bluuebunny/crossref_metadata_2025_split huggingface dataset:
1180. Empiric treatment of uncomplicated intraabdominal infection with cefazolin with or without metronidazole
Authors: Borkowski Jaime , Polisetty Radhika S , Shah Rishita , Liu Jay , Manrique Luis , Grohmann Stephen , Johnson Nicholas 
Published: November 2023

Abstract

Background
Treatment guidelines for management of intra-abdominal infection (IAI) differ on whether cefazolin should be used first line to treat uncomplicated infection. In an effort to reduce unnecessary fluoroquinolone and piperacillin/tazobactam use, protocols were implemented with which recommendations were made to narrow to cefazolin ± metronidazole for uncomplicated IAI. The purpose of this study was to determine if there is a difference in outcomes with cefazolin +/- metronidazole versus broader-spectrum antibiotics for treatment of uncomplicated IAI.

Methods
This was a retrospective cohort study that reviewed inpatients at three acute-care community teaching hospitals from January 1, 2017, through December 31, 2021. Treatment groups were patients treated with cefazolin +/- metronidazole (study group) compared to those treated with piperacillin/tazobactam or ceftriaxone, ciprofloxacin, or cefepime each +/- metronidazole (control group). Inclusion criteria were age ≥ 18 years old; admission diagnosis of uncomplicated cholecystitis, diverticulitis, or appendicitis; and received as empiric inpatient treatment either cefazolin ± metronidazole, piperacillin/tazobactam, or ceftriaxone, ciprofloxacin, or cefepime ± metronidazole for at least 24 hours. Exclusion criteria were presence of perforation or abscess for cholecystitis or diverticulitis, cholangitis or pregnancy. The primary outcome measure was all-cause 30-day readmission rate.

Results
A total of 779 patients were included in the cefazolin group and 2269 patients were included in the broader-spectrum group. All-cause 30-day readmission rate was 5.8% in the cefazolin +/- metronidazole compared to 12.1% in the broader-spectrum group (OR 0.38, 95% CI 0.27-0.53, p &lt; 0.001). Average length of stay was 3.6 days for the cefazolin group vs. 4.4 days for the broader-spectrum group (cefazolin group range 1 to 35 days, broader-spectrum group range 1 to 59 days, p &lt; 0.0001).

Conclusion
Empiric treatment of uncomplicated intra-abdominal infection with cefazolin +/- metronidazole did not result in an increase in 30-day readmissions compared to broader-spectrum empiric antibiotics.

Disclosures
All Authors: No reported disclosures
1182. Impact of Penicillin Allergy Focused Antimicrobial Stewardship Interventions on Antimicrobial Use and Allergy Documentation - Optimizing Allergy Prescribing Alerts and Pharmacy Allergy Assessments
Authors: Stephens Emily , Riney Jennifer , Burnett Yvonne J 
Published: November 2023

Abstract

Background
The discrepancy between true prevalence and reported penicillin (PCN) allergies results in suboptimal antimicrobial use, which is associated with increased adverse drug reactions, antimicrobial resistance, increased hospital length of stay, and poor outcomes. Many patients with mild-moderate reactions tolerate other beta-lactams, but allergy records are often inaccurate or missing information. In 2021, our institution began suppressing prescriber-facing PCN allergy alerts when ordering cephalosporins for patients with mild-moderate PCN reactions. More recently, a pharmacist-driven allergy assessment via chart review +/- patient interview was piloted to clarify PCN allergy documentation. This quasi-experimental study evaluated the effect of PCN allergy interventions on antimicrobial use.

Methods
Days of broad-spectrum antimicrobials in patients with PCN allergies was compared between groups [pre-intervention (G1, n=100), post-alert suppression (G2, n=100), and allergy assessment (G3, n=50)]. Patients were excluded for cephalosporin allergy, MRSA or ESBL history, surgical prophylaxis or UTI indication, or antibiotics within 48 hours of mechanical ventilation. Groups were matched 2:2:1 based on length of stay and antibiotic indication. Additional outcomes included cephalosporin use, allergy clarifications, and time spent per allergy assessment.

