bluuebunny/crossref_metadata_2025_split huggingface dataset:
1787. The Effects of a Systemwide Diagnostic Stewardship Change on West Nile Virus Disease Ordering Practices
Authors: Karaba Andrew H , Blair Paul W , Martin Kevin M , Saheed Mustapha O , Carroll Karen C , Borowitz Mike J 
Published: October 2019

Abstract

Background
Neuroinvasive West Nile Virus (WNV) often leads to prolonged neurological deficits and carries a high case fatality rate. The CSF IgM (MAC-ELISA) is preferred over the CSF nucleic acid-based test (NAAT) by the CDC due to its higher sensitivity. However, our hospital system was observed to have an over-utilization of NAAT testing compared with MAC-ELISA testing. The primary objective was to compare the number of MAC-ELISA and NAAT WNV tests ordered before and after a diagnostic stewardship intervention. The secondary objectives were to determine whether this change to lead to any cost savings and increased detection of probable cases of WNV-ND.

Methods
In an effort to increase the use of the MAC-ELISA and to decrease unnecessary NAAT testing, the NAAT test was removed in April 2018 from the test menu in the electronic health record of a health system comprising five hospitals in the Maryland and Washington, D.C. area. NAAT testing remained possible via a paper order form. This study was a retrospective review of WNV testing done on CSF samples from July 2016 through December 2018. The seasonal and yearly number of total tests, positive tests, and total costs were determined from the period of July, 2017 to April, 2018 and were compared with May, 2018 to January, 2019. A paired t-test was performed to evaluate for differences in total testing, total positives, and total costs during non-winter months before and after the intervention.

Results
A total of 12.59 MAC-ELISA tests/month (95% CI: 10.29, 14.89) increased to 41 tests/month (95% CI: 34.35, 47.65) which was significantly different (P < 0.001). In contrast, there were 46.23 NAAT tests/month (95% CI: 39.55, 52.91) which decreased to 0 NAAT tests/month after the intervention (P < 0.001). This resulted in an average decrease in WNV test spending from $7200 per month to $471 per month (P < 0.001). Preceding the intervention in test ordering, 0.23% of WNV CSF tests were positive (NAAT+MAC-ELISA) while 2.44% WNV CSF tests were positive after the intervention (P = 0.03).

Conclusion
Elimination of electronic WNV NAAT ordering is an effective way of decreasing inappropriate WNV NAAT testing, decreasing associated costs, and may lead to improved diagnosis of WNV-ND.

Disclosures
All authors: No reported disclosures.
1980. Variability in Antifungal Stewardship Strategies Among Society for Healthcare Epidemiology of America (SHEA) Research Network Facilities
Authors: Fitzpatrick Margaret A , Albarillo Fritzie S , Ochoa Aaron , Suda Katie J , Evans Charlesnika T 
Published: October 2019

Abstract

Background
The incidence of invasive fungal infections (IFI) and antifungal utilization is increasing in many healthcare settings. Little is known regarding antifungal stewardship strategies within broader antimicrobial stewardship programs (ASPs). This survey aimed to identify the use of antifungal stewardship at a diverse range of hospitals.

Methods
A cross-sectional electronic survey of the SHEA Research Network (SRN) was completed August–September 2018 by a physician or pharmacist ASP leader. The SRN is a consortium of >100 hospitals participating in multicenter healthcare epidemiology research projects. Survey questions pertained to various aspects of antifungal stewardship, including audit and feedback, laboratory testing, and surveillance. Chi-square tested associations between ASP and hospital characteristics and use of antifungal stewardship strategies.

Results
45/111 (41%) facilities responded, including 10 international sites. Most facilities are academic medical centers (64.6%) and care for stem cell (73.3%) and solid-organ transplant (80.0%) patients. Most facilities have large, well established ASPs (60.0% > 5 members; 68.9% duration ≥6 years). 43 (95.6%) facilities use antifungal stewardship strategies in their ASP; most commonly prospective audit and feedback (33/43, 73.3%) performed by a pharmacist (23/33, 71.4%). Only half of ASPs (51.1%) create guidelines for IFI management. Most (71.1%) facilities offer rapid laboratory tests to diagnose IFI, but availability of PCR for fungal speciation and antifungal susceptibility testing varies (Figure 1). 29 ASPs (64.4%) perform surveillance of antifungal utilization, but only 9 (31.0%) report data to CDC’s National Healthcare Safety Network (NHSN). ASP size, ASP duration, and presence of transplant populations were not associated with a higher likelihood of using antifungal stewardship strategies (P > 0.05 for all).

