bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1633. Evaluating an Urgent Care Antibiotic Stewardship Intervention: A Multi-Network Collaborative Effort
Authors: Roberts Annie , Park Daniel E , Balthrop Sabrina , Hamdy Rana F , Hamdy Rana F , Dolan Patrick , Liu Cindy 
Published: January 2025

Abstract

Background
Urgent care centers (UCCs) have previously been associated with high rates of inappropriate antibiotic prescribing without supporting appropriate diagnoses. Prior antibiotic stewardship studies in urgent care settings have generally been limited to pediatric clinics and diagnoses or conducted within single urgent care networks. Broadly generalizable stewardship efforts targeting common diagnoses across ages are needed.

Methods
This quality improvement study's participants were UCC clinicians from a national collaborative of 49 UCCs in 27 networks across 18 states within the United States. Stewardship interventions included signing of a commitment statement, and a choice of intervention options to implement during two plan-do-study-act (PDSA) cycles during the intervention period. The primary outcome was the percent of urgent care encounters (from randomly selected patient charts) for viral illness or bronchitis diagnoses with inappropriate antibiotic prescribing, stratified by whether the clinician was a direct participant in the quality improvement study and by diagnosis. A 3-month baseline and 9-month intervention period were compared using an interrupted time series with a generalized estimating equation model.

Results
15,588 patient encounters were included with a diagnosis of bronchitis or viral illness. The intervention was associated with a 39% relative decrease in inappropriate antibiotic prescribing (aOR=0.61, 95%CI 0.48-0.77) among participating clinicians compared to baseline. The intervention did not result in a significant change in inappropriate antibiotic prescribing (aOR=1.08, p=0.54) for clinicians who did not directly participate.

Conclusion
This antibiotic stewardship intervention was associated with significant reductions in inappropriate prescribing among clinicians who directly participated. Implementing stewardship interventions in UCCs may reduce inappropriate antibiotic prescriptions for common diagnoses; however, direct clinician participation may be necessary, especially in settings with high rates of clinician turnover.

Disclosures
All Authors: No reported disclosures
P-1638. Prevalence and Correlates of Inappropriate Antibiotic Prescribing in Japanese Primary Care Settings
Authors: Miyawaki Atsushi , Ladines-Lim Joseph B , Chua Kao-Ping , Tsugawa Yusuke 
Published: January 2025

Abstract

Background
Since the release of its 2016 National Action Plan on Antimicrobial Resistance (AMR), Japan has promoted antimicrobial stewardship in various ways (e.g. AMR awareness campaigns) but remains short of meeting benchmarks, e.g. reduction of antibiotic use per capita by one-third by 2020 versus 2013 (decreased only by 4.4% as of 2019). Effective stewardship interventions require comprehensive assessment of antibiotic prescribing appropriateness, with the most recent national-level data from 2012–2015. To fill this knowledge gap, we evaluated antibiotic prescribing appropriateness in Japanese outpatient primary care visits using nationally representative data.
Characteristics of patients who received ≥1 antibiotic prescription and visits in which physicians wrote antibiotic prescriptions from October 2022 to September 2023, JAMDAS

Methods
In a cross-sectional analysis of 2,809 primary care clinics, we analyzed all antibiotic prescriptions from October 1, 2022, to September 30, 2023. We adapted an established ICD-10-based classification scheme (Chua et al, BMJ, 2019) to the Japanese context, classifying prescriptions as “appropriate” (associated with ≥1 “always” code), “potentially appropriate” (associated with ≥1 “sometimes” code but no “always” codes), “inappropriate” (associated only with “never” codes), or “not associated with recent diagnoses.” We used regression to examine the association between prevalence of inappropriate antibiotic prescriptions and patient, clinic, and visit characteristics, adjusting for month indicators.
Prevalence of antibiotic prescriptions in each appropriateness category, JAMDAS

