bluuebunny/crossref_metadata_2025_split huggingface dataset:
1037. A Pharmacist-Driven 48 Hour Antibiotic Time Out Pilot at a Large Academic Medical Center
Authors: Carlson Travis J , Ryan Russo Hannah , Phe Kady , Al Mohajer Mayar 
Published: October 2019

Abstract

Background
The Centers for Disease Control and Prevention published The Core Elements of Hospital Antibiotic Stewardship Programs in 2014, which recommended that all clinicians perform an antibiotic time out (ATO) after 48 hours. The best methods to operationalize these recommendations remain unclear. Given our information technology barriers, we developed a targeted, pharmacist-driven, 48 hour ATO pilot.

Methods
This pre-post intervention pilot study included hospitalized adults admitted to one of the four wards between 5/1/18 and 6/30/18. Patients who received ≥48 hours of broad-spectrum intravenous antibiotics (vancomycin, piperacillin–tazobactam, cefepime, a carbapenem, or a fluoroquinolone) were prospectively identified via TheraDoc (Premier Inc., Charlotte, NC). An infectious diseases (ID) trained pharmacist reviewed patients on a daily basis during June. The primary outcome was days of therapy (DOT), which was assessed with Spearman’s rank-order correlation. All P-values were from 2-sided tests, and results were deemed statistically significant at P < 0.05.

Results
A total of 151 unique patients were identified during the study period. The most common antibiotic indications were skin and soft-tissue infection (31.1%), urinary tract infection (22.5%), and intraabdominal infection (22.5%). An ID physician was consulted on 59% of patients. The pharmacist reviewed an average of 7 patients (3 unique) each day during the intervention month. A total of 27 recommendations were made with 15 (56%) being accepted. The most common recommendations were to de-escalate therapy (n = 8), stop antibiotics (n = 6), and add a stop date to the antibiotic order (n = 4). DOT in the pre- and post-intervention period did not differ (P = 0.28).

Conclusion
A month-long, targeted, pharmacist-driven, 48 hour ATO pilot was unable to demonstrate a reduction in DOT. Furthermore, only 56% of pharmacist recommendations were accepted despite targeting low-acuity infections, which may have limited our ability to observe a reduction in DOT. Larger studies are warranted to further evaluate how ATOs influence DOT over time.

Disclosures
All authors: No reported disclosures.
1042. Antibiotic Stewardship Program (ASP) Implementation of Short-course Antimicrobials for Low-Risk Enterobacteriaceae Blood Stream Infection (EBSI) at a Tertiary Care Center
Authors: Alex Viehman J , Scott Gordon , Goshorn Eli S , Volpe Peter , Marini Rachel V , McCreary Erin K , Nguyen Minh-Hong 
Published: October 2019

Abstract

Background
Literature demonstrates short course (e.g., 7 days) of antibiotic therapy for EBSI is appropriate in low-risk patients. Real-world experience with the implementation of this approach is not known.

Methods
In January 2019, a prospective ASP pathway was implemented to review all ESBI. The ASP contacted treatment teams of patients (patients) with low-risk ESBI between day 4–6 of antibiotic therapy to recommend short-course antimicrobial therapy (SC, ≤10 days). Low-risk ESBI was defined as: (1) venous catheter-associated infection (with removal), or an uncomplicated urinary tract infection (UTI), and 2) absence of: organ transplant, polymicrobial or persistent bacteremia ( ≥3d), or lack of improvement at 72h. Controls were pre-intervention patients with low-risk EBSI between July 2016-December 2017. Carbapenem-resistant isolates were excluded; multi-drug-resistant (MDR, ≥3 class acquired resistance) and extended-spectrum β-lactamase (ESBL) bacteria were included.

