bluuebunny/crossref_metadata_2025_split huggingface dataset:
132. Standardized Antimicrobial Administration Ratios to Guide Antimicrobial Stewardship in the Neonatal Intensive Care Unit: a Single Center Experience
Authors: Smoke Steven , Hasan Uzma , Steffen Eileen , Vangvanichyakorn Kamtorn 
Published: December 2021

Abstract

Background
Antimicrobial stewardship (AMS) is particularly challenging in the neonatal population. Both under- and overuse can negatively impact outcomes. There are limited reports of strategies to improve AMS in the neonatal population. Standardized Antimicrobial Administration Ratios (SAARs) are novel metrics of antimicrobial use, recently introduced for neonatal populations by the National Healthcare Safety Network (NHSN). We describe our experience using SAARs to guide AMS in the neonatal intensive care unit (NICU).

Methods
This was a retrospective study conducted from January 2020 to April 2021. A team consisting of AMS and NICU department staff identified and implemented AMS strategies. Based on a review of NICU SAAR data, a goal was set to reduce third generation cephalosporin use by encouraging aminoglycoside use when appropriate. The pre-implementation period was January 2020 to May 2020 and the post-implementation period was July 2020 to April 2021. Antibiotic use was measured as SAARs and compared between study periods. The primary outcome was the neonatal SAAR for third generation cephalosporins. Secondary outcomes included SAARs for aminoglycosides and all neonatal antibacterial agents. SAARs were compared using the NHSN Statistics Calculator.

Results
For third generation cephalosporins, there were 385 observed antimicrobial days (OAD) and 115 expected antimicrobial days (EAD) in the pre-implementation period compared to 597 OAD and 228 EAD in the post implementation period. This resulted in a SAAR of 3.34 and 2.62, respectively; a reduction of 22% (p &lt; 0.001). For aminoglycosides, there were 713 OAD and 584 EAD compared to 1617 OAD and 1155 EAD. This resulted in a SAAR of 1.22 and 1.4; an increase of 15% (p = 0.002). For all neonatal antibacterial agents, there were 2716 OAD and 1739 EAD compared to 5321 OAD and 3438 EAD. This resulted in a SAAR of 1.56 and 1.55; indicating no change in use (p = 0.70). See Table 1 for results.
Table 1. Antibiotic Use

Conclusion
While this initiative resulted in decreased use of third generation cephalosporins, this was not associated with a decrease in antibiotic use overall. Use of SAARs in the NICU may be helpful in both identifying opportunities to improve antibiotic use and monitoring antibiotic use over time.

Disclosures
Steven Smoke, PharmD, Karius (Advisor or Review Panel member) Shionogi (Scientific Research Study Investigator, Advisor or Review Panel member)
134. Impact of an Antibiotic Stewardship Treatment and Management Algorithm for Liver Abscesses
Authors: Vanderburg Hunter , Meredith Jacqueline , Jaffa Rupal K , Aviles Cesar , Motz Benjamin M , Cochran Allyson , Shastry Vivek , Vrochides Dionisios , Medaris Leigh Ann 
Published: December 2021

Abstract

Background
Antibiotic prescribing for pyogenic liver abscess(es) (PLA) is highly variable with literature primarily aimed at assessing surgical intervention with a scarcity of data for antibiotic selection and duration of therapy. Given the lack of data, there is no clear consensus for treatment options or length of treatment. Our Antimicrobial Support Network (ASN) in collaboration with the hepatopancreatobiliary (HPB) team created a treatment and management algorithm to guide duration of therapy and antibiotic selection.

Methods
A retrospective, quasi-experimental cohort study was performed at Carolinas Medical Center in hospitalized patients with PLA with an HPB and/or infectious diseases consult. The primary outcome was antipseudomonal beta-lactam days of therapy (DOT) per 1000 patient days (PD) in the pre-versus post-intervention group. Secondary outcomes included rates of treatment failure at 90 days, 90-day all-cause and abscess-related hospital readmission, C. difficile and multi-drug resistant organism (MDRO) colonization at 90 days from diagnosis, and hospital length of stay (LOS). Additional a priori subgroup analyses of duration of therapy, treatment failure, all-cause and abscess-related readmissions were also conducted based on surgical intervention.

