bluuebunny/crossref_metadata_2025_split huggingface dataset:
2236. Evaluation Of Antibiotic Utilization For Urinary Tract Infections In Two Community Hospitals In Miami
Authors: Boatwright Renata , Salazar Veronica , Quintana Elianis , Rosa Rossana , Abbo Lilian M 
Published: November 2023

Abstract

Background
Antimicrobial Stewardship (ASP) of urinary tract infections (UTIs) remain a challenge as UTIs continue to be over-diagnosed. Lack of documentation of symptoms, unclear clinical indication for cultures and improper culture collection are some of the contributing factors. Thus, over-diagnosis of UTIs leads to unnecessary antimicrobial exposures adding to increased risk of Clostridioides difficile infection and antimicrobial resistance. Our study aimed at assessing the magnitude of inappropriate antimicrobial exposures related to UTIs at Jackson South (JSMC) and Jackson North (JNMC) Medical Centers, two mid-size hospitals in the Miami area, to guide future stewardship measures.

Methods
A retrospective chart review of 18% of UTI orders during March 2023 was conducted. The orders were evaluated for four criteria: documentation of UTI symptoms; antimicrobial selection, dose and frequency; treatment duration including antibiotic prescriptions upon discharge and appropriateness of testing. Antibiotic orders were deemed appropriate if all criteria were met. Prescribing pattern was also evaluated for critical care status.

Results
A total of 3,472 antibiotic orders were prescribed during the study period of which 10% were indicated for UTI. The study was powered at 95% confidence interval. Inappropriate testing was the most common occurrence at 42%, followed by treatment duration 32%. JNMC prescription orders contributed to 72% of inappropriate treatment length compared to 40% at JSMC. Lack of UTI symptom documentation represented 28% of the cases and lastly antibiotic choice, dose and frequency contributed with 16%. Overall, 36% of the UTI orders were deemed appropriate at JSMC versus 20% at JNMC (Fig. 01).The majority of the orders were outside of critical care units for both centers (Fig. 02).

Conclusion
UTI over-diagnosis has led to inappropriate antibiotic usage. Excessive laboratory testing, prolonged treatment duration and lack of assessment of UTI symptoms were the main opportunities identified. Leveraging algorithm technology for increased compliance with symptom assessment and reduced screening as well as implementation of outpatient prescription stewardship would be beneficial to the health system.

Disclosures
Lilian M. Abbo, MD, MBA, Ferring: Advisor/Consultant|Pfizer: Advisor/Consultant|Regeneron: Grant/Research Support|Shionogi: Advisor/Consultant
2255. The Effect of Penicillin Allergy Labels on Perioperative Antibiotics for Elective Procedures
Authors: Hasse Eileen , Zhang Minhua , Stone Cosby A , Weaver Sheena Marie , Wanderer Jonathan , Staub Milner , Nelson George E 
Published: November 2023

Abstract

Background
As many as 20% of patients in the United States report a penicillin (PCN) allergy, of which 4% or less are true allergies. Previously, cephalosporins and PCN were estimated to have 10% cross-reactivity, but recent studies show lower rates. Patients with reported PCN allergy have increased surgical site and urinary tract infections, emergency room visits, and readmissions post-operatively, possibly due to unnecessary cefazolin avoidance. At Vanderbilt University Medical Center (VUMC), patients have an appointment with Vanderbilt Perioperative Evaluation Clinic (VPEC) to review medical history prior to elective procedures.

Methods
In this retrospective cohort study, we evaluated patients ≥ 18 years old seen at VPEC prior to an elective procedure from 1/1/2022-1/1/2023. We excluded patients who did not receive perioperative antibiotics, did not undergo elective procedure, and patients with cephalosporin allergies. We compared demographics, clinical characteristics, and perioperative antibiotics received based on PCN allergy label presence in the electronic medical record (EMR). All variables were analyzed in R programming language with chi square or Fisher exact test.
Figure 1. Exclusion Criteria Table 1. Demographics and Clinical Characteristics by Cohort

