bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1676. Retrospective Evaluation of the Impact of Infectious Diseases Consultation on Prescribing Patterns and Clinical Outcomes among Patients with Gram-negative Bacteremia in the Community Hospital Setting
Authors: Warehall Rowan , Gothard David , Fabian Amy 
Published: January 2025

Abstract

Background
Gram-negative bloodstream infections (BSI) are concerning due to high mortality rates reporting up to 30%; however, infectious diseases (ID) consultation has been associated with reduced mortality. According to consensus statement recommendations, fluoroquinolones (FQ) or trimethoprim-sulfamethoxazole (TMP/SMZ) are first-line oral treatment options and high bioavailable beta-lactams (HBBL) are alternatives for the treatment of Gram-negative BSI. The objective of this study is to evaluate differences in oral antibiotic prescribing patterns and outcomes between ID and non-ID providers among patients with Enterobacterales BSI in a community hospital setting.

Methods
This is a multi-centered, retrospective cohort. Adult patients who received treatment for confirmed Enterobacterales BSI between January 1, 2022 and June 30, 2023 were included. Patients who completed treatment with only IV antibiotics, were greater than 89 years of age, elected palliative or hospice care before completion of treatment, died prior to receiving oral antibiotics, or with polymicrobial blood cultures were excluded. The primary outcome was the proportion of patients ordered FQ, TMP/SMZ, HBBL, or low-moderate bioavailable beta-lactam (LBBL) as oral stepdown. Secondary outcomes included length of stay, IV, oral, and total length of therapy (LOT), 30-day readmission, Clostridioides difficile infection (CDI), and all-cause mortality. The primary outcome was analyzed using a chi-square test with post hoc Bonferroni adjusted z tests to determine specific categorical differences.

Results
In the ID consult group (n=95) 72.6% of patients received a FQ, 6.3% TMP/SMZ, 16.8% HBBL, and 4.2% LBBL whereas in the non-ID consult group (n=77) 50.6% received a FQ, 5.2% TMP/SMZ, 39% HBBL, and 5.2% LBBL (p=0.009; Bonferroni z test p&lt; 0.0125 for FQ and HBBL). Secondary outcomes did not differ significantly between the two groups.

Conclusion
FQ were more likely to be prescribed for oral stepdown in the ID consult group whereas HBBL were more likely to be prescribed in the non-ID consult group. Overall, among either group rates of prescribing were low for both TMP/SMZ and LBBL.

Disclosures
All Authors: No reported disclosures
P-1679. Discrepancies in antibiotic prescribing: revealing inappropriate use patterns
Authors: Silva-Pereira Andrea P , Arias-Ariza Anderson F , Ochoa-Vera Miguel , Luna-Gonzalez Maria L , Bernal-Garcia Edgar 
Published: January 2025

Abstract

Background
Inappropriate antibiotic prescribing fuels antimicrobial resistance (AMR) and compromises patient outcomes. This study aimed to elucidate the prevalence and factors associated with inappropriate antibiotic use across various agents and antibiotic groups.Table 1.Assessment of Inappropriate Antibiotic Prescribing Patterns by Antibiotic Type

Methods
A retrospective analysis of 1647 cases evaluated antibiotic prescribing patterns. We assessed both prescription rates and prevalence ratios (PR) to examine the appropriateness of antibiotic choice within and across groups.Table 2.Comparative analysis of prevalence factors for various antimicrobial groups

Results
Prescription rates indicated higher rates of inappropriate use for meropenem (22.8%) and carbapenems (20%) compared to other agents and groups. Conversely, PR analysis revealed a significantly lower likelihood of inappropriate prescribing for cephalosporins compared to carbapenems (adjusted PR: 0.43, 95%CI 0.29-0.66, p &lt; 0.001). Glycylcyclines exhibited a markedly higher risk of inappropriate use (adjusted PR: 3.00, 95%CI 1.44-6.24, p=0.003), while glucopeptides also demonstrated a propensity for inappropriate prescribing (adjusted PR: 1.46, 95%CI: 1.12-1.89, p=0.004).

Conclusion
our study reveals notable discrepancies in the appropriateness of antibiotic prescriptions across different agents and antibiotic groups. While the analysis based on prescription rates demonstrated higher rates of inappropriate use for meropenem and carbapenems overall, prevalence ratio analysis highlighted specific trends within antibiotic classes. Cefalosporins consistently demonstrated a lower likelihood of inappropriate prescribing compared to carbapenems, suggesting their preferential use in clinical practice. However, caution is warranted with glicylcyclines, which exhibited a higher risk of inappropriate prescription. These findings underscore the importance of tailored interventions to optimize antibiotic prescribing practices, mitigate antimicrobial resistance, and improve patient outcomes.

