bluuebunny/crossref_metadata_2025_split huggingface dataset:
121. Evaluation of Multifaceted Antimicrobial Stewardship in Optimizing Antimicrobial Usage in Intraabdominal Infection at a Community Hospital
Authors: Pham Tho H , Huang Angela , Hall Scott T , Huang Vanthida 
Published: December 2021

Abstract

Background
Treatment of intraabdominal infections (IAI) commonly involves broad spectrum antimicrobials based on the severity and etiology of infections as well as the underlying medical conditions. However, the overuse of broad-spectrum agents has driven selection for Gram-negative and -positive resistance, as well as collateral consequences such as Clostridioides difficile colitis. We sought to evaluate the utilization of a pharmacy-driven multifaceted antimicrobial stewardship (AMS) intervention to optimize empiric antimicrobial therapy by risk stratification among IAI patients and reduce the number of antibiotic treatment days.

Methods
This is a single-center case observation study in hospitalized adult IAI patients on antimicrobial therapy from Dec 2019-Feb 2020 compared to patients from Dec 2020-Feb 2021 after initiation of AMS with daily prospective audit and feedback. The composite primary outcome is reduction of antibiotic treatment days and de-escalation from broad spectrum antibiotics (fluoroquinolones, piperacillin/tazobactam, and carbapenems) to cephalosporins.

Results
We identified 40 patients each in the baseline (pre-AMS group) and post-AMS group via electronic medical record. Baseline characteristics were well-matched between groups. The majority of patients were diagnosed with community-acquired IAIs such as appendicitis, diverticulitis, and cholecystitis. Fluoroquinolone use as empiric therapy was significantly lower in the post-AMS group vs. pre-AMS group (2.5% vs. 25%, p&lt; 0.001), while non-Pseudomonas cephalosporin use was increased (25% post-AMS vs. 0% pre-AMS, p&lt; 0.001). Oral fluoroquinolone use at discharge was significantly decreased in the post-AMS group (p&lt; 0.001). Antibiotic treatment days remained unchanged. There was no statistical difference between the two groups in 30-day mortality, 30-day readmission, relapse, and C. difficile colitis.

Conclusion
A multifaceted antimicrobial therapy intervention successfully reduced the use of fluoroquinolones in patients with community-acquired IAI during hospitalization and discharge. No differences in mortality, readmission, or relapse rates were observed.

Disclosures
All Authors: No reported disclosures
127. Living on the Edge: The Impact of MIC Distributions on Empiric Antibiotic Selection
Authors: Bauer Karri A , Hidayat Levita K , Klinker Kenneth , Motyl Mary , Andrew DeRyke C 
Published: December 2021

Abstract

Background
Due to variability in the precision of an MIC, concern may exist in optimizing PK/PD using standard doses when the MIC is at the susceptibility breakpoint (SBP). This is notable when treating infections in critically ill patients. Evaluating MIC distributions among commonly used antibiotics and accounting for isolates at the SBP represents an additional enhancement to inform empiric therapy. The aim of the study was to evaluate antibiotic susceptibility for commonly used β-lactams against Pseudomonas aeruginosa (PA) in a syndromic antibiogram, incorporating MIC distribution.

Methods
20 US institutions submitted yearly up to 250 consecutive targeted Gram-negative pathogens from hospitalized patients as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART) in 2016-2019. MICs were determined by broth microdilution and interpreted using 2021 CLSI breakpoints. The syndromic antibiogram included PA from a blood or respiratory source based on patient location. Based on CLSI guidance, an empiric antibiotic susceptibility threshold of ≥ 90% was deemed optimal.

Results
2,500 PA blood (n=680) and respiratory (n=1,820) isolates were evaluated; piperacillin/tazobactam (P/T), cefepime (FEP), meropenem (MEM), and ceftolozane/tazobactam (C/T) susceptibilities were 69.6%, 74.2%, 75.3%, and 95%, respectively (Figure 1). Isolates with MICs at the SBP were observed in 12.1%, 18.7%, 7.5%, and 6.5% for P/T, FEP, MEM, and C/T, respectively. Susceptibilities were lower when stratified by ICU, 64.8%, 71.2%, 70.7%, and 93.7% for P/T, FEP, MEM, and C/T, respectively with a similar frequency of SBP isolates (Figure 2).
Figure 1. Syndromic antibiogram evaluating P. aeruginosa blood and respiratory isolates.