Results
A total of 93 patients were included, 49 patients in the pre-intervention group and 44 patients in the post-intervention group. Baseline characteristics were similar between the groups. The majority of liver abscesses were unilocular and monomicrobial. Anti-pseudomonal beta-lactam DOT per 1000 PD decreased by 13.8% (507.4 versus 437.5 DOT/1000 PD). Treatment failure occurred in 30.6% of pre-intervention patients and 18.2% of post-intervention patients (p = 0.165). Patients in the post-intervention group were discharged a median of 2.4 days sooner than the pre-intervention period (12.2 days vs. 9.8 days, p = 0.159). No significant differences resulted in 90-day readmission rates or 90-day C. difficile or MDRO rates.
Table 1. Primary Outcome for Patients with Pyogenic Liver Abscesses Treated Pre- and Post-Antibiotic Stewardship Algorithm

Table 2. Secondary Outcomes for Patients with Pyogenic Liver Abscesses Treated Pre- and Post-Antibiotic Stewardship Algorithm

Conclusion
The implementation of a PLA treatment and management algorithm led to a decrease in anti-pseudomonal beta-lactams without impacting clinical outcomes and a trend towards decreased LOS.

Disclosures
All Authors: No reported disclosures
135. Influence of Prescribers on Antibiotic Use among Skilled Nursing Care Residents in 29 U.S. Nursing Homes
Authors: Wilson Brigid , Marek Joseph , Jump Robin L , Jump Robin L , Song Sunah 
Published: December 2021

Abstract

Background
In nursing homes, federal mandates call for more judicious use of antibiotics and antipsychotics. Previous research indicates that practice patterns of nursing home practitioners, rather than resident’s signs and symptoms or overall medical conditions, drive antibiotic use. We hypothesized that nursing home practitioners who prescribe antibiotics more frequently than their peers may display a similar practice pattern for antipsychotics. Here, we examine similarities in prescribing patterns for antibiotics and antipsychotics among practitioners at 29 U.S. nursing homes.

Methods
Prescription data came from 2016 invoices from a pharmacy common to all 29 nursing homes. We defined practitioners as individuals who prescribed ≥1% of systemic medications at a nursing home and excluded practitioners without no prescriptions for anti-hypertensive drugs assuming they were not treating a general nursing home population (i.e. treating hospice or dementia patients). Using anti-hypertensive starts for standardization, we calculated the expected number of starts for both antibiotics and antipsychotics. Using funnel plots with Poisson 99% control limits for the observed-to-expected ratio, we identified practitioners whose use of either class of drugs exceeded these control limits. Practitioners were classified as high, average, or low prescribers for each class of drugs.

Results
We analyzed 129 practitioners who wrote for 113669 systemic medications. For antibiotics, 27 (20%) and 19 (15%) of practitioners were low and high prescribers, respectively. For antipsychotics, 53 (41%) and 14 (11%) were low and high prescribers, respectively (Figure 1). Among the low antibiotic prescribers, 59% (16/27) were also low antipsychotic prescribers. Among the high antibiotic prescribers, 21% (4/19) were also high antipsychotic prescribers (Figure 2).
Figure 1. (a) Funnel plot for antibiotics

(b) Funnel plot for antipsychotics

Figure 2. Type of prescriber

Conclusion
Practitioners who were low prescribers for antibiotics were also likely to be low prescribers for antipsychotics, suggesting judicious use for both classes of medications. Further understanding of the behaviors of these individuals, as well as those who are high prescribers for both classes, has implications for improving antibiotic stewardship practices in nursing homes.

Disclosures
Robin L. Jump, MD, PhD, Pfizer (Individual(s) Involved: Self): Consultant
137. Impact of Antimicrobial Stewardship Interventions on Post-Elective Caesarean Antibiotic Prophylaxis and Surgical Site Infections
Authors: Seah Xue Fen Valerie , Ong Yue Ling Rina , Poh Wei Ming Cedric , Siraj Shahul Hameed Mohamed , Kam Kai-Qian , Thoon Koh Cheng 
Published: December 2021

Abstract

Background
Antimicrobial stewardship programs (ASP) aim to improve appropriate antimicrobial use. Post-operative antibiotics are generally not necessary, especially those without surgical site infections risk factors (e.g. obesity). Few studies have described the impact of ASP interventions on patient outcomes especially in unique populations such as obstetrics. This study aims to evaluate the impact of ASP interventions on post-elective caesarean (eLSCS) oral antibiotic prophylaxis use and patient outcomes including SSI rates.

