bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1645. Appropriateness of Ambulatory Antibiotic Prescriptions Given Outside of Formal Patient-Clinician Encounters
Authors: Shively Nathan R , Carr Dustin R , Moffa Matthew A , BCHECH G E O R G E , Rothman Ryan , Appiah-Kubi Edmund , Barber Sophia , Kalu Vivian , Nagel James J , Bremmer Derek N , Buchanan Carley , Trienski Tamara , Zhu Shenjun , Walsh Thomas L 
Published: January 2025

Abstract

Background
There are limited published data on the frequency and appropriateness of outpatient antibiotic prescriptions ordered outside of formal patient-clinician encounters.

Methods
A random sample of oral antibiotics prescribed to adult patients from 4 primary care practices were manually reviewed for appropriateness. The need for any antibiotic, as well as the appropriateness of agent selection and duration, were compared between visit-based (formal in-person, video, or telephone encounters) and non-visit-based encounters.

Results
Of the 859 prescriptions reviewed, 543 (63.2%) were generated from visit-based encounters (48.2%, 13.2% and 1.9% were from in-person, video, and telephone visits, respectively) and 316 (36.8%) were non-visit-based. Overall, 29.7% of prescriptions were written despite no antibiotic indication (Table). Antibiotics were indicated in 382/543 (70.3%) of visit-based encounters, vs 165/316 (52.2%) of non-visit-based encounters (P&lt; 0.0001). When an antibiotic was indicated, agent selection was more frequently appropriate in visit-based encounters (88.7% vs 81.8%, P=0.006), with no difference in appropriate duration (81.9% vs 89.7%, P=0.49). When duration was inappropriate, it was too long in 94.5% of cases. Among visit-based prescribing, antibiotic prescriptions were indicated more frequently from in-person encounters as compared to virtual (combined video and telephone) encounters (73.4% vs 60.5%, P=0.008). Compared to visit-based antibiotic prescriptions, significantly fewer non-visit-based antibiotic prescriptions were associated with any diagnosis code (543/543 (100%) vs 189/316 (59.8%), P&lt; 0.0001). Azithromycin and fluoroquinolones were more likely to be inappropriately chosen agents compared to other antibiotics (46.7% vs 12.4%, P&lt; 0.0001, and 45.5% vs 12.4%, P&lt; 0.0001, respectively).

Conclusion
Compared to antibiotic prescriptions from formal patient-clinician encounters, antibiotic prescriptions generated from non-visit-based encounters were significantly less indicated, with less appropriate agent selection, and were frequently not associated with a diagnosis code. Outpatient stewardship efforts should target non-visit-based encounters.

Disclosures
Dustin R. Carr, PharmD, BCPS, BCIDP, Merck: Advisor/Consultant Derek N. Bremmer, PharmD, BCIDP, Thermo Fischer Scientific: Expert Testimony
P-1647. Prevalence of Unnecessary Antibiotic Prescribing for Acute Respiratory Illnesses in U.S. Outpatient Settings, 2022
Authors: Schwarze Tessa , McDonald Emily , Kim Christine , Kabbani Sarah , Hersh Adam , Hicks Lauri A 
Published: January 2025

Abstract

Background
Antibiotics are commonly prescribed for acute respiratory illnesses (ARIs) in outpatient settings, yet up to 50% of antibiotics prescribed for ARIs are unnecessary. We aimed to estimate the prevalence of outpatient antibiotic prescribing for ARIs with no clinical indication for antibiotics (“No Antibiotics Indicated ARIs” or “NAI-ARIs”) and compare it to previously published estimates.

Methods
Patients ages 0–64 years and ≥ 65 years with medical and prescription drug coverage were identified from Merative MarketScan commercial claims and Medicare Part B claims and Part D event files, respectively. We included outpatient visits in 2022 associated with a NAI-ARI diagnosis of asthma/allergy, bronchitis/bronchiolitis, COVID-19, influenza, non-suppurative otitis media, respiratory syncytial virus (RSV) or viral upper respiratory infection (URI). We calculated the visit rate per 1,000 patient-years and proportion of visits resulting in an oral antibiotic for each diagnosis stratified by age group and outpatient setting. The proportion of unnecessary prescribing for individuals ages &lt; 65 years was compared to published proportions from 2011 and 2018; no comparable prior estimates are available for adults ages ≥ 65 years.

