bluuebunny/crossref_metadata_2025_split huggingface dataset:
1773. Development and Evaluation of an Automated Adenovirus Quantitative Assay Using the Luminex ARIES® System
Authors: Wu Fann , Shi Jun , Desai Shailesh , Green Daniel A , Whittier Susan 
Published: October 2019

Abstract

Background
The quantification of circulating human adenovirus (HAdV) DNA is the recommended diagnostic method to predict disseminated disease. Most current HAdV quantitative assays are manually performed and lack the flexibility needed to provide rapid answers when required.The purpose of this study was to evaluate the application of MultiCode® HAdV PCR assay for use with the Luminex ARIES® system (Luminex Corporation, Austin, TX) as an automated and random access test for the quantitative detection of HAdV DNA in plasma.

Methods
Analytical performance characteristics including assay limit of detection/quantitation (LoD/LoQ), accuracy, and inter-, intra-reproducibility were studied using commercial panels (Exact Diagnostics, Fort Worth, TX). Assay specificity was determined usingHAdV reference strains obtained from the American Type Culture Collection (Manassas, VA) and plasma spiked with related Herpes viruses and pathogens commonly found in the blood. Assay accuracy was verified with analysis of 30 plasma samples spiked with different concentrations of control material that covered the full range of HAdV DNA levels. We also prospectively analyzed 180 plasma samples collected from 102 patients. DNA from all samples were extracted, amplified and detected on a single automated Luminex ARIES® system.

Results
The assay has a wide linear range from 2.55 to 9.4 log10 HAdV DNA copies/mL (coefficient of determination; R2 = 0.995) with a detection limit of 1.82 log10 (95% positivity rate), and a limit of quantification of 2.55 log10 copies/mL. The assay detected HAdV DNA from Adenovirus groups A-F, although slight shifts in Tm peaks were observed. Inter- and intra-assay reproducibility was evaluated using 6 panels of commercial standards, producing variation coefficients of 5% and 2%, respectively. Assay accuracy results reflected a good correlation with a mean difference of 0.10 log10 copies/mL. The results of the prospective study showed 6/102 (5.8%) patients had HAdV viremia, including 4 (3.9%) patients with a viral load ≥4 log10/mL, which might necessitate therapy.

Conclusion
The HAdV quantitative assay using the Luminex ARIES® system provides excellent performance for routine testing with the additional advantage of random access capabilities for urgent testing to identify patients at risk for disseminated disease.

Disclosures
All authors: No reported disclosures.
1983. Adherence vs. Non-adherence: Clinical Outcomes of an Antimicrobial Stewardship Directed Treatment Protocol for Clostridioides difficile Infection
Authors: Begnoche Brendan , Chen Victor , Saraiya Nidhi , Guo Yi 
Published: October 2019

Abstract

Background
The 2018 Infectious Diseases Society of America (IDSA) C. difficile infection (CDI) treatment guideline no longer recommends metronidazole as first-line therapy in adults, instead recommending vancomycin or fidaxomicin. At our 1500-bed academic medical center, a new CDI treatment protocol was initiated by the antimicrobial stewardship program (ASP) to guide treatment based on disease severity and risk factors for recurrence. In this study, we compared the clinical cure rate and 30-day recurrence rate in patients who are adherent and non-adherent to our institutional CDI treatment protocol.

Methods
Patients with CDI between September-December 2018 were identified using electronic health record (EHR) reports. A retrospective chart review was conducted to collect the following information: baseline demographics, white blood cell count, CDI severity, and risk factors, etc. Outcome measures included clinical cure rate, 30-day recurrence rate, and global cure rate, stratified by whether treatment was adherent or non-adherent to institutional protocol. Student’s t-test was used for continuous variables. Fisher exact test or Chi-square test was used for categorical variables.

Results
A total of 188 patients (adherent group n = 100; non-adherent group n = 88) were included. Patient demographics and baseline risk factors did not differ between groups. Clinical cure rate was higher in adherent group (P < 0.05), while no significant differences were observed in recurrence and global cure rates between the two groups (Figure 1). The overall protocol adherence rate was 53%. The most common reasons for non-adherence are inappropriate vancomycin dose for fulminant CDI (69%) and insufficient duration of treatment (27%).

