bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1609. Provider and Nursing Perspectives on "Panculture": Opportunities for Innovative Diagnostic Stewardship Interventions
Authors: Gibas Kevin , Mermel Leonard 
Published: January 2025

Abstract

Background
Overutilization of diagnostic tests results in inappropriate antibiotic use, increased hospital length of stay, higher healthcare costs, overdiagnosis of healthcare-associated infections, and antimicrobial resistance.
Table 1
Participant Characteristics

Methods
From January 3 – February 26, 2024, we conducted two prospective surveys focused on the evaluation of febrile inpatients at Rhode Island Hospital. One survey was of medical providers trained in internal medicine, surgery, pediatrics, emergency medicine, and neurology and the other was of nursing staff in inpatient areas and the emergency department (ED).

Results
70 providers (9%) and 178 nursing staff (12%) completed their respective surveys. When asked about evaluating febrile inpatients, 64% of providers (n=43) reported “always” or “often” ordering full fever workups or ‘panculturing’ and 67% of providers (n=47) reported “always” or “often” physically evaluating febrile patients at the bedside (Table 2). In contrast, only 45% of nursing staff (n=80) reported that providers “always” or “often” evaluate febrile patients in person. 76% of nursing staff (n=135) responded providers “always” or “often” order full fever workups. When asked about hand-off practices for febrile patients, 71% of providers (n=50) reported “always” or “often” receiving written hand-offs. 86% of providers (n=60) reported the hand-offs are “always” or “often” accurate; however, only 17% of providers responded these were “always” accurate. 77% of providers (n=54) reported “always” or “often” following hand-off instructions to obtain a full fever workup if a patient becomes febrile, regardless of a patient’s clinical status. Responses differed significantly by nursing unit type (Table 3) and by provider specialty and position (Tables 3 & 4).
Table 3
Nursing Staff Responses by Unit Type

Conclusion
This study elucidates drivers of inefficient and excessive utilization of diagnostic studies at RIH and identifies potential targets for diagnostic stewardship interventions.
Table 4
Provider Responses by Specialty and Position

Disclosures
Leonard Mermel, DO, ScM, Citius Pharmaceuticals: Advisor/Consultant|CorMedix Pharma: Advisor/Consultant|Destiny Pharma: Advisor/Consultant|Lightline Medical: Advisor/Consultant|Lightline Medical: Stocks/Bonds (Private Company)|Pristine Access Technologies: Advisor/Consultant|Pristine Access Technologies: Stocks/Bonds (Private Company)
583. Increasing Diversity, Equity, and Inclusion in the Antimicrobial Stewardship Workforce through the SIDP Certificate Program
Authors: Eudaley Sarah , Johnson Melissa D , Jeffres Meghan N , Lawrence Kenneth , Bergman Scott J , Elizabeth Hermsen D , Zembles Tracy N 
Published: January 2025

Abstract

Background
A diverse workforce provides opportunities for patients to be served by healthcare practitioners sharing a common race, ethnicity, culture, language, or disability. The Society of Infectious Disease Pharmacists (SIDP) aims to increase engagement in an Antimicrobial Stewardship Certificate Program (ASCP) among clinicians identifying with underrepresented minoritized (URM) groups to increase workforce diversity, equity and inclusion; reduce antimicrobial resistance; and improve outcomes.

Methods
SIDP updated and redesigned its long-standing ASCP in May 2023. Healthcare professionals identifying as URM were invited to apply for a scholarship to complete the ASCP, with planned enrollment of 130 participants over 3 years. Baseline data collection included demographics, motivation for training, anticipated challenges in completing the ASCP, and confidence in stewardship activities (Likert scale 1-5, with 5 as the highest level). Demographic data prior to May 2023 was not available.

Results
To date, 97 individuals received a scholarship and were enrolled. Most were pharmacists (65%), with allied health professionals comprising the remainder. Participants most commonly identified as Black or African American (29%), Hispanic or Latin descent (21%), and Asian (18%) (Table 1). Considering non-scholarship enrollments (among those reporting race/ethnicity) over the same time-period (n=385), the scholarship increased the proportion of total participants in the program identifying as Black or African American (11% v 6%), Hispanic or Latin descent (9% v 6%), and Middle East or North African (2% v 0%). Among scholarship recipients who started the program and received an entrance survey (n=45), 80% (n=36) responded. The most anticipated challenge for successfully completing the program was knowledge to design a quality improvement project (Figure1). Respondents reported the least confidence in ability to establish an antimicrobial stewardship program (Figure 2).

