bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1739. Impact of a Urinary Tract Infection Treatment Algorithm on Antimicrobial Prescribing at a Small Rural Hospital without Formally Trained Infectious Disease Team Members
Authors: West Daniel , Becker Shane , McClew Nancy 
Published: January 2025

Abstract

Background
Small, rural community hospitals lack certified infectious disease (ID) staff, which can make antimicrobial stewardship (AMS) interventions challenging. At our Critical Access Hospital, we developed a treatment algorithm for urinary tract infections (UTIs) and assessed appropriate duration of therapy (DOT), and appropriate antimicrobial selection in cases before and after implementation of our algorithm.
Figure 1.

Methods
In this retrospective observational study, the AMS team published a treatment algorithm for UTIs (Figure 1) in Q1 2023. Implementation of the algorithm focused on physician exposure, buy-in, and follow-up. A webpage was created to house the algorithm. Buy-in was obtained from key physicians. Antimicrobial prescribing was reviewed at quarterly AMS meetings and physician leaders took this information back to their teams for review. A retrospective review was performed after 2 quarters of interventions.
We obtained prescribing data via electronic health records. Baseline characteristics are in Table 1. Each UTI case was manually reviewed for DOT and appropriateness of antibiotic choice as defined by agreement with our algorithm.

Results
The study included in-patients who were treated for UTI between 10/1/21 through 3/31/22, and 10/1/23 through 3/31/24. Exclusion criteria included concomitant infections, inability to follow-up, and expiration. A t-test was performed to compare antibiotic DOT for UTI treatment. The distribution of DOT is presented in Figure 2. There was a decrease in DOT after our intervention (M=3.84, SD 1.95) compared to baseline (M=4.95, SD=2.64); t(2.2491), P=0.0271. Appropriateness of therapy was assessed (Figure 3). A Chi-square test showed association between the intervention and appropriate choice of therapy, χ2 (1, N= 88)= 12.90, p=0.0003.
Figure 2.
Antibiotic days for the treatment of UTI. Antibiotic days calculated to include discharge medications.

Conclusion
The development of a treatment algorithm for UTI, paired with stakeholder buy-in, exposure, and follow-up, led to shifts in prescribing habits. We found a reduction in DOT, as well as better adherence to guideline driven antibiotic selection. This study, which included discharge prescribing, is unique in that it follows our cases through the continuum of care. We show that rural hospitals without certified ID staff can effectively implement AMS best practices and affect meaningful change.
Figure 3.
Retrospective contingency table summarizing number of appropriate and inappropriately treated UTIs. Appropriateness determined by AMS team by comparing antibiotic selection to our UTI algorithm.

Disclosures
All Authors: No reported disclosures
P-1743. Impact of a carbapenem centered antimicrobial stewardship program in the antibiotic consumption patterns and healthcare infections in a tertiary public hospital in Colombia
Authors: Muñeton Lopez Gerardo A , Amaya Maria Juliana , Suarez David , Vergara Hernan 
Published: January 2025

Abstract

Background
Antimicrobial stewardship programs (ASP) recommend the control of multiple antibiotics related to bacterial resistance in order to prevent the induction of ESBL, carbapenemases, and vancomycin resistance. Nevertheless, the control of all these antibiotics sometimes is not possible due to the limited workforce in the ASP team. In this study, we decided to limit all ASP interventions to the control of carbapenems, leaving the intervention of other antibiotics as a secondary task

Methods
A before and after study was conducted from July 2022 to July 2023, with a baseline period (July to December 2022) and an intervention period (January to July 2023). During the intervention, the ASP emphasized carbapenem prescription control while addressing other antibiotics as secondary concerns. Daily monitoring of meropenem and ertapenem prescriptions was prioritized, with other antibiotics monitored as resources allowed only when all carbapenem prescriptions were assessed. Selective reporting eliminated carbapenems from antibiograms in natural resistance patterns, and susceptibility testing for piperacillin-tazobactam was expanded to guide carbapenem-sparing therapies. Educational sessions focused on appropriate carbapenem use

Results
A decrease in the consumption of carbapenems was observed between the baseline period and the intervention period going from 13.52 (DDD/100 patient days) to 5.84 for meropenem and from 2.70 to 0.59 for ertapenem. Chart1. Additionally, a decrease in the infection rate was observed going from an average of 0.79 (cases/1000 patient days) in the baseline period to an average of 0.47 in the intervention period. Chart 2. The prevalence of carbapenemase producing enterobacterales did not change between the pre and post intervention period but the infection rate did. Chart 3. The non supervised use of other antibiotics was not related to an increase in their consumption. Chart 4.