Figure 2. Syndromic antibiogram evaluating Pseudomonas aeruginosa blood and respiratory isolates stratified by ICU. *MIC breakpoints used to determine susceptibility included: P/T MIC ≤ 16/4 µg/ml, FEP ≤ 8 µg/ml, MEM ≤ 2 µg/ml, C/T ≤ 4 µg/ml

Conclusion
Our analysis demonstrated that first line antipseudomonal agents, P/T and FEP, have susceptibility rates lower than the CLSI recommended threshold. A significant portion of the MICs within the susceptible range are at the SBP. Due to the frequency of baseline resistance and challenge in achieving adequate PK/PD in critically ill patients, clinicians may be concerned with relying on certain antibiotics when the MIC is at the SBP. Antimicrobial stewardship programs should consider incorporating MIC distributions into syndromic antibiograms to better inform empiric therapy recommendations.

Disclosures
Karri A. Bauer, PharmD, Merck & Co., Inc. (Employee, Shareholder) Levita K. Hidayat, PharmD BCIDP, Merck & Co., Inc. (Employee, Shareholder) Kenneth Klinker, PharmD, Merck & Co., Inc. (Employee, Shareholder) Mary Motyl, PhD, Merck & Co., Inc. (Employee, Shareholder) C. Andrew DeRyke, PharmD, Merck & Co., Inc. (Employee, Shareholder)
133. A Review of Antimicrobial Formularies at Rural Hospitals: Stewardship Opportunities Abound
Authors: Bulger Peter , Castillo Alyssa Y , Lynch John B , Lynch John B , Pottinger Paul , Chan Jeannie D , Jain Rupali , Naderi Mandana , Kassamali Zahra , Bryson-Cahn Chloe 
Published: December 2021

Abstract

Background
Management of a hospital’s antimicrobial formulary is an important aspect of antimicrobial stewardship and cost containment strategies. Ensuring that essential medications for clinical care are available and excluding therapeutic duplicates and unnecessary antimicrobials is time and resource intensive. Comparisons of antimicrobial formularies across multiple rural hospitals have not been evaluated in the literature. We hypothesized that a comprehensive formulary evaluation would reveal important opportunities for antimicrobial stewardship efforts and could help smaller hospitals optimize available medications.

Methods
The University of Washington Tele-Antimicrobial Stewardship Program (UW-TASP) is comprised of 68 hospitals of varying sizes, most of which are rural and critical access, in Washington, Oregon, Arizona, Idaho, and Utah. We surveyed UW-TASP participating hospitals and other networked rural hospitals in multiple Western states using REDCap, a HIPAA-compliant, electronic data management program. Respondents reported which antimicrobials are on their hospital formulary as well as basic information about hospital size and inpatient units. Data were reviewed by a panel of infectious diseases trained physicians and pharmacists at UW-TASP.

Results
Surveys from 49 hospitals were received; two were excluded from the data analysis (Table 1) – one submission was incomplete, and one was a large inpatient psychiatric hospital. Select antimicrobials and proportion of hospitals carrying these agents is shown in Table 2. Several antimicrobials are on the formulary at all hospitals, regardless of size. In some critical access hospitals (&lt; 25 beds), empiric first-line bacterial meningitis and viral encephalitis coverage (Table 3) was lacking. Six hospitals (12.7%) lacked ampicillin for Listeria coverage and only one had a suitable alternative agent (meropenem). Seven hospitals (14.9%) lacked intravenous acyclovir, although three had oral valacyclovir. Formulary inclusion of agents for multi-drug resistant organisms was rare.

Conclusion
In critical access hospitals in the Western USA, lack of essential empiric antimicrobials may be more of a concern than inclusion of agents with unnecessarily broad spectra.

