bluuebunny/crossref_metadata_2025_split huggingface dataset:
107. Impact of a Rapid Blood Culture Identification Panel at a Community Teaching Hospital: a Pre-Post Quasi-Experiment
Authors: Trinh Catherine , Richardson Steven , Ereshefsky Benjamin 
Published: January 2021

Abstract

Background
Rapid diagnostic tests (RDT) for positive blood cultures can lead to quicker identification of organisms and key resistance elements. As a result time to targeted therapy may decrease, thus reducing the duration of broad, empiric antibiotic use. The purpose of this study was to determine the impact of implementing the BioFire® FilmArray® Blood Culture Identification (BCID) Panel for gram-positive organisms on antimicrobial process measures and patient outcomes at an academic community hospital.

Methods
This was a single-center, pre-post intervention, quasi-experimental study evaluating hospitalized adult patients who had at least one positive blood culture with gram-positive organisms from June 1, 2018 to August 31, 2018 and June 1, 2019 to August 31, 2019. Patients in the pre-intervention group were randomized and post-intervention patients were matched by identified organism. The primary outcome was the time to targeted therapy from blood culture collection. Secondary outcomes included time to targeted therapy from positive Gram stain, vancomycin and anti-pseudomonal β-lactam length of therapy (LOT), institutional vancomycin days of therapy (DOT), length of stay (LOS), and estimated hospitalization costs.

Results
A total of 75 patients in each group were included. The time to targeted therapy from blood culture collection was significantly decreased after RDT implementation [32.9 (23.2–51.8) hours vs. 49.2 (37.1–76.3 hours, p &lt; 0.001)], as was time to targeted therapy from Gram stain results [8.5 (0–25.2) hours vs. 30 (19.4–52.9) hours, p &lt; 0.001]. No difference was found between the groups with respect to LOS or estimated hospitalization cost. Overall the vancomycin LOT [0.86 (0.09–2.38) days vs. 2.18 (1.37–4.34) days, p = 0.001] and anti-pseudomonal β-lactam LOT for MRSA, MSSA, Streptococcus, and Enterococcus subgroup [1.15 (0.06–2.07) vs. 1.78 (1.28–2.89) days, p = 0.026] were significantly decreased in the post-RDT group.

Figure 1: Institutional Use of Vnacomycin

Conclusion
Implementation of a rapid diagnostic test on gram-positive blood cultures was associated with decreased time to targeted therapy from blood culture collection, time to targeted therapy from positive culture, and vancomycin LOT.

Disclosures
All Authors: No reported disclosures
1339. Antibiotic Prescribing Varies among Patients with a Documented Penicillin or Cephalosporin Adverse Drug Reaction
Authors: Lee Brian R , Newland Jason , Goldman Jennifer 
Published: January 2021

Abstract

Background
Studies have shown that over half of hospitalized children receive an antibiotic during their encounter, of which between 30-50% is considered inappropriate. Antibiotic prescribing is further complicated as approximately 10% of children are labeled beta-lactam allergic, resulting in the use of either broad-spectrum or suboptimal therapy. The purpose of this study was to compare antibiotic prescribing between patients with a documented ADR vs. those without using a nationwide sample of hospitalized children.

Methods
We performed a point prevalence study among 32 hospitals between July 2016-December 2017 where data were collected via chart review on pediatric patient and antimicrobial characteristics, including the indication for all antimicrobials. In additional, ADR history data were collected on which antimicrobial(s) were documented (e.g., penicillin, cephalosporins). Patients were mutually assigned into either: 1) no documented ADR; 2) penicillin ADR-only; 3) cephalosporin ADR-only; and 4) ADR for both penicillin and cephalosporin. The distribution of antibiotics were compared between the ADR groups, stratified by the indication for treatment.