Conclusion
Use of antifungal stewardship strategies is high at SRN hospitals, but mainly involves audit and feedback. ASPs should be encouraged to disseminate guidelines for IFI management, to promote access to laboratory-based tests for rapid and accurate IFI diagnosis, and to perform surveillance for antifungal utilization with data reporting to NHSN.

Disclosures
All authors: No reported disclosures.
1988. Impact of a Novel Pharmacist Practice Model on Antimicrobial Usage and Hospital-acquired Clostridium difficile (HACDI) Rates
Authors: Pourgolafshan Pegah , Ying Ivan , Chen Danny 
Published: October 2019

Abstract

Background
The Antimicrobial Stewardship Program (ASP) was implemented at our 425-bed community hospital in June of 2012. The ASP team, 1 pharmacist, and 1 infectious diseases physician reviewed all intensive care patients on antimicrobials as well as patients on select broad-spectrum antibiotics. In 2016, ASP expansion was undertaken without additional staffing using a novel unit pharmacist model. The effectiveness of in-house antimicrobial stewardship (AMS) training programs for unit pharmacists is not well described. We report the impact of our model on antimicrobial usage and HACDI rates.

Methods
In 2016, an extensive AMS training and certification program was developed for all unit pharmacists. The program consisted of learning modules, didactic lectures, competency assessments, and individual teaching by the ASP team. In 2017, the practice model was rolled out and the ASP team met with each pharmacist biweekly to review prospective audit and feedback cases with a focus on ceftriaxone and fluoroquinolones. Antimicrobial usage was tracked by defined daily doses (DDD) per 1,000 patient-days, as defined by the World Health Organization. HACDI rates per 1,000 patient-days were defined by the Ontario Ministry of Health and Long Term Care.

Results
Since the model launched in 2017 until March of 2019, total antimicrobial usage was decreased by 22% (P < 0.001), fluoroquinolones by 21% (P = 0.01), and ceftriaxone by 53% (P < 0.001). HACDI rates decreased from 0.30 to 0.16 cases per 1,000 patient-days (47%, P = 0.12) (Figure 1). Since ASP implementation in 2012, total antimicrobial usage has been reduced by 35% (P < 0.01), fluoroquinolones by 73% (P < 0.001), clindamycin by 70% (P = 0.05) and rates of HACDI by 73% (P < 0.0001) (Figure 2). Pseudomonas susceptibility rates improved (2012 vs. 2017) for meropenem (86% to 93%), ciprofloxacin (73% to 90%), and piperacillin–tazobactam (80 to 92%), but did not reach statistical significance.

Conclusion
To the best of our knowledge, this is the first description in the literature of an in-house AMS training and certification program for unit pharmacists and its impact on clinical outcomes. This novel approach creates a sustainable and staffing neutral practice model that effectively reduces unnecessary antimicrobial usage and HACDI, resulting in improved patient safety.

Disclosures
All authors: No reported disclosures.
1995. Serial Procalcitonin Measurement in a Community Intensive Care Unit: Is There Value in the Setting of an Established Antibiotic Stewardship Program?
Authors: Seah Jenny , Beriault Daniel , Langford Bradley , Schwartz Kevin L , Cirone Robert , Pasic Maria , Chan April , Downing Mark 
Published: October 2019

Abstract

Background
Procalcitonin (PCT) monitoring has been shown to result in reduced antibiotic use without an impact on patient outcomes. However, the real-world value of this biomarker has yet to be determined, particularly when efforts to optimize antibiotic use are already in place. We evaluated the feasibility and impact of PCT-guided antibiotic duration combined with an established antibiotic stewardship program (ASP) in a community hospital intensive care unit (ICU) in Toronto, Canada.

