bluuebunny/crossref_metadata_2025_split huggingface dataset:
190. Which antibiotic are you? Evaluation of a global antibiotic awareness personality quiz
Authors: Langford Bradley J , Laguio-Vila Maryrose R 
Published: January 2021

Abstract

Background
Improving understanding of the impact of antibiotic overuse is a key component of the global action plan to address antibiotic resistance. Play is an underutilized opportunity to engage adults in learning about antibiotic resistance and the importance of appropriate antibiotic use in mitigating this public health threat. Our objective was to evaluate the reach of a web-based antibiotic awareness personality quiz.
Figure 1. Antibiotic Personality Quiz Participants

Methods
A personality quiz (http://www.tiny.cc/antibioticquiz) was developed using an online platform (Tryinteract.com). The quiz included a series of short personality-based questions. Once complete, based on the responses provided, the respondent was automatically assigned an antibiotic that best matched their personality. This result was accompanied by key teaching points about the assigned antibiotic, a statement about the importance of appropriate antibiotic use and links to find more information. The quiz was launched in November 2017 to coincide with World Antibiotic Awareness Week and disseminated via social media. It was updated iteratively each year. We evaluated usage statistics from November 7 2017 to June 7 2020.

Results
During the 31-month evaluation period, there were 287,868 views of the quiz, and it was completed 207,148 times. The quiz was shared extensively on social media (Facebook 1667 shares, Twitter 1390 clicks). From a subset of 37,825 recent participants who were asked about their profession, most identified as non-infectious diseases healthcare professionals (n= 18,235, 48.2%), followed by infectious disease healthcare professionals (n=8,119, 21.8%), and healthcare students (n=6,986, 18.5%) (Figure 1). Respondents were well-represented globally, including US, Canada, Spain, France, India, United Kingdom, and Indonesia.

Conclusion
This exploratory analysis suggests incorporation of play into social media campaigns may augment the size of the receiving audience. An antibiotic awareness personality quiz engaged a high volume and broad range of non-infectious disease experts in learning more about antibiotic resistance. Antimicrobial stewards and public health campaign leaders should incorporate play into awareness opportunities and evaluate their impact.

Disclosures
All Authors: No reported disclosures
194. Antibiotic-resistant bloodstream infections in pediatric oncology patients on levofloxacin prophylaxis
Authors: Sridhar Sunita , Agrawal Anurag K , Ferrerosa Lauren , Lee Brian , Singh Prachi 
Published: January 2021

Abstract

Background
Levofloxacin prophylaxis in pediatric oncology patients with chemotherapy-induced severe prolonged neutropenia has been shown to reduce risk for febrile neutropenia and systemic infections. With increased use of prophylaxis there is concern for development of antibiotic-resistant infections. We analyzed bloodstream infections (BSI) in pediatric oncology patients exposed to levofloxacin prophylaxis during prolonged severe neutropenic episodes to determine the rate of antibiotic resistance

Methods
We performed a retrospective chart review of pediatric oncology patients who received levofloxacin prophylaxis between January 2015 – December 2019. Patients were placed on levofloxacin prophylaxis based on institutional guidelines for patients at risk for severe prolonged neutropenia (i.e., absolute neutrophil count [ANC] &lt; 500 cells/µL for &gt;7 days). Demographic information, start and end dates for levofloxacin prophylaxis, and all BSI episodes within 2 months after exposure to the fluoroquinolone were collected

Results
Thirty-five patients were identified who received levofloxacin prophylaxis. There were 32 BSI in 12 patients. Twenty-five BSI involved gram-positive organisms (GP), including nine (36%) due to coagulase negative Staphylococcus and seven (28%) due to viridans Streptococcus. Seven BSI episodes involved gram-negative (GN) organisms with 4 (57%) from E.coli. Resistance to fluroquinolones was noted in 42% and 48% of BSI from GN and GP organisms respectively. The vast majority (85%) of viridans Streptococcus isolates were resistant to levofloxacin. In contrast, 8% of viridans Streptococcus isolates were resistant to fluoroquinolones from the same time frame per our hospital antibiogram.

Conclusion
In this recent cohort of pediatric oncology patients with BSI after exposure to levofloxacin prophylaxis, there was a high percentage infected with fluoroquinolone-resistant organisms.This contrasts with some of the earlier published data from adults which reported low rate of fluoroquinolone resistance. This case series highlights the need for close monitoring for development of antibiotic resistance as utilization of prophylactic levofloxacin increases in pediatric oncology patients.

