bluuebunny/crossref_metadata_2025_split huggingface dataset:
1130. Impact of a New Pediatric Antibiotic Stewardship Program on Ceftriaxone Use at an Academic Medical Center
Authors: Evans Derek , Lanata Piazzon Mariana M , Schomburg Kaitlyn 
Published: December 2021

Abstract

Background
Hoop’s Family Children’s Hospital is a pediatric hospital with 72 beds, nested within Cabell Huntington Hospital. There is an established adult antibiotic stewardship program (ASP), however, since 2014 there has not been a pediatric infectious disease (ID) specialist and no pediatric ASP. With the recent hire of a pediatric ID specialist in Oct 2019 and the formation of a targeted pediatric ASP, we tracked the use of ceftriaxone (CRO) in our facility.

Methods
Starting January 2020, education was provided to pediatric providers in regards to appropriate CRO dosing and clinical indications via email communication. The main goals were to limit 100mg/kg/day dosing to severe infections and reduce CRO use in community-acquired pneumonia. This was sustained through intermittent prospective audits and feedback. A retrospective chart review was done from 2019-2021 for the months of January, April and December of each year. Patients ≤18 years of age who received CRO were included. Dosing, interval frequency, indication, and treatment duration were reviewed. Patients who received a single dose of CRO were excluded.

Results
From Jan 2019 – April 2021, 391 patient charts were reviewed (189 in the pre-intervention period and 202 in the post intervention period). There were no significant differences in age, race/ethnicity and gender in the two study groups. In the pre-intervention period, 86% of patients were prescribed CRO at severe infection dosing vs 33% in the post intervention period (p&lt; 0.0001) (Figure 1). When dosing was paired with indication, only 20% of patients in the pre intervention period had the appropriate dosing per clinical indication compared to 83% in the post intervention period (p&lt; 0.0001) (Figure 2). We also saw that in the pre-intervention period the most common indication for CRO was pneumonia (66%), which decreased to 57% in 2020 and to 35% in 2021 (p&lt; 0.0001) (Figure 3).

Figure 1 describes the percentage of patients receiving ceftriaxone at severe infection dosing. This changed from an average of 86% in the pre-intervention period to 33% in the post-intervention period.

Figure 2 describes the percentage of patients receiving ceftriaxone at the appropriate dosing dependent on the clinical indication provided. This changed from 20% in the pre-intervention period to closer to 90% in the post-intervention period.

Conclusion
Pediatric specific ASP efforts and expertise proved to be crucial in appropriate CRO use in our institution. With a feasible education strategy and targeted prospective audit and feedback, there has been a sustained impact in inappropriate CRO use. This underscores the importance of targeted pediatric ASP efforts in pediatric hospitals within larger adult hospitals.

Disclosures
All Authors: No reported disclosures
1131. You’re Never Too Old for a Time-Out: Implementing Antibiotic Time-Outs on Pediatric Inpatient Teams
Authors: Hayes Catherine , Swartwood Michael J , Zwemer Eric , Doughman Danielle , Mavrogiorgos Nikolaos , Daniels Lindsay M , Wellborn Rebecca , Hill Daniel , Wilson William , Willis Zachary 
Published: December 2021

Abstract

Background
Antibiotic overuse leads to antimicrobial resistance, adverse events, and excess costs. Antibiotic time-outs (ABTOs) offer a structured approach to reevaluate antimicrobial regimens, but implementing and maintaining ABTOs can be challenging. In this project, we built on previous ABTO implementation in adult inpatient units to incorporate ABTOs in pediatrics using quality improvement (QI) methods.

