bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1650. Clinical Outcomes among Patients Prescribed Suboptimal Antibiotic Therapy on Discharge to Nursing Homes
Authors: Short Emily K , Noble Brie , Crnich Christopher J , Chan Dominic , Hildebrand Andrea , Nguyen Thuan , Zhou Michelle H , Santos Evita T , Ham YoungYoon , Shephard Emily , McGregor Jessina C , Jolles Sally , McCracken Caitlin M , Bearden David T , Izumi Seiko , Furuno Jon P 
Published: January 2025

Abstract

Background
Little is known regarding outcomes for patients prescribed antibiotics on discharge from the hospital to nursing homes (NHs). We quantified the association between suboptimal antibiotic prescribing and clinical outcomes at discharge to NHs.

Methods
This was a multicenter, retrospective cohort study of adult (age &gt;18 years) patients prescribed systemic antibiotics on discharge from 9 acute care hospitals in Oregon, Washington, and Wisconsin to a NH from 2016 – 2018. Study data were electronically extracted from hospital and NH electronic health records and supplemented with chart review. Suboptimal antibiotic therapy was determined by an infectious disease pharmacist or physician using clinical information (e.g., antibiotic regimen, indication, and culture results) available at discharge. Outcomes included emergency department (ED) visits, hospital readmissions, or Clostridioides difficile infection (CDI) within 30 days of hospital discharge. Comparison of outcomes between patients with suboptimal and non-suboptimal antibiotic therapy were tested by chi-squared tests.

Results
Among 280 included patients, mean (SD) age was 76.0 (11.5) years, 35.7% (n=100) were male, and median (IQR) inpatient length of stay was 6 (4-9) days. The most prevalent antibiotic indications were urinary tract infections (n =109, 38.9%), lung indications (n=60, 21.4%), and prophylaxis (n=29, 10.4%). Among 317 antibiotic prescriptions, the most frequently prescribed antibiotic classes were cephalosporins (n=83, 29.6%), fluoroquinolones (n=57, 20.4%), and beta-lactam/beta-lactamase-inhibitors (n=40, 14.3%). Fifty-eight patients (20.7%) were prescribed suboptimal antibiotic therapy on hospital discharge. There were no significant differences in the frequency of 30-day ED visits (14% vs 11%, p=0.76) or hospital readmission (19% vs 18%, p=0.94) between patients prescribed and not prescribed suboptimal antibiotics; however, suboptimal antibiotics were significantly associated with CDI within 30 days of discharge (10% vs 2%, p=0.01).

Conclusion
Suboptimal antibiotic prescribing on discharge to NHs was associated with increased risk of CDI within 30 days of discharge. This finding may inform interventions to improve antibiotic prescribing on discharge to NHs.

Disclosures
YoungYoon Ham, PharmD, Gilead: Honoraria Jon P. Furuno, PhD, Merck & Co., Inc: Grant/Research Support
P-1652. Geographical factors associated with antibiotic use for non-bacterial upper respiratory infections using nationwide Japanese data
Authors: Kitano Taito , Tsuzuki Shinya , Koizumi Ryuji , Aoyagi Kensuke , Asai Yusuke , Kusama Yoshiki , Ohmagari Norio 
Published: January 2025

Abstract

Background
The large number of antibiotic prescriptions for non-bacterial upper respiratory infections has been reported globally. The reduction of unnecessary antibiotic use for non-bacterial upper respiratory infections is critical. Elucidating geographical factors associated with antibiotic use for non-bacterial upper respiratory infections using nationwide data may guide national policy regarding antibiotic stewardship.

Methods
This study evaluated geographical factors regarding antibiotic use for patients with sole diagnosis of upper respiratory infections using health insurance claims data across all Japanese prefectures. A multivariable negative binomial regression analysis was implemented for the outcome of the defined daily doses per 1,000 habitants per day by prefecture with patient- and physician-level variables. Total and sub-class antibiotic use were analyzed.

Results
In 2019, 116,174,509 defined daily doses of antibiotic use for non-bacterial upper respiratory infections were included from all 47 prefectures. The annual number of diagnoses related with upper respiratory infections per 1,000 inhabitants per day (adjusted rate ratio [aRR] 1.001, [95% confidence interval 1.000-1.001], p=0.001) were significantly correlated with total antibiotic use. The mean age of physician (aRR 1.059 [1.009-1.113], p=0.019) for third generation cephalosporins and aRR 1.065 [1.011-1.122], p=0.016) for fluoroquinolones and the proportion of children age under 15 years (aRR 0.920 [0.876-0.966], p&lt; 0.001) for third generation cephalosporins and aRR 0.926 [0.879-0.977], p=0.002 for fluoroquinolones) was also associated with the consumption of third generation cephalosporins and fluoroquinolones.

