bluuebunny/crossref_metadata_2025_split huggingface dataset:
2200. The Antibiotic Steward's Nightmare: Long-Term Antibiotics in An Infectious Disease Practice
Authors: Karkenny Gabriel , Pao Megan , Demissie Seleshi , Shah Nikeith , Hirsch Bruce 
Published: November 2023

Abstract

Background
The effects of long-term antibiotic use, including the frequency of recurrent infections and new-onset resistant infections, are not fully understood. The role of antibiotics in the disruption of the gut microbiota has been well-described, impacting insulin susceptibility and lipid deposition.
Prolonged antibiotic use may have potential to be implicated in obesity, diabetes, and hyperlipidemia. There may also be an effect on the incidence of secondary infections with new organisms, the frequency of breakthrough infections from the index organism, and the selection for resistant infections.

Methods
This retrospective study evaluated 78 patients seen at an outpatient infectious disease practice. Inclusion criteria were patients with prescription of an oral antibiotic for 90 or more consecutive days between 9/1/18 and 12/31/2019, who utilize a health system pharmacy. Data was collected from patient charts at baseline prior to antibiotic initiation, and at time of most recent follow up after the initiation of antibiotic.

Results
Cephalexin (37.2%), azithromycin (34.6%) and amoxicillin (12.8%) were the most common antibiotics prescribed. Mean patient age was 69.4 years. Indications for antibiotic use included NTM infections (34.6% of cases), prosthetic joint infections (21.8%), recurrent UTIs (10.3%), and prosthetic valve infection (7.7%). 23.4% of patients experienced breakthrough infection with the index organism, while 21.8% experienced new, unrelated infection during follow-up, of which 52.9% had a resistant organism isolated. Mean BMI at baseline was 26.9, and BMI at follow-up was 27.3. The difference between baseline and follow-up BMI was not statistically significant (p=0.177). A1C, LDL, and cholesterol rose from baseline to follow-up, but did not reach statistical significance.

Conclusion
Patients on long-term antibiotics had a numerical increase in BMI, A1C, LDL, and cholesterol values following initiation, but those increases were not statistically significant. Recurrence of infection and emergence of resistance was common. The small sample size and limitation of studying patients from one practice within one health system pharmacy are limitations of the study. Further studies with larger sample sizes and comparative groups by diagnosis are needed.

Disclosures
All Authors: No reported disclosures
2202. Missed Opportunities for Penicillin Allergy De-labeling in Infectious Disease Clinics
Authors: Martinez-Palmer Meaghan , Khan Parisa F , Xu Teena 
Published: November 2023

Abstract

Background
90% of patients who report a penicillin allergy are not truly allergic and can safely receive penicillins. Patients labeled as “penicillin allergic” are more likely to receive non-beta lactam antibiotics and suffer worse clinical outcomes. In this study, we aimed to quantify the rate of missed opportunities for penicillin allergy de-labeling in patients seen in ID clinic.

Methods
This single-center retrospective study identified patients with a documented penicillin allergy who attended an ID clinic appointment between 1/1/21 and 12/31/22. Allergy history was ascertained by chart review. Extracted data included date of reaction entry into the medical record, reaction type (IgE-mediated, unknown reaction, side effect, severe cutaneous adverse reactions/non-IgE-mediated), observed or historical reaction, severity of reaction, and documented tolerance of penicillin since initial reaction. Patients who had tolerated penicillins since reaction or had side effects were eligible for immediate de-labeling. Patients with unknown reactions, remote IgE-mediated allergies &gt;10 years ago, or non-severe IgE-mediated allergies &gt;5 years ago were considered candidates for further evaluation and penicillin allergy testing. All other reactions were considered ineligible for further evaluation.

Results
Of the 83 patients reviewed, 54 had reactions suggestive of an IgE-mediated allergy (Figure 1). 99% of patients had historical, self-reported reactions. At the time of ID clinic visit, 31 patients were eligible for immediate de-labeling due to tolerance of penicillins since reaction. Only 4 patients were ineligible for further evaluation. Median duration of penicillin allergy label was 18.8 years. 12 patients were ultimately de-labeled by the time of chart review.
Figure 1
Types of Reactions

Conclusion
37% of patients with penicillin allergies seen in an ID clinic were eligible for immediate allergy de-labeling. These findings demonstrate a high rate of missed opportunities for ID providers to remove penicillin allergies during clinic visits.

