bluuebunny/crossref_metadata_2025_split huggingface dataset:
1178. The Dalba Diary: A Retrospective Review of Dalbavancin Use, Clinical Outcomes, and Treatment Adherence Challenges at an Academic Medical Center
Authors: Black Cassandra E , Gregory Eric , Wilson Nicole , Shoemaker D Matthew , Haas Gabriel Ann , Wark Kellie , Kimball Joanna 
Published: November 2023

Abstract

Background
Dalbavancin is FDA-approved for skin and skin tissue infections (SSTI) and is an alternative therapy for deep-seated gram-positive infections when avoidance of long-term catheters or prolonged hospitalization for intravenous (IV) antibiotics is desired. This observational, retrospective study evaluated the utilization of dalbavancin at a large academic medical center between May 1, 2021, and November 30, 2021. The objectives were to analyze the patient characteristics, clinical outcomes (including treatment adherence), and economic impact by looking at the estimated length of stay (LOS) and cost avoidance associated with dalbavancin use.

Methods
Variables of interest were analyzed with descriptive statistics. A chi-square test was used to assess the relationship between no-shows and infection-related readmissions. A multivariate logistic regression analysis was used to predict factors associated with treatment nonadherence.

Results
We examined 96 cases consisting of 34 patients with IV drug use (35.4%), 47 with non-IV substance use (49.0%), and 22 with homelessness (24.0%). The most common indication for use was non-vertebral osteomyelitis (34.4%, n=33), followed by SSTI (16.7%, n=16) and endocarditis (14.6%, n=14) (Table 1). Treatment adherence was found to be 84.4% (n=81), and readmissions and adverse reactions were rare (Table 2). The average LOS avoided was 28 days (SD, 13.6). The average cost avoided was $56,000 US dollars (SD, $27,180.63). No-shows were not associated with infection-related readmissions (p =.99). In our multivariate analysis, those with non-IV substance use were significantly less likely to attend their scheduled infusion (p=.003), and those with higher Charlson Comorbidity Index (CCI) were significantly more likely to attend their infusion (p=.013) (Table 3).

Conclusion
Dalbavancin was a safe and economically beneficial alternative for deep-seated infections. Readmissions and adverse reactions were uncommon, and there were no documented deaths within 90 days of discharge. Treatment adherence was high. Those with non-IV substance use and possibly homelessness may be at higher risk for nonadherence, but treatment nonadherence did not lead to poorer outcomes.

Disclosures
All Authors: No reported disclosures
1179. Infectious Diseases Trained Pharmacist: When More Means Less
Authors: Blum Sharon , Akerman Meredith 
Published: November 2023

Abstract

Background
The archived Antimicrobial Stewardship Guidelines from the Infectious Diseases Society of America outline core members of the multidisciplinary team including an infectious diseases trained clinical pharmacist. Evidence exploring impact of infectious diseases (ID) training on a clinical pharmacist's ability to provide effective stewardship are lacking.

Methods
This is a time series data analyzed using control charts examining authorization patterns between ID trained clinical pharmacists and clinical pharmacists without additional ID training covering the antimicrobial stewardship prior authorization and approval requests. U-charts were used to show the proportion of approved antibiotics overall, as well as separately by antibiotic type in subgroups of various sample sizes at 3 time points including: 1. a baseline period of coverage by ID trained clinical pharmacist, 2. a transition to coverage by clinical pharmacists without specific ID training, and 3. a return to the baseline coverage. If any of the points in the chart were outside of ± 3σ limit, then the process was considered out of control at that time point. Analyses were performed using SAS PROC SHEWHART (SAS Institute Inc, Cary, NC).

