bluuebunny/crossref_metadata_2025_split huggingface dataset:
1627. Antibiotic Use and Clinical Outcomes in Peripartum Infections
Authors: Siegrist Emily A , Sassine Joseph 
Published: November 2023

Abstract

Background
Peripartum infections are a leading cause of maternal morbidity and mortality. Historically, these infections have been treated with combinations of ampicillin and gentamicin with or without clindamycin. However, resistance in anaerobic and gram-negative bacteria to these antimicrobials has been increasing nationally. There is limited modern data evaluating the incidence and outcomes of chorioamnionitis and endometritis, especially in the context of modern resistance patterns and antibiotic regimens.

Methods
This is a single-center, retrospective study at an academic medical center. The primary objective is to describe antibiotic use and outcomes in patients diagnosed with chorioamnionitis or endometritis. Patients were identified by ICD codes using Vigilanz software. Patients with a coded diagnosis for chorioamnionitis or endometritis in 2022 were included and stratified according to highest level of care. Chi-square and Fisher’s exact test were used for categorical variables, Mann-Whitney test for continuous variables.Table 1Baseline DemographicsTable 2Pregnancy and Delivery Characteristics

Results
We included 176 patients, indicating 4.6% of deliveries were complicated by a peripartum infection. Seven patients (4%) required ICU level of care. These patients were more likely to be multiparous, have longer time from rupture of membranes to delivery, have vaginal discharge, and had more pronounced leukocytosis with left shift. The most common organism isolated was Escherichia coli and only piperacillin-tazobactam (TZP) was active against all isolates. Patients admitted to the ICU were more likely to have received metronidazole, TZP, vancomycin or a cephalosporin, to have switched antibiotics and to have longer days of therapy. Only one patient from the ICU group passed away for causes unrelated to the infection.Table 3Peripartum Infection CharacteristicsTable 4Peripartum Infection ManagementTable 5Outcomes

Conclusion
Peripartum infections are common, and most patients improve on short courses of clindamycin, gentamicin, and ampicillin. Historical antibiotic regimens may not have desired activity against E. coli isolates, and clinicians may consider use of TZP for patients failing to improve on standard therapy. Larger studies are needed to establish a more specific diagnosis, validate risk factors for severity, and explore the efficacy of updated antimicrobial regimens.

Disclosures
All Authors: No reported disclosures
1638. Development of a Model to Estimate Persistence of hSBA Titers Over Time Following a Primary Series and Booster Dose of the Pentavalent Meningococcal MenABCWY Vaccine
Authors: Cai Bing , Peyrani Paula , Beeslaar Johannes , Maguire Jason , Maansson Roger , Palmer Paul 
Published: November 2023

Abstract

Background
Serogroups A/B/C/W/Y cause nearly all meningococcal disease. Therefore, comprehensive protection requires vaccination against all 5 serogroups. A pentavalent MenABCWY vaccine, composed of 2 licensed vaccines (MenB-fHbp, MenACWY-TT), is undergoing clinical development in adolescents and young adults. We predicted persistence of serum bactericidal activity against human complement (hSBA) titers 5 years after both a MenABCWY primary series and booster dose using a power law model (PLM).

Methods
The PLM was fitted with hSBA data from a previous MenABCWY clinical trial (NCT03135834) assessing a 2-dose primary regimen (0, 6 months), immunopersistence 4 years post primary, and booster vaccination given observed titers in healthy 10–25-year-olds. The PLM was then used to predict hSBA titers against test strains up to 5 years after the primary series and up to 5 years after a booster dose. The hSBA lower limit of quantitation (LLOQ) was 1:16 for the A22 MenB strain and 1:8 for all other test strains.

Results
The PLM-predicted hSBA titers were consistent with those observed after a 2-dose MenABCWY primary series and a booster dose, which was given 4 years after the primary series (Figure 1–2). At 5 years post primary series, the percentage of individuals with hSBA titers ≥ LLOQ was predicted to range from 63.4%‒100% for MenA/C/W/Y strains and 8.0%–26.8% for MenB strains. Five years after the booster dose, the PLM predicted that 97.0%–100% and 45.7%‒88.6% of individuals had MenA/C/W/Y and MenB hSBA titers ≥ LLOQ, respectively.

