bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1677. Assessing An Institution’s Approach to Management of Gram-Negative Bacteremia in High-Risk Populations
Authors: Mostaghim Anahita , Hashem Nehal G , Pathan Sabina , Han Alison 
Published: January 2025

Abstract

Background
Immunocompromised populations present unique antimicrobial management and stewardship challenges. These challenges can persist despite existing stewardship policies. This study examined management of gram-negative bacteremia (GN-BSI) in a diverse immunocompromised population at the National Institutes of Health Clinical Center (NIH CC).

Methods
Episodes of GN-BSI admitted to the NIHCC from January 1 to December 31, 2023 were identified through positive blood culture results. Charts were abstracted for baseline demographics, episode-specific data, antimicrobial prescribing, and clinical outcomes.

Results
Seventy-five episodes of GN-BSI were identified. Thirty-six (48%) were undergoing cellular therapy and 54 (58.7%) were neutropenic. About 50.7% identified translocation as etiology of infection. Eleven (14.7%) were ESBL-positive by BCID2 panel. Seventy-two (96%) involved infectious disease (ID) consultation. Empiric choice of gram-negative antibiotics included ceftazidime/avibactam in 9 (12%) episodes, meropenem in 38 (50.7%) episodes, piperacillin/tazobactam in 15 (20%) episodes, and an anti-pseudomonal cephalosporin in 32 (42.7%). Twenty (26.7%) received 2+ empiric anti-pseudomonal antibiotics. After 72 hours, 37 (49.3%) still received meropenem with most isolates susceptible to narrower spectrum (Table 1). Similar results were seen with final ID recommendations (Table 2). Seven (10%) had transitioned to an oral agent by the seventh day. Comparing 72-hour antibiotic (Meropenem vs anti-pseudomonal cephalosporin), ICU admission (32.4% v 25%, p=0.62) and 30-day mortality (5.4% v 6.3%, p=0.87) were similar. Median therapy duration was 14 days (IQR 14-18.5). Of the 65 episodes with indwelling central venous access (CVAD), only 16 had removal of all CVADs. Those with CVAD removal had lower 30-d mortality (0% v 11.9%, p=0.22) though not statistically significant.

Conclusion
In a high-risk immunocompromised population, there is a low rate of narrowing gram-negative coverage at 72 hours although options for narrowing exist. Choice of empiric antimicrobial and targeted therapy for these GN-BSI episodes are the two major areas of improvement in our population. Primary teams and ID consultants should be involved in ongoing stewardship interventions.

Disclosures
All Authors: No reported disclosures
P-1678. Post Implementation Analysis of Inpatient Review by Infectious Diseases Pharmacists of Outpatient Parenteral Antimicrobial Therapy (OPAT) Prior to Discharge
Authors: Skillings Anna , Hart Delaney , Herstine Emily , Gens Krista 
Published: January 2025

Abstract

Background
The Infectious Diseases Society of America OPAT guidelines recommend all patients should have ID expert review prior to initiation of OPAT. Prior to 2020, no formal OPAT program existed at this hospital system and prescribing was not limited to any specialty. However, in February 2020, the Outpatient Parenteral Antimicrobial Therapy - Inpatient Review (OPAIR) program was created in response to pre-implementation data showing only 16% of patients were discharged on appropriate therapy per IDSA OPAT guidelines.
Figure 1.
Outpatient Parenteral Antimicrobial Therapy Inpatient Review (OPAIR) program process

Methods
This retrospective, observational chart review identified patients for data collection if they had pharmacist documentation of OPAIR review during their index hospital stay. Patients were included in the pre-implementation group if prescribed OPAT and admitted between January 1, 2017, and December 31, 2017, in the health system. Patients were included in the post-implementation group if 18 years and older, prescribed OPAT, and admitted between February 2, 2020, to August 1, 2023, at Abbott Northwestern, New Ulm, Owatonna, Faribault, or River Falls Hospitals. Exclusion criteria include OPAT prescribed by an Infectious Disease (ID) provider or prior to index hospitalization. Chi squared tests were performed for all outcomes.
Figure 2.
Primary outcome of OPAT appropriateness. Appropriateness defined as a composite outcome: appropriate monitoring or follow up​, indication​, antibiotic selection​, antibiotic dose/frequency/duration, and recommended laboratory monitoring.

