bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1574. Asymptomatic Bacteriuria Not a Predictor of Clinical Failure in Uncomplicated Urinary Tract Infections (uUTI): A Prospective Analysis of Women Treated for uUTI from the REASSURE Trial
Authors: Aronin Steven I , Dunne Michael , Puttagunta Sailaja 
Published: January 2025

Abstract

Background
Per FDA Guidance, the primary efficacy endpoint for trials evaluating antimicrobials for treatment of UTI is a combined clinical/microbiologic response. Overall success requires both resolution of UTI symptoms and demonstration that the causative uropathogen is reduced to &lt; 103 CFU/mL at a fixed time point after randomization, regardless of whether the patient is asymptomatic. Previously, we retrospectively evaluated the impact of post treatment asymptomatic bacteriuria (ASB) for Phase 3 clinical trial patients with UTI and found that ASB was not a predictor of subsequent clinical failure. In this study, we prospectively assessed the impact of post treatment ASB on subsequent clinical response for adult women with uUTI.

Methods
Study IT001-310 was a Phase 3 randomized, double-blind, double-dummy, active controlled trial to evaluate the safety and efficacy of sulopenem/probenecid (SUL) versus amoxicillin/clavulanate (AMC) for the treatment of uncomplicated UTI (uUTI). Adult women were randomized to receive SUL or AMC, both bid for 5 days. The primary efficacy outcome was overall success (combined clinical/microbiologic success) at the Test of Cure (TOC) visit in the mMITT population. ASB at TOC was prespecified as an additional efficacy endpoint to be assessed, and the presence of ASB at the End of Treatment (EOT) and TOC visit was evaluated to see if it impacted clinical response at the following visit.

Results
2,222 women were randomized; 990 (44.6%) were in the mMITT population. ASB was the reason for nonresponse in 74 (14.2%) and 93 (19.9%) patients treated with SUL and AMC, respectively. As shown in the table, for both treatment arms, the presence of ASB at the EOT and TOC visit did not lead to clinical failure at the following visit.

Conclusion
SUL and AMC, both β-lactams, appear to have similar effects on the frequency of post treatment ASB. For patients in both treatment arms, the presence of ASB a week after completing UTI therapy was not a marker of subsequent clinical failure. The inclusion of ASB as part of the primary endpoint for studies of UTI should be reconsidered. Inclusion of microbiologic results from asymptomatic patients after complete resolution of uUTI symptoms is a practice inconsistent with available treatment recommendations.

Disclosures
Steven I. Aronin, MD, Iterum Therapeutics: Employee|Iterum Therapeutics: Employee|Iterum Therapeutics: Stocks/Bonds (Public Company)|Iterum Therapeutics: Stocks/Bonds (Public Company) Michael Dunne, MD, Iterum Therapeutics: Advisor/Consultant|Iterum Therapeutics: Board Member|Iterum Therapeutics: Stocks/Bonds (Public Company) Sailaja Puttagunta, MD, Iterum Therapeutics: Employee|Iterum Therapeutics: Employee|Iterum Therapeutics: Stocks/Bonds (Public Company)|Iterum Therapeutics: Stocks/Bonds (Public Company)
P-1640. Antibiotic prescribing guideline-concordance for sinusitis in adult and pediatric primary care practices
Authors: Dutcher Lauren , Gonzalez-Hernandez Graciela , Rendell Sara , Serletti Lacey M , Boustany Mickael , O’Connor Karen , Weissenbacher Davy , Cressman Leigh , Gerber Jeffrey S , Grundmeier Robert , Hamilton Keith W 
Published: January 2025

Abstract

Background
Antibiotics are only sometimes indicated for acute sinusitis, a commonly diagnosed infection in the ambulatory setting and an important target for antibiotic stewardship. However, assessment of the appropriateness of antibiotic use for sinusitis is based on clinical signs and symptoms, and therefore requires manual chart abstraction. We present a study assessing the appropriateness of antibiotic prescribing in adult and pediatric sinusitis visits.

Methods
Outpatient encounters for sinusitis in adult and pediatric primary care practices within two health systems with an antibiotic prescribed from July 1, 2017 through June 30, 2021 were identified by ICD-10 code (J01 and J32). Of these, 600 encounters were randomly selected for review (300 from adult practices; 300 from pediatric practices). Five trained physician annotators reviewed prescriber notes from these encounters and identified relevant signs/symptoms, duration of illness, and disease trend and severity; annotators used these findings to assess overall guideline concordance of antibiotic prescribing using definitions adapted from clinical guidelines (table 1). Two physicians performed adjudication for disagreements (LD, KWH).

