bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1698. Prevalence of Anaerobes, Enterococcus, and Pseudomonas Among Patients with Complicated Biliary Infections
Authors: Mitsuuchi Taylor , Lau Janice , Hori Mike , Huang Joanne 
Published: January 2025

Abstract

Background
Current 2010 Infectious Diseases Society of America (IDSA) guidelines indicate that community acquired biliary infections do not require antimicrobial therapy directed against Enterococcus spp., Pseudomonas (PSA), or anaerobes in the absence of select risk factors. We evaluated empiric prescribing practices for complicated biliary infections at Valley Medical Center (VMC).

Methods
This was a single center retrospective study including patients 18 years or older with complicated biliary infections admitted at VMC from 1/1/2018 - 2/28/2022. Patients who did not require surgical intervention, had no cultures collected, or noted cephalosporin allergy were excluded. The primary outcome was to evaluate the prevalence of anaerobic, Enterococcus spp., and PSA bacteria isolated from culture. Secondary outcomes evaluated rate of Intensive Care Unit (ICU) admissions, all cause 30-day readmission, and C. difficile infections (CDI).

Results
191 patients with complicated biliary infections with culture data were included. Anaerobes and Enterococcus spp. were the most commonly isolated organisms, accounting for 19.4% and 11.5%, respectively. Of anaerobic cultures obtained, 6 (3.1%) were identified as gram-negative anaerobes and 26 (13.6%) were identified as gram-positive anaerobes. Pseudomonas spp. was uncommon (0.5%). 78 (40.8%) had negative cultures. 85 (44.5%) received empiric ceftriaxone. Of those on ceftriaxone, 75 also received metronidazole. 88 (46.1%) received empiric piperacillin tazobactam and the remaining 18 patients received alternative therapies. 59 (30.9%) were either admitted or transferred to ICU during their index admission. Of these, 48 (81.4%) were on piperacillin tazobactam. Similar all-cause 30-day readmission was observed among patients on ceftriaxone and piperacillin tazobactam (43.4%). Diagnosis with CDI within 90 days of discharge was uncommon (1.6%).

Conclusion
PSA and Gram-negative anaerobe prevalence was low; Enterococcus and Gram-positive anaerobes was higher. Lower rates of ICU admission and CDI were observed in patients on ceftriaxone, though may be in part due to less severe illness. Additional studies are needed to evaluate risk factors that may be predictive of Enterococcus and anaerobic infection.

Disclosures
All Authors: No reported disclosures
P-1710. Prescribing Patterns for Clostridioides difficile Treatment in Outpatient Setting Using the Collaboration to Harmonize Antimicrobial Registry Measures (CHARM)
Authors: Nandi Tiasha , Pawlowski Kathryn M , Pontefract Benjamin , Klepser Michael , Sohn Minji 
Published: January 2025

Abstract

Background
Clostridioides difficile infection (CDI) is a form of infectious diarrhea associated with antibiotic use. In 2021, the IDSA released guidelines for treatment of CDI, which recommended fidaxomicin for 10 days as the first line treatment and vancomycin as an acceptable alternate. It is unclear to what extent prescribers have adopted this recommendation. This study aimed to examine patients’ antibiotic exposure before developing CDI and describe the prescribing patterns for CDI treatment in outpatient settings.Table 1:Frequency and Duration of Initial Clostridioides difficile Infection (CDI) Therapy

Methods
This observational study used the CHARM database, which contains outpatient encounter data extracted from the medical records of nine health systems. Patients with CDI were identified using ICD-10 codes and medications commonly used for CDI. The data period was between July 2019 and June 2023. The frequency and duration of antibiotics used for CDI treatment and the percentage of patients receiving subsequent therapy were estimated. Antibiotics prescribed within 180 days prior to a diagnosis of CDI visit were captured.Figure 1:Duration Distribution of Initial Clostridioides difficile Infection (CDI) Therapy

Results
A total of 551 patients with CDI were identified. Of those, 439 (80%) received vancomycin, 80 (15%) received fidaxomicin, and 52 (9%) received metronidazole. The average duration of therapy in days for vancomycin, fidaxomicin, and metronidazole was 12, 8, and 10, respectively (Table 1). The most common duration of therapy was 7-days for vancomycin (46%), fidaxomicin (41%), and metronidazole (50%) (Figure 1). After the initial treatment, 4% received a subsequent treatment within 3 weeks. Fluoroquinolone prescriptions had the highest prevalence of CDI (3.6 cases per 10,000 prescriptions). Of patients with an identified antibiotic 30 days prior to CDI, 38% had multiple courses of antibiotics.

Conclusion
Receiving multiple courses of antibiotics is associated with developing CDI. The majority of patients with CDI received vancomycin treatment (the alternative recommended therapy). The average duration of therapy was longer than recommended. Metronidazole use is still common.