Conclusion
The scholarship program has increased the proportion of URM clinicians in the ASCP, resulting in a potentially more diverse workforce. Identifying and mitigating barriers to completion and assessing participant confidence in stewardship activities will inform additional program development.

Disclosures
Melissa D. Johnson, PharmD MHS AAHIVP, Biomeme: Licensed Technology|Scynexis, Inc: Grant/Research Support|UpToDate: Author Royalties Kenneth Lawrence, BS, PharmD, Seres Therapeutics: Employee Hermsen D. Elizabeth, PharmD, MBA, Pfizer, Inc.: Employee|Pfizer, Inc.: Stocks/Bonds (Public Company)
P-1628. Impact of the BioFire® FilmArray® BCID2 Panel and Antimicrobial Stewardship on Clinical Outcomes in Patients with Antimicrobial Resistant Bacteremia
Authors: Li Yihan , Dubrovskaya Yanina , Siegfried Justin , Decano Arnold , Mazo Dana , Zacharioudakis Ioannis , Marsh Kassandra 
Published: January 2025

Abstract

Background
Bloodstream infections (BSIs) carry high rates of morbidity and mortality, with delays in appropriate therapy associated with worse outcomes. Given limited available literature, our objective was to describe the impact of BioFire® FilmArray® Blood Culture Identification 2 (BCID2) panel implementation on clinical outcomes in patients with organisms not covered by empiric regimens.

Methods
This was a retrospective review comparing adults with extended-spectrum β-lactamase (ESBL), carbapenemase (CRE), or AmpC-producing Enterobacterales, Acinetobacter baumannii, Stenotrophomonas maltophilia, or Enterococcus species BSIs pre- (7/2020–12/2021) and post- (7/2022–12/2023) BCID2 implementation. Patients were excluded if the initial positive blood culture (BCX) was from an outside facility, had organisms not on the BCID2 panel, or if they died or were discharged prior to BCX results. The primary outcome was time from BCX positivity to initiation of effective therapy. Process measures included pharmacist interventions. Clinical outcomes included recurrence, resistance development, readmission, Clostridioides difficile infection, and mortality.

Results
319 patients were included (pre-BCID2 n=128; post-BCID2 n=191), with a median age of 69 years (57-81). The most common infecting organisms were Enterococcus spp. (44%) and ESBL Enterobacterales (41%), and the majority were from urinary (35%) or intra-abdominal (28%) sources. Time to effective therapy was significantly shorter post-BCID2 (7 v. 4 hours, p=0.011), particularly among those with ESBL (40 v. 5 hours, p&lt; 0.001), high-risk AmpC-producing organism (41 v. 6 hours, p=0.174), and E. faecium infections (17 v. 5 hours, p=0.067). Antimicrobial stewardship pharmacists performed more interventions post-BCID2 (34% v. 49%, p=0.006) with a higher number of interventions performed pre-MALDI-TOF speciation (22% v. 39%, p=0.002). Given low event rates, we were unable to demonstrate clinically meaningful differences in secondary endpoints between groups.Figure 1.Primary Outcome: Time to Effective Therapy

Conclusion
Implementation of BCID2 in conjunction with antimicrobial stewardship was associated with shorter time to effective therapy. Further studies are needed to understand the impact of this on patient-related outcomes.

Disclosures
All Authors: No reported disclosures
P-1655. Impact of an Educational Leaflet on Urinary Tract Infections, Asymptomatic Bacteriuria, and Antibiotics for Adults ≥65 years
Authors: Thorpe Alistair , Lee Rachael A , Szymczak Julia E , Farrell Madeline C , Fong Karen , Muller Brandi M , White Andrea T , Fagerlin Angela , Vaughn Valerie 
Published: January 2025

Abstract

Background
Adults ≥65yrs are at high risk of harm from antibiotic overuse due to misdiagnosis of asymptomatic bacteriuria (ASB) as urinary tract infection (UTI). Alongside strategies to improve clinician prescribing, patients should be educated on ASB and empowered to discuss harms and benefits of antibiotic treatment. Previously, we used a user-centered design process to develop a patient-focused educational leaflet on UTI, ASB, and antibiotic use (Figure 1). Here, we tested whether the leaflet improved patients’ knowledge about ASB and willingness to avoid unnecessary antibiotics.Figure 1.A three-page antibiotic education designed with patients, caregivers, and clinicians.