Results
Pre-intervention, 107 patients met low-risk ESBI criteria. In the intervention period, 15 patients had low-risk ESBI. The ASP pathway was executed in 13/15 patients (87%) with an 85% success rate. Charlson Comorbidity Index scores and Pitt Bacteremia Scores were similar pre- and post-intervention. The post-intervention group was older (median 71y vs. 63y, P = 0.02). Otherwise, clinical characteristics did not differ pre- and post-intervention: cirrhosis (8 vs. 13%), renal failure (4% vs. 0%), ICU admission (29% vs. 33%) and BSI with ESBL or MDR bacteria (8% vs. 7%) and (21% vs. 20%). UTI was the most common source pre- and post-intervention (61% and 73%) Time to active therapy did not differ (median 0.15d vs. 0.12d). The median duration of active therapy for ESBI was 15d pre-intervention and 8d post-intervention (P < 0.001). SC rate improved from 11% to 67% post-intervention. There was no significant difference in recurrence (2% vs. 0%), mortality (2% vs. 0%) or readmission rates (25% vs. 20%) at 30d.

Conclusion
A multidisciplinary ASP pathway for low-risk ESBI resulted in the decreased duration of antimicrobial therapy without increased rates of recurrence, readmission, or morality at 30d. SC therapy was also effective for BSI due to MDR or ESBL producing bacteria.

Disclosures
All authors: No reported disclosures.
1051. The Use of Survey-Driven Feedback to Improve Antimicrobial Stewardship Efforts at a Single Center
Authors: Albarillo Fritzie S , Joyce Cara J , Santarossa Maressa 
Published: October 2019

Abstract

Background
Antimicrobial stewardship (AS) efforts have led to improved patient outcomes, reduction in unnecessary costs, and decrease in antimicrobial resistance (AR). Loyola University Medical Center (LUMC) is a quaternary care system that has primarily employed a formulary restriction and preauthorization process as the foundation of its Antimicrobial Stewardship Program (ASP).

Methods
In January 2018, a voluntary online survey was created and disseminated to all providers at LUMC to evaluate their baseline knowledge and perception of AS and AR, as well as to solicit feedback on current AS practices at LUMC. Based on the results of the survey, our AS team implemented the following changes to the AS program: removed prior-authorization of cefepime, piperacillin–tazobactam and vancomycin; required documentation of antimicrobial indications and duration upon order entry in the electronic medical record; and provided education to all providers via newsletters and lectures. In January 2019, a second survey was distributed to all providers with the primary goal of evaluating changes in the providers’ knowledge and perception of AS and AR post-program modifications. The secondary goal was to gather feedback on the major changes we have implemented in our program.

Results
A total of 167 providers completed the first survey and 173 completed the second survey. Over 95% of providers were aware that inappropriate use of antimicrobials can be harmful to patients, and that AS can decrease AR. Unfamiliarity with AS practices remains an issue. More than half agreed that unrestricting antibiotics improved their workflow, though almost half agreed that it led to inappropriate use by providers in general but not their own. Finally, most providers agreed that documenting indications and duration of antibiotics facilitated antibiotic optimization with no interference in their workflow.

Conclusion
Hospital-specific surveys on providers’ perception and knowledge on AS and AR can be used to guide future ASP interventions, as well as to evaluate the effectiveness of these interventions. Our ASP at LUMC implemented strategies to improve antimicrobial utilization based on our providers’ feedback. Our team will continue to use surveys to further guide our AS efforts.

Disclosures
All authors: No reported disclosures.
1090. Practicing Antimicrobial Stewardship: De-escalating Empiric Antibiotics in Patients with Acute Myelogenous Leukemia and Neutropenic Fever
Authors: Fuller Risa , Moshier Erin , Jacobs Samantha E , Tremblay Douglas , Lancman Guido , Coltoff Alexander , Caro Jessica , Mascarenhas John , Rana Meenakshi 
Published: October 2019

Abstract

Background
In the era of increased antibiotic resistance, minimizing the use of broad-spectrum antibiotics is essential. We sought to determine whether there was a difference in risk of recurrent fever in patients with acute myelogenous leukemia (AML) and neutropenic fever without an identifiable source in which antibacterials were de-escalated prior to neutrophil recovery compared with those that continued until recovery.

Methods
We performed a retrospective chart review of adult patients with AML undergoing induction chemotherapy at Mount Sinai Hospital in New York, NY from 2009–2017. Neutropenic fever was defined as a temperature of 100.4°F for 1 hour or single temperature of 101°F in a patient with an absolute neutrophil count (ANC) of less than 500 cells/μL. Febrile patients were treated with cefepime, piperacillin–tazobactam, or a carbapenem. De-escalation was defined as changing from one of these antibiotics to antibacterial prophylaxis such as levofloxacin, or discontinuing antibiotics. The primary outcome was recurrent neutropenic fever. Secondary outcomes were adverse events related to antibiotics, intensive care unit (ICU) transfer, and all-cause mortality.