Conclusion
ASP strategies can be directed toward a specific antimicrobial group in the pursuing of controlling specific problems such as carbapenem overuse and carbapenemase-producing-enterobacterales. These directed strategies can be implemented without an increase in the consumption of other antimicrobial groups.

Disclosures
All Authors: No reported disclosures
P-1746. Evaluating Microbiology Reporting on Time to Appropriate Therapy for Organisms Producing Extended-spectrum and AmpC β-lactamases
Authors: Samsel Alison , Kelly Jennifer , Harrington Nicole , Curran Kelly , Ing Julie , Borja Clint 
Published: January 2025

Abstract

Background
Our Antimicrobial Stewardship Program (ASP) implemented specific treatment recommendations and suppression of select susceptibility results for microbiology reports positive for extended-spectrum β-lactamases (ESBL) and AmpC producing organisms. These statements also recommend Infectious Diseases (ID) consult if needed. This change is in alignment with the Clinical and Laboratory Standards Institute (CLSI) recommendations.Figure 1:Microbiology lab reporting statementsA. ESBL organism statements. B. AmpC organism statements.

Methods
This study was a single-center, retrospective cohort of adult patients with monomicrobial infections due to organisms at high-risk for AmpC or ESBL production. The intervention was effective February 28th, 2023. See Figure 1. Data was collected by chart review for pre- and post-intervention groups from April 1st to September 30th, 2022, and April 1st to September 30th, 2023, respectively. The primary outcome was the time to appropriate definitive antibiotic administration. Appropriate antibiotic therapy was defined by the Infectious Diseases Society of America (IDSA) 2023 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections guidelines. Secondary outcomes included guideline-adherent antibiotic therapy, frequency of ID consultations, and inappropriate antibiotic de-escalation.

Results
Time to appropriate antibiotic administration was not significantly different between the pre- and post-intervention group (median time 8.6 hours vs. 8.3 hours, respectively). The frequency that patients received guideline-adherent therapy significantly increased between groups (pre- 67% vs post- 81%, p = 0.024). ID consultations also significantly increased (pre- 52% vs post- 77%, p = 0.005). Inappropriate de-escalation of therapy based on susceptibilities significantly decreased between groups (pre- 12% vs post- 2%, p = 0.047).

Conclusion
The implementation of microbiology reporting statements increased guideline-adherent definitive antibiotic therapy, increased ID consultations and decreased inappropriate antibiotic de-escalation.

Disclosures
All Authors: No reported disclosures
P-1749. Implementation of an Automatic 36-hour Stop Order on Empiric Meropenem Usage
Authors: Parker Connor , Schneider Jack G , Boyd LaKeisha , Kussin Michelle L 
Published: January 2025

Abstract

Background
Implementation of automatic stop orders (ASOs) for empiric antimicrobials have reduced antimicrobial use without negatively impacting patient outcomes. Given a recent increase in empiric meropenem use at our tertiary referral pediatric hospital, a 36-hour meropenem ASO option was implemented in the EMR for patients with sepsis requiring empiric antibiotics active against ESBL-producing organisms. We sought to evaluate the impact this initiative had on meropenem use and safety outcomes.

Methods
A 36-hour ASO for meropenem was implemented on October 12th, 2022. We conducted a single-center, retrospective pre/post evaluation of order set implementation of all patients admitted to Riley Hospital for Children and treated with meropenem between 9/01/2019–9/01/2021 (pre-intervention) and 10/13/2022–10/13/2023 (post-intervention). The primary outcome was meropenem utilization, as measured by the number of meropenem days and doses per admission. Secondary outcomes included total hospital and ICU mean length of stay (LOS), mortality within 30 days of meropenem exposure, and 30-day readmission rate.