Disclosures
All Authors: No reported disclosures
195. Antimicrobial Stewardship Incorporating New Antimicrobials for Use against Multi-Drug Resistant Pseudomonas aeruginosa in Cystic Fibrosis
Authors: Jo Jinhee , Gonzales-Luna Anne J , Garey Kevin W 
Published: January 2021

Abstract

Background
Cystic fibrosis (CF) is a life-limiting genetic disease affecting approximately 80,000 people worldwide, including 30,000 in the United States. Chronic Pseudomonas aeruginosa (PA) infections in CF often develop to be multidrug-resistant (MDR) and are associated with worse clinical outcomes. Ceftolozane/Tazobactam (C/T) has shown benefits over other standards of therapy in selected populations with MDR-PA infections, but studies are lacking in the CF population. The objective of this study was to evaluate the current use and antimicrobial stewardship of C/T in CF patients with MDR-PA.

Methods
This is a retrospective study of hospitalized CF patients with infections due to positive cultures for MDR-PA from 2016–2019 at Baylor St. Luke’s Medical Center in Houston, Texas. Electronic medical records were reviewed for patient demographics, presence of infectious diseases (ID) consult, antibiotics use, and clinical outcomes. A descriptive analysis was performed to compare the patient demographics and clinical outcomes between patients receiving C/T-based and non-C/T therapies.

Results
A total of 56 CF patients with positive MDR-PA cultures were identified (18 receiving C/T and 38 receiving non-C/T antibiotics). Most MDR-PA was cultured from the lungs (94.6%, 54/56). Patient age, weight, and body mass index were similar between those receiving C/T and non-C/T therapies as was the overall duration of antibiotic therapy 16.3 (± 8.7) vs. 13.9 (± 3.5) days in C/T and non-C/T groups, respectively. More patients in the C/T group had severe forced expiratory volume in 1 s (FEV1) [£40%] at baseline (66.7% vs. 21.1%) and higher ICU admission rates (44.4% vs 2.6%). All C/T patients had an ID consult placed (3 ± 3.1 days after admission) but none in the non-C/T group. The 30-day recurrent pulmonary exacerbation rate was comparable between C/T and non-C/T groups (22.2% vs. 15.8%).

Conclusion
C/T was reserved for the sickest group of CF patients with severe FEV1. Given the devastating disease progression with MDR organisms in CF, new antibiotics with better clinical outcomes against chronic MDR-PA should be considered earlier in therapy for this population. Larger studies are warranted to analyze cost-effectiveness and clinical outcomes.

Disclosures
Kevin W. Garey, PharMD, MS, FASHP, Merck & Co. (Grant/Research Support, Scientific Research Study Investigator)
196. Assessing the Clinical Impact of Intravenous Acyclovir Dosing in Obese Patients: Should We Be Using Ideal, Adjusted, or Total Body Weight?
Authors: Mulvey Nicole , Jain Sumeet , Falsetta Keith , Doan Thien-Ly 
Published: January 2021

Abstract

Background
Obesity impacts the pharmacokinetics and pharmacodynamics of medications. Pharmacokinetic studies of intravenous (IV) acyclovir have demonstrated that dosing obese patients according to their ideal body weight (IBW) may provide a sub-therapeutic dose, while dosing based on total body weight (TBW) may increase adverse effects. This has led to the use of adjusted body weight (AdjBW) for dosing in this population; however, this has not been evaluated clinically. The purpose of this study is to assess the impact of different dosing strategies of IV acyclovir in obese patients.

Methods
This retrospective observational chart review evaluated adult patients admitted to Long Island Jewish Medical Center with a body mass index greater than or equal to 30 kg/m2 who received at least 48 hours of high-dose IV acyclovir therapy during the study period of January 2014 to August 2019. Patients were stratified to IBW, AdjBW, and TBW for analysis. The primary statistical tests utilized include descriptive statistics and logistic regression. The primary endpoint was the outcome of infection. The secondary endpoints included duration of therapy, length of stay, and adverse effects.

Results
51 patients were included in the efficacy analysis and 84 patients were included in the safety analysis. Treatment failure occurred in 3 out of 51 patients (1 patient in IBW group, 2 patients in AdjBW group, p=0.445). There was no significant difference in median length of stay (p=0.977) or median duration of IV therapy (p=0.78). Nephrotoxicity occurred in 22.2%, 19.2%, and 22.7% of patients in the IBW, AdjBW, and TBW groups respectively (p=1).

Conclusion
When comparing different dosing modalities, there was no significant difference in the outcome of infection, duration of therapy, or length of stay. The results of this study were limited by small sample size. However, dosing patients according to AdjBW led to smaller doses of acyclovir, and therefore less drug exposure.