Results
The proportion of NAI-ARI visits resulting in an antibiotic was 18% for adults ages ≥ 65 years, 11% for adults ages 20–64 years, and 8% for children ages 0–19 years. The overall proportion of prescribing for individuals ages &lt; 65 years was lower in 2022 compared to both 2011 and 2018 (Figure 1). Across all age groups, bronchitis/bronchiolitis had the highest proportion of visits with an antibiotic, while viral URI had the highest rate of visits with an antibiotic (Table 1). Urgent care settings had the highest proportion of visits with an antibiotic across outpatient settings, irrespective of age (Figure 2 and Figure 3).

Conclusion
Among patients ages &lt; 65 years, the proportion of unnecessary antibiotic prescribing for NAI-ARIs declined over the past decade, possibly due to antibiotic stewardship activities. Continued efforts to improve outpatient antibiotic use should focus on viral URI, bronchitis/bronchiolitis, and emphasize reducing unnecessary prescribing in older adults and urgent care settings.

Disclosures
All Authors: No reported disclosures
P-1649. Nursing Home Clinician Rationales Underlying Antibiotic Decision-Making for Suspected Urinary Tract Infection
Authors: Jolles Sally , Crnich Christopher J , Taylor Lindsay , Jump Robin , Bej Taissa A , Kowal Corinne , Hicks Oteshia , Wilson Brigid , Langenstroer Madeline C , Jacob Deepthi 
Published: January 2025

Abstract

Background
The factors underlying antibiotic decision-making in nursing homes (NHs) remains poorly understood. We conducted an analysis of discrete and free text responses from a mixed-methods survey presenting NH clinicians with two patient clinical vignettes on asymptomatic bacteriuria (ASB) and cystitis (CYS) designed to assess clinicians’ treatment (TX) threshold.Table 1:Clinical Vignettes

Methods
NH clinicians were recruited nationally via professional organizations from December 2021 to April 2022. A web-based survey tool was used to administer the vignettes (Table 1) to participants who were asked to document their TX decision and justification. Treater (TRT) and non-treater (NTRT) responses were stratified by vignette and textual responses were uploaded to NVivo. A hybrid directed and conventional content approach was utilized to develop a codebook using the constant comparison technique.Table 2:Factors Contributing to Clinicians’ Treatment Decisions by Vignette and Treatment Choice

Results
Among 298 survey respondents; 10.4% treated ASB while 61.1% treated CYS. Seven factors contributing to clinicians’ TX decisions were identified (Table 2). For the ASB vignette (Table 3), TRTs framed the patient’s positive test results as infection (84%) while NTRTs framed it as contamination (79%). TRTs were less likely than NTRTs (26% vs 91%) to note the absence of signs and symptoms (S/S). Both groups cited the patient’s comorbidities and/or medical history (42% vs. 54%) in their TX decision. In the CYS vignette (Table 4), TRTs focused on positive patient S/S (91%) while NTRT did not feel there were sufficient frequency or severity of symptoms to justify immediate therapy (77%). TRTs were more likely to rely on positive test results (59%) and have more concern for patients’ comorbidities and/or medical history (18%).Table 3:Asymptomatic Bacteriuria Vignette Illustrative Quotes

Conclusion
Both TRTs and NTRTs use urine diagnostics in their decision-making, with TRTs having more confidence in the positive predictive value of urine diagnostics. NTRTs highlighted the lack of S/S as a justification for withholding therapy in both vignettes. TRTs accurately identified S/S for CYS, however, TRTs for ASB expressed concern that S/S might be underreported. This study shows how TRTs and NTRTs justify their rationales, however the next steps involve understanding how these decision-making patterns are amenable to education, information framing and/or risk management interventions.Table 4:Cystitis Vignette Illustrative Quotes

Disclosures
Robin Jump, MD, PhD, Abacus: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support
P-1662. Antifungal Prophylaxis in Liver Transplants: Navigating the Optimal Duration
Authors: Dammann Fabian , Anjan Shweta , Vega Ana , Natori Yoichiro , Selvaggi Gennaro , Vianna Rodrigo , Abbo Lilian M , Vu Christine A 
Published: January 2025

Abstract

Background
Invasive candidiasis (IC) is associated with a high mortality rate following liver transplantation (LT). Data on ideal duration of antifungal prophylaxis post-LT is limited. We investigated the effect of decreasing antifungal prophylaxis duration on the incidence of IC in LT recipients.