Conclusion
The PLM supports that persistence of MenA/C/W/Y and MenB antibody responses after primary MenABCWY vaccination are maintained to at least 5 years. At 5 years after the booster dose, a substantial percentage of adolescents and young adults are predicted to have protective hSBA titers against all 5 serogroups.
Funding: Pfizer Inc

Disclosures
Bing Cai, PhD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Paula Peyrani, MD, Pfizer, Inc: Employee|Pfizer, Inc: Stocks/Bonds Johannes Beeslaar, MD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Jason Maguire, MD, Pfizer, Inc.: Employee|Pfizer, Inc.: Stocks/Bonds Roger Maansson, MS, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Paul Palmer, PhD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds
1641. Prescribing and Dispensing Delayed Antibiotics to Pediatric Patients with Acute Otitis Media and Pharyngitis
Authors: Balasubramaniam Shobhitha , Melanie Melanie , Fitzpatrick Eleanor , Hurley Katrina , Black Emily 
Published: November 2023

Abstract

Background
Delayed antibiotic prescriptions with instructions to wait a defined period of time before filling the prescription is a strategy often used to decrease the unnecessary use of an antibiotic. Although "watchful waiting" for illnesses, such as acute otitis media (AOM) and pharyngitis, that are suspected of being viral is recommended, little is known about how often delayed antibiotics are prescribed at our institution. The primary objectives of this study were to characterize delayed prescriptions for pediatric patients with AOM or pharyngitis and to assess each prescription for adherence to guidelines.

Methods
Design: This study was a retrospective chart review. Pediatric patients with AOM and pharyngitis assessed and discharged from the Emergency Department (ED) between March 1, 2019 to February 28, 2021 were considered for inclusion. Data were collected from the ED Treatment Record by a trained research assistant.
Setting: Our study was completed in a pediatric ED at a tertiary hospital in Canada.
Exposures or interventions: Patients prescribed a delayed antibiotic on discharge from the ED.
Main Outcome Measures: Frequency of delayed antibiotic prescribing, proportion of antibiotic prescriptions adherent to guidelines for empiric choice, dose, and duration. Adherence to guidelines was assessed using local guidelines and position statements by the Canadian Pediatric Society as the gold standards.
Statistical analysis: Data were entered in REDCap and exported to excel for descriptive analysis.

Results
Delayed antibiotics were prescribed to 21.2% (332/1563) of patient encounters during the study period. Amoxicillin was the most commonly prescribed antibiotic (88.6%, 294/332). The majority of delayed prescriptions were prescribed for AOM (77.7%, 258/332). Most patients (94.8%, 309/326) received a delayed prescription for an empiric antibiotic that adhered to guidelines. Fewer prescriptions adhered to guidelines for dose (75.8 %, 247/326) and duration (73.6%, 240/326).

Conclusion
Most patients received the appropriate empiric antibiotic to treat AOM and pharyngitis however, dose and duration of use may be improved through antimicrobial stewardship initiatives.

Disclosures
Emily Black, BSc(Pharm), PharmD, Drug Evaluation Alliance of Nova Scotia: Grant/Research Support|Research Nova Scotia: Grant/Research Support
1647. Clinical Outcomes in Pediatric Appendectomy Patients Treated with Piperacillin-Tazobactam versus Ceftriaxone/Metronidazole
Authors: Cosimi Reese , Daragjati Florian , Ward Sasha , Whitmore Maria , Marisol Fernandez , Moreno Ana Cristina Perez , Miller Collin , Fakih Mohamad G 
Published: November 2023

Abstract

Background
Appendicitis is the most common cause of emergent pediatric surgeries. The standard treatment includes surgical removal of the appendix plus or minus antibiotic therapy. Piperacillin-tazobactam or ceftriaxone/metronidazole are commonly utilized antibiotic regimens. While the latter option may be preferable for antimicrobial stewardship measures due to its narrower spectrum of activity, current existing evidence is conflicting as to whether one results in improved clinical outcomes.

Methods
Retrospective cohort study across four regionally diverse pediatric hospitals of all admitted patients aged 0 to 17 years with a procedure code for appendix resection between January 1, 2021 to December 31, 2022. Patients were included if they received either piperacillin-tazobactam or ceftriaxone/metronidazole during the encounter corresponding to the appendectomy procedure. Outcomes measured include length-of-stay (LOS) and 30-day readmission.

