bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1744. Impact of a Multimodal Antimicrobial Stewardship Intervention on Fluoroquinolone Usage for Antimicrobial Prophylaxis before Urologic Procedures at South Texas Veterans Health Care System
Authors: Kinyua Gertrude , Harb Gaielle , Hopkins Teri L , Frei Christopher R , Mendoza Vidal M , Cadena-Zuluaga Jose , Walter Elizabeth 
Published: January 2025

Abstract

Background
Fluoroquinolones (FQ) are frequently prescribed for urologic procedure prophylaxis, despite being associated with a myriad of adverse events and increasing rates of resistant bacteria. The purpose of this project was to evaluate the impact of a multimodal antimicrobial stewardship intervention on FQ usage for antimicrobial prophylaxis in urologic procedures in an outpatient setting.

Methods
This was a single-center, retrospective, cohort study of patients at the South Texas VA who underwent urologic procedures from December 1, 2020 to February 28, 2024. Initiatives conducted during this period included academic detailing, generation of provider specific FQ usage reports for review by the chief of urology, and prospective reviews of preoperative urine cultures followed by feedback on pathogen-directed therapy. The study was composed of a pre-intervention cohort and 3 post-intervention cohorts. The primary outcome was FQ days of therapy (DOT). Secondary outcomes included number of ≥3-day versus 1-2-day supply prescriptions, percentage of inappropriate prescriptions, rate of 30-day postoperative urinary tract infection (UTI), surgical site infection (SSI) and blood stream infection (BSI), emergence of FQ resistance within 1 year after procedure, and Clostridioides difficile infection (CDI) 30 days after completion of antimicrobial prophylaxis.

Results
Data from 548 patients were included for analysis (150 PRE; 139 POST2021; 168 POST2022; 91 POST2023). The majority of patients were male (94.5%), with a median age of 67 (IQR, 59-74) years. Antimicrobial and microbiological characteristics are described in Table 1. A significant decrease in pre-operative FQ DOT/100 procedures was observed between the pre- and post-intervention groups (Fig 1). This decrease was driven by a reduction of pre-operative IV FQ usage (Fig 3) with minimal impact observed with pre-operative PO FQ usage (Fig 2). No difference was observed in percentage of inappropriate prescriptions which was entirely driven by inappropriate day supply. No significant differences were observed in the secondary outcomes assessed.

Conclusion
A multimodal stewardship initiative decreased overall FQ usage prior to urologic procedures.

Disclosures
Christopher R. Frei, PharmD, FCCP, BCPS, AstraZeneca: Grant/Research Support
P-1752. Antimicrobial Stewardship Initiative on Prescribing at Discharge from a Community Medical Center
Authors: Adenkar Gargi , Raja Karan , Chen Brandon , Patel Mitesh , Philips Mona 
Published: January 2025

Abstract

Background
Inappropriate antimicrobial prescribing and overuse propagates multi-drug resistant organisms and increases risk of adverse drug events. Antimicrobial stewardship programs (ASP) focus a majority of interventions on hospital inpatients, but efforts at discharge remain limited. A recent gap analysis at our institution found that 53% of antimicrobial regimens prescribed at discharge were inappropriate in drug choice, dosing, and/or duration. Therefore, a multifaceted ASP initiative focusing on discharge antimicrobial regimens was implemented at our institution. The study objective was to assess program impact on prescription appropriateness.
Overall Appropriateness of Antimicrobial Prescriptions

Methods
Components of the stewardship initiative included development of an institution-specific prescribing guideline, clinician education, and pharmacist prospective audit and feedback at discharge. This IRB-approved study evaluated oral antimicrobial regimens prescribed to adults patients upon discharge from a community medical center. Patients were randomized irrespective of encounter type or discharge destination. Pregnant and post-partum patients were excluded. The validated National Antimicrobial Prescribing Survey (NAPS) tool was used to categorize antimicrobial appropriateness as appropriate (optimal or adequate), inappropriate (suboptimal or inadequate), or not assessable. Hospital-specific treatment guidelines, literature references, and patient-specific factors were used to determine appropriateness. The primary outcome was the proportion of appropriate discharge antimicrobial regimens before versus after initiative implementation.
Proportion of Each NAPS Category

Results
One hundred antimicrobial regimens were analyzed in each cohort. The proportion of appropriate antimicrobial regimens increased by 15% after program implementation (47% vs. 62%, p = 0.03). Exploratory outcome analyses indicated an increase in optimal regimens (26% vs. 44%) and a decrease in suboptimal (33% vs. 26%) and inadequate (20% vs 12%) therapy as categorized by the NAPS tool.

