bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1684. Characterization of Bacteremia and de-escalation practices among 13 public hospitals in Chile: Results from the 2022-2023 Chilean PPS
Authors: Benadof Dona , Acuña Mirta , Lichtenberger Paola , Herrera Tania ,   P , Bustos Mejia Jose Luis , Zamora Francisco , Rosales Ruth A , Lobos Maria Alejandra , Rojas Loreto , Orellana Rodrigo , Soto Ricardo J , Gutierrez Catalina C 
Published: January 2025

Abstract

Background
Antimicrobial resistance (AMR) is a global concern. Collecting data and implementing interventions to optimize antimicrobial (AM) use has significant potential to lower AMR.There is no information in Latin American Region on how prescribers are using data from positive blood culture results to de-escalate AM. We present a sub-analysis of the 2022-2023 Latin-PPS performed in Chile including the characterization of bacteriemia and de-escalation practices.
Antimicrobial distribution to treat bacteremia

Methods
13 public hospitals joined the Latin-PPS group. This PPS is based on the WHOPPS methodology. Each hospital conducted a survey in which everyday data from AM prescriptions was collected by ward. We include only patients that received AM related to documented bacteremia. The purpose of this study is to describe the etiological agents that caused bacteremia, AM use and compare the blood culture result with appropriate AM prescription.
Most common etiological agents and antimicrobials used.

Results
Chilean PPS included 3,342 beds, where 1302 AM treatments were given and 1,928 AM were administered to a national prevalence of 38.84%. Bacteremia is the 6th most common diagnosis related to AM use and corresponds to 3,76% . We found 49 bacteremia episodes, 9 occurred in ICU. The most common etiological agent was Staphylococcus aureus (16/49). Table 1 describes: most common etiological agents and AM used. The AM distribution to treat bacteremia is shown in graphic 1.
37/49 (75.5%) bacteremia had an organism that matched an appropriate AM. 10 of those missed an opportunity of de-escalation and 7 possibly represented contaminations in which AM could be stopped.

Conclusion
The AM prescription in hospitalized patients in Chile is lower compared to other LMIC. We found opportunities for AM optimization by de-escalating or stopping AM when blood culture results are available in bacteremia. We plan to recommend evidence-based strategies implementation aiming to de-escalate AM to a narrow more tailored regimen by audit and feedback supported with guidelines. Also to raise awareness about the possibility of contamination when blood cultures isolate coagulase negative staphylococcus as an opportunity to stop antimicrobials. PPS is an effective method to detect antimicrobial prescription habits and prioritize Antimicrobial Stewardship activities with local data.

Disclosures
Dona Benadof, MD, Biomerieux: Grant/Research Support Mirta Acuña, MD, Pfizer: Grant/Research Support P. , PharmD, Eli Lilly: Stocks/Bonds (Private Company)|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant Ruth A. Rosales, n/a, BECTON DICKINSON DE CHILE: Advisor/Consultant|BECTON DICKINSON DE CHILE: Speaker|Pfizer SA: Speaker
P-1690. The relationship of prescriber role and timing of prescribing to antibiotic prescribing appropriateness at a tertiary academic hospital
Authors: Greidanus Paul , LeBlanc Ryan , Kabbani Dima , Smith Stephanie W , Doucette Karen , Lau Cecilia , Bains Serena , Fong Karen G , Stewart Jackson J , Zeggil Teagan , Chen Justin 
Published: January 2025

Abstract

Background
There are limited studies examining antibiotic prescription appropriateness that compare trainees versus attending physicians or time of prescription in relation to working hours. Antimicrobial stewardship (AMS) prospective audit and feedback (PAF) was implemented in 2018 at a tertiary care centre targeting six restricted antibiotics (carbapenems, daptomycin, linezolid, and tigecycline). The agent, regimen, and duration were assessed by AMS pharmacists and/or physicians against institutional prescribing guidelines (expert opinion if not available) and recorded prospectively in the AMS quality improvement database. Real time written and verbal feedback were provided to the most responsible physician.
Table 1
Baseline prescription demographics.

