bluuebunny/crossref_metadata_2025_split huggingface dataset:
590. Vancomycin Infusion: Algorithmic Analysis of Unstructured Real-World Data Captured from Automated Infusion Devices
Authors: Bostick David L , Yu Kalvin , Yamaga Cynthia , Liu-Ferrara Ann , Morel Didier , Tabak Ying P 
Published: January 2021

Abstract

Background
Large scale research on antimicrobial usage in real-world populations traditionally does not consist of infusion data. With automation, detailed infusion events are captured in device systems, providing opportunities to harness them for patient safety studies. However, due to the unstructured nature of infusion data, the scale-up of data ingestion, cleansing, and processing is challenging.
Figure 1. Illustration of dosing complexity

Methods
We applied algorithmic techniques to quantitate and visualize vancomycin administration data captured in real-time by automated infusion devices from 3 acute care hospitals. The device data included timestamped infusion events – infusion started, paused, restarted, alarmed, and stopped. We used time density-based segmentation algorithms to depict infusion sessions as bursts of event activity. We examined clinical interpretability of the cluster-defined sessions in defining infusion events, dosing intensity, and duration.

Results
The algorithms identified 13,339 vancomycin infusion sessions from 2,417 unique patients (mean = 5.5 sessions per patient). Clustering captured vancomycin infusion sessions consistently with correct event labels in &gt;98% of cases. It disentangled ambiguity associated with unexpected events (e.g. multiple stopped/started events within a single infusion session). Segmentation of vancomycin infusion events on an example patient timeline is illustrated in Figure 1. The median duration of infusion sessions was 1.55 (1st, 3rd quartiles: 1.14, 2.02) hours, demonstrating clinical plausibility.

Conclusion
Passively captured vancomycin administration data from automated infusion device systems provide ramifications for real-time bed-side patient care practice. With large volume of data, temporal event segmentation can be an efficient approach to generate clinically interpretable insights. This method scales up accuracy and consistency in handling longitudinal dosing data. It can enable real-time population surveillance and patient-specific clinical decision support for large patient populations. Better understanding of infusion data may also have implications for vancomycin pharmacokinetic dosing.

Disclosures
David L. Bostick, PhD, Becton, Dickinson and Co. (Employee) Kalvin Yu, MD, Becton, Dickinson and Company (Employee)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Cynthia Yamaga, PharmD, BD (Employee) Ann Liu-Ferrara, PhD, Becton, Dickinson and Co. (Employee) Didier Morel, PhD, Becton, Dickinson and Co. (Employee) Ying P. Tabak, PhD, Becton, Dickinson and Co. (Employee)
591. A Model for assessing staffing needs for an Outpatient Parenteral Antibiotic Therapy (OPAT) program
Authors: Munsiff Sonal , Burgoyne Colleen , Goins Peter 
Published: January 2021

Abstract

Background
Management of patients needing OPAT is complex, and requires a multidisciplinary team for transitioning patients from inpatient to outpatient care, ongoing monitoring of labs, antibiotic levels, managing complications of the drugs and intravenous access, and communicating with patients, family, home infusion pharmacies, home care nursing agencies, and the patients’ physicians and other providers. In addition, documentation of each of these activities in the EMR is necessary. Guidance on how to determine number of staff needed for an OPAT program is lacking.

Methods
We created a detailed step by step list of the various activities done by our OPAT nurse (RN) and determined the time needed to perform each activity. We calculated how many hours of nursing time would be needed per week to perform all the activities for patient care based on our OPAT volume.

Results
In 2019 we enrolled 767 patients in 835 episodes of OPAT. Our weekly census averages about 120–135 patients. Median duration on OPAT was 30 days. We calculated that our OPAT RN workload was an average of 47.5 hours/week (range of 40–55 hours/week), with time per activity ranging from 5 minutes to 3 hours (table). As this calculated to more than one full time RN position, additional staff were requested.
Assessment of Staffing Requirements for an OPAT Program

Conclusion
We have assessed the workload for OPAT RN(s) in our program based on our 2019 patient volume. We recommend that one RN can safely manage about 500–550 patients per year. Based on this analysis we were successfully able to justify the need for a second RN for our program.
Any OPAT Program can do such analysis to determine their OPAT staffing needs, and also plan for the anticipated increases in OPAT volume because of increasing longevity of the population, increase in diabetes incidence, invasive procedures such as arthroplasties, cardiac devices, etc.

