bluuebunny/crossref_metadata_2025_split huggingface dataset:
980. Risk Factors for Central Line Associated Bloodstream Infection Prior to and During the COVID-19 Pandemic
Authors: Priem Jennifer , Sampson Mindy , Kester Shelley , Bischoff Werner , Passaretti Catherine , Stephens Casey 
Published: November 2023

Abstract

Background
Central line associated bloodstream infections (CLABSIs) increased during the COVID-19 pandemic1-3, especially in patients infected with SARS-CoV-2,4 but there has been limited analysis on other risk factors associated with this increase.

Methods
We conducted a retrospective cohort study to assess risk factors for developing a CLABSI prior to (1/2019-3/2020) and during the COVID-19 pandemic (3/2020-2021) across 12 acute care hospitals in the Southeastern U.S. A multivariable logistic regression analysis was performed comparing patients with and without CLABSI.

Results
Of the 46,259 patients with central lines, 313 developed a CLABSI during the study period (109 pre- and 204 during- pandemic, a significant proportional increase.) Risk factors for CLABSI in the pre-pandemic period included cancer diagnosis, receipt of total peripheral nutrition (TPN) during hospital stay, Intensive Care Unit encounter, and longer length of stay and average line days (Table 1). During the pandemic, cancer diagnosis was no longer significantly associated with risk of CLABSI, but additional risk factors included Medicare insurance (OR 1.68), presence of a dialysis catheter (OR 1.57), COVID-19 diagnosis (OR 2.14), higher body mass index (OR 1.01) and Black race (OR 1.36). During the pandemic, we found that Black patients without COVID were 1.6 times (95% CI 1.09, 2.41) more likely to develop CLABSI compared to White patients (Table 2).

Conclusion
We detected a shift in risk factors for CLABSI during the pandemic. While COVID-19 diagnosis increased the risk of CLABSI, as has been shown in other studies4, our data additionally revealed a shift in risk factors in patients without COVID-19 showing a higher risk in those with black race, Medicare for insurance and presence of a dialysis catheter during the pandemic. These results suggest that alterations may have occurred in healthcare delivery, specifically in vulnerable populations, laying the foundation for future investigations into potential care improvements.

Disclosures
All Authors: No reported disclosures
1012. Protective Effects of Maternal Influenza Vaccine during Pregnancy and Breastfeeding on Risk of Infant Influenza
Authors: Rick Anne-Marie , D’Agostino Helen , Liu Hui , Williams John V , Balasubramani G K , Martin Judith M 
Published: November 2023

Abstract

Background
Children &lt; 6 months of age are not eligible for influenza vaccine but are at high risk of influenza and its complications. Maternal influenza immunization (MII) in pregnancy or during lactation are two ways to provide infants vaccine specific influenza antibodies that could confer protection. Limited data delineate the individual and combined protective effects of MII and breastfeeding on influenza in infants. We aimed to evaluate the independent and combined protective effects of MII during pregnancy and breastfeeding against influenza during the first 6 months of life.

Methods
We utilized a retrospective cohort of mother-infant pairs, including infants born between January 1, 2012, to December 31, 2019 with longitudinal care within a single health system. Maternal influenza vaccine, breastfeeding and important covariates (Table 1) were obtained from electronic health records. We evaluated the odds of laboratory-confirmed influenza among infants &lt; 6 months of age based on MII in pregnancy and breastfeeding status at 3 months of age using unadjusted and adjusted logistic regression following stepwise regression for covariates with p-value &lt; 0.15.

Results
Of the 44,132 mother-infant pairs included, 0.3% (N=141) of infants had laboratory-confirmed influenza between birth and 6 months of age. 54% of infants received some/exclusive breastmilk at 3 months of age; 51% of mothers had MII during pregnancy. Breastfeeding alone (aOR: 0.77; 95%CI: 0.51-1.16) did not significantly protect against influenza compared to infants who received no breastmilk and no MII. In contrast, exposure to MII trended toward decreased risk of influenza by 37% (aOR: 0.63; 95%CI: 0.39-1.01), and the combination of MII in pregnancy and breastfeeding significantly decreased odds of infant influenza by 60% (aOR: 0.40; 95%CI: 0.25-0.66) (Table 1).

Conclusion
MII in pregnancy can effectively reduce the risk of influenza between 40-60% in children &lt; 6 months. Breastfeeding significantly enhances that protection, either through its broad immune properties and/or the vaccine-specific antibodies in milk. Increasing the administration and acceptance of MII in pregnancy and improving sustained breastfeeding rates may help reduce the burden of infant influenza.