Methods
This pre-post quasi-experimental study was conducted over 9 months (2 months pre- and 7 months post-intervention) in all women admitted for eLSCS in our institution. Interventions included eLSCS surgical prophylaxis guideline dissemination, where a single antibiotic dose within 60 minutes before skin incision was recommended. Post-eLSCS oral antibiotics was actively discouraged in those without SSI risk factors. This was followed by ASP intervention notes (phase 1) for 3 months, and an additional phone call to the ward team for the next 7 months (phase 2). Phase 3 (next 6 months) constituted speaking to the operating consultant. The primary outcome was post-operative oral antibiotics prescription rates. Secondary outcomes included rates of 30-day post-operative SSI.

Results
A total of 1751 women was reviewed. Appropriateness of pre-operative antibiotic prophylaxis was 98% in our institution. There were 244 women pre-intervention, 274 in post-intervention phase 1, 658 in phase 2 and 575 in phase 3. Pre-intervention post-eLSCS antibiotic prescribing rates was 82% (200), which reduced significantly post-intervention to 54% (148) in phase 1, 50% (331) in phase 2 and 39% (226) in phase 3 (p&lt; 0.001). There was no significant difference in patients who developed post-operative SSI pre-post intervention (0.8%, 2 of 242 vs. 1.9%, 28 of 1479, p=0.420) and among who received post-operative oral antibiotics compared to those without (1.9%, 17 of 905 vs. 1.5%, 13 of 846, p=0.582).

Conclusion
ASP interventions can reduce post-eLSCS antibiotic prophylaxis rates without adversely impacting patient safety.

Disclosures
All Authors: No reported disclosures
138. Implementation of an Antimicrobial Stewardship Order Set in the Emergency Department at a Quaternary Care Facility
Authors: . Al Shaqfa Salma M , El Lababidi Rania M , El Nekidy Wasim S , Hisham Mohamed , Nasef Rama , Elrefaei Hazem , Bonilla Fernanda 
Published: December 2021

Abstract

Background
Implementation of antimicrobial stewardship (AS) interventions in the emergency department (ED) has been associated with improved patient outcomes. One potentially promising AS strategy is the implementation of an ED-specific, evidence-based antimicrobial order set. In this study, we aimed to examine the impact of implementing an ED-specific order set (EDOS) on the appropriateness of empiric antimicrobial therapy.

Methods
We conducted a pre-post quasi experimental study on 160 adult patients presenting to the ED with suspected or confirmed common infections at our quaternary healthcare facility. The EDOS was implemented in December 2020, providing evidence-based recommendations for the management of common infectious diseases. Data was collected between September 2019 and March 2020 for the pre-EDOS implementation group and between January 2021 and April 2021 for the post-EDOS implementation group.
Pregnant women and patients with suspected or confirmed COVID-19 infection were excluded. Data were analyzed using two-sample T-test and mixed effects logistic regression. The primary study outcome was the appropriateness of antimicrobials selected, and the secondary outcomes were clinical and microbiologic cure, length of hospital stay, Clostridioides difficile infection, and the number of changes in antimicrobial therapy on transition to inpatient setting.

Results
A total of 100 ED patients pre-EDOS implementation and 60 patients post-EDOS implementation were compared. At baseline, patients in the post-EDOS group were older (59.83±20.30 years vs. 50.17±19.97 years, P=0.0037). A higher number of patients in the post-EDOS group had a history of multiple comorbidities (76.67% vs. 54%, P=0.0039). There was a higher rate of appropriate antimicrobial use in the post-EDOS group as compared to the pre-EDOS group (88.3% vs. 50%, P&lt; 0.001). Longer hospital stays were observed in the post-EDOS group (P=0.0005). Clinical cure was similar between the two groups (96.6% vs. 94%, P=0.4568).

Conclusion
In our study, we observed higher rates of appropriate antimicrobial selection after implementation of an EDOS. Use of an EDOS may represent a valuable AS intervention to guide appropriate antimicrobial prescribing in the ED, and larger studies are needed to confirm those findings.