Results
A total of 12,250 pediatric patients (17,929 antibiotic orders) who were actively receiving antibiotics were identified. A history of penicillin and cephalosporin ADR was documented in 5.5% and 2.8% of these patients, respectively. When compared to patients with no documented ADR, penicillin ADR patients were more likely to receive a fluoroquinolone for a SSTI infection (odds ratio [OR]: 5.6), surgical prophylaxis (OR: 18.8) or for surgical treatment (OR: 5.2) (see Figure). Conversely, penicillin ADR patients were less likely to receive first-line agents, such as narrow-spectrum penicillin for bacterial LRTI (OR: 0.08) and piperacillin/tazobactam for GI infections (OR: 0.22). Cephalosporin ADR patients exhibited similar patterns with increased use of carbapenems and fluoroquinolones when compared to patients with no ADR.
Figure 1: Odds of Receiving Select Antimicrobials Among PCN ADR Patients When Compared to Non-ADR patients, by Indication

Conclusion
A large, nationwide sample of pediatric patients who were actively prescribed antibiotics helped identify several diagnoses where comprehensive guidelines for appropriate ADR prescribing and increased ADR de-labeling initiatives are needed to ensure optimal treatment.

Disclosures
Brian R. Lee, MPH, PhD, Merck (Grant/Research Support) Jason Newland, MD, MEd, FPIDS, Merck (Grant/Research Support)Pfizer (Other Financial or Material Support, Industry funded clinical trial)
1340. Assessment of the impact of multiplex PCR panels in sepsis evaluations of young febrile infants
Authors: Ratliff Hunter , Tran Tuan , Williams-Bouyer Natalie , Nguyen Diana 
Published: January 2021

Abstract

Background
The management of febrile infants under the age of 3 months has long been a controversial topic, often requiring them to be subject to a battery of tests, antibiotics, and hospitalization. Multiplex polymerase chain reaction (PCR) panels can provide a rapid diagnosis, but their role in managing these patients is still unknown.
Our objective was to determine if multiplex respiratory and meningitis/encephalitis PCR panels decreased antibiotic duration of therapy (DOT) and hospital length of stay (LOS) when used in sepsis evaluations of febrile infants less than 90 days of age.

Methods
We performed a retrospective chart review of infants younger than 90 days old who were admitted to the pediatric ward for concerns of fever or sepsis from 1/1/2016 to 9/30/2019. Subjects with documented bacterial infections were excluded. Our primary outcomes were differences in DOT and LOS between patients admitted before and after PCR panels became available (Pre-PCR era and PCR era).

Results
118 subjects were included in our analysis, with 52 (44.1%) coming from the Pre-PCR group. Descriptive statistics, stratified by era, are available in Table 1. The unadjusted mean LOS and DOT decreased by 8.4 (P = .003) and 32.8 (P &lt; .001) hours, respectively.
Multivariate regression demonstrated that LOS was 1.16 times longer in the Pre-PCR era (95% CI: 1.10 - 1.22; P &lt; .001). Similarly, patients in the Pre-PCR era had DOT that was 1.95 times longer (95% CI: 1.55 - 2.46; P &lt; .001) when adjusting for covariates.
Adjusted LOS and DOT by Era and Diagnosis

PCR panel results by pathogen

Conclusion
We conclude that multiplex PCR panels can potentially influence the management of young febrile infants admitted for sepsis evaluations by rapidly diagnosing viral infections and thus decreasing DOT and LOS. In turn, that may improve patient outcomes and satisfaction, as well as possibly decrease costs. Multiplex PCR panels should be considered as part of routine sepsis evaluations in young febrile infants. Larger studies are needed, including in depth cost analysis.
Table 1: Demographics

Table 2: Results between Eras

Disclosures
All Authors: No reported disclosures
1342. Clinical failure rates of amoxicillin for the treatment of acute otitis media in young children
Authors: Frost Holly M , Dominguez Samuel , Parker Sarah , Byars Andrew , Michelson Sara , Keith Amy , Jenkins Timothy C 
Published: January 2021

Abstract

Background
Acute otitis media(AOM) is the most common indication for antibiotics in children. The primary pathogens that cause AOM have changed since the introduction of the pneumococcal conjugate vaccine(PCV). The clinical failure rate of amoxicillin for treatment of AOM post-PCV is unknown.We aimed to determine the clinical failure rate of amoxicillin for the treatment of uncomplicated AOM in children.
Organisms identified on culture and amoxicillin treatment failure from nasopharyngeal specimens of children age 6-35 months with uncomplicated acute otitis media at Denver Health, Denver, CO from April 2019-March 2020.

