bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1630. Retrospective Evaluation of Urinalysis to Urine Culture Reflex Frequency and Criteria
Authors: Zheng Dina , Hirsch Elizabeth B , Hamid Lina , Bixby Morgan L , Bixby Morgan L 
Published: January 2025

Abstract

Background
Patients with asymptomatic bacteriuria (ASB) often receive inappropriate treatment despite IDSA guidelines recommendation against antimicrobial treatment of ASB in the majority of adults. Emphasis on laboratory results rather than symptoms often triggers ASB treatment. At our institution, a urinalysis (UA) positive for ≥ 1 criteria ( &gt; 10 WBC / HPF, leukocyte esterase (LE), or nitrites) results in a reflex to urine culture (UC). The objective of this study was to assess the frequency of UC reflex orders and the specific criteria driving reflex to identify opportunities for diagnostic stewardship and treatment guidance.

Methods
Retrospective data were provided by the Best Practices Integrated Informatics Core for hospitalized adults with an ICD-10 diagnosis of urinary tract infection (UTI) or related condition and a UA +/- UC order within 72 hours between 11/1/2022 and 4/30/2023 at a large academic medical center. Number and frequency of UA to UC reflex and UA criteria driving UC reflex were assessed. LE results were considered positive if “moderate” or “large” and negative if “small”, “trace”, or “negative”. RStudio (version 2023.06.0) was utilized to perform logistic regression analyses with univariable and multivariable models to calculate odds ratios for reflex to UC.

Results
This cohort comprised 2007 unique patients with a total of 3193 UA orders. Of 3193 UA orders, 1016 (31.8%) reflexed to UC. The highest frequency of UC reflex was with 2 of 3 UA criteria positive (43.2%), followed by 1 of 3 criteria positive (39.0%), then 3 of 3 criteria positive (9.5%), and lastly, the remaining 8.3% of patients had UC reflexed for unknown reasons that need to be further investigated (Table 1). All 3 criteria when positive had increased odds for triggering UC reflex (Table 2). In the multivariable model, LE had the highest odds of triggering UC reflex (OR 1.73, 95% CI: 1.68-1.78).

Conclusion
Despite frequent UA orders, only 31.8% reflexed to UC. Following these results, retrospective chart review will be completed to characterize patients with symptomatic UTI vs. ASB based on review of progress notes. These data will identify whether certain UA criteria are more highly correlated with symptomatic UTI and will help inform the need for revised UA and UC diagnostics.

Disclosures
Elizabeth B. Hirsch, PharmD, FCCP, FIDSA, GSK: Advisor/Consultant|GSK: Honoraria
P-1641. Comparing Traditional and Weighted Incidence Combined Syndromic Antibiograms in Nursing Homes
Authors: Taylor Lindsay , Jolles Sally , Bej Taissa A , Kowal Corinne , Hicks Oteshia , Gangnon Ronald , Furuno Jon P , Nace David A , Jump Robin , Crnich Christopher J 
Published: January 2025

Abstract

Background
Aggregate susceptibility reports, commonly referred to as antibiograms, may assist empiric antibiotic decisions. Creating traditional antibiograms (TAs) is hampered by the limited number of cultures collected in NHs. A weighted incidence syndromic combined antibiogram (WISCA) is an alternative method of representing susceptibility data. We compared TAs and WISCAs in a sample of NHs from three U.S. regions.
Table: Success Rate of Creating a TA and WISCA Using One Year of Culture Data in 75 Nursing Homes

Methods
Data on urine cultures collected in 75 NHs in Ohio, Oregon, and Pennsylvania (2018-2021) were obtained from their reference laboratories. Clinical & Laboratory Standards Institute (CLSI) breakpoints were used to normalize susceptibility interpretations across laboratories. We attempted to create a TA and WISCA for each study NH using the 3 most prevalent uropathogens (Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae) and susceptibilities to 5 commonly prescribed antibiotics. Sensitivity analyses using different isolate number thresholds (10 & 30) and years of culture data (1 & 2) were conducted.Figure:Success Rate of Creating a TA and WISCA Using Two Years of Culture Data in 75 Nursing Homes

Results
15,238 unique urine cultures obtained from 7,703 residents were obtained from reference laboratories. The final sample was 12,789 cultures after excluding duplicate isolates obtained from the same resident within 3 monthsof an index urine culture. A TA could be constructed for ∼5% (1.5% - 5.1%) of NHs using a single year of culture data and an isolate number threshold of 10 (Table). This increased to ∼11% when combining two years of culture data (Figure). A 1- or 2-year TA could not be constructed for any of the NHs using the CLSI recommended isolate threshold of 30. We were able to construct a WISCA for most of the study NHs (63% - 80%) using a 10-isolate threshold and this improved slightlyby combining two years of culture data. We were only able to construct a 1-year WISCA for a third of NHs (29% - 34%) using a 30-isolate threshold but this improved to 57% of NHs when combining 2 years of culture data.

