bluuebunny/crossref_metadata_2025_split huggingface dataset:
2071. A Survey of Antibiotic Prescribing Practices Among Adult Primary Care Physicians in Idaho
Authors: Kanwar Anubhav , Heppler Susan , Madaras-Kelly Karl , Jaworski Martha , Donskey Curtis 
Published: October 2019

Abstract

Background
Prescribing an antibiotic is a complex process involving an interplay of prescriber’s knowledge, diagnostic acumen and patient factors. Understanding the prescriber rationale is key to provide feedback which might improve appropriateness of antibiotic prescribing. Currently, there are limited data on prescribing and test ordering practices among primary care physicians.

Methods
We surveyed primary care physicians taking care of adults (age 18 years and above). Physicians were contacted through the Idaho State Medical Board by a one-time email containing the survey link. The survey consisted of 25 questions under 2 major themes of diagnostic and antimicrobial stewardship (AS). It assessed physicians’ practice setting, ordering of diagnostic tests and antibiotics for common infections, delivery of patient education regarding antibiotics, availability of antibiogram and antimicrobial stewardship services, and assessment of penicillin allergy. Two infectious diseases physicians independently reviewed the results for appropriateness of testing and antibiotic prescribing per IDSA guidelines.

Results
Of 929 physicians surveyed, 157 (17%) responded. Of the respondents, 95 (61%) were male, the mean age was 50 years, and 72% worked in outpatient settings and were family medicine specialists. Only 55% of physicians reported having an AS program at their healthcare facility. Test-of-cure for C. difficile infection (24%) and UTI (13%) and use of superficial culture data to guide the treatment of osteomyelitis (27%) were the most common reasons for inappropriate testing. Longer than recommended duration, antibiotic combinations with overlap of spectrum, and guideline-discordant indications for prescribing antibiotics were the main reasons for inappropriate antibiotic use. The main factors influencing the decision to prescribe an antibiotic were diagnostic uncertainty (42%), being unsure of patient follow-up (23%) and cost of testing (21%).

Conclusion
The survey results highlight the need for prescriber education for decreasing inappropriate test ordering and antibiotic prescribing. Additional studies involving a review of patient records, lab and prescription data are needed to confirm these practices.

Disclosures
All authors: No reported disclosures.
2078. Patterns, Indications, and Appropriateness of Antibiotics Prescribed at a Private Dental Practice
Authors: Khan Mahnoor , Soltau Rhea , Sea Juehwan , Sofjan Amelia K 
Published: October 2019

Abstract

Background
Although dentists prescribe 10% of all outpatient antibiotics in the United States (US), prescribing patterns among dentists in the United States are largely unknown especially in private practice. We aimed to describe the patterns and indications of antibiotics prescribed at a United States private dental practice and evaluate prescription appropriateness.

Methods
This was a retrospective cohort study of all patients who received an antibiotic at a private dental practice in Baytown, TX, between 2017 and 2019. A thorough guideline and literature search was conducted to define the indication-specific appropriateness of antibiotics. The prescribing dentist and an antimicrobial stewardship pharmacist reviewed each patient chart to verify diagnosis and antibiotic indication. Each prescription was categorized as appropriate (evidence supports use), inappropriate (evidence does not support use), indeterminate (insufficient evidence to support or not support use), or not enough information (inadequate patient-specific data to determine appropriateness).

Results
Of 3,700 patient encounters, an antibiotic was prescribed for 230 (6.2%) encounters. Antibiotics prescribed were amoxicillin (52.2%), amoxicillin/clavulanate (27.8%), penicillin VK (7.8%), azithromycin (4.8%), clindamycin (3.5%), cephalexin (2.2%), and metronidazole (1.7%). Excluding antibiotics given as a single pre-operative dose (6% of antibiotics), the mean duration of antibiotics was 5 ± 0.6 days (mean ± SD). Antibiotic indications were symptomatic apical periodontitis or localized acute apical abscess (51.3%), symptomatic irreversible pulpitis (17.8%), prevention of implant failure (11.7%), pericoronitis (4.3%), acute apical abscess with systemic involvement (3.9%), and others (11%). Of the 230 antibiotic prescriptions, 27.8% were appropriate, 3.9% inappropriate, 66.1% indeterminate, and 2.2% not enough information.