Results
Demographics and characteristics of included encounters are reported in Table 2. In adults, 19 encounters were excluded after review due to a note being unrelated to the sinusitis encounter; of the remaining 281, 37 (13.2%) were considered guideline concordant, 157 (55.9%) were considered not guideline-concordant, and 87 (31.0%) were potentially guideline concordant but with insufficient information. In pediatrics, 184 (61.3%) were considered guideline concordant, 99 (33.0%) were considered not guideline-concordant, and 17 (5.7%) were potentially guideline concordant but with insufficient information. Common reasons for guideline non-concordance are described in Table 3.

Conclusion
Antibiotic prescribing forsinusitis was frequently not concordant with guidelines. Prescribing was more frequently concordant in pediatric compared to adult-care settings. In both groups, duration of symptoms was frequently documented as fewer than 10 days, suggesting a potential target for antibiotic stewardship interventions.

Disclosures
All Authors: No reported disclosures
P-1651. Utilizing Electronic Medical Record (EMR) Based Tools to Shorten Duration of Therapy for Community Acquired Pneumonia in the Ambulatory Setting
Authors: Upadhyayula Shankar , Williamson Kelly 
Published: January 2025

Abstract

Background
Community acquired pneumonia (CAP) is a commonly encountered diagnosis is the pediatric outpatient setting. Short durations of antimicrobial therapy of 5-7 days are considered adequate for uncomplicated CAP. We wanted to utilize Electronic medical record (EMR) based tools to standardize treatment durations for CAP. Akron children’s hospital is a large pediatric health care provider in Northeast Ohio and offers pediatric care through more than 30 pediatric offices in the community. This extensive network of primary care offices affords unique opportunities to use the EMR based tools for care standardization.
Counts of antibiotic orders based on duration.

Methods
The antimicrobial stewardship committee developed a guideline for diagnosing and managing community acquired pneumonia and distributed it to all primary care providers. A standardized smart set provided clinical decision support regarding choice of antibiotics and duration of therapy. A visit diagnosis of Community acquired pneumonia prompted the use of the smart set. Smart set usage and duration of therapy (7 days or less vs 8 days or more) were monitored. Baseline data for one year prior and 3 years post-introduction were tracked to measure impact and monitor sustainability of change.
Percentage of antibiotic orders based on duration.

Results
The smart set went live in January 2020. Data review from January 2019 to December 2023 showed the percentage of orders with antibiotic prescriptions of 8 days or more decreased from 97% to 34% while 7 days or less increased from 3% to 66% (Figures 1,2). This change is associated with a high utilization of the pneumonia smart set of &gt; 70 percent (Figure 3). Even though the project is in its maintenance phase the gains have sustained over time.
Smart set usage for antibiotic orders

Conclusion
Utilizing EMR based tools can help shorten antibiotic duration for community acquired pneumonia in a sustainable fashion. This approach holds promise as it can be easily utilized to standardize care for other common outpatient conditions. Expectedly the strategy would be most applicable to health care networks with a wide outreach. It also requires intensive education of providers at the outset, but this can be accomplished by using interested primary care providers to partner with antimicrobial stewardship teams.

Disclosures
All Authors: No reported disclosures
P-1663. Evaluating Peripartum Antimicrobial Use in Intraamniotic Infection Patients
Authors: Pazienza Grace , Schacht Lance , Thomas Mattie Jo , Palomo Jennifer , Stuart Sean , Withers Sarah , Crockett Amy H , Bailey Pamela 
Published: January 2025

Abstract

Background
Intraamniotic infections (IAI, e.g. chorioamnionitis) require urgent antimicrobial administration. These patients may also require group B Streptococcus (GBS) prophylaxis (ppx) or surgical site infection (SSI) ppx. Many of these patients may receive duplicative antimicrobial coverage due to multiple clinical scenarios. We sought to characterize antimicrobial use in these patients, particularly after a clindamycin shortage generated a change to cefoxitin at our institution in June 2023. We sought to characterize the impact of our transition to cefoxitin monotherapy on overall antimicrobial use in patients diagnosed with IAI.Table 1.Exposure to Antimicrobials

Methods
A retrospective cohort study was performed. Patients were identified by ICD diagnoses, from February 2016 through October 2023. All charts were reviewed for medication administration as well as appropriate indications. Comparisons were made between the traditional regimen prior to our clindamycin shortage and the revised regimen after cefoxtin was recommended using chi square testing.