Disclosures
All Authors: No reported disclosures
P-1687. Antibiotic Prophylaxis before Dental Procedures to Prevent Prosthetic Joint Infections
Authors: Raheem Mariam , Kuhn Ryan , Natesan Suganthini Krishnan , Dhar Sorabh 
Published: January 2025

Abstract

Background
Antibiotic prophylaxis before invasive dental procedures (IDP) to reduce the risk of late prosthetic joint infections (PJI) is a controversial, yet common practice despite lack of supporting evidence. Antibiotics are no longer recommended, except for certain high-risk populations, highlighted in dental and orthopedic guidelines. To assist providers, the American Academy of Orthopedics (AAOS) has developed an algorithmic clinical decision support tool (CDS) “appropriate use criteria” matrix. However, uptake of these criteria for dental prophylaxis and antibiotic prescribing in routine dental care of patients with prosthetic joints remains unclear.

Methods
This retrospective review at a Veterans Affairs hospital evaluated use of amoxicillin and clindamycin over 16 months for prophylaxis prior to high risk dental procedures in patients with prosthetic joints. Clinical data was reviewed for 5 indications defined by the AAOS including: 1) Invasive dental procedure (manipulation of the gingiva or periapical tissues), 2) Immunocompromised status, 3) Diabetic glycemic control (as defined by hemoglobin A1C ≥ 8 or blood glucose ≥ 200), 4)previous history of (PJI), and 5)timing of the joint replacement (≥ 1 year). The use of the antibiotic was categorized into 3 groups per AAOS guidance: 1). Appropriate, 2). Maybe Appropriate, 3). Rarely appropriate. Records were also reviewed for subsequent joint infection, antibiotic adverse events, and development of Clostridioides difficile infection (CDI).

Results
Indications for dental prophylaxis among the 36 cases reviewed are shown in table 1. Of the records reviewed, 0 (0%) were deemed “appropriate”, 2 (5.6%) “maybe appropriate”, and 34 (94.4%) “rarely appropriate.” No joint infections, adverse antibiotic events, CDI were noted in the subsequent 90 days.

Conclusion
Despite the availability of a clinical decision support tool for prescribing prophylactic antibiotics to patients with prosthetic joints, 95% of antibiotics were found to be unnecessary per current AAOS guidelines. Provider feedback and updated evidence-based recommendations are needed to promote appropriate antibiotic use.

Disclosures
All Authors: No reported disclosures
P-1708. Frontline Febrile Neutropenia Antibiotic Treatment Across Institution Types: A Multicenter Survey Study
Authors: Castillo Maia , Gross Derick , Harding Stephanie 
Published: January 2025

Abstract

Background
American Society of Clinical Oncology febrile neutropenia guidelines highlight the importance of quick empiric antipseudomonal coverage, and use of gram-positive active agents only in special circumstances. Despite this, first line vancomycin use increased over the years, thus, our study hoped to gain information on how institutions treat febrile neutropenia and if any patterns emerge between institution types.

Methods
A survey was distributed via email to IDSA and ACCP listservs. A survey tool was used for survey questions and to collect responses pertaining to febrile neutropenia management, institution demographics, and routine antibiotics used. Descriptive statistics, chi-squared tests and Mann-Whitney U tests were used to analyze the data as indicated.

Results
Eighty-four survey results were included in the analysis. When comparing academic medical centers (AMC) to non-AMCs there was more initial oncology responsibility for treatment (50.9% vs 22.6%; p-value = 0.047) and less empiric MRSA coverage (p-value = 0.039). When comparing institutions with &gt; 500 beds to those with &lt; = 500 beds similar results were seen with more initial oncology responsibility (53.2% vs 25%; p-value = 0.047), and more primary oncology responsibility in larger locations (70.2% vs 36.1%; p-value = 0.039), and less empiric MRSA coverage (p-value = 0.02). When comparing institutions with internal protocols versus without, there was less empiric MRSA coverage with a protocol (p-value = 0.006). No statistically significant difference in percentage of patients treated with MRSA or pseudomonal coverage were found when comparing service lines responsible for febrile neutropenia treatment.

