bluuebunny/crossref_metadata_2025_split huggingface dataset:
1009. Measuring the quality of fluoroquinolone prescribing in hospitals: results from the Emerging Infections Program Hospital Prevalence Survey Antimicrobial Quality Assessment
Authors: Magill Shelley S , O’Leary Erin , Nadle Joelle , Johnston Helen , Janelle Sarah J , Maloney Meghan , Ray Susan , Wilson Lucy E , Lynfield Ruth , Rainbow Jean , Sievers Marla M , Dumyati Ghinwa , Ocampo Valerie , Samper Monika , Zhang Alexia Y , Evans Christopher D , Kainer Marion A , Edwards Jonathan R , Chea Nora , Neuhauser Melinda M 
Published: October 2019

Abstract

Background
Improving antimicrobial use is a key component of controlling antimicrobial resistance. Multiple factors influence inpatient provider antimicrobial prescribing decisions, making it challenging to develop standard methods to evaluate prescribing quality in hospitals. In 2015, CDC’s Emerging Infections Program (EIP) conducted a hospital antimicrobial use prevalence survey and collected data to assess prescribing quality in selected scenarios, including fluoroquinolone (FQ) treatment.

Methods
EIP sites (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN) each recruited up to 25 hospitals for the survey. Each hospital selected a survey date during May–September 2015. Among randomly selected inpatients on the survey date, EIP staff identified those ≥18 years old who received FQ treatment on the survey date or the day prior and reviewed medical records to gather data on underlying conditions, infections, and diagnostic tests. We used these data to update a previously developed prescribing quality assessment pathway that categorized FQ treatment as supported or unsupported based on medical record documentation.

Results
Among 12,299 patients in 199 hospitals, 1084 (8.7%) received FQ treatment; 756 (70%) were treated for a single infection type during their hospitalization and were ≥18 years old. The pathway categorized FQ treatment as supported for 646 (85.4%) and unsupported for 110 patients (14.6%) (figure). Almost half of unsupported treatment was due to a lack of compatible signs or symptoms of infection in a patient from whom an organism susceptible or likely susceptible to an FQ was identified from a nonsterile site (49/110 patients, 44.5%), suggesting colonization.

Conclusion
Utilization of a pathway that incorporates detailed clinical data enabled us to apply a standard approach to assess FQ prescribing quality in hospitals. A high percentage of FQ treatment was supported, possibly reflecting efforts in recent years to reduce inappropriate use. Our assessment approach also identified opportunities for further improvements in inpatient FQ stewardship. Incorporation of additional elements in the pathway, such as the availability of other antibiotic choices in clinical scenarios where FQ use is currently supported (e.g., pneumonia) could further enhance the pathway’s performance.

Disclosures
All authors: No reported disclosures.
1011. Hospital Antibiogram Variation within a Veterans Affairs (VA) Regional Network
Authors: Ho Macy , Armstrong Elizabeth R , Graber Christopher J , Chau Tony T , Johns Scott T , Namdar Rocsanna , Varker Andrew S , Ma Ariel , Goetz Matthew B 
Published: October 2019

Abstract

Background
VISN 22 is comprised of eight VA hospitals serving Southern California, Arizona, and New Mexico. The VISN 22 Antimicrobial Stewardship Workgroup formed in November 2018 with the purpose of sharing strong practices and program strategies. We compared antibiogram compilation strategies and antimicrobial susceptibilities and correlated antimicrobial susceptibilities for Pseudomonas aeruginosa and Escherichia coli with inpatient and outpatient antibiotic use.

Methods
2018 antibiograms were collected from each hospital. Antibiotic utilization rates (antibiotic days per 1000 patient-days present) were extracted from VA Corporate Data Warehouse data. Pearson correlation coefficients were calculated between 2018 utilization of specific agents and P. aeruginosa and E. coli susceptibilities to those agents at each facility.