Results
309 admissions during which meropenem was administered were included. Demographics between pre-ASO (147 patients; n = 193 admissions) and post-ASO (88 patients; n = 116 admissions) groups were similar. There was no difference in the number of meropenem days (pre and post-ASO: median = 4; p = 0.88) or the number of meropenem doses (pre-ASO: 11 vs. post-ASO: 10; p = 0.63). Secondary safety outcomes including death within 30 days of meropenem administration (8.7% vs. 8.7%; p = 0.99), hospital LOS (18 vs 15.5 days; p = 0.42), ICU admission, and 30-day readmission rate were not significantly different. The new ASO was utilized in 23.3% of admissions in the post-implementation period.

Conclusion
Use of the new ASO was not widely adopted, making evaluation of impact difficult. No significant difference in meropenem use nor clinical outcomes were identified after implementation, which has informed the next Plan-Do-Study-Act (PDSA) cycle for quality improvement at our center, likely with a focus on EMR modifications and education.

Disclosures
Jack G. Schneider, MD, MiraVista Diagnostics: Advisor/Consultant
P-1753. Impact of a Microbiology Reporting Change on Treatment Selection and Clinical Outcomes for Organisms at Low-Risk for Significant AmpC Production
Authors: Hodapp Ellie , Kinn Patrick M , Ford Bradley A , Auerbach Sarah , Weiner Lukasz , Ince Dilek , Percival Kelly M 
Published: January 2025

Abstract

Background
AmpC β-lactamase production can be induced after exposure to beta lactam antimicrobials, most notably ceftriaxone (CRO), leading to development of resistance on therapy. New guidance from IDSA indicates that the risk of AmpC enzyme production is not equal among all Enterobacterales and those deemed low-risk may be treated with CRO. The purpose of this study was to evaluate the impact of a microbiology reporting change made in collaboration with our antimicrobial stewardship program (ASP) to guide antibiotic selection for low-risk AmpC organisms.

Methods
This was a pre-test, post-test quasi-experimental study with data collected by chart review. A microbiology comment warning against the potential for inducible resistance on therapy with CRO was present pre-test and was removed in the post-test period. A didactic education session was given by ASP to medicine services. The study enrolled hospitalized patients ≥1 month old treated for infection with a low-risk AmpC organism (Serratia marcescens, Morganella morganii, Proteus vulgaris, and Providencia spp.) pre- (3/21-2/22) and post-intervention (8/22-7/23). Further inclusion and exclusion criteria are in table 1. The primary outcome was rate of carbapenem-sparing definitive treatment. Secondary outcomes were rate of CRO definitive therapy along with 30-day readmission, retreatment, mortality, and development of CRO resistance.

Results
73 patients were included: 36 (49%) pre- and 37 (51%) post-intervention. Patient, infection, and treatment characteristics are described in table 2.Serratia marcescens was the most common organism isolated with the most frequent sources being respiratory and urinary. There was no significant difference in the rate of carbapenem-sparing therapy between the pre- (83%) and post-(81%) intervention, p=0.59. No difference was found in CRO as definitive therapy in either group (25% vs. 33%, p=0.49) as well. No difference was seen in secondary clinical outcomes (table 3). For those with repeat positive cultures within 30 days, none developed CRO resistance.

Conclusion
The combination of changing microbiology reporting and a single ASP education session did not change antibiotic selection for low-risk AmpC producing organisms. Despite updated guidance the uptake in practice is slow.

Disclosures
All Authors: No reported disclosures
P-1754. An Antimicrobial Stewardship Program (ASP) Without Antibiotic Restrictions - Performance Update
Authors: Leuthner Kimberly D 
Published: January 2025

Abstract

Background
In 2011, University Medical Center of Southern Nevada (UMC) in Las Vegas presented introductory results of a simple, yet effective ASP program with the unique strategy of not restricting antibiotics. Since this time, ASP has continued to strive towards appropriate antimicrobial use in an attempt to improve patient care and minimize development of resistance. This project is an update of the progress of this ASP program in terms of resistance, antibiotic use and costs.

Methods
ASP started January 2008 with minimal resources. Baseline activities included targeted medication use evaluation (MUE), duration regulation, expansion of infection prevention and education. In contrast to many ASP programs our program did not restrict antibiotics – formulary agents were available for any practitioner. Over time activities were adjusted, reporting technologies advanced although personnel resources remained limited. ASP modifications:Added MUE agentsTiered sensitivity reportingReduce duration to 7 daysExpand service to 6 days per week
Deviating from initial procedures, in 2015 we implemented restriction of 5 “last-line” antimicrobials to UMC employed Infectious Disease Physicians (table 1) using the EHR. Markers of ASP progress was monitored by rates of organism isolation per 1000 patient days and antimicrobial in days of therapy per 1000 patient days. Financial implications were based on antibiotic expenditures per adult patient day.