Results
The most common antibiotic indications were pneumonia (54%) and intra-abdominal infection (28%). No differences were noted in median duration of broad-spectrum therapy (2 vs 1 vs 1 days, p=0.52) or cephalosporin therapy (1 vs 2 vs 3 days, p=0.39). However, more patients received cephalosporins as initial therapy post-alert suppression, G1 40 (40%) vs G2 57 (57%), p=0.02 vs G3 26 (52%). A pharmacist completed 50 allergy assessments (50 chart review with 19 interviews) and clarified 43 (86%) records to include previous beta-lactam tolerance. Average time of chart review and interview was 4 minutes each.

Conclusion
PCN allergy alert suppression significantly increased initial cephalosporin use and decreased broad-spectrum use. Pharmacist allergy assessment improved allergy documentation accuracy, but future study is required to assess the clinical impact on antimicrobial use.

Disclosures
All Authors: No reported disclosures
1185. Evaluation of Antimicrobial Stewardship Practices at a Veterans Affairs Health Care System Community Living Center
Authors: Ampuero Andrea , Melville Brittany , Guest Bailey , Creel Joseph 
Published: November 2023

Abstract

Background
Antimicrobial stewardship programs (ASP) have demonstrated improvement in patient outcomes, reduction of antimicrobial adverse drug events (ADE) and a decrease in antimicrobial resistance in hospitals. Antimicrobials maintain the second highest rate of ADEs in long-term care facilities. Prescribed antimicrobials in nursing homes may be unnecessary or inappropriate in upwards of 75% of cases. There is limited evidence available quantifying the impact of pharmacist-led ASP interventions in long-term care facilities. The purpose of this project is to evaluate the effectiveness of antimicrobial stewardship interventions completed at the Salisbury Veterans Affairs Health Care System Community Living Center (SVAHCS CLC).

Methods
This is a retrospective quality improvement project. Eligible subjects included Veterans residing in the SVAHCS CLC to which an ASP intervention documented in TheraDoc® was proposed from May 2018 to January 2021. The primary objective is to determine the effectiveness of ASP interventions in the CLC based on acceptance rate. Secondary objectives include to assess safety of select implemented CLC ASP interventions through reported ADEs within 30 days of performed CLC ASP intervention and determine potential cost savings of the implemented ASP interventions.

Results
A total of 379 interventions were included. Of these interventions, 370 were accepted (98%), 5 were accepted with modification (1%) and 4 were rejected (1%). The most common ASP interventions included lab monitoring, renal adjustment, pharmacokinetic consults and duration changes. The most common indications for many ASP interventions performed were osteomyelitis, influenza and bacteremia. Vancomycin, cefepime and ceftriaxone were the most common antimicrobials involved for which ASP interventions were performed. Of the 131 interventions assessed for safety, one Veteran experienced ADEs within 30 days of the intervention including nephrotoxicity and Clostridioides difficile infection. There was a total potential cost savings of $101,704.
Most Common Infections
ASP Intervention Acceptance Rate and ADEs within 30 Days of ASP Intervention

Conclusion
This study demonstrates that pharmacist-led ASP interventions proposed in the SVAHCS CLC were effective with a high rate of acceptance. These interventions resulted in a low rate of ADEs and potential cost savings for the facility.

Disclosures
All Authors: No reported disclosures
1188. Evaluation of Antimicrobial Stewardship Discontinuation of Antimicrobial Therapy for Misdiagnosed Urinary Tract Infections in Hospitalized Patients
Authors: Duke Jessica A , White Brittany N , White Cyle 
Published: November 2023

Abstract

Background
Urinary tract infections (UTIs) are often misdiagnosed resulting in unnecessary treatment of asymptomatic bacteriuria (ASB) and pyuria. This practice has been associated with the development of antimicrobial resistance and increased risk of antibiotic-related adverse events, including Clostridioides difficile infection (CDI).