Disclosures
All Authors: No reported disclosures
139. Improving Skin and Soft Tissue Infection Antibiotic Duration Concordance with National Guidelines in Pediatric Urgent Care Clinics
Authors: Hamner Megan , Nedved Amanda , Austin Holly , Wyly Donna , Burns Alaina , King Diana , Lee Brian R , El Feghaly Rana E 
Published: December 2021

Abstract

Background
Skin and soft tissue infections (SSTIs) are the second most common diagnosis leading to pediatric antibiotic prescriptions in the outpatient setting after respiratory diagnoses. Children with SSTIs often receive &gt; 7 days of antibiotics, although current guidelines recommend 5-7 days for most diagnoses. At Children’s Mercy Hospital (CMH) urgent care clinics (UCC), only 58% patients received the recommended 5-7 days of antibiotics. We aimed to increase the percentage of patients receiving 5-7 days of oral antibiotics for SSTIs from 58% to 75% by December 31st, 2021.

Methods
We formed a multidisciplinary team in April 2020. A provider survey assessed factors influencing prescribing habits. We completed cause-and-effect analyses and developed a driver diagram (Figure 1). Interventions were chosen based on the potential for highest impact and lowest effort. Our first Plan-Do-Study-Act (PDSA) cycle provided an update on current guidelines for UCC providers. The second PDSA cycle updated prescription sentences in the electronic health record (EHR) and organized them from shortest to longest duration. The third PDSA cycle provided a project update via email to UCC providers. Our outcome measure is the percentage of patients receiving 5-7 days of antibiotics for SSTIs. Process measure is the number of updated prescriptions used. Balancing measure is the number of patients returning for SSTI within 14 days of their visit. Results are displayed using a run chart.

Results
After initiation of the project in April 2020, the percentage of patients receiving 5-7 days of antibiotics increased to 68% (Figure 2). This percentage increased to our goal of 75% after the 1st PDSA cycle (October-December 2020), 80% following the second PDSA cycle in February 2021, and 90% following the third PDSA cycle in April 2021. There was no change in balancing measure numbers.
Run Chart

Conclusion
Prior to our project, only 58% of children seen in CMH UCCs for SSTIs received the recommended antibiotic duration. By addressing the primary drivers uncovered through QI methodology, we surpassed our goal of 75%. Additional PDSA cycles are planned along with expansion to other departments. This work will allow us to expand antibiotic stewardship efforts to other infectious diagnoses as well.

Disclosures
Brian R. Lee, PhD, MPH , Merck (Grant/Research Support)Pfizer (Grant/Research Support)
140. Variations in Rates of Antimicrobial Use in Primary Care, in Relation to the Presence of Chronic Diseases, Québec, Canada, 2014-2017
Authors: Fortin Elise , Sirois Caroline , Quach Caroline , Simard Marc , Jean Sonia , Irace-Cima Alejandra , Magali-Ufitinema Nadine 
Published: December 2021

Abstract

Background
Chronic diseases may increase one’s risk of infection and ensuing complications, which in turn may lower clinicians’ tolerance threshold for antimicrobial prescription, while potential drug interactions may limit therapeutic options. Objective of the study was to measure the impact of chronic diseases on the rates of antimicrobial use in the Province of Québec.

Methods
Individuals covered by the public drug insurance plan between April 2014 and March 2017 were included in our cohort to describe rates of antimicrobial dispensing per 1,000 person-years, per age group (0-17 years old, 18-64 years old and 65 years old or over) and category of chronic disease (respiratory, cardiovascular, diabetes, mental disorder, none of these). For 2014-2017, ratios of extended-to-narrow spectrum antimicrobials were computed and multivariate Poisson regression was used to measure the impact of categories of chronic diseases on rates of total antimicrobial dispensing (in prescriptions and defined daily doses).

Results
A total of 1 259 833 children-years, 5 281 026 person-years between 18 and 64 years and 3 841 359 person-years 65 years or older were included in the study. Ratios of extended-to-narrow spectrum antimicrobials varied from 3.1 (adults 18-64 years old with no chronic disease) to 14.6 (children with no chronic disease); ratios for individuals with chronic diseases were lower in children but higher in adults. Adults with chronic respiratory diseases were twice more exposed to antimicrobials (increase of 109%) than those with none of the studied diseases (62% increase in children). In adults, antimicrobial use was also 48% higher in presence of a mental disorder (22% in children), 40% higher with diabetes (102% in children) and 31% higher with a cardiovascular disease (no data in children). These differences were all statistically significant (α = 0,05).