Disclosures
John V. Williams, MD, Merck: Grant/Research Support|Quidel: Board Member Judith M. Martin, MD, Merck, Sharp and Dhome: Grant/Research Support
1017. Impact of a Multifaceted Approach to Audit-and-Feedback Antimicrobial Stewardship Intervention in Acute Leukemia Patients Using Measures of Appropriateness
Authors: So Miranda , Alahmadi Ghadeer , Hamandi Bassem , Husain Shahid 
Published: November 2023

Abstract

Background
Prospective audit-and-feedback (PAF) for hospitalized leukemia patients is resource-intensive, while data on stadardized assessment of the quality, i.e. appropriateness, of antimicrobial prescribing are scarce. We implemented a multifaceted program combining patient-level PAF with unit-level appropriateness reports generated by serial point-prevalence surveys using the web-based Canadian National Antimicrobial Prescribing Survey (NAPSTM) platform. Quality of prescribing was assessed based on local guidelines and clinical justification using published definitions (Fig. 1). The objective of the study was to evaluate the impact of PAF+NAPS interventions on antibiotic use (AU) in acute leukemia patients at an academic cancer center, compared to PAF-only.

Methods
In this retrospective cohort study, during the PAF-only period (Jun 1 2017-May 31 2019), the AMS team led 30-minute PAF rounds with prescribers 2x/week. After implementating PAF+NAPS (Jun 1 2019-Mar 31 2020), we met 2x/month for 30 minutes. At each meeting we presented an automated NAPS dashboard report (Fig. 2) of aggregate appropriateness adjudication of antibiotic prescriptions, followed by targeted PAF on select patients with complex antimicrobial needs. We analyzed the impact of the two-step approach on the primary outcome of AU (defined daily dose [DDD]/100 patient-days [PD]) using interrupted time series models. Secondary outcomes were appropriateness of AU during PAF+NAPS, lenght of stay and in-hospital mortality. Target appropriatenesss was at least 90%. Categorical variables were compared using chi-square test and continuous variable using Mann Whitney U test.Fig. 2Sample Canadian NAPS Dashboard Report From a Point-Prevalence Survey

Results
Patient characteristics and outcomes were presented in Table 1. AU data were presented in Table 2. AU of piperacillin-tazobactam and vancomycin decreased significantly after implementation of 2x/month PAF+NAPS, compared to 2x/week PAF-only interventions (Fig. 3). Overall appropriateness was 91.4% (1757/1921 prescriptions).

Conclusion
Despite reducing frequency of interventions from 2x/week to 2x/month, PAF+NAPS was an efficient and sustainable AMS model that promoted appropriate and judicious antimicrobial use in hematology-oncology patients (Fig. 4), allowing the AMS team to expand to other specialized areas.

Disclosures
Shahid Husain, MD, Astellas: Grant/Research Support|Avir: Grant/Research Support|F2G: Grant/Research Support|Gilead: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Pulmocide: Grant/Research Support|Synexis: Grant/Research Support|Takeda: Honoraria
1106. Comparison of Diagnostic Power of Conventional Culture and Automated Blood Culture System with Pleural Fluid
Authors: Ho Lee Young , Kim Si-Ho , Yang Jinyoung , Ko Jae-Hoon , Young Cho Sun , Huh Heejae , Yong Lee Nam , Kang Cheol-In , Ryeon Chung Doo , Ran Peck Kyong , Huh Kyungmin 
Published: November 2023

Abstract

Background
Microbiological diagnosis of empyema is often hindered by low sensitivity of conventional culture. Automated blood culture system has been reported to enhance diagnostic power for culture of non-blood specimens. The purpose of this study is to compare the diagnostic power of conventional bacterial culture and automated blood culture system (ABCS) in patients who underwent thoracentesis or percutaneous drainage.

Methods
Non-duplicate patients whose pleural fluid was tested using both conventional culture and ABCS (BACT/ALERT 3D and VIRTUO, bioMerieux) from 1 Jan 2001 to 31 Dec 2021 were included. Cases in which coagulase-negative staphylococci were only positive isolates were excluded. Culture results, demographic information, and laboratory test results were obtained from the clinical data warehouse of Samsung Medical Center. The results from conventional cultures were compared against those from ABCS.