Results
Table 1 shows characteristics for patients who received ≥1 antibiotic prescription and visits in the sample. Among 2,058,021 prescriptions to 1,267,708 patients, 17.9% were inappropriate (Table 2). The adjusted prevalence of inappropriate antibiotic prescriptions was higher for children (&lt; 18 years), patients with comorbidities (sourced from the Charlson Comorbidity Index), older physicians, physicians with higher antibiotic prescription volumes, and telehealth visits versus office visits (Figure 1). There were no differences by patient or physician sex, total patient volume, region, or regular versus after hours.
Association of patient, clinic, and visit characteristics with prevalence of inappropriate antibiotic prescriptions

Conclusion
Antibiotic stewardship initiatives in Japanese primary care targeting children, patients with more comorbidities, older physicians, physicians with high antibiotic prescription volumes, and telehealth settings may be warranted.

Disclosures
Atsushi Miyawaki, MD, PhD, M3, Inc.: Advisor/Consultant
P-1639. Assessing Disparities in Inappropriate Outpatient Antibiotic Prescriptions in Tennessee
Authors: Thure Katie A , Mutamba Glodi , Kirtz Erika , Evans Christopher D 
Published: January 2025

Abstract

Background
The Centers for Disease Control and Prevention (CDC) estimates almost 47 million antibiotics are prescribed each year for indications that do not warrant antibiotic use. Identifying populations that are inappropriately prescribed antibiotics is imperative to address health inequities and prevent antimicrobial resistance. Tennessee Department of Health (TDH) evaluated disparities in outpatient antibiotic prescriptions in patients of different age groups, gender, geographical location, and insurance type.

Methods
The IQVIA Medical Claims and Longitudinal Prescription Claims databases were used to perform a cross-sectional study to evaluate the appropriateness of all outpatient antibiotics dispensed from retail pharmacies in TN from January 1–December 31, 2022. Data were categorized using a tiered system utilizing ICD-10 codes. Logistic regression was performed to predict whether age, gender, insurance type, and residence were associated with receiving an antibiotic in encounters for which antibiotics are rarely indicated (tier 3).

Results
In 2022, 2,017,863 prescribed antibiotics were linked to the medical claims database. Over half of these antibiotics were classified as a tier 3 encounter. Females were prescribed more antibiotics (62.0%). For tier 3 encounters specifically: 41.0% of antibiotics were prescribed to patients 65 and older. Residence in low and high socially vulnerable index (SVI) counties accounted for 27.9% and 24.9% of antibiotics, respectively. 37.2%, 16.5%, and 44.5% of antibiotics prescribed were billed to third-party payers (e.g., private health insurance), Medicaid, and Medicare Part D, respectively. Logistic regression showed female gender, younger age, and residence in low SVI had significantly higher odds of receiving an antibiotic for a tier 3 encounter; whereas prescriptions filled with Medicaid and Medicare were less likely to be associated with tier 3 encounters.

Conclusion
Previously TDH had not explored outpatient antibiotic use through a health equity lens. While the study provided basic demographic information about patients, there is a need to continue exploring disparities within various populations to aid in targeting inventions that drive appropriate antimicrobial use in ambulatory clinical settings.

Disclosures
All Authors: No reported disclosures
P-1653. Current Prescribing Practices and Guideline Concordance for the Treatment of Community-Acquired Bacterial Pneumonia (CABP) across Outpatient and Urgent Care Visits
Authors: Asempa Tomefa E , Ackley Tyler , Linder Kristin E , Nicolau David P 
Published: January 2025

Abstract

Background
Resources and support for antibiotic stewardship programs (ASP) have focused on hospitalized patients and there is minimal prescribing data and interventions among outpatients. We aimed to assess the treatment of CABP in adults in order to develop interventions to improve antibiotic utilization.

Methods
This retrospective study (2022-2022) included patients within a large healthcare system presenting to outpatient clinics (n=120) and affiliated Urgent Care Centers (n=24) across Connecticut. Patient encounters were identified via CABP ICD-10 codes and IDSA relevant patient comorbidities (chronic heart, lung, liver, or renal disease; diabetes; alcoholism; malignancy; asplenia) were extracted from patient problem lists. Primary outcome was to describe the proportion of patients receiving concordant therapy (antibiotic choice and prescription of monotherapy or combination therapy depending on presence of comorbidity) per IDSA guideline and local antibiogram.

