bluuebunny/crossref_metadata_2025_split huggingface dataset:
1783. More than Which Molecular Test: Following the Directions in How and Who to Test in the Diagnosis of Influenza
Authors: Mayer Jeanmarie , Spangler Kathryn , Hanson Kimberly , Hanson Kimberly , Fendler Jamie , Pearson Lauren , Couturier Marc Roger 
Published: October 2019

Abstract

Background
The CDC and IDSA recommend testing hospitalized patients with suspected influenza using molecular assays, in part to implement precautions to prevent transmission. Both PCR and a rapid isothermal nucleic acid amplification test (NAAT) for influenza detection are available at the University of Utah Health (UU). The UU has required the more-sensitive PCR to discontinue isolation for suspect in patients, but we hypothesized the NAAT could be sufficient in most patients.

Methods
A retrospective review of influenza diagnostics pre- and post-reinforcement of proper test procedures was performed across a university healthcare system, including a 650-bed tertiary care and 100-bed cancer hospital. During August 2018, providers and staff involved in testing were interviewed to describe their practices. Gaps were addressed in September 2018 with flyers outlining procedures, providing optimal sampling supplies, and EHR prompts for appropriate specimen type. A subset of UU patients tested by both NAAT and PCR within a 48 hour period were identified from the corporate data warehouse as Pre (September 2016 through March 2018) or Post reinforcement (October 2018 through March 2019). Agreement within PCR/NAAT test pairs was determined, with chart reviews of patients with discrepant results. Time of testing from the onset of symptoms was noted, and flu-like symptoms were defined as fever (>38°C) and cough or sore throat.

Results
Prior to reinforcement, most hospital staff were unaware of the optimal specimen type and collection swab for NAAT vs. PCR. Units initially lacked appropriate sampling supplies for NAAT. Providers complained of needing to confirm negative NAAT for inpatients with questionable symptoms, and supported the reinforcement to target follow-up PCR in those clearly symptomatic or immunocompromised. Concordance with NAAT and PCR pre- and post-reinforcement of proper test procedures when both methods were done is shown in the Figure.

Conclusion
Diagnosis of influenza is important in hospitalized patients. In addition to selecting a sensitive assay, attention to optimize test performance is critical. Our results suggest there is a need to train and monitor clinicians in identifying who to test and when, what specimen to collect and how, and in interpreting results.

Disclosures
Kimberly Hanson, MD, MHS, BioFire: Consultant, Grant/Research Support; T2 Biosystems: Consultant.
1793. Clinical Outcomes among Febrile Infants Before and After Implementation of BioFire® FilmArray® Panels
Authors: Crook Jennifer , Xu Meng , Slaughter Chris , Browning Whitney , Estrada Cristina , Gay James , Thomas Gale , Quinn Criziel , Benton Alison , Schmitz Jonathan , Banerjee Ritu , Banerjee Ritu 
Published: October 2019

Abstract

Background
The clinical benefits of multiplex polymerase chain reaction panels are not well defined. We evaluated outcomes among infants before and after implementation of the BioFire® FilmArray® Respiratory Panel 2 (RP2) and Meningitis Encephalitis Panel (MEP).

Methods
This single-center study compared outcomes among infants ≤ 90 days presenting to the Emergency Department with fever (T ≥ 38.0°C) or hypothermia (T < 35.8°C) during 3 time periods. P1 (January 1, 2011–December 31, 2014) had batch testing using a Genmark Dx® respiratory viral panel (RVP) and no standardized clinical practice guideline (CPG); P2 (January 1, 2015–April 30, 2018) had the RVP and a CPG; and P3 (May 1, 2018–March 31, 2019) had on-demand RP2 and MEP testing and a CPG. Clinical data were collected from medical records. Statistical analyses were performed using Kruskal–Wallis and Pearson tests.