Results
There were 101 patients included in the pre and 79 in the post-implementation analysis. Internal Medicine was the most common prescriber in both the pre and post-implementation groups (60% vs 67%). OPAT appropriateness was significantly higher in the post-implementation group than in the pre-implementation group (52% (n=41/79) vs 16% (n=16/101), p&lt; 0.001). The most common cause of inappropriate OPAT prescribing was a lack of monitoring or follow up (n=8/79). Complication rates were similar between pre and post groups (12% vs 18%, p=0.19) as was the 30-day readmission rate (17% vs 23%, p=0.32). Actual cost savings totaled $33,600 and maximum potential cost savings totaled to $214,200. The rates of midline utilization increased by 62% (p&lt; 0.001).
Figure 3.
Secondary outcome of complication rate.

Conclusion
The OPAIR program at this health system significantly increased non-ID provider OPAT prescribing appropriateness. These results support the creation of a new workflow and expansion of the OPAIR program.
Figure 4.
Secondary outcome of cost avoidance.

Disclosures
All Authors: No reported disclosures
P-1683. Evaluation of Outpatient Clindamycin Prescriptions Across a Large Military Healthcare Network
Authors: Derasmo Mark , Scheps Kayla R , Marcus Joseph 
Published: January 2025

Abstract

Background
Introduction: While clindamycin has broad Gram-positive and anaerobic activity, its use has been limited by toxicity and increasing resistance. Multiple clinical practice guidelines (CPGs) at Joint Base San Antonio recommend against clindamycin usage due to poor coverage of Gram-positive bacteria in local antibiograms. Despite this recommendation, a significant number of clindamycin outpatient prescriptions are ordered each year. The driver of these prescriptions is unknown. This study describes prescriber, diagnostic, and patient factors contributing to outpatient clindamycin usage at a large military medical system.Table 1Characteristics of 882 Patients Who Received an Outpatient Clindamycin Prescription at Joint Base San Antonio, 2023

Methods
Outpatient clindamycin prescriptions from January-December 2023 filled at pharmacies on Joint Base San Antonio were evaluated to determine prescription duration, diagnostic indication, age, antibiotic allergies, prescriber, and prescribing clinic. Antibiotic indication was compared between those with beta-lactam allergies to those without beta-lactam allergies by Chi-squared.Table 2Prescriptions by Diagnostic Group and Beta-Lactam Allergy Status of Patient

Results
During the study period there were 941 prescriptions in 882 patients. The cohort was predominately female (52%) with a median age of 51 [IQR 40-68] (Table 1). Of these scripts, 229 (24%) were written by clinicians outside the military facility. The clinics with the most prescriptions were the Emergency Department (33%), Dental clinics (21%), Primary Care (16%), and Surgical clinics (14%). Patients with beta-lactam allergies were significantly more likely to have a dental indication (39.7% vs. 16.9%, p=&lt; 0.0001) and those without beta-lactam allergies were more likely to have a skin and soft tissue infection (49.8% vs. 22.2%, p=&lt; 0.0001) (Table 2). While there were 491 prescribers in this study, ten (2%) clinicians (six from the Emergency Department) prescribed 18% of all clindamycin prescriptions, 67% of which were in the absence of a beta-lactam allergy.

Conclusion
Patterns of outpatient clindamycin use across large health systems have not been well described. This study identifies potential areas for local stewardship interventions that have not previously been considered, including focused CPGs for emergency room clinicians as well as penicillin allergy de-labeling in outpatient dental clinics.

Disclosures
All Authors: No reported disclosures
P-1689. Impact of Antibiotic Usage on Antimicrobial Resistance Rates among Gram-Negatives at a COVID-Care Facility
Authors: Aguirre-García Gloria Mayela , Baylon-Valdez Victor , Gonzalez-Gonzalez Luisa F , Medina-Hernandez Rodolfo , Guajardo-Lara Claudia E , Martínez-Reséndez Michel F , Disease Infectious , Aleman-Bocanegra Mary C 
Published: January 2025