Results
Monitored bacterial pathogens decreased 65 – 94% (table 2). The largest reduction was with Acinetobacter sp. followed by carbapenem resistant P. aeruginosa. Antibiotic use also improved (table 3). Overall use was decreased 71.3 ± 14.7% with the largest changes with fluoroquinolones and piperacillin/tazobactam. Of note, not all antibiotics reported are MUE, and use of these agents still improved. Despite expanding formulary, and cost monitoring activities, antibiotic expenditures decreased 47% per adult patient day.

Conclusion
ASP at UMC has demonstrated that simple programs, with limited resources, can decrease the use of unnecessary antimicrobial agents and isolation of specific bacterial pathogens. Additional benefits include a decrease in hospital costs without requiring significant restriction of antimicrobial agents.

Disclosures
Kimberly D. Leuthner, PharmD, FIDSA, AbbVie Inc.: Advisor/Consultant|AbbVie Inc.: Honoraria|Basilea Pharamceutica: Advisor/Consultant|La Jolla Pharmaceutical Company: Honoraria|Merck: Advisor/Consultant|Merck: Honoraria|Shionogi, Inc: Honoraria
P-1755. Impact of A Pharmacist Vancomycin Dosing and Monitoring Consult Service in The Medical Intensive Care Unit
Authors: McNaught Krysten , Hedvat Jason , Lee Young , Perlman David C , Koshy Sanjana , Sharma Aniket , Devlin Amanda 
Published: January 2025

Abstract

Background
Pharmacist-led vancomycin dosing and monitoring is associated with significant decreases in acute kidney injury (AKI), improvement in treatment efficacy, and reduced mortality. Critically ill patients experience variability of vancomycin pharmacokinetics and pharmacodynamics and require increased monitoring. This study aimed to compare patient outcomes before and following the implementation of a pharmacist consult vancomycin dosing and monitoring service in critically ill patients.

Methods
This was a pre- and post-study conducted in a 16-bed medical intensive care unit (MICU) at Mount Sinai Beth Israel. All adult patients who received vancomycin from January 1, 2022, to June 30, 2022, in the pre-group and from February 21, 2023, to May 23, 2023, in the post-group were included. The primary outcome was the proportion of patients within therapeutic trough range at 72 hours. Secondary outcomes included the proportion of patients with AKI, supra-therapeutic levels, sub-therapeutic levels, appropriate initial level time, dose, and frequency. A therapeutic level was defined as 10-15 mg/L for urinary tract and skin and soft tissue infections or 15-20 mg/L for bacteremia, pneumonia, meningitis, endocarditis, and osteomyelitis. Comparisons were performed using Chi-squared test. P &lt; .05 was considered statistically significant.

Results
Ninety-six patients were included in the final analysis; 53 patients in the pre-group and 43 patients in the post-group. The most common indication for vancomycin was pneumonia (64%). No statistically significant difference was found for the primary outcome between the two groups (43% vs. 41%, P = .8). The proportion of patients with supra-therapeutic levels or with AKI at 72 hours was significantly higher in the pre- group vs. the post-group (52% vs. 12%; P = .0007) and (57% vs. 30%; P = .001) respectively. Patients in the pre-group vs. the post-group were significantly less likely to have an appropriate initial level time (57% vs. 79%; P = .03) and initial vancomycin frequency (51% vs. 86%; P = .0003). No significant differences were found in any of the other secondary endpoints.

Conclusion
A pharmacist consult vancomycin dosing and monitoring service significantly reduced the incidence of AKI and supra-therapeutic vancomycin levels in MICU patients.