Results
There were 5195 total patients: 2514 in P1, 2082 in P2, 599 in P3. Groups did not differ in pathogens or antimicrobials used. Testing was faster and performed more commonly in P3 than P1 or P2 (P1, 10%; P2, 6.9%; P3, 71%; Table 1). From P1 to P3 there were significant decreases in length of stay (LOS), % receiving antimicrobials, antibiotic durations, ancillary test use, lumbar punctures (LPs), and chest X-rays (Table 1). In P3 compared with P2, infants more commonly received no antimicrobials (43.1% vs. 32.4%, P < 0.001; Figure 1), had fewer median (IQR) number of ancillary tests (5 (5–8) vs. 7 (3–10); P < 0.001), and shorter median (IQR) days of antibiotics (2.0 (1.0–2.7) vs. 2.4 (1.1–3.4); P < 0.001; Table 1). Among P3 infants, those with positive RP2 and/or MEP results were less likely to receive antimicrobials, be hospitalized or readmitted, had fewer ancillary tests and LPs, and shorter LOS and antibiotic durations than those with negative tests (Table 2).

Conclusion
In this large pre-post intervention study among infants ≤ 90 days with fever or hypothermia, a clinical guideline plus rapid testing with RP2 and MEP was associated with less antimicrobial use and ancillary testing than a clinical guideline alone. Infants with positive RP2 and/or MEP results had fewer admissions, shorter LOS, and less antimicrobial and ancillary test use than those with negative tests. Rapid pathogen testing has benefit for infants.

Disclosures
Ritu Banerjee, MD, PhD, Accelerate Diagnostics: Grant/Research Support; BioFire: Research Grant; Biomerieux: Research Grant; Roche: Research Grant.
1977. Comparing Acute Kidney Injury Risk among Antibiotic Classes: A Study of the FDA Adverse Event Reporting System (FAERS)
Authors: Patek Taylor M , Teng Chengwen , Kennedy Kaitlin E , Frei Christopher R 
Published: October 2019

Abstract

Background
A recent article published in 2018 studied the FDA Adverse Event Reporting System (FAERS) and listed the most common medications associated with acute kidney injury (AKI) based on number of AKI reports. In regards to antibiotics, the study only ranked vancomycin, fluoroquinolones, penicillin combinations, and trimethoprim–sulfamethoxazole as having a significant association with AKI. The objective of this study was to evaluate those and additional antibiotic classes using FAERS, and to compare their risk associated with this adverse drug event.

Methods
FAERS reports from January 1, 2015 to December 31, 2017 were included in the study. The Medical Dictionary for Regulatory Activities (MedDRA) was used to identify AKI cases. Reporting Odds Ratios (RORs) and corresponding 95% confidence intervals (95% CI) for the association between antibiotics and AKI were calculated. An association was considered statistically significant when the lower limit of the 95% CI was greater than 1.0.

Results
A total of 2,042,801 reports (including 20,138 acute kidney injury reports) were considered, after inclusion criteria were applied. Colistin had the greatest proportion of AKI reports, representing 25% of all colistin reports. Acute kidney injury RORs (95% CI) for antibiotics were (in descending order): colistin 33.10 (21.24–51.56), aminoglycosides 17.41 (14.49–20.90), vancomycin 15.28 (13.82–16.90), trimethoprim-sulfamethoxazole 13.72 (11.94–15.76), penicillin combinations 7.95 (7.09–8.91), clindamycin 6.46 (5.18–8.04), cephalosporins 6.07 (5.23–7.05), daptomycin 6.07 (4.61–7.99), macrolides 3.60 (3.04–4.26), linezolid 3.48 (2.54–4.77), carbapenems 3.31 (2.58–4.25), metronidazole 2.55 (1.94–3.36), tetracyclines 1.73 (1.26–2.36), and fluoroquinolones 1.71 (1.49–1.97).

Conclusion
This study found 17 classes of antibiotics and combinations that were significantly associated with AKI compared with four antibiotics that were mentioned in a recently published article looking at drug-associated AKI. While this study confirmed previous literature of certain antibiotics associated with increased risk of AKI, it also compared antibiotics within classes and provided additional insight regarding which antibiotics had the highest associated risk of an AKI.

Disclosures
All authors: No reported disclosures.
1993. Impact of Pharmacist Intervention in Response to Rapid Molecular Testing Results of Blood Cultures
Authors: Baskett Lauren , Colley Peter , Nguyen Hoa L , Berhe Mezgebe 
Published: October 2019

Abstract

Background
Rapid diagnostic testing can identify bacterial pathogens and genetic markers of resistance. This information can aid in deescalating antimicrobial therapy based on local patterns prior to the return of final culture and susceptibility reports. In August of 2017 at our institution, pharmacists were incorporated in the review of these rapid diagnostic tests in real time with recommendations for changes to therapy paged to providers. The purpose of this study was to determine whether the inclusion of a pharmacist in this workflow reduces time to change in antimicrobial therapy.