Results
A total of 600 appendectomy cases were included in the analysis of which 463 received ceftriaxone/metronidazole and 137 patients received piperacillin-tazobactam. Patients aged &lt; 10 years old were more likely to receive piperacillin-tazobactam. More perforated appendicitis cases were noted in the patients who received ceftriaxone/metronidazole. Average LOS in days (standard deviation) was not different between the two groups, 4.2 (6.1) and 3.9 (6.3), respectively (p=0.25). Readmissions were more common in the patients who received piperacillin-tazobactam, 3.2% and 7.3% (p=0.04).

Conclusion
Clinical outcomes in pediatric appendectomy patients do not appear to be associated with antibiotic regimen selection. Our study supports the continued use of ceftriaxone/metronidazole first line for appendicitis treatment in children taking into account local susceptibility patterns.

Disclosures
Reese Cosimi, PharmD, Allergen: Advisor/Consultant
1648. Impact of a Pediatric Antimicrobial Stewardship Program on Optimizing Antibiotic Usage in a Non-Freestanding Children’s Hospital (PEDS-ASP)
Authors: Siu Anita , Barron Linda , Kohute Michelle , Rawstron Sarah A , Eller Amy A , Cruz Liliana , Cruz Mariawy Riollano 
Published: November 2023

Abstract

Background
Antibiotic misuse can lead to poor patient outcomes, including ineffective treatment of infections, increased adverse effects, and development of antibiotic resistance. Implementing an antimicrobial stewardship program (ASP) is a vital strategy to improve and measure the appropriate use of antibiotics. This study aimed to assess the impact of pediatric ASP implementation on the reduction of restricted antibiotic usage and the improvement of patient outcomes.

Methods
A single-center retrospective-prospective study was conducted at a children’s hospital and included patients admitted to general pediatric or pediatric intensive care units receiving one or more restricted antibiotics. Prior-authorization of these restricted antibiotics was implemented as the ASP strategy. A three-month pre- and post-implementation chart review was completed. The primary outcome was optimizing restricted antibiotic usage. Secondary outcomes included provider compliance, antibiotic days of therapy (DOT), hospital length of stay (LOS), and readmissions within 30 days.
Table 1
Restricted antibiotics

Results
50 patients were included in the study. Restricted antibiotic orders for 18 out of 24 patients in the post-implementation group (75%) were compliant with obtaining pre-approval. Vancomycin, cefepime, and metronidazole were the most common agents ordered. The most common indications were skin and soft tissue infections, musculoskeletal infections, and preemptive sepsis coverage. Patients receiving restricted antibiotics decreased by two (-7.7%) while total restricted antibiotic orders increased by five (16.7%) following ASP implementation. Mean antibiotic DOT increased by 2.02 days (42.7%) and mean hospital LOS increased by 1.8 days (31.0%) in the post-implementation group. There was no difference in 30-day readmissions.
Figure 1
Restricted antibiotics ordered post-implementation of a pediatric antimicrobial stewardship program.
Figure 2
Use of restricted antibiotics pre- and post-implementation of a pediatric antimicrobial stewardship program

Conclusion
The results of this study not only aided in establishing baseline data but also provided a starting point for future efforts concerning the appropriate use of restricted antibiotics. While the findings were inconsistent with those of other institutions, incomplete program compliance and patient complexity in the post-implementation group likely contributed to the increase in DOT and hospital LOS. A longer study duration is needed to assess the true impact of this program.

Disclosures
All Authors: No reported disclosures
1654. Impact of a Daily Web-Based Educational Quiz on Appropriateness of Pediatric Outpatient Antibiotic Prescribing
Authors: Lehrer Brittany J , Banerjee Ritu , Katz Sophie E 
Published: November 2023

Abstract

Background
Nearly ⅓ of outpatient antibiotic prescriptions are unnecessary or inappropriate. QuizTime is a web-based application based on Test-Enhanced Learning Theory that delivers daily case-based questions to a learner’s email or cell phone. We performed a prospective cohort study to evaluate the impact of a QuizTime module on appropriateness of pediatric outpatient antibiotic prescriptions.

Methods
Participants received one question daily for 10 days starting in July 2022. Quiz topics included age-appropriate antibiotic duration for acute otitis media (AOM), empiric antibiotics for uncomplicated urinary tract infections (UTI), and empiric antibiotics and duration for community-acquired pneumonia (CAP) (Table 1). Participants were pediatric prescribers (physician, resident, physician assistant, nurse practitioner) in a primary care, urgent care, retail health, or emergency department setting. Antibiotic prescription data were collected during the “baseline” period (Jul 1, 2021 – Jun 30, 2022) though 3 months after QuizTime participation (Jul 15 – Oct 15 2022) defined as the “post-quiz” period. Pre- and post-intervention data were analyzed in aggregate (not at the provider-level). Significance was determined by calculating a 95% confidence interval (CI) for the difference of proportions. Outcome measures are listed in Table 1.Figure 1.Prisma diagram showing providers and oral antibiotics prescribed in each cohort.