Conclusion
This ecological study demonstrated that the proportion of children and the mean age of physicians were associated with the use of third generation cephalosporins and quinolones for non-bacterial upper respiratory infections. The results may contribute to the further development of the national stewardship strategies to reduce unnecessary antibiotic use for upper respiratory infections.

Disclosures
All Authors: No reported disclosures
P-1667. Effect of Penicillin Allergy on Common Urinary Tract Pathogens within a Community Health-System Antibiogram
Authors: Weller Katherine , Bland Christopher M , Bradley Logan C , Smith Susan E , Jones Bruce M 
Published: January 2025

Abstract

Background
A penicillin allergy label promotes use of broad-spectrum and alternative antibiotics, which can cause an increase in resistance. Urinary tract infections are commonly encountered in health systems and few studies have shown how a documented penicillin allergy affects resistance on a yearly antibiogram for these isolates.
Urinary Antibiogram for Penicillin and Non-penicillin Allergic PatientsTable 1lists Gram negative isolates for penicillin and non-penicillin allergic patients and Table 2 lists the Gram positive isolates

Methods
This was a retrospective, observational chart review of patients admitted in 2022 within a two-hospital community health-system. Using a query language server and third-party software, patients with a first positive bacterial culture were compared with those with a penicillin allergy to create distinct antibiograms. Data collected included culture site and organism, antibiotic susceptibility, and presence of an infectious diseases (ID) consultation. The primary outcome was percentage of susceptible and non-susceptible isolates of E. coli, P. mirabilis, K. pneumoniae, P. aeruginosa, and E. faecalis in penicillin allergic and non-penicillin allergic patients. A secondary outcome was to determine if ID consultation was different between subgroups. Chi-squared and student's t-test were used for categorical and continuous variables, respectively.

Results
Of 3,757 patients meeting inclusion criteria, 12.8% (n=484) were penicillin allergic with results in Table 1&2. E. coli had a significantly lower susceptibility rate for ciprofloxacin (p &lt; 0.001), levofloxacin (p &lt; 0.001), and trim/sulfa (p=0.002) in penicillin allergic patients. P. mirabilis had a significantly lower susceptibility rate for cefepime (p=0.015), gentamicin (p=0.006), levofloxacin (p=0.025), ciprofloxacin (p=0.023), and pip/tazo (p=0.012). K. pneumoniae showed higher susceptibility rates for multiple antibiotics in the penicillin allergic group. P. aeruginosa and E. faecalis did not show any statistically significant differences. There was ID consultation on 137/484 (28.3%) of penicillin allergic patients and 899/3273 (27.5%) of non-penicillin allergic patients, which was not statistically different (p=0.7719).

Conclusion
Labeled penicillin allergic patients demonstrated increased resistance in E. coli and P. mirabilis, while K. pneumoniae had higher resistance rates in non-allergic patients. Both groups had similarly high rates of ID consultation.

Disclosures
Christopher M. Bland, PharmD, FCCP, FIDSA, BCPS, Merck: Honoraria|Nestle/Seres: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria Bruce M. Jones, Pharm.D., FIDSA, BCPS, AbbVie: Advisor/Consultant|AbbVie: Honoraria|Ferring: Honoraria|Innoviva: Honoraria|Paratek: Honoraria
P-1686. Appropriateness of Antibiotic Prescribing in Urgent Care Centers in Chicago, 2019-2022
Authors: Li Linda F , Cervantes Estrella , Walblay Kelly , Black Stephanie R , Kim Do Young 
Published: January 2025

Abstract

Background
Urgent care centers (UCC) face unique challenges such as high patient volume and turnover, contributing to increased overall antibiotic prescriptions and inappropriate prescribing. The Chicago Department of Public Health (CDPH) obtained the IQVIA Longitudinal Prescription and Medical Claims dataset to evaluate antibiotic prescribing trends between 2019-2022 in Chicago UCC, including appropriateness.