Results
We identified 301 patients who received antimicrobials for IAI. 19 patients (6.3%) received antimicrobials for all three indications of IAI, GBS ppx, and SSI ppx.
After cefoxitin-based guidelines implementation, there was a significant difference in the number of antimicrobials to which patients were exposed (p&lt; 0.01, Table 1). There was a significant difference in patients receiving two cephalosporins in the traditional (n=1, 2.8%) and revised (n=34, 97.1%) groups (p&lt; 0.001), and in those receiving two types of penicillin coverage (traditional, n=26, 86.7%) vs revised (n=4, 14.3%) (p=0.008).
Rates of SSI ppx were high for patients with cesarean delivery (n=105/113). A prescribing error was noted with 5 patients undergoing unlabored caesarean deliveries receiving azithromycin. Appropriate prescribing for GBS ppx was also high (n=43/49).

Conclusion
Pregnant persons with IAI are being exposed to significant amounts of antimicrobials during labor and delivery, which was streamlined by our transition to cefoxitin monotherapy for IAI. Many patients received antimicrobials for multiple indications, which should be addressed in guidelines when antimicrobials have overlapping spectrums of activity.

Disclosures
All Authors: No reported disclosures
P-1666. Hematology-Oncology Unit-Specific Antibiogram: A Decade of Experience at a Large Academic Medical Center
Authors: Clement Josh , Rivera Christina G , Cole Nicolynn , Schuetz Audrey N , Estes Lynn L 
Published: January 2025

Abstract

Background
Antibiograms are an important stewardship tool that can inform optimal empiric therapy; most antibiograms are hospital-wide. Unit-specific antibiogram data for unique patient populations including intensive care unit and pediatrics is robust; however, published experience with unit-specific antibiograms in the hematology-oncology (heme-onc) population is limited. These patients are unique because of the common use of antimicrobial prophylaxis, prolonged broad-spectrum antibiotics, and an immunocompromised state. We sought to examine the trends in antibiogram antimicrobial susceptibility over time.

Methods
This retrospective quality initiative included microbiology results (first isolates per patient per timeframe) from Mayo Clinic Rochester from 2012 to 2022. Eligible cultures were those identified as being obtained from one of 8 hematology, oncology, or bone marrow transplant inpatient units. Agar dilution susceptibility testing and Clinical and Laboratory Standards Institute (CLSI) breakpoints were used. Screening PCRs (eg, VRE PCR) were excluded. Culture and susceptibilities were identified by an EMR based report, compiled annually, and reported for two-year periods. Susceptibility rates were compared using the Chi-square test and Chi-square analysis for trends.

Results
There were 4 gram-negative and 5 gram-positive organism groups that met CLSI antibiogram criteria of ≥ 30 isolates and were included (tables 1-4). There were several significant differences in comparison to the hospital-wide antibiogram, with lower antibiotic susceptibility rates in the heme-onc units for multiple organisms, notably fluoroquinolones to E.coli and P. aeruginosa and several cephalosporins to Enterobacterales as well as penicillin and levofloxacin to Viridans group Streptococcus and vancomycin to E. faecium (tables 1&2). Over the period of 2012-2013 to 2021-2022, susceptibility rates remained stable among the heme-onc antibiogram, with few significant changes (tables 3&4).

Conclusion
Heme-onc antibiograms illustrated susceptibility rate differences compared to our hospital-wide antibiograms, particularly for antimicrobials used as prophylaxis. Through population-specific antibiograms, providers may be able to improve empiric antibiotic selection.

Disclosures
Christina G. Rivera (O'Connor), Pharm.D, Gilead Sciences: Board Member
P-1736. Examining the Impact of Eliminating a Transitions of Care Pharmacist Program on Antimicrobial Use
Authors: Godsey Mary , Duenn Angela , Collins Curtis D 
Published: January 2025

Abstract

Background
Antimicrobial stewardship interventions during transitions of care (TOC) have increased guideline concordant prescribing at hospital discharge. A TOC pharmacy program targeting discharging patients at the high risk for mortality was established at our community teaching hospital in 2016. A previous program analysis reported 14.4% of all pharmacist interventions made involved antimicrobials. The TOC pharmacy program was eliminated in 2022. The purpose of this study was to assess the impact of program elimination on appropriate and optimal antimicrobial prescribing.