Conclusion
A facility-specific urinary antibiogram can be produced for the majority of NHs by using a WISCA approach and combining more than one year of culture data. Additional study to examine the effects of pooling facility culture results on WISCA success rates and effects on susceptibility estimates are needed.

Disclosures
Jon P. Furuno, PhD, Merck & Co., Inc: Grant/Research Support Robin Jump, MD, PhD, Abacus: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support
P-1685. Knowledge, Attitudes, and Practice of Healthcare Providers Regarding Oral Antibiotic Use in a Health System
Authors: Gammill Emily , Shephard Emily , Bhagat Hita , Chan Dominic 
Published: January 2025

Abstract

Background
Treating infections with oral (PO) antibiotics is associated with reduced risk for catheter associated infections, costs, and length of stay. However, barriers in appropriate transition to PO antibiotics exist.
Intravenous versus oral antibiotics by treatment indication
The most common treatment indications were pneumonia, cellulitis, bacteremia, and urinary tract infection. A lower proportion of patients with cystitis and bacteremia were transitioned to oral antibiotics compared to other indications.

Methods
This study aims to understand the knowledge, attitudes, and practice of healthcare providers regarding PO antibiotics. This is a cross-sectional, descriptive survey followed by a multi-center, retrospective chart review. A web-based questionnaire was distributed electronically and promoted during meetings to healthcare providers. The retrospective chart review included admitted adult patients who were administered antibiotics for targeted infections. Patients that were pregnant, incarcerated, had inadequate PO absorption, or lack of source control were excluded. The primary outcome was to identify areas for antimicrobial stewardship intervention. This was done by identifying discordances between provider knowledge or attitudes and prescribing practices. Descriptive statistics and regression analyses were conducted.

Results
The survey collected 119 total responses from pharmacists (47.1%), physicians (36.1%), medical residents (5.9%), and advanced practice providers (5%). Providers were most comfortable using PO antibiotics for cellulitis (88.2%), cystitis (86.6%), and community acquired pneumonia (82.4%), and were least comfortable using PO antibiotics for osteomyelitis (26.1%), prosthetic joint infection (16.8%), and endocarditis (14.3%). The most common barrier was the concern that PO antibiotics are not as effective (86.6%). The retrospective chart review included 224 patients, of which 164 were transitioned to PO antibiotics at any point. A lower proportion of patients with cystitis (60%) and bacteremia (57.7%) were transitioned to PO. The largest discordance between comfort using PO antibiotics and actual prescribing practices occurred with cystitis. Average duration of intravenous (IV) antibiotics were 4.2 days for pneumonia, 4.2 days for cellulitis, and 3.3 days for cystitis.

Conclusion
Antimicrobial stewardship initiatives can be targeted at education on oral antibiotic options that have high efficacy, improving IV to PO conversion rates for cystitis, and implementing criteria for early transition to PO antibiotics.

Disclosures
All Authors: No reported disclosures
P-1713. Impact of an Evidence-Based Order Panel on Antimicrobial Prescribing in Ambulatory Patients with Complicated and Uncomplicated Cystitis
Authors: Neumann Matt , Jensen Kelsey L , Stevens Ryan W W , Ilges Dan , Virk Abinash , Vergidis Paschalis , Mara Kristin 
Published: January 2025

Abstract

Background
Optimizing antimicrobial prescribing for urinary tract infections (UTI) represents an area of opportunity for ambulatory antimicrobial stewardship programs. A pre-populated, ambulatory antibiotic order panel for UTI was implemented in the Mayo Clinic Enterprise on 5/16/2022. The order panel provides antimicrobial regimens which align with both institutional and national treatment guidelines based on patient comorbidities, complicating factors, and beta-lactam allergy status. We aimed to assess the impact of panel use on antibiotic prescribing for complicated and uncomplicated cystitis in the ambulatory setting.