Results
Of 390 AML patients undergoing induction chemotherapy, 135 had a neutropenic fever; of whom, 77 had no identifiable infectious source. Of those 77, 38 had antibiotics de-escalated prior to ANC recovery (“short”) and 39 had antibiotics continued until ANC recovery or discharge (“long”). Demographics were similar (Table 1). The median number of antibiotic days for the first fever was 9 in the short group and 15 in the long group (P = 0.0008) (Table 2). Risk of recurrent fever was 46% lower in the short group compared with the long group (hazard ratio 0.54, 95% CI: 0.34–0.88; P = 0.01). There was no significant difference in ICU transfer (P = 0.11) and in-hospital mortality (P = 0.36) between the short and long groups (Table 2). There were 7 adverse drug outcomes, 2 in the short group and 5 in the long group (Table 3).

Conclusion
Antibiotic de-escalation in AML patients with neutropenic fever with no identifiable infectious source was associated with a lower rate of recurrent fever without affecting ICU transfer, adverse drug events, and death. Physicians should consider de-escalation prior to ANC recovery in the appropriate setting.

Disclosures
All authors: No reported disclosures.
1128. Knowledge, Attitudes and Perceptions about Antibiotic Stewardship (AS) Programs among Neonatology Trainees
Authors: Akinboyo Ibukunoluwa C , Mukhopadhyay Sagori , Dukhovny Dmitry , Young Rebecca R , Puopolo Karen , Guzman-Cottrill Judith 
Published: October 2019

Abstract

Background
Antibiotic stewardship (AS) is a fundamental aspect of medical training. Neonatal Intensive Care Units (NICU) often have unique stewardship needs as they are ideal settings for the emergence and spread of drug-resistant bacteria. Assessing neonatology fellowship trainees’ knowledge and perceptions will highlight deficits in AS education and inform future curriculum development.

Methods
Prospective electronic survey study, distributed by Accreditation Council for Graduate Medical Education (ACGME) program directors to neonatology fellows in the United States over 4 months (January to April 2018). The objective was to assess neonatology fellows’ knowledge, attitudes and perceptions about AS to inform sustainable NICU-specific AS programs.

Results
Of 99 programs and 700 fellows, 159 respondents (23%) from 40 neonatology training programs (40%) responded to the survey and 139 (87%) provided complete responses. Respondents were equally spread across all 3 years of training
Seventy-two percent confirmed an institutional AS program existed, yet, only 33% were able to identify the components of AS programs and 66% either did not or were unsure if they had received AS training during fellowship. Furthermore, only 51% identified the appropriate empiric antibiotic for neonatal meningitis and 12% identified optimal methicillin-susceptible Staphylococcus aureus (MSSA) treatment while answering clinical case study questions. Notably, fellowship training year was not significantly related to the proportion of incorrect responses (P = 0.40).
Small group sessions were identified as the best teaching format (35%). This was followed by audit and feedback of individual prescribing behavior and didactic lectures which had an equal proportion of respondents (22%). Seventy-eight percent of respondents preferred a trainee-led AS program targeting necrotizing enterocolitis, antifungal prophylaxis and appropriate surgical prophylaxis.

Conclusion
Antibiotic stewardship is a critical part of physician training. While most institutions have a stewardship program, a dedicated curriculum incorporating small group sessions and didactics may be beneficial for educating neonatology trainees.

Disclosures
All authors: No reported disclosures
1130. Vancomycin Use in Pediatric Severe Sepsis at a Freestanding Children’s Hospital
Authors: Islam Shamim M , Yi Stacie M , Miller Anna , Sandhu Gurjot , Hassinger Amanda 
Published: October 2019

Abstract

Background
Surviving Sepsis Campaign guidelines recommend antibiotics be administered within 1 hour of severe sepsis (SS) onset, but do not suggest which agents to give. Vancomycin (VAN) is often chosen as empiric therapy for severe sepsis (SS) in children without evidence of the prevalence or risk factors for infections requiring VAN. As VAN is associated with significant nephrotoxicity, this study was performed to measure the risk-benefit ratio of empiric VAN use in pediatric sepsis.