Limitations
This analysis does not include time spent by inpatient staff to arrange for home care and home infusion services. It also does not account for an ID pharmacist time, or the physicians and APP time for management of these patients outside of the billable visit.

Disclosures
All Authors: No reported disclosures
595. Characteristics of Antimicrobials Which Affect Parenteral Antibiotic Therapy Outcomes
Authors: Shah haroon M , Guenther Erin , Dysart Claire , Sherman Katherine , Gundacker Nathan 
Published: January 2021

Abstract

Background
Outpatient parenteral antibiotic therapy (OPAT) has reduced length of stay, decreased nosocomial infections, and improved patient satisfaction/outcomes. Factors for choosing candidates and regimens for OPAT include: type of infection, organisms, antibiotic side effects, number of antibiotics and frequency of administration. This study sought to evaluate if antibiotic type, frequency, and duration, are associated with complications, and particularly if vancomycin is associated with an increase rate of complication.

Methods
Retrospective chart review of Zablocki VA Medical Center patients, Milwaukee, WI discharged from 2013-2017 on OPAT evaluated types of infection, antimicrobial regimens, number of antibiotics, duration, frequency, adverse events and outcomes. Primary outcome analyzed was whether or not there was a complication. Complication defined as antibiotic change/dose adjustment, PICC line complication, or additional clinic/hospital visit

Results
294 cases identified during study period. 286 (95.7%) were male. Most common antibiotics were vancomycin (78; 26.53%), daptomycin (42;14.9%) ertapenem (81, 27.55%), cefazolin (24;8.16%) and ceftriaxone (50;17%). Staphylococcus and Streptococcus were the most common organisms at 42.86% and 22.79% respectively. Univariate analysis of the most common antibiotics, maximum frequency and duration are summarized in table 1. A multivariable found cephalosporins were associated with no complication (OR 2.23, CI 1.20-4.35), and Vancomycin (OR 0.20, CI 0.11-0.36) and Gentamicin (OR 0.06, CI 0.06-0.58) were significantly associated with complication. Antibiotic frequency, duration, bacterial speciation were associated with no complication when controlling for antibiotic type
Table 1

Conclusion
Antibiotics given for longer durations or require more frequent monitoring like vancomycin may have higher rates of complications. This study supports the hypothesis that vancomycin and aminoglycosides are associated with complications even when controlling for duration and frequency; cephalosporins are associated with no complication. New, safer antibiotics like long acting lipoglycopeptides may provide alternatives to Vancomycin to diminish the burden on ancillary OPAT staff who deal with OPAT complications.

Disclosures
All Authors: No reported disclosures
597. Comparison of Vancomycin and Daptomycin Complications and Interventions in Outpatient Parenteral Antimicrobial Therapy
Authors: Nakrani Monark , Yu Diana , Sikka Monica , Lewis James , Douglass Alyse , Mayer Heather , Young Kathleen , Streifel Amber C 
Published: January 2021

Abstract

Background
Vancomycin and daptomycin are commonly used in outpatient parenteral antimicrobial therapy (OPAT) for patients requiring lengthy courses of intravenous antimicrobials who are otherwise stable for discharge. Balancing the convenience and cost-savings of OPAT with the potential for adverse effects is challenging, this study compared the rates of complications and antimicrobial interventions for patients receiving vancomycin versus daptomycin across multiple OPAT settings.