Results
Patient characteristics are listed in Table 1. Overall guideline concordance rate was 36.6% (1,468/4,011 antibiotic orders). Among orders in patients with comorbidities (n=2,212), a large proportion received discordant therapy (n=1,417; 64.1%) via monotherapy particularly doxycycline (DOX) or azithromycin (AZM). Among appropriate combination therapy orders (n=370) in patients with comorbidities, the most common pairings were amoxicillin-clavulanate plus AZM (160/370; 43.2%) followed by amoxicillin-clavulanate plus DOX (86/370; 23.2%). 10.5% (232/2,212) received a guideline concordant respiratory fluoroquinolone monotherapy.
Among antibiotic orders in patients with no comorbidity (n=1,799), 1,126 (62.6%), orders were discordant largely due to inappropriate monotherapies (742/1,126; 65.9%) in particular AZM monotherapy (352/1,126; 31.3%) despite local pneumococcal resistance rates &gt;25%.

Conclusion
Guideline concordance was low, primarily due to lack of combination therapy in patients with comorbidities, as well as use of AZM monotherapy despite high resistance rates. Overall, these data will be instrumental in our current efforts to initiate an outpatient ASP and deploy interventions to improve care across the continuum of care.

Disclosures
Tomefa E. Asempa, PharmD, FDA/CDER: Grant/Research Support|Paratek: Grant/Research Support|Shionogi: Grant/Research Support|Spero: Grant/Research Support|VenatoRx: Grant/Research Support David P. Nicolau, PharmD, CARB-X: Grant/Research Support|Innoviva: Grant/Research Support|Innoviva: Honoraria|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Shionogi: Honoraria|Venatorx: Grant/Research Support
P-1656. Different Drugs for Different Bugs? A Comparison of a Solid Organ Transplant Population-specific Antibiogram with the Hospital-wide Antibiogram
Authors: Borgetti Scott , Ali Arzina Aziz , Gross Alan E , Mena Lora Alfredo J , Knodle Ryan D , Ismail Nahed , Ali Taha 
Published: January 2025

Abstract

Background
Solid organ transplant (SOT) recipients are vulnerable to infections with multi-drug resistant organisms. Studies have shown that SOT patients often do not receive adequate empiric antimicrobials for serious Gram-negative infections. Knowledge of epidemiologic differences in resistance rates in this population may help guide empiric antibiotic choices for SOT patients.
Cohort A

Methods
We performed a retrospective cohort study comparing antibiotic susceptibility rates of Gram-negative sepsis in SOT patients (cohort A) between 1/1/2021 and 4/30/2023 to the hospital-wide inpatient antibiogram for 2021-2022 (Cohort B). Using resistance rates from Cohort A, we developed a weighted-incidence syndromic combination antibiogram (WISCA) comparing SOT population specific empiric antibiotic therapy to the institutional empiric antibiotic recommendations for non-SOT patients with sepsis (figure 3).
Cohort B

Results
Cohort A had 90 Gram-negative isolates compared to 1328 in cohort B. Pseudomonas (27%) and E.coli (31%) were the most common isolates in cohorts A and B respectively. Pseudomonas isolates in cohort A were less likely to be susceptible to common anti-pseudomonal beta-lactams compared to cohort B, including piperacillin-tazobactam (46% vs 72% susceptible; OR 0.33, 95%CI 0.13-0.83), imipenem (33% vs 70% susceptible; OR 0.21, 95%CI 0.08-0.56), and cefepime (42% vs 70% susceptible; OR 0.31, 95%CI 0.12-0.80). E. coli isolates in cohort A were less likely to be piperacillin-tazobactam (50% vs 78% susceptible; OR 0.28, 95%CI 0.09-0.89) susceptible than isolates in cohort B, but not significantly less likely to be susceptible to imipenem (94% vs 100% susceptible; OR 0, 95%CI 0-1.53) or cefepime (75% vs 84% susceptible; OR 0.57, 95%CI 0.17-2.5). WISCA analysis of Gram-negative sepsis for SOT patients yielded imipenem (62% of isolates covered) as the optimal beta-lactam as opposed to the institutional recommendation of piperacillin-tazobactam (only covered 39% of SOT isolates).