Results
A total of 12,938 non-PCN allergy and 1,657 PCN allergy patients were included. Patients with PCN allergies were more often older (55 years vs 57 years; P = 0.001), women (53% vs 63.5%; P &lt; 0.001), and white (83.3% vs 86.4%; P = 0.03). Antibiotic use differed between those with and without PCN allergies across all surgical services and in all classes except carbapenems, most notably cefazolin (80.4% vs 37.4%; P &lt; 0.001), clindamycin (2.5% vs 48.3%; P &lt; 0.001), and vancomycin (16.7% vs 19.5%; P = 0.005). There was also a difference in patients receiving ≥ 2 perioperative antibiotics (21% vs 32.5%; P &lt; 0.001).Figure 2.Relative Proportion of Antibiotic Administration by CohortFigure 3.Cefazolin, Clindamycin, and Vancomycin Administration by CohortFigure 4.Relative Proportion of Cefazolin, Clindamycin, and Vancomycin Administration by Cohort and Surgical Service

Conclusion
Patients with PCN allergies receive less perioperative cefazolin, more clindamycin, and more vancomycin for elective surgeries at VUMC. We have created a PCN allergy risk questionnaire to identify those with low-risk allergies at their VPEC appointment. This will be documented in their perioperative note and allergy section of the EMR. We plan to measure post-implementation cefazolin use, antibiotic exposure, and adverse outcomes.

Disclosures
Cosby A. Stone, Jr., MD, MPH, American Academy of Allergy, Asthma, and Immunology Foundation: Grant/Research Support Milner Staub, MD, MPH, Gilead: Stocks/Bonds|Johnson & Johnson: Stocks/Bonds
2259. Reversal of antimicrobial consumption: long-term impact of COVID-19 pandemic
Authors: Koizumi Ryuji , Tsuzuki Shinya , Asai Yusuke , Ohmagari Norio 
Published: November 2023

Abstract

Background
The global decrease in antimicrobial consumption (AMC) in 2020 has been associated with the COVID-19 pandemic.
However, it is not clear whether this downward trend will continue.
Several reports, including ESAC-Net, have documented an increase in antimicrobial use after a decrease in antimicrobial consumption following the COVID-19 pandemic in some countries.
The aim of this study is to examine the global trend in AMC following the emergence of COVID-19 in the long term.

Methods
After comparing the change rate of AMC in 67 countries’ using IQVIA MIDAS® monthly sales data of antimicrobials between 2019 and 2020 and between 2021 and 2022, changepoint detection was conducted in time-series data from November 2016 to October 2022.
Additionally, we examined the impact of implementation and lifting of movement restriction in G7 countries by interrupted time-series analysis (ITSA).

Results
In the IQVIA MIDAS sales data, 65 among 67 countries have one or two changepoints (Table1).
59 among 65 countries experienced a decrease in AMC after the beginning of COVID-19 pandemic.
However, 50 among 59 countries showed reversal increase trend of AMC in 2022 (Figure1).
ITSA showed that implementation of movement restriction had negative impact on AMC in all G7 countries (Figure2).
Table 1. Number of antimicrobial consumption changepoints after COVID-19 pandemic Figure 1. Change rate in monthly antimicrobial consumption in each country from 2019 to 2020 and 2021 to 2022, March-August Figure 2. Interrupted time series analysis of antimicrobial consumption data in G7 countries

Conclusion
The global decrease in AMC in 2020 may not be due to COVID-19 itself, but to non-pharmaceutical interventions such as movement restrictions.
Human mobility may be one of the key determinants of antimicrobial use at the population level.

Disclosures
All Authors: No reported disclosures
2262. Evaluation of Ceftriaxone Versus Cefazolin as a Surrogate Marker for Cefpodoxime Susceptibility in Enterobacterales Isolates
Authors: Lambert Kaitlyn , Demkowicz Ryan , Slain Douglas , Murray Amanda , Howard Catessa A 
Published: November 2023

Abstract

Background
Cefpodoxime is increasingly being explored as an option for intravenous-to-oral step-down therapy in Enterobacterales infections, but it is rarely included in routine susceptibility testing. The Clinical and Laboratory Standards Institute (CLSI) states that cefpodoxime susceptibility among urinary isolates can be inferred from the result for cefazolin. However, cefazolin resistance may overcall resistance to cefpodoxime. Studies directly comparing ceftriaxone, cefazolin, and cefpodoxine susceptibilities are lacking. The purpose of this study was to determine correlation of ceftriaxone or cefazolin susceptibilities as a surrogate marker for cefpodoxime susceptibility in Enterobacterales.