Methods
This retrospective review included ambulatory encounters from the Mayo Clinic Enterprise in 2022 and 2023. Eligible encounters were randomly selected and included those with a primary ICD-10 code of cystitis performed by primary care or urgent care clinicians. Encounters were excluded if patients had symptoms indicative of pyelonephritis, underwent urinary instrumentation within 30 days, or had a urinary pathogen isolated within 90 days. The primary outcome was concordance with institutional guidelines. Secondary outcomes included repeat healthcare contact and therapy duration. Outcomes were analyzed with Pearson's chi-squared and Wilcoxon rank sum tests (α level = 0.05).

Results
793 encounters (397 panel vs. 396 non-panel) were included. Prescribing was guideline concordant in 79.3% and 64.9% (p&lt; 0.001) of panel and non-panel encounters, respectively. Inappropriate duration was the most common reason for non-concordance in the panel use cohort. There was no difference between groups for repeat healthcare contact incidence. Antimicrobials prescribed differed between panel and no-panel groups (Table 1), with higher use of sulfamethoxazole/trimethoprim and lower use of cefdinir in the panel cohort. Numerically shorter durations were seen in the panel group, with more 3- and 5-day regimens than the no-panel group.

Conclusion
Use of a pre-populated antimicrobial order panel for outpatient cystitis encounters resulted in greater adherence to institutional guideline recommendations, particularly in terms of antimicrobial selection, without adversely impacting repeat healthcare contact.

Disclosures
Paschalis Vergidis, MD, MSc, AbbVie: Advisor/Consultant|Ansun Biopharma: Grant/Research Support|Cidara Therapeutics: Grant/Research Support|F2G: Grant/Research Support|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support
P-1719. Promoting antibiotic stewardship for commercial poultry production in Bangladesh: using social and behavioral change communication approach
Authors: Murshid Hasan S M 
Published: January 2025

Abstract

Background
Bangladesh has a high prevalence of antimicrobial resistance due to extensive antibiotic use in humans and animals. This study aimed to develop social and behavioral change communication (SBCC) strategies to promote antibiotic stewardship in commercial poultry production in Bangladesh.

Methods
In 2022, we used formative research findings to explore contextual factors of antibiotic sale, prescribing, promotion, and use among four groups in Narsingdi, Bangladesh: 1) poultry farmers, 2) pharmacy shop employees, 3) veterinarians, and 4) pharmaceutical representatives. We conducted multiple intervention design workshops to select target behaviors and develop SBCC messaging. We used the behavior change wheel model to analyze the data and summarize the findings.

Results
Participants identified their behaviors considered to be changed and assisted in developing SBCC for all four stakeholder groups. Poultry farmers had two behaviors to change: not following infection control measures and irrational antibiotic use. SBCC target behaviors included taking appropriate infection control measures, seeking registered veterinarian consultations, and rational antibiotic use. Pharmacy shop employees had one behavior to change: unnecessary antibiotic dispensing practices. SBCC target behaviors included asking farmers for prescriptions and referring them to registered veterinarians. Registered veterinarians had one behavior to change: unnecessary antibiotic prescribing practices. SBCC target behaviors included appropriate antibiotic prescribing practices and increasing farmer awareness for rational antibiotic use. Pharmaceutical sales representatives had one behavior to change: unethical antibiotic promotion. SBCC target behaviors included appropriate antibiotic promotion.

Conclusion
We identified stakeholders considered behavior change and SBCC intervention delivery to them to promote antibiotic stewardship for commercial poultry production, including improved health-seeking behaviors, and improved health literacy on antibiotic transactions. The study findings may contribute to developing health communication materials to promote antibiotic stewardship among stakeholders in commercial poultry production in Bangladesh.

Disclosures
All Authors: No reported disclosures
P-1721. Antibiotic Prescribing in Oregon, an Analysis of Outpatient Prescribing Patterns for Acute Respiratory Tract Infections Using Oregon’s All Payer All Claims Database
Authors: Gilbreath Terran , Iguchi Lisa , Breitenstein Elizabeth , Zhang Alexia Y , Cieslak Paul R , Tran Dat 
Published: January 2025

Abstract

Background
Acute respiratory tract infections (ARTIs) often lead to antibiotic prescriptions in outpatient settings, many of which are unnecessary. Inappropriate prescribing of antibiotics contributes to the emergence of antibiotic resistance. Antibiotic surveillance related to ARTIs is important for identifying diagnoses and populations for which stewardship efforts are needed. The purpose of this study was to describe antibiotic prescribing trends for ARTIs in outpatient settings in Oregon, both before and during the COVID-19 public health emergency.