Methods
In an online survey experiment of US adults ≥65yrs, respondents read a scenario of themselves as an asymptomatic patient with a positive urine test during prescreening for non-urologic surgery. Respondents were randomized to one of four experimental conditions which varied educational leaflet provision and the surgeons’ treatment recommendation (Figure 2). Outcome measures included whether respondents thought they (as the patient described in the case) had a UTI, how comfortable they would be not taking antibiotics, and their knowledge about UTIs, ASB, and antibiotics

Results
Figure 2 shows characteristics of the 504 study respondents [completion=89%].
Compared to those not provided the educational leaflet, respondents shown the educational leaflet were less likely to believe they had UTI (p&lt; .001), were more comfortable not taking antibiotics (p&lt; .001), and answered more knowledge questions correctly (p&lt; .001) (Figures 3&4).
Conversely, respondents who were told the surgeon recommends antibiotics were more likely to believe they had UTI (p&lt; .001) and less comfortable with not taking antibiotics (p=.013) but did not differ in their knowledge (p=.096).

Conclusion
A patient-centered educational leaflet, designed with patients, caregivers, and clinicians, was effective in aligning antibiotic treatment preferences with clinical guidelines and improving knowledge about UTI, ASB, and antibiotics. Findings offer important preliminary evidence on the potential for patient/caregiver-focused education to help prepare patients/caregivers to engage in treatment decisions and contribute to reducing antibiotic overuse and its associated harms.

Disclosures
All Authors: No reported disclosures
P-1661. Characteristics and Outcomes Associated with Treatment of Asymptomatic Bacteriuria Among Patients with Neurogenic Bladder in a Statewide Hospital Database
Authors: Amenta Eva , Trautner Barbara , Horowitz Jennifer , McLaughlin Elizabeth , Czilok Tawny , Bernstein Steven J , Nielsen Daniel , Ratz David , Gupta Ashwin , Malani Anurag , Gandhi Tejal N , Petty Lindsay A , Flanders Scott A , Vaughn Valerie 
Published: January 2025

Abstract

Background
Inappropriate treatment of asymptomatic bacteriuria (ASB) among hospitalized patients leads to longer length of stay (LOS) without improving outcomes. ASB is common in individuals with neurogenic bladder (NB); however, little is known about the epidemiology, treatment, and outcomes of inpatients with NB and ASB.

Methods
Between 1/1/2017-12/31/2023, abstractors collected deidentified data—including signs/symptoms of urinary tract infections (UTI) and 30-day outcomes—from inpatients with a positive urine culture (UC) at 46 hospitals. Due to poor documentation of NB, we defined NB using surrogates (Table 1). Patients without signs or symptoms of UTI were classified as ASB. Characteristics of patients a) with vs. without NB and b) with NB and ASB who were treated vs. untreated were compared using t or chi-squared tests. Finally, we compared 30-day outcomes of patients with NB and ASB treated vs. untreated using general estimating equation models adjusting for variables known to be associated with the outcomes via inverse probability of treatment weighting.

Results
Of 45,800 inpatients with a positive UC, 6% (2,769) had NB (Table 2). Compared to patients without NB, patients with NB were more often male (59% vs. 29% p&lt; 0.001), younger (median age 69 vs. 76 p&lt; 0.001), less likely to be white (64.6% vs. 77% p&lt; 0.001) and more likely to use a catheter (76% vs. 17% p&lt; 0.001). While ASB rates (25.7% vs. 25.2%, p=0.62) were similar, bacteremia from a presumed urinary source (4.6% vs. 7.2%, p&lt; 0.001) was less common in patients with NB. 85.1% (605/711) of patients with NB with ASB received antibiotic therapy. Similar to patients without NB, altered mental status (AMS) was the main predictor of ASB treatment (23.8% vs. 13.3% p=0.017; Table 3). LOS after UC was longer among those with NB and ASB who were treated vs. untreated (4 vs. 3 days, aIRR: 1.538, 95% CI: 1.33-1.77 p&lt; 0.001; Table 4).