Methods
This retrospective study over two periods in 2016 and 2018 analyzed the pre- and post-implementation of a workflow incorporating pharmacist review of positive blood cultures analyzed by rapid molecular assay. Patients were included if they were at least 18 years of age and were initiated on empiric antibiotics prior to test results. Patients were excluded if transitioned to hospice within 24 hours of test results, discharged prior to test results, if more than one infectious process or organism was identified, or if test results were positive for coagulase-negative staphylococci. The primary outcome of the study was the time to change to targeted antimicrobials. Secondary outcomes were rates of Clostridium difficile infection within 3 months and inpatient mortality. Categorical variables were evaluated using chi-squared or Fisher exact tests, and continuous variables were evaluated using Wilcoxon rank-sum tests.

Results
A total of 199 patients were included, with 98 and 101 patients in the pre- and post-implementation groups, respectively. The median time to change to targeted antimicrobials was significantly reduced with pharmacist intervention from 18.35 to 8.43 hours (P = 0.042). The groups had similar rates of C. difficile infection (1% vs. 0%, P = 0.492) and mortality (7.1% vs. 5%, P = 0.564). The post-group also had significant reductions in antibiotic days of therapy (10.5 vs. 9 days, P = 0.014) and intensive-care unit length of stay (3.04 vs. 1.44 days, P = 0.046).

Conclusion
Incorporating pharmacist review of rapid molecular results of blood cultures decreased time to change in antimicrobial regimen and reduced antibiotic days of therapy.

Disclosures
All authors: No reported disclosures.
2014. Assessment of Cost, Morbidity, and Mortality Associated with Blood Culture Contamination
Authors: Davis Kevin A , Painter Jacob , Lakkad Mrinmayee , Dare Ryan K 
Published: October 2019

Abstract

Background
Blood cultures are the primary diagnostic tool for bloodstream infections, but accuracy of results is dependent on collection technique. Decreasing blood culture contaminations is a priority for antimicrobial stewardship programs as false positives can expose patients to adverse effects of unnecessary antibiotics. In this study, we present an analysis comparing clinical outcomes and cost associated with false-positive and true negative blood cultures at our institution.

Methods
We conducted a single-center, retrospective, case–control study in patients admitted following blood culture collection in the emergency department from 2014 to 2018. Demographic and clinical characteristics were evaluated in patients with false-positive blood cultures (cases) and negative blood cultures (controls). Contaminants were identified per American Society of Microbiology recommendations. Clinical outcomes were compared between cases and controls, and adjusted analyses were performed with logistic regression, linear regression, and generalized linear models controlling for age, race, body mass index, and sepsis. Statistical analysis was performed using SAS 9.4.

Results
A total of 1,102 cases and 11,266 controls were included in analysis. All clinical outcome measures were significantly higher in patients with contaminated blood cultures (see table). Select clinical outcomes remained significant when controlling for potential confounders.

Conclusion
To the best of our knowledge, this is the largest study evaluating the clinical and financial impact of blood culture contamination with inclusion of >1,000 cases during a 5-year period. Our study shows that blood culture contamination is associated with increased length of stay, unnecessary exposure to antibiotics and procedures, development of antibiotic-associated adverse events, and higher hospital charges as reported in smaller studies. However, this study is the first to the best of our knowledge reporting increased mortality associated with blood culture contamination. Implementation of innovative strategies to reduce contamination should be pursued. Antimicrobial stewardship programs should prioritize identification of contaminants and rapid de-escalation of inappropriate antibiotics in these patients to improve patient care.