Abstract

Background
Antimicrobial resistance is directly associated with antimicrobial use and abuse, becoming an important public health problem in modern practice. Unchecked prescriptions, noncompliance with antimicrobial stewardship programs, pandemics, and outbreaks contribute to this issue. This study aims to analyze the antimicrobial resistance patterns over the years in a tertiary-level facility compared to antibiotic usage.
E. coli antimicrobial resistance rates and antibiotic usage

Methods
A retrospective single-center study from 2019 to 2022 was conducted at the Intensive Care Unit of Hospital San Jose, Monterrey, Mexico. Antibiotic usage was calculated using a defined daily dose (DDD) in g/100 beds for Cefepime, Ceftazidime, Ceftriaxone, Ertapenem, Levofloxacin, Meropenem, and Piperacillin/tazobactam. Antimicrobial resistance rates to these antibiotics by Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa isolates from ICU were calculated and compared against antibiotic usage over the years.
P. aeruginosa antimicrobial resistance rates and antibiotic usage

Results
During COVID-19 pandemic in 2020, there was an increased resistance rate of E. coli to cephalosporins (ceftriaxone 80%, ceftazidime 80% and cefepime 80%) in comparison to 2019 and the following years. Klebsiella pneumoniae had a similar behavior, with high resistance rates to cephalosporins (60% each). Pseudomonas aeruginosa isolates also presented a higher resistance rate in 2020 to cefepime (49.6%), ceftazidime (41.6%), meropenem(57.4%) and piperacillin-tazobactam(31.2%) during 2020. During the same year, high DDDs were observed for ceftriaxone (53.3) and meropenem (32.79). Nonetheless, resistance rates to meropenem by P. aeruginosa in 2019 and 2020 (60, 57.4%), E. coli (5.6, 4.4%) and K. pneumoniae (26.3, 7.4%) were not influenced by overuse of meropenem, neither during COVID-19 or the following years.
K. pneumoniae antimicrobial resistance rates and antibiotic usage

Conclusion
Besides overuse of Beta-lactam antibiotics such as ceftriaxone and meropenem during the COVID-19 pandemic, surpassing importantly recommended DDDs by the WHO, resistance rates to these antibiotics in the following years was not affected. Multidisciplinary teams including an infectious disease specialist were fundamental for antimicrobial stewardship during the pandemic, positively impacting resistance rates of Gram-negatives.

Disclosures
All Authors: No reported disclosures
P-1691. Palliative medicine consultation does not reduce antimicrobial use during end-of-life care
Authors: Akalu Hanna Y , DeWitt Michael E , Bantikassegn Amlak , Brooten Justin , Maves Ryan C 
Published: January 2025

Abstract

Background
The role of antimicrobial drugs in end-of-life (EOL) care is uncertain, with the potential palliative benefit of antimicrobials in some settings being outweighed by potential limited benefit and added toxicity. In this study, we aimed to analyze the roles of palliative care consultation and code status change on antimicrobial prescribing practices at the EOL. We hypothesized that palliative medicine consultation (PMC) reduces antimicrobial use in patients receiving EOL care.

Methods
This was a retrospective cohort study conducted on adult patients who were admitted to Wake Forest Baptist Health facilities between January-December 2019 and who were either transitioned to comfort care or discharged to hospice. Patients were stratified based on the presence or absence of PMC during their hospitalization. The primary outcome was the mean days of therapy (DOT) per patient before and after EOL care. DOTs were defined as a calendar day when a single systemic antimicrobial was administered. Antimicrobials given topically or prescribed solely for Pneumocystis or herpesvirus prophylaxis were excluded.

Results
A total of 2242 patients were identified, of whom 621 received PM consultation during their hospitalization. Among those receiving PMC, there were a total of 3301 days of hospitalization and 4560 DOTs prior to the transition to EOL care, for a mean DOT/hospital day of 1.38 (95% CI 1.34-1.42). There were 6,563 hospital days and 11,466 DOTs among the non-PMC group, for a mean DOT/hospital day of 1.75 (1.72-1.78). Following transition to EOL care, antimicrobial use decreased rapidly, with 0.087 DOTs/hospital day in the PMC group (0.077-0.097) and 0.051 DOTs/hospital day (0.044-0.056) in the non-PMC group.