Methods
We conducted a quality improvement initiative in our ICU from November 2017 to October 2018 measuring daily PCT levels for immunocompetent patients receiving antibiotic therapy for suspected or proven bacterial infection with an expected duration between 48 hours and 21 days. Our protocol recommended stopping antibiotic therapy if PCT fell below 0.5 μg/L (absolute threshold) or if it dropped more than 80% from its peak value (relative threshold). ASP rounds took place twice weekly since 2013, integrating a regular discussion about PCT levels once this initiative was implemented. We evaluated the adherence to stopping criteria within 48h, antibiotic use (days of therapy per 1,000 patient-days), length of stay, 48h re-admission, and ICU-mortality. Interrupted time series with segmented regression was performed to evaluate pre-post intervention differences compared with the 12-months prior to implementation.

Results
A total of 297 antibiotic courses were monitored with PCT in 217 patients. Respiratory (62%), unknown infection (11%), and intra-abdominal infection (7%) were the most common reasons for antibiotics. Protocol adherence was 34% (absolute threshold: 39%, relative threshold: 12%). Adherence by ICU physician varied widely between 24% and 52%. Antibiotic use pre-PCT was 1,002 DOTs/1,000 PDs and post-PCT was 817 DOTs/1,000 PDs (adjusted change −15%, 95% CI: −28% to +8%) (Figure 1). No statistically significant changes in clinical outcomes were noted.

Conclusion
In the context of an active ASP in a community hospital ICU, PCT monitoring was associated with a non-significant decrease in antibiotic use. Further evaluation of reasons for inter-physician variability in adherence and opportunities for improved and sustained overall adherence should be explored.

Disclosures
All authors: No reported disclosures.
2026. A Current Status of Antimicrobial Stewardship Programs in Korean Large Hospitals: A Nationwide Survey in 2018
Authors: Kim Bongyoung , Jin Lee Myung , Mi Moon Song , Yoon Park Se , Song Kyoung-Ho , Lee Hyunju , Su Park Jeong , Suk Lee Mi , Choi Su-Mi , Yeom Joon-Sup , Yong Kim Jin , Kim Chung-Jong , Chang Hyun-Ha , Suk Kim Eu , Hyong Kim Tae , Bin Kim Hong 
Published: October 2019

Abstract

Background
The aim of this study was to examine the current status of antimicrobial stewardship program (ASP) in large hospitals in South Korea, identifying problems and hurdles for implementation of proper ASP, and providing a reference for the proposal of ASP policies.

Methods
The questionnaire was designed based on the “Seven Core Elements of Hospital Antibiotic Stewardship Programs” from Centers for Diseases Control and Prevention of the U.S. and modified from the questionnaire of the previous survey on ASP in Korea, 2015. The survey targeted all the hospitals with 500 beds or more in South Korea in 2018. The online-based survey using SurveyMonkey® platform was conducted for 3 weeks from June to July 2018. Only one ASP-associated physician per hospital participated in the survey.

Results
The response rate to the survey was 88.4% (84/95). The median number of medical personnel participating in ASP was 4 [interquartile range (IQR) 2.25–5], most of which were infectious diseases specialists (median 2, IQR 1–2). Besides, some pediatric infectious diseases specialists, pharmacists, etc. were participating in the ASPs. Only 6.0% (5/84) of hospitals had full-time workers for ASP. Restrictive measures for designated antibiotics was a widely accepted ASP strategy among Korean hospitals (88.1%, 74/84) and the median number of designated antibiotic classes was 16 (IQR 11–19). An 11.9% (10/84) of hospitals introduced monitoring and intervention program against inappropriate antibiotic combination therapy. The proportion of hospitals which had interventions for inappropriate long-term antibiotic use and parenteral to oral conversion strategy were 9.5% (8/84) and 1.2% (1/84), respectively. Lack of time, personnel, and appropriate reward were perceived as the major barriers to establishing ASP in Korean hospitals.

Conclusion
ASP in Korean hospitals were mainly carried out by 1–2 infectious diseases specialists and it heavily depended on restrictive measures for designated antibiotics. Supporting manpower and establishment of the appropriate reward system is necessary for improvement of ASP in Korean hospitals.