Methods
We examined all prescriptions subjected to PAF from 2018 to 2023, with the primary objective to assess prescription appropriateness for medical trainees versus staff physicians. Secondary objectives were to evaluate whether other variables including time of day (working vs off hours), weekday vs weekend, and the COVID-19 pandemic period (Mar 2020-May 2022) impacted appropriateness. Multiple logistic regression was used to determine factors independently associated with optimal prescribing of antibiotics. Institutional ethics approval was obtained.
Figure 1
Odds ratios of prescription appropriateness for each independent variable (reference in parentheses).

Results
Overall, 3685 prescription audits were included in this study. Baseline prescription demographics are shown in Table 1. Of these, 1106 (32%) audited prescriptions were assessed by AMS PAF as not optimally prescribed requiring actionable AMS intervention. Prescriptions written by trainees were not less appropriate compared to staff (OR 1.27 [95%CI 0.97-1.66]). Off hours prescriptions had lower odds of being optimal (OR 0.81 [0.64-1.02], NS). Other secondary outcomes are reported in Figure 1. Prescriptions initiated by infectious disease (ID) had higher odds of being optimal (4.88 [3.68-6.55]).

Conclusion
In our cohort, we did not find a difference in appropriateness of restricted antibiotic prescriptions between trainees and staff, with a trend towards decline in optimal prescribing during off hours and weekends. ID had higher odds of optimally prescribing. Appropriateness improved over time and the COVID-19 pandemic did not have a negative effect at our center.

Disclosures
All Authors: No reported disclosures
P-1692. Evaluation of Antibiotic Appropriateness at Discharge in a Community Teaching Hospital
Authors: Patel Hinal , Poulsen Melissa 
Published: January 2025

Abstract

Background
Antimicrobial therapy is prescribed for approximately 20% of patients upon hospital discharge. The CDC and Joint Commission emphasize antimicrobial stewardship as a standard of care. While inpatient programs have processes in place to monitor and optimize antimicrobial therapy, monitoring and intervention during transitions of care is an unmet need for many hospital-based antimicrobial stewardship programs. We sought to evaluate antibiotic use at discharge at our institution to help develop potential strategies for monitoring and intervention.
Figure 1
Appropriateness of overall discharge antimicrobial therapy and breakdown by specific domains

Methods
This retrospective single center chart review evaluated adult patients discharged on oral antibiotics and diagnosed with pneumonia, skin and soft tissue infection, urinary tract infection, intra-abdominal infection, or bacteremia secondary to these infections. Exclusion criteria included pharmacist intervention on discharge orders, discharge parenteral antibiotics, and immunocompromised patients. The primary outcome was antibiotic appropriateness defined as right drug, dose, duration, and antibiotic-appropriate indication. Secondary outcomes included total duration of antibiotics, 30-day mortality, infection recurrence, and Clostridium difficile occurrence. Descriptive statistics were used for demographics and primary and secondary endpoints, and comparative statistics were used to evaluate the relationship between secondary outcomes and appropriateness.

Results
A total of 150 patients were included, of which 43/150 (28.7%) were prescribed appropriate antimicrobial therapy on discharge. Cefpodoxime was the most commonly prescribed antibiotic (45/150, 30%). The most common cause of inappropriate therapy was excess duration. The average excess duration of therapy was 4.4 days. The most common antibiotic indication was urinary tract infection, of which 33/52 (63.5%) cases were asymptomatic. Of note, the inappropriate use group had a statistically significant higher rate of 30-day readmission (12/107 versus 0/43, p = 0.022).

Conclusion
Inappropriate discharge antibiotics were common and associated with increased 30-day readmission rates, indicating a need for increased antimicrobial stewardship monitoring and intervention on hospital discharge.