Conclusion
In this observational study, antimicrobial drug use decreased markedly in patients transitioning to EOL care. However, the rate of antimicrobial use in EOL patients was not reduced by PMC and was greater than in those patients not receiving PMC, although this difference was not clinically substantial. Antimicrobial use was infrequent in EOL patients in our cohort. Future studies should evaluate the palliative benefit of antimicrobials in specific subgroups of patients receiving EOL care.

Disclosures
Ryan C. Maves, MD, AiCuris: Grant/Research Support|Biotest: Grant/Research Support|GeoVax: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria|Sound Pharmaceuticals: Grant/Research Support
P-1697. Antibiotic prescribing patterns among outpatients with acute sinusitis in Michigan
Authors: Wangchinda Walaiporn , Haddad Anne , Stier Elisia , Brennan Brenda M , Malani Anurag , Pogue Jason M 
Published: January 2025

Abstract

Background
Acute sinusitis is a common presenting illness in the outpatient setting. While antibiotics are often prescribed, they are infrequently indicated in adults. Limited data are available assessing prescribing practices. This study aimed to describe statewide antibiotic prescribing for sinusitis among outpatients in Michigan to identify opportunities for antimicrobial stewardship (AMS) interventions for clinical and public health partners.Figure 1:Outpatient antibiotic prescribing practices for sinusitis in Michigan, 2019-2021

Methods
The Michigan Department of Health and Human Services received medical and pharmacy claims data from IQVIA from 2019 – 2021. Outpatients with medical claims data with a diagnosis code (J01) for acute sinusitis were included, while those with concomitant upper respiratory tract, urinary tract, or skin and soft tissue infectious diagnoses codes were excluded. Patients with a J01 diagnosis in their medical claims were linked to their corresponding antibiotic prescriptions from pharmacy claims based on patient identifier, prescription date, ordering provider, and antibiotic utilized. Prescribing patterns of antibiotics (frequency of prescription, agent selection, and duration of therapy) were analyzed for the overall cohort and stratified by place of service, provider specialty, year of service, patient zip code, age, and gender.Figure 2:Frequency of acute sinusitis encounters with an antibiotic prescription by 3-digit zip code

Results
From 2019 - 2021 there were 560,255 unique encounters from 424,684 patients for acute sinusitis in Michigan within the IQVIA medical claims database. Antibiotics were prescribed in 66% of these cases. Amoxicillin-clavulanic acid (33%), azithromycin (25%), and amoxicillin (20%) were the most prescribed antibiotics, with median durations of 10 days, 5 days, and 10 days, respectively. The prescription patterns among different groups are shown in Figures 1 and 2. Prescription rates, agent selection, and durations were remarkably consistent across calendar year, age group, sex, place of service, provider specialty, and patient zip code.

Conclusion
The study revealed a concerning pattern of high antibiotic prescription rates, inappropriate antibiotic selection, and prolonged durations of therapy in the outpatient management of acute sinusitis in Michigan. These findings were consistent in all subgroups analyzed and emphasize the need to prioritize outpatient AMS practices for sinusitis.

Disclosures
jason M. Pogue, PharmD, Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Venatorx: Advisor/Consultant
P-1700. Benchmarking Clinical Outcomes by Antimicrobial Spectrum in Patients with Community-Acquired Pneumonia
Authors: Beaulac Kirthana , Mentler Philippe , Nagel Jerod , Postelnick Michael , Patel Pratish C , McCoy Christopher , Kinn Patrick M , Casaus Danielle , Smith Ethan A 
Published: January 2025

Abstract

Background
Antimicrobial benchmarking provides insight into practice variation relative to peers and outcomes relative to projections. Incorporation of patient-level risk-adjustment amplifies the validity and utility of data generated. The Vizient Clinical Data Base (CDB) is a healthcare analytics platform incorporating granular patient-level data from over 1,100 US hospitals and can be used to benchmark patient outcomes. The CDB’s multi-variate 2023 Academic Medical Center Risk Model is validated to produce reliable estimates for patient outcomes.