Disclosures
All Authors: No reported disclosures
2212. Cessation of fluoroquinolone prophylaxis in inpatients with haematological malignancy – a retrospective cohort analysis
Authors: Bapat Anjaneya , Drumright Lydia N , Caldwell Louise , Jimenez-England Fergus , Lambourne Jonathan , Agrawal Samir 
Published: November 2023

Abstract

Background
Fluoroquinolone prophylaxis remains standard-of-care for inpatients with hematological malignancy expected to have prolonged neutropenia. However, there are increasing concerns about drug toxicities, the negative impact on the microbiome, antimicrobial resistance and mortality.

Methods
In our centre, ciprofloxacin prophylaxis was used for patients with acute leukaemia, high-risk myelodysplastic syndrome and those receiving a hematopoietic stem cell transplant until September 2019 (period T1). Thereafter, ciprofloxacin prophylaxis was stopped (period T2). This retrospective cohort analysis analysed 2391 admissions among 1089 patients between April 2017 and January 2022 for outcomes including mortality, Gram-negative bloodstream infection (GNBSI) and admission to the intensive care unit (ICU).

Results
Patients in T1 and T2 were well-balanced for age, gender, underlying diagnosis and treatments (Table 1). The cessation of fluoroquinolone prophylaxis was associated with a significant reduction in mortality (16.7% vs 11.0%, p=0.008), increase in GNBSI (8.5% to 12.4%, p=0.038), but no difference in ICU admissions (8.2 vs 8.3%, p=0.945). Patients in T2 who developed GNBSI had significantly lower rates of fluoroquinolone resistance (RR=0.32; 95% CI: 0.18 -0.56) and extended spectrum beta-lactamase production (RR 0.23; 95% CI: 0.09-0.55). In time updated Cox proportional hazard models, patients in T2 were significantly less likely to die than those in T1 (RR=0.46, 95% CI: 0.37-0.58) in fully adjusted models (Figure 1). The survival benefit seen in T2 patients was seen in both patients with, and without, GNBSI.
Table 1
Participant characteristics at first included visit for all ciprofloxacin prophylaxis eligible haemato-oncology inpatients by time period, fluoroquinolone prophylaxis (T1) given and no prophylaxis (T2) given
Figure 1
Survival over study time based on contributions to time period 1 with routine ciprofloxacin prophylaxis (T1) and time period 2 with no fluoroquinolone prophylaxis given (T2) among inpatients in haemato-oncology who were fluoroquinolone prophylaxis eligible (n=1089). Fully adjusted models are adjusted for age, sex, admitted through emergency, currently receiving hematopoietic stem cell transplant, cycle of treatment, and diagnosis.

Conclusion
The cessation of fluoroquinolone prophylaxis was associated with significantly lower mortality, lower antimicrobial resistance, no change in ICU admission rates but a higher recorded rate of GNBSI. It is possible that the widespread use of fluoroquinolone prophylaxis may have been causing harms in this patient population.

Disclosures
Anjaneya Bapat, FRCPath, Gilead: Honoraria Jonathan Lambourne, MB BS, BA, MSc, DTM&H FRCP, FRCPath, PhD, Mundipharma: Advisor/Consultant|Mundipharma: Advisor/Consultant Samir Agrawal, MD PhD, Pfizer: Grant/Research Support|Pfizer: Honoraria|Shionogi: Honoraria
2233. Burden of Bacterial Antimicrobial Resistance in United States in 2019: A Systematic Analysis
Authors: Amin Vishrant Prafulchandra , Dhanani Maulik , Patel Juhi , Dhawan Arushi , Mahesh Gangannapalle , Chenna Venkata Sai Harshabhargav , Kyada Sumit , Dekhne Anushka , Desai Hardik Dineshbhai 
Published: November 2023

Abstract

Background
The burden of AMR in the United States (US) is significant. According to the Centers for Disease Control and Prevention (CDC), at least 2.8 million people in the United States acquire antibiotic-resistant infections each year, and more than 35,000 people die as a result.

Methods
Using the Global Burden of Disease, Antimicrobial resistance (AMR) methodology, data were obtained on deaths and DALYs attributable to and associated with bacterial AMR for 23 pathogens in the US in 2019.