Disclosures
All authors: No reported disclosures.
2034. Standardized Point Prevalence Survey on Antibiotic Use to Inform Antimicrobial Stewardship Strategies in the Caribbean
Authors: Hsieh Jenny , Sati Hatim , Ramon-Pardo Pilar , Bruinsma Nienke , F. Galas Marcelo , Marie Rwangabwoba Jean , Irene. Fletcher Payton Zoila , Bonet Mariano , Forde Corey A , Alladin-Karan Bibi A , Mohamed-Rambaran Pheona , Chery Gemma , Singh Nalini 
Published: October 2019

Abstract

Background
Inappropriate use of antimicrobials is one of the core contributors to antimicrobial resistance. While hospitals create high selection pressures on bacteria due to the high quantity and broader spectrum of antibiotics used, information on antimicrobial use at the patient level in the Caribbean is sparse. In response, PAHO implemented a standardized WHO methodology to engage national leaderships, build local capacity, and facilitate the use of data to inform antimicrobial stewardship programs (ASP) in the Caribbean.

Methods
Point prevalence surveys (PPS) were performed in four acute care hospitals in Barbados, Guyana and Saint Lucia between June and July 2018. Medical records of all inpatients were reviewed to collect information on antibiotic use, indications and use of laboratory services (Figure 1). A hospital questionnaire was used to assess hospital infrastructure, policy and practices, and monitoring and feedback systems (Figure 2). Training on PPS methods and electronic data collection tool in REDCap™ were provided to build local capacity and identify potential ASP leaderships. A standardized data validation, analysis and reporting system was built in R to streamline the process. Results and recommendations were disseminated to national authorities and stakeholders to support hospital and national decision-making and training for healthcare providers (Figure 3).

Results
A total of 60 physicians, nurses, pharmacists, laboratory technicians, and infection control specialists were trained and participated in the PPS. The survey collected records of 816 patients in which 442 (54%) were females and 374 (46%) were males. In total, 356 (44%) patients received 551 antibiotics. Overall, 300 (75%) of 398 indications for antibiotic use were treatment and 72 (18%) were prophylaxis. A higher use of parenteral antibiotics (79%) was observed compared with oral antibiotics (21%). Antibiotic prescribing patterns differed across hospitals. The most commonly used antibiotics were metronidazole (12%) and amoxicillin/clavulanate (11%).

Conclusion
The PPS method provided a feasible and effective way to collect baseline data and identify target areas for interventions. Engaging national leaderships and building local capacity offered a sustainable way in optimizing antimicrobial use in resource-limited settings.

Disclosures
All authors: No reported disclosures.
2049. Trends in Antibiotic Use and Antibiotic Resistance among Veterans Affairs Community Living Centers from 2011 to 2017
Authors: Appaneal Haley , Caffrey Aisling , Hughes Stephanie , Lopes Vrishali , Jump Robin L , Dosa David , LaPlante Kerry 
Published: October 2019

Abstract

Background
Antibiotic resistance is a global public health crisis, with antibiotic overuse contributing to selection pressure, and thus driving antibiotic resistance. Strategies to reduce antibiotic overuse may slow the development of resistance, but large-scale studies assessing trends in antibiotic use and resistance among nursing homes at the national level are limited. We describe trends in antibiotic use and resistance nationally among Veterans Affairs (VA) Community Living Centers (CLCs).

Methods
We assessed antibiotic use and microbiological cultures among VA CLC residents from 2011 to 2017. Antibiotics were grouped into eight drug classes and annual days of antibiotic therapy per 1,000 bed-days were calculated. Facility-weighted annual antibiotic resistance rates were calculated. Joinpoint Software was used for regression analyses of trends over time and to estimate annual average percent changes (AAPC) with 95% confidence intervals (CI).

Results
Over 7 years and among 146 CLCs, several significant trends in decreasing antibiotic use and corresponding reductions in resistance were identified. Fluoroquinolone use decreased by 9.9% annually (95% CI −11.6 to −8.2%) and fluoroquinolone resistance decreased by 2.3% per year for Escherichia coli, 5.1% for Klebsiella spp., 1.8% for Proteus mirabilis, 4.9% for Pseudomonas aeruginosa, 12.6% for Enterobacter spp., and 3.2% for Enterococcus spp. Anti-pseudomonal penicillin use decreased by 6.6% annually (95% CI −10.6 to −2.4%) and anti-pseudomonal penicillin resistance rates decreased each year by 7.9% for Escherichia coli, 8.9% for Klebsiella spp., 15.2% for Proteus mirabilis and 4.2% for Pseudomonas aeruginosa. Anti-staphylococcal penicillin use decreased by 5.4% annually (95% CI −10.0 to −0.5%) and resistance in Staphylococcus aureus decreased 1.7% per year.