Disclosures
All authors: No reported disclosures.
2031. Impact of Education and Antibiotic Guidelines on Dispensing Antibiotics with Community Pharmacists in a Low- and Middle-Income Country
Authors: Gudipati Smitha , Bajracharya Deepak , Jimee Lenjana , Maki Gina , Zervos Marcus , Prentiss Tyler , Kaljee Linda 
Published: October 2019

Abstract

Background
Non-prescription use of antibiotics in low- and middle-income countries has contributed to significant antimicrobial resistance (AMR). Henry Ford Health System has partnered with multinational organizations in Nepal to address the need for increasing awareness of AMR and implementation of effective antimicrobial stewardship. This partnership confirmed the importance of increasing knowledge and awareness regarding AMR and antibiotic use to community pharmacists. The present pilot study assessed if outpatient antibiotic dispensing guidelines given to community pharmacists could result in a reduction of unneeded antibiotic use.

Methods
Nine community pharmacies from Kathmandu were selected of which two were used as controls. Seven pharmacists were educated on the appropriate use of antibiotics, and outpatient dispensing before and after guidelines at all pharmacies were evaluated. The pharmacists were given guidelines on antibiotic use and duration needed for common bacterial infections encountered. Controls were not given guidelines. At baseline and post-intervention (1 week), pill counts were performed of the top six antibiotics that were dispensed by the pharmacist. Pharmacists were requested to keep a log of how many antibiotics were dispensed for one week. The pharmacists also were requested to fill out a post-intervention educational assessment to evaluate retention.

Results
Pill count pre-intervention was 15,856 and 1512 and post-intervention was 11,168 and 1,440 in the intervention and control groups respectively (Table 1). A post-intervention educational assessment revealed that both the intervention and control groups believed antibiotics can treat viruses (57% vs. 50%) and that antibiotics do not kill good bacteria that protect the body from infection (57% vs. 50%) (Table 2).

Conclusion
There was no difference in the dispensing of antibiotics between pre- and post-intervention. The findings of this study show significant room for improvement in continuing education about antibiotic use in outpatient pharmacies. Further studies are needed to target outpatient antibiotic dispensing with education and identifying economic or other incentives in hopes of reducing the burden of AMR in low- and middle-income countries.

Disclosures
All authors: No reported disclosures.
2037. A Novel Strategy of Antimicrobial Stewardship in Shanghai: Preliminary Practice with Integration of Three Surveillance Networks
Authors: Wang Minggui , Hu Fupin , Hu Bijie , Lv Qianzhou , Wu Wenhui 
Published: October 2019

Abstract

Background
The bacterial resistance surveillance networks, antimicrobial clinical use surveillance networks and provincial hospital-acquired infection (HAI) surveillance have been well established in China. They aim to inform the current situation of bacterial resistance, antimicrobial use and HAI, and to guide the rational use of antimicrobials. However, these three networks presently are running separately. To increase the data value in antimicrobial stewardship (AMS)practice, those three surveillance networks are integrated in Shanghai

Methods
The Committee of Rational Use of Antimicrobials and AMS of Shanghai Municipal Health Commission, consisting of health administrators, clinical physicians and microbiologists, clinical pharmacologists and infection control experts, was formed in 2017. The oversight committee developed a comprehensive AMS score index mainly based on the surveillance data of the three networks to evaluate the AMS requirements in the hospitals. The AMS score index consists of 3 surveillance network indexes: resistance weight index; antimicrobial weight index and HAI weight index; each of the indexes is further divided into two parts, namely the surveillance quality score and data-related score. For example, the data-related score in the resistance index is calculated for the prevalence of 6 most important MDR/XDR bacteria (CRKP, CRAB, CRPA, ESBL, MRSA, VRE). A multi-disciplinary AMS team was convened to provide expert on-site visit of the hospitals and offered AMS support in the form of practical guidance and advice.

Results
AMS score and detailed score such as the prevalence of CRKP were ranked among 50 hospitals within the networks. These scores will support the AMS team to find out the main drivers of resistance/antibiotic use and thereby support appropriate interventions during the on-site visit. For example, a hospital visited which had a high consumption of carbapenems (ranked third in Shanghai) and also had a high percentage of carbapenems used in the department of liver transplantation. The advice of the on-site visit team was to encourage a more diverse group of antibiotics so as to spare carbapenems.

Conclusion
Involvement of the multi-disciplinary team and integration of surveillance networks are very helpful in AMS practice.