Methods
The study was conducted on clinical isolates of E. coli, Klebsiella spp., and Proteus spp. from urine, blood, respiratory, surgical, or wound cultures. Susceptibility testing was conducted by manual Kirby Bauer disk diffusion for cefpodoxime, ceftriaxone, and cefazolin (in duplicate) following standard procedures. The VITEK 2 automated system was used to adjudicate discrepancies between duplicates. Breakpoints from the current CLSI M100 were used to assign categories (S, R, I) for the different methods of susceptibility testing. Categorical agreement, very major, major, and minor error rates between ceftriaxone or cefazolin and cefpodoxime were calculated.

Results
A total of 88 clinical isolates were evaluated. The categorical agreement rate was 64% for cefazolin and 97% for ceftriaxone (P =0.0001). The major error rate was 15% (11/74) for cefazolin and 0% for ceftriaxone. The very major error rate was 7% (1/14) for cefazolin and 21% (3/14) for ceftriaxone. The minor error rate was 22% (19/88) for cefazolin and 0% for ceftriaxone.
Isolate Characteristics

Conclusion
Ceftriaxone appears to be a better surrogate marker for predicting cefpodoxime susceptibility, when compared to cefazolin. In addition, ceftriaxone demonstrated lower major and minor error rates.

Disclosures
All Authors: No reported disclosures
2276. Utilization of Vancomycin in the Emergency Department at a Community Hospital and Implications of its Use
Authors: Snodgrass Danielle , White Kristina E , Azar Aline , Sudhindra Praveen 
Published: November 2023

Abstract

Background
Antimicrobial Stewardship in the Emergency Department has many challenges. Our region performed a utilization review of vancomycin prescribed in the Emergency Department over a 2-month period in 2022.
In this utilization review, we sought to examine vancomycin continuation when a patient was admitted from the Emergency Department, whether vancomycin was indicated for the suspected diagnosis, and if a potential vancomycin-induced adverse drug event (ADE) occurred from its administration.

Methods
A retrospective chart review across three campuses of a hospital system examined 265 emergency room encounters where vancomycin was ordered and administered. Data was recorded on concurrent antibiotic administration, the order set utilized and indication when ordering, admission versus discharge of the patient, continuation of vancomycin upon admission, and appropriateness of vancomycin for the documented indication. Adverse drug event data (Table 2) was recorded, when possible, within seven days of vancomycin administration. This included the presence of acute kidney injury, thrombocytopenia, neutropenia, or a possible drug-induced rash.

Results
Results are summarized in Tables 1-3.

Conclusion
Our findings showed that there are negative implications associated with vancomycin use from the Emergency Department. Data revealed that only 51.7% of patients who received vancomycin truly had indications for its use based on the suspected diagnosis, and 29.4% of patients who were admitted subsequently had vancomycin discontinued upon admission. In addition, 19.6% of patients were discharged directly from the Emergency Department, never being admitted.
More importantly, 21% of patients experienced an ADE following vancomycin administration. With half of vancomycin use being categorized as unnecessary, this number emphasizes that harm can, and often does, occur with unnecessary vancomycin administration. The most common ADEs were thrombocytopenia at 12.8% and acute kidney injury at 9.4%. This review brings further attention and awareness to the need for Antimicrobial Stewardship in the Emergency Department. More guidance should be offered for triaging appropriate empiric antibiotics when infection is present.

Disclosures
All Authors: No reported disclosures
2279. Appropriateness of Antibiotic Prescribing Before vs. After Minimum Inhibitory Concentration (MIC) Suppression in Culture Reports: A Quasi-experimental Study
Authors: Aljedaani Huda Jamaan , Thabit Abrar K , Al Munjem Manea , Bazuqamah Mohammed 
Published: November 2023

Abstract

Background
Culture and susceptibility results are essential to identify the offending organism and optimize antibiotic treatment; hence, decrease the emergence of antibiotic resistance and achieve better clinical outcomes. Antibiotic prescribers should learn how to interpret MIC breakpoints to prescribe a suitable antibiotic as different antibiotics have different MIC breakpoints against different microorganisms. No study to date has evaluated the impact of MIC suppression in culture reports while keeping interpretation results on the appropriateness of antibiotics choice by non-infectious diseases prescribers. We assessed the impact of MIC suppression on the appropriateness of antibiotic prescriptions.