Disclosures
All Authors: No reported disclosures
198. Clinical Prediction of Bacteremia and the Need for Early Antibiotic Therapy in Solid Tumor Cancer Patients
Authors: Hyak Jonathan M , Mohajer Mayar Al , Musher Daniel , Musher Benjamin 
Published: January 2021

Abstract

Background
Cancer patients (pts) frequently receive empiric antibiotics without clear indication. This retrospective study investigated the relationship between the systemic inflammatory response syndrome (SIRS), early antibiotic (Anb) use, and bacteremia in solid tumor pts presenting to the emergency department (ED).

Methods
We extracted data from the electronic medical records of adults with solid tumors admitted to a tertiary care hospital through the ED for any reason over a 2 year period. Pts with neutropenic fever, organ transplant, trauma, or cardiopulmonary arrest were excluded. Rates of SIRS and bacteremia among pts receiving early Anb (eAnb, within 8 hours of admission) were compared to all others using χ 2. Binomial regression and receiver operator curves assessed predictors of bacteremia.

Results
Of 3580 eligible pts, 1344 pts were SIRS positive (≥ 2 criteria) and 2236 were SIRS negative; 501 (37%) and 493 (22%), respectively, received eAnb (p&lt; 0.001). eAnb use increased with additional SIRS criteria (Fig 1). Of SIRS positive pts, 860 (64%) had BCs drawn within 48 hrs of presentation, of which 19% were positive. Of SIRS negative pts, 826 (37%) had cultures drawn within 48 hrs of presentation, of which 14% were positive (19% vs 14%, p=0.004). Of pts who had BCs drawn, the proportion of positive BCs among those who received eAnb and those who did not was identical (16% in each group; p=1). Of 276 pts ultimately proven to have bacteremia within 48 hrs, only 59% were SIRS positive, and only 49% received eAnb in the ED. By regression, only two SIRS components predicted bacteremia, fever (OR 1.8 ± 0.39, p=0.01) and tachycardia (1.4 ± 0.22, p=0.03), and SIRS criteria as a whole were poorly predictive of bacteremia (AUC 0.57, Table 1). A more robust model, which included additional labs and vital signs, was only marginally better (AUC 0.61, Table 2).
Figure 1: Proportion of patients receiving early antibiotics by SIRS score

Table 1: SIRS as a predictor of bacteremia

Table 2: Best predictive model of bacteremia

Conclusion
Clinicians still use SIRS criteria to determine the need for eAnb. However, SIRS criteria are poor predictors of bacteremia in solid tumor pts, who frequently manifest them due to complications of cancer or cancer-directed therapy rather than infection. Furthermore, patients who are SIRS negative may be bacteremic. More reliable models are needed to guide judicious use of Anb in the solid tumor population.

Disclosures
All Authors: No reported disclosures
199. Evaluating long-term care pharmacy dispense data to monitor antibiotic use in U.S. nursing homes
Authors: Gouin Katryna A , Creasy Stephen M , Kulkarni Manjiri , Wdowicki Martha , Stone Nimalie D , Hicks Lauri , Kabbani Sarah 
Published: January 2021

Abstract

Background
Automated reporting of antibiotic use (AU) in nursing homes (NHs) may help to identify opportunities to improve antibiotic prescribing practices and inform implementation of stewardship activities. The majority of U.S. NHs contract with long-term care (LTC) pharmacies to dispense prescriptions and provide medication monitoring and reviews. We investigated the feasibility of leveraging LTC pharmacy electronic dispensing data to describe AU in NHs.

Methods
We analyzed all NH antibiotic dispenses and monthly resident-days in 2017 reported by a large LTC pharmacy. The dispense-level data included facility and resident identifiers, antibiotic class and agent, dispense date and days of therapy (DOT) dispensed. We identified NH antibiotic courses, inclusive of both antibiotic starts and continuations from hospital-initiated courses, by collapsing dispenses of the same drug to the same resident if the subsequent dispense was within three days of the preceding end date. The course duration was the sum of DOT for all dispenses in the course. The AU rate was reported as DOT and courses per 1,000 resident-days.