Disclosures
Hinal Patel, PharmD, BCPS, BCIDP, Abbvie: Stocks/Bonds (Public Company)
P-1693. Comparison of Initial Treatment Strategies for Outpatients with Suspected Community Acquired-Pneumonia (CAP)
Authors: Munir Sheheryar , Iqra Soonha , Natesan Suganthini Krishnan , Kuhn Ryan , Dhar Sorabh 
Published: January 2025

Abstract

Background
Initial therapies for outpatient community acquired pneumonia (CAP) remain variable based on geographic location and resistance patterns. Infectious Diseases Society of America (IDSA) guidelines recommend either monotherapy for patients who lack comorbidities or risk factors for resistant organisms, or combination therapy for those at risk for severe pneumonia. Despite clinical guidance, it remains challenging for providers to prescribe guideline recommended therapies. Assessments of local practices and outcomes are essential for optimal CAP management.
Table 1
Community Acquired Pneumonia (CAP) Antibiotics Regimens and Patient Characteristics

Methods
A retrospective review of outpatient antibiotics prescribed from 1/2023 to 3/2024 for the indication of pneumonia was conducted at a Veterans Affairs Hospital. Clinical and antibiotic data were collected and analyzed to for comorbidities, risk factors, and outcomes, and assessed for indications for monotherapy or combination therapies in concordance with current IDSA guidelines. Antibiotics assessed included amoxicillin, doxycycline, azithromycin, amoxicillin/clavulanate either as monotherapy or combination therapy (beta-lactam antibiotic + azithromycin or doxycycline). Outcomes were compared between the 2 groups.
Table 2

Results
A total of 169 patients were reviewed of which 103 (60%) had comorbidities or risk factors for MRSA and pseudomonas. Most common antibiotics prescribed were amoxicillin/clavulanate + azithromycin in 81 (47.9%) and amoxicillin/clavulanate in 42 (24.9%) of patient (table 1). Monotherapy was prescribed in 40.8% of patients of whom 24 (34.8%) had no comorbidities or risk factors for resistance, while combination therapy prescribed in 100 (59.2%) patients of whom 58 (56.3%) possessed risk factors for resistance (p=0.4). There were no other differences noted in the clinical characteristics, risk factors, or outcomes between the monotherapy and combination therapy group.

Conclusion
Antibiotic prescribing for CAP was found to be variable with low concordance with guideline recommendations for monotherapy and combination therapies. Despite variability in regimens, no differences were noted in risk factors or outcomes suggesting that regional practices dictate CAP antibiotic selection. Appropriate prescribing patterns need to be assessed by stewardship programs.

Disclosures
All Authors: No reported disclosures
591. The Agency for Healthcare Research and Quality (AHRQ) Safety Program for MRSA Prevention: Impact of an Educational and Implementation Project in United States (US) Hospitals
Authors: Maragakis Lisa L , Miller Melissa A , Lin Leyi , Ahn Roy , Speck Kathleen , Gao Yue , Titus Jennifer , Dullabh Prashila 
Published: January 2025

Abstract

Background
The AHRQ Safety Program for MRSA Prevention utilizes evidence-based infection prevention interventions and the Comprehensive Unit-based Safety Program (CUSP) framework to decrease invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in intensive care units (ICUs), non-ICUs, surgical services, and long-term care facilities. We report the program's effect on hospital-onset MRSA bacteremia rates (HOB-MRSA) in 106 ICUs and 87 non-ICUs from 94 US hospitals.Table 1.Educational Toolkit Content for the AHRQ Safety Program for MRSA Prevention

Methods
The ICU/non-ICU Safety Program for MRSA Prevention was implemented from April 2022 to September 2023. The Safety Program aimed to decrease invasive MRSA infections through education, technical support, reinforcement of safety culture, and implementation of evidence-based infection prevention practices. Chlorhexidine bathing and nasal decolonization were major foci of the intervention, along with disinfection of the environment and practices to prevent person-based MRSA transmission and device-related infections. The project team provided 22 live webinars, supporting materials, and other tools to assist units with MRSA prevention (Table 1). Units were also assigned an implementation adviser who provided support through monthly coaching calls.
Units submitted monthly data for HOB-MRSA per 10,000 patient days (PD) as well as data regarding process measures. Linear mixed effects models were employed to calculate pre-post intervention changes in HOB-MRSA events.