Methods
This retrospective, single center, pre-post cohort study investigated the impact of the elimination of the TOC program on appropriate and optimal antimicrobial prescribing. Adult inpatients with the highest risk of 30-day mortality receiving an antimicrobial at discharge between September - November 2021 (TOC pharmacist program cohort) and September - November 2022 (post-TOC cohort) were included. Appropriate antimicrobial use was defined as prescribing of indication-based effective and safe therapy. Optimal prescribing was defined as adherence to institutional guideline-based antimicrobial stewardship recommendations.

Results
Six-hundred twenty-six patients were included with 313 patients in each cohort. Baseline characteristics between cohorts were generally similar with significant differences in the number of patients treated for community-acquired pneumonia (20.4% vs. 28.4%; P = 0.026) and bacteremias (11.5% vs. 5.1%; P = 0.004). There were no differences in appropriate (90.4% vs. 90.1%; P = 0.893), or optimal prescribing (80.8% vs. 78%; P = 0.374) between cohorts. There were no differences in incidence of non-optimal antimicrobial dosing (6.4% vs. 5.8%; P = 0.738), or non-optimal antimicrobial selection (1.3% vs. 2.9%; P = 0.161); however, the incidence of non-optimal duration decreased in the post-TOC cohort (22% vs. 15%; P = 0.024).

Conclusion
The elimination of the TOC pharmacy program did not impact appropriate or optimal antimicrobial prescribing. Relatively high appropriate and optimal prescribing were noted in both cohorts and additional ongoing stewardship interventions may have confounded results.

Disclosures
All Authors: No reported disclosures
P-1802. Assessing the Effectiveness and Essentialness of Antimicrobial Stewardship Practices in Multiple States
Authors: Thure Katie A , Patel Dipen , Biehle Lauren , Evans Christopher D 
Published: January 2025

Abstract

Background
Acute Care Hospitals (ACH) self-report on implementation of the Core Elements of Antimicrobial Stewardship through the National Healthcare Safety Network’s (NHSN) Annual Facility Survey. By 2022, a majority of ACHs in Tennessee (TN), Colorado (CO), and Virginia (VA) reported achieving all seven core elements. To gain better insight into their stewardship practices, the Healthcare-Associated Infection Programs from TN, CO, and VA developed a survey assessing the value of specific antimicrobial stewardship practices.Table 1.Ratings of how essential and effective interventions are to antibiotic stewardship.

Methods
Key stewards at ACHs were identified and received the survey electronically. Respondents rated how essential each stewardship intervention in the NHSN Survey is to the success of their stewardship program and how effective each specific intervention is at driving antibiotic use at their facility. Respondents rated each intervention from 1 to 7 with 1 being non-essential/effective and 7 being absolutely essential/effective. The overall mean for each category was calculated by averaging the means of each intervention for that specific element.

Results
A total of sixty-four stewards responded to the survey. 82.8% of respondents were Pharmacists. Microbiology based interventions were rated to be the most essential NHSN Survey category with a mean of 5.9, while nurse-driven interventions were the least essential with a mean of 4.3. Pharmacy Interventions were deemed the most effective with a mean of 5.4, whereas Nurse Driven Interventions were also rated the least effective with a mean of 3.4 (Table 1).

Conclusion
Respondents considered all interventions essential. On average, ratings for effectiveness of each intervention were lower than those for essentialness. Microbiology based interventions were rated most essential. This could be attributed to items stewards are able to act on objective data. Even though Nursing Driven interventions had the lowest mean ratings for both essentialness and effectiveness, they also had the lowest number of interventions, which could skew the results. As evidenced by these data, not all stewardship interventions are perceived as equal in driving antimicrobial usage.