Results
Eighty clinicians participated in QuizTime totaling 13,478 antibiotic prescriptions [AOM 5,613 (41.6%), UTI 668 (5.0%), CAP 225 (1.7%)] compared to 776 non-QuizTime clinicians totaling 43,321 antibiotic prescriptions [AOM 15,258 (35.2 %), UTI 2,528 (5.8%), CAP 849 (2.0%)] (Figure 1). AOM guideline-concordant antibiotic duration was significantly higher among participants than non-participants (Table 2). There were encouraging trends towards improvement in secondary outcomes (Table 3, 4).

Conclusion
Clinicians who participated in a QuizTime module on pediatric outpatient antibiotic prescribing showed improvement in antibiotic appropriateness suggesting web-based microlearning modules are an effective tool for disseminating antibiotic stewardship education. Creation, dissemination, and evaluation of additional QuizTime modules is ongoing.

Disclosures
Ritu Banerjee, MD, Ph.D, bioMerieux: Grant/Research Support|bioMerieux: company is providing partial support for an ongoing trial unrelated to submitted abstract Sophie E. Katz, MD MPH, Dolly Parton Pediatric Infectious Diseases Research Funds: Grant/Research Support|Optum: Advisor/Consultant|Pfizer: Grant/Research Support
1656. Evaluation of Using Oxacillin versus Vancomycin for Empiric Therapy of Late-Onset Neonatal Sepsis in NICU
Authors: Lien Tsung-Chi , Husted Harlan , Taha Sahar , Ip Alice , Covarrubias Laurie , Henschel Kathleen , Mendoza Maria Concepcion , Rajani Anand , Rongkavilit Chokechai 
Published: November 2023

Abstract

Background
Our Pediatric Antimicrobial Stewardship Program (PedASP) assessed methicillin-sensitive (MSSA) and methicillin-resistant S. aureus (MRSA) infections in neonatal intensive care unit (NICU) and created a NICU-specific antibiogram. Due to a rising trend of NICU MSSA infections seen in our 84-bed NICU, empiric therapy of late-onset neonatal sepsis (LONS) was modified from vancomycin to oxacillin in January 2021. We report the two-year results of using empiric oxacillin for LONS.Figure 1.Summary of S. aureus identified in LONS cases

Methods
We assessed MSSA versus MRSA isolated from blood and non-blood cultures in NICU between January 2019 and December 2022. Infants with weight less than 750 grams, previous MRSA infections, maternal MRSA colonization, or serious infections based on clinical judgement were advised to use empiric vancomycin. We examined the vancomycin eligibility criteria, antibiotic-pathogen mismatch rate, 30-day mortality, and frequency of peripheral intravenous (PIV) access loss after vancomycin or oxacillin administration. The cost-savings was estimated by comparing drug and lab costs associated with vancomycin and oxacillin use.

Results
LONS cases are summarized in Figure 1. There was no statistical difference in incidence of S. aureus bacteremia before and after protocol implementation (p=0.45). Antibiotic-pathogen mismatch rate was 0%. Cases of MRSA bacteremia increased from 0 to 3 post protocol initiation; all cases met vancomycin eligibility criteria. The 30-day mortality among MRSA infections increased from 0 to 1 case. Post protocol implementation, the PIV loss rate decreased from 4.7 to 3.3% (p=0.04), and vancomycin use decreased by 1154 doses while oxacillin use increased by 485 doses. Based on antibiotic use and 141 vancomycin levels averted, the estimated cost-savings was $140,229.

Conclusion
Our PedASP utilized local susceptibility data to change empiric antibiotics for LONS, reinforcing the benefit of using antibiogram to optimize antibiotic use in NICU. Implementing a NICU-specific antibiogram improved the effectiveness of antibiotic treatment and achieved significant cost savings.