Methods
Single-center, retrospective study was performed comparing two prophylaxis strategies in adult LT recipients at a large transplant center. In 2021, a stewardship intervention was made to decrease the duration of antifungal prophylaxis. In pre-intervention group (Jan 1 - Dec 31, 2020), patients received no prophylaxis (low risk), fluconazole for 14 days (intermediate risk), or micafungin for 14 days (high risk). For the post-intervention group (Jan 1 to Dec 31, 2022), this was decreased to fluconazole for 5 days (intermediate risk) or micafungin for 7 days (high risk). Primary outcome was incidence of IC, defined as isolation of Candida spp. from a sterile site. For risk factor assessment, Chi-square and Mann-Whitney U test were conducted as univariate analysis. Multivariate logistic regression model was developed based on univariate analysis. Log-rank test was utilized to compare the incidence between pre- and post- intervention era.

Results
Of the 176 LT recipients included, 53 (30%) in the pre-intervention group and 123 (70%) in the post-intervention group (Table 1), 2 (3.8%) versus 9 (7.3%) patients developed IC respectively (p=0.37). Five (45.5%) patients developed IC while on prophylaxis. Overall mortality was 16 (9.0%), with one death related to IC (Table 2). In a univariate analysis, prolonged mechanical ventilation (p=0.002), re-opening of abdomen (p=0.023), ICU stay prior to transplant (p=0.036), prior antifungals (p=0.021), prior antibiotics (p=0.016), MELD &gt; 30 (p=0.004) were associated with increased risk for IC in both groups. After a multivariate analysis, MELD &gt; 30 (p=0.039, OR 3.94, 95%CI 1.07-14.49) and prolonged mechanical ventilation (p=0.020, OR 4.84, 95%CI 1.29-18.18) was associated with increased risk for IC.

Conclusion
Decreasing the duration of antifungal prophylaxis in LT recipients did not significantly impact the incidence of IC. Further research is needed to refine antifungal stewardship strategies in this high risk patient population.

Disclosures
Yoichiro Natori, MD, Eurofin/Viracor: Honoraria|Nobel Pharma: Advisor/Consultant
588. The Association Between Contact Precautions for Methicillin-resistant Staphylococcus aureus (MRSA) Colonization and MRSA Bloodstream Infection (BSI) Rates in Los Angeles County Hospitals: Results of a Countywide Survey
Authors: Lee Pam , OYong Kelsey , Rubin Zachary A , Miller Loren G , Kupferwasser Deborah 
Published: January 2025

Abstract

Background
Contact precautions are frequently used to prevent in-facility transmission of MRSA, but their efficacy has been questioned. We hypothesized that contact precautions use would not correlate with MRSA bloodstream infection (BSI) rates in LA County hospitals.

Methods
The LA County Department of Public Health conducted a survey of LA County acute care hospitals’ use of contact precautions for MRSA colonization, history of MRSA infection/colonization, and active MRSA infection with or without uncontained purulence. We modeled National Healthcare Safety Network (NHSN) reported healthcare-associated MRSA BSI rates from 2022-23 via a negative binomial multivariable regression model. We controlled for hospital type (general acute care hospitals vs. long-term acute care hospitals (LTACHs)), number of intensive care unit (ICU) beds, and MRSA BSI admission prevalence rates.

Results
Of the 82 acute care hospitals in LA County, 69 completed the survey (84% response rate). MRSA contact precaution use was stratified into three groups: Least strict (no contact precautions or contact precautions only for active infection with uncontained purulence, 24% of hospitals), intermediate (contact precautions for any active infection, 32% of hospitals), and most strict (contact precautions for &gt;2 reasons, 44% of hospitals).
We found higher MRSA BSI in LTACHs vs. hospitals (Incidence rate ratio [IRR] 3.50, 95% CL 1.80-6.80, p = 0.0002), but no relationship with ICU beds (IRR 1.00, 95% CL 0.99-1.01, p = 0.15), MRSA BSI admission prevalence rates (IRR = 4.40, 95% CL 0.30-63.10, p = 0.27), or contact precaution use (IRR 0.80, 95% CL 0.50-1.30, p = 0.29 for the least strict group; IRR 1.40, 95% CL 0.89-2.20, p = 0.14 for the intermediate group, both in comparison to the most strict group).

