bluuebunny/crossref_metadata_2025_split huggingface dataset:
1254. DoD Adherence to CDC Core Elements of Hospital Antibiotic Stewardship Programs
Authors: Lynch LeeAnne C , Tribble David R , Tribble David R , Mende Katrin 
Published: November 2023

Abstract

Background
In response to the 2014 Executive Order on Combating Antibiotic-Resistant Bacteria, the Centers for Disease Control and Prevention (CDC) released “Core Elements of Hospital Antibiotic Stewardship Programs” in 2014 and updated it in 2019. In 2017, the Department of Defense (DoD) required hospitals to establish antimicrobial stewardship programs (ASPs) that include CDC Core Elements (CEs). DoD ASPs are often evaluated at the facility level but have not yet been assessed system-wide. This study aims to analyze DoD ASPs as an enterprise to inform future quality improvement.

Methods
Data from the CDC’s National Healthcare Safety Network (NHSN) hospital annual survey, which includes self-reported responses about facility characteristics and various hospital programs (including ASPs), were analyzed in Stata/IC 16.1. A framework analysis was conducted to determine how ASPs are structured, using CDC CEs as a guide. DoD adherence for each individual and all CEs was compared to national data for 2017-2021 and averaged over the same time frame. Adherence was measured using CDC methodology: a positive response to &gt; 1 question within a CE was categorized as that CE being met.

Results
From 2017-2021, between 4,940 and 5,053 hospitals responded to the NHSN annual survey, including 46 to 48 DoD hospitals (1.0% of reporting facilities). Reporting facility participation varies year-to-year, but average percent CE adherence nationally and for the DoD showed education, reporting, and tracking had the lowest adherence (Table 1; Figure 1). DoD differed from national adherence for the CEs of education (-1.9%) and action and tracking (-1.3%). All CEs were met for 82.7% of DoD hospitals compared to 87.2% of hospitals nationally.

Conclusion
National and DoD CEs adherence levels both showed the largest 2017-2021 average deficiencies in education, followed by tracking and reporting. Differences between national and DoD adherence levels were observed for several CEs. The DoD sample size is small and adherence was variable. However, these findings suggest that the CEs where DoD lags national adherence - education, action, and tracking - present opportunities for the DoD to improve its ASPs. A similar comparison with national adherence percentages may also prove useful for other health systems to undertake.

Disclosures
All Authors: No reported disclosures
1255. Filipino Health Care Professionals’ Knowledge, Attitude and Perception regarding Drug-Susceptible and Drug-Resistant Tuberculosis in a High TB Burden City in Central Luzon: A Cross- Sectional Study
Authors: MANZANO J E R O M E G , Redondo-Samin Divina Cristy 
Published: November 2023

Abstract

Background
Tuberculosis (TB) is one of the major diseases responsible for the public health and economic crisis in low-income countries, with the Philippines as one of the eight countries in 2020 that accounted for two thirds of the new TB cases worldwide. Its three most populous regions which are the National Capital Region, Calabarzon and the Central Luzon Region reported the highest number of TB cases in 2015. One important consideration is that health care providers’ knowledge, attitude and perception regarding TB largely affects the success of TB treatment.

Methods
This study assessed the knowledge, attitude and perception among health care professionals who manage tuberculosis, using a validated questionnaire regarding drug-susceptible and drug-resistant tuberculosis in Cabanatuan City, Nueva Ecija. Cross-sectional study was used in this research. All health care professionals assigned in each identified health facility were asked to participate in the study. After obtaining informed consent, a self-administered questionnaire was given to all participants to answer. Descriptive statistics and Chi-square tests were used in data analysis.
Figure 1
Selection of Study Participants through Purposive Sampling

Results
Table 1
Socio-Demographic Profile of HCPs in Cabanatuan City Nueva Ecija
Table 2
Knowledge of HCPs on Diagnosis and Nature of Tuberculosis
Table 3
Attitude of HCPs towards Patients with Tuberculosis and the TB Control Systems

Conclusion
The lack of training may have largely contributed to the poor knowledge of HCPs which may possibly hinder the success of providing TB treatment. It is therefore a paramount consideration that prior to the HCP’s assignment in TB DOTS centers, all HCPs must first undergo training in order to manage TB treatment properly and successfully.
Table 4
Perception of HCPs towards Tuberculosis
Table 5.1
Significant Difference between overall TB Knowledge of HCPs and the Socio-Demographic Profile
Table 5.2
Significant Difference between MDR-TB Knowledge of HCPs and the Socio-Demographic Profile