Results
A total of 9,020 patients who met the study criteria were identified. Among them, 819 patients had positive results other than coagulase-negative staphylococci from ABCS. Conventional culture was also positive in 360 (44.0%) patients, while 459 (56.0%) patients had isolates only from ABCS.
Pleural fluid from female and the patients with no pre-existing pleural drainage were significantly more likely to be culture positive by ABCS only (Table 1 and 2). In addition, pleural fluid LDH and serum CRP were significantly lower and pleural fluid glucose was significantly high in the patients with positive results from ABCS only. Among organisms isolated from both conventional culture and ABCS, the most frequently identified species was Staphylococcus aureus, followed by Klebsiella spp., and viridans group streptococci (Figure 1). Viridans group streptococci, Candida spp., and S. aureus were the most common species isolated from ABCS only (Figure 1).

Conclusion
More than a half of the patients whose pleural fluid culture were positive using ABCS had a negative conventional culture. Viridans group streptococci, Candida spp., and S. aureus were common species causing the discrepancy. Our results suggest that ABCS may enhance microbiologic diagnosis of empyema.

Disclosures
All Authors: No reported disclosures
1111. Lack of Effectiveness of Colistin in Carbapenem-Resistant Acinetobacter baumannii : A Retrospective Single Center Cohort Study
Authors: Kim Si-Ho , Jeon Cheon-Hoo , Mi Wi Yu 
Published: November 2023

Abstract

Background
Acinetobacter baumannii is a major pathogen for nosocomial infection. The emerging resistance of A. baumannii to carbapenem limits the appropriate antimicrobial agent options. Colistin has been used for the treatment of carbapenem-resistant A. buamannii (CRAB), but there were only a few studies evaluating effectiveness of colistin with appropriate controls. In this regard, we investigated the effectiveness of colistin in treating pneumonia caused by CRAB compared to CRAB pneumonia treated with no active drug.

Methods
Adult patients (≥ 18 years old) with CRAB isolated from their respiratory specimens were screened. Then, patients with pneumonia who were treated with colistin monotherapy (colistin group) as active antibiotics based on antimicrobial susceptibility and without any active antibiotics (no active drug group) were included. Pneumonia is defined as a new infiltrate on chest image and two of the following: 1) hyper or hypothermia (≥ 37.8 or ≤ 36.0 °C), 2) purulent respiratory secretion, 3) leukocytosis, and 4) hypoxemia. The primary outcome was 30 days of all-cause mortality. The secondary outcome was acute kidney injury within 30 days after pneumonia diagnosis or colistin administration. Only the patients who had baseline creatinine less than 2mg/dL were evaluated for the secondary outcome.

Results
Among 828 patients with CRAB in their respiratory specimens, 45 patients were treated with colistin, and 123 received no active antibiotics susceptible to CRAB. Most of the CRAB pneumonia was hospital-acquired pneumonia (91.1%), and 51.1% of patients were ventilator-associated pneumonia. Purulent respiratory secretion (100% vs. 87.8%, P=0.012) and use of carbapenems (71.1% vs. 48.8%, P=0.010) were more frequent in the colistin group. There was no difference in 28 days of all-cause mortality in colistin (41.7%) and no active drug group (43.9%) in raw (P=0.62) and adjusted analysis (adjusted HR 0.72, 95% CI 0.45-1.2). Incidence of acute kidney injury was numerically common in the colistin group (65.3% vs. 39.0% ) but no statistical significance was observed (P=0.143).
Survival curve since the onset of CARB pneumonia

Conclusion
Colistin might not have survival gain for the treatment of CRAB pneumonia. Newer effective antimicrobials effective for CRAB should be developed, evaluated, and rapidly applied to clinical practice.

Disclosures
All Authors: No reported disclosures
1929. Evaluating Disparities in Recurrent Clostridioides difficile Infection (CDI) and Fecal Microbiota Transplant (FMT) Treatment using Geospatial and Social Vulnerability Analytic Tools
Authors: Little Keighly , Mehta Nirja , Goodenough Dana , Dhonau Robin , Gupta Nitin , Woodworth Michael H , Fridkin Scott 
Published: November 2023

Abstract

Background
Recurrent CDI (rCDI) can be deadly and live biotherapies such as fecal microbiota transplantation (FMT) are now recommended at 2nd recurrence. Although incidence of Clostridioides difficile infection (CDI) historically is higher in white compared to black patients, the role of race or social determinates of health on rCDI is unclear. This study explores social determinants of risk for rCDI and treatment with FMT.