Methods
This single-center, retrospective, observational review assessed the effect of a unique antimicrobial stewardship initiative to reduce inappropriate antibiotic use in patients with misdiagnosed UTIs. In July 2018, Erlanger Health System revised the antimicrobial stewardship policy to include automatic discontinuation of antibiotics for patients with misdiagnosed UTIs. Adult patients admitted from November 2017 to November 2022 who received an antibiotic order for ASB or pyuria were included. Presence of UTI symptoms was evaluated via comprehensive chart review. The intervention group consisted of patients with ASB in which antibiotics were discontinued by the antimicrobial stewardship team. Patients with altered mental status (AMS) were included. The primary endpoint was days of antimicrobial therapy. Secondary outcomes included 30-day hospital readmission, hospital mortality, incidence of CDI, hospital length of stay (LOS), and growth of multidrug-resistant organisms in subsequent urine cultures.

Results
A total of 306 patients were included in this study. After propensity score matching, 70 patients were included in each group. The median age was 74 ± 10 years, 85.7% were female, and 55% presented with AMS. Patients in the intervention group received a median of 2 days of antibiotics compared to 6 days in the pre-intervention control (p&lt; 0.0001). Hospital LOS was longer in the intervention group (6 vs 4 days, p&lt; 0.0001). There were no significant differences in other secondary outcomes. Antibiotics were reinitiated in 7% of patients.

Conclusion
This antimicrobial stewardship initiative was associated with a reduction in inappropriate antibiotics days for misdiagnosed UTIs. This intervention is novel as most interventions described are passive and rely on recommendations to providers. The findings of this evaluation highlight the effectiveness of active interventions on reducing inappropriate antimicrobial use.

Disclosures
All Authors: No reported disclosures
1193. Impact of Removing Extended-spectrum Beta Lactamase Status Labeling from Culture Reports on Carbapenem Use for Non-bacteremic Patients With Urinary Tract Infections: A Multi-hospital Assessment
Authors: Alvarado Lourdes R Menendez , Landayan Alice Margulis , Williams Kelsey N , Frederick Corey M , Murillo Jorge , Gauthier Timothy P 
Published: November 2023

Abstract

Background
Reporting extended-spectrum beta lactamase (ESBL) status on microbiology results for Enterobacterales is not required by laboratory, infection prevention, or antimicrobial stewardship guidelines. Ceftriaxone (CRO) resistance may be utilized as a proxy for ESBL production. Current practice guidelines recognize select non-carbapenems as acceptable treatment options for ESBL-producing uncomplicated urinary tract infections (UTI). This project aimed to evaluate carbapenem prescribing for CRO-resistant UTIs caused by Enterobacterales before and after removal of ESBL status from microbiology laboratory results at seven sites across a large health system.

Methods
This was a retrospective cohort study of adult patients treated for at least 48 hours for an ESBL-producing/CRO-resistant Enterobacterales UTI. Patients were excluded if they had a concomitant infection outside the urinary tract, a polymicrobial infection, or if treatment was started outside the hospital. The primary endpoint was the rate of carbapenem prescribing for initial definitive treatment of UTIs. Secondary endpoints included total days of therapy for initial definitive therapy with carbapenems, clinical cure rates, time to transition to oral antibiotic therapy for initial definitive therapy, rate of guideline-compliant therapy, 30-day readmission rate, rate of relapsed infection within 30 days, and 30-day all cause in-hospital mortality. This study was approved by the Institutional Review Board.

Results
Of 3055 patients screened, 199 were included in the pre-group and 153 were included in the post-group. Demographics are displayed in Table 1. The rate of carbapenem prescribing for initial definitive treatment was 156 patients (78%) in the pre group, compared to 93 patients (61%) in the post group (p=&lt; 0.01). The rate of non-carbapenem prescribing was 43 patients (22%) in the pre-group, compared to 60 patients (39%) in the post-group (p=&lt; 0.01). There was a 40% reduction in total days of therapy for initial definitive therapy with carbapenems (620 vs. 372, p=&lt; 0.01). Other secondary outcomes are listed in Table 2.

Conclusion
Removal of ESBL status labels from laboratory reports may substantially reduce carbapenem use for initial definitive treatment of UTIs without impacting clinical outcomes.