Disclosures
All Authors: No reported disclosures
1260. A Retrospective Observational Study on Assessing the Use of Antibiotic Prophylaxis for Outpatients in the Dental and Ophthalmic Department in a Tertiary Care Hospital
Authors: Dorairajan Suresh Kumar , Rajakumar Ratheesh , Basha Safiya Banu Sadik 
Published: November 2023

Abstract

Background
Antibiotics are most commonly used in outpatient setting when compared to inpatient setting. Inappropriate antibiotics prescribing in dental and ophthalmic outpatient setting without following any proper guidelines has been identified as a potential driver for antimicrobial resistance especially in the developing world. As there is no sufficient data in India regarding efficient prophylactic use of antibiotics in dental and ophthalmic department, this study is aimed to address this by assessing the antibiotic prophylaxis among outpatients.

Methods
This retrospective observational study was conducted in the Dental and Ophthalmic outpatient’s department in a tertiary care hospital in South India for 3 months from April 2022 to June 2022. The data regarding the Antibiotic prophylaxis were collected from records of the patients’ prescription and analyzed using simple statistics.

Results
A total of 395 prescriptions are collected. Mean age was found to be 53.5 years. The key findings are summarized in Table 1 below.

Conclusion
85% of patients were prescribed with antibiotics in Dental OP whereas 90% of patients were prescribed with antibiotics in Ophthalmic OP in which 56% of patients were found to have inappropriate duration of Antibiotic therapy. Understanding the current patterns of antibiotic prophylaxis in outpatient setting is necessary to implement antibiotic stewardship and large multicentric studies in the future will help to reduce unnecessary antibiotic use in the developing world.

Disclosures
All Authors: No reported disclosures
1262. The Impact of Antimicrobial Stewardship on Antimicrobial Consumption and Resistance Trends at a Tertiary Care Center in Beirut
Authors: Haddad Nisrine , Abdallah Tamara , Rizk Nesrine , Zeenny Rony , Kanj Souha S 
Published: November 2023

Abstract

Background
Antimicrobial Resistance (AMR) is a threat to public health, causing increased morbidity and mortality particularly among hospitalized patients. The COVID-19 pandemic has further worsened the situation globally, causing a surge in the number of critically ill patients, and an increase in antimicrobial consumption resulting in the spread of infections with multidrug-resistant organisms (MDROs). Antimicrobial Stewardship Programs (ASP) play a crucial role in optimizing antimicrobial consumption to fight AMR. In this study, we evaluate the impact of ASP interventions on antibiotic consumption and trends of AMR among bacterial pathogens at a tertiary care center in Beirut before and after the pandemic.

Methods
ASP team recommendations are labeled as interventions. We compiled the ASP interventions from January 2019 until December 2021. Data on antimicrobial consumption, expressed as defined daily dose (DDD) per 100 patient days, for all anti-infectives and restricted anti-infectives was collected per quarter. Data on MDRO resistance trends were obtained from the clinical microbiology laboratory from 2019 to 2022.

Results
The number of ASP recommendations is reported in Figure 1. There is a noticeable correlation between COVID-19 surges in Lebanon and the number of ASP interventions. We note an increase in all antimicrobial consumption after the onset of the pandemic, with a peak in Q4 2020 (142.8 DDD/100 patient days) (Figure 2), and in Q1 2021 for restricted antimicrobials (79.1 DDD/100 patient days) (Figure 3). Importantly, there were no noteworthy changes in resistance patterns for MDR gram-negative organisms, except for MDR Acinetobacter baumannii and Carbapenem resistant Klebsiella spp., which decreased by 27% and 8%, respectively. We witnessed a rise in Gram-positive resistance trends for Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococcus (f29% to 33% and 9% to 14% in 2019 to 2022, respectively).Figure 1.Number of ASP Interventions Pre- and During COVID-19Figure 2.All Antimicrobials Defined Daily Dose per 100 Patient Days and Resistance Trends of MDROsFigure 3.Restricted Antimicrobials Defined Daily Dose per 100 Patient Days and Resistance Trends of MDROs

Conclusion
This study highlights the importance of ASP activities despite and during a pandemic. The results emphasize the role of ASP to mitigate the impact of the pandemic on antimicrobial resistance. The ASP team maintained its operations, monitoring antibiotic consumption and providing recommendations to limit antibiotic misuse.