Conclusion
Our survey of hospitals across LA County, which has a population of ∼10 million, found no significant association between stringency of MRSA contact precaution use and healthcare-associated MRSA BSI rate. Our findings support other data that fail to find clinical benefit to contact precautions for MRSA colonization/infection. Considering potential downsides of contact precautions for MRSA, the assumption that MRSA requires contact precautions may need to be reconsidered.

Disclosures
Loren G. Miller, MD MPH, Armata: Grant/Research Support|Contrafect: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Paratek: Grant/Research Support
P-1668. Perioperative Antibiotic Use for Heart Transplantation at Children’s Hospitals in the United States
Authors: Inagaki Kengo , Tribble Alison C 
Published: January 2025

Abstract

Background
Data on perioperative antibiotic use for pediatric heart transplantation are scarce, although such information can inform the optimal approaches for perioperative antibiotic prophylaxis.

Methods
We identified children undergoing heart transplantation in the Pediatric Health Information System database. The primary outcomes of interest were perioperative antibiotics other than cefazolin single therapy and prolonged duration (defined as more than 1 postoperative calendar days) of postoperative antibiotics.Figure 1.Rate of the Use of Cefazolin Single Therapy at the Time of Transplantation Surgery in Children’s Hospitals by Transplantation VolumeHospitals that performed 50 or more transplantations were included in this FigureThe hospital with the rate of 0% (#28) was a 4th-quartile transplantation volume hospital

Results
Cefazolin was used predominantly (i.e. &gt; 50% of cases) as part of the perioperative antibiotic regimen at 22 of 28 (78.6%) hospitals, while only 12 of 28 hospitals (42.9%) predominantly used cefazolin as a single therapy. The predominant use of two or more antibiotics (with or without cefazolin) perioperatively was seen in 12 of 28 hospitals (42.9%). The median postoperative duration of antibiotics was 2 calendar days (interquartile range: 1-3). Patients undergoing transplantation at higher transplantation volume hospitals were less likely to receive antibiotics other than cefazolin single therapy or to receive prolonged duration (odds ratio, OR: 0.45 [95% confidence interval, CI: 0.38-0.53], and OR: 0.76 [95%CI: 0.63-0.91], respectively, for the 4th quartile hospitals).Figure 2.Factors Associated with the Use of Perioperative Antibiotic Other Than Cefazolin Single Therapy among Children Undergoing Heart Transplantationa obtained using multivariable logistic regressionAbbreviations: CI, confidence interval; ECMO, extracorporeal membrane oxygenationHospitals that performed 50 or more transplantations were included

Conclusion
Perioperative antibiotic use for heart transplantation varies substantially across children’s hospitals. Higher transplantation volume hospitals were more likely to use cefazolin single therapy and shorter durations of antibiotics although there remain rooms for improvement. Careful review of the best available evidence should be incorporated in developing institutional perioperative antibiotic approaches for heart transplantation, particularly at low-volume hospitals.Figure 3:Factors Associated with Postoperative Duration of Antibiotics More Than 1 Calendar Daysa obtained using multivariable logistic regressionAbbreviations: CI, confidence interval; ECMO, extracorporeal membrane oxygenationHospitals that performed 50 or more transplantations were included

Disclosures
Kengo Inagaki, MD, AstraZeneka: Grant/Research Support
P-1672. Novel Software and Web Application to Facilitate and Simplify Antibiotic Stewardship to Improve Antibiotic Days of Therapy (DOT) and Cost Savings with Evidenced-Based Algorithms in Long Term and Post Acute Care Facilities (LTPAC)
Authors: Williams Steve J 
Published: January 2025

Abstract

Background
According to the Centers for Disease Control (CDC), 4.1 million Americans are admitted to reside in LTPAC during a year, 70% of those receive antibiotics, and only 25% are used correctly prompting a 2017 mandate for Antimicrobial Stewardship by the Center for Medicare and Medicaid Services (CMS). Most facility programs miss many of the seven core elements as outlined by CDC (Fig 1) lacking the expertise and oversight to improve antibiotic use, decrease days of therapy, and reduce resistant organisms and adverse outcomes.Figure 1.Core Elements of LTPAC Antibiotic Stewardship Programs