Results
There was an increase in the rate of approved antibiotics, in the rate of approved Carbapenem, and in the rate of approved Quinolone during the second time period, clinical pharmacists without additional ID training, that lied outside of the ± 3σ limit. The remaining approved antibiotic rates lied within the acceptable ± 3σ limit.
Overall Antibiotic Approvals
Vancomycin approvals
Piperacillin/tazobactam Approvals

Conclusion
There was a significant difference in antibiotic approvals when Antimicrobial Stewardship coverage was provided by an ID trained clinical pharmacist compared to coverage by clinical pharmacists without additional ID training. ID trained clinical pharmacists were more successful in ability to guide providers to narrower spectrum options or to avoid antibiotic use altogether.
Carbapenem Approvals
Quinolone Approvals
Cefepime Approvals

Disclosures
All Authors: No reported disclosures
1195. "The Economic Impact of Antimicrobial Use for Surgical Prophylaxis: A Prospective Study
Authors: Gnanamani James , Rajakumar Ratheesh , Dorairajan Suresh Kumar 
Published: November 2023

Abstract

Background
Antibiotic prophylaxis is commonly used to prevent surgical site infections in patients. However, excessive use of antibiotics can lead to adverse effects such as the development of antibiotic resistance and increased healthcare costs.Unless there is a known infection, prophylactic antibiotics should be discontinued within 24 hours.This study aimed to evaluate the cost implications of antibiotic prophylaxis in patients who received prophylaxis for a duration longer than recommended by the World Health Organisation (WHO).

Methods
This prospective observational study was conducted in a tertiary care hospital in India for a period of two months. Data on patient demographics and Surgical antimicrobial usage were collected to surgical patient cases. Follow-up was performed to determine whether the antibiotics has been stopped after 24 hours. Financial implications, such as increase in drug costs were documented when the surgical prophylaxis was continuing after 24 hours. The necessity of antimicrobial usage and its cost effectiveness were analysed using basic statistical method.

Results
This study included 174 patients of surgical antimicrobial therapy. Out of these, 58 patients (33%) had their surgical antimicrobial therapy stopped after 24 hours, while 116 patients (66%) continued to receive surgical antimicrobial therapy beyond the recommended duration. The data was then analysed, with a focus on the cost of the antimicrobial medication (as shown in Table 1).

Conclusion
The study revealed that when surgical antibiotic prophylaxis was administered for more than 24 hours, the average expenditure per person per day increased by ₹5206 ($68.83). Additionally, patients who received antibiotic prophylaxis beyond the recommended duration incurred significantly higher costs than those who received prophylaxis for the recommended duration, with the cost of antibiotics accounting for the majority of the excess expenditure. These findings emphasise the potential cost savings associated with reducing the duration of antibiotic prophylaxis to the recommended duration, without compromising patient outcomes. Further research is necessary to evaluate the cost-effectiveness of implementing this practice.

Disclosures
All Authors: No reported disclosures
1198. More is not Merrier: Mitigating Meropenem Misuse in the ICU at an Academic Medical Center
Authors: Huang Angela , Sacco Alicia , Skolnik Aaron , Siebeneck Eric , Ilges Dan , Seville Maria T 
Published: November 2023

Abstract

Background
Inappropriate use of carbapenems is a major driver of antimicrobial resistance. The intensive care unit (ICU) at Mayo Clinic Arizona had a higher meropenem (MER) days of therapy (DOT) per 1000 patient days (PD) compared to other Mayo Clinic Enterprise sites, despite low rates of Pseudomonal resistance to narrower spectrum anti-pseudomonal beta-lactams.

Methods
A multidisciplinary team of infectious diseases (ID) and critical care medicine (CCM) physicians and pharmacists was created to reduce inappropriate use of MER in the ICU. The baseline rate of appropriateness was determined by evaluating all MER days in the ICU during Q4 2019 and Q4 2020. Each MER day was designated as appropriate or inappropriate based on pre-determined criteria after review by at least one ID and one CCM member. Discordant days were evaluated by the whole team to achieve consensus. The team provided education to the CCM department on the initiative, baseline data, and strategies to reduce inappropriate MER use. The active intervention included prospective audit and feedback of all patients on MER performed by the ID clinical pharmacists Mon-Fri 0700-1530 in Q4 2022. DOT/1000 PD was assessed for the pre-intervention and intervention periods.