Conclusion
ASP initiative implementation increased the proportion of appropriate discharge antimicrobial regimens. Study results highlight the positive impact of a multidisciplinary approach in improving discharge antimicrobial prescribing.

Disclosures
All Authors: No reported disclosures
P-1759. Antibiotic De-Escalation in Neutropenic Fever
Authors: Evans Michelle , Tremblay Douglas , Rana Meenakshi M , Jacobs Samantha E , Fuller Risa 
Published: January 2025

Abstract

Background
Cancer patients with neutropenic fever are frequently continued on broad-spectrum empiric antimicrobial therapy (EAT) until neutrophil recovery, but recent randomized trials demonstrate that EAT de-escalation prior to neutrophil recovery is safe in certain subgroups. We evaluated outcomes of EAT de-escalation based on clinical criteria in patients with neutropenic fever at our institution.

Methods
We retrospectively reviewed charts of 49 patients with acute myeloid leukemia (AML) or hematologic stem cell transplantation (HSCT) and neutropenic fever following revisions to Standard of Practice (SOP) institutional guidelines (hereafter “SOP” group) allowing for antibiotic de-escalation using a clinical approach in comparison to a historic cohort of 60 patients. The revised SOP recommended antibiotic de-escalation to levofloxacin prophylaxis in patients who received ≥ 72 hours of EAT, were afebrile and clinically stable for 48 hours, and did not have a clinically or microbiologically documented infection. The primary endpoint was the EAT duration. Secondary end points included incidence of recurrent fever, infections, vasopressor support and/or intensive care unit (ICU) stay, and in-hospital mortality.

Results
Baseline characteristics were similar between both groups, with differences including a larger proportion of males in the SOP group compared to the control group (59% vs. 35%) and the primary underlying malignancy of multiple myeloma in the SOP group compared to AML in the control group. The median duration of EAT prior to de-escalation was shorter in the SOP group compared to the historic cohort (5.0 [IQR 4.0, 6.0] vs. 7.0 days [IQR 5.0, 10.2], p&lt; 0001). There was no difference in incidence of recurrent fever (20% vs. 30%, p=0.3) or secondary infection (10% vs. 12%, p=0.8). Incidence of vasopressor support and/or ICU stay(10% vs. 3.3%, p=0.2) and in-hospital mortality (2.0% vs. 3.3 %, p &gt;0.9) were also similar between both groups.

Conclusion
Our study indicates that our new institutional guidelines successfully lead to reduced broad spectrum antimicrobial exposure without increased infections, ICU stays, or mortality. Thus, de-escalation of EAT based on clinical criteria is safe in this high risk patient population.

Disclosures
Douglas Tremblay, MD, AbbVie: Advisor/Consultant|Astellas: Grant/Research Support|Cogent Biosciences: Advisor/Consultant|Cogent Biosciences: Grant/Research Support|Gilead: Grant/Research Support|GSK: Advisor/Consultant|Novartis: Advisor/Consultant|Sierra Oncology: Advisor/Consultant|Sobi: Advisor/Consultant|Sobi: Grant/Research Support|Sobi: Patent for use of pacritinib and azacitidine in CMML|Sumitomo: Grant/Research Support Samantha E. Jacobs, MD, MS, Ansun Biopharma: Advisor/Consultant|Eurofins, Viracor, LLC.: Grant/Research Support
P-1763. Implementation of a Pharmacy-based Automated MRSA PCR Screening Intervention to Guide Discontinuation of Vancomycin for Pneumonia
Authors: Azem Reem , Saade Elie , Veltri Courtney , Newman Nicholas , Kolehmainen Natalie , Dang Khoi , Stempak Lisa M , Wilson Brigid , Hojat Leila S 
Published: January 2025

Abstract

Background
Vancomycin is administered for suspected methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in hospital settings, but is also associated with adverse effects, emergence of resistance, and requires lab and pharmacy monitoring. MRSA nares screening has excellent negative predictive value for MRSA pneumonia and results faster than culture. We sought to decrease vancomycin overuse by identifying patients at low risk for MRSA pneumonia using rapid polymerase chain reaction (PCR) as part of an automated pharmacy-based intervention.

Methods
We performed a retrospective cohort study of inpatients prescribed vancomycin for pneumonia at University Hospitals Cleveland Medical Center from November to May 2022 (pre-intervention) and November 2022 to May 2023 (post-intervention). In June 2022, we implemented a rapid MRSA PCR screen that was automatically added to orders when vancomycin was ordered for pneumonia. We compared median time to vancomycin discontinuation between the two groups. We performed a desirability of outcome ranking and response adjusted for duration of antibiotic risk (DOOR-RADAR) analysis, ranking patients according to duration of therapy within clinical categories to assess the effect of the intervention on patient-centered outcomes.