Conclusion
Among inpatients with NB in a statewide dataset, ASB was common, more frequently treated with antibiotics, and treatment was associated with longer LOS. AMS was the main predictor of ASB treatment. Bacteremia was lower among patients with NB, suggesting UC overuse.

Disclosures
Barbara Trautner, MD, PhD, Abbott Laboratories: Stocks/Bonds (Public Company)|AbbVie: Stocks/Bonds (Public Company)|Bristol Myers Squibb: Stocks/Bonds (Public Company)|Pfizer: Stocks/Bonds (Public Company)|Phiogen Pharma: Advisor/Consultant Elizabeth McLaughlin, MS, RN, Blue Cross Blue Shield of Michigan: Salary Support
P-1665. Predictors of Antibiotic Prescription for Upper Respiratory Tract Infections in Cancer Patients
Authors: Jang Hyeon Mu , Boumiza Aida , Lin I Hsin , Cohen Nina , Shah Krishna , Majeed Jibran , Groeger Jeffrey , Seo Susan K 
Published: January 2025

Abstract

Background
Antibiotic stewardship efforts are ongoing to improve antibiotic prescribing in the outpatient setting for patients with acute upper respiratory infection (URI). Limited data regarding predictors of antibiotic prescription for acute URI are available for ambulatory patients with cancer.

Methods
Adult cancer patients with URI who presented to the Urgent Care Center (UCC) or Symptom Care Clinic (SCC) at Memorial Sloan Kettering Cancer Center and underwent respiratory pathogen panel (RPP) between September 1, 2019, and March 11, 2020, prior to the start of the Coronavirus Disease 2019 pandemic were evaluated. Study population was dichotomized by receipt of antibiotic prescription (yes vs. no). Demographics, cancer treatment, URI characteristics, and URI management were compared by the Student's t test or Mann Whitney Wilcoxon test and Chi-square or Fisher's exact test as appropriate. Logistic regression was performed to evaluate the predictors of antibiotic prescription.

Results
Of 552 patients, 343 (62.1%) had a solid tumor, 384 (69.6%) received cancer treatment within 30 days of the URI, and 377 (68.3%) had a positive RPP result. Antibiotics were prescribed in 156 (28.3%) patients. Only 16.7% (26/156) were appropriate based on the Centers for Disease Control’s Adult Outpatient Treatment Recommendations. Multivariable logistic regression showed that predictors of antibiotic prescribing included SCC visit location (odds ratio (OR) 2.09, 95% confidence interval (CI) 1.30-3.38), symptom duration &gt; 7 days (OR 2.29, 95% CI 1.26-4.17), earache (OR 9.30, 95% CI 3.47-24.93), sinus pain/headache (OR 2.64, 95% CI 1.53-4.56), negative RPP result (OR 1.88, 95% CI 1.18-2.98), and negative RPP result for influenza (OR 3.31, 95% CI 1.53-7.16). Cancer therapy within 30 days of URI diagnosis and pharyngitis were insignificantly associated with antibiotic prescriptions.

Conclusion
Almost one-third of outpatients at a single cancer center were prescribed antibiotics for URI with only 16.7% being appropriate. Getting real-time RPP results can be helpful to optimize antibiotic prescribing. Understanding risk factors for antibiotic prescribing in ambulatory cancer patients with URI may better direct antimicrobial stewardship efforts.

Disclosures
Susan K. Seo, MD, Merck: Grant/Research Support
P-1670. Digital Five-Step Tool Enhances Standard Perioperative Prophylaxis by Delabeling Surgical Patients from Allergy to Beta-Lactam Antibiotics
Authors: Röder Daniel , Eichhorn Kathrin , Meybohm Patrick , Stoevesandt Johanna , Surat Güzin 
Published: January 2025

Abstract

Background
Up to 90% of patient-reported allergy to one or more beta-lactam antibiotics (BLA) are misdiagnosed, underscoring the widespread issue of incorrect allergy identification. The Infectious Diseases Society of America (IDSA) guidelines and local Antimicrobial Stewardship Programs advocate for the delabeling of self-reported BLA allergies in preoperative settings to facilitate the administration of BLAs, the standard for perioperative antibiotic prophylaxis (PAP). This study evaluates the safety of a novel, digitally-based questionnaire designed to delabel surgical patients from BLA allergies, promoting the use of standard PAP.
Digital five-step tool to delabel surgical patients from allergy to beta-lactam antibiotics
Workflow of the digital delabeling tool as published by Schrüfer (2022) Allergy, Asthma & Clinical Immunology, 18(1), 26.