Conclusion
An ASP directed new CDI treatment protocol was successfully implemented at our institution. Patients treated according to our institutional protocol resulted in a higher overall cure rate than those non-adherent. Global cure and 30-day recurrence rates were similar. An overall protocol adherence rate of 53% is consistent with previously published literature. Future direction to develop an EHR order set with targeted recommendations is anticipated to further improve adherence and clinical outcomes.

Disclosures
All authors: No reported disclosures.
1996. Enteric Multiplex PCR Testing: Antimicrobial Stewardship Friend or Foe
Authors: Ellen Acree Mary , McElvania Erin , Charnot-Katsikas Angella , Beavis Kathleen , Matushek Scott , Pettit Natasha N 
Published: October 2019

Abstract

Background
There are advantages and challenges associated with enteric multiplex PCR testing. Fast turnaround time can lead to prompt pathogen identification and antibiotic initiation, decreased length of stay and decreased time in isolation. Challenges include identification of multiple organisms, carrier state detection, and detection of organisms with uncertain pathogenic potential, which can lead to unnecessary antibiotic use.

Methods
Two institutions transitioned from stool culture to stool PCR testing for identification of diarrheal pathogens. On February 1, 2016, Center 1 employed the BioFire® FilmArray® GI Panel, which detects 22 organisms and includes targets of unclear clinical significance. Center 2 implemented the BD MAX™ Enteric Bacterial Panel on 3/6/2019, which reports 4 bacterial known pathogens. Fluoroquinolone (FQ) and third-generation cephalosporin (TGC) prescribing in response to positive PCR testing was assessed over a 1 month period. Antibiotics were counted when prescribed within 72 hours of the collection date.

Results
At Center 1, 332 GI PCR panels were ordered, 94 (28.3%) were positive and 15 (16%) were treated; 4 received an FQ (26%), and 11 (73%) received a TGC. Center 1 organisms included 44 Clostridioides difficile, 27 Norovirus, 8 Enteropathogenic E. coli, 7 Sapovirus, 4 Campylobacter species, 2 Giardia lamblia, 2 Rotavirus, 1 Shigella/Enteroinvasive E. coli and 1 Salmonella species. Of 642 PCR tests ordered at Center 2, 16 (2.5%) were positive and 11 (69%) were treated; 10 (91%) received a FQ, and 1 (9%) received a TGC. Center 2 organisms included 8 non-typhoidal Salmonella species, 5 Aeromonas species, 2 Shigella sonnei and 1 Salmonella typhi.

Conclusion
Implementation of an enteric multiplex PCR test with targets of uncertain clinical significance is more likely to yield an abnormal result than a PCR test with only known pathogens. However, careful interpretation of results can avoid unnecessary antimicrobial use. Antimicrobial stewardship teams should work in tandem with microbiology laboratories to implement enteric multiplex PCR tests and monitor the impact on antibiotic use. Larger studies are needed to definitively assess the impact of the GI panel on antimicrobial prescribing within the context of patient comorbidities and institutional practices.

Disclosures
All authors: No reported disclosures.
2029. Prevalence of Antibiotic Use and Administration among Hospitalized Adult Patients at a Tertiary Care Hospital in Kilimanjaro, Tanzania
Authors: Lyamuya Furaha , Muro Florida , Sheng Tianchen , Mallya Rose , Uronu Tabitha S , Minde Rehema M , Anderson Deverick J , Woods Chris W , Mmbaga Blandina T , Tillekeratne L Gayani 
Published: October 2019

Abstract

Background
Antimicrobial stewardship programs (ASPs) have been shown to improve the appropriate use of antimicrobials, especially in high-income countries. However, ASPs are relatively less well implemented in low-or-middle income countries. To improve the effectiveness of ASPs in these settings, it is important to determine the core actions and targets for improving antimicrobial use. We sought to describe the prevalence and patterns of antibiotic use at a tertiary care hospital in Tanzania.