Methods
This was a retrospective study of children with SS between 1/1/2015 to 6/30/2018 at the Women and Children’s Hospital of Buffalo, as captured by billing data and sent to state Department of Health for mandated reporting. SS cases were assessed for risk factors for Gram-positive infections, including presence of a central venous line (CVL) or other invasive device; history of MRSA infection or nasal colonization within the last 2 years; skilled nursing facility (SNF) residence; and prolonged hospitalization of >1 month. Invasive infections for which vancomycin is an optimal agent, specifically culture-proven methicillin-resistant Staphylococcus aureus (MRSA), coagulase-negative Staphylococcus (CoNS), and ampicillin-resistant Enterococcus infections, were defined as vancomycin requiring (VAN-req). Acute kidney injury (AKI) was defined as having a serum Creatinine of twice normal per age-related reference values.

Results
Of 304 identified SS cases, 8.9% had VAN-req infections. VAN was empirically given to 58.2% of cases (177); 86.4% ultimately did not have VAN-req infections. 9.2% of all SS cases had AKI at SS onset; this included 15.8% of patients (28) receiving VAN, of which only 1 (3.6%) had a VAN-req infection. History of a past MRSA infection, prolonged hospitalization, SNF residence, and CVL presence were found to be independent risk factors for a VAN-req infection (Table 1). VAN-req infections in patients lacking these four risk factors was 3.1% (4/130).

Conclusion
VAN was given empirically in the majority of pediatric SS cases, but culture-proven infections requiring the drug were infrequent, especially in patients without specific risk factors. The use of empiric VAN for SS should be guided by well-defined criteria, as the drug’s potential risks are likely to outweigh any benefit in most patients.

Disclosures
All authors: No reported disclosures.
Development of a 22/43 GHz-band quasi-optical perforated plate and dual-band observation system of the Nobeyama 45 m telescope
Authors: Okada Nozomi , Hashimoto Ikumi , Kimura Kimihiro , Manabe Takeshi , Tokuda Kazuki , Onishi Toshikazu , Ogawa Hideo , Imai Hiroshi , Minamidani Tetsuhiro 
Published: October 2019

Abstract
We have developed a system of simultaneous observations in the 22 and 43 GHz bands using the Nobeyama 45 m telescope, and are also working to add the 86 GHz band. Multi-frequency observations are realized by mounting perforated plates in the optics as dichroic frequency-selective devices. This paper presents the development of the perforated plate for the 22 and 43 GHz bands and the results of the commissioning observations with this plate on the Nobeyama 45 m telescope. The perforated plate is designed to be installed in the large telescope optics with a physical beam diameter as large as $50\:$cm for transmitting the higher frequency (43 GHz) band and for reflecting the lower frequency (22 GHz) band. The developed plate achieves an insertion loss of $0.22\:$dB (5%) at $43\:$GHz. The effects of the mounted plate on the systematic offsets and on the accuracy degradation of pointing were confirmed to be negligible. The differences in the main-beam/aperture efficiencies from those without the plate were confirmed to be within a few percent points. In addition, we successfully detected interferometry fringes in a very long baseline interferometry (VLBI) observation using the 45 m telescope and the VLBI Exploration of Radio Astrometry (VERA) 20 m telescopes, which confirmed that the dual-band observation system is operationally effective in both single-dish and VLBI observations.
Image-processing the topological charge density in the $\mathbb{C}P^{N-1}$ model
Authors: Abe Yuya , Fukushima Kenji , Hidaka Yoshimasa , Matsueda Hiroaki , Murase Koichi , Sasaki Shoichi 
Published: October 2019