Methods
A single-center retrospective observational study was conducted from September 2020 to October 2022, analyzing surgical patients who reported BLA allergies during preoperative assessments. A digital tool integrated into the patients’ electronic health records assessed the risk of a genuine allergy using five specific questions and then provided recommendations for or against the use of standard PAP (Figure 1). Subsequent allergic reactions to PAP were monitored for 24 hours.

Results
Of the 983 patients reporting BLA allergy, 322 (32.7%) did not require PAP. Among the remaining 661 patients, the questionnaire targeted 420 (63.5%) for delabeling. Within this group, 262 patients (62.4%) received standard BLAs and reported two allergic reactions (0.8%), while 158 (37.6%) were administered alternative antibiotics, experiencing two allergic reactions (1.3%). The tool’s negative predictive value was 99.2%. Conversely, of the 241 patients advised to maintain the BLA allergy label, 197 (81.7%) received alternative antibiotics with four allergic reactions (2.0%), and 44 (18.3%) were administered BLAs contrary to the tool’s advice, yet experienced no allergic reactions.

Conclusion
The use of a novel, digitally-based five-step questionnaire in the preoperative setting successfully delabeled reported BLA allergies in over 60% of patients. This tool proved straightforward and safe, substantially enhancing the use of standard first-line antibiotics and thereby adhering to best practice guidelines.

Disclosures
Daniel Röder, MBA, Biotest AG: Honoraria
589. Late Onset Invasive Group B Streptococcal Disease Outbreak in a Neonatal Intensive Care Unit Identified Through Whole Genome Sequencing — Connecticut, 2020–2024
Authors: Lambert Matthew C , Jones Sydney , Mueller Kelly , Maloney Meghan , Perera Neranjan , Incekara Kutluhan , Petit Susan , Ramachandran Veena , Grossman Marissa , Valderrama Amy , Chochua Sopio , McGee Lesley , Metcalf Benjamin , Schrag Stephanie , Sosa Lynn 
Published: January 2025

Abstract

Background
Group B Streptococcus (GBS) is a major cause of neonatal sepsis. Outbreaks of GBS late-onset disease (LOD), defined as infection during the first 7–89 days of life, are uncommon. In September 2023, 4 GBS LOD cases were reported by a neonatal intensive care unit (NICU) to the Connecticut Department of Public Health (DPH). We investigated to characterize the outbreak and guide response.

Methods
We identified patients with invasive (i.e., GBS isolated from a sterile site) LOD hospitalized in the NICU through review of data from DPH’s Active Bacterial Core Surveillance Program during January 2019–April 2024. We distinguished outbreak cases through whole-genome sequencing (WGS) of associated bacterial isolates. Single nucleotide polymorphism (SNP) analysis with a cutoff of ≤12 SNPs defined a case as outbreak-related. We abstracted medical records to collect case data. We performed 3 on-site assessments of infection prevention and control (IPC) practices and policies. To monitor response effectiveness, we performed weekly GBS colonization screening (aural, oropharyngeal, rectal sites) of infants admitted to the NICU during December 2023–April 2024. We performed WGS on GBS isolates associated with each colonization.

Results
We identified 12 outbreak-related cases during January 2020–April 2024 based on WGS. Median case interval, time between illness onset, was 85 days but ranged from three days to 458 days; 3 outbreak-patients died. Chart abstraction and on-site assessments indicated the milk room as an area for potential transmission. Variability was noted in adherence to appropriate hand hygiene, personal protective equipment use, and environmental cleaning throughout the NICU. Screening identified 7 colonized infants; GBS isolates from 3 infants matched the outbreak, and 1 colonized infant developed LOD. We recommended addressing IPC gaps and continuing GBS colonization screening to monitor for ongoing transmission.

Conclusion
This investigation highlights the integration of WGS with classic epidemiology to distinguish outbreak-related cases with long intervals between identification. In LOD GBS outbreaks where IPC gaps appear to contribute to transmission, colonization screening and WGS can evaluate effectiveness of implementation of protocols to address IPC gaps.

Disclosures
Meghan Maloney, MPH, Pfizer Global R&D: Former employee, separated in 2009. I do have a retirement entitlement which I do not actively manage/no stock options. PGRD offers periodic buy outs