Methods
We identified champions, including attending physicians, residents, nurses, team coordinators, and pharmacists. Following pilot testing, ABTOs began in November 2019 and January 2020 for two general pediatric teams, and in June 2020 in the pediatric ICU (PICU). Patients were eligible for an ABTO if they had been on antibiotics for 36-72 hours. ABTOs were documented in the electronic medical record (EMR) with a structured note template. These notes along with patient antimicrobial regimens were extracted and analyzed using an automated EMR query. Metrics included: (1) Proportion of ABTO-eligible patients with an ABTO; (2) Proportion of ABTOs conducted within goal time frame; (3) Documented plan changes in ABTO (e.g. change IV antibiotics to PO); and (4) Proportion of documented changes completed within 24 hours

Results
To date, there have been 342 pediatric ABTOs over 145 team weeks on the general pediatrics teams and 50 weeks in the PICU, representing 96.9% of eligible patients. 77.8% of ABTOs were completed within the recommended time frame. A majority of ABTOs (67%) resulted in no change to antibiotic regimen, and 18% of patients had already had de-escalation. In 10.5% of patients, the ABTO led to a de-escalation (antibiotics discontinued in 2%, converted from IV to PO in 8.5%). 86.8% of planned changes occurred within 24 hours of ABTO.

Figure 1. Compliance with antibiotic time-outs over time, by week. The green line represents the goal of 80%, and the orange line represents median performance.

Figure 2. Planned changes to antimicrobial regimen documented in antibiotic time-out.
Table 1. Antibiotic time-out performance on participating pediatric services.

Conclusion
This project demonstrates that ABTOs can be implemented across a variety of teams and showed successful spread of an adult-based QI project to pediatrics. ABTOs led to clear de-escalation in 10.5% of cases, with other changes made in 5% of cases. Future directions include continued spread to inpatient teams, development of EMR-based ABTO alerts, comparison of overall antibiotic use and adverse events before and after ABTO implementation, and characterization of antimicrobial optimization prior to ABTO.

Disclosures
All Authors: No reported disclosures
1134. The Effect of Telehealth Antimicrobial Stewardship Program on Antimicrobial Use in a Pediatric Intensive Care Unit
Authors: Alghounaim Mohammad , Abdelmoniem Ahmed , Elseadawy Mohamed , Surour Mohammad , Basuni Mohamed , Papenburg Jesse , Alfraij Abdulla 
Published: December 2021

Abstract

Background
Inappropriate antimicrobial use is common in pediatric intensive care units (PICU). We aimed to evaluate the effect of telehealth antimicrobial stewardship program (ASP) on the rate of PICU antimicrobial use in a center without a local infectious diseases consultation service.

Methods
Aretrospective cohort study was performed between October 1st, 2018 and October 31st, 2020 in Farwaniyah Hospital PICU, a 20-bed unit. All pediatric patients who were admitted to PICU and received systemic antimicrobials during the study period were included and followed until hospital discharge. Patients admitted to the PICU prior to the study period but still receiving intensive care during the study period were excluded. Weekly prospective audit and feedback on antimicrobial use was provided starting October 8th, 2019 (post-ASP period) by the ASP team. A pediatric infectious diseases specialist would join ASP rounds remotely. Descriptive analyses and a pre-post intervention comparison of days of therapy (DOT) were used to assess the effectiveness of the ASP intervention

Results
There were 272 and 152 PICU admissions before and after initiation of ASP, respectively. Bronchiolitis and pneumonia were the most common admission diagnoses, together compromising 60.7% and 61.2% pre- and post-ASP. Requirement for respiratory support was higher post-ASP (76.5% vs 91.5%, p&lt; 0.001). Average monthly antimicrobial use decreased from 92.2 (95% CI 74.5 to 100) to 48.5 DOT/1,000 patient-days (95% CI 24.6 to 72.2, P &lt; 0.05) (figure). A decline in DOT was observed across all antibiotic classes, except for ceftriaxone and clarithromycin. No effect on length of PICU stay, hospital length of stay, or mortality was observed. Most (89.7%) ASP recommendations were followed fully or partially changes in antimicrobial days of therapy (DOT)/1,000 patient-days over time. The dashed line represents the start of the antimicrobial stewardship program (ASP)

Conclusion
In settings where infectious diseases services are not available, telehealth stewardship can be effectively implemented and associated with a significant reduction of antimicrobial use.