Methods
We performed a retrospective chart review of adult OPAT patients who received &gt;72 hours of vancomycin or daptomycin via home infusion, infusion center, or skilled nursing facility between January 2017 and August 2019. The outcomes evaluated included the rates of adverse drug reactions (ADRs), laboratory results above a defined threshold (vancomycin levels &gt;20 mg/mL in the vancomycin arm and creatinine phosphokinase (CPK) levels &gt;500 units/L in the daptomycin group), line complications, emergency department (ED) visits, and hospital readmissions. Other outcomes included additional phone calls and interventions required to coordinate care (additional labs, assessment of symptoms, additional test or antimicrobial-related dose changes) by the OPAT team.

Results
180 patients were included; 130 received vancomycin and 50 received daptomycin. (Table 1) Patients in the vancomycin group had more supratherapeutic vancomycin troughs than elevated CPK for patients in the daptomycin group (rate ratio [RR] 0.16, 95% CI 0.05-0.50, p=0.0018). Rates of interventions (RR 0.37, 95% CI 0.26-0.52, p&lt; 0.0001) and additional phone calls (RR 0.56, 95% CI 0.43-0.72, p&lt; 0.0001) were also higher for patients in the vancomycin group. There were no statistically significant differences between groups in the rates of ADRs, line complications, ED visits, or hospital readmissions. (Table 2)
Table 1. Baseline Characteristics

Table 2. Outcomes

Conclusion
Vancomycin-treated patients had significantly more laboratory abnormalities and required significantly more time in patient care coordination by the OPAT team. The difference in healthcare utilization between these groups suggests a potential for significant cost-savings for OPAT patients and the healthcare system.

Disclosures
All Authors: No reported disclosures
598. Correlation of International Classification of Diseases (ICD) codes to initial provider-selected antibiotic indications in hospitalized adult patients within the Duke Antimicrobial Stewardship Outreach Network (DASON)
Authors: Livengood Spencer J , Jones Travis M , Moehring Rebekah W , Spires Steven S , Johnson Melissa D , Dyer April , Davis Angelina , Ashley Elizabeth Dodds 
Published: January 2021

Abstract

Background
Provider-selected antibiotic indications are a measure to help track antibiotic use, and facilitate stewardship activities. International Classification of Diseases 10th version (ICD-10) codes have been widely used in the medical field for a variety of purposes, including billing for reimbursement, disease epidemiology, administration, and research. The ability of these codes to accurately describe the true disease diagnosis has been questioned. The purpose of this study is to provide insight into correlation between ICD-10 codes and provider-selected antibiotic indications recorded upon antibiotic order entry.

Methods
This multicenter, retrospective cohort study was performed using data from 17 hospitals in the DASON network. Antibiotic orders during calendar year 2019 for inpatients ≥ 18 years of age that included an indication for use were extracted from the DASON antimicrobial stewardship assessment portal. Orders with the antibiotic indication category of prophylaxis (medical or surgical) and other were excluded. The primary outcome was agreement between antibiotic indication and any discharge ICD-10 code from the same hospital admission. Secondary analyses stratified results by antibiotic and indication. Descriptive statistics were used to describe outcomes.

Results
A total of 246,999 unique antibiotic orders were identified in 180,109 admissions. After removing prophylaxis (n=75,124) and other (n=36,359), 135,516 orders were included. Most orders did not have an ICD-10 code matching the prescriber indication (92,237 [68%]). All indications except HEENT (18% mismatch) and genitourinary infections (46% mismatch) lacked a corresponding diagnosis code in more than 50% of cases (Table 1). Urinary tract infections (93%), bloodstream infections (90%), and central nervous system infections (80%) showed the highest rates of mismatch among indications (Table 1).
Table 1: Correlation of ICD-10 Codes to Provider Selected Indications

Conclusion
We observed a high rate of mismatch between antibiotic indications and ICD-10 codes. Provider-selected antibiotic indications at the time of empiric treatment may be more reflective of diagnostic differential but is a poor indicator of ultimate patient diagnosis.