Disclosures
Jorge Murillo, MD, FIDSA, FACP, Insmed: Advisor/Consultant|Melinta Therapeutics: Advisor/Consultant|Merck: Advisor/Consultant Timothy P. Gauthier, PharmD, BCPS, BCIDP, Ferring: Advisor/Consultant|Firstline: Advisor/Consultant|Firstline: Writing|GSK: Advisor/Consultant|LearnAntibiotics.com & IDstewardship.com: Owner|Melinta: Advisor/Consultant|Pattern Biosciences: Advisor/Consultant|Pfizer: Advisor/Consultant
1209. Let’s take a time-out: Implementing a standardized process to assess the clinical use of vancomycin for pharmacists
Authors: Oderinde Jennifer , Chiang Anthony , Juska Alicia , ADEYEMI O L U W A D A M I L O L A A 
Published: November 2023

Abstract

Background
Vancomycin is often started empirically for its reliability with gram-positive pathogens, particularly Methicillin Resistant Staph aureus (MRSA). Consequently, it is often over-prescribed. Antimicrobial stewardship programs (ASP) have used time-outs to ensure therapies are tailored to the patient with proper indication and coverage. This study aims to evaluate the impact of a standardized vancomycin time-out to optimize utilization and safety.

Methods
This is a pre-/post-implementation study conducted at a community teaching hospital. The study was separated into a pre-implementation phase (July-September 2022), implementation/teaching phase (October 2022), and post-implementation phase (November 2022-February 2023). Study subjects included inpatient adults on vancomycin for longer than 48 hours. Patients who are immunocompromised, hospice, or on a vancomycin regimen prior to admission were excluded.
Primary outcomes include (1) percent appropriate vancomycin continued after time-out, (2) percent inappropriate vancomycin discontinued during time-out, and (3) time to de-escalation. Additional outcomes include vancomycin days of therapy (DOT) per 1000 patient days, hospital length of stay, and acute kidney injury (AKI) incidence rate.
This study looked at 182 patients in the retrospective arm and 214 patients in the prospective arm. Preliminary data was initially presented at the Illinois Pharmacy Residency Conference when only 195 total patients had been reviewed.

Results
There was a statistically significant difference seen in percent appropriate vancomycin continued after time-out, with 57% and 40.2% seen in the prospective and retrospective arm respectively. The percent inappropriate vancomycin discontinued during time-out was also statistically significant with 69.9% and 38.8% respectively. With a time-out, average days to discontinuation for continued inappropriate regimens, and overall vancomycin DOT were decreased. There was no significant difference seen in safety outcomes including AKI incidence rates.

Conclusion
Pharmacy driven time-outs are useful for promoting antimicrobial stewardship and can contribute to decreased vancomycin use,

Disclosures
All Authors: No reported disclosures
1212. Impact of Infectious Diseases Fellow Collaboration in the Medical Intensive Care Unit and Medical Intermediate Unit on Antimicrobial Utilization in COVID-19 Patients
Authors: Rajput Smit , Mikell Franklin , Kipp Aaron , Emberger Jennifer 
Published: November 2023

Abstract

Background
During the COVID-19 pandemic, historic gains made in antibiotic stewardship were challenged as antibiotic utilization for patients with COVID-19 increased despite low co-infection rates, as evidenced by a 15% increase in resistant infections 2019 - 2020. Studies demonstrate that input of an infectious diseases (ID) specialist can improve appropriate antibiotic use without increasing length of stay or mortality. But, there is limited data on this among COVID-19 patients. We evaluated the impact of an ID fellow rounding in the Medical ICU (MICU) and medical intermediate unit (MIU) on antibiotic prescribing among COVID-19 patients admitted to a tertiary care center in eastern North Carolina.

Methods
An ID fellow rounded with the MICU and MIU teams twice weekly to provide antibiotic guidance from 3/21-6/21. The intervention group comprised patients admitted with COVID-19, prescribed antibiotics, and receiving antibiotic guidance. Concurrent (3/21 - 6/21) and retrospective (11/20 – 1/21) controls met the same criteria but without ID fellow antibiotic guidance. Antibiotic and other data were obtained from chart review. Prescribing rates (antibiotic days per 1000 hospital days) were calculated and compared using Poisson regression to estimate rate ratios while controlling for covariates.