Results
AU was described in 326,713 residents admitted to 1,348 NHs (9% of U.S. NHs), covering 38.1 million resident-days. There were 576,228 dispenses for a total of 3.3 million antibiotic DOT at a rate of 86 DOT/1,000 resident-days. After collapsing dispenses, 324,306 antibiotic courses were defined at a rate of 9 courses/1,000 resident-days. During the year, 45% of residents received an antibiotic. The most frequently prescribed classes by DOT and courses were cephalosporins, penicillins, urinary anti-infectives and quinolones (Fig. 1). The top agents by DOT were levofloxacin (12%), sulfamethoxazole/trimethoprim (12%) and cephalexin (11%). Most course durations were 1–7 days (54%) or 8–14 days (35%) (Fig. 2). Long-term antibiotic courses (&gt; 30 days) contributed to 5% of courses and 30% of overall DOT. The mean duration per course was 7.5 days when courses &gt; 30 days were excluded.
Figure 1. Distribution of antibiotic courses and days of therapy by antibiotic class for 324,306 antibiotic courses and 3.3 million days of antibiotic therapy dispensed to 1,348 nursing homes from a long-term care pharmacy in 2017

Figure 2. Distribution of antibiotic course duration and cumulative percent of total antibiotic days of therapy for 324,306 antibiotic courses dispensed to 1,348 nursing homes from a long-term care pharmacy in 2017

Conclusion
LTC pharmacy dispenses may be an accessible data source to report NH AU rates and prescribing patterns by antibiotic class and agent. Further evaluation of data sources for facility- and national-level AU reporting in NHs is needed to support stewardship implementation.

Disclosures
All Authors: No reported disclosures
200. Frequency and Characteristics of Patients Switched from Intravenous to Oral Antibiotic Therapy on Discharge to Nursing Homes
Authors: Colangeli Hailey N , Noble Brie N , Crnich Christopher J , McGregor Jessina C , Bearden David T , Chan Dominic , Furuno Jon P , Furuno Jon P 
Published: January 2021

Abstract

Background
Determining eligibility for intravenous (IV) to oral (PO) antibiotic conversion is challenging in patients transitioning to nursing homes (NHs) due to atypical infection presentation, increased diagnostic uncertainty, and multimorbidity. Understanding current practice and patient characteristics influencing prescriber behavior is necessary to provide effective antibiotic stewardship in this vulnerable population. We compared the frequency and characteristics of patients discharged with IV antibiotics to those switched from IV to PO therapy.

Methods
This was a retrospective cohort study of Oregon Health & Science University Hospital patients treated with IV antibiotics and discharged to a NH from 1/1/2016-12/31/2018. We focused on IV to PO antibiotic switch within 48 hours of discharge. Using a repository of electronic health record data, we collected patient demographic, diagnosis, length of stay, and treatment duration data.

Results
Among 2,410 patients discharged to a NH on antibiotics, 1,483 (61.5%) received an IV antibiotic within 48 hours of discharge. IV to PO switch occurred in 46.7% of patients prior to discharge, and these patients had fewer baseline comorbidities (Table 1). Of those continuing IV antibiotics, 96.1% were prescribed a different PO medication at discharge indicating potential to take PO medications. Cephalosporins (45%) and penicillins (22%) were the most commonly prescribed IV antibiotics, with IV to PO conversion rates of 26% and 46%, respectively. The median (interquartile range) outpatient duration of therapy was 21 (12–33) days for IV antibiotics and 7 (4–10) days for PO antibiotics. Osteomyelitis diagnosis was more frequent among IV therapy patients; pneumonia and urinary tract infections were more frequent in IV to PO switch patients. IV to PO switch patients were less likely to experience a hospital stay &gt; 7 days or receive an infectious disease consult (p &lt; 0.001).
Table 1. Comparison of Patient and Treatment Characteristics among IV and Oral Antibiotic Prescriptions on Discharge

Conclusion
The proportion of patients discharged to a NH on IV antibiotics remains high, even among patients able to tolerate PO medication. Continuing IV therapy was associated with longer treatment durations, hospital stays, and broad spectrum regimens, while patients with IV to PO switch had a higher comorbidity burden at baseline.

Disclosures
All Authors: No reported disclosures
203. Opportunities for Antimicrobial Stewardship in Febrile Neutropenia
Authors: Shoff Christopher , Baskett Jordan , Messina Julia A , Baker Arthur W , Turner Nicholas A , Spivey Justin , Wrenn Rebekah , Moehring Rebekah W , Spires Steven S 
Published: January 2021

Abstract

Background
Emerging evidence suggests antibiotics may be safely discontinued before neutropenia resolves in patients without identifiable infection. We estimated the volume of encounters and antibiotic use for future stewardship interventions shortening FN treatment duration.