Methods
A stewardship software system was developed for LTPAC at www.idsteward.com. Six facilities were evaluated for 2023. Entries were categorized as facility-acquired infections and other-acquired infections. Newly diagnosed facility infections were primarily analyzed and subject to 2020 updated McGeer screening criteria. Entries were reviewed for length of therapy, diagnosis, and substitutions (Fig 2), and released back as a reviewed “stewardship recommendation(s)” in real-time, indicating neutral, agree, disagree, modify, or disagree with proposed therapy. Cost was estimated as the mean for each antibiotic through Lexidrug. DOT and costs were calculated for both the provider and the “Steward”. Providers of facilities were compared to the Steward and received feedback in real-time per facility discretion as well as quarterly.Figure 2.Sample algorithm

Results
Six Facilities were evaluated via the software for 2023. A total of 14320 days of therapy were observed by the providers (Fig 3). A total of 13666 antibiotic days were realized by the steward with a total 654 DOT saved, or a 4.6% decrease (Fig 4). Cost savings for those DOT saved and antibiotic substitutions were estimated at $34692 total ($5782 average).Figure 3.Days of Therapy Analysis

Conclusion
Antimicrobial stewardship in LTPAC poses many obstacles given their challenges with staffing, lack of resources to antibiotic expertise, and provider oversight and education. Antibiotic usage by a facility can be supervised with a software-based automated algorithm that can recommend real-time changes to antibiotic length of therapy based on standardized screening criteria such as McGeer, resulting in saved DOT and cost.Figure 4.Days of Therapy Saved and Cost Saved

Disclosures
All Authors: No reported disclosures
P-1673. Antibiotic Stewardship in a palliative care setting reduces antimicrobial consumption and is cost-effective
Authors: Dörr Tamara K , Buschor-Bichsel Miriam , Thompson Lora , Rüfenacht Susanne , Eberhard-Kuhn Nadia , Cipriani Michela , Kuster Stefan , Kohler Philipp 
Published: January 2025

Abstract

Background
More than 50% of patients in palliative care (PC) receive antibiotics in the final days of their life. While infection commonly occurs in this heterogenic population, clinical signs such as fever, malaise and elevation of inflammatory markers may also be attributable to the underlying disease. We evaluated the impact of a PC antimicrobial stewardship (ASP) intervention on antimicrobial consumption and cost effectiveness.

Methods
Starting 08/2022, the ASP and PC team of our tertiary care hospital in Switzerland conducted an interdisciplinary stewardship intervention. During weekly visits, the ASP team provided review and feedback on cases selected by the PC physicians, recommendations made were contextualized with the patient’s superordinate goals. In added teaching sequences, general stewardship principles were explained to the PC team.
Cases were documented prospectively, gathering patient characteristics (i.e. age, sex, diagnoses), the ASP recommendation made regarding antimicrobials (i.e. none, start, continuation, oral switch, stop), its acceptance by the PC team (defined as realization within 48h) and hospitalization markers (i.e. length of stay (LOS), discharge location). Impact of the intervention on LOS and days of antimicrobials were estimated independently by two members of the ASP; disagreements were resolved by an arbiter.
Descriptive analysis was performed, associated cost savings were calculated and offset with ASP operational costs.
Proportions of recommendations made by ASP team

Results
Between 08/2022 and 12/2023, 96 interventions were made in 90 patients (median age 72 years), malignancy was present in 61 (68%) (Table). The most frequent recommendation was to stop antimicrobials (45%), in 17% the initiation of antimicrobials was discouraged (Figure). Overall, 96% of recommendations were accepted by the PC team, leading to an overall saving of 63 hospitalization days and 177 days of parenteral antimicrobials. Calculating the net economic effect of the ASP intervention, savings of 140’314 USD were offset by 9767 USD operational cost, resulting in overall savings of 130’547 USD.

Conclusion
Weekly interdisciplinary case discussions between the ASP and the PC team reduces antimicrobial consumption and hospitalization days and can be cost-effective.

Disclosures
All Authors: No reported disclosures