unnecessary UAs, institution wide education, development of a new UA order with reflex to UC, and prospective audit and feedback. Our primary outcome was the incidence of AUP treatment.

Results

A total of 381 patients were evaluated with 204 in the pre-implementation group and 177 in the post-implementation group. Following implementation there was a trend toward decreased treatment for AUPs (42.2% vs. 35.0%, p=0.154). In the post-implementation group, fewer patients were treated for a UTI with altered mental status as the only reported symptom (10.8% vs. 5.1%, p=0.042). Moreover, overall adherence to guidelines significantly improved in the post-implementation phase (28.4% vs. 42.9%, p=0.003). There was also a notable enhancement in culture-targeted definitive therapy selection in the post-implementation group (20.1% vs. 37.3%, p < 0.001) as well as the number of patients who received appropriate antibiotic durations for a UTI in the post-implementation group (38.7% vs. 53.1%, p= 0.005).

Conclusion

The implementation of a UTI-focused disease state stewardship initiative led to improvements in overall guideline adherence, culture-targeted definitive therapy selection, and therapy duration. Although further reductions in treatment of AUPs are still needed, these results suggest that a UTI-focused initiative improves overall UTI management and decreases unnecessary antimicrobial use.

Disclosures

Sarah Cotner, PharmD, BCPS, Gilead Sciences, Inc: Advisor/Consultant
P-1773. Impact of a Pharmacist-driven Antipseudomonal Antibiotic Time-out
Authors: Diaz Carina , Landayan Alice Margulis , Porras Lorenzo , Samsundar Sonia , Murillo Jorge , Gauthier Timothy
Published: January 2025

Background

Antipseudomonal antibiotics are key weapons in the fight against antimicrobial resistance but misuse can contribute to numerous adverse effects. It is imperative to identify opportunities to further implement strategies for sustained improvement in antipseudomonal antibiotic utilization. The purpose of this quality improvement project was to evaluate the impact of a pharmacist-driven antipseudomonal antibiotic time-out.

Methods

This was a single-center retrospective evaluation of adults that received piperacillin/tazobactam, cefepime, aztreonam, ciprofloxacin, or levofloxacin while hospitalized. Patients were excluded if pregnant, incarcerated, taking chronic suppressive or prophylactic antimicrobial therapy, receiving hospice care, or on comfort measures only. The primary outcome was the proportion of target antipseudomonal versus all other systemic antibiotic days of therapy adjusted to days present in evaluated units January through February 2023 (pre-implementation) versus January through February 2024 (post-implementation). Qualitative secondary outcomes evaluated for the post-implementation group included pharmacist antibiotic intervention detail, intervention acceptance rate, antipseudomonal agent duration of therapy, incidence of Clostridioides difficile infection, and length of hospital stay. The project was Institutional Review Board approved.

Results

The proportion of target antipseudomonal versus all other systemic antibiotic days of therapy adjusted to days present was 234/898 (26%) for the pre-implementation group versus 210/1321 (16%) for the post-implementation group (p < 0.001). Demographics are listed in table 1. In the post-period 537 patients were reviewed, with 200 patients intervened on and a total of 255 interventions performed with a 99% acceptance rate. The most common types of interventions were antimicrobial de-escalation, order stop date modification, and antimicrobial discontinuation. Pharmacist intervention details are shown in table 2. Other secondary outcomes are displayed in table 3.

Conclusion

Implementation of a pharmacist-driven antibiotic timeout can drive meaningful reductions in antipseudomonal antibiotic use with high provider acceptance rates without unfavorable clinical outcomes.

Disclosures

Jorge Murillo, MD, Paratek Pharma: Advisor/Consultant Timothy Gauthier, PharmD, BCPS, BCIDP, AbbVie Pharma: Advisor/Consultant|Antimicrobial Therapy, Inc: Advisor/Consultant|Ferring Pharma: Advisor/Consultant|Firstline Mobile Health: Advisor/Consultant|Gilead Pharma: Advisor/Consultant|GoodRx: Advisor/Consultant|GSK Pharma: Advisor/Consultant|Melinta Pharma: Advisor/Consultant|Pattern Biosciences: Advisor/Consultant|Pfizer Pharma: Advisor/Consultant|ProCE: Honoraria|WWW.LearnAntibiotics.com: Ownership Interest