Disclosures
All Authors: No reported disclosures
1658. Rational use strategy for clarithromycin in a pediatric hospital: is it used more than is required?
Authors: Londono-Ruiz Juan Pablo , Lombo Julian Enrique Avila , Losada Maria Alejandra Medina , Gutierrez-Tobar Ivan Felipe , Rodriguez-hernandez Andrea Esperanza 
Published: November 2023

Abstract

Background
Clarithromycin is a macrolide used to treat microorganisms that cause atypical pneumonia or whooping cough in pediatrics. Studies have shown that its use in typical pneumonia does not change clinical outcomes. The implementation of an Antimicrobial Stewardship (ASP) strategy directed at this antibiotic and its rational use allows for reductions in its unnecessary consumption. The aim of this work is to show the impact of an antibiotic control intervention on the use of clarithromycin in a pediatric hospital.

Methods
A before-and-after study was carried out in between 2018 and 2022. In 2020 begins the intervention period during which several educational measures aimed at the clarithromycin formulation were implemented, including a virtual training space, a graphic piece for knowledge of the tools, and the implementation of an audit and feedback system for all clarithromycin formulations. Special emphasis was placed on the differential diagnosis of atypical pneumonia caused by viruses and the promotion of the oral route for this antibiotic. Antibiotic consumption was measured using Days of Therapy (DOT) and adherence to local prescription guidelines. R (version 4.2.2) was used for statistical analysis.

Results
Two years prior to the intervention (2018 and 2019) were analyzed, 2020 was taken as the washout year, and two years after the intervention (2021 and 2022) were analyzed. The average DOT in the pre-intervention period was 10 DOT x 1,000 hospital discharges, compared to the post-intervention period where it was 0.8 DOT x 1,000 hospital discharges (p value &lt; 0.001). In the pre-intervention years, a peak in formulation related to the respiratory peak was observed (between March and May) (Figure 1). Adherence to local prescription guidelines increased from 60% to 95% in the post-intervention period (p value &lt; 0.05).

Days of Therapy (DOT) x 1.000 hospital beds between 2018 and 2022. A decrease in the consumption of antibiotics is shown after the implementation of ASP strategy in February 2020

Conclusion
The use of the tools of an antibiotic control program aimed at the use of clarithromycin showed a decrease in the consumption of this antibiotic and increased adherence to the prescription guidelines. It is possible that, on many occasions, the formulation of this was unnecessary.

Disclosures
All Authors: No reported disclosures
1662. Perspectives of Caregivers of Children with Community-Acquired Pneumonia in the Emergency Department: A Qualitative Study
Authors: Murphy Lara , Huang Nelson , Kandasamy Sujane , Wahi Gita , Pernica Jeffrey 
Published: November 2023

Abstract

Background
Despite the fact that paediatric community-acquired pneumonia (CAP) is usually caused by viruses, antibiotics are often prescribed. The objective of this study was to understand caregiver perspectives and experiences relating to the treatment of paediatric CAP.

Methods
This was a phenomenologically-informed qualitative study involving interviews with caregivers of young children in Hamilton, Ontario. Caregivers were interviewed with open-ended questions relating to germ theory, the nature of pneumonia, and the role of antibiotic treatment. The principles of conventional content analysis were used to guide the coding and synthesis of the transcribed interviews.

Results
Eleven caregivers were interviewed. Most had a good understanding of the difference between bacteria and viruses and many knew that antibiotics were not effective against all types of infections. Many also stated that there was an increased risk of developing resistance with frequent antibiotic use. However, there were misconceptions that probiotics effectively mitigated antibiotic side effects and few were familiar with the potential long-term impacts of antibiotic use in children. There was variability in the perceived severity of paediatric CAP. For children sick enough to require treatment in the emergency department (ED), some participants thought that antibiotic treatment would be important to prescribe to accelerate recovery, as well as to prevent caregivers from feeling helpless. However, participants also thought it was inappropriate for physicians to prescribe antibiotics solely to make the caregiver feel better. Many caregivers also felt strongly that clinical follow-up and discussions on treatment risks and benefits would be desirable and might counteract feelings of helplessness that might result from being sent home without a prescription.

Conclusion
Recognizing that parents may have misperceptions about antibiotic use for CAP (and may seek antibiotics without strong rationale) can inform clinicians’ efforts to better educate and support caregivers in the ED. Care strategies informed by caregiver experiences can improve parent-provider communication, increase trust in the attending clinician, and reduce antibiotic misuse.

Disclosures
Jeffrey Pernica, MD, MSc, FRCPC, DTMH, MedImmune: Grant/Research Support|Merck: Grant/Research Support