Methods
Children age 6-35 months seen at Denver Health, Denver, CO with uncomplicated AOM and prescribed amoxicillin were prospectively enrolled. An interim analysis of patients enrolled from April 2019-March 2020 was completed. Patients completed surveys that included the AOM-SOS©(UPMC, Pittsburgh, PA) at enrollment, days 5, 14, and 30 and had chart abstraction completed. Treatment failure was defined as: (1) requiring a new antibiotic within 14 days; (2) AOM-SOS© score on day 5 or 14 not improved by a relative reduction of ≥ 55% from baseline. Recurrence was defined as requiring a new antibiotic within 15-30 days. Nasopharyngeal swabs were obtained and bacterial culture was completed.

Results
In total,110 patients were enrolled. Rates of treatment failure defined by AOM-SOS© were 28.4%(37; 95%CI:25.5-33.6%) at 5 days and 15.5%(27; 95%CI:17.5-24.5%) at 14 days. However, only 4.5%(5; 95%CI:2.0-4.5%) required a new antibiotic. Recurrence occurred in 5.5% (6, 95%CI:2.5-5.5%) of patients. Of patients who had not received antibiotics before enrollment(82), culture yielded no organism in 17.0%, one organism in 42.7%, and multiple organisms in 40.0% (Table). M.catarrhalis was the most frequently identified organism (53.7% of children). Of H.influenzae isolates 52.9% (9/17) produced beta-lactamase, resulting in no treatment failures or recurrences requiring a new antibiotic. Failure rates were similar between organisms.

Conclusion
Despite the change in otopathogen prevalence post-PCV, preliminary data suggest that while early subjective treatment failure was common, the 14 day treatment failure and 30 day recurrence rates was low when measured by need for a new antibiotic. Failure was low even among patients with organisms that would not be expected to be treated successfully with amoxicillin, such as those with beta-lactamase producing H.influenzae and M.catarrhalis.

Disclosures
Samuel Dominguez, MD, PhD, BioFire (Consultant, Research Grant or Support)
1344. Impact of Pharmacist-Physician Team on Antimicrobial Utilization at a Pediatric Hospital
Authors: Sapozhnikov Julia , Fernandez Marisol 
Published: January 2021

Abstract

Background
“Handshake stewardship” is now considered a leading practice in antimicrobial stewardship (AMS) by The Joint Commission. This study aims to evaluate the impact of a pharmacist-led and physician-pharmacist led handshake stewardship method on antimicrobial utilization at a pediatric hospital.

Methods
This was a single-center, retrospective quality improvement study at a teaching children’s hospital in central Texas. We retrospectively measured hospital-wide antimicrobial utilization from June 2015 to May 2020. We compared the time periods with an ID pharmacist participating in handshake stewardship ([A] July 2012 to April 2015,[B] May 2015 to May 2018 and [D] August 2019 to May 2020) and without an ID pharmacist ([C] June 2018 to July 2019). We also compared time periods with only an ID pharmacist led ASP [A] compared to a physician-pharmacist led ASP [B].The primary endpoint was days of therapy per 1,000 patient days (DOT/1000 PD).
Table 1. Overall Antimicrobial Utilization During Changes in ASP Structure