Results
We identified 127 pre-intervention and 125 post-intervention patients (Table 1). Median vancomycin order to discontinue time was lower in post-intervention patients, though this was meaningfully different only for patients whose PCR test was collected after the automated order was placed (41.75 vs 55 hours respectively, p = 0.035) (Table 2). Most patients in the post-intervention group with vancomycin duration &gt;48 hours had delayed collection or were treated for other infections (Figure 1). The DOOR ranks for median time to discontinuation within clinical outcome categories were not meaningfully different between the two groups (p &gt;0.05) (Table 2 and Figure 2) which may relate to sample size.

Conclusion
Vancomycin treatment duration was shorter in patients after a pharmacy-based automated MRSA PCR screening intervention when implemented efficiently. This research will guide future interventions including pairing automated rapid testing with active stewardship response.

Disclosures
Elie Saade, MD, MPH, FIDSA, Janssen Global Services: Advisor/Consultant|Janssen Global Services: Advisor/Consultant|Janssen Research and Development: Advisor/Consultant|Janssen Research and Development: Advisor/Consultant Lisa M, Stempak, MD, Cytovale Inc.: Advisor/Consultant
P-1765. Are we there yet? The ongoing journey for improving management of asymptomatic bacteriuria
Authors: Kenney Rachel M , Gunaga Satheesh , Cahill Megan M , Leman Lori , Beaulac-Harris Amy , Eriksson Erin , Geyer Abigail , Shallal Anita , Stein Tricia L , Mazzetti Nicole , Kaiser Kiera , Dubay Janeen , Arthur Ashli , Higginbottom Manal , Jayaprakash Namita , Dass Sairia , Haddad Ayyoub , Boxwalla Asgar , Kaatz Scott , Tibbetts Robert , Veve Michael , Suleyman Geehan 
Published: January 2025

Abstract

Background
Treating asymptomatic bacteriuria (ASB) with antibiotics contributes to preventable patient harm. This quality improvement study aimed to evaluate the effectiveness of ongoing diagnostic and antibiotic stewardship interventions in reducing unnecessary testing and treatment of ASB.

Methods
This retrospective, cross-sectional quality improvement study spanned from 1/2017-3/2024 at a five-hospital urban and suburban health system in Michigan. Interventions included i). Implementation of urinalysis with reflex to urine culture in 2/2019, with reflex criteria revised in 7/2022 to ≥ 10 WBCs; ii). Adoption of a urine culture hard stop after hospitalization day 3 (3/2021); iii). Introduction of an ASB progress note smart phrase and educational initiative via a 1-page handout and narrated slides in the first quarter of 2023. The primary endpoint was the proportion of patients with ASB who received antibiotic treatment, as defined by Vaughn et al JAMA Intern Med 2023. Secondary endpoints encompassed the number of provider smart phrase documentations; overall urine culture volume per year; proportion of all positive urine cultures representing ASB; and overall ASB antibiotic use, calculated as the ratio of ASB treated with antibiotics to all positive urine cultures.

Results
The annual volume of urine cultures decreased by approximately 25% (Figure 1), from 87,556 in 2017 to 65,955 in 2023. The percentage of positive cultures representing ASB is depicted in Figure 2. The ASB smart phrase was documented in the medical record of 233 patients over one year: 165 (71%) were women, with a median age of 72 [48, 82] years. Emergency medicine providers utilized the smart phrase most frequently (97/233, 42%), followed by consultants (79/233, 34%). Overall ASB antibiotic use ranged from 9.7-22.7% in Q1 2022 and declined to 4.5-7% in Q1 2024. The primary endpoint, the system-wide average treatment of patients with ASB, declined modestly over time, but improvements were inconsistent among hospitals (Figure 3).

Conclusion
Ongoing interventions targeting diagnostic and antibiotic stewardship through educational efforts were associated with a reduction in testing and treatment of ASB. However, suboptimal treatment of ASB remain a concern.