Disclosures
Rebekah W. Moehring, MD, MPH, Agency for Healthcare Quality and Research (Grant/Research Support)Centers for Disease Control and Prevention (Grant/Research Support) Melissa D. Johnson, PharmD, MHS, Charles River Laboratories (Grant/Research Support)Cidara (Consultant)Merck & Co (Scientific Research Study Investigator)Paratek (Consultant)Scynexis (Scientific Research Study Investigator)Shionogi (Consultant)UpToDate (Other Financial or Material Support, Royalties)
599. Dalbavancin Utilization in Rural Healthcare Setting: A Single Center Three Years’ Experience
Authors: AlSalman Ahmad , Worby Craig P , Considine emma , Zijoo Ritika , Kershaw Colleen 
Published: January 2021

Abstract

Background
Dalbavancin is a second generation lipoglycopeptide, approved by the Food and Drug Administration (FDA) for treatment of acute bacterial skin and skin structure infections (ABSSSI). The weekly dosing of Dalbavancin has encouraged its off-label use to treat other severe infections, especially in patients deemed to be poor candidates for intravenous antimicrobial therapy through a long-term intravenous catheter.

Methods
Single center retrospective chart review of 33 patients who were planned to receive Dalbavancin between March 2015 and March 2019 at a rural medical center in New Hampshire.
We reviewed demographics, indications, microbiological, intravenous drug use status and compliance data.

Results
Dalbavancin therapy was planned for 25/33 patients (75.75%) specifically due to safety concerns around use of a peripherally inserted central catheter (PICC) in Persons Who Inject Drugs (PWID). All 25 patients (75.75%) were actively injecting at the time of the infection with 16/33 patients (48.48%) receiving or newly enrolled in medication assisted treatment. The planned duration of therapy was not completed in 15/33 patients (45.45%) and all were PWID. 11/33 patients (33.3%) were lost to follow up. Additionally, 6 patients experienced insurance coverage issues or difficulty having peripheral access placed. The average driving distance between home and infusion suite was 47 miles.
Methicillin Resistant Staphylococcus aureus (19/33) and Methicillin Susceptible Staphylococcus aureus (8/33) were the most commonly treated organisms and the average pathogen-directed therapy duration prior to starting Dalbavancin was 15 days.

Conclusion
Despite recent data suggesting that Dalbavancin therapy for PWID has good compliance rates in urban settings, our experience suggests that the same principle might not be true in rural settings as the non-compliance and loss to follow up rates were very high.

Disclosures
All Authors: No reported disclosures
600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program
Authors: Agnihotri Gaurav , Gross Alan E , Seok Minji , Yen Cheng Yu , Khan Farah , Ebbitt Laura M , Bleasdale Susan C , Sikka Monica K , Trotter Andrew B 
Published: January 2021

Abstract

Background
Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program.

Methods
This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p&lt; 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission.

Results
Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2.
Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention

Table 2. Factors independently associated with hospital readmission in OPAT patients

Conclusion
An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future.

Disclosures
All Authors: No reported disclosures
601. Disparities in Diabetes Care: Smoking Cessation among Women and Minorities Living with HIV at an Urban Academic Medical Center
Authors: Cangialosi Peter , Liotta Mark , Finkel Diana , Swaminathan Shobha , Keller Steven 
Published: January 2021

Abstract

Background
People living with HIV (PLWH) and diabetes mellitus are at increased risk of developing significant medical complications such as atherosclerotic cardiovascular disease. Disproportionate rates of diabetes and HIV among minority groups raise the issue of how demographic disparities may impact care. The American Diabetes Association (ADA) 2020 guidelines for diabetes care recommend optimal glycemic levels (A), blood pressure control (B), lipid reduction (C), and smoking cessation (N), commonly referred to as ABC or ABCN criteria. This quality assessment project examines diabetes management in PLWH by gender, race/ethnicity, and BMI, in a predominantly minority-serving clinic, as assessed by rates of guideline adherence to the above metrics.

Methods
This project was reviewed and approved by the Rutgers IRB. Patients from an HIV registry of University Hospital Infectious Disease Outpatient clinic in Newark, NJ were reviewed for a diagnosis of diabetes and both a clinic visit and an A1c score recorded between 2/1/2019 and 1/31/2020. Achieving glycemic target was defined as HbA1c &lt; 7.5 for patients &lt; 65 and HbA1c &lt; 8 for patients &gt; 65. Target adherence criteria also included a blood pressure average of &lt; 140/90 over this period and an LDL-c of &lt; 100 mg/dL. Non-smoking status includes both former and never smokers.