Results
Antibiograms varied according to authorship (microbiology and/or infectious diseases), reporting frequency, rules regarding isolate reporting, and location and specimen specificity (Table 1). Facilities reported at least 90% susceptibility to a median of 3 antibiotics (range 1 to 5) for P. aeruginosa and 5 antibiotics (range 1 to 7) for E. coli.
The strongest negative correlations between antimicrobial use and susceptibility were observed for meropenem/imipenem (-0.43) and piperacillin–tazobactam (-0.41) with P. aeruginosa and piperacillin–tazobactam (-0.23) and fluoroquinolones (-0.21) with E. coli. A moderate negative correlation was observed between outpatient fluoroquinolone prescriptions per 1000 patients and E. coli susceptibility (-0.24).

Conclusion
Antibiogram composition is variable across VISN 22; not all reporting is consistent with CLSI recommendations. There was a modest correlation between some categories of antimicrobial use and resistance in P. aeruginosa and E. coli. Sharing antibiogram and antibiotic utilization data are helpful in developing antimicrobial stewardship strategies especially as we examine those hospitals with lower rates of resistance and antibiotic use.

Disclosures
All authors: No reported disclosures.
1032. Impact of an Antimicrobial Stewardship Team-Led Initiative – Assessment of Therapy Appropriateness at Patient Discharge
Authors: Epie Loveta Eningan , Timothy Caroline , Douglas-Louis Rachid , Onwumbiko Chi , Shah Gita K 
Published: October 2019

Abstract

Background
Current focus and emphasis on managed care have encouraged the practice of discharging patients admitted for infections as soon as possible which in-turn has increased the likelihood of patients being discharged on antimicrobials once the acute infection is under control. Many programs have demonstrated success of antimicrobial stewardship (AMS) initiatives but there is little in the published literature surrounding transitional care AMS.

Methods
Patients admitted to University of Maryland Prince George’s Hospital who were to be discharged on antimicrobials within 24 hours were identified during multidisciplinary patient rounds over a 2-phase period (each 3 weeks long). Rounds were attended by the AMS team composed of Post-Graduate Year 1 pharmacy residents and/or the AMS pharmacist and/or the AMS physician. Both the choice of antimicrobial and total treatment days including post-discharge days were evaluated and interventions were made based on adherence to current published guidelines. If antimicrobial selection or treatment duration appeared to be inconsistent with guidelines, the case was discussed with the prescriber and agreed-upon changes made prior to the patient’s discharge. Accepted and denied recommendations were documented. Patients were also educated on indications, directions and side effects of their antimicrobials.

Results
The AMS team evaluated patients for selected antimicrobial drug and duration of outpatient treatment over the 2-phase period with 20 patients in phase 1 and 26 patients in phase 2. Interventions needed to be made for 100% of patients in phase 1 but only for 50% of patients in phase 2. Duration of treatment was the only intervention which needed to be made with 85% of the interventions in phase 1 accepted and 85% in phase 2. The most common indications for treatment are represented in Figure 1.
The average decrease in treatment duration for phase 1 and 2 was 3.6 days and 2.8 days respectively.

Conclusion
These findings suggest that discharge AMS initiatives can decrease patients’ overall antimicrobial exposure and potential adverse events, educate providers on treatment guidelines especially of common disease states, increase overall provider compliance with evidence-based literature, and ascertain the appropriateness of therapy choices.

Disclosures
All authors: No reported disclosures.
1038. Impact of an Electronic Antibiotic Timeout on the Utilization of Frequently Prescribed Antibiotics in Hospitalized Patients
Authors: Drake Ty C , Janak Chase E , Garey Kevin W , Carlson Travis J , Musick William L , Gentry Clare N , Perez Katherine K 
Published: October 2019

Abstract

Background
Methods to operationalize antibiotic timeouts (ATO) among hospitalized patients are often constrained by the high volume of antibiotic orders that surpass the capabilities of the antimicrobial stewardship program (ASP) to intervene. Houston Methodist Hospital implemented a streamlined electronic ATO process that alerted providers to evaluate the need for continued antibiotics on day 4 of predefined anti-infective therapy. Unresolved alerts were reviewed by clinical pharmacists the following day. The objective of this study was to determine the impact of this electronic ATO on frequently prescribed antibiotics.