Conclusion
Institution size or academic affiliation does not directly impact adherence to guidelines, internally published FN guidelines can increase adherence to IDSA/ASCO guidelines and are a modification that any institution can implement. Having a small sample size with perception-based data was a large limitation of this study, therefore future studies with larger sample sizes and concrete usage data could be pursued in the future to better understand febrile neutropenia treatment guideline adherence.

Disclosures
All Authors: No reported disclosures
P-1709. Factors Associated with Anti-Methicillin-Resistant Staphylococcus aureus and Anti-Pseudomonas aeruginosa Therapy in Critically Ill Patients with Community-Acquired Pneumonia: A Single-Center Experience
Authors: Trujillo Nalea , Diep Calvin , Garcia Ariadna , Holubar Marisa , Ha David R 
Published: January 2025

Abstract

Background
Current American Thoracic Society and Infectious Diseases Society of America community-acquired pneumonia (CAP) guidelines recommend empiric antibiotic therapy against methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa (P. aeruginosa) in individuals with major risk factors: (1) MRSA or P. aeruginosa growth in respiratory cultures within the past year or (2) severe CAP with prior hospitalization and receipt of parenteral antibiotics within the preceding 90 days. The objective of this study was to describe factors associated with empiric antibiotic therapy against MRSA and P. aeruginosa in critically ill patients with CAP.

Methods
This was a single-center retrospective study including adult patients admitted to the intensive care unit (ICU) with a diagnosis of pneumonia and who received systemic antibiotics solely for CAP from January 2022 to December 2023. The primary outcome was factors associated with empiric anti-MRSA and anti-P. aeruginosa therapy. Secondary outcomes included empiric antibiotic use relative to guideline-stated risk factors.

Results
169 patients were included in the final analysis. No risk factors were associated with empiric anti-MRSA therapy. Multivariate regression analysis showed that the following were associated with empiric anti-P. aeruginosa therapy: presence of guideline-stated risk factors for P. aeruginosa (OR 12, 95% CI 1.31-109, p&lt; 0.05) and prior immunosuppression (OR 3.67, 95% CI 1.47-9.17, p&lt; 0.01). Prevalence of MRSA CAP was 1.8% and prevalence of P. aeruginosa CAP was 2.4%. Of the 79 patients who received empiric anti-MRSA therapy, 68 (86.1%) did not have guideline-stated risk factors. Of the 105 patients who received empiric anti-P. aeruginosa therapy, 88 (83.8%) did not have guideline-stated risk factors.

Conclusion
Presence of guideline-stated P. aeruginosa risk factors as well as prior immunosuppression were associated with empiric anti-P. aeruginosa therapy and no factors were associated with empiric anti-MRSA therapy. Despite low incidence of MRSA and P. aeruginosa CAP, use of broad-spectrum antibiotics was frequent. Development of a protocol to guide empiric anti-MRSA and anti-P. aeruginosa therapy may help reduce unnecessary use of broad-spectrum antibiotics.

Disclosures
All Authors: No reported disclosures
P-1724. Knowledge, Attitude, and Practices (KAP) on Appropriate Antibiotic Use among Healthcare Providers in Qatar - A cross-sectional study
Authors: Shams Sherin , Nafady-Hego Hanaa , Al Nuaimi Asma Ali , Saleem Samah , Aziz Maryan Hassan , Seyam Naheel Ismail , Aziz Kamran , Kandil Dalia , Malik Aimon , Thomas Anil G , Al-Kuwari Mohamed Ghaith , Saeed Wael Ezzeldin , Al Abdulla Samya Ahmad , Krishnan Jeyaram Illiayaraja , Semaan Sandy , Abou-Samra Abdul-Badi , Butt Adeel A 
Published: January 2025

Abstract

Background
There has been growing awareness of antibiotic resistance as a significant public health issue, notably a widespread prescription of antibiotics for upper respiratory tract infections (URTIs).
Understanding the knowledge, attitude, and practices (KAP) of healthcare providers is crucial in designing interventions to reduce inappropriate antibiotics use. Our aim was to determine the KAP of primary care physicians towards antibiotics prescriptions in the outpatient setting to develop strategies to improve appropriate antibiotics use.
Physician responses to KAP Survey.

Methods
We employed a cross-sectional survey to determine the KAP of physicians at 4 Primary Healthcare Centers (PHCCs) in Qatar. The KAP questionnaire was structured into three main sections: evaluating physicians' knowledge regarding Upper Respiratory Infections (URIs) and antibiotics, examining attitudes encompassing beliefs or perspectives on antibiotic usage for URIs, and investigating practices to understand how physicians implement their knowledge and attitudes in their actions. A 5-point Likert scale was used for the questions.