Disclosures
All Authors: No reported disclosures
P-1871. Surge Protector: Characterizing the Challenges of Fluctuating OPAT Volume
Authors: Schranz Asher J , Ponder Madison , Swartwood Michael , Kinlaw Alan C , Oosterwyk Teresa M , Perhac Angela , Marx Ashley H , Bowman Mary Catherine , Farel Claire E 
Published: January 2025

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) is often overseen by multidisciplinary teams in infectious diseases (ID) provider groups. OPAT programs serve an important role in health systems to decrease inpatient length of stay and ensure safe transitions of medically complex patients. The optimal composition and staffing needs of OPAT teams are not defined. To gauge challenges facing OPAT program administration and provide insights for those initiating an OPAT program, we described trajectories in patient volume throughout our OPAT program.

Methods
We included all UNC OPAT courses from inception in 2015 through 2023. The OPAT team mainly provides care for home infusion OPAT, providing lab monitoring, assessment of adverse events, and care coordination. The OPAT team does not cap enrollment and currently accepts patients seen by general ID providers who require &gt;14 days parenteral antimicrobials. OPAT team staffing has varied since inception. It is currently primarily administered by a nurse and a pharmacist, with support from a scheduler and an ID physician. We calculated the average monthly census of patients followed by the OPAT team over time. Census was defined as the number of outpatients followed by the OPAT team at a time. To gain granular detail we also trended the average weekly OPAT census in 2022 and 2023.

Results
2,878 OPAT courses were cared for by the OPAT team. Median days on OPAT was 35. The most common diagnoses were osteomyelitis (43%), bacteremia (20%) and diabetic foot infection (12%). Average monthly OPAT census overall increased since inception (Fig 1) and demonstrated marked monthly variation across the entire period. In 2022-2023, the weekly census ranged from 32 to 60 patients, with a median weekly census of 45 patients (IQR, 41-50) (Fig 2).

Conclusion
We found our OPAT census underwent frequent, wide fluctuations in volume, which was met with adjustments in task prioritization and approach to accommodate surges. Of note, the OPAT team provides assessment and transition management for referred patients prior to discharge. These patients are not counted in census but are a key area to improve safety and stem readmission. Our results demonstrate that OPAT workload can be volatile and needs robust, expert staffing to meet unpredictable demands and patient needs.

Disclosures
Asher J. Schranz, MD, MPH, UpToDate: I receive fees for authorship of an UpToDate article.
P-1896. Comparing Clinical Diagnoses of Intraamniotic Infections to the Guideline Definitions
Authors: Pazienza Grace , Schacht Lance , Thomas Mattie Jo , Palomo Jennifer , Stuart Sean , Withers Sarah , Crockett Amy H , Bailey Pamela 
Published: January 2025

Abstract

Background
Intraamniotic infection (IAI) or chorioamnionitis is an intrapartum clinical diagnosis. Treatment delay for confirmatory test results can lead to maternal and fetal morbidity. The American College of Gynecology (ACOG) defines “suspected IAI” as persistently elevated temperatures plus findings of purulent cervical discharge, maternal leukocytosis, fundal tenderness, and maternal or fetal tachycardia. These variable and relatively complex diagnostic criteria may introduce clinical confusion and lead to overtreatment. We sought to evaluate compliance with ACOG guidelines in our hospital.Table 1:Diagnostic criteria for IAI including categories of maternal fever and clinical findings

Methods
A retrospective cohort study was planned. Patients with IAI were identified by ICD diagnoses, and screened for appropriateness. Manual chart abstraction was performed to identify diagnostic criteria for IAI per ACOG guidelines. Additionally, culture and pathology results were reviewed when available. Comparisons between groups were made using chi square.

Results
301 patients with IAI were identified between Feb 2016 and Oct 2023. Most (n=281, 93.4%) met ACOG diagnostic criteria but 20 (6.6%) did not have documented indications for initiation of treatment. There is no statistical significance between the number of symptoms and fevers (p=0.55) between groups (Table 1).
Few (n=59, 19.6%%) patients had cultures collected, and of these 35.5% (n=21) were positive including placenta (n=10, 47.6%) and blood (n=2, 9.5%). There was not a difference in patients with positive cultures compared to patients with negative or no cultures in fevers (p=0.77) or number of suspected IAI signs (p=0.11).

Conclusion
The diagnostic criteria for IAI should be refined or reevaluated, particularly in light of their complexity in accurately diagnosing IAI. This is especially important in light of antimicrobial stewardship initiatives in an effort to improve patient care, as well as an introduction of rapid diagnostics improving earlier identification of organisms in blood cultures which could significantly impact organism identification earlier than traditional microbiology.

Disclosures
All Authors: No reported disclosures