Conclusion
Antimicrobial resistance rates were higher in SOT patients with Gram-negative sepsis compared to the non-SOT hospital population. Imipenem was a more active empiric Gram-negative antimicrobial for sepsis in the SOT patients compared to the institutional recommendation of piperacillin-tazobactam.

Disclosures
Scott Borgetti, MD, GSK: Grant/Research Support Alan E. Gross, PharmD, Becton Dickinson Co: Advisor/Consultant
P-1659. Clinical and Safety Outcomes of Uniform Thrice-Weekly Daptomycin Dosing Based on Adjusted Body Weight in Patients Receiving Intermittent Hemodialysis
Authors: Adams David T , Kaur Satwinder S 
Published: January 2025

Abstract

Background
Limited evidence exists on optimal dosing of daptomycin (DAP) in patients receiving intermittent dialysis (HD). Current labeling recommends every 48 hour (q48h) dosing which often causes additional DAP doses to be given throughout the week when the schedules become unaligned. Alternatively, current recommendations for thrice weekly dosing suggest a larger dose for the 72-hour interdialytic interval, which makes operationalization difficult within current inpatient electronic systems.

Methods
A retrospective observational cohort study comparing clinical and safety outcomes of adult patients receiving DAP with HD was performed between 01/2021 and 04/2024. Updated dosing recommendations for DAP with HD was modified on 1/2023 to indication based uniform adjusted body weight (AdjBW) dosing with each HD session compared to the previous recommendation of q48h based on total body weight. Clinical outcomes included microbiologic recurrence and escalation of dose or antibiotic therapy. Safety outcomes included CK elevation and development of rhabdomyolysis. Patients were excluded if they were on DAP prior to admission or received &lt; 2 DAP doses.

Results
In total, 79 patients met inclusion. BMI, acuity of infection, length of stay, and duration of therapy were similar between the q48h (n=42) and the with each HD groups (n=37). There was a significant reduction in total weekly AdjBW DAP received in the with each HD group (23.8mg/kg vs 28.8 mg/kg, p &lt; .0001) despite a higher utilization of the 8 mg/kg strategy (64.9% vs 26.2%). There was no significant difference in the clinical failure (5.4% vs 4.8%, p = 0.90) or safety outcomes (0% vs 6.5%, p = 0.12) between the post- and pre-groups, including after propensity matching based on BMI, AdjBW dose received, and receipt of source control.

Conclusion
Utilizing uniform DAP doses with each HD compared to standard q48h frequency in patients receiving HD did not result in worse clinical or safety outcomes while reducing the overall weekly exposure to DAP. This strategy further supports the use of AdjBW as the preferred dosing weight for DAP, including in HD patients, who have been underrepresented in previous studies. This method could also be useful in the outpatient setting to help optimize DAP exposure.

Disclosures
All Authors: No reported disclosures
P-1674. Comparative study of advance practice providers and physician prescribing practices for complicated intra-abdominal infections in patients hospitalized at a safety-net community hospital
Authors: Balaji Aakash , Pomerantz Ben , Hua Jessica , Huber Dylan , Ali Mirza , Sanchez Lawrence , Mena Lora Alfredo J 
Published: January 2025

Abstract

Background
The expansion of advanced practice providers (APPs) in the inpatient setting warrants understanding of their antimicrobial prescribing practices in these settings to help adapt antimicrobial stewardship (ASP) strategies. Variability in APP training programs further complicates the landscape. This study aims to investigate disparities in antibiotic prescription practices for complicated intra-abdominal infections (cIAI) between APPs and physicians.
Figure 1
clAl severity and empiric antimicrobial selection by physicians and APPs