Results
106 ICUs and 87 non-ICUs from 94 hospitals completed the Safety Program, including 31 (33%) academic medical centers (AMC), 37 (39%) non-AMC teaching hospitals, and 26 (28%) non-teaching community/other hospitals. From July-September 2021 to July-September 2023, HOB-MRSA events declined from 5.7 to 1.5 per 10,000 PD among ICUs (p&lt; 0.001)(Figure 1) and from 3.4 to 0.2 for non-ICUs (p&lt; 0.001) (Figure 2).
Similar results were found in comparisons among other pre-program vs, end-of-program quarters.

Conclusion
The AHRQ Safety Program for MRSA Prevention supported implementation of evidence-based infection prevention practices, including decolonization, and was associated with reduced HOB-MRSA rates across participating ICUs and non-ICUs.

Disclosures
All Authors: No reported disclosures
P-1694. Estimating the Use of Newer Beta-lactam Gram-negative Targeted Antibiotics Across Greater than 700 Hospitals in the United States
Authors: Harris Anthony , Goodman Katherine E , Pineles Lisa , Walker Morgan , Bork Jacqueline T , Heil Emily L , Claeys Kimberly C , Brooks Justin , Kadri Sameer S , Maron Brad , Baghdadi Jonathan 
Published: January 2025

Abstract

Background
Newer broad-spectrum beta-lactam antibiotics (cefiderocol, ceftazidime-avibactam, ceftolozane-tazobactam, imipenem-relebactam, meropenem-vaborbactam) have been introduced. Ceftazidime-avibactam and ceftolozane-tazobactam predominated newer antibiotic use through 2021; however, less is known about current use patterns and for what clinical indications, in inpatient settings. The aim of this study was to describe the use of these newer antibiotics across a large national cohort.

Methods
We performed a retrospective cohort study of adults discharged from June 2022 through May 2023 among hospitals in the Premier Healthcare Database. Antibiotic utilization was ascertained from daily charge data, and clinical indication(s) were inferred from ICD-10 diagnosis codes. A stratified analysis was performed among patients receiving &gt;3 days of antibiotic therapy to understand when these antibiotics are being used as definitive therapy.

Results
Across 832 hospitals, 3,890,557 admissions (61.9% of all admissions) included receipt of antibiotics. In 8,655 admissions (0.2% of antibiotic-prescribing admissions), newer antibiotics were prescribed (see Table 1 for patient demographic distribution). Ceftolozane-tazobactam was prescribed in 4157 (48%), 3660 (42.3%) ceftazidime-avibactam, 1060 (12.2%) cefiderocol, 456 (5.3%) meropenem-vaborbactam, and 99 (1.1%) imipenem-relebactam. Most patients who received newer antibiotics (69%, n=5,998) received them for greater than 3 days. Of these, ceftolozane-tazobactam was prescribed in 2607 admissions (43.5%), 2505 (41.7%) ceftazidime-avibactam, 832 (13.9%) cefiderocol, 332 (5.5%)meropenem-vaborbactam, and 68 (1.1%) imipenem-relebactam for greater than 3 days. Sepsis was the most common clinical indication for receipt of newer agents, followed by urinary tract infection (Table 2).

Conclusion
Ceftazidime-avibactam and ceftolozane-tazobactam remain the most frequently prescribed new antibiotics, with uptake of subsequently approved agents trailing. Most of the prescribing of these antibiotics are for sepsis.

Disclosures
Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor Kimberly C. Claeys, PharmD, PhD, bioMérieux: Advisor/Consultant|bioMérieux: Honoraria
P-1695. Antimicrobial prescribing differences for urinary tract infections between advanced practice practitioners and physicians at a safety-net community hospital
Authors: Hua Jessica , Balaji Aakash , Pomerantz Ben , Huber Dylan , Sanchez Lawrence , Ali Mirza , Mena Lora Alfredo J 
Published: January 2025

Abstract

Background
Advanced practice practitioners (APPs) are increasingly working in inptient settings as hospitalists. Despite these trends, there's a paucity of data on APP antimicrobial prescribing practices. Antimicrobial stewardship programs (ASPs) can reduce antimicrobial overuse and misuse. One of the most common infections in the inpatient setting is urinary tract infections (UTIs). We examine antibiotic prescribing practices of APPs and physicians for treatment ofUTIs. Understanding prescribing practices can highlihgt stewardship gaps and help guide ASP efforts.
Figure 1
UTI severity and empiric antimicrobial selection by physicians and APPs