Results
In the US, there were 60,813 deaths (95% uncertainty interval [UI]:32,520-102,231) associated with and 14,987 deaths (95% UI:7,712-25,156) attributable to bacterial AMR in blood stream infection highest in 2019. Staphylococcus aureus (61,011) and E Coli (41,656) accounted for the majority of deaths attributable to and associated with AMR in 2019, and resistance was high among multiple types of antibiotic class. There is a significant burden of AMR in Staphylococcus aureus, with up to 50% of the resistance attributed to macrolides, 38% attributable to fluoroquinolones.
Deaths associated and attributable to bacterial antimicrobial resistance by pathogen in USA, in 2019
A) All age-counts B) Age-standardized Rate
Deaths Associated with and attributable to bacterial Antimicrobial resistance by syndrome in USA, in 2019

A) All age counts B) Age-Standardized Rate
DALYs attributable to and associated with bacterial antimicrobial resistance in USA, in 2019
A) Age-standardized DALY by Infectious Syndrome B) Age-Standardized DALY by Pathogen

Conclusion
AMR is a serious burden in the United States, with millions of people acquiring antibiotic-resistant infections each year and tens of thousands dying as a result. Preventing the spread of AMR requires a multifaceted approach that includes improved infection control practices, more judicious use of antimicrobial drugs, increased surveillance and monitoring of resistance patterns, and the development of new antibiotics and other treatment options.

Disclosures
All Authors: No reported disclosures
2243. Patterns of Micafungin Prescribing in the Intensive Care Unit in an Observational Retrospective Cohort
Authors: Cozzi Francesca E , Rodriguez Raul , Herald Fischer , Hodgson Hayley A , Sansom Sarah E , Shankaran Shivanjali , Varughese Christy A , Won Sarah Y 
Published: November 2023

Abstract

Background
Micafungin is restricted by the Antimicrobial Stewardship group at Rush University Medical Center (RUMC), but use in intensive care units (ICUs) is higher than predicted according to benchmarking data. Micafungin is frequently requested empirically for sepsis despite the lack of evidence to support a mortality benefit. The objective of this review was to characterize micafungin requests in the ICUs at RUMC.

Methods
Retrospective data was collected from June 2020 - August 2022 at RUMC, an academic tertiary care center in Chicago, IL with 104 adult ICU beds. Any patient with a new micafungin order during an ICU stay was reviewed for order appropriateness and clinical outcomes. Micafungin requests were classified as “empiric” or “documented candidiasis.” The primary outcome was incidence of fungemia on culture drawn 3 days before to 7 days after the micafungin order. Among empiric requests, incidence of invasive fungal infection (IFI), defined as fungi isolated in a culture from a sterile site, was also evaluated.

Results
232 new micafungin orders were placed during the study period, of which 51 (22%) were prescribed for documented candidiasis and 181 (78%) were empiric. Of patients for whom empiric micafungin was ordered, 18/181 (10%) subsequently developed an IFI. Of these, only 6/181 (3%) developed fungemia. Other IFI identified included 8/181 (4%) abdominal infections and 4/181 (2%) with positive miscellaneous cultures. 90% (163/181) of patients with an empiric micafungin order did not develop an IFI.

Conclusion
The overall incidence of critically ill patients who developed an IFI within 7 days of a micafungin request was very low. Data sharing, prescriber education, and additional stewardship interventions should be explored to improve the appropriateness of antifungal prescribing.

Disclosures
All Authors: No reported disclosures
2267. Evaluation of Antibiotic Prescribing Trends from a Dental Clinic After Implementation of a Dental Antimicrobial Stewardship Initiative
Authors: Njeim Noor M , Stilwell Allison , Horowitz Harold , Brandwein Aaron , Sconzo James , Droumbakis Claire 
Published: November 2023

Abstract

Background
Inappropriate antibiotic prescribing by dentists is as high as 80% and in the U.S., dentists rank third for writing the most antibiotic prescriptions. At NewYork-Presbyterian Brooklyn Methodist (NYP-BMH), the Antimicrobial Stewardship Program (ASP) and Division of Dental Medicine collaborated to create a clinical practice guideline regarding antibiotic use in dentistry that was implemented in May 2021 and is reinforced with annual education to dental prescribers. The purpose of this study is to compare outpatient antibiotic prescribing trends pre- and post-guideline implementation.

Methods
Patients presenting to NYP-BMH dental clinic for an emergent indication and prescribed an antibiotic from January-April of 2019-2021 (pre) and January-April of 2022 (post) were included. The primary outcome was appropriateness of antibiotic therapy. Secondary outcomes included a comparison of antibiotic selection, dosing and duration of therapy. A subgroup analysis of patients with reported penicillin allergies was conducted to compare alternative agents prescribed.