Conclusion
Commonly prescribed antibiotics in this study were amoxicillin or amoxicillin/clavulanate for a mean duration of 5 days. The most common indication was symptomatic apical periodontitis or localized acute apical abscess. Two-thirds of antibiotics were prescribed without sufficient evidence to support or not support use.

Disclosures
All authors: No reported disclosures.
2092. Acceptability and Effectiveness of Implementation Strategies on Fluoroquinolone (FQ) Prescribing
Authors: Suda Katie J , Clore Gosia , Evans Charlesnika T , Reisinger Heather , Kale Ibuola , Echevarria Kelly , Reddy Sujan , Neuhauser Melinda M , Perencevich Eli , Goetz Matthew B 
Published: October 2019

Abstract

Background
The Food and Drug Administration (FDA) has issued multiple FQ safety warnings and recommends prescribing FQ only where alternatives are not available. We sought to assess the effectiveness and acceptability of differing implementation strategies on inpatient FQ prescribing.

Methods
Antimicrobial stewardship champions at 15 PBRN sites completed a survey in April 2018 regarding local use and acceptability of differing strategies to improve FQ prescribing. Sites with audit and feedback (PAF) and/or prior approval (PA) were compared with sites without these strategies. Antibiotic days of therapy (DOT) per 1000 days-present (DP) were extracted from the VA Corporate Data Warehouse for 2017–2018. Independent t-tests, contingency tables and simple linear regression were applied.

Results
60% of sites had PAF or PA implemented for FQ. When compared with sites with no strategies in place (64.2 ± 34.4 DOT/DP), mean FQ prescribing rates were lower for sites that employed PAF/PA (35.5 ± 9.8; P = 0.03) and decreased over the 2-year period (P < 0.001 for trend by month). This decrease occurred without an increase in third/fourth-generation cephalosporins for the PAF/PA group (83.5 ± 18.8; P = 0.1 for trend), but increased for sites with no strategies in place (93.6 ± 55.2; P < 0.01 for trend). However, total antibiotic prescribing rates were not different for sites with PAF/PA (561.7 ± 77.8) or without strategies (644.1 ± 157.7; P = 0.2) and did not change over time (p> 0.2). Sites with PAF/PA that reported FQ implementation strategies were “completely” accepted had lower FQ rates than where it was moderately accepted (34.2 ± 5.7 vs. 48.7 ± 4.5; P < 0.01). The PBRN sites perceived that clinical pathways/local guidelines (93% of 15 sites), PA (93%), and order forms (80%) “would” or “may” be effective in improving FQ use. While most sites (73%) indicated that requiring infectious disease consults “would” or “may” be effective in improving FQ use, 87% perceived implementation to be difficult.

Conclusion
PAF and PA implementation strategies focused on FQ were associated with lower FQ prescribing rates, but not overall antibiotic use, indicating class substitution. This may indicate increased acceptability of implementation strategies and/or sensitivity to the FDA warnings.

Disclosures
All authors: No reported disclosures.
2097. Antimicrobial Stewardship Programs in Missouri Hospitals: Facilitators, Barriers, and Complexity of Implementation
Authors: Sayood Sena , Hseuh Kevin , Newland Jason , Babcock Hilary , Warren David K , Turabelidze George , Burnham Jason P , McKay Virginia , Rachmiel Erin C , Habrock-Bach Tracey , MD Michael Durkin, 
Published: October 2019

Abstract

Background
Antibiotic stewardship programs (ASPs) in acute care hospitals reduce unnecessary antibiotic use and attendant complications. In the state of Missouri, all hospitals are required to have an ASP. Additionally, the Joint Commission mandates ASP implementation for accreditation based on core elements defined by the Centers for Disease Control (CDC). No studies have evaluated the uptake of ASP since the Missouri state law and Joint Commission mandate. Furthermore, data are limited examining barriers to implementation across hospitals with variable resources. We evaluated ASP uptake across Missouri hospitals, assessed differences in program complexity, and identified facilitators and barriers to implementation.

Methods
A 94-question survey was administered electronically in the spring of 2019 to 130 Missouri hospitals. Information was collected regarding implementation details of CDC-defined ASP core elements and tools used to overcome implementation barriers. Results were self-reported by the stewardship pharmacist, the director of pharmacy, or the person most familiar with antimicrobial stewardship if the former were not available.