Methods
A retrospective analysis of antimicrobial prescriptions was conducted at a 151-bed community hospital. ASP prospective audit and feedback (PAF) data for UTIs from July 2022 to June 2023 was reviewed, including initial antimicrobial selection, duration, and guideline concordance for APPs and physicians. Guideline adherence, antimicrobial effectiveness based on local antibiogram, and days of therapy (DOT) per 1000 patient days was compared between APPs and physicians.
Figure 2
Empiric antimicrobial selection by physicians and APPs

Results
A total of 209 initial PAF events for UTIs were reviewed, of which, 161 were physicians and 48were APPs. Physicians’ initial empiric choice was 9% (15) guideline discordant and ineffective. APP initial choice was 17% (8) guideline discordant and ineffective. TMP-SMX was more commonly used by APPs (Figure 1). Total DOT/1000 was 145. DOT/1000 was 44 for physicians, of which 11% were anti-pseudomonal beta lactams (APBLs) and 34% non-APBLs. DOT/1000 was 21 for APPs, of which 19% were APBLs and 27% non-APBLs (Figure 2). DOT/1000 was 44 for physicians, of which 11% were anti-pseudomonal beta lactams (APBLs) and 34% non-APBLs. DOT/1000 was 21 for APPs, of which 19% were anti-pseudomonal beta lactams (APBLs) and 27% non-APBLs (Figure 2).

Conclusion
APPs more commonly chose guideline discordant or ineffective initial empiric choices for UTIs compared to physicians. Empiric selection of ineffective agents according to local antibiogramswas higher for APPs. This underscores the importance of targeted ASP education on UTI guidelines and local antibiogram interpretation to improve antibiotic prescribing practices among APPs.

Disclosures
All Authors: No reported disclosures
P-1699. Antimicrobial Administration and 30-Day Outcomes in Patients Hospitalized with MRSA-Related Infections who Self-Discharge
Authors: Lewis Julia , Nechodom Kevin , Jones Makoto M 
Published: January 2025

Abstract

Background
Management of serious infectious diseases typically includes hospitalization and IV antibiotics, particularly where methicillin-resistant Staphylococcus aureus (MRSA) is the causative organism. When patients with these infections decide to self-discharge, it presents a challenging clinical decision for their providers. Here we describe antimicrobial prescribing practices for patients hospitalized with different infectious disease diagnoses and their 30-day outcomes.

Methods
This retrospective cohort study included patients 18 years and older admitted between January 1, 2010, and December 31, 2019, with admission blood cultures growing MRSA. Veterans Affairs (VA) electronic health data was extracted from the Veterans Informatics and Computing Infrastructure, microbiology data, inpatient antibiotic administration, discharge antibiotic prescriptions, ICD-9- and ICD-10-CM coded infectious disease discharge diagnoses, discharge type (self-discharge or regular discharge), as well as 30-day all-cause mortality and readmission. Descriptive statistics were used to compare antibiotic prescribing for specific infectious diseases between self- and regular discharges.

Results
While hospitalizations with patients self-discharging were lower for each infectious disease, their total antibiotic days were similar for most listed MRSA-related infections. However, for 30-day readmission rates, there was a higher rate among self-discharged patients for most all infections except cardiovascular. Conversely, 30-day mortality appeared to be higher among regular discharges for most infectious disease diagnoses except central nervous system and bloodstream infections.

Conclusion
While this analysis is preliminary, there is a concerning trend towards higher 30-day readmissions for patients with MRSA infections who self-discharge, despite similar durations of MRSA-directed antibiotic prescribing. This suggests additional factor(s) than antibiotic administration that play a role in readmissions for this patient population. Further research is needed to elucidate what factors contribute to readmission for patients who self-discharge from hospitalization for serious MRSA-related infections.

Disclosures
All Authors: No reported disclosures