Disclosures
All authors: No reported disclosures.
2040. Evaluation of Inpatient Antimicrobial Prescribing Practices in Cochabamba, Bolivia
Authors: Campion Maureen G , Castro Rosario , Saavedra Borda Rocio , Wessolossky Mireya 
Published: October 2019

Abstract

Background
Many developed nations have made antimicrobial stewardship a priority, creating benchmarks and national standards. Little has been published on the antimicrobial use and stewardship efforts in resource-limited countries due to difficulties collecting data. Viedma Hospital (VH) is a 200-bed hospital in Cochabamba, Bolivia, with no formulized antimicrobial stewardship (AMS) program. To better understand the antibiotic (ABX) use at VH, a point prevalence study was conducted in partnership with UMass Medical School. Point prevalence studies comprehensively review patients prescribed antibiotics using standard criteria in the hospital at a specific point-in-time. Using prevalence studies, areas of opportunity can be identified to focus on limited AMS efforts.

Methods
This was an observational study completed through a 2-day chart review. Patients were included if they were greater than 16 y/o, admitted to the general medicine, surgical or intensive care floors at VH and receiving systemic ABXs at the time of review. Data were collected on location, clinical service, day of hospitalization, sex, age, fever, white blood cell count, immunocompromised status, ABXs prescribed including dose, duration and frequency, the indication for each ABX and microbiology results.

Results
161 patients were admitted to the hospital during the point prevalence study, of which 85 (52.7%) were prescribed ABXs. Most ABXs were empiric (83%) and frequent indications included intra-abdominal infections (21.3%) and cellulitis (14.5%). Based upon evaluation utilizing standard criteria, 60% of ABXs were considered unnecessary, inappropriate or suboptimal. Common reasons for unnecessary ABXs was the excessive length of antimicrobial therapy (14%), inappropriate dosing of ABXs (8.5%) and no documented infection (51%).

Conclusion
There is limited data discussing ABX utilization in Bolivia, despite continued use and growing resistance. The point prevalence review identified areas of inappropriate use. This evidence will be utilized to focus AMS efforts on the creation of empiric ABX selection, dose and duration recommendations for common indications.

Disclosures
All authors: No reported disclosures.
2042. Impact of an Antimicrobial Stewardship Program on the Healthcare-Associated Infections in a Third-Level Hospital in Yucatán, México
Authors: Torres Erazo Darwin Stalin , Judith Nuñez Caamal Nelda , Berenice Carrillo Basulto Milagros , Cicero Ancona Miguel , Armando Cuevas Sosa Luis , Meropenem Escuadron 
Published: October 2019

Abstract

Background
Antimicrobial stewardship programs (ASPs) promote the responsible use of antimicrobials by limiting inappropriate use. This study evaluates the impact of a prospective ASP implementation on the health-care-associated infections (HCAIs) in a third-level hospital in Yucatán, México, after the establishment of an ASP in October 2017.

Methods
This was a prospective, single-center (Hospital de Alta de Especialidad de la Península de Yucatán -HRAEPY-), pre and post-intervention study, designed to analyze the impact of an ASP on health-care-associated infections rate, during January–October 2017 (pre-ASP) and January–October 2018 (post-ASP) by using comparative descriptive statistic of the monthly and annual rate of health-care-associated infections according to hospital network of epidemiological surveillance (RHOVE) in Mexico.

Results
During 2017, RHOVE reported 225 cases of HCAIs equivalent to a rate of 7.46/1,000 days of hospital stay. After ASP in 2018, the RHOVE reported 111 cases of HCAIs, equivalent to a rate of 4.38/1,000 days of hospital stay. This difference represented a reduction of −41.28% of the rate of HCAIs in the HRAEPY (Graphic 1). Antimicrobial susceptibility increased (pre-ASP vs. post-ASP) for 3 Gram-negatives associated with HCAIs at HRAEPY: TMP/SMX for E. coli (49% to 62%), Ciprofloxacino for K. pneumoniae (42% to 51%) and Piperacillin/Tazobactam (62% to 93%); Meropenem (61% to 72%) and Ciprofloxacino (67% to 79%) for P. aeruginosa (Graphic 2).

Conclusion
ASP contributed to reducing the rate of HCAIs in the HRAEPY when it was implemented as an additional measure to the strategies for control of nosocomial infections. Additionally, this ASP caused an increase in the bacterial susceptibility of the most important microorganisms as a cause of infections associated with healthcare in HRAEPY.

Disclosures
All authors: No reported disclosures.