Results
Preliminary results have been collected from 37 hospitals ranging in size from 15 to 1303 beds (IQR: 54, 274). 16% were critical access hospitals. 54% of hospitals had ASPs adherent to all 7 CDC core elements. Another 27% had implemented 6 of the core elements, with all of those reporting that they lacked a single pharmacist leader. All facilities had implemented at least some measures to improve antibiotic use, ranging from 4 to 13 measures. 45% of programs used state-based antimicrobial stewardship collaboratives, and 52% of those found such programs to be “very” or “extremely” useful.

Conclusion
All hospitals surveyed are performing ASP activities in concordance with Missouri state law. However, only half contain the 7 core elements required by the Joint Commission. Furthermore, ASP implementation and activities vary widely. While physician leadership was commonly defined, appropriate pharmacist support was frequently lacking. State-based collaboratives are the most widely used resource, and at least half who use them find them to be helpful.

Disclosures
All authors: No reported disclosures.
2112. Voriconazole for Primary Prophylaxis: A Decade of Trends and Outcomes
Authors: Mourad Ahmad , Johnson Melissa D , Perfect John R 
Published: October 2019

Abstract

Background
Invasive fungal infections (IFI) continue to affect the immunocompromised patient population. Many of these patients require antifungal prophylaxis. Voriconazole is an azole antifungal that has been utilized for preventing IFIs but does not have an approved indication for prophylaxis.

Methods
Adult patients admitted to Duke University Hospital from January 1, 2005 to December 31, 2015 who had received at least 2 days of systemic voriconazole as primary prophylaxis were included in this retrospective medical records review. Demographics, underlying comorbidities, adverse events, drug interactions, voriconazole blood concentrations, and microbiological data were assessed.

Results
Our review identified 403 patients receiving voriconazole for primary prophylaxis. 220 (55.6%) were male, 303 (75.2%) were Caucasian, and the mean age was 46.0 ± 15.7 years. 233 (57.8%) had leukemia, and 63 (15.6%) had lymphoma. 301 (74.7%) underwent hematopoietic transplant (BMT), and 45 (11.2%) had a solid-organ transplant. 176 (43.7%) patients received chemotherapy and 261 (64.8%) received immunosuppressive drugs. The mean voriconazole total daily maintenance dose was 416.1 ± 65.9 mg (5.5 ± 1.6 mg/kg/day). Patients received inpatient voriconazole for a mean of 19.5 ± 16.5 days. 371 (92.1%) patients received a concomitant interacting drug. Only 140 (43.7%) patients had therapeutic drug monitoring. The mean first voriconazole serum concentration was 1.8 ± 1.7 mg/L. 87 (21.6%) patients discontinued voriconazole prematurely; 41 (10.2% overall) of these patients had an adverse event requiring discontinuation. 5 had breakthrough fungal infections with microbiological data identifying a fungal species, which included Rhizopus spp. among others.

Conclusion
Voriconazole is frequently used for primary prophylaxis of IFIs and most commonly in BMT. It appears to be relatively well tolerated with some adverse side-effects (~10%) despite many potential drug–drug interactions and provides appropriate fungal coverage for many immunosuppressed patients. However, few patients had breakthrough fungal infections while receiving voriconazole. In a real-world setting, voriconazole can provide antifungal prevention in certain high-risk patients.

Disclosures
All authors: No reported disclosures.
2113. Evaluation of Empiric Antifungal Therapy in Critically Ill Patients with Liver Disease, Sepsis, and No Evidence of Active Fungal Infection
Authors: Britt Rachel S , Mahoney Monica V , Gold Howard , McCoy Christopher 
Published: October 2019

Abstract

Background
While candidemia is uncommon in the immunocompetent, critically ill population, it is associated with longer lengths of stay (LOS), higher cost, and higher mortality. In critically ill patients with liver disease and sepsis of unknown origin, antifungals (AF) are commonly used empirically. Recent studies suggest that this practice may not improve clinical outcomes but had little representation of patients with liver disease. This study aims to evaluate clinical outcomes of critically ill patients with liver disease, sepsis, and no evidence of active fungal infection who received empiric AF vs. those who did not.