Methods
Consecutive patients admitted to an adult medical ward at a tertiary care hospital, Kilimanjaro Christian Medical Centre, in Moshi, Tanzania were enrolled from June 2018 to March 2019. The medical record was reviewed for data regarding the type of antibiotics prescribed, indications for use, and microbiologic testing ordered.

Results
A total of 1103 patients were enrolled during the study period. The majority of patients were males (663, 60.1%), with the median age being 54 years (IQR 39–70). About one-third (390, 35.4%) of the admitted patients received antimicrobials during hospitalization, with pneumonia being the leading indication for antimicrobial use (158, 40.5%). The most commonly used antibiotics included ceftriaxone in 285 (73.1%), metronidazole in 155 (39.7%), and amoxicillin/ ampicillin in 46 (11.8%) patients. The median duration of antimicrobial use was 5 days (IQR 3–7). Few patients on antimicrobials (27, 6.9%) had culture results, of which half (15, 55.6%) were positive for an organism and a minority (8, 29.6%) were susceptible to the antibiotics being used. Overall, mortality in the cohort was 22.7% and the median duration of hospitalization was 5 days (IQR 3–8).

Conclusion
Antibiotics were used in a substantial proportion of admitted patients. However, in most cases, treatment was empirical with limited use of culture results. Future ASP efforts can target the improved use of microbiologic cultures to target antimicrobial use.

Disclosures
All authors: No reported disclosures.
2038. Antimicrobial Stewardship (AS) Recognition, Confidence, and Organizational Factors: Multi-center Survey of Bedside Nurses
Authors: Monsees Elizabeth , Monsees Elizabeth , Goldman Jennifer , Popejoy Lori 
Published: October 2019

Abstract

Background
There is no literature on practices nurses associated with AS processes and how patient safety culture influences nursing AS understanding and confidence.

Methods
This cross-sectional study used an investigator-developed survey with optional comments to describe how bedside nurses recognize and perceive their confidence performing nursing activities that support AS processes and the potential role of organization culture as an AS engagement factor. 9 hospitals ranging in size from 42 to 562 beds participated. Composite scores for practice, confidence, and safety were calculated and correlated. ANOVA with Tukey HSD post-hoc tests and non-parametric (Kruskal–Wallis) tests with Bonferroni adjusted P-values for multiple comparisons were used to evaluate differences by clinical unit and years of clinical experience.

Results
A total of 558 inpatient nurses participated (response rate 13%). A significant positive association was identified between nurses’ beliefs about nursing practices that contribute to the antibiotic stewardship process and their perceived confidence to perform rs = 0.454, P < 0.001. Nurses ≤5 years of experience were significantly less confident than those with >15 years of experience in: (a) assessing for a history of an adverse drug reaction (P = 0.049, P = 0.023), (b) reviewing preliminary microbiology results and comparing susceptibilities (P = 0.011, P < 0.001), and (c) notifying a provider of a wrong antibiotic dose (P = 0.011, P = 0.017). Medical/surgical nurses (P = 0.003 recognized that taking an allergy history contributes to the stewardship process significantly more than ICU respondents and were more confident, in assuring that cultures are obtained prior to antibiotic administration (P = 0.038). Free text comments indicated: organizational factors (n = 50), knowledge gap (n = 35) and poor communication (n = 11) impeded AS engagement.

Conclusion
This is the largest multi-site study on nursing stewardship practice that includes organizational culture as a factor influencing behavior to steward. The results identify interprofessional collaboration is needed to improve organizational factors so nurses can serve as powerful AS collaborators in this important patient safety effort.