Results
Antimicrobial utilization during pharmacist-led ASP [A] was significantly higher than during the pharmacist-physician led ASP time period [B] (95% CI, 68.8-76.8; P=0.001). No significant difference was observed for mean hospital-wide antimicrobial, meropenem, piperacillin-tazobactam, or cefepime DOT/1000 PD from period [B] to [C]. However, the increase in mean DOT/1000 PD during these time periods was statistically significant for ceftriaxone (95% CI, 6.3-23.9; P=0.001) and vancomycin (95% CI, 1.2-18.1; P=0.03). For time period [C] to [D], there was a statistically significant reduction in mean DOT/1000 PD seen in overall antimicrobial use (95% CI, 156.9-313.6; P&lt; 0.0001). Statistically significant decreases in DOT/1000 patient days were also seen for cefepime (95% CI, 11.4-36.4; P&lt; 0.0007), ceftriaxone (95% CI, 5.0-24.8; P=0.005), and vancomycin (95% CI, 6.1-23.1; P=0.002). No difference was seen for piperacillin-tazobactam or meropenem DOT from [C] to [D].
Figure 1. Hospital-Wide Monthly Days of Therapy per 1000 Patient Days

Conclusion
Active engagement with frontline providers via handshake stewardship offers a more successful approach to decreasing antimicrobial utilization. A greater reduction in overall antimicrobial utilization was seen when the ASP was led by a pharmacist-physician team compared to when it was pharmacist-led without a physician champion.

Disclosures
All Authors: No reported disclosures
1345. Impact of the COVID-19 Pandemic on Pediatric Ambulatory Antibiotic Use in an Academic Health System
Authors: Katz Sophie E , Spencer Hillary , Zhang Jim , Banerjee Ritu , Banerjee Ritu 
Published: January 2021

Abstract

Background
It is unclear how the COVID-19 pandemic has impacted outpatient pediatric antibiotic prescribing.

Methods
We compared diagnoses and antibiotic prescription rates for children pre- vs post-COVID-19 in 5 ambulatory settings affiliated with Vanderbilt University Medical Center: emergency department (ED), urgent care clinics (including pediatric-only after-hours clinics [AHC]s and walk-in clinics [WIC] for all ages), primary care clinics (PCC), and retail health clinics (RHC). Time periods were pre-COVID-19 3/1/19 – 5/15/19 (P1); and post-COVID-19 3/1/20 – 5/15/20 (P2). Diagnoses and percent of encounters with an antibiotic prescription were analyzed by encounter (in-person vs telemedicine [TMed]), clinic and provider type. We also interviewed 16 providers about perceived COVID-19 impact on pediatric ambulatory antibiotic prescribing. Student’s T and χ 2 tests were used as appropriate.

Results
The number of pediatric ambulatory visits was 16671 in P1 and 7010 in P2. There were no TMed visits in P1 vs 188 in P2 (2.7% of total P2 visits); 186 (99% of TMed visits) were in PCC (Table). In all settings, the number of encounters was lower in P2 vs P1 (p&lt; 0.001). The percent of encounters with an antibiotic prescription was lower in P2 (32%) than in P1 (38.2%) (p&lt; 0.001) (Table) overall and in all settings except RHCs. Only 14 (7.4%) TMed visits resulted in an antibiotic prescription. There were no differences in antibiotic prescribing rates by provider type. Diagnoses varied significantly between periods in all clinic types except the ED, with noninfectious diagnoses being higher in P2 vs P1 (Figure 1). Providers felt that COVID-19 led to fewer but sicker patients presenting for care, and variable impact on antibiotic prescribing (Figure 2).
Table. Percent of Encounters with an Antibiotic by Clinic Type, Pre- and Post-COVID-19

Figure 1. Diagnosis Rates by Clinic Type, Pre- and Post-COVID-19

Figure 2. Themes from Provider Interviews about perceived Impact of COVID-19 on Clinician Practice

Conclusion
The proportion of encounters with non-infectious diagnoses increased and antibiotic prescribing rates decreased significantly in all pediatric ambulatory settings post-COVID-19 except RHCs. Almost all TMed encounters occurred in the primary care setting, and few resulted in an antibiotic prescription. Providers felt they saw fewer patients and higher acuity of illness post COVID-19.