Conclusion
Nationally among VA CLCs, we observed significant reductions in the use of several classes of antibiotics with corresponding reductions in antibiotic resistance, including an impressive decline in fluoroquinolone use and corresponding decreases in fluoroquinolone resistance among six organisms. Future research should assess whether reductions in antibiotic use predict later reductions in antibiotic resistance and improvements in resident outcomes.

Disclosures
All authors: No reported disclosures.
2052. Characterizing Nursing and Provider Social Networks to Develop an Instrument to Improve Antibiotic Stewardship Efforts in Nursing Homes
Authors: Ewers Tola , Mundt Marlon P , Crnich Christopher 
Published: October 2019

Abstract

Background
Inappropriate antibiotic use is a common problem in nursing homes (NHs). Antibiotic decision-making in NHs is complex. Characterizing the patterns and nature of social interactions between providers and nursing staff may offer insights into the factors influencing antibiotic decisions and opportunities to improve their quality in NHs.

Methods
Chart reviews and interviews with key informants were used to identify social interactions between nursing staff and providers associated with antibiotic prescribing decisions in three NHs. Data collection was restricted to provider-nurse exchanges following a resident change in condition recognition up to receipt of an order for an antibiotic. A survey administered to nursing staff was used to collect information on employment tenure and their perceptions about facility team climate. UCINET software was used to describe network characteristics, including density and centrality.

Results
Urinary tract infections (UTIs) accounted for nearly 40% of antibiotic events across all sites. The number of contacts between nursing staff and providers was approximately two-times greater for treated UTI events when compared with treated soft-tissue infections and were four-times as great as for treated pneumonia events. Network structures were different at each study NH with varying numbers of core team members and network density (Figure 1). Team climate survey responses across SNFs demonstrate generally positive climates (4.1 on a scale of 1 to 5, 5 reflects positive).

Conclusion
NHs have unique network structures; however, more complex social interactions associated with UTI events were common across all sites. Future studies should examine influences of different social network structures on antibiotic decision-making in NHs and whether modification of network structures or their characteristics is amenable to change.

Disclosures
All authors: No reported disclosures.
2053. Information Gaps Among Patients Prescribed Antibiotics on Discharge to Nursing Homes
Authors: Furuno Jon P , Noble Brie N , Weber Bo , Nordby Vicki , McGregor Jessina C , Bearden David T , Chan Dominic , Tjia Jennifer , Crnich Christopher 
Published: October 2019

Abstract

Background
Antibiotic use in nursing homes (NHs) is frequently initiated in acute care hospitals. Comprehensive antibiotic administration instructions are critical to inform antimicrobial stewardship efforts in NHs. However; little is known about the quality of discharge communication for residents transitioning from hospitals to NHs with an antibiotic prescription.

Methods
We reviewed hospital discharge summaries from a 10% random sample of hospital-initiated antibiotic prescriptions among residents of 17 for-profit NHs in Oregon, California, and Nevada admitted between January 1 and December 31, 2017. Data elements of interest were documentation of antibiotic choice, indication, instructions, and pending microbiology tests.

Results
Among 217 hospital-initiated antibiotic prescriptions, mean (standard deviation) age was 64 (29) years and 57% were female. The most frequently prescribed hospital-initiated antibiotics were cephalosporins (36%), fluoroquinolones (16%), and penicillins (14%). Hospital discharge summaries were missing from 19% (42/217) of the resident medical records. Core antibiotic prescribing information was missing from 38% (67/175) of the medical records with a discharge summary: 11% (20/175) were missing all core elements, 23% (41/175) were missing the antibiotic indication, 27% (48/175) were missing antibiotic dose, 27% (48/175) were missing antibiotic frequency, and 32% (56/175) were missing antibiotic duration. Parental antibiotics were more frequently missing information compared with oral antibiotic prescriptions (45% vs. 37%, P = 0.32).

Conclusion
Information gaps around antibiotic prescriptions are prevalent in transfer documentation for NH residents admitted from acute care hospitals. Interventions are needed to improve the quality of information transferred from acute care hospitals to NHs.

Disclosures
All authors: No reported disclosures.