Methods
Georgia’s Emerging Infections Program (EIP) (supported by CDC) conducts CDI surveillance in 8 metropolitan Atlanta counties. Incident CDI (+toxin or molecular assay) in resident of catchment area (without previous + within 14 days) between 2016 and 2019 were categorized as single episode or rCDI ( &gt;1 episode within 365 days) and geocoded (ArcGIS)-linked to CDC’s 2020 Social Vulnerability Index (SVI) data. Numerical values of each SVI variable (Table 1) were assigned to each patient. SVI theme and composite SVI were assessed as predictors for each rCDI and FMT receipt with most vulnerable defined categorically (top quartile) in log binomial logistic regression. Spatial analysis produced spot map of FMT, and choropleth maps of the CDI and rCDI rates per 100,000 persons.

Results
Among the 13,835 residents with CDI, 3,038 (22.0%) had rCDI and 250 (1.8%) had an FMT. Housing type and transportation was the only SVI predictor for rCDI while it was one of several SVI themes predictive of not receiving FMT (Table 2). Adjusting for age and sex, the most vulnerable patients in housing and transportation theme were 13% more likely to have recurrence (P-value&lt;0.01) (Table 3). Independent predictors of FMT receipt included younger age and female sex. Importantly, patients living in a largely minority census tract were 37% less likely to receive an FMT and those in a largely uninsured tract 39% less likely (Table 3). Spatial analysis illustrates a strong discordance between FMT receipt and rCDI rates (Figure 1).

Conclusion
More socially vulnerable populations, defined by access to transportation and the level of household crowding, are more likely to develop rCDI. Likelihood of receiving FMT is substantially reduced among uninsured and persons of black race; both associations need consideration as novel live biotherapeutic products become available.

Disclosures
Nitin Gupta, MD, Abbvie: Advisor/Consultant|Amgen: Grant/Research Support|Bristol Myers Squibb: Advisor/Consultant|Bristol Myers Squibb: Grant/Research Support|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Pfizer/Arena: Advisor/Consultant|Pfizer/Arena: Grant/Research Support
1186. Beta is Better: Impact of a Multifaceted Stewardship Initiative on the Sequential Timing of Beta-Lactam Administration
Authors: Deri Connor R , Schultheis Jennifer , Shroba Jenny , Boreyko John , Wrenn Rebekah , Keener Cynthia , Moehring Rebekah W 
Published: November 2023

Abstract

Background
Appropriate antibiotic sequence (i.e. beta-lactam before vancomycin) may reduce early mortality in patients with bloodstream infections (BSIs). Herein, we describe the impact of a multifaceted stewardship initiative on the sequence of antibiotic administration across three hospitals.

Methods
We performed a pre-post analysis describing the impact of a multifaceted stewardship initiative from March 1, 2021 – May 22, 2022 (pre) and May 31, 2022 – Feb 12, 2023 (post) on the sequence of antibiotic administrations in adults &gt; 18 years old with at least one positive blood culture who received vancomycin and a beta-lactam (i.e. cefepime, meropenem, or piperacillin-tazobactam) across three hospitals: a major university hospital and two community hospitals. Our initiative consisted of 1) a health-system wide adult beta-lactam order panel combining load and maintenance doses for select beta-lactams (Figure 1) 2) nursing administration instructions facilitating the appropriate sequential order of antibiotic administration (i.e. beta-lactam before vancomycin) (Figure 2) and 3) system-wide education to physicians, pharmacists, and nurses. The rate of beta-lactam first administration was compared between groups. Beta-lactam first rates were further stratified by hospital and antibiotic administration locations. Chi-square tests were used to compare rates between groups.
Beta-Lactam Order Panel, Piperacillin-tazobactam
Beta-Lactam First: Nursing Administration Instructions, Cefepime

Results
361 patients were included for analysis: 224 pre- and 137 post-intervention. Piperacillin-tazobactam was the most common beta-lactam among studied patients (71.5%, Table 1). Beta-lactam first rates were already high at baseline, then higher post-intervention compared to pre-intervention (96.4% vs 93.8%, p = 0.283) (Table 2).Table 1.Receipt of Beta-Lactam Therapy in Adult Patients with Positive Blood CulturesTable 2.Sequence of Antibiotic Administration

Conclusion
A multifaceted initiative to promote beta-lactam before vancomycin administration increased adherence to this preferred practice in our health system, though baseline rates were high. Clinical decision support paired with system-wide education involving key stakeholders can help standardize appropriate antibiotic sequence. Future study could evaluate impact on a larger scale, on patient outcomes, and evaluate sustainability of beta-lactam first practice.