Disclosures
All Authors: No reported disclosures
P-1760. Pre- and Post-Guideline Implementation Comparison of Skin and Soft Tissue Infection Empiric Antibiotic Prescribing and Antimicrobial Stewardship Interventions
Authors: Ryan Mitchel , Caverzagie Brady A , Ross Jennifer , Chandorkar Aditya 
Published: January 2025

Abstract

Background
Skin and soft tissue infections (SSTIs) are common in the acute care setting, ranging from uncomplicated cellulitis to necrotizing fasciitis. In 2021, a retrospective review was completed in patients admitted from the Emergency Department (ED) with an SSTI to Lakes Medical Center, a small community hospital, to assess prescribing habits and antimicrobial stewardship (AMS) interventions. An evidence-based guideline for empiric treatment of SSTIs in adults was introduced in 2022 to establish a best practice framework. The purpose of this study is to assess changes in empiric antibiotic use with SSTIs and evaluate guideline adherence following implementation.
Antibiotic Breakdown

Methods
Adult patients started on antibiotics in the ED for an SSTI and subsequently admitted between 1/2023 and 12/2023 were included in this retrospective pre/post implementation study. Patients diagnosed with an SSTI after admission or not started on empiric antibiotics in the ED were excluded. The type of SSTI was determined by ED provider description and pictures uploaded to the electronic health record. Allergies to antibiotics, previous therapies, MRSA history and SIRS criteria were assessed upon presentation. A Fisher Exact test was used to determine significance between categorical values.

Results
Eighty-four patients were included in the post-intervention group compared to 113 patients in the pre-implementation cohort. The proportion of patients by indication were similar between pre/post implementation patients (Table 1). There was no significant difference in the number of patients diagnosed with a non-purulent cellulitis (p= .57). A significant difference was seen in antipseudomonal antimicrobials (p=.029) (Figure 1). Combination therapy was initiated in a similar proportion of patients (p= 1) (Table 2). Pharmacist driven AMS interventions decreased following guideline implementation from 11 to 6 among non-purulent cellulitis cases (p= .43) (Table 3).

Conclusion
Following the implementation of an SSTI guideline, there were significantly fewer patients started on empiric anti-pseudomonal antimicrobials for SSTIs. There was a trend towards decreased antimicrobial stewardship interventions post-implementation.

Disclosures
Jennifer Ross, PharmD, BCIDP, Shionogi Inc.: Advisor/Consultant
P-1779. Effect of a Transitions of Care Pharmacist Intervention on Discharge Oral Antibiotic Prescribing
Authors: Argiro Stephen , Hedvat Jason , Myerson Michaela L 
Published: January 2025

Abstract

Background
An emerging area of focus in antibiotic stewardship programs (ASP) is appropriate antibiotic selection at hospital discharge. The purpose of this study was to assess the effect of a transitions of care (ToC) pharmacist-led review of discharge oral antibiotic therapy on antibiotic appropriateness.

Methods
This was a prospective single center case-control study at Mount Sinai Beth Israel that included adult patients (≥18 years old) discharged on oral antibiotics for the treatment of common infectious diseases syndromes between February 13, 2023 and May 13, 2023. Appropriateness of antibiotic regimen was based on standardized guidance developed by the ASP team. The primary outcome was the difference in percentage of inappropriate antibiotic prescriptions between the provider-only and ToC pharmacist-reviewed groups. Secondary outcomes included mean duration of therapy between the two groups, percentage of pharmacist interventions accepted, and number of fluoroquinolone prescriptions avoided. Comparisons were performed using Chi-squared or Fischer’s exact test for categorical variables and Student’s t test or the Mann-Whitney U test for continuous variables, as appropriate. P &lt; .05 was considered statistically significant.

Results
A total of 182 patients were included in the analysis, 81 patients in the provider-only group and 101 patients in the ToC pharmacist-reviewed group. The most common diagnoses were intra-abdominal infection (37.9%), urinary tract infection (23.1%), skin and soft tissue infection (21.4%), and community acquired pneumonia (17.6%). Patients in the ToC pharmacist-reviewed group were significantly less likely to have an inappropriate antibiotic prescription at discharge when compared to the provider-only group (25.7% vs. 87.7%; p &lt; .001). The mean duration of therapy was significantly lower in the ToC pharmacist-reviewed group when compared to the provider-only group (7.7 vs. 9.1 days; p =.007). In the ToC pharmacist-reviewed group, 56.9% (33/58) of pharmacist interventions were accepted and 19.3% (11/57) of fluoroquinolone prescriptions were avoided.

Conclusion
A ToC pharmacist’s review of oral antibiotics at discharge significantly reduced inappropriate antibiotic selection and duration of therapy.

Disclosures
All Authors: No reported disclosures