Results
Analysis included 48 intervention patients, and 38 concurrent and 64 retrospective controls. The intervention group had higher BMI, longer hospital stay, and more frequent ICU stay than either control group (Table 1). The median prescribing rate in the intervention group (788.9 antibiotic days per 1000 hospital days) was lower than the retrospective controls but higher than the concurrent controls (Figure 1). Upon adjusting for covariates, the intervention group had a 32% lower antibiotic prescribing rate than retrospective controls (rate ratio: 0.68; 95% CI: 0.50 – 0.77). A similar result was seen when compared to the concurrent controls (Table 2).
Table 1
Demographic, clinical, and hospital stay characteristics, by intervention group, among those prescribed any antibiotics
Figure 1
Median antibiotic days per 1,000 hospital days, by intervention group
Table 2
Adjusted analysis of antibiotic prescribing rate (per hospital stay) 1: Adjusted for age, BMI, and spending time in the ICU (Yes/No) 2: Restricted to only the Concurrent Control and Intervention group, Adjusted for age, BMI, and spending time in the ICU (Yes/No)

Conclusion
We found a significant reduction in antibiotic prescribing among COVID-19 patients when an ID fellow provided antibiotic guidance. Our study contributes to the growing body of data that ID providers are critical to the fight against antimicrobial resistance and are valuable resources in determining the need for antimicrobials.

Disclosures
All Authors: No reported disclosures
1219. Utility of Plasma Microbial Cell-Free DNA Testing for Therapeutic Management and Antimicrobial Stewardship
Authors: Thompson Riley , Donnelley Monica , Thompson George R , Desai Angel 
Published: November 2023

Abstract

Background
Microbial cell-free DNA (mcfDNA) sequencing is a promising potential tool in the detection of infectious pathogens when traditional methods fail to identify the causative agent. It may be particularly helpful in identifying pathogens that are present at low levels or that do not grow well in standard culture. The aim of this study was to determine whether plasma mcfDNA sequencing resulted in a change in therapeutic management.

Methods
A retrospective cohort at UC Davis Medical Center was reviewed. All patients, both pediatric and adult, that underwent plasma mcfDNA (Karius) sequencing between December 11th, 2019, and January 4th, 2023, were included. Patient demographics, comorbid conditions, immunocompromised status, indication for testing, pre and post antimicrobial therapies from when the sample was collected, pathogen identified, ID consultation status, and ordering service at the time of testing were recorded. Each patient was analyzed by two independent reviewers for clinically significant microbial findings, treatment, and reviewer concordance with therapeutic management. If discordance between reviewers was present, a third reviewer analyzed the data.

Results
A total of 127 Karius tests were reviewed from 71 patients. Baseline characteristics included 62 (48%) pediatric and 65 (51%) adult tests. 25 (33%) tests were from female patients, and 37 tests (50%) were obtained from immunocompromised patients. The most frequent adult ordering services included the Medical Intensive Care Unit and Bone Marrow Transplant Unit. The most frequent pediatric ordering services included the Pediatric Intensive Care Unit followed by General Pediatrics. 69 (95%) of tests had a formal Infectious Diseases consultation associated with testing. 22 (30%) tests resulted in a change in antimicrobial therapy, and 35 (47%) of tests resulted in a clinically significant organism.

Conclusion
In this retrospective cohort study conducted at a single center, Karius testing resulted in clinically significant pathogens in less than half of all tests conducted, and most test results did not lead to a change in therapeutic management. Testing in certain clinical scenarios or high-risk settings may be warranted, however further studies are needed.

Disclosures
George R. Thompson, III, MD, Astellas: Advisor/Consultant|Astellas: Grant/Research Support|Cidara: Advisor/Consultant|Cidara: Grant/Research Support|F2G: Advisor/Consultant|F2G: Grant/Research Support|Mayne: Advisor/Consultant|Mayne: Grant/Research Support|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support