Results
Of 1035 patients reviewed, a total of 172 met criteria. Adherence rate for achieving goal HbA1c was 61.6% (95% CI 54.2-68.6, n=172). Blood pressure and LDL-c adherence rates were 65.1% (95% CI 57.7-71.8, n=172) and 67.4% (95% CI 60.1-74.0, n=172), respectively. ABC and ABCN rates were 24.4% (95% CI 18.6-31.4, n=172) and 18.6% (95% CI 13.5-25.1, n=172). The overall smoking rate, as well as the rates in the female subgroup, those with BMI 18.5-24.9, and the non-Hispanic black subgroup were significantly higher than the national average (P&lt; 0.05).
Table 1: Demographic Data of PLWH and Diabetes

Table 2: Adherence to ABCN Criteria in Diabetes Care by Demographics for PLWH from 2/1/2019 – 1/31/2020

Conclusion
For diabetic PLWH, smoking cessation requires improvement, particularly in female, normal BMI, and non-Hispanic black subgroups. These findings, in addition to a majority overweight patient population, highlight the need for increased education and interventions aimed at nutritional counseling and risk factor mitigation among all patient subgroups.

Disclosures
All Authors: No reported disclosures
602. Do These Labs Really Matter? Searching for the Benefit of Laboratory Monitoring in Outpatient Parenteral Antimicrobial Therapy (OPAT)
Authors: Zukauckas Kelsea N , Benefield Russell J , Certain Laura 
Published: January 2021

Abstract

Background
Weekly laboratory monitoring is routinely performed for patients treated with Outpatient Parenteral Antimicrobial Therapy (OPAT). However, minimal evidence exists to guide this practice.

Methods
This was a single-center, retrospective cohort study to assess the value of laboratory monitoring in patients being treated with beta-lactam OPAT. This study included adult patients discharged from University of Utah Health (UUH) between January 1, 2018, and July 31, 2019, on beta-lactam OPAT with follow-up care with a UUH Infectious Diseases (ID) Provider. Patients discharged to a skilled nursing facility or long-term acute care hospital, or who received OPAT for a duration less than 7 days, were excluded. The primary aim was to describe how often abnormal laboratory values led to a therapy modification or documented adverse drug reaction (ADR) for patients receiving beta-lactam OPAT. Abnormal laboratory values were defined by consensus criteria for clinical significance (e.g., RIFLE criteria for kidney injury). Therapy modification and ADR occurrence was determined by chart review for UUH ID Provider documentation.

Results
A total of 346 patients were included; two hundred seventy-four (79%) had abnormal laboratory values during OPAT. Of these, 12 patients had a modification to their OPAT due to abnormal laboratory values. The most common therapy modification due to abnormal laboratory values was a change of antibiotic (9/12). Two hundred thirteen of 274 patients (78%) with abnormal laboratory values were maintained on their OPAT regimen without a modification. Of the 67 therapy modifications observed, 55 (82%) were due to reasons other than abnormal laboratory results (Table 1).
Abnormal laboratory values meeting criteria for clinical significance and possible ADR were observed in 469 instances. Of these, 43 (9%) were considered ADRs by the ID provider (Table 2).
Table 1 describes therapy modifications for patients on beta-lactam OPAT

Table 2 describes documented ADRs in the presence of abnormal labs for patients on beta-lactam OPAT

Conclusion
Weekly laboratory monitoring was associated with therapy modifications and documented ADRs in a small number of patients receiving beta-lactam agents as OPAT. This supports current guideline recommendations for laboratory monitoring, even for beta-lactam agents, which are considered relatively safe. Further investigation into the cost-effectiveness of this approach is warranted.

Disclosures
Russell J. Benefield, PharmD, Merck and Co (Grant/Research Support)Paratek Pharmaceuticals (Grant/Research Support)Rempex Pharmaceuticals (Grant/Research Support)