Methods
This was a single-center, retrospective review of adults with liver disease and sepsis, identified by ICD-10 codes, who were discharged from the intensive care unit (ICU) between October 1, 2015 and December 31, 2018. Patients with neutropenia, marrow or organ transplant, HIV infection, systemic immunosuppressants, or fungal infection at sepsis onset were excluded. The primary outcome was inpatient mortality. Secondary outcomes included ICU LOS, total LOS, and development of fungal bloodstream infection (BSI) > 48 hours after sepsis onset. Fisher’s exact and Wilcoxon rank-sum tests were used to compare baseline characteristics. Multivariable logistic regression models were used to compare outcomes. Model covariates were variables with P-values < 0.2 in univariate analysis.

Results
A total of 119 patients were included with 92 receiving empiric AF (micafungin or fluconazole) and 27 receiving no AF. Patients receiving empiric AF were more likely to have hepatic disease upon admission and less likely to have a bacterial infection. Both groups were similar in intubation and vasopressor requirements, febrile episodes, and Candida score. Unadjusted inpatient mortality for empiric vs. no AF was 70.4% vs. 70.7%. Unadjusted ICU LOS, total LOS, and development of a fungal BSI were 10 vs. 11 days, 19 vs. 19 days, and 63.0% vs. 2.2% (P < 0.001). In multivariable models, there was no difference in inpatient mortality between groups (OR 1.20, 95% CI 0.77–1.63).

Conclusion
In critically ill patients with liver disease, sepsis, and no evidence of active fungal infection, receipt of empiric antifungal therapy did not improve inpatient mortality, ICU LOS, or total LOS but did reduce fungal BSI.

Disclosures
All authors: No reported disclosures.
2124. The Epidemiology, Demographics, and Geographical Distribution of Human Non-Tuberculosis Mycobacteria (NTM) Disease in the Endemic Central Florida Region
Authors: Vanessa. Garcia Cristina , E. Teo Greg Matthew , Morano Jamie P , Casanas Beata , Aslam Sadaf , Montero Jose , Zeitler Kristen , Jariwala Ripal , Cannella Anthony 
Published: October 2019

Abstract

Background
Of the >100,000 people in the United States infected yearly with non-tuberculosis mycobacteria (NTM), Florida has the highest yearly incidence and prevalence of NTM disease. However, little has been documented on the epidemiology and distribution of NTM disease within Central Florida.

Methods
A retrospective case review study was conducted from January, 2011 to December, 2017 at a large tertiary acute care medical center in Tampa, Florida to identify all NTM infection cases. Demographics (age, sex at birth, ethnicity), comorbidities, HIV testing status, residential zip code, NTM species, and specimen sources were collected.

Results
Of the 507 isolates, Mycobacterium abscessus group was the most common (45.4%; n = 230), and contained M. abscessus spp. abscessus (34.5%; n = 175), M. abscessus spp. massilense (8.7%; n = 44), and M. abscessus spp. bolletii (1.18%; n = 6). Other rapid growers were M. fortuitum species (6.9%; n = 35) and M. chelonae (2.56%; n = 13). Of the slower growers, M. gordonae (19.9%; n = 101) and M. avium complex (8.28%; n = 42) were the most common. Of the M. avium complex, M. chimera was most common (4.9%; n = 25). Samples were mostly isolated from sputum (51.7%; n = 262), bronchial lavage (26%; n = 132), skin and soft tissue (11%; n = 58), and blood (7.1%; n = 36). Of the 361 unique patients, average age was 59.2 years (12 to 95 years), with 47.6% (n = 172) greater than 65 years of age, and mostly male 57.9% (n = 208). Caucasians represented 73.4% (n = 265) of our cohort, and African Americans and Hispanics represented 16.3% (n = 59) and 6.8% (n = 24), respectively. Most cases were in those residing outside the Tampa Bay metro area 81.2% (n = 293/361). Notable comorbidities included COPD (n = 83), cystic fibrosis (n = 41), lung transplant (n = 40), heart transplant (n = 12), pulmonary fibrosis (n = 12), and renal transplant (n = 7). A total of 145 individuals received HIV testing at the hospital facility, and of these 44 individuals were living with HIV.

Conclusion
This study identified a diversity of NTM species across a wide geographical and demographic distribution in the endemic Central Florida region. M. abscessus group had the highest prevalence. This is valuable in understanding which populations are at risk for developing NTM infection in this area of Florida.