Conclusion
In Québec, antimicrobial dispensation was more frequent for individuals with at least one chronic disease. This raises the question of how much antimicrobial use can be reduced or improved to limit the selection of resistant bacteria.

Disclosures
All Authors: No reported disclosures
142. Effect of Discontinuation of Antimicrobial Stewardship Programs on the Antibiotic Usage Pattern and Incidence of Antibiotic Resistance in the Major Bacterial Species
Authors: Jang Wooyoung , Hwang Hyeonjun , Jo Hyun-uk , Cha Yong-Han , Kim Bongyoung 
Published: December 2021

Abstract

Background
The aim of this study was to analyze the effect of discontinuation of antimicrobial stewardship programs (ASP) activity on the antibiotic usage pattern.

Methods
An interrupted time series analysis assessing the trends in antibiotic use and incidence of antimicrobial resistance in major pathogens was conducted between March 2017 and April 2019 in an 859-bed university-affiliated hospital in Korea, where all ASP activities were discontinued in February 2018. The major activity of the ASP was a restrictive measure for designated antibiotics. We defined antibiotics as medication with the Anatomical Therapeutic Chemical class J01, and the antibiotic consumption was measured as days of therapy (DOT), which was then standardized per 1,000 patient-days.

Results
The use of antibiotics against multidrug-resistant pathogens increased immediately after the discontinuation of restrictive antibiotic program (41.01 and 150.99 days of therapy [DOT]/1,000 patient-days in the general ward [GW] and intensive care unit [ICU], respectively). In addition, there were positive changes for the GW and ICU (4.20 and 31.57 DOT/1,000 patient-days per month, respectively). The use of broad-spectrum antibiotics in patients in the ICU significantly decreased (-674.26 DOT/1,000 patient-days). For non-broad-spectrum antibiotics, there were positive changes for the GW and ICU (18.17 and 22.69 DOT/1,000 patient-days per month, respectively.

Conclusion
In conclusion, after discontinuation of ASP, antibiotic usage patterns rapidly returned to the patterns prior to ASP implementation.

Disclosures
All Authors: No reported disclosures
143. Antibiotic Use for Common Infections in British Columbia and Ontario: A Review of Outpatient Prescribing to Seniors from 2000 – 2018
Authors: Saatchi Ariana , Reid Jennifer , Povitz Marcus , Shariff Salimah , Silverman Michael , Morris Andrew , Patrick David M , Marra Fawziah 
Published: December 2021

Abstract

Background
Antimicrobials remain among the most prescribed medications in Canada, with over 90% prescribed in outpatient settings. Older adults (aged ≥65 years) prescribed antimicrobials are particularly vulnerable to adverse drug events and antimicrobial resistance. This study compared annual rates of indication-associated, outpatient prescribing to seniors across two Canadian provinces.

Methods
All outpatient, oral antimicrobials dispensed to older adults (≥65 years) were identified from administrative health databases, from 2000 to 2018. Antimicrobials were limited to outpatient use only and linked to an indication using a 3-tiered diagnostic hierarchy. When possible, a record of dispensation was matched to a tier 1 indication (always require antibiotics) first. In the absence of a tier 1 indication, priority was given to tier 2 (sometimes require antibiotics), then 3 (never require antibiotics). Prescription rates were calculated per 1000 population, and trends were examined overall, by drug class, and patient demographics.

Results
Our study included over 18 million individuals (aged ≥65 years) with a total of 23,773,552 antibiotic prescriptions issued to seniors, for common infections. In both provinces, prescribing for tier 1 diagnoses increased over the study period (BC: 44%; ON: 28%). Urinary tract infections accounted for most prescriptions within this tier (ON: 89 prescriptions/1000, BC: 129 prescriptions/1000 population by 2018). Pneumonia-associated prescribing increased by roughly 10% in both provinces. In any given study year, for both provinces, tier 3 diagnosis was the most common reason for antibiotic use, accounting for 50% of all indication-associated antibiotic prescribing. As diagnoses within this tier do not warrant prescribing all antibiotics issued are therefore inappropriate prescriptions.
Figure 1. Rates of indication-associated antibiotic use in Canadian seniors, from 2000 to 2018.

Conclusion
Elevated prescribing to seniors continues across Canadian outpatient settings. Antibiotic prescribing remains an issue of high concern with 50% of all antimicrobials prescribed to seniors, for common infections, used inappropriately.

Disclosures
All Authors: No reported disclosures