Disclosures
Rachel M. Kenney, PharmD, BCIDP, Medtronic Inc: Spouse is an employee, stockholder Erin Eriksson, PharmD, BCPS, BCIDP, Stryker Corp: Stocks/Bonds (Public Company)
P-1768. Evaluation of Pharmacist-Driven Automatic 5-day Stop Dates for Ceftriaxone in Respiratory Tract Infections
Authors: Adams David T , Kaur Satwinder S 
Published: January 2025

Abstract

Background
Despite 2019 ATS/IDSA CAP guideline support for a 5-day treatment duration, compliance with these recommendations remains suboptimal. Patients that receive extended courses of antibiotics are at increased risk for adverse outcomes, longer hospitalization stays, and development of antimicrobial resistance. The objective of this study was to compare hospital length of stay (LOS) and length of therapy (LOT) before and after a pharmacist-driven automatic stop date protocol for ceftriaxone for CAP and COPD exacerbations.

Methods
A retrospective cohort study conducted at Texas Health Harris Methodist Hospital Fort Worth evaluated patients before June 2023, and after November 2023. Patients were excluded if treatment indications were for non-respiratory indications, received ≤2 ceftriaxone doses, admitted into the ICU, LOS ≥10 days, or if placed on hospice within 72 hours of admission. Pharmacists then adjusted ceftriaxone orders to 5 total days for CAP and COPD exacerbations. The primary outcome was hospital LOS and LOT. Secondary outcomes included 30-day all-cause in-hospital mortality and 30-day hospital readmission due to infections.

Results
295 patients were included in the final analysis with 145 patients in the pre- and 150 patients in the post-group. After implementation of the protocol, a statistically significant reduction in hospital LOS was observed in the post-group (4 days vs 5 days, p &lt; 0.0001). There was also a statistically significant reduction in median LOT for CAP and COPD (5 days vs 7 days, p &lt; 0.0001). No increase in 30-day all-cause mortality (0% vs 4%, p =0.012) or 30-day hospital re-admission rates due to infections (3% vs 8%, p =0.033) were observed in the post- compared to the pre-group.

Conclusion
Based on the results of this study, implementation of a pharmacist-driven automatic 5-day stop date protocol for ceftriaxone is an effective antimicrobial stewardship initiative that can help increase compliance to guideline recommendations for CAP and COPD while also decreasing hospital LOS. Additionally, this initiative was not associated with increased rates of mortality or hospital re-admissions compared to longer durations and influenced discharge antibiotic prescription habits.

Disclosures
All Authors: No reported disclosures
P-1772. Reduction in Vancomycin-Associated Acute Kidney Injury with Montelukast
Authors: Teran Nicholas , Phe Kady , Tam Vincent 
Published: January 2025

Abstract

Background
Vancomycin is the most common antimicrobial used for the treatment of serious infections implicated by β-lactam resistant Gram-positive bacteria but has been associated with acute kidney injury (AKI) in up to 43% of cases. Reduction in renal injury associated with nephrotoxins has been reported in an animal model with adjuvant montelukast. However, it is unclear if this protective effect could be translated to improve patient outcomes. The objective of this study was to ascertain if montelukast is correlated with reduced vancomycin-associated AKI.

Methods
We conducted a retrospective study of adults (≥ 18 years) who received intravenous vancomycin at our institution between 01/2020-01/2024. Patients were included if they met these criteria: vancomycin therapy ≥ 3 days and baseline serum creatinine (SCr) &lt; 1.5 mg/dL. Patients who received concomitant montelukast (intervention) were compared to those without (control). The primary outcome was the prevalence of AKI (rise in SCr ≥ 1.5x baseline) as defined by Risk, Injury, Failure, Loss, or End-stage kidney disease (RIFLE) criteria. The primary outcome was compared using the Fisher’s exact test while the duration of vancomycin therapy was compared by the Student’s t test. Independent risk factors associated with AKI were identified by multivariate logistic regression.

Results
Of 1739 patients screened, 110 patients were included in the intervention arm and 330 in the control. Patients received vancomycin for similar durations (mean ± SD, 5.1 ± 4.1 vs 5.9 ± 3.3 days, respectively; P = 0.06) and serum trough concentrations were comparable (P = 0.39). The intervention cohort experienced 2.7% AKI compared with 10.6% in the control (P = 0.01). The multivariate logistic regression analysis revealed that weight (OR, 1.02; 95% CI, 1.004 to 1.03; P = 0.011) and intensive care unit admission (OR, 6.9; 95% CI, 2.8 to 17.1; P &lt; 0.001) were independently associated with acute kidney injury, while montelukast was protective (OR, 0.29; 95% CI, 0.09 to 0.98; P = 0.046).

Conclusion
This study suggests that montelukast may be protective against vancomycin-associated nephrotoxicity, which may reduce patient harm and healthcare costs. Additional studies to investigate the nephroprotective mechanism will be conducted to corroborate these findings.