Disclosures
Hillary Spencer, MD, MPH, NIH (T32 grant support) (Grant/Research Support)
1346. Implementation of a Multidisciplinary 48 Hour Antibiotic Timeout in a Pediatric Population
Authors: Konold Victoria , Bhagat Palak , Pisano Jennifer , Pettit Natasha N , Choksi Anish , Nguyen Cynthia , Kumar Madan 
Published: January 2021

Abstract

Background
To meet the core elements required for antimicrobial stewardship programs, our institution implemented a pharmacy-led antibiotic timeout (ATO) process in 2017 and a multidisciplinary ATO process in 2019. An antibiotic timeout is a discussion and review of the need for ongoing empirical antibiotics 2-4 days after initiation. This study sought to evaluate both the multidisciplinary ATO and the pharmacy-led ATO in a pediatric population, compare the impact of each intervention on antibiotic days of therapy (DOT) to a pre-intervention group without an ATO, and to then compare the impact of the pharmacy-led ATO versus multidisciplinary ATO on antibiotic days of therapy (DOT).

Methods
This was a retrospective, pre-post, quasi-experimental study of pediatric patients comparing antibiotic DOT prior to ATO implementation (pre-ATO), during the pharmacy-led ATO (pharm-ATO), and during the multidisciplinary ATO (multi-ATO). The pre-ATO group was a patient sample from February-September 2016, prior to the initiation of a formal ATO. The pharmacy-led ATO was implemented from February-September 2018. This was followed by a multidisciplinary ATO led by pediatric residents and nurses from February-September 2019. Both the pharm-ATO and the multi-ATO were implemented as an active non-interruptive alert added to the electronic health record patient list. This alert triggered when new antibiotics had been administered to the patient for 48 hours, at which time, the responsible clinician would discuss the antibiotic and document their decision via the alert workspace. Pediatric patients receiving IV or PO antibiotics administered for at least 48 hours were included. The primary outcome was DOT. Secondary outcomes included length of stay (LOS) and mortality.

Results
1284 unique antibiotic orders (n= 572 patients) were reviewed in the pre-ATO group, 868 (n= 323 patients) in the pharm-ATO and 949 (n= 305 patients) in the multi-ATO groups. Average DOT was not significantly different pre vs post intervention for either methodology (Table 1). Mortality was similar between groups, but LOS was longer for both intervention groups (Table 1).
Impact of an ATO on DOT, Mortality and LOS

Conclusion
An ATO had no impact on average antibiotic DOT in a pediatric population, regardless of the ATO methodology.

Disclosures
All Authors: No reported disclosures
1347. Improved Antibiotic Prescribing Practices for Respiratory Infections Through Use of Computerized Order Sets and Educational Sessions in Pediatric Clinics
Authors: Zahlanie Yorgo , Mang Norman , Lin Kevin , Hynan Linda S , Prokesch Bonnie C 
Published: January 2021

Abstract

Background
The literature about comprehensive outpatient antimicrobial stewardship programs remains sparse. However, computerized clinical decision support systems (CDSSs) have shown promising effectiveness in improving outpatient antibiotic prescribing.

Methods
We developed an intervention in the form of EPIC order sets comprised of outpatient treatment pathways for 3 pediatric bacterial acute respiratory infections or ARIs (otitis media, community-acquired pneumonia, and streptococcal pharyngitis) coupled with educational sessions. Two study periods were included, and 4 pediatric clinics were randomized into intervention and control arms. Education was provided to the 2 intervention clinics between the study periods, and EPIC order sets became available to these 2 clinics at the beginning of the post-intervention period. The primary endpoint was the rate of first-line antibiotic prescribing, and the secondary endpoints included antibiotic duration and antibiotic prescription modification within 14 days.