Methods
This was a quasi-experimental study (pre-post intervention) that was conducted over 14 months on hospitalized patients in the medical floor who had a symptomatic infection with a positive culture and were prescribed a full course of definitive antibiotics by prescribers not specialized in infectious diseases pre and post MIC suppression in culture reports. The primary outcome was appropriateness of antibiotic selection (the de-escalation to the narrowest spectrum antibiotic to which the organism is susceptible with appropriate dose). Secondary outcomes were clinical cure (resolution of signs and symptoms, including defervescence and normalization of white blood cells count), length of stay (LOS), and antibiotics expenditure as defined daily dose (DDD) per 1,000 patient days and days of therapy (DOT) per 1,000 patient days.

Results
100 patients were included, 50 in each phase. No difference was observed in the baseline characteristics, including age, sex, infection site, isolated organism, and prescribers’ departments. Appropriate antibiotic selection was significantly higher in the post-intervention phase compared to the pre-intervention phase (62% vs. 40%; P=0.028). LOS was shorter in the post-intervention phase compared to the pre-intervention phase (5 vs. 9.5 days; P=0.011). No difference was reported in the other outcomes.

Conclusion
Our study showed that suppressing MIC values from cultures reports was helpful in choosing the appropriate antibiotic and minimizing the LOS. Future research is needed to confirm these findings.

Disclosures
All Authors: No reported disclosures
2281. Trends in Antibiotic Prescriptions in U.S. Nursing Homes, 2018-2020
Authors: Vo Quynh , Dionne Brandon , Doron Shira , Noubary Farzad , Briesacher Becky 
Published: November 2023

Abstract

Background
An estimated 25% of U.S. nursing home residents may have an antibiotic resistant infection. Antibiotic resistance is primarily driven by antibiotic use, thus, increasing our understanding of trends in antibiotic use within nursing homes is needed to address this public health threat. Our study examined changes in antibiotic prescriptions among nursing home residents using claims data from January 2018 through December 2020.

Methods
Linked files from Medicare Part D and the Minimum Dataset 3.0 covering years 2018-2020 were used to describe antibiotic use in U.S. nursing homes via nationwide trend analysis. Over two million adults, aged 65 years and older, who were covered by Medicare Part D for the entire duration of their stay were included. Changes in trends by antibiotic class and U.S. region were also assessed.

Results
The majority of antibiotics prescribed in U.S. nursing homes were administered by the oral route (98%), and cephalosporins were the most prescribed class of antibiotics (38.6%). The overall proportion of orally administered antibiotics prescribed across U.S. nursing homes increased from January 2018 through December 2020 by 2.6%. There were 155 DOT/1000 patient days in 2018, 166 in 2019, and an increase to 269 in 2020 for oral antibiotics. Intravenous (IV) antibiotic prescribing increased by 71% during this time but only accounted for 2% of all antibiotic prescriptions. There was 1 DOT/1000 patient days in 2018 and 2019 and 3 DOT/1000 patient days in 2020 for IV antibiotics. Variations in prescribing were seen by U.S. region, with the largest increase in oral antibiotics in the West (4.6% increase); and by antibiotic class, with increases in the use of carbapenems (82%), cephalosporins (11.3%), oxazolidinones (70.1%), and Daptomycin (65.3%). All changes were statistically significant at the 0.05 cutoff level.

Conclusion
From 2018 through 2019, antibiotic prescribing rates remained relatively unchanged in U.S. nursing homes. However, there were differences by antibiotic class and U.S. region. There was a large increase in the use of both oral and IV antibiotics in 2020, most likely due to confounding factors introduced by the COVID-19 pandemic.

Disclosures
All Authors: No reported disclosures
2283. COVID-19 among Febrile Patients Presenting without Respiratory Symptoms in Six Hospitals along the Thai-Lao and Thai-Myanmar Borders, 2021-2011
Authors: Bhengsri Saithip , Bloss Emily , Skaggs Beth , Sawatwong Pongpun , Chuenchom Nuttagarn , Lertwitayakumjorn Tanaphat , Piralam Barameht , Chaoprasert Samkan , Simmali Tuwan , Bungkanjana Pornpan , Boonlong Sutthinee , Heffelfinger James D , Sujariyakul Anupong 
Published: November 2023

Abstract

Background
Thailand’s national surveillance system to detect COVID-19 infection typically relies on a combination of fever, respiratory symptoms, and risk factors. We describe the frequency, epidemiologic characteristics, and risk factors for COVID-19 in patients without respiratory symptoms and the utility of saliva and nasal swabs (NS) to detect SARS-CoV-2.