Disclosures
Jesse Papenburg, MD, AbbVie (Grant/Research Support, Other Financial or Material Support, Personal fees)Medimmune (Grant/Research Support)Sanofi Pasteur (Grant/Research Support)Seegene (Grant/Research Support, Other Financial or Material Support, Personal fees)
1135. The Effect of Penicillin Allergy Labels on Antibiotic Prescribing for Children Diagnosed with Upper Respiratory Tract Infections in Two Primary Care Networks
Authors: Joerger Torsten , Taylor Margaret , Palazzi Debra , Gerber Jeffrey 
Published: December 2021

Abstract

Background
In pediatric inpatient settings, unconfirmed penicillin allergy labels (PALs) are associated with increased broad-spectrum antibiotic use, costs, and adverse events. However, 90% of antibiotics are prescribed in the outpatient setting and 70% of these antibiotics are given for upper respiratory tract infections (URTI.) Little is known about the effect of PALs on antibiotic prescribing in the pediatric outpatient population.

Methods
A retrospective birth cohort was created of children born between January 1st 2010 and June 30th 2020 and seen at one of 91 Texas Children’s Pediatrics or Children’s Hospital of Philadelphia primary care clinics. Children with an ICD10 code for an URTI and an antibiotic prescription were stratified into those with or without a penicillin allergy label at the time of the infection. Rates of second-line and broad-spectrum antibiotic use were compared.

Results
The birth cohort included 334,465 children followed for 1.2 million person-years. An antibiotic was prescribed for 696,782 URTIs and the most common diagnosis was acute otitis media. Children with PALs were significantly more likely to receive second-line antibiotics (OR 35.0, 95% CI 33.9-36.1) and broad-spectrum antibiotics (OR 23.9, 95% CI 23.2-24.8.) Children with PALs received more third generation cephalosporins (60% vs. 15%) and more macrolide antibiotics (25% vs. 3%) than those without a PAL. Overall, 18,015 children (5.4%) acquired a PAL during the study period, which accounted for 23% of all second-line antibiotic prescriptions and 17% of all broad-spectrum antibiotic use for URTIs.

Multivariable logistic regression for receipt of second-line antibiotics for upper respiratory tract infections

Conclusion
PALs are common and account for a substantial proportion of second-line and broad-spectrum antibiotic use in pediatric outpatients treated for URTIs. Efforts to de-label children with PALs are likely to increase first-line antibiotic use and decrease broad-spectrum antibiotic use for URTIs, the most common indication for antibiotic prescribing to children.

Disclosures
Debra Palazzi, MD, MEd, AAP (Other Financial or Material Support, PREP ID Editorial Board, PREP ID Course)AHRQ (Research Grant or Support)Elsevier (Other Financial or Material Support, Royalties for writing and editing chapters)JAMA Pediatrics (Board Member)
1136. Effect of Weekly Antibiotic Rounds as a Core Strategy of the Antimicrobial Stewardship Program on Antibiotic Utilization in a Terciary-care Neonatal Intensive Care Unit, Medellin, Colombia
Authors: Diaz Alejandro Diaz , Mesa-Monsalve Juan Gonzalo , Echavarria-Gil Adriana M , Jimenez Carolina 
Published: December 2021

Abstract

Background
Antibiotics are among the most prescribed drugs in the neonatal intensive care unit (NICU), but frequently are used inappropriately exposing preterm neonates to additional harm. Antibiotic stewardship programs (ASP) have demonstrated impact on antibiotic use in the hospital setting, but implementation in neonatal units is challenging. We sought to determine the effects of weekly antibiotic rounds on overall antibiotic consumption in the NICU.

Methods
Single-center, retrospective observational study. In November 2014, we implemented weekly antibiotic rounds in a 60-bed tertiary-care NICU, led by a pediatric infectious disease physician. Antibiotic therapy decisions were made in collaboration with neonatologists. Data collected included the proportion of patients receiving antibiotics, irrespective of the indication. Multimodal ASP was implemented hospital-wide in 2015. Antibiotic consumption was measured with days of therapy (DOT). Data on costs and in-hospital mortality were obtained from pharmacy and hospital records.