Methods
This was a quasi-experimental study in a 924-bed quaternary care hospital comparing days of therapy (DOT) in patients admitted prior to (February 2017 – January 2018) and after implementing an ATO process (March 2018 – February 2019). Antibiotics evaluated included vancomycin, cefepime, piperacillin/tazobactam, and meropenem. ATO alert logic was simulated retrospectively to capture the pre-ATO cohort. The primary outcome was mean composite DOT per patient admission. Secondary outcomes included total hospitalization cost, Clostridioides difficile infection (CDI) and multidrug-resistant organism (MDRO) rates.

Results
A total of 8,458 patients met ATO alert criteria for inclusion in the pre-ATO timeframe and 6,901 patients with an ATO alert in the post-ATO group; 2,642 (38%) prompted a pharmacists’ review. The average composite DOT was 11.5 per admission in the pre-ATO cohort compared with 11.1 in the post-ATO cohort (P = 0.02). After multivariate linear regression, the ATO was significantly associated with a decrease of 0.5 DOT per patient admission (P < 0.001). Other factors associated with a reduction in DOT included age (P < 0.001), service line (P = 0.003), and admission source (P = 0.031). Mean hospital costs per admission were significantly reduced in the post-ATO group: $67,613 vs. $66,615 (P = 0.01). There was no difference in rates of CDI and MDRO.

Conclusion
Implementation of our electronic ATO process demonstrated significant reductions in overall DOT for frequently prescribed antibiotics and decreased total hospital costs across a diverse patient population. This process provides a real-world strategy to operationalize a large-scale ATO as an adjunct to an ASP.

Disclosures
All authors: No reported disclosures.
1054. Impact of Prospective Review and Feedback with Peer Comparison on Carbapenem Utilization by Physicians Practicing at a Community Teaching Hospital
Authors: Rosa Rossana M , Bushman Amanda 
Published: October 2019

Abstract

Background
Behavioral interventions such as peer comparison have shown to reduce inappropriate antibiotic utilization in outpatient settings. We aimed to estimate the impact of prospective review and feedback with periodic peer comparison on carbapenem use by physicians in an inpatient setting.

Methods
Interrupted time series study conducted at a 400-bed community teaching hospital with an Antimicrobial Stewardship Program (ASP) in place since 2012. Prospective review and feedback is the ASPs main strategy. Carbapenem use is not restricted. The intervention was limited to internal medicine residents, system-employed hospitalists, critical care specialists, surgery residents and surgery attendings directly supervising residents. Each carbapenem day of therapy (DOT) was reviewed by an infectious diseases (ID) physician or ID pharmacist and classified as adequate, suboptimal unnecessary or inappropriate. For the purposes of peer comparison, each DOT was attributed to the physician directly responsible for patient care on the day a carbapenem was administered. Among patients admitted to teaching services, both the resident and their supervising attending were deemed responsible. Individual physicians’ proportions of adequate use were calculated and compared with the aggregate proportion of adequate use by service, i.e., hospitalists were compared with other hospitalists. An email summarizing utilization metrics and comparing to their peers was sent on a monthly basis. The main outcome of interest was hospital-wide carbapenem use measured in DOT per thousand patient-days. Carbapenem DOT use by service was a secondary outcome. Changes in post-intervention trends were calculated as incidence rate ratios (IRR).

Results
Following the onset of the intervention there were no changes in hospital-wide trends of carbapenem use (IRR 1.04; 95% CI 0.98–1.10; P = 0.21) (Figure 1). Analysis of carbapenem use by service showed prescribing trends remained stable within services, with IRR in medical service of 0.98 (95% CI 0.92–1.05; P = 0.61) and IRR in the surgical service of 1.05 (95% CI 0.99–1.13; P = 0.11) (Figures 2 and 3). No changes were seen in proportions of adequate use.

Conclusion
Addition of peer comparison to an ASP utilizing prospective review and feedback did not decrease carbapenem use.