Disclosures
All Authors: No reported disclosures
629. Evaluation of Neurocysticercosis Healthcare Provider Diagnostic Practices in Houston, Texas
Authors: Sepulveda Theresa , Centeno Fernando H , Serpa Jose , Weatherhead Jill E , Clark Eva 
Published: January 2025

Abstract

Background
Neurocysticercosis (NCC) is a neglected tropical disease caused by infection with the pork tapeworm Taenia solium that affects 2-8 million people globally and is responsible for ∼30% of epilepsy cases in endemic countries. Based on case series data, &gt; 4,000 new NCC cases are estimated to occur annually in the US. The gold standard for NCC diagnosis as outlined in the Infectious Disease Society of America (IDSA) guidelines is neuroimaging with computed tomography (CT: to detect calcifications) and magnetic resonance imaging (MRI: to detect viable disease), followed by confirmatory serologic testing with the enzyme-linked immunoelectrotransfer blot (EITB) or other reliable assay. Our study aims to describe healthcare provider diagnostic practices at a public healthcare system serving at-risk patients in Texas.

Methods
We retrospectively identified patients ≥ 18 years old tested for NCC in the Harris Health System [HHS] between 2017-2021, systematically extracted variables from the patients’ electronic medical records, and recorded this data via a REDCap instrument. We classified NCC patients by NCC type and performed descriptive statistics.

Results
We identified 113 patients with NCC (Table 1). Family medicine (n=44, 39%) or internal medicine (n=29, 26%) providers evaluated most patients in their first diagnostic encounter. Presenting signs/symptoms included seizure (n=75, 66%) and chronic headaches (n=77, 68%). 77% of patients with calcified disease and 88% with viable disease were diagnosed within 5 years after symptom onset. Only 63% of patients had both CT and MRI completed. Zero initial providers ordered EITB confirmatory serologic testing; n=4, 3% ordered other types of serologic testing. Only five patients ultimately had EITB sent; of those, two tested positive. While 47% of initial providers referred patients to neurology and 18% referred to neurosurgery, only 35% referred to tropical medicine or infectious diseases specialties.

Conclusion
Improved education of frontline healthcare providers on NCC presentation and diagnosis may reduce time to NCC diagnosis. Future work should target the need for structured education and standardization of diagnostic practices especially amongst frontline healthcare providers serving at-risk communities in the US.

Disclosures
All Authors: No reported disclosures
P-1777. Low adherence to institutional antibiotic clinical practice guideline in patients diagnosed with Clostridioides difficile infection
Authors: Marcus Joseph , Scheps Kayla R , Matthews Zachary K 
Published: January 2025

Abstract

Background
Previous antimicrobial therapy is a common risk factor for Clostridioides difficile infections (CDIs). Clinical practice guidelines (CPGs) assist clinicians in prescribing the correct antibiotics for various clinical syndromes to avoid unnecessary or overly broad-spectrum antibiotic use. Retrospective analysis of CDIs may serve as a guide for the high-risk antimicrobials included in CPG development.

Methods
Patients who tested positive for C. difficile at Brooke Army Medical Center from November 2022 to October 2023 were reviewed. Demographics, C. difficile treatment, antibiotic allergies, antibiotics received in the preceding 90 days prior to a positive test, and indication for antibiotic therapy were recorded. If a treatment indication appeared on the institutional CPG, adherence to the antibiotic recommendation was recorded. Patients who received no antibiotics or only antibiotics as guided by the correct CPG were considered unpreventable.

Results
During the study period, 128 positive cases were identified. The median patient age was 56.5 years [IQR: 25-75.3] (Table 1). 80% of cases were ultimately treated for infection, with fidaxomicin representing the treatment of choice in 81% of treated patients. In the preceding 3 months prior to a positive test, 67% of patients had at least one day of antibiotic exposure. The median number [IQR] of total antibiotic days within 30, 60, and 90 days of a positive test was 1 [0-7], 3.5 [0-8.75], and 5 [0-9.75] respectively. For 47 (55%) cases, all antibiotic indications within the previous 90 days appeared on the CPG. However, prescribers did not adhere to the CPG (Table 2) in 22 (47%) of these cases. The most common inpatient and outpatient indications not on the CPG were perioperative antibiotics and otitis media, respectively. Overall, only 58 cases (45%) were considered unpreventable.

Conclusion
In this single center study, retrospective analysis of individual C. difficile cases provided direction for the antimicrobial stewardship team by identifying CPG recommendations that were not followed as well as identifying conditions not on previous CPGs. Tying patient harm from CDIs with inappropriate antimicrobial use builds the local evidence base to prevent future CDIs.

Disclosures
All Authors: No reported disclosures