Results
The baseline rate of inappropriate MER use in the ICU was 52% (442/846 days). The two most common reasons for inappropriate MER use in the baseline period were: susceptible organism for which a narrower agent could have been used (93/442, 21%), and infectious workup/cultures negative (89/442, 20%). During the intervention period, the inappropriate rate of MER use was reduced to 23%, below the pre-determined goal of 30%. The MER DOT/1000 PD in the baseline period were 103.9 (Q4 2019) and 151.5 (Q4 2020) versus 66.1 (Q4 2022) in the intervention period. There was no difference in ICU sepsis-related mortality in the pre-intervention vs intervention period (13.4 vs 0%, p=0.04).

Conclusion
A multidisciplinary team approach, including education and prospective audit and feedback, reduced inappropriate MER use in the ICU of an academic medical center from 52 to 23%. An associated decrease in MER DOT/1000 patient days was also observed.

Disclosures
All Authors: No reported disclosures
1201. Putting a CAP on Discharge Antimicrobial Therapy: Evaluation of a Systematic Transitions of Care Process for Patients with Community Acquired Pneumonia (CAP) and Chronic Obstructive Pulmonary Disease (COPD)
Authors: Belza Ana Christine , Efta Jessica , MacDonald Nancy , Kenney Rachel M , Patel Nisha 
Published: November 2023

Abstract

Background
Prescribing excess antibiotic duration at hospital discharge is common. A collaborative, pharmacist-led Antimicrobial Stewardship Transition of Care (ASP TOC) intervention implemented in our hospital was associated with improved discharge prescribing and reduced patient harm. However, the sustainability of this pharmacy service was challenging. To improve sustainability, the electronic scoring system (ESS) in the electronic medical record, used by inpatient pharmacists to prioritize patient care and identify interventions, had implemented an ASP TOC decision support in 2023. The purpose of this study was to evaluate the implementation of ASP TOC in the ESS.

Methods
This IRB-approved retrospective quasi-experiment included patients discharged on oral antibiotics for community-acquired pneumonia or chronic obstructive pulmonary disease exacerbation (LRTI) from 11/2021 to 2/2022 (pre-intervention) or 11/2022 to 2/2023 (post-intervention). The primary endpoint was optimized discharge antimicrobial regimen, defined as guideline concordant selection, dose, and duration. 194 patients were required to achieve 80% power and detect 20% reduction of non-optimized therapy. Multivariable logistic regression was used to identify factors associated with optimized regimens.

Results
200 patients were included. Similar baseline demographics were found in both the pre-intervention group and post-intervention group (Table 1). Optimized discharge regimens improved from 69% in the pre-intervention group to 82% in the post-intervention group (p = 0.033). ASP TOC interventions by the pharmacist increased from 4% to 25% in the post-intervention group (p &lt; 0.001). After adjustment for the type of LRTI, ASP TOC intervention was independently associated with optimized discharge regimens (aOR 6.57; 95% CI 1.51-28.63).Table 1.Baseline Demographics

Conclusion
After launch of the ASP TOC decision support, there was an increase in optimized discharge regimens and ASP TOC interventions completed. Pharmacist use of ASP TOC decision support through an ESS can aid in improving discharge prescribing by the primary medical team, leading to improved outcomes.

Disclosures
All Authors: No reported disclosures
1204. Evaluation Of An Antimicrobial Stewardship Scorecard For Hospitalized Patients With Community-Acquired Pneumonia
Authors: Klatt Megan , Wilson Nicole , Lamberton Kathryn 
Published: November 2023

Abstract

Background
Community-acquired pneumonia (CAP) is a common infectious disease state that provides multiple opportunities for antimicrobial stewardship interventions to optimize therapy management.

Methods
This retrospective cohort study evaluated the impact of a service-level scorecard (Figure 1) with prescribing feedback on the rate of guideline concordant therapy and order set utilization in non-immunocompromised, adult patients with CAP and admitted to internal medicine and family medicine services. Scorecards were shared with teams as part of a larger antimicrobial stewardship “bundle” that included order set and guideline development, and clinician education. The primary outcome was the proportion of guideline concordant therapy defined as meeting three of our four scorecard domains: appropriate duration of therapy, appropriate empiric therapy, and inpatient IV to PO transition. Secondary outcomes included individual scorecard components of appropriate treatment duration, empiric therapy, inpatient IV to PO transition, and order set utilization.Figure 1:Monthly Scorecard Example