Methods
This retrospective cohort study used electronic health records from inpatient encounters on the hematologic malignancies ward at Duke University Hospital from 5/21/2018 to 12/31/2019 where patients received at least one antibiotic for an indication of “neutropenic fever.” The primary outcome was length of therapy (LOT) of broad Gram-negative (GN) agents, including cefepime, piperacillin-tazobactam, meropenem, or aztreonam. FN LOT was counted by calendar day, starting with the first day of administration of a broad GN agent and ending with antibiotic discontinuation or hospital discharge. Encounters with at least one positive blood culture (positive cohort) were compared to those with no positive blood cultures (negative cohort) to assess if culture positivity was associated with differences in FN LOT. We included the first FN LOT from each encounter in the negative cohort and the FN LOT associated with the first positive blood culture in the positive cohort. We used descriptive statistics and a Gaussian density function to calculate the percent of encounters exceeding FN LOT of 14 days and the percent of broad GN agent days.

Results
We evaluated 15,678 GN antibiotic administrations from 471 unique FN encounters. Blood culture results were available for 443 encounters— 122 (27.5%) in the positive cohort, and 321 (72.5%) encounters in the negative cohort. Thirty percent of encounters (36/122) in the positive cohort received more than one GN treatment course, compared to 10% (32/321) of those in the negative cohort. FN LOT was significantly longer in the positive cohort (median 10.5, IQR 13 days vs. 6, IQR 8 days, p &lt; 0.001). Among encounters with negative cultures, 57 (17.8%) had a first FN LOT greater than 14 days, accounting for 44% of broad GN agent days within that population (Figure 1).
Gram-Negative Antibiotic Therapy in Blood Culture-Negative Febrile Neutropenia

Conclusion
Nearly 20% of blood culture-negative encounters received initial GN treatment courses exceeding 14 days, representing a sizeable target for antimicrobial stewardship interventions focused on FN treatment duration.

Disclosures
Rebekah W. Moehring, MD, MPH, Agency for Healthcare Quality and Research (Grant/Research Support)Centers for Disease Control and Prevention (Grant/Research Support)
207. Travel Related Risk Behaviors and Antibiotic Use among Older Travelers
Authors: Costello Varea H , Tribble David , Eickhoff Christa , Tilley Drake H , Utz Gregory , Telu Kalyani , Ganesan Anuradha , Fraser Jamie , Lalani Tahaniyat 
Published: January 2021

Abstract

Background
Older travelers (≥ 60 years) are a unique risk population for travel related infections and adverse events from antibiotics. We evaluated the differences in travel characteristics, exposures, illnesses and antibiotic use among older travelers and those between 18 – 59 y using a prospective, observational cohort of US Department of Defense (DoD) beneficiaries traveling outside the US for ≤ 6.5 months (TravMil).

Methods
Adult DoD beneficiaries were enrolled pre-travel. Itineraries limited to Western/Northern Europe, Canada, or New Zealand and active duty personnel on military travel were excluded. Demographics, itineraries and prescriptions were abstracted. A post-travel survey collected information on exposures and illnesses (travelers’ diarrhea (TD), influenza-like illness (ILI) or febrile illness). Categorical variables were analyzed using chi-square or Fishers exact test and the Mann-U Whitney test was used for continuous variables.

Results
Of the 1468 travelers, 755 were ≥ 60y and 719 were &lt; 60y. Asia (35%) and South/Central America (28%) were the most common travel regions. Older travelers were more likely to be Caucasian (80% vs. 67%), male (52% vs. 39%) and travel for tourism (84% vs. 51%) (p&lt; 0.05). Younger travelers were more likely engage in risk behaviors (e.g. consume poorly cooked meat or seafood (16% vs 9%) or street vendor food (26% vs 8.6%), wade in fresh water (24% vs. 18%), and non-compliance with malaria prophylaxis (22% vs 12%) (p&lt; 0.05). Older travelers had a lower incidence of TD (18% vs 24%), and a higher proportion of cases with loose stool or mild TD that did not interfere with daily activities (63% vs. 51%) (p&lt; 0.05). Inappropriate antibiotic use for loose stool or mild TD were similar among the two age groups (67% vs 59%). Non-significant trends of lower incidence and mild infections were observed for ILI and febrile illness in older travelers.

Conclusion
Older travelers were less likely to engage in risk behaviors, had a lower TD incidence and reported mild diarrheal symptoms. Inappropriate antibiotic use for loose stool or mild TD was common in both age groups. Enhancing antibiotic stewardship is important for older travelers to prevent potential side effects, drug interactions and antibiotic resistance.

Disclosures
All Authors: No reported disclosures