Methods
We analyzed IQVIA data from 2019-2022, restricted to encounters with Chicago UCC providers. Claims data were linked to prescription data using a unique patient identifier. Using previously published methodology, antibiotic appropriateness was assessed by assigning ICD-10 codes to three tiers: tier 1 conditions, for which antibiotics are almost always indicated; tier 2, antibiotics may be indicated; and tier 3, antibiotics are almost never indicated.

Results
There were 24,776 antibiotic prescriptions with matched diagnosis codes attributed to Chicago UCC providers between 2019-2022, representing 19,809 unique patients. Tier 3 conditions accounted for 44.6% of prescriptions, followed by tier 2 (37.0%) and tier 1 (18.4%) conditions . The most common tier 3 diagnosis codes were respiratory infections (43.2%), including viral upper respiratory infections (40.4%), bronchitis/bronchiolitis (11.9%), and other respiratory conditions (37.7%). Inappropriate prescribing was lowest in 2019 and highest in 2021, with 40.1% and 48.3% of prescriptions matched to a tier 3 condition, respectively. The three most frequently prescribed antibiotics following an encounter for a tier 3 condition were azithromycin (25.2%), amoxicillin (12.3%), and amoxicillin/clavulanate (11.4%). Nurse practitioners (29.1%) were the most frequent tier 3 prescribers followed by family medicine (25.4%) and internal medicine (24.0%) physicians.

Conclusion
Nearly half of antibiotics prescribed in Chicago UCC from 2019-2022 were associated with a condition where antibiotics are almost never indicated, and this trend increased during the COVID-19 pandemic. Antibiotic stewardship efforts should target unnecessary antibiotic treatment for respiratory infections, and stewardship education should prioritize nurse practitioners, and family medicine and internal medicine physicians.

Disclosures
All Authors: No reported disclosures
P-1726. Antibiotics Prescribing Practices for Skin and Soft Tissue Infections in an Urban Urgent Care Setting
Authors: Xie Chuman , Devlin Amanda , Koshy Sanjana , Eiting Erick , Hedvat Jason 
Published: January 2025

Abstract

Background
Skin and soft tissue infections (SSTIs) are amongst the most common bacterial infections in the ambulatory care setting. Initial antibiotic treatment should consider anticipated pathogens, severity, patient-specific considerations, and local antibiogram data. This study evaluated the alignment of antibiotic prescription practices for SSTIs with IDSA guidelines to identify opportunities to improve antibiotic prescribing at a single urgent care (UC) center.

Methods
This was a retrospective study conducted at the UC in an urban academic health system of adult patients with SSTI diagnosis receiving at least one antibiotic prescription from July 1, 2022, to August 31, 2023. The primary outcome was the proportion of patients with antibiotic prescriptions deviated from IDSA guidelines, considering individual patient factors and local antibiogram data. Secondary outcomes included evaluating the use of clindamycin when better alternatives were available, combination therapy when monotherapy would have been sufficient, deviations from guideline-recommended dosage regimen, and bug-drug mismatch rates. Descriptive statistics were used for outcome analysis.

Results
141 patients were included in the final analysis; 80 patients with purulent SSTIs and 61 patients with nonpurulent SSTIs. Incision and drainage occurred in 70% of patients with purulent SSTIs, but only 11% of patients had cultures obtained. The most common antibiotics prescribed were cephalexin (41%), trimethoprim-sulfamethoxazole (TMP/SMX) (40%), and doxycycline (20%) for purulent SSTIs, and cephalexin (56%) and TMP/SMX (25%) for nonpurulent SSTIs. 50% of patients received antibiotic prescriptions not aligned with guidelines, accounting for individual patient factors and local antibiogram data. 8% of patients were prescribed clindamycin when a better alternative existed. Combination antibiotic therapy was used in 12% of patients where monotherapy would suffice. 10% of patients with purulent SSTIs and 15% with nonpurulent SSTIs received antibiotics without a guideline-recommended dosage regimen.

Conclusion
This study demonstrated that there is room for improvement to align with IDSA guidelines at the UC. Additional provider education on appropriate antibiotic prescribing for SSTIs is warranted.