Disclosures
Chloe Bryson-Cahn, MD, Alaska Airlines (Other Financial or Material Support, Co-Medical Director, position is through the University of Washington)
155. Antimicrobial Resistance Patters as a Predictor of Standardized Antimicrobial Administration Ratio: A National Correlation Study
Authors: Rubio Andrew , Cooper Mandelin , Greer Nickie , Goldin Laurel , Moody Julia , Signorelli Heather , Burgess H L 
Published: December 2021

Abstract

Background
Data on antimicrobial usage (AU) and antimicrobial resistance (AR) is submitted to the National Healthcare Safety Network (NHSN) from facilities monthly. Bacterial proportion resistant (%R) from the AR option reports proportion of isolates resistant to specific antimicrobial categories. Standardized Antimicrobial Administration Ratio (SAAR), generated under the AU option, compares observed to predicted days of antimicrobial therapy. The purpose of this study was to evaluate the association between %R and SAAR for broad-spectrum antibacterial agents predominantly used for hospital-onset infections (BSHO) and antibacterial agents predominantly used for resistant gram-positive infections (gram-pos) in adult intensive care units (ICUs) and medical-surgical wards (M/S).

Methods
This retrospective observational review utilized data reported to NHSN to examine the association of BSHO and gram-pos SAARs with %R for various phenotypic categories by quarter from 2017 through the second quarter of 2020. Phenotypic categories included methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecalis and faecium (VRE), extended-spectrum cephalosporin-resistant Escherichia coli and Klebsiella spp. (ESBL), and multi-drug resistant Pseudomonas aeruginosa (MDR PSA). Pearson correlations were used to quantify the associations between SAARs and %R.

Results
A total of 182 institutions were included for analysis. Weak, positive correlations were observed between SAAR for BSHO in ICU and M/S for MDR PSA %R and also for ESBL %R (r = 0.14 to 0.22, all p &lt; 0.0001). For the gram-pos SAAR in ICU and M/S, there were weak positive correlations between MRSA %R and VRE %R (r = 0.20 to 0.31, all p &lt; 0.0001).

Conclusion
SAARs are multifactorial, yet these results highlight that more resistant organisms may possibly be contributing to higher use of antimicrobials for facilities. Future SAAR calculations could consider incorporating resistance trends from %R within the institution for increases in AU and adjusting SAARs accordingly. Comprehension of the relationship between %R and SAAR can aid facilities with stewardship programs and understanding how resistance contributes to antibiotic usage.

Disclosures
Julia Moody, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)
157. A Multicenter, Mixed-Method Evaluation of Delayed Hospital Discharge in Patients with Invasive Candidiasis Receiving Echinocandins
Authors: Jo Jinhee , Hendrickson Joshua , Almutairi Masaad , Alnezary Faris S , Beyda Nicholas , Gonzales-Luna Anne J , Tran Truc T , Simmons Debora , Garey Kevin W 
Published: December 2021

Abstract

Background
Patients with systemic candidiasis often receive prolonged echinocandin therapy in the inpatient or outpatient setting. Rezafungin is a novel echinocandin currently in clinical trials characterized by once-weekly dosing interval. In order to understand the potential benefit of rezafungin to facilitate earlier hospital discharge, the purpose of this project was to better understand barriers to discharge in patients with proven or suspected invasive candidiasis.

Methods
Electronic health records from two large health systems (20+ hospitals) were reviewed to identify patients given an echinocandin. Patients given an echinocandin until hospital discharge were evaluated for outpatient use as well as barriers that prevented earlier discharge. Identified barriers were developed into a quantitative framework and a qualitative interview guide. Using a constant comparative method, the framework for hospital discharge barriers was constructed using a series of open-ended questions and axial coding to identify discharge barrier themes. Results were integrated to produce a mixed-method model.

Results
A total of 1,665 echinocandin courses were evaluated. Five hundred and thirty-four patients (32%) received echinocandin therapy until at least the day of hospital discharge of which 328 of 534 (61%) patients were either discharged to home or transferred to another facility. Significant predictors for outpatient echinocandin use were osteomyelitis (OR 4.07, 95% CI: 1.06-15.66; p=0.041) and other deep-seated infection (OR 4.44; 95% CI: 1.65-11.96; p=0.003). Stewardship analysis identified the majority of patients (54%) had the possibility for at least one day earlier discharge (potential earlier discharge:1.65±1.16 days). The quantitative model identified major barriers to be transition of care-, other medical care-, and infectious diseases-related. The qualitative model largely agreed with the quantitative model with additional psychosocial and health care access variables identified.