Results
From November 2014 to December 2020, we evaluated 13609 neonates admitted to the NICU during rounds. Of those, 3607 (27%) were receiving at least one antibiotic. Overall, the proportion of patients with antibiotics decreased from 31% to 19% during the study period (p&lt; 0.001). In 2017, an outbreak of neonatal necrotizing enterocolitis (NEC) occurred. Specific countermeasures as well as reinforcement of ASP were implemented. Despite Antibiotic usage by DOT increased in 2017 driven by empiric treatment with piperacillin tazobactam in patients with NEC, overall antibiotic consumption decreased from 254.4 DOT/1000 patient days (PD) to 162.4 DOT/1000 PD (Figure 1). Annual costs from antibiotic prescriptions were US&23,161 in 2015 and decreased to US&12.046 in 2020 saving over US&3,800/year (fig 2a). During the study period, we did not observe an increase in crude in-hospital mortality rate (Figure 2b).

Primary Y axis indicates the proportion of patients with at least one antibiotic prescription during rounds. Secondary Y axis indicates antibiotic consumption by days of therapy metrics.
Antibiotic prescription costs and NICU mortality rates during study period

A. Annual antibiotic prescription costs; B. NICU mortality rate

Conclusion
Weekly antibiotic rounds led to a significant decrease in antibiotic utilization in our NICU. This strategy is relatively simple and low-cost, saves hospital resources and has a large impact on antibiotic use. Hence, its implementation is encouraged as part of successful antimicrobial stewardship programs.

Disclosures
All Authors: No reported disclosures
1138. Utility of Methicillin-resistant Staphylococcus aureus Nares Screening in Hospitalized Children With Acute Infectious Disease Syndromes
Authors: Sands Ashley , Mulvey Nicole , Iacono Denise E , Hagmann Stefan 
Published: December 2021

Abstract

Background
Empirical antibiotic regimens frequently include treatment for methicillin-resistant Staphylococcus aureus (MRSA). Studies in adults with pneumonia support the use of a negative MRSA nares screening (MNS) to help de-escalate antibiotic therapy. Comparable pediatric data in the literature is scarce. We aimed to evaluate the use of MNS for antibiotic de-escalation in hospitalized children (&lt; 18 years) at a tertiary children’s hospital.

Methods
A retrospective chart review was conducted of pediatric inpatients (January 01, 2015 to December 31, 2020) with a presumed infectious diagnosis who had a PCR-based MNS test and a clinical culture (i.e. site of infection or blood) performed as part of their diagnostic work up. Those who were screened &gt;5 days since admission or &gt; 48 hours since start of MRSA-active antimicrobials, and those who had antibiotic treatment withdrawn after 48 hours because of negative cultures were excluded.

Results
A total of 101 children were included with a median age (range) of 2 years (0-17) and about half (n=57, 56.4%) were male. Top three diagnosis groups were skin and soft tissue infections (n=33, 32.7%), toxin-mediated syndromes (n=21, 20.8%), and osteoarticular infections (n=13, 12.9%). Pneumonia accounted for only six (5.9%) patients. The prevalence of nasal MRSA colonization was 6.9% (n=7). The sensitivity of the MNS test to predict a MRSA infection was 42.9% with a specificity of 95.7%. The positive predictive value (PPV) and negative predictive values (NPV) were 42.9% and 95.7%, respectively. In about half (55/95, 57.9%) of patients initiated on anti-MRSA therapy, these agents were discontinued during the admission. A quarter (n=14, 25.5%) were de-escalated based on the negative MNS test alone, and another third (n=21, 38.2%) after negative MNS test and negative culture results became available.

Conclusion
Pediatric providers at this institution have started to use the MNS to help limit anti-MRSA therapy. We noted a high NPV which suggests that MNS may be useful for timely de-escalation of anti-MRSA therapy and thereby a useful antimicrobial stewardship tool for hospitalized children. Prospective studies to evaluate the utility of MNS for the various infectious syndromes are warranted.

Disclosures
All Authors: No reported disclosures
1139. Reducing Collection of Tracheal Aspirate Bacterial Cultures: A Diagnostic Test Stewardship Intervention
Authors: Chiotos Kathleen , Lee Giyoung , Sydney Guy , Wolfe Heather , Blumenthal Jennifer , Stinson Hannah , McGowan Nancy , Harab Julie , Traynor Danielle , Dudhia Aaditya , Piccione Joseph , Burke Jennalyn , Doll Ashley , Keim Garrett , Woods-Hill Charlotte , Jennings Megan , Harris Rebecca , Gerber Jeffrey 
Published: December 2021

Abstract

Background
Tracheal aspirate (TA) bacterial cultures are often collected in mechanically ventilated children to evaluate for ventilator-associated infections (VAI), including tracheitis and pneumonia. However, frequent bacterial colonization of tracheal tubes results in poor specificity of positive TA cultures for distinguishing bacterial infection from colonization, which contributes to antibiotic overuse for VAI. We performed a quality improvement project to reduce collection of TA cultures through implementation of a consensus guideline to standardize culture ordering, and measured its impact on antibiotic use in a tertiary PICU.