Disclosures
Souha S Kanj, MD, Gilead: Advisor/Consultant|Menarini: Advisor/Consultant|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant
1265. Penicillin Allergy Delabeling: A Quality Improvement Project
Authors: Shah Ibrahim , Sheraz Sana , Ali Marriam 
Published: November 2023

Abstract

Background
15% of all hospitalized patients report a penicillin allergy, and greater than 90% of them are not truly allergic. Penicillin allergy labels are associated with worse clinical outcomes, increasing in-hospital mortality, and increasing hospital stays. Historically, penicillin allergies were delabeled by either allergists or infectious disease specialists. Pharmacy-led delabeling programs are emerging but are limited due to pharmacists not having provider status in all states. Also, after successful delabeling, a significant number of patients were relabeled for penicillin allergies on subsequent hospital visits.

Methods
We conducted an internal medicine resident-driven quality improvement project in a 350 bed community hospital. Fifty-six patients with a penicillin allergy label in the electronic medical record (EMR) were randomly selected from the inpatient service. If the patient had a non-allergic reaction or had prior exposure to penicillin without a reaction, they were directly delabeled. The remainder underwent risk stratification using the PENFAST scoring tool. Very low-risk and low-risk patients underwent an oral challenge after obtaining written consent. Following this, a hospital-wide pharmacist-triggered physician-driven delabelling protocol was established.

Results
We assessed 56 patients between 04/2022 and 09/2022. Thirty-eight patients were delabeled: 18 by direct delabeling and 20 via oral penicillin challenge. One patient who underwent the oral challenge had an adverse reaction (nausea and vomiting). Seven months later, we conducted a secondary survey to assess the durability of our delabeling. Thirteen percent of patients (n=5) had the penicillin allergy label re-added to their chart on subsequent hospital admissions.

Conclusion
Delabeling patients on the inpatient service is effective, carries little risk, and requires minimal resources. Additionally, it does not require specialist services. However, the durability of delabeling needs to be reinforced with a robust hospital delabeling protocol, continuous patient education, and EMR alerts to prevent allergy labels from being added back on subsequent visits.

Disclosures
All Authors: No reported disclosures
1266. Refining Antimicrobial Stewardship by De-escalating Vancomycin Using MRSA (Methicillin Resistant Staphylococcus aureus) Nasal Screening in a Community Hospital Setting
Authors: Shah Ruta , Sorell Caroline , Onussiet Monika 
Published: November 2023

Abstract

Background
Our institution has prioritized appropriate use of anti-Methicillin-resistant Staphylococcus aureus (MRSA) drugs such as vancomycin. The overuse of anti-MRSA drugs contributes to drug toxicities and development of resistant organisms such as vancomycin-resistant enterococcus (VRE). Recent studies show that MRSA nasal surveillance screening has a high negative predictive value of 96.5% in all types of pneumonia. At our community hospital a decentralized pharmacist-driven MRSA nares screening protocol was novel. We report the results of implementing a MRSA nares screening protocol for vancomycin de-escalation in pneumonia patients.

Methods
A decentralized pharmacist reviewed patients with a diagnosis of pneumonia and prescribed vancomycin. The pharmacist ensured that a culture-based MRSA nares screen was performed within 48 hours of admission, if not already ordered. If the nares screen returned negative and respiratory cultures did not grow MRSA at 48 hours, the decentralized pharmacist contacted the medical team to recommend discontinuing vancomycin. Reasons for exclusion included a positive respiratory culture for MRSA within the prior 7 days, septic shock, alternative site of MRSA infection, and greater than 48 hours of anti-MRSA therapy at time of swab collection.

Results
164 patients were reviewed by pharmacy between 6/16/22 and 4/25/23. 98% of MRSA nares screening had been performed within 48 hours of admission. MRSA screen was ordered by the decentralized pharmacist in 44% of patients. 89% of patients screened were negative for MRSA and reviewed for de-escalation of vancomycin. In 40% of patients, vancomycin was discontinued after recommendations by the decentralized pharmacist, with 95% of the recommendations accepted by the primary hospitalist physician. 37% of patients' vancomycin was discontinued by the attending physician. Overall, 77% of patients with negative MRSA nasal screen results were successfully de-escalated.