Disclosures
All authors: No reported disclosures.
1079. Impact of Antimicrobial Stewardship Program (ASP) on Patients with Neurological Conditions
Authors: Hoon Andrea Kwa Lay , Wen Loo Li , Liew Yixin , Piotr Chlebicki Maciej 
Published: October 2019

Abstract

Background
Rising rates of antimicrobial resistance worldwide has dire consequences on patient care, as infections with resistant organisms impair patients’ recovery, resulting in protracted illness and hence prolonged hospital stay. Antimicrobial Stewardship Programs (ASPs) have shown to effectively reduce antibiotic resistance. Locally, we observed that patients with neurological conditions were often initiated on antibiotics for change in mental state or isolated fevers. Little is known whether these patients truly require antibiotics and hence, we aim to study the impact of ASP in these patients.

Methods
Retrospective review of ASP database between January 2014 and December 2017 was conducted, among all patients admitted to the neurology department in SGH and in whom the ASP team recommended discontinuation of empiric use of antibiotics. Demographics were collected. Clinical outcomes, duration of antibiotics therapy, length of hospital stay (LOS), infection-related readmissions and mortality, were compared between interventions accepted and rejected groups.

Results
The ASP team recommended 184 interventions [overall acceptance rate of 82.6% (152/184)]. There was no significant difference in underlying demographics, and Charlson Co-morbidity score between the 2 groups. However, the interventions-acceptance group had shorter duration of therapy by 1.67 days (4.99 ± 2.50 days vs. 6.66 ± 2.34 days; P < 0.01) and LOS by 2 days (22.5 ± 51.4 days vs. 24.5 ± 3.04 days; P = 0.83). There were no significant differences in 14-day mortality and readmission rates between the 2 groups.

Conclusion
In patients with neurological conditions, ASP interventions were safe, and associated with a significant reduction in the duration of therapy and LOS.

Disclosures
All authors: No reported disclosures.
1084. A Pre- and Post-Intervention Study to Implement a Successful Antimicrobial Stewardship Program at an Urban Chronic Hemodialysis Center
Authors: Park Jenny , Nakeshbandi Mohamed , Saggi Subodh , Sharma Roopali 
Published: October 2019

Abstract

Background
Patients receiving chronic outpatient hemodialysis (CHD) are at high risk for bloodstream and vascular access infections due to the immune-compromised status of patients and repeated vascular access. CHD patients are especially vulnerable to multidrug-resistant organisms due to extensive exposure to antibiotics (ABX). It is estimated that more than 40% of CHD patients receive ≥1 ABX course each year. As data characterizing ABX use and reasons for inappropriate prescribing is still scarce in CHD patients, our objective was to assess ABX use pre- and post-implementation of antimicrobial stewardship program (ASP).

Methods
A retrospective cohort study to analyze appropriate ABX use from 2015–2018 in CHD patients was conducted. Starting January 15, 2019, ASP was established at the hemodialysis center and tracked all ABX doses including appropriate indication, dosage, frequency, route, therapeutic drug monitoring (TDM) and duration of therapy. All results are presented as descriptive statistics.

Results
Of the 250 accounts of antibiotics that were assessed retrospectively in all patients from ages 12 to 95 years old, 50% of antibiotics ordered were inappropriately prescribed. The following were the reasons for inappropriateness: indication (59%), duration (14%), culture susceptibility (7%), dose (12%), narrow-spectrum warranted (2%), TDM (6%). Twenty-three accounts were assessed post-implementation phase. ASP implementation led to 100% compliance with regards to the appropriateness of ABX usage (indication, dose, and duration). Additional, ASP interventions included recommendations to obtain blood cultures and conduct TDM in 47% of patients.

Conclusion
This study identified inappropriateness of antibiotic usage without an established ASP in CHD patients. Implementation of ASP was associated with a positive impact on all ABX doses prescribed and this can have a significant outcome on optimizing ABX use in CHD patients.