Methods
During June 2021-December 2022, a period of high COVID-19 incidence in Thailand, we enrolled patients aged &gt;2 years presenting with a temperature ≥37.5 °C or a history of fever ≤14 days and no cough, dyspnea, or sputum production at 6 hospitals in Nakhon Phanom and Tak provinces, Thailand. Saliva, NS, and nasopharyngeal/oropharyngeal swabs (NP/OP) were collected to detect SARS-CoV-2 using real-time RT-PCR. Multivariable analysis was done to assess factors independently associated with COVID-19 infection. Cases were defined as persons with SARS-CoV-2-positive RT-PCR specimens.

Results
Cases were detected in 358/1,648 (22%) persons. The median age among cases was 31 (IQR 21-45) years; 210 (59%) were female. Compared to non-cases, cases were more likely to present with malaise (52% vs. 40%, p&lt; 0.001), hyposmia (10% vs. 1.4%, p&lt; 0.001), dysgeusia (11% vs. 4.8%, p&lt; 0.001), and muscle pain (53% vs. 47%, p=0.04); cases were less likely to have chills (41% vs. 50%, p=0.002), low appetite (29% vs. 41%, p&lt; 0.001), nausea/vomiting (17% vs. 29%, p&lt; 0.001) and abdominal pain (4.7% vs. 16%, p&lt; 0.001). Cases were more likely to have been in contact with persons with COVID-19 infection (adjusted odds ratio [95% confidence interval]: 12 [8.1-16]), febrile household members (2.6 [1.8-3.8]), and persons with respiratory symptoms (2.2 [1.4-3.7]), have a history of travel (1.7 [1.0-2.7]), current alcohol consumption (1.7 [1.2-2.4]) and obesity (1.5 [1.1-1.9]). Among cases, SARS-CoV-2 was detected in 95% of saliva, 92% of NS, and 99% of NP/OP specimens; RT-PCR was positive in all 3 specimen types from 319 (89%) cases. Compared to NP/OP, the sensitivity of testing saliva and NS were 96% and 93%.

Conclusion
SARS-CoV-2 was detected in more than one-fifth of febrile patients without respiratory symptoms. A broader national surveillance case definition would increase case detection. Saliva and NS demonstrated high sensitivity for SARS-CoV-2 detection.

Disclosures
All Authors: No reported disclosures
2284. SARS-CoV-2 Transmission in Utah Nursing Homes
Authors: Bohman Julia , Khader Karim , Thomas Alun , Ferraro Jeffrey , Samore Matthew H 
Published: November 2023

Abstract

Background
The goal of this study was to apply a dynamic modeling approach to assess the impact of COVID-19 control measures in nursing homes. Utah's strategy for COVID control in nursing homes included serial point prevalence surveys, triggered when a staff or resident case was detected. However, implementation of the policy varied across nursing homes.

Methods
We used state-collected testing data from 70 different Utah nursing homes from March 2020 to April 2021 to estimate a facility specific transmission. Data included facility id, COVID-19 test results, number of days since the first covid test administration, and a December 2020 population census. We constructed a stochastic Reed Frost based model, using the stan library in R using the Hamiltonian Monte Carlo algorithm to estimate parameter values.

Results
COVID attack rates tended to peak between 50-100 days from the onset of included data, averaging 14.2% (Figure 1). A high degree of day-to-day variability in SARS-CoV-2 test collection was observed, consistent with uneven implementation of serial point prevalence surveys. Nonetheless, we were able to achieve excellent model calibration and estimate the basic reproductive number (R0) in all included facilities. The stochastic model captured differences between facilities; the estimated facility R0 ranged from 1.4 to 2.5 (Figure 2). We did not find evidence that a delay in collection of point prevalence survey was associated with an increased R0.

Conclusion
Fitting simple dynamic models to COVID surveillance data enables a comparison of nursing homes with respect to facility R0 and an evaluation of the effect of different control policies. More complex models are needed to yield insights about the relative importance of alternative transmission pathways, such as combinations between staff and residents.

Disclosures
All Authors: No reported disclosures