Methods
The CDB evaluated length of stay (LOS) and mortality for hospital admissions for community-acquired pneumonia (CAP). Admissions in CY2023 were included when labeled with a principal ICD-10 code for bacterial pneumonia, adjudicated as present on admission, and when the admission source was an outpatient location. Compared to the observed LOS, the risk model computed expected LOS (eLOS) and produced an observed to expected (O:E) index; a similar O:E index was created for mortality. Those who received narrow-spectrum (NS) antimicrobials, defined as ceftriaxone plus either azithromycin (CA) or doxycycline (CD), or levofloxacin or moxifloxacin (FLQ) monotherapy, were compared to patients who received broad-spectrum (BS) therapy, defined as vancomycin plus either piperacillin/tazobactam (VPT) or cefepime (VCP). Admissions attributed to the NS cohort did not receive any doses of a BS (VPT/VCP) antimicrobial and vice versa. Admissions were limited to those with eLOS of 3-7 days to balance medical complexity between NS and BS cohorts and limit confounding amongst eLOS, morality estimates, and antimicrobial prescribing.

Results
A principal diagnosis of CAP was assigned to 46,585 admissions. The LOS index was &lt; 1 for NS regimens, but &gt; 1 for those receiving BS therapy (Table 1). All deviations were statistically significant. The mortality index was &lt; 1 for all antimicrobial combinations; however, it was significantly lower than expected (p &lt; 0.01) for NS regimens (CA 0.36; CD 0.27; FLQ 0.52), but not for VPT 0.81 or VCP 0.95 (p &gt; 0.05).

Conclusion
After risk-adjusting for patient-level confounders impacting LOS and mortality, the use of NS antimicrobials for the treatment of CAP was associated with better outcomes than BS antimicrobials.

Disclosures
Kirthana Beaulac, PharmD, Abbvie: Honoraria Pratish C. Patel, PharmD, BCIDP, AAHIVP, VBI Vaccines: Stocks/Bonds (Public Company)
P-1737. A pilot intervention trial to reduce the use of post-procedural antimicrobials after common endoscopic urologic surgeries
Authors: Livorsi Daniel J , Shi Qianyi , Alberding Steven , Carter Knute , Steinberg Ryan 
Published: January 2025

Abstract

Background
Post-procedural antimicrobial prophylaxis is not recommended by professional guidelines but is still commonly prescribed and can lead to patient harm. The goal of this multicenter pilot intervention trial was to encourage less frequent use of post-procedural antimicrobials after common endoscopic urologic procedures.Table 1.Characteristics of patients across the 3 participating hospitals during both the baseline and intervention periods

Methods
We evaluated a bundled intervention using a pre-post, quasi-experimental design at three Veterans Affairs medical centers that performed common endoscopic urologic procedures: ureteroscopy and transurethral resection of a bladder tumor or prostate. There was a 2-year baseline, 1-month implementation, and 12-month intervention period. The intervention consisted of education, local champion(s), and audit-and-feedback of data, aggregated to the hospital-level, on the frequency of post-procedural antimicrobial use with comparisons to other facilities. The primary outcome was antimicrobial use on post-procedural day 1 and was evaluated using a logistic regression model for each site. Secondary outcomes were a) unplanned visits (i.e., Emergency Department visits and/or hospital readmissions within 30 days of the procedure) as well as b) late antimicrobial prescriptions (i.e., antimicrobials prescribed within 7-30 days after the procedure).Figure 1.Probability of post-procedural antimicrobial use after common urologic procedures across the 3 participating hospitals during the baseline and intervention periods

Results
There were 1,272 procedures performed across all sites at baseline compared to 525 during the intervention period (Table 1). During the baseline period, 644 (50.6%) patients received post-procedural antimicrobials compared to 216 (41.1%) during the intervention period. There was no change in the use of post-procedural antimicrobials at sites 1 and 2 between the two periods (Figure 1). At site 3, the odds of prescribing a post-procedural antimicrobial significantly decreased during the intervention period relative to the baseline time trend (0.089; 95% CI 0.016-0.445). There was no significant increase in unplanned visits or late antimicrobial prescriptions at any of the sites.

Conclusion
Implementation of a bundled intervention was associated with reduced post-procedural antimicrobial use after urologic procedures at 1 of the 3 participating sites. These mixed findings support the safety and also the difficulty of implementing guidelines on surgical antimicrobial prophylaxis.

Disclosures
Daniel J. Livorsi, MD, Merck: Grant/Research Support