Conclusion
Our data highlights the effectiveness of close physician-pharmacy collaboration. Most nares cultures were negative for MRSA allowing for de-escalation of antibiotics. Pharmacist recommendations were accepted majority of the time. Given the data, we plan to apply this approach for other ongoing stewardship initiatives.

Disclosures
All Authors: No reported disclosures
1274. Long-term Sustainability of Improvements in Antibiotic Prescribing for Inpatient Skin and Soft Tissue Infections after Implementation of Local Treatment Guidelines
Authors: Voyer Kira , Shihadeh Katherine C , Cooper Margaret , Jenkins Timothy C 
Published: November 2023

Abstract

Background
Institutional guidelines for the management of inpatient skin and soft tissue infections (SSTIs) were implemented at an academic public safety-net hospital in 2009. This led to an immediate and marked decrease in unnecessary use of broad-spectrum antibiotics and durations of therapy. The objective of this study was to determine if these changes in prescribing have been sustained over time.

Methods
This was a retrospective review of patients hospitalized with cellulitis or abscess at Denver Health Medical Center between July 2016 and August 2022 (maintenance period). Case identification and data collection methods were identical to those used in a previous publication describing pre-intervention (January to December 2007) and intervention (July 2009 to July 2010) period data. The main outcomes were the proportion of patients exposed to an antibiotic with broad-spectrum gram-negative or antipseudomonal activity and the median duration of therapy.

Results
A total of 186 patients from the maintenance period were included for comparison with those from the pre-intervention (n = 169) and intervention (n = 175) periods. In the maintenance period, the median patient age was 41 years and 74% were male. The most common comorbid condition was injection drug use (27%). Overall clinical characteristics were similar between the three periods. The proportion of patients exposed to an antibiotic with broad gram-negative activity was 66% during the pre-intervention period, 33% during the intervention period, and 27% during the maintenance period. The proportion of patients exposed to an antibiotic with antipseudomonal activity was 28%, 18%, and 16% during the pre-intervention, intervention, and maintenance periods, respectively. The median total duration of therapy was 13 (IQR 10-15), 10 (IQR 9-12), and 8 (IQR 7-10) days in the pre-intervention, intervention, and maintenance periods, respectively.

Conclusion
Reductions in use of broad-spectrum antibiotics and durations of therapy for inpatients with SSTIs were sustained 12 years after implementation of a local treatment guideline. These findings add to the evidence that local guidelines are an effective antibiotic stewardship tool and demonstrate that resultant improvements in prescribing can be sustained over prolonged periods.

Disclosures
Timothy C. Jenkins, MD, Basilea: Clinical events adjudication committee
1284. Racial disparities in periprosthetic joint infections: A retrospective study
Authors: Davis Joshua B , Jamison Matthew P , Liimakka Adriana , Chen Antonia , Nelson Sandra B , Pinkney Jodian 
Published: November 2023

Abstract

Background
Total joint arthroplasty (TJA) is one of the most common surgical operations performed in the US. Periprosthetic joint infection (PJI) is a daunting complication of TJA and is associated with high morbidity. Previous studies have shown that racial disparities exist in postoperative complications of TJAs, including readmissions and mortality. However, it is unclear if such disparities also exist for PJI.

Methods
A single large hospital system database was used to identify all patients who underwent either primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) between January 2018 and December 2021. Patients were stratified by self-identified racial categories. PJI was defined by ICD-9/10 coding. We present descriptive data as frequencies and percentages for categorical variables and means and standard deviations for continuous variables. We used chi-square tests to estimate crude risk ratios (cRR) and 95% confidence intervals (CIs) for PJI by race.

Results
A total of 11,818 patients were included in the final analysis. The majority (96.6%) of patients identified as non-Black (Table 1). The mean age was 69.4 (±10.3) years for non-Black patients and 65.5 (±11.5) years for Black patients. Females represented the majority of non-Black and Black patients who underwent TJA (54.1% and 66.9%, respectively). The majority of TJAs were TKAs for both non-Black and Black patients (54.6% and 56.1%, respectively). The incidence of PJIs was 1.6% among non-Black patients compared to 3.3% among Black patients (cRR (95% CI): 1.99 (1.17 – 3.39); p=0.0112). The majority of PJIs occurred post TKA (Table 1).