Conclusion
Using a mixed method approach, barriers to hospital discharge and potential use of new antifungal therapies were identified. These data could be used to assist transitions of care in patients with invasive candidiasis.

Disclosures
Truc T. Tran, PharmD, Merck (Grant/Research Support) Kevin W. Garey, Pharm.D., M.S., FASHP, Summit Therapeutics (Research Grant or Support)
164. Restriction of Antimicrobials Dispensing without Prescription on a National Level: Impact on the Overall Antimicrobial Utilization in Community Pharmacies in Saudi Arabia
Authors: Eljaaly Khalid , Al-Jedai Ahmed , Almogbel Yasser , Alqahtani Nasser , Almudaiheem Hajer , Awad Nancy , Alissa Dema , Assiri Abdullah , Alaama Tareef 
Published: December 2021

Abstract

Background
High rates of non-prescription dispending of antimicrobials has led to a significant increase in antimicrobial overuse and misuse in Saudi Arabia (SA). The objective of this study was to evaluate antimicrobial utilization following enforcement of a new prescription-only antimicrobial dispensing policy in the community pharmacy setting in SA.

Methods
Data were extracted from the IQVIA database between May 2017 and May 2019. Antimicrobial consumption rate based on the sales, defined daily dose in grams (DDD), DDD/1000 inhabitants’/day (DID), and antimicrobial claims for pre-policy (May 2017 to April 2018) and post-policy (June 2018 to May 2019) periods was assessed.

Results
Overall antimicrobial utilization slightly declined (~9-10%) in post-policy vs. pre-policy period (sales, 31,334 vs.34,492 thousand units; DDD, 183,134 vs. 202,936 thousand grams), with an increase in the number of claims (~16%) after policy implementation. There was a sudden drop in the consumption rate immediately after policy enforcement; however, the values increased subsequently, matching closely to the pre-policy values. Consumption patterns were similar in both periods. Penicillins were the most commonly used antimicrobial (sales, 14,700 - 11,648 thousand units; DDD, 71,038 - 91,227 thousand grams; DID, 2.88 - 3.78). For both the periods, the highest dip in utilization was observed in July (sales, 1,027 - 1,559 thousand units; DDD, 6,194 - 9,399 thousand grams), while the highest spike was in March/October (sales, 3,346 - 3,884 thousand units; DDD, 22,329 - 19,453 thousand grams).

Conclusion
Non-prescription antimicrobial utilization reduced minimally following policy implementation in the community pharmacy setting across SA. Measures to aid effective implementation of prescription-only regulations are necessary.

Disclosures
All Authors: No reported disclosures
185. Does an Infectious Diseases Consultation Improve Clinical Outcomes and Treatment Bundle Adherence for Enterococcal Bacteremia in a Multicenter Healthcare System?
Authors: Shephard Emily A , Mondy Kristin E , Reveles Kelly R , Jaso Theresa , Rose Dusten T 
Published: December 2021

Abstract

Background
Infectious diseases consultation (IDC) for Staphylococcus aureus bacteremia has a known mortality benefit, but for other gram positive bacteremias the benefit is not known. This study examined differences in outcomes for enterococcal bacteremia when management includes IDC.

Methods
This retrospective multicenter observational cohort study included adults with at least 1 positive blood culture with Enterococcus species. Patients who died or transferred to palliative care within 2 days of positive blood cultures were excluded. The primary outcome was a composite of clinical failure, including persistent blood cultures or fever for 5 days and in-hospital mortality. Secondary outcomes included adherence to a treatment bundle (appropriate empiric/definitive antibiotics, echocardiography (ECHO), duration of treatment, and repeat blood cultures).