Methods
We queried medical and pharmacy claims during 2018–2022 in Oregon’s All Payer All Claims (APAC) database. Medical claims were restricted to index ARTI visits in outpatient settings. Antibiotic pharmacy claims were matched to ARTI claims using a unique person identifier. We defined “antibiotic use” as ARTI claims that filled an antibiotic prescription within three days of the ARTI visit.

Results
Antibiotic use was observed in 41% of ARTI visits during 2018–2022. Antibiotic use followed approximately 45% of visits in both 2018 and 2019, 37% in 2020, 30% in 2021, and 41% in 2022. Acute otitis media (AOM) had the highest antibiotic use at 81% of visits, followed by sinusitis (69%), bronchitis (56%), pharyngitis (28%), and upper respiratory infections (URI) (11%). Antibiotic use decreased with age for AOM, pharyngitis, and sinusitis - and increased with age for URIs. During 2020-2022, lower antibiotic use for ARTIs was observed, and telehealth use increased. Approximately 27% of ARTI telehealth visits, largely observed in 2020 and 2021, received antibiotics.

Conclusion
These data are likely confounded by the COVID-19 public health emergency, making comparison to previous analyses difficult. Trends in prescribing for bronchitis, pharyngitis, and URIs showed decreasing antibiotic use from 2018 to 2022. Prescribing trends for sinusitis and bronchitis, where antibiotic use is often unnecessary, indicated these ARTIs as possible targets for stewardship interventions. More broadly, claims data allows public health to monitor prescribing for diagnoses that often do not require antibiotics. Monitoring antibiotic use for ARTIs is important to identify conditions and populations for which stewardship efforts may be needed.

Disclosures
All Authors: No reported disclosures
P-1723. Comparison of Antibiotic Prescribing for Urinary Tract Infections (UTI), Sinusitis, Group A Streptococcal Pharyngitis, and Pyelonephritis by Prescriber Type
Authors: Vanhouten Brianna , Eckardt Owen , Sohn Minji , Pontefract Benjamin , Klepser Michael 
Published: January 2025

Abstract

Background
Introduction: Currently, 25%-40% of all outpatient visits are with physician's assistants (PAs) or nurse practitioners (NPs)1 . PAs and NPs receive less formal education on diagnosis and pharmacology than physicians. The goal of this study was to determine if there is a difference in prescribing patterns between physicians and PAs/NPs for selected infectious diseases.

Methods
Design: This was a cross-sectional study utilizing the CHARM (Collaboration to Harmonize Antimicrobial Registry Measures) database.

Methods
The CHARM database is a Michigan multi-system registry containing archival data previously collected from the medical records of partnering health systems regarding outpatient antibiotic prescribing. This project evaluated antibiotic prescribing data from July 2021 to June 2023 available through CHARM. Antibiotic prescriptions were identified and associated with ICD-10 codes for acute sinusitis, chronic sinusitis, group A streptococcal pharyngitis, UTI, and pyelonephritis. Guideline concordance between prescriber types was compared using chi-square tests.

Results
137,960 prescriptions were included in the study. Of those, 63.7% were written by PAs and NPs, and 36.3% were written by physicians. Compared to physicians, PAs and NPs, prescribed concordant antibiotics more often for acute sinusitis, chronic sinusitis, group A streptococcal pharyngitis, and pyelonephritis (P &lt; 0.01). There was no significant difference between groups for uncomplicated UTIs (P= 0.10).

Conclusion
Our data suggests PAs and NPs prescribe antibiotics at a higher rate of guideline concordance than physicians.

Disclosures
Minji Sohn, PhD, Emergent BioSolutions, Inc.: Grant/Research Support
P-1730. Implementation of Pharmacist-Led Intervention on Oral Antibiotic Prescribing within Hospital Discharge Medication Reconciliation
Authors: Patel Amolee R , Gavaghan Victoria , Dilworth Thomas J 
Published: January 2025

Abstract

Background
Inappropriate antibiotic exposure places patients at risk for collateral damage. Hospital discharge presents an opportunity to ensure antibiotic regimens represent an appropriate continuation of inpatient therapy and adhere to evidence-based activity spectrum and therapy duration recommendations. We sought to determine the impact of a pharmacist-led antibiotic stewardship intervention on oral antibiotic prescribing at hospital discharge, informed by institutional guidelines and targeted pharmacist education.