Disclosures
Rebekah W. Moehring, MD, MPH, FIDSA, FSHEA, UpToDate, Inc.: Author Royalties
1190. Nudging Away from Alert Fatigue: A Novel Method for Tracking the Impact of Integrated Clinical Decision Support on Meropenem Order Rates
Authors: Ezran Camille , Mercuro Nicholas J , Rokas Kristina E , Dryer Vince , Rawlings Stephen , Herrle Elizabeth 
Published: November 2023

Abstract

Background
The electronic health record (EHR) has streamlined quality of care and hospital prescribing; however, interruptive alerts and hard restrictions on antibiotic ordering can disrupt clinical workflow, often without significant benefit. This study aimed to determine the impact of permissive restriction on meropenem orders with embedded clinical decision support and prescriber attestation.

Methods
A quality improvement intervention implemented at Maine Medical Center (MMC, a 700-bed academic medical center) was evaluated through a multisite, quasiexperimental study within MaineHealth Hospitals. The intervention consisted of a provider-facing summary of guideline-directed indications for empiric and culture-directed uses of meropenem attached alongside the EHR order, and a required attestation button. To track meropenem order rates for adult patients prior to (Oct – Dec 2022) and after (Jan – Mar 2023) the intervention, the EHR was configured to fire a “silent” Best Practice Advisory behind-the-scenes when a provider opened the meropenem order. Rates of ordering were also monitored at other sites in MaineHealth, where the intervention was not implemented. The primary endpoint was the rate of “back-out” events, defined as a prescriber beginning a meropenem order but not signing it, and the secondary endpoint was the meropenem administration rate within 24 hours of opening an order.

Results
A meropenem order was initiated in 824 unique encounters during the study period; following the intervention at MMC, the back-out rate for orders increased from 20.3% (n =291) to 32.7% (n= 147, p = .01), while there was no significant difference during the same period at institutions where the intervention was not implemented (Table 1). The rate of patients who received meropenem within 24 hours following an order being opened decreased from 90.0% pre-intervention to 74.8% post-intervention (p &lt; 0.01).

Conclusion
This study suggests that simple, non-resource intensive antimicrobial stewardship ‘nudges’ can simultaneously be implemented and monitored through creative EHR design, leading to a reduction in overall completion of meropenem orders and a decrease in inappropriate antibiotic prescribing. Similar interventions can be implemented in all fields of healthcare stewardship.

Disclosures
All Authors: No reported disclosures
1200. Evaluation of Pharmacist-Driven Azithromycin Dose Optimization Protocol for Respiratory Tract Infections as an Antimicrobial Stewardship Initiative
Authors: Kaur Satwinder S , Adams David T , Schrank Casey L 
Published: November 2023

Abstract

Background
Azithromycin is a macrolide antibiotic commonly used empirically to treat atypical pathogens in CAP and acute COPD exacerbations. Due to its longer half-life and high tissues concentrations, a total treatment dose of 1.5 g (given over either 3 or 5 days) provides therapeutic exposure lasting approximately 10 days. Multiple randomized studies demonstrated similar treatment efficacy between 3 days and 5 days of azithromycin. Due to the increased rates of macrolide-resistant Streptococcus pneumoniae strains, shorter courses of azithromycin may decrease the emergence of more bacterial resistance, improve patient compliance, and decrease antibiotic-associated adverse events.

Methods
A retrospective cohort study conducted from March 2022 to March 2023 at Texas Health Harris Methodist Hospital Fort Worth. Pharmacists automatically adjusted azithromycin orders to a duration of 3 days and a dose of 500 mg for CAP and acute COPD exacerbations. Patients were excluded if treatment indications were for prophylaxis, mycobacterial disease, or Legionnaires disease. The primary outcome was azithromycin duration of therapy (DOT) after protocol implementation and secondary outcomes included 30-day all-cause in-hospital mortality and 30-day hospital readmission.

Results
507 patients were included in the final analysis with 267 patients in the pre- and 240 patients in the post-group. After protocol implementation, a statistically significant reduction in mean azithromycin DOT was observed in the post- compared to the pre-group (3 days vs 5 days), p &lt; .0001. No increase in 30-day all-cause in-hospital mortality (2.1% vs. 7.1%, p = .008) or 30-day hospital re-admission rates (5.4% vs. 15.3%, p = .001) were observed in the post- compared to the pre-group.

Conclusion
Based on the results of this study, implementation of a pharmacist-driven azithromycin dose optimization protocol is an effective antimicrobial stewardship initiative that can decrease unnecessary azithromycin DOT. The 3-day duration of high dose azithromycin was not associated with increased rates of mortality or hospital re-admissions compared to longer durations.

Disclosures
All Authors: No reported disclosures