Disclosures
All Authors: No reported disclosures
P-1728. Let's Settle the "Score": Implementation of a Prioritization Tool into an Antimicrobial Stewardship Prospective Audit and Feedback Program
Authors: Cain Alexander R , Claeys Kimberly C , Dunning Megan , Heil Emily L , Noval Mandee , Lapin Jonathan S , Lee Sara , Tripathi Ravi , Bork Jacqueline T 
Published: January 2025

Abstract

Background
Prospective audit and feedback (PAF) remains the backbone of antimicrobial stewardship (AS) action. However, PAF is time consuming and does not always result in intervention. A prioritization scoring tool is a proposed solution to improve AS efficiency. We sought to assess the impact of a scoring tool (‘score’) on the efficiency of our AS program.Figure 1.Interrupted Time Series Analysis of Intervention Rate Pre-Post Score Implementation

Methods
A pre-post evaluation of AS PAF at an academic medical center was performed. The pre-score period (November 2022 – June 2023) consisted of standard PAF (largely 48-hour review). The post-score period (July 2023 – March 2024) included standard PAF in addition to the score. The scoring tool is embedded within the AS surveillance system in the electronic medical record and is used to readily identify patients with opportunities for antimicrobial optimization. It consists of pre-defined “points” for each programmed alert (e.g. bug-drug mismatch=10) which are reported in real-time as a prioritized list (higher score = higher priority). An interrupted time series was conducted to compare the intervention rate pre- and post-score implementation. A subgroup analysis was conducted on the post-score period comparing the reviews triggered by the score versus the 48-hour review. A univariate logistic regression was carried out to determine the association of the score with AS intervention.Table 1.Comparison of Score Interventions vs 48-hour Review during the Post-Period

Results
There were 5801 AS reviews in total, 2927 pre-score and 2874 post-score (92 missing outcome data). The mean intervention rate pre- and post-score was 46.2% and 52.3%, respectively (p&lt; 0.001), with a +2.2% difference per month (p=0.036) as illustrated by Figure 1. The change was gradual without any significant, immediate level change. The score subgroup consisted of 312 reviews and were compared to 1180 48-hour reviews during the same period. Table 1 compares the two groups demonstrating overall high intervention rate in the score group (52.6% vs 40.9%, p &lt; 0.0001); however, notable characteristics were different. An AS intervention was 1.6 times more likely when using the score approach (OR 1.6, 95% CI 1.3 – 2.0).

Conclusion
Implementation of an antimicrobial scoring tool may improve PAF efficiency by better predicting patients for antimicrobial optimization than standard 48-hour review. The scoring tool can be an impactful method when performing PAF.

Disclosures
Kimberly C. Claeys, PharmD, PhD, bioMérieux: Advisor/Consultant|bioMérieux: Honoraria
P-1756. Impact of order set implementation on appropriate treatment of community acquired pneumonia (CAP)
Authors: Pham Han , Stein Mitchell , Worden Lacy 
Published: January 2025

Abstract

Background
The overuse and misuse of antibiotics can lead to adverse events, antibiotic resistance, and increased healthcare costs. In 2022, Ascension Borgess Hospital implemented a community acquired pneumonia (CAP) order set to help guide appropriate antimicrobial prescribing.The orderset included guideline-concordant agents and durations of therapy for CAP as well as comments empowering pharmacists to adjust total duration of therapy to account for antimicrobial doses received in the emergency department. The purpose of this study is to evaluate appropriate antimicrobial prescribing after implementing a pneumonia order set.

Methods
This retrospective cohort study was conducted at a 450-bed community teaching hospital. The primary objective of this study was a composite outcome of appropriate empiric antimicrobial selection, dosing, and duration in accordance with the national guidelines. Secondary outcomes include length of hospital stay (LOS), readmission rates, mortality rates and Clostridium difficile infection rates. An exploratory outcome was pre-determined to evaluate pharmacists' intervention on duration of therapy, and utilization of the order-set to prescribe antibiotics. Patients were eligible for inclusion if they were 18 years or older and treated for CAP between 10/1/2021 and 8/1/2023

Results
A total of 236 patients were included (118 patients per group). Significantly more patients in the post-implementation group received guideline-concordant therapy for CAP (5.9% vs 35.6%, p&lt; 0.001). Results were heavily influenced by improvements in appropriate durations of therapy (pre- 6.8% vs post 39.9%, p&lt; 0.001). There were no significant differences observed for LOS, 30 day readmission rates, C. difficile infections within 30 days, or mortality rates between groups. For exploratory endpoints, the orderset was utilized in 66.1% of patients included in the post-implementation group. Additionally, pharmacists were more likely to intervene following implementation of the orderset (22.9% v 43.2%, p &lt; 0.001), as a result of order comments and increased awareness.

Conclusion
Implementing a guideline concordant orderset significantly improved inpatient antibiotic prescribing for CAP with no difference in clinical or safety outcomes.