Methods
This was a quasi-experimental study in which an antibiotic stewardship intervention was implemented within a 27-hospital, integrated health-system for patients discharging on oral antibiotics. Data following systemwide implementation (Jan-March 2023; POST) were compared to retrospective data without intervention (Aug-Sept 2022; PRE). The primary outcome measure was institutional guideline-discordant discharge regimens (agent, dose, duration of therapy). Secondary outcomes included treatment associated adverse-events, 30-day readmissions and treatment failure.

Results
A total of 560 patients were included, 300 (53.6%) in PRE and 260 (46.4%) in POST. The most common antibiotic indications were community-acquired pneumonia (13.7%), urinary tract infection (26.8%) and skin and soft tissue infection (31.1%). The most frequent discordances included extended durations of therapy (47.7%), inappropriate targeted or empiric coverage (11.4%) and fluoroquinolone use in the setting of available alternatives (7.9%). Outcome results shown in Table 1. Pharmacists intervened upon 63 (24.2%) patients in POST with an 81.0% intervention acceptance rate. Rates of guideline-discordant regimens and treatment-associated adverse events were significantly lower in POST. Both median outpatient duration of therapy and total duration of therapy were significantly lower in POST as seen in Table 2.

Conclusion
Hospital discharge is an important opportunity for antimicrobial stewardship programs. A pharmacist-led antibiotic stewardship initiative resulted in intervention on and optimization of guideline-discordant regimens. This initiative was also associated with both decreased antibiotic exposure and treatment-associated adverse events.

Disclosures
All Authors: No reported disclosures
595. The Effect of Herpes Zoster Vaccination on New Diagnoses of Dementia: A Quasi-randomized Study in Australia
Authors: Pomirchy Michael , Bommer Christian , Geldsetzer Pascal 
Published: January 2025

Abstract

Background
We have recently provided evidence from a quasi-randomized study in Wales that herpes zoster (HZ) vaccination reduced the incidence of new dementia diagnoses. This study used a similar quasi-randomization in Australia to determine the effect of HZ vaccination on new dementia diagnoses over 7.5 years.Figure 1:Eligibility for a free herpes zoster (HZ) vaccine reduces dementia diagnosesIn panel (a), a regression discontinuity is plotted, where the forcing variable is the number of weeks from the cutoff (November 2, 1936) and the outcome is dementia diagnoses (in percentages). The triangular dots indicate dementia diagnoses for the comparison group, scaled up by the intercept for the main cohort. Panel (b) describes this effect for different follow-up periods, and panel (c) shows the effect for different grace periods.

Methods
In Australia, starting on November 1 2016, live-attenuated HZ vaccination was provided for free to individuals aged 70 to 79 years of age. Thus, those whose 80th birthday was just a few days prior to November 1 2016 never became eligible, whereas those whose 80th birthday was a few days later were eligible for one year. There is no reason to expect that these population groups who differ in their age by only a minute degree should differ in any of their dementia-related characteristics. We used detailed primary healthcare records (provided by PenCS) with week-of-birth information from 65 general practices across Australia. We analyzed our data using a comparative regression discontinuity design, with dementia diagnoses from older birth cohorts serving as a comparison group.

Results
Of 108,670 patients in our data, 15,297 were born between November 2 1928 and November 2 1944. At baseline, patients were well-balanced across the date-of-birth eligibility threshold (November 2 1936) for HZ vaccination in their preventive health services uptake and chronic disease diagnoses. There was an abrupt increase of 13.2 (95% CI: [8.7, 17.6], p = 0.001) percentage points in the probability of ever receiving HZ vaccination between patients born shortly before versus shortly after the eligibility threshold. Eligibility for a free HZ vaccination caused a 3.9 percentage point (95% CI: [1.7, 6.1], p = 0.001) decrease in the probability of receiving a new dementia diagnosis over 7.5 years. Being eligible for HZ vaccination did not affect the probability of taking up other preventive health services (including other vaccinations) nor do we find consistent evidence that it affected the probability of receiving any of the twenty most common disease diagnoses in our data.

Conclusion
In conjunction with our findings from Wales, these results from Australia constitute robust evidence that live-attenuated HZ vaccination may delay or prevent dementia.

Disclosures
All Authors: No reported disclosures