Disclosures
All authors: No reported disclosures.
2125. Staphylococcus Species Identification by Fourier Transform Infrared (FTIR) Spectroscopic Techniques: A Cross-Lab Study
Authors: Tsutsumi Tamao , Shah Alok , Lam Lisa M T , Schlebusch Sanmarie , Krueger Annika , Frazer Ian , Hugenholtz Phil , Soyer H Peter , Morrison Mark , Hill Michelle , Sedman Jacqueline , Ismail Ashraf 
Published: October 2019

Abstract

Background
Staphylococcus aureus is well known to be associated with atopic dermatitis. Recent studies also report S. aureus presence in lesional skin of squamous cell carcinoma (SCC) and its precursor lesion, actinic keratosis (AK). Therefore, it is of potential clinical interest to monitor skin S. aureus colonization on AK lesions. Fourier transform infrared (FTIR) spectroscopy is a cost-effective, nondestructive, and reagent-free technique for rapid microbial identification. It is based on the use of spectral databases developed with well-characterized strains in conjunction with the application of multivariate statistical analysis to elaborate classification models. In the present cross-lab study, spectral databases containing FTIR spectra of over 1000 staphylococcal isolates obtained from reference and clinical microbiology laboratories across Canada were employed in the FTIR spectroscopic identification of Staphylococcus spp. isolated from AK, SCC and perilesional skin of patients at the Princess Alexandra Hospital Dermatology Clinic in Brisbane, Australia.

Methods
FTIR spectra of 51 staphylococcal isolates from AK, SCC and perilesional skin were acquired by both attenuated total reflectance (ATR)-FTIR and transflection-FTIR spectroscopy. All isolates had been previously characterized by 16S rRNA sequencing. ATR- and transflection-FTIR spectra were recorded in triplicate from isolated colonies taken from the same agar plate. Identification of the bacteria was based on the similarities of their spectra with those in ATR- and transflection-FTIR spectral databases originating from the Canadian lab.

Results
Among the 51 staphylococcal isolates included in this study, identification of S. aureus (n = 24) with 100% specificity and 100% sensitivity was achieved by both ATR- and transflection-FTIR spectroscopy. Overall, FTIR-based species identification was in 90.2% concordance with 16S rRNA sequencing.

Conclusion
This cross-lab study demonstrates the applicability of Canadian isolate-based ATR- and transflection-FTIR spectral databases for the identification of clinical staphylococcal isolates obtained in Australia. The results support the potential utility of FTIR spectroscopic techniques to monitor skin S. aureus colonization on AK lesions.

Disclosures
All authors: No reported disclosures.
2145. Carbapenem-Resistant Enterobacteriaceae infections at the Maharaj Nakorn Chiang Mai Hospital
Authors: Chaiwarith Romanee , Supparatpinyo Wisarut 
Published: October 2019

Abstract

Background
Nowadays, carbapenem-resistant enterobacteriaceae (CRE) infection has been spreading worldwide in a tertiary care hospital and causing globally health damage. In Thailand, the studies of the epidemiology of CRE are scarce. This study aimed to describe epidemiology, clinical characteristics and treatment outcome of CRE infection.

Methods
A retrospective cohort study was conducted among patients admitted to the Maharaj Nakorn Chiang Mai Hospital between January 2014 and December 2016 who had clinical diagnosis of CRE infection. Characteristics between groups were compared using Chi-square, Fisher exact test or Student t-test, Mann–Whitney U test. Factors associated with mortality in univariate analysis were analyzed in the logistic regression model.

Results
Among 241 patients who had clinical specimens grew CRE, 51 had infection. Twenty-five patients (49%) were previously hospitalized within 90 days and 42 patients (82.4%) had exposed to antibiotics before documented CRE infection. The most common sites of clinical isolates were urine (33.3%), sputum (29.4%), and blood (21.6%). The mortality rate was 47.1%, which 17 (33.3%) patients’ death was attributable to CRE infection. Factor associated with mortality was higher body temperature (OR 4.8, P = 0.005) and thrombocytopenia.

Conclusion
CRE infections cause high mortality. Strategies to prevent emergence through prudent uses of antibiotics and transmission through infection control measures should be implemented in order to reduce mortality.

Disclosures
All authors: No reported disclosures.