Results
A total of 141 physicians were surveyed and 96% responded. Nearly 80% were &gt;40 years old, approximately half were women and 69% had ≥10 years of clinical experience. A majority of physicians (97.8%) agreed that inappropriate antibiotic use contributes to the rise of antibiotic resistance, 80.8% expressed disagreement with prescribing antibiotics for fever alone, and 40.4% admitted to experiencing patient pressure to prescribe antibiotics even when unnecessary. Conversely, 13.4% admitted to frequently prescribing antibiotics solely due to patient requests, and 37.6% confirmed encountering patient complaints or patient migration to other doctors if antibiotics were not prescribed.

Conclusion
Primary care physicians are knowledgeable about the role and risks associated with antibiotics, but frequently felt pressured by the patients/families to prescribe antibiotics. Intervention strategies to educate the public and empower the physicians are needed to address the inappropriate use of antibiotics.

Disclosures
Adeel A. Butt, MD, MS, Gilead Sciences: Grant/Research Support
P-1725. A Cluster Randomized Trial of Bundled Interventions to Reduce Inappropriate Antibiotic Use in the Outpatient Setting
Authors: Shams Sherin , Al Nuaimi Asma Ali , Krishnan Jeyaram Illiayaraja , Saleem Samah , Aziz Maryan Hassan , Seyam Naheel Ismail , Aziz Kamran , Kandil Dalia , Malik Aimon , Thomas Anil G , Nafady-Hego Hanaa , Saeed Wael Ezzeldin , Semaan Sandy , Al Abdulla Samya Ahmad , Al-Kuwari Mohamed Ghaith , Abou-Samra Abdul-Badi , Butt Adeel A 
Published: January 2025

Abstract

Background
Antibiotics are often inappropriately prescribed in the outpatient settings. Among the most common reasons for inappropriate antibiotic prescriptions are upper respiratory tract infections (URI) which are known or highly likely to be viral in origin. Our aim was to test a bundle of complementary interventions to reduce inappropriate antibiotic prescriptions in the outpatient setting for patients presenting with various URIs. Here we present preliminary data from the cluster randomized trial using pre-intervention baseline data (August to October 2023) and after implementation of interventions (December 2023 to March 2024).Figure 1.Comparison of inappropriate antibiotic prescriptions for URTIs between the intervention and control groups during the pre-intervention (Aug 2023 – Oct 2023) and post-intervention phases (Dec 2023 - Mar 2024).

Methods
We randomly assigned 2 Primary Healthcare Centers (PHCC) in Qatar to receive a 4 component intervention: 1) extensive provider education; 2) providing an algorithm driven decision support tool based on professional society recommendations for appropriate use of antibiotics for various URIs; 3) option for deferred prescription; and 4) monthly feedback to all physicians regarding their prescription patterns including anonymized comparison with their peers. Two PHCCs in the control group received a single intervention which was randomly chosen. For this study, we identified 4 common URIs for which professional society guidelines do not recommend use of antibiotics (acute bronchitis, acute laryngitis, common cold, influenza without mention of pneumonia). Prescriptions written and corresponding diagnoses were retrieved from the electronic medical records. Children &lt; 2 years of age, and individuals with any immune compromising condition or medications were excluded.Table. 1Appropriate and Inappropriate use of antibiotics in URTIs

Results
A total of 7,246 antibiotic prescriptions were written for 4 included URIs during the study period. The percentage of inappropriate prescriptions in the intervention group decreased from 67.7% to 62% in the first 4 months after the intervention (p-value &gt;0.05). The proportion of inappropriate prescriptions in the control groups remained steady at 70% before and after the intervention.

Conclusion
While not statistically significant in this early stage, our preliminary results indicate a trend in reduction in inappropriate prescriptions of antibiotics for URIS in the outpatient setting.

Disclosures
Adeel A. Butt, MD, MS, Gilead Sciences: Grant/Research Support
P-1761. Safety and Efficacy of Antimicrobial Optimization based on Negative Results from BioFire FilmArray Pneumonia Panel
Authors: Yoo Noah , Cheng Xian Jie , Chung Juri , Chawla Shalinee , Zacharioudakis Ioannis , Dubrovskaya Yanina 
Published: January 2025

Abstract

Background
The BioFire FilmArray Pneumonia (BFP) panel is a multiplexed nucleic acid test intended for detection of multiple respiratory viral and bacterial specimens from sputum or bronchoalveolar lavage (BAL) specimens, with high specificity and turnaround time. Efficacy and safety of de-escalation strategies in patients with negative BFP have not been adequately described.