Abstract
We study the topological charge density distribution using the 2D $\mathbb{C}P^{N-1}$ model. We numerically compute not only the topological susceptibility, which is a spatially global quantity, to probe the topological properties of the whole system, but also the topological charge correlator with finite momentum. We perform a Fourier power spectrum analysis for the topological charge density for various values of the inverse temperature $\beta$. We propose to utilize the Fourier entropy as a convenient measure to characterize spatial distribution patterns and demonstrate that the Fourier entropy exhibits nontrivial temperature dependence. We also consider the snapshot entropy defined with the singular value decomposition, which also turns out to behave nonmonotonically with the temperature. We give a possible interpretation suggested from the strong-coupling analysis.
Increased blood pressure during the suggested immobilization test in Restless Legs Syndrome
Authors: Rassu Anna Laura , Chenini Sofiène , Barateau Lucie , Lopez Regis , Evangelista Elisa , Guiraud Lily , Jaussent Isabelle , Dauvilliers Yves 
Published: October 2019

Abstract

Objective
To investigate the relationship between sensory discomfort/motor component and cardiovascular autonomic response by continuous beat-to-beat blood pressure monitoring (CBPM) during the suggested immobilization test (SIT) in patients with restless legs syndrome (RLS).

Methods
Thirty-two drug-free patients with primary RLS (10 men; mean age 60.29 ± 10.81 years) and 17 healthy controls (2 men; mean age 58.82 ± 11.86 years) underwent a 1-hour SIT starting at 8 pm with concomitant CBPM to measure the heart rate (HR) and systolic/diastolic blood pressure (SBP, DBP). In all subjects, the presence of sensory discomfort and motor component during the SIT (S-SIT+ and M-SIT+, respectively) was quantified. Mixed regression models were used to compare the SBP, DBP, and HR profiles during the SIT by taking into account the repeated measures (6 time periods of 10 minutes).

Results
In patients with S-SIT+ (n = 17), SBP (p &lt; 0.0001), DBP (p = 0.0007), and HR (p = 0.03) increased during the SIT compared with other patients and controls. Seventeen patients had M-SIT+ (none among healthy controls). Classifying patients in 4 groups in function of the presence/absence of the SIT sensory and motor components revealed that SDB and DBP increased throughout the SIT in patients with S-SIT+, independently of the motor component (p &lt; 0.0001 and p = 0.0008 for SBD; p &lt; 0.0001 and p = 0.01 for DBP in the S-SIT+/M-SIT− and S-SIT+/M-SIT+ groups, respectively).

Conclusion
During the SIT, BP concomitantly increased only in patients with RLS and sensory discomfort, with or without motor component. This highlights the link between evening sensory RLS symptoms, autonomic activation, and potential long-term cardiovascular consequences.
Keeping Residents Well: How Important Are Perceptions of Program Support and Psychological Safety to Resident Wellness?
Authors: Hylton Jordan , Karjane Nicole , Santen Sally , Rigby Fidelma , Appelbaum Nital 
Published: October 2019

PURPOSE:
We aimed to test whether measures of resident well-being correlated with perceptions of program support and psychological safety.

BACKGROUND:
Trainee well-being is a crucial component of developing competent and skilled OB/GYN physicians. While there are several measures of well-being collected at the national-level, there is little insight in the role of individual programs to foster trainee well-being. Perceived organizational and psychological safety are two constructs that can help identify cultural aspects of the clinical learning environment that may relate to trainee well-being.

METHODS:
OBGYN residents in a training program were recruited to complete an IRB-approved survey through paper and electronic methods between May-June 2018. Measures included the Survey of Perceived Organizational Support (POS), Psychological Safety Scale (PS), Perceived Stress Scale (PSS), Wayne State Wellness Scale (RWS) and Physician Well-Being Index (PWBI); all demonstrate validity and reliability evidence to assess factors of well-being and cultural aspects of the training program.

Results:
20 OBGYN residents completed our survey. Results indicated a strong relationship between perceived organizational support and wellness (r=.62, P<.01 for RWS, r=.50, P<.05 for PWB)., suggesting greater perceptions of support relate to better wellness. Similarly, psychological safety also had a strong relationship with wellness (r=.56, p<.05 for RWS; r=-.72, p<.01 for PWB).

DISCUSSION:
Our findings suggest that there is a strong relationship between trainee wellness and the cultural measures of support and safety, especially between psychological safety and negative indicators of well-being (e.g., feeling burnt out from work, feelings of irritation). Further research should include interventions to improve perceptions of support and safety.