Results
A total of 119 patients in the pre and 100 patients in the post-guideline period were included. The primary outcome of appropriate antibiotic prescriptions significantly improved after guideline implementation (pre 45% vs post 64%, p&lt; 0.01). The majority of antibiotic indications were treatment-related and the most common dental diagnosis was caries. The most common antibiotic prescribed in the study was amoxicillin. Compared to pre-guideline, there was significant decreased utilization of penicillin VK (pre 3.4% vs post 0%, p=0.05) and amoxicillin-clavulanate post-guideline (pre 16% vs post 8%, p=0.02). A wide variety of dosing regimens were utilized with more guideline-concordant regimens utilized post-guideline (pre 59% vs post 72%, p=0.04). On average, shorter durations of therapy were prescribed post-guideline (pre 6.8 days vs post 5.7 days, p&lt; 0.02). Penicillin-allergic patients were prescribed less clindamycin after guideline implementation.

Conclusion
ASP initiatives and collaboration with outpatient dental clinics can improve appropriate antibiotic prescribing. As ASPs look to expand into ambulatory care settings, dental clinics should be prioritized.

Disclosures
All Authors: No reported disclosures
2272. Leftover antibiotics are a major barrier to antibiotic stewardship: results from a survey in over 500 patients in ambulatory care settings
Authors: Shah Jesal R , Trautner Barbara , Olmeda Kiara , Salinas Juanita , Laytner Lindsey , Faustinella Fabrizia , Raphael Jean , Paasche-Orlow Michael , Grigoryan Larissa 
Published: November 2023

Abstract

Background
Taking leftover previously prescribed antibiotics without consulting a healthcare professional is problematic in terms of efficacy, safety, and antibiotic stewardship. We sought to quantify and describe this practice in outpatient populations in a major urban area.

Methods
The cross-sectional survey was conducted in English or Spanish between January 2020 and June 2021 in six publicly funded primary care clinics and two private emergency departments around Houston. We assessed the rates and reasons for stopping prescribed antibiotics early and what was done with these leftover antibiotics. We compared the reasons for stopping antibiotics early between private and public clinic patients. Additionally, we determined the prevalence of prior leftover antibiotic use and the intention to use leftover antibiotics in the future.

Results
A total of 564 respondents (median age of 51 years) completed the survey, of whom 72% were female, 47% were Hispanic, 33% non-Hispanic black, and 16% non-Hispanic white (Table 1). 251 (45%) respondents reported stopping prescribed antibiotics early (Figure 1), including 171 (42%) who received care in the public and 80 (52%) in the private healthcare system. The most common rationale for stopping early was “because they felt better” (77%), followed by “forgot to finish all of the antibiotics” (18%). Respondents from the private system were more likely to stop early due to healthcare provider recommendations or side effects (Figure 2). Of all the respondents who stopped early, 74% kept the leftover antibiotics and 24% threw them away. Notably, 51% reported they intended to take leftover antibiotics without contacting a healthcare provider in the future. Over 26% (149) said they had previously taken leftover prescription antibiotics.

Conclusion
Stopping prescribed antibiotics early and saving residual supplies for future use are common. As patients mostly ascribed early discontinuation to feeling better, providers may have dispensed scripts for overly long durations or inappropriate indications. To curb nonprescription antibiotic use and antimicrobial resistance, we must tackle all facets of the leftover antibiotic use continuum, from over prescribing to hoarding.

Disclosures
Barbara Trautner, MD, PhD, Genentech: Grant/Research Support|Peptilogics: Grant/Research Support
2307. Respiratory Virus Testing Strategy on Admission to Hospital in a Season where SARS-CoV-2 is Co-circulating with Seasonal Respiratory Viruses
Authors: Reason Paige , Williams Victoria R , Mieusement Lorraine Maze Dit , Candon Heather , Li Xena , Kozak Robert , Leis Jerome A 
Published: November 2023

Abstract

Background
Syndromic multiplex testing is the mainstay of viral respiratory surveillance, yet some evidence supports the use of asymptomatic testing for SARS-CoV-2 on patient admission. We conducted a prospective quality improvement study to determine the adherence and outcomes associated with a hybrid surveillance strategy for patients being admitted to an acute care hospital who underwent testing on admission.

Methods
In November, 2022, corporate education recommended that patients with compatible viral respiratory symptoms undergo respiratory multiplex testing for 15 viral pathogens, while those without viral respiratory symptoms (considered asymptomatic) undergo SARS-CoV-2 PCR testing alone. Between December 1, 2022 to March 30, 2023, we measured the testing strategy using positivity rate, rate of omission (i.e., SARS-CoV-2 testing for symptomatic patients, defined as needing a repeat swab for multiplex within 24-hours of admission), and rate of commission (i.e., multiplex testing for asymptomatic patients). Those with detection of non-SARS-CoV-2 respiratory viruses in absence of symptoms were prospectively assessed for 24 hours for development of symptoms and roommate contacts underwent syndromic surveillance for 72-hours.