Disclosures
All authors: No reported disclosures.
1094. Safety of Administering Cefazolin vs. Other Antibiotics in Penicillin Allergic Patients with Anaphylaxis for Surgical Prophylaxis
Authors: Song Wendy , Lau Tim , Grant Jennifer , Shajari Salomeh , Aulakh Amneet , Forrester Leslie , Partovi Nilu 
Published: October 2019

Abstract

Background
Approximately 10% of patients report a history of penicillin allergy. Recent literature suggests cross-reactivity between cephalosporins and penicillins are due to side-chain similarities. Since cefazolin has a unique side-chain from other β lactams, it can be safely administered in penicillin-allergic patients for surgical prophylaxis. Since October 2018, our hospital updated all surgical prophylaxis preprinted orders to use cefazolin in penicillin-allergic patients, except in those with histories of cefazolin-specific allergy or delayed skin reactions (e.g., Stevens–Johnson syndrome). This study aims to retrospectively determine outcomes and safety of cefazolin as compared with other antibiotics for surgical prophylaxis in penicillin-allergic patients with histories of anaphylaxis prior to implementation of cefazolin preprinted orders.

Methods
All patients with reported anaphylactic reactions to penicillins prescribed surgical prophylaxis from October 9, 2017 to October 9, 2018 were included. Patients were stratified based on antibiotic received (i.e., cefazolin, clindamycin, vancomycin, other antibiotic) and a retrospective chart review was performed to assess for outcomes and safety.

Results
One-thousand-seventy-three prescriptions for prophylactic antibiotics were identified. Of these, 223 cases met inclusion with histories of anaphylaxis to pencillins: 72 (32%) cefazolin, 70 (31%) clindamycin, 34 (15%) vancomycin, and 47 (21%) other antibiotics. General and orthotrauma surgeries used the most cefazolin in penicillin-allergic patients, while gynecology clindamycin and thoracics vancomycin. Amongst those receiving cefazolin, no critical incidents of allergic reactions were reported and the rates of adverse events, such as pruritus, hives and rash, did not differ between any antibiotic group.

Conclusion
Cefazolin appears to be a safe option for surgical prophylaxis in patients with history of penicillin anaphylaxis. No differences in incidences of allergic reactions, complications or surgical delays were reported, as compared with alternate antibiotics. Further larger studies are needed to confirm our findings and determine rates of adverse events associated with the various antibiotic regimens.

Disclosures
All authors: No reported disclosures.
1098. Perioperative Antibiotic Stewardship for Interventional Radiology Cases Improves Antibiotic Decision-Making
Authors: Sterling Stephanie , Decano Arnold , Fabian Evelyn 
Published: October 2019

Abstract

Background
Appropriate periprocedural antibiotic prophylaxis is critical to optimize in order to reduce excessive antibiotics exposure for patients and to minimize the risk for procedure-related infection. Wrong antibiotic or excess antibiotics increase the risk for development of antimicrobial resistance, Clostridium difficile infection, adverse side effects. Incorrect or missed antibiotic can put the patient at risk for an infection.

Methods
Interventions included education of vascular and interventional radiology (IR) consult RN and physicians regarding updated institutional antimicrobial prophylaxis guidelines for vascular and IR procedures, creation of a consulting template that incorporated ongoing antibiotics. Review of recent cultures was incorporated into workflow and consult evaluation. Handoff between the IR RN and IR attendings was expanded to include a review of antimicrobials.

Results
All IR cases were reviewed for antibiotic administration for 3 months pre- and post-intervention. In the pre-intervention timeframe, 23 of 290 procedures (7.9%) were associated with inappropriate antibiotic administration, further delineated as 6 cases where no antibiotics were given, 7 cases of inappropriate antibiotics administered, and 10 cases where extraneous antibiotics were administered. Of the 39 total procedures where antibiotics were indicated, 17 (43.6%) were associated with antibiotic errors. In the post-intervention period, only 9 of 309 total procedures (10.3%) were associated with inappropriate antibiotic administration: missed antibiotics in 3 cases, inappropriate antibiotics in 4 cases, and unnecessary antibiotics in 2 cases. Of the 32 cases where antibiotics were indicated, only 7 (21.9%) were associated with antibiotic errors.

Conclusion
Incorporating current antibiotics and review of culture data in a preoperative review and template for patients who need a surgical procedure helps guide appropriate antibiotic decision-making and greatly decreases administration of unnecessary antibiotics.

Disclosures
All authors: No reported disclosures.