Results
A total of 250 patients were included. IDC was obtained in 62.0% of patients. More patients in the IDC group had endocarditis (20% vs 0%, p &lt; 0.0001) and bone and joint infections (13.5% vs 1.1%, p = 0.001), compared to more UTI (16.8% vs 39.0%, p &lt; 0.0001) in the non-IDC group. Patients in the IDC group had more murmurs on initial exam (21.3% vs 6.3%, p = 0.002), prosthetic device (49.7% vs 27.4%, p = 0.001), and NOVA scores of ≥ 4 (40.6% vs 18.9%, p &lt; 0.0001). Most infections were due to E. faecalis (78.4%) and most were susceptible to vancomycin and ampicillin at 90.4% and 92.4%, respectively. The composite of clinical failure occurred in 22.6% of patients with IDC and 16.8% in the non-IDC group (p=0.274). There was higher adherence to the treatment bundle in the IDC group (Figure 1). More patients in the IDC group were treated with ampicillin (47.1% vs 22.1%, p &lt; 0.0001), and numerically more patients received treatment with vancomycin in the non-IDC group (17.4% vs 24.2%, p = 0.068). In the multivariate analysis, vasopressors were the only independent predictor of the primary outcome (OR 9.3, 95% CI 3.5-24.8, p &lt; 0.0001).
Figure 1. Adherence to treatment bundle. IDC = infectious diseases consultation, Echo = echocardiogram, * = p &lt; 0.05

Conclusion
There was no difference in rates of composite failure in patients with or without IDC; however, adherence to a treatment bundle was higher in the IDC group. IDC demonstrated stewardship benefits with regards to vancomycin usage.

Disclosures
All Authors: No reported disclosures
192. Epidemiology, Microbiological Characteristics and Clinical Outcomes of Invasive Blood Stream Infections of Group B Streptococcal Isolates From Qatar
Authors: Ali Maisa , Alamin Mohammed , Ali Gawahir , Alzubaidi Khalid , Ali Bashir , Waqqad Abdellatif , Almaslamani Muna , Hadi Hamad Abdel 
Published: December 2021

Abstract

Background
Group B Streptococci (GBS) or Streptococcus agalactiae colonize humans genitourinary and gastrointestinal tracts particularly of females. The pathogen is capable of causing invasive disease primarily in infants, pregnant and postpartum women as well as the elderly and patients with comorbidities. There is paucity of studies of the disease with regional differences in prevalence and presentation of invasive blood stream infection (BSI). In this study, we aim to assess prevalence, microbiological characteristics as well as clinical outcomes of invasive GBS disease from all ages groups at Hamad Medical Corporation (HMC), Qatar.

Methods
A retrospective study was conducted on all patients with microbiologically confirmed GBS bacteraemia between January 2015–March 2019. Demographic, microbiological characteristics as well as clinical data were extracted from hospital information system.

Results
Out of 196 confirmed cases of GBS blood stream infection, 63.7 % were females (125/196) of whom 44.8 % were pregnant (56/125), 53.6 % (30/56) were colonized while 36.3 % (71/196) were males. There were three distinct age group populations, paediatric less than 4 years of age at 35.7 %, young adults 25-34 (20.9 %) and the elderly &gt; 65 year (17.4 %). Presenting symptoms were mild with fever recognised in only 53 % of cases (104/196) while 89% of cases had low Pitt bactermia score of 0-2. Microbiological characteristic using disc diffusion tests demonstrated all isolates were universally sensitive to penicillin (100%, 196/196) with significant resistance to clindamycin at 28.6 % (56/196) and erythromycin at 49 % (96/196) of which 34.4 % (33/96) had inducible clindamycin resistance. Clinical outcome showed high cure rate of 87.25% (171/196) with low complications at 8.76 % (17/196) and 4% (8/196) 30-day mortality.

Antibiotic sensitivity profile for GBS isolates

Conclusion
Streptococcus agalactiae blood stream infection in Qatar is common in females, affects the very young, young adults and the elderly. Almost half of affected pregnant women are colonized. The organism remains universality sensitive to pencilling with significant resistance to clindamycin and erythromycin. Patients presents with mild symptoms with high cure rates, low complications and safe outcome for the majority of cases.

Disclosures
All Authors: No reported disclosures