Disclosures
All authors: No reported disclosures.
2043. The “Resistance Calculator”: Refining Empiric Practices of Antimicrobials Prescription in the Era of Widespread Resistance
Authors: Zilberman-Itskovich Shani , Strul Nathan , Chedid Khalil , Shorbaje Akram , Lazarovitch Tsilia , Zohar Yarden , Razin Hadas , Low Amitai , Strulovici Ariela , Katz David , Dhar Sorabh , Milton Parsons Leo , Ramos-Mercado Abdiel , Zaidenstein Ronit , Martin Emily T , Marchaim Dror 
Published: October 2019

Abstract

Background
In the era of widespread resistance, there are two events in the course of a hospitalized septic patient where the majority of empiric prescription errors occur: (1) infections upon admission (UA) due to multi-drug-resistant organisms (MDRO) and (2) nosocomial infections due to extensively drug-resistant organisms (XDRO). These errors seriously impact patient outcomes and the ecological burden of resistance. Our objective was to develop a tool, to calculate the probability of MDRO UA, and nosocomial XDRO infections, in order to reduce delays in initiating appropriate therapy to the “right population,” i.e., with “resistant pathogens,” while avoiding overuse of broader (frequently more toxicת less efficacious) therapeutics to the “wrong population,” i.e., with “susceptible pathogens.”

Methods
Retrospective case–control analyses were conducted for septic adults at Shamir Medical Center, Israel (2016). Logistic regression was used to develop models of risk factors. All parameters incorporated into the models were readily accessible at the point of care. The performances of the development cohorts, and on 8 other validation cohorts, were assessed by the area under the receiver operating characteristic curve (ROC AUC). A web calculator (mobile modifiable) was generated.

Results
A total of 4,199 patients were enrolled: 2,472 with sepsis UA, and 1,727 with nosocomial sepsis. The “MDR UA score” included 10 parameters and with a cutoff of ≥22 points, had a ROC AUC of 0.85 (sensitivity 86%, NPV 98%). The “Nosocomial XDR score” included 7 parameters and with a cutoff of ≥36 points, had a ROC AUC of 0.88 (sensitivity 90%, NPV 96%). The median ROC AUC was 0.75 among the validation cohorts of the “MDR UA score,” and 0.66 among the “Nosocomial XDR score.” A free web tool was generated: https://assafharofe.azurewebsites.net/.

Conclusion
A simple electronic calculator was generated to aid in bedside empiric prescription practices. The tool is composed of two scores to assist in common scenarios where the majority of errors occur. Prospective interventional investigations, should trial the performances of this tool in improving patient outcomes and the ecological burden in the facility.

Disclosures
All authors: No reported disclosures.
2046. A Qualitative Study on Perceived Barriers and Facilitators of Implementing an Antimicrobial Stewardship Intervention in the Management of Urinary Tract Infections in a Long-Term Care Setting
Authors: Chan April , O’Donnell Denis , Kaasa Benjamin , Mathers Annalise , Paraschiv Nicoleta , Goldstein Mark L , Brazil Kevin , Papaioannou Alexandra , Dolovich Lisa 
Published: October 2019

Abstract

Background
50% of antibiotic courses in long-term care facilities (LTCFs) are unnecessary, leading to increased risk of harm such as Clostridiodes difficile infection and antibiotic-resistant organisms. Antimicrobial stewardship (AS) interventions play an important role in optimizing antibiotic use. Most studies addressing strategies to improve antibiotic prescribing in LTCFs showed modest and unsustained results. We aimed to identify facilitators, barriers and strategies in implementing a urinary tract infection (UTI)-focused AS intervention at an LTCF in Toronto.

Methods
A qualitative approach using conventional content analysis was used. Through purposeful sampling, we recruited different LTCF healthcare providers and administrators at Kensington Gardens. Interviewees attended focus groups or one-on-one interviews. Data were collected using a semi-structured interview guide. Data were analyzed inductively using a codebook modified in an iterative analytic process. Barriers and facilitators with potential strategies were summarized and mapped using the COM-B (capability, opportunity, motivation and behavior) model (Mitchie et al.) and emerging themes identified.

Results
Sixteen participants were interviewed. The most common barriers were family pressure, lack of access and test result delay while the barrier themes were lack of access, inadequate communication, lack of time and lack of knowledge of both HCPs and resident’s families. These can be addressed by the most common facilitators and facilitator themes, which included good communication between healthcare professionals (HCPs), education for HCPs and families and collaboration between HCPs. Most barriers and facilitators were mapped to the opportunities domain of the COM-B model.