Results
A total of 2690 antibiotic prescriptions were written for bacterial ARIs. At pre-intervention, there was no difference between the study arms in terms of first-line antibiotic prescribing (74.9% vs. 77.7%, P=0.211) and antibiotic duration (9.69 ±0.96 days vs. 9.63 ±1.07 days, P&gt;0.999). Following the intervention, the intervention clinics had higher rate of first-line antibiotic prescribing (83.1% vs. 77.7%, P=0.024) and shorter antibiotic duration (9.28 ±1.56 days vs. 9.79 ±0.75 days, P&lt; 0.001) compared to the control clinics. The rate of modified antibiotics was small in all clinics (1.1-1.6%) and not different at pre-intervention (P=0.852) and post-intervention (P=0.552).
Analysis of categorical variables

Analysis of continuous variables

Distribution of the antibiotic prescriptions among the 3 bacterial acute respiratory infections

Conclusion
A computerized CDSS involving treatment pathways in the form of order sets coupled with educational sessions was associated with a higher rate of first-line antibiotic prescribing and shorter antibiotic duration for the outpatient treatment of bacterial ARIs. More studies are needed in order to assess the utility of multimodal approaches in pediatric outpatient antimicrobial stewardship.

Disclosures
All Authors: No reported disclosures
1348. Indirect Standardization to Improve Comparison of Children’s Hospitals’ Antimicrobial Use
Authors: Wattier Rachel , Thurm Cary , Banerjee Ritu , Banerjee Ritu , Hersh Adam 
Published: January 2021

Abstract

Background
Antimicrobial use (AU) measured by days of therapy per 1000 patient-days (DOT/1000pd), the most established metric, varies widely between children’s hospitals despite robust adoption of antimicrobial stewardship. Differences in diagnoses and procedures (case mix) between hospitals are a source of AU variation not included in adjustment methods such as the Standardized Antimicrobial Administration Ratio. In this study, we evaluated an indirect standardization method to adjust children’s hospital AU for case mix.

Methods
This multicenter retrospective cohort study included 51 children’s hospitals participating in the Pediatric Health Information System database from 2016-2018. All inpatient, observation, and neonatal admissions were included, with a total of 2,558,948 discharges. Hospitalizations were grouped into 83 strata defined based on All Patients Refined Diagnosis Related Groups (APR-DRGs). Observed to expected (O:E) ratios were calculated by indirect standardization of mean antibiotic DOT per case, with expected values from 2016-2018 and observed values from 2018, and compared to DOT/1000pd. Outlier hospitals were defined by O:E z-scores corresponding to below 10th percentile (low outlier) and above 90th percentile (high outlier).

Results
Antibacterial DOT/1000pd ranged from 345 to 776 (2.2-fold variation from lowest to highest), whereas O:E ratios ranged from 0.8 to 1.14 (1.4-fold variation from lowest to highest) (Figure 1). O:E ratios were moderately correlated with DOT/1000pd (correlation estimate 0.45; 95% CI 0.19-0.64; p=0.0008). Three high outlier hospitals and 6 low outlier hospitals were identified. Examining hospitals with comparably high DOT/1000pd but discordant O:E ratios, differences could be explained by variation in both case mix and condition-specific AU within strata defined by APR-DRGs.
Figure 1. Individual hospitals labeled on the X-axis, ordered by level of antibacterial DOT/1000pd (left axis), represented by bars. Diamonds represent O:E ratios derived by indirect standardization (right axis). Outlier hospitals (low and high) are highlighted in yellow. Dashed horizontal lines represent 10th percentile (lower) and 90th percentile (upper) limits of the O:E ratio distribution.

Conclusion
The observed variation in DOT/1000pd between hospitals is reduced when indirect standardization is applied to account for case mix differences. This approach can be adapted for more specific uses including clinical conditions, patient populations, or antimicrobial agents. Indirect standardization may enhance stewardship efforts by providing adjusted comparisons that incorporate case mix differences between hospitals.

Disclosures
All Authors: No reported disclosures