Results
239 patients were included consisting of 182 in the pre-dissemination of scorecard group (December 2022 – February 2023) and 57 in the post-dissemination group (March 2023). Median age in both groups were 68-69 years with 49% males in the pre-dissemination group and 63% males in the post-dissemination group. The majority of patients were treated under the internal medicine service (Table 1). Proportion of guideline concordant therapy in the pre-dissemination group was 9% (n=16) and 25% (n=14) in the post-dissemination group (p=.007). Appropriate empiric therapy was utilized in 77% (n=140) patients in the pre-dissemination group and in 95% (n=54) in the post-dissemination group (p=.003) (Table 2).

Conclusion
Service-level scorecard distribution increased the rate of guideline concordant therapy amongst internal medicine and family medicine services and provided insight into creative solutions to optimize future disease state-based antimicrobial stewardship interventions.

Disclosures
All Authors: No reported disclosures
1205. Antibiotic-prescribing for all respiratory tract diagnoses across a network of walk-in clinics: clinician-level variation and correlation with other performance metrics
Authors: Livorsi Daniel J , Clore Gosia , Ince Dilek , Percival Kelly M , O’Shea Amy , Shaw Nathan , Dukes Kimberly , Sherlock Stacey Hockett , Perencevich Eli 
Published: November 2023

Abstract

Background
It is unclear which stewardship metrics are most effective for audit and feedback to outpatient clinicians. In this study, we explored a metric that captures antibiotic-prescribing for all respiratory tract diagnoses to determine if it could serve as an appropriate metric for feedback.

Methods
We performed a retrospective cohort study of in-person visits to the 7 walk-in clinics, including 3 Urgent Care locations, within University of Iowa Health Care during 2018-2022. Visits were categorized as respiratory visits (RVs) if a respiratory tract diagnosis was coded and the patient lacked complicating factors, such as a concomitant non-respiratory infection or certain comorbidities. We built a hierarchical logistic regression model that adjusted for antibiotic appropriateness tiers (1-3) to identify factors associated with antibiotic-prescribing for RVs. Using Spearman’s correlation, we compared the frequency at which clinicians prescribed antibiotics for RVs and other types of visits.

Results
There were 331,496 visits, and 96,546 (29.1%) led to an antibiotic prescription; 44,498 (46.1%) of these were for RVs (Tables 1 and 2). At the clinician-level (n=89), the mean frequency of antibiotic-prescribing for RVs was 36.4% (standard deviation 11.6). Factors at the visit-level associated with an increased odds of antibiotic use for RVs included age ≥ 65 (OR=1.5; 95% CI=1.4-1.6) and having at least one comorbidity (OR=1.2; 95% CI=1.1-1.2). The frequency at which a clinician prescribed antibiotics for RVs was strongly correlated with antibiotic use for all visits (r=0.77, p&lt; 0.001). Clinicians who more often prescribed antibiotics for RVs also more often prescribed antibiotics for respiratory infections that are always viral (r=0.73, p&lt; 0.001), sinusitis (r=0.49, p&lt; 0.001), and non-streptococcal pharyngitis (r=0.69, p&lt; 0.001). There was no correlation between antibiotic-prescribing for RVs and the frequency of return visits within 30 days (r=0.11, p=0.29).

Conclusion
A metric that quantifies the frequency of antibiotic-prescribing for all respiratory tract diagnoses correlated strongly with clinicians who over-use antibiotics for walk-in visits. Future studies should assess whether this type of metric is acceptable to clinicians and an effective tool for feedback.

Disclosures
Daniel J. Livorsi, MD, Merck: Grant/Research Support Kelly M. Percival, PharmD, Gilead Sciences Inc: Advisor/Consultant
1207. Impact of a switch from ciprofloxacin to ceftriaxone on infectious complications after transrectal ultrasound-guided biopsy of the prostate
Authors: Hecker Michelle T , Donskey Curtis , Mendo-Lopez Rafael , Lengu Irma , Nguyen Carvell 
Published: November 2023

Abstract

Background
Transrectal ultrasound-guided biopsy of the prostate (TRUBP), first described in the 1980s, remains a commonly performed procedure. Since approximately 2010, increasing infection rates due to fluoroquinolone-resistant E. coli have been reported. These data prompted a change in our recommended antibiotic prophylaxis in March 2014 from ciprofloxacin to ceftriaxone. Limited data are available on whether this strategy leads to improved outcomes or contributes to emergence of infections due to ceftriaxone-resistant organisms.