Methods
A multidisciplinary team including PICU, pulmonary, and ID clinicians developed the consensus guideline in November 2019-February 2020. The first Plan-Do-Study-Act (PDSA) cycle occurred in August 2020 and included provider education, providing a link to the guideline in the TA culture order, and signs and screensavers highlighting key guideline recommendations. The second PDSA cycle occurred in October-December 2020 and included weekly emails to on service PICU clinicians. Statistical process control charts were used to measure the number of TA cultures collected/100 ventilator days and broad-spectrum antibiotic DOT/100 ventilator days. The number of patients treated for VAI/100 ventilator days and guideline compliance were also measured.

Results
The baseline rate of TA culture collection was 4.58/100 ventilator days. A centerline shift to 3.33 cultures/100 ventilator days occurred in March 2020. Following PDSA 1 and 2 in October 2020, a second downward centerline shift to 2.22 cultures/100 ventilator days occurred (Figure 1). Broad-spectrum antibiotic days of therapy/100 ventilator days decreased in November 2019 coincident with the start of the project, but no further reductions occurred after PDSA 1 and 2 (Figure 2). The number of patients treated for VAI decreased from a baseline of 1.24/100 ventilator days to 0.66/100 ventilator days. Finally, the proportion of TA cultures ordered that were non-compliant with the guideline recommendations was unchanged throughout the study period (Table 1).

Conclusion
A consensus guideline reduced collection of TA cultures, with a modest reduction in the rate of antibiotic treatment for VAI.

Disclosures
All Authors: No reported disclosures
1140. Impact of a Rapid Molecular Bloodstream Diagnostic Test on Optimal Antibiotic Use in Infants
Authors: Norman Savanah , Burton Alexandra , Mumphrey Christy , Joslyn Peter , Cook Gregory 
Published: December 2021

Abstract

Background
Rapid molecular bloodstream diagnostics have been shown to decrease time-to-optimal antibiotic therapy in adult and pediatric patients. The purpose of the study was to compare the time-to-optimal antimicrobial therapy both pre-and post- implementation of rapid diagnostic testing in infants.

Methods
This was a single-center quasi-experimental study conducted from December 2018 to December 2020 at Children’s Hospital New Orleans. A rapid, multiplex polymerase chain reaction bloodstream diagnostic was implemented in January 2019. Antimicrobial Stewardship performed a daily review of all antimicrobials during both periods and made recommendations when necessary. The primary outcome was the difference in time-to-optimal therapy. Secondary outcomes included time-to-effective therapy, 30-day all-cause mortality rate, 30-day recurrent bacteremia rate, and time-to-microbiologic clearance. Patients were excluded if they had an unrelated concomitant infection, withdrawal of care before the result, bacteria not identified by the panel, or were over 6 months of age.

Results
Thirty-five and forty-three patients met inclusion criteria pre-and post-implementation. The median post-natal age was 2 months and median PRISM score was 12 in both groups. Median time-to-optimal therapy was 53.1 hours in the pre-intervention and 24.4 hours in the post-intervention group (-28.7 hours, P = 0.03). Median time-to-effective therapy was 0 and 1.4 hours, respectively (+1.4 hours, P = 0.02). There was no significant difference in 30-day all-cause mortality (3 vs. 4 patients, P = 0.62), 30-day recurrent bacteremia (0 vs. 2 patients, P = 0.2), or microbiologic clearance (37.3 vs. 26.2 hours, P = 0.09).

Conclusion
Implementation of a rapid, multiplex bloodstream diagnostic lead to a significant decrease in time-to-optimal antibiotic therapy in infants when compared to standard microbiological techniques.

Disclosures
All Authors: No reported disclosures