Results
Among 5659 patients tested on admission, 2868(50.6%) underwent multiplex testing while 2791(49.3%) were tested only for SARS-CoV-2. The positivity rate for multiplex testing, positivity rate for COVID SARS-CoV-2 testing, omission rate and commission rate were 249/2868(8.7%), 81/2791 (2.9%), 259/1403(17.8%), 1618/4091(39.6%), respectively. Symptom status for 165 patients was not available. Asymptomatic non-SARS-CoV-2 positive patients made up 0.6% of all admissions, of whom none developed symptoms within 24 hours, and the attack rate among roommate contacts was zero (0/20). There were only 31 additional days of precautions for asymptomatic non-SARS-CoV-2 respiratory virus detection that made up 4.4% of overall precaution-days for respiratory virus infection.

Conclusion
A hybrid surveillance strategy for patients admitted to hospital based on presence of symptoms was implemented with relatively low rates of repeat testing and asymptomatic non-SARS-CoV-2 virus detection.

Disclosures
Jerome A. Leis, MD MSc FRCPC, Ontario Hospital Association, Ministry of Attorney General of Ontario, Seneca College: Expert Testimony
2338. Robust and Persistent B Cell Responses Following Third Dose SARS-CoV-2 Vaccine Determine Protection from COVID-19
Authors: Byrne Joanne , Gu Lili , García-León Alejandro , Gaillard Colette Marie , Tomás-Cortázar Julen , Negi Riya , Alalwan Dana , Saini Gurvin , Donohue Sean , Reynolds Bearach , Kenny Grace , Leamy Kelly , O’Gorman Tessa , O’Broin Cathal , Savinelli Stefano , Feeney Eoin R , Yousif Obada , Cotter Aoife , de Barra Eoghan , Sadlier Corinna , Landay Alan , Doran Peter , Cox Rebecca J , Olesen Ole , Lelièvre Jean-Daniel , Cornely Oliver A , Gautier Virginie , Mallon Patrick 
Published: November 2023

Abstract

Background
The immunological memory to SARS-CoV-2 (SCV-2) vaccination has multiple components, with robust antibody (Ab) and B cell responses demonstrated post vaccination. The extent and persistence of T cell responses to vaccination remains unclear. We explored SCV-2 specific Ab, B cell and T cell responses to 3rd dose vaccine and their relationship to incident COVID-19.

Methods
In plasma from adults enrolled in a multicentre prospective cohort, sampled before, 14 days and 10 months post 3rd dose vaccine (BNT162b2) we measured anti-SCV-2 receptor binding domain (RBD) Ab by electrochemiluminescence assays. Subjects reported incident COVID-19 that occurred post vaccination. In a subanalysis, we assessed SCV-2-specific plasma cell, memory B cell and T cell responses in peripheral blood mononuclear cells after stimulation with wild type (WT) RBD, WT full Spike antigen, Omicron RBD and Omicron S1 antigens by ELISpot (Mabtech ELISpot, Sweden, Fig 1). We compared between-group differences in immunological outcomes by incident infection by Wilcoxon signed rank or Mann–Whitney U tests. Data are median (IQR) unless specified.

Results
Of 132 subjects (age 43 [32-50], 81% female (Table 1), 47 (36%) reported incident SCV-2 infection at 18 (16-21) weeks post 3rd vaccine. 76 subjects contributed to the cellular immunity subanalysis [23 of whom provided additional samples 10 months post vaccine (Table 1)]. RBD titres and B cell responses increased significantly 2 weeks post 3rd vaccine (Fig 2, p&lt; 0.001), with RBD titres and WT-specific memory B cell responses remaining significantly higher than pre-booster vaccine levels at 10 months (Fig 2, p&lt; 0.001). In contrast, there was no significant difference in T cell responses at two weeks or 10 months post 3rd dose vaccine (Fig 2). There was no difference in 2-week post vaccine RBD or T cell responses in those with and without incident SCV-2 infection. However, those with incident infection had significantly lower WT RBD-specific plasma and memory B cell levels (Table 2, all p&lt; 0.05).

Conclusion
3rd dose vaccination induced robust antibody and B cell responses which persist at 10 months, but not T cell responses. Higher memory B cell responses post vaccination, rather than circulating antibody titres or T cells, are associated with protection from subsequent infection.

Disclosures
Oliver A. Cornely, MD PhD, DZIF: Advisor/Consultant|DZIF: Board Member|DZIF: Grant/Research Support|DZIF: Honoraria|DZIF: Stocks/Bonds