Conclusion
Strategies for improved UTI-focused antimicrobial stewardship intervention in LTC setting should focus on increasing opportunities and innovative formats for education, communication and collaboration among HCPs and with families although barriers and facilitators in all aspects of the COM-B model were identified.

Disclosures
All authors: No reported disclosures.
2059. Antimicrobial Stewardship of Community Parenteral Antimicrobial Therapy: A Health System Approach
Authors: Buckel Whitney R , Olson Jared , Hersh Adam , Matheu Michelle , Stenehjem Edward A 
Published: October 2019

Abstract

Background
Community parenteral antimicrobial therapy (CoPAT) allows patients to receive intravenous (IV) antimicrobials outside the hospital; however, inappropriate use occurs and can lead to adverse outcomes. In addition, these patients are at high risk of readmission. Our objective was to assess the quality of CoPAT in a large healthcare system in order to guide implementation of an intervention requiring mandatory review by antimicrobial stewardship.

Methods
We identified patients with orders for IV antimicrobials at discharge between January 1 and December 10, 2018. Patients were excluded if transferred to an acute care facility, left against medical advice, or died. 250 patients were selected using a random number generator and reviewed consecutively until 100 confirmed CoPAT encounters were identified. Each encounter was evaluated for evidence of ID consultation, opportunities for stewardship interventions in seven categories (See Table 1), and adverse events such as emergency room (ER) visits and readmissions.

Results
The query identified 4,642 potential CoPAT discharges from 22 hospitals (see Table 2). 117 encounters were reviewed to reach 100 true CoPAT discharges (85% query accuracy). Of these, 55 (55%) received a formal ID consult, 6 (6%) had an ID pharmacist or ID physician curbside, and 5 (5%) had an ID clinic follow-up appointment scheduled without formal ID consult. Opportunity for stewardship intervention was found in 50 (50%) patients (see Table 1). There were 31 (31%) patients who were seen in the ER (n = 21) and/or re-admitted (n = 19) to the hospital during or shortly after completion of CoPAT, of which 25 (81%) were potentially related to CoPAT, including abnormal laboratory findings, PICC-line complications, and signs or symptoms of infection.

Conclusion
CoPAT patients are complex with high healthcare utilization. Mandatory ID review of patients receiving CoPAT has the potential to impact 2,000 lives annually in a large health system.

Disclosures
All authors: No reported disclosures.
2061. Private Practice Dentists and Orthopedic Surgeons (PPD&OS) Engage in a Novel Stewardship Forum: Consensus to Use Less Antibiotics Achieved
Authors: Goff Debra A , Mangino Julie E 
Published: October 2019

Abstract

Background
The American Dental Association (ADA) favors no antibiotic prophylaxis for joint implant patients (JIP), while the American Association of Orthopedic Surgeons’ (AAOS) guidance favors up to lifetime prophylaxis for JIP. Private practice dentists (PPD) represent 80% of all US dentists and to date, no one has attempted dental stewardship with PPD&OS to address this issue. Our purpose is to engage PPD&OS in the same room to address dental stewardship.

Methods
A town hall community evening forum led by an infectious diseases pharmacist and physician, including an oral surgeon, OS, hospital lawyers, and physicians from the CDC. One hour of didactics was presented to 28 PPD&OS followed by a breakout session with interdisciplinary groups to address 2 cases and 10 thought provoking questions to get at rationale for answers. Team leaders presented answers for discussion and “next-steps” to engage more PPD&OS. A pre- and post-survey was administered.

Results
PPD&OS’ “next-steps” were: online continuing education webinar, develop a process to inform PPD&OS if patients develop CDI or a “superbug,” more presentations by ASP experts at local/national meetings, and use local media to engage consumers. The opportunity to meet and work through cases together was highly valued.

Conclusion
An interdisciplinary community forum effectively allowed for consensus among PPD&OS to use fewer antibiotics for JIP receiving dental treatment. Fear of lawsuits impacts antibiotic use; as guidelines are updated and dental stewardship with PPD expands definitive recommendations and improved communications are key.

Disclosures
All authors: No reported disclosures.