Methods
This was a multi-center, retrospective analysis of adult patients with suspected pneumonia and sputum or BAL samples that tested negative on BFP. Patients for whom antibiotic therapy was discontinued (ATDC Group) were compared to patients who had their antibiotic therapy continued (ATC Group). Outcomes included in-hospital mortality, 30-day readmission, and hospital and ICU length of stay. Impact on the total number of days on antibiotics and the safety of the intervention were also assessed.

Results
Out of 500 patients with negative BFP assay, a total of 185 patients were included in the final analysis (59 ATDC Group vs. 126 ATC Group). 67.6% of samples were sputum and 32.4% were BAL in the entire cohort. The groups were generally well-balanced in baseline characteristics, but more patients in ATC Group had community-acquired pneumonia (59% vs 79%, p = 0.006), higher initial white blood cell count (10 vs 13, p = 0.038), and higher quick Pitt Bacteremia Score (1 [IQR 0-1] vs 1 [IQR 0-3], p = 0.020). The ATDC Group had significantly shorter days of total antibiotic therapy (1.0 days vs 10.6 days, p &lt; 0.001). 30-day readmission rates (16.95% vs 15.87%, p = 0.853) and the hospital length of stay (8.34 days vs 7.75, p = 0.960) did not differ. The ATDC Group experienced fewer AKI (8% vs 37%, p = 0.004).
Duration of Antibiotics

Conclusion
Antibiotic discontinuation based on BFP was associated with significant reduction in the number of total days on antibiotics. Discontinuation was not associated with increases in in-hospital mortality, length of stay, or readmission, but was associated with a significant reduction in acute kidney injury.

Disclosures
All Authors: No reported disclosures
P-1771. Impact of a Multistep Urinary Tract Infection-Focused Disease State Stewardship Initiative on the Treatment of Asymptomatic Urinary Presentations
Authors: Tyler Pitcock C , Casaus Danielle , Cotner Sarah , Ruf Kathryn , Burgess David S , Burgess Donna R , VanHoose Jeremy , Mynatt Ryan P , Mansoor Armaghan-E Rehman , Van Sickels Nicholas , Maskey Mitu , Myint Thein , Wallace Katie L 
Published: January 2025

Abstract

Background
Asymptomatic bacteriuria (ASB) is often overtreated, risking patient harm through unnecessary antimicrobial use and fostering antimicrobial resistance. This study assessed the impact of a multistep urinary tract infection (UTI)-focused stewardship intervention by comparing the incidence of asymptomatic urinary presentation (AUP) treatment before and after implementation.

Methods
This retrospective quasi-experimental study included patients &gt; 18 years at University of Kentucky HealthCare who received antimicrobial therapy with a urinalysis (UA) and/or urine culture (UC) collected for a presumed UTI between January 2023 to March 2023 (pre-implementation) and January 2024 to March 2024 (post-implementation). The steps implemented sequentially as part of the initiative included order set optimization with removal of unnecessary UAs, institution wide education, development of a new UA order with reflex to UC, and prospective audit and feedback. Our primary outcome was the incidence of AUP treatment.

Results
A total of 381 patients were evaluated with 204 in the pre-implementation group and 177 in the post-implementation group. Following implementation there was a trend toward decreased treatment for AUPs (42.2% vs. 35.0%, p=0.154). In the post-implementation group, fewer patients were treated for a UTI with altered mental status as the only reported symptom (10.8% vs. 5.1%, p=0.042). Moreover, overall adherence to guidelines significantly improved in the post-implementation phase (28.4% vs. 42.9%, p=0.003). There was also a notable enhancement in culture-targeted definitive therapy selection in the post-implementation group (20.1% vs. 37.3%, p &lt; 0.001) as well as the number of patients who received appropriate antibiotic durations for a UTI in the post-implementation group (38.7% vs. 53.1%, p= 0.005).

Conclusion
The implementation of a UTI-focused disease state stewardship initiative led to improvements in overall guideline adherence, culture-targeted definitive therapy selection, and therapy duration. Although further reductions in treatment of AUPs are still needed, these results suggest that a UTI-focused initiative improves overall UTI management and decreases unnecessary antimicrobial use.

Disclosures
Sarah Cotner, PharmD, BCPS, Gilead Sciences, Inc: Advisor/Consultant