Disclosures
All Authors: No reported disclosures
627. Outcomes of Military Blood Donors Screening Positive for Trypanosoma cruzi
Authors: Wells Michael , Casleton Brian , Rivera Glorimar , Phelps Megan , Casey Theresa , Osuna Angela , Gella Melita , Jung Ga O , Winkler Erin , Yun Heather , Marcus Joseph 
Published: January 2025

Abstract

Background
First time blood donors at the Armed Service Blood Bank-San Antonio are screened for Trypanosoma cruzi infection with a chemiluminescent microparticle immunoassay (CMIA) followed by a confirmatory enzyme strip assay (ESA). In military populations, T. cruzi positivity on a screening test accounts for the fourth most common reason for post-donation deferral. With concerns for low positive predictive value in a low prevalence disease, this study evaluated the clinical outcomes and diagnostic work-up of blood donors who screened positive on T. cruzi CMIA testing.Table 1:Workup of 49 blood donors who screened positive for Trypanosoma cruzi infection

Methods
All blood donors from 2017-2022 were screened for T. cruzi antibodies with CMIA and deferred indefinitely if screening was positive, regardless of ESA result. All donors that initially screened positive for T. cruzi infection were evaluated to determine diagnostic work-up, further testing, specialty appointments seen, and final diagnosis of each case following their initial positive blood donation screen.Table 2:Clinical outcomes of 4 blood donors with positive T. cruzi screening test and confirmatory test

Results
Of 89,459 blood donors during the study period, 49 (57.3 per 100k donors) screened positive for Chagas disease on initial blood donation. Of those individuals, 4 (8%) had positive, 18 (36%) had indeterminate, and 30 (61%) had negative confirmatory tests. The evaluation varied significantly depending on the results of ESA testing, however there were no blood donors who met criteria for Chagas disease (Table 1). Evaluation of four donors with positive CMIA and ESA showed only one with repeat positivity on one assay, but all were ultimately deemed negative (Table 2).

Conclusion
While positive T. cruzi antibodies were a common reason for post-donation deferral in this cohort, there were no confirmed cases of Chagas disease, despite most patients receiving an extensive work-up. Patients with positive or indeterminate ESA received more specialty care and more confirmatory testing than those with a negative confirmatory test. This study demonstrates the need for higher specificity screening and confirmatory tests for T. cruzi in blood donors in low prevalence settings.

Disclosures
All Authors: No reported disclosures
P-1757. Standardizing the Penicillin Allergy Documentation Program and Optimizing the Use of Beta Lactam Antibiotics In a Tertiary Care Hospital
Authors: Kuriakose Linta Susan 
Published: January 2025

Abstract

Background
The adoption of standardized penicillin allergy assessment protocols and the optimization of beta-lactam antibiotic usage have been advocated by international guidelines on Antibiotic Stewardship Programs (ASPs). However, the precise effects of conducting these assessments on allergy documentation and antibiotic prescription practices remain inadequately characterized.

Methods
A retrospective quasi-experimental study was devised to assess the repercussions of implementing a standardized penicillin allergy assessment initiative led by the Antimicrobial Stewardship Team, comprising Infectious Disease (ID) Physicians, clinical pharmacists, and nurses. Commencing January 2022, nursing personnel conducted comprehensive evaluations of hospitalized patients with documented penicillin allergies, with subsequent review by clinical pharmacists. The pre-intervention phase encompassed randomly selected adult patients with reported penicillin allergies admitted between January 2019 and December 2021. The principal study endpoint was the accurate delineation of penicillin allergies in the electronic health record (EHR), encompassing clarification of allergic reactions and removal of erroneously labelled allergies. Secondary endpoint was beta-lactam antibiotic utilization within 90 days of hospitalization.

Results
A total of 360 patients were enrolled, comprising 140 during the intervention phase and 220 during the pre-intervention phase. The proportion of patients with updated allergy information surged from 22% to 53% post-implementation of the program (P &lt; 0.0001), with inappropriate allergy designations rectified in 18 (5%) patients. Notably, the program's implementation did not alter the proportion of patients receiving beta-lactam antibiotics (22% vs. 25%; P = 0.51).

Conclusion
The adoption of a standardized penicillin allergy assessment initiative exerted a significant influence on allergy documentation within the EHR, without imposing excessive burdens on clinical team. This initiative facilitated the updating of allergy information for the majority of patients and rectified inaccurately labelled penicillin allergies.

Disclosures
All Authors: No reported disclosures