Methods
We conducted a retrospective, single-center cohort study comparing patients who received ciprofloxacin monotherapy from 1/1/2011 through 2/28/2014 and patients who received ceftriaxone monotherapy from 3/1/2014 through 12/31/2022 as prophylaxis for TRUBP. The primary outcomes were the percentage of procedures with positive blood cultures within 30 days after the procedure and the percentage of urinary tract infections (UTI), defined as a positive urine culture, within 30 days after the procedure. Secondary outcomes included the percentage of procedures with UTI due to specific organisms, including E. coli, fluoroquinolone-resistant E. coli, and extended-spectrum beta-lactamase producing (ESBL) E. coli within 30 days after the procedure.

Results
Of 2,910 total TRUBP procedures, ciprofloxacin was used for prophylaxis in 653 procedures in 578 patients, and ceftriaxone was used for 2,257 procedures in 1,794 patients. As shown in Table 1, patients receiving ceftriaxone prophylaxis had significantly fewer positive blood and urine cultures in the 30 days after the procedure and significant reductions in positive urine cultures with E. coli, fluoroquinolone-resistant E. coli, and non-E. coli Enterobacteriaceae.

Conclusion
Our findings suggest that in the setting of increasing rates of fluoroquinolone resistance in E. coli, switching from ciprofloxacin to ceftriaxone for TRUBP prophylaxis may result in fewer infectious complications without increasing the risk for emergence of infections due to ceftriaxone-resistant organisms.

Disclosures
All Authors: No reported disclosures
1211. Impact of Gram-Negative Rod Bacteremia Rapid Diagnostic Testing and Real-Time Clinical Staff Pharmacist Review
Authors: Kremer Abby , Orvin Alison 
Published: November 2023

Abstract

Background
Although Rapid Diagnostic Testing (RDT) enables optimization of antimicrobial therapy, there is no consensus on how to integrate utilization into clinical practice. At our institution, the BIOFIRE® Blood Culture Identification 2 (BCID2) RDT was implemented in September 2021 in conjunction with real-time clinical staff pharmacist result notification and review. The objective of this study was to determine the impact of RDT plus real-time clinical staff pharmacist review on the management of gram-negative rod (GNR) bacteremia.

Methods
This retrospective, matched cohort study included patients with a positive blood culture for a GNR on the BCID2 panel from September 2020 to August 2021 (historical) and October 2021 to September 2022 (interventional). Exclusion criteria were polymicrobial bacteremia, discrepant RDT results from traditional culture, 24-hour mortality, and comfort care or not admitted at the time of RDT result. Patients were randomly screened to include 120 patients in each group and matched based on age, pathogen, and resistance mechanism. The primary endpoint was time from Gram stain to appropriate antibiotic therapy. Secondary endpoints included time to first pathogen-directed change in therapy, days of anti-pseudomonal therapy, length of stay (LOS), and inpatient mortality.

Results
The study population was predominantly female (61%) and the majority were over 70 years old (55%). Escherichia coli was isolated in 71% of patients with extended-spectrum beta-lactamase-producing organisms isolated in 8%. The median time to appropriate therapy was 0 hours for both groups, indicating patients were on appropriate therapy at the time of Gram stain result (p=0.28). There was a statistically significant decrease in time to first pathogen-directed change in therapy (40 vs. 11 hours; p&lt; 0.01). There was no difference in days of anti-pseudomonal therapy, LOS, or inpatient mortality between groups.

Conclusion
Implementation of RDT plus real-time clinical staff pharmacist intervention did not impact time to appropriate therapy in patients with GNR bacteremia but did significantly reduce time to pathogen-directed antibiotic changes. RDT plus real-time clinical staff pharmacist intervention is a practical method of utilizing technology to improve patient care.

Disclosures
All Authors: No reported disclosures