Methods
A retrospective review of antibiotic orders was conducted at a 151-bed community hospital. ASP prospective audit and feedback (PAF) data from July 2022 to June 2023 was reviewed, including initial antibiotic selection, duration, and guideline concordance for APPs and physicians. Guideline adherence, antimicrobial effectiveness, 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 175 initial empiric PAF entries for cIAI were reviewed, of which 145 were from physicians and 30 from APPs. Guideline non-adherence was 10% (14) for physicians and 20% (6) for APPs. Additionally, 3% (5) of physician and 7% (2) of APP prescriptions were ineffective. Critical illness was higher for physician cases (Figure 1). Physicians prescribed more antipseudomonal beta-lactam (APBLs) than APPs (52% vs 30%). APPs prescribed more quinolones (FQ) than physicians (33% vs 26%). Of the patients treated with FQs by APPs, 37% had allergies to beta-lactams, compared to 22% of patients treated by physicians. Total DOT/1000 during the study period 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 anti-pseudomonal beta lactams (APBLs) and 27% non-APBLs (Figure 2).

Conclusion
Empiric antimicrobial selection for cIAI differed between APPs and physicians, with APP showing higher quinolone use, a non-preferred agent, and almost double the level of non-adherence to guidelines. These findings underscore the need for tailored ASP education and interventions that address the unique practices and educational backgrounds of APPs, aiming to standardizing and optimizing antimicrobial use. APPs may require specific education for cIAI and ASP guidance.

Disclosures
All Authors: No reported disclosures
P-1675. Antibiotic Inertia Occurs Frequently in Patients Admitted from the Emergency Department on Guideline Non-Concordant Therapy
Authors: Creel Joseph , Elashker Adrianna , DeWitt Michael E , Beardsley James R , Ohl Christopher , Banoub Mary , Randazza Olivia , Taylor Alex D , Williamson John C , Hartis Charles , McCormick Ryan C , Luther Vera P 
Published: January 2025

Abstract

Background
Antibiotic (abx) inertia is when inpatient providers continue inappropriate empiric abx started in the emergency department (ED) rather than changing to an appropriate regimen. Studies using hypothetical case scenarios estimate that this occurs in 39% of cases, but the phenomenon has not been studied using actual prescribing data. The objective of this study is to evaluate abx inertia in real-world clinical practice.

Methods
This retrospective chart review of adult inpatients at an 885-bed tertiary care referral center from January - October 2022 evaluated whether guideline non-concordant (GNC) abx therapy started in the ED was continued upon admission to an inpatient team. Patients admitted with a diagnosis of acute uncomplicated cystitis, pyelonephritis, community-acquired pneumonia (PNA), or skin/soft tissue infection (SSTI) who received abx in the ED were eligible for inclusion. ICU admissions were excluded. Ten patients meeting study criteria were randomly chosen from each month. Abx regimens were compared to those listed in corresponding IDSA guidelines. The primary outcome was the continuation of empiric GNC abx by the inpatient team at the time of admission.

Results
Of the 100 patients evaluated, 56 were started on GNC abx therapy in the ED. Of these, 25 (45%) were continued on GNC regimens. Vancomycin and cefepime, prescribed in 18 (72%) and 10 (40%) cases, were the most commonly continued GNC abx. The majority [23 (92%)] of continued GNC regimens were broader than those listed in the guidelines; 17 (68%) continued an abx not listed in guidelines while also omitting a listed abx. It took a median of 63 hours (95% CI 48-80) for those started on GNC abx in the ED to receive guideline concordant abx (figure 1). There was no difference in age, comorbidities, admission diagnosis, change in diagnosis, prior infections or allergies in patients whose GNC abx were continued versus not. Patients admitted to a hospitalist service were more likely to have GNC abx continued (p &lt; 0.05), table 1.

Conclusion
Abx inertia occurred in almost half of patients started on GNC abx in the ED. Vancomycin and cefepime as well as a specific inpatient service were often associated with continued GNC abx. These observations offer potential targets for antimicrobial stewardship efforts.

Disclosures
John C. Williamson, PharmD, Armata Pharmaceuticals: Grant/Research Support|Blue Collar Vaccines and Therapeutics: Board Member|Blue Collar Vaccines and Therapeutics: Ownership Interest|Paratek Pharmaceuticals: Grant/Research Support|ST Pharm Co, Ltd: Grant/Research Support