Conclusion
Preliminary findings suggest that racial disparities exist in PJIs. These findings were not adjusted for possible confounding factors such as age, sex and comorbidities. Future studies are needed to determine if such disparities persist when other factors are considered.

Disclosures
Antonia Chen, MD, MBA, Adaptive Phage Therapeutics: Advisor/Consultant|Adaptive Phage Therapeutics: Grant/Research Support|Avanos: Advisor/Consultant|BICMD: Advisor/Consultant|Convatec: Advisor/Consultant|Elute: Grant/Research Support|Ethicon: Advisor/Consultant|GLG: Advisor/Consultant|Guidepoint: Advisor/Consultant|Heraeus: Advisor/Consultant|Hyalex: Stocks/Bonds|IlluminOss: Stocks/Bonds|Irrimax: Advisor/Consultant|Irrimax: Stocks/Bonds|Journal of Bone and Joint Surgery: Deputy Editor|Osteal Therapeutics: Advisor/Consultant|Osteal Therapeutics: Stocks/Bonds|Peptilogics: Advisor/Consultant|Peptilogics: Grant/Research Support|Pfizer: Advisor/Consultant|SLACK Incorporated: royalties|Smith and Nephew: Advisor/Consultant|Sonoran: Stocks/Bonds|Stryker: Advisor/Consultant|Taylor & Francis Group: Royalties|UpToDate: Royalties
1286. Evaluating Dalbavancin Suppression Therapy in Patients at High Risk for Recurrent Infections
Authors: Shaw Michael , Derrick Caroline , Pizzuti Morgan , Justo Julie Ann , Frens Jeremy J , Kufel Wesley D , de Lima Corvino Daniela , Krekel Tamara , Kabbani Salam , Brock Jeff , Derringer Jon , La Hoz Ricardo M , Kinn Patrick M , Diaz Beatriz , Brandon Bookstaver P , Antolí Ana Cristina 
Published: November 2023

Abstract

Background
Dalbavancin is a long-acting lipoglycopeptide used off-label in the treatment of deep-seated infections. An emerging potential niche for dalbavancin is chronic suppressive therapy in patients with retained sources. Limited data exists describing the use of DST. The purpose of this study is to evaluate the long-term safety, effectiveness, and optimal dosage regimens of dalbavancin suppression therapy (DST).

Methods
This was a multicenter, multinational, retrospective observational cohort study among adult patients who received as least 1 dose of suppressive dalbavancin between January 1, 2018 and March 31, 2023. The primary endpoint was the proportion of patients on DST who experienced treatment-emergent adverse events (TEAEs). Additional endpoints included assessment of clinical failure defined as hospitalization or microbiological recurrence due to index organism a and a detailed assessment of dosing regimens used.

Results
A total of 46 patients who received DST were assessed. Therapy was continued for an average of 6.8 months. The majority of patients (83%) had a retained prosthesis or device. Staphylococcal spp. was the most prevalent pathogen (47%) and the majority were monomicrobial. TEAEs were observed in 18 (39%) patients. Nephrotoxicity was the most common TEAE with 15 (33%) patients experiencing an AKI during DST. Only 1 TEAE (2.2%) was considered related to dalbavancin therapy TEAEs that led to the discontinuation or dosing modification of DST occurred in 1 (2.2%) patient. The most frequently used dosage scheme was 1500 mg IV every 2 weeks, followed by 1000 mg IV every 4 weeks. Eight patients (17%) were hospitalized or had microbiological recurrence due to the index organism, occurring an average of 7 months after starting DST.

Conclusion
DST was utilized for a variety of infections, most of which involved prostheses. Though TEAEs were observed in nearly 40% of patients, those resulting in discontinuation or dose modification were rare despite long-term follow-up. Majority of patients experienced clinical success at an average 7-month follow-up. Future prospective studies should assess pharmacokinetics of DST to determine the optimal dosage regimen.

Disclosures
Julie Ann Justo, PharmD, MS, FIDSA, BCPS, Gilead Sciences: Advisor/Consultant|Shionogi: Advisor/Consultant|Vaxart: Stocks/Bonds Wesley D. Kufel, Pharm.D., BCPS, BCIDP, AAHIVP, Merck & Co.: Grant/Research Support Tamara Krekel, PharmD, BCPS, BCIDP, AbbVie: Honoraria|Merck: Honoraria|Shionogi: Honoraria Ricardo M. La Hoz, MD, Takeda: Advisor/Consultant