Disclosures
Minji Sohn, PhD, Emergent BioSolutions, Inc.: Grant/Research Support
P-1717. Perception and Practice of Physicians' Antibiotic Use at Tertiary Military Hospitals in Bangladesh
Authors: Hassan Syed Abul , Saha Sharmi , Dostogir Harun Md Golam , Amin Sumon Md Shariful , Jahan Ishrat , Ul Anwar Md Mahabub , Siddiquee Taufiq H 
Published: January 2025

Abstract

Background
Inappropriate use of antibiotics, which contributes to increased antimicrobial resistance (AMR), is common in healthcare settings across the globe, especially in low-resources settings. Antibiotics are widely and inappropriately used without adherence to international guidelines in Bangladesh, which may contribute significantly to the development AMR. Military hospitals are known for better compliance of health care system. We sought to investigate the perceptions of Physicians of Tertiary military hospitals in Bangladesh regarding appropriate antibiotic use and prescribing approach.
Physicians' AMR perception

Methods
We conducted a cross-sectional survey using a semi-structured questionnaire and data collected through face to face interview from 84 Military doctors of two major tertiary military hospitals of Bangladesh – Combined Military hospital (CMH) Dhaka (1650 bedded) and Jashore (500 bedded) between September 2020 and January 2021. Descriptive statistics were performed to analyze the data and for interpretation
Approach of physician to prescribing antibiotic

Results
Out of 84 respondents, 70% of the physicians considered AMR is a significant concern worldwide, but only 26.7% Physician of Dhaka CMH and 11% of Jashore CMH considered it as a problem in their hospital. Two-third respondent (66%) considered that inappropriate use of antibiotic is the main cause of rising AMR, followed by Over prescription of broad-spectrum antibiotics by 62.2%, and Easy access to antibiotics without a prescription by 58.8%. Around 36.2% opined that poor IPC practices by health professionals are also important factor. Total 72.6% respondent ensure that they routinely step down I/V antibiotics to oral antibiotics as earliest, 13.4% physicians considered cost affordability of the patient affects their choice of antibiotics. Over half of the physicians (51.2%) use prophylactic antibiotic for 3 to 7 days after any surgical procedure of a clean-contaminated case without signs of infection, where only 7.3% doctor use single dose antibiotic prophylaxis.
Use of antibiotic prophylaxis in surgical procedure

Conclusion
Physicians' perception on AMR and rational antibiotic prescription were found fall of short of the standard. Strict compliance of antibiotic use and trade guideline, Introduction of formal antibiotic stewardship program in Bangladesh may be a useful intervention

Disclosures
All Authors: No reported disclosures
P-1718. Use of Collaboration to Harmonize Antimicrobial Registry Measure (CHARM) to Assess Antibiotic Prescribing in Dental Practices
Authors: Smith Cameron , Sohn Minji , Pontefract Benjamin , Dahal Kushal , Klepser Michael , Mishreky Helen 
Published: January 2025

Abstract

Background
Dentists account for 10% of all antibiotic prescriptions in the United States. Limited data exist describing antibiotic use in dental practices; however, it appears that many antibiotics may not be warranted or consistent with treatment guidelines.1,2,3 Of particular concern is the unwarranted use of clindamycin. No standardized methods exist for gathering data and assessing the concordance of use related to antibiotic use in dental practices.

Objectives
Describe patterns of antibiotic prescribing in dental clinics within the CHARM network. Identify areas for stewardship intervention within dental practices. top 5 antibiotic prescription in dental clinics
name of antibiotic, the number of prescriptions, percentages, and average duration

Methods
Dental practices were identified from 5 dental clinics that participate in CHARM. The CHARM database is a registry containing data collected from the electronic medical records of partnering health systems about outpatient antibiotic prescribing. Episodes of antibiotic prescribing were identified in dental clinics and extracted between January 2022 to June 2023. Data collected included the ICD-10 code, antibiotic, and regimen used. When a diagnosis was provided, the appropriateness of antibiotic selection was assessed in concordance with guidelines. The most common antibiotics and diagnoses were identified.

Results
4,028 antibiotic prescriptions were written by 42 prescribers in 5 dental clinics. The most prescribed antibiotics were amoxicillin (n=2,400; 59.6%), penicillin (n=700;17.3%), and clindamycin (n=400;9.9%). The average length of therapy was 7.0, 8.2, and 6.9 days for amoxicillin, penicillin, and clindamycin, respectively. ICD-10 codes were recorded for 1,722 (43%) prescriptions. No indication/diagnosis was provided for 2,278 (57%) antibiotic prescriptions. While many prescriptions were not linked to any diagnosis (n=2,300; 57.1%), the most common diagnosis codes were general dental exam (n=1,400; 34.8%) and general dental infection (n=300; 7.4%).

Conclusion
For visits where the dentist prescribed antibiotics, clindamycin was prescribed about 10% of the time. Clindamycin is no longer recommended for use in most procedures that dentists manage.4 Reducing clindamycin use in dental practices represents a stewardship opportunity in dental practices.

Disclosures
Minji Sohn, PhD, Emergent BioSolutions, Inc.: Grant/Research Support
P-1722. Short versus Long Duration of Empiric Antifungal Use Among Patients with Sepsis or Septic Shock
Authors: Rust Thomas J , Binkley Shawn , DiCesare Michael , Lawson Shannon , Athans Vasilios 
Published: January 2025

Abstract

Background
Invasive candidiasis is associated with high mortality rates among critically ill patients. There are currently no data to guide duration of empiric antifungal therapy (EAT) when indicated in high-risk patients with sepsis. The aim of this study was to evaluate clinical outcomes associated with a short versus long course of EAT in patients with sepsis or septic shock.

Methods
This was a retrospective cohort study of adults admitted to the medical ICU who received &gt; 2 days of EAT with fluconazole or caspofungin for sepsis or septic shock. Patients were excluded if they expired within 48 hours, had a positive fungal culture from a sterile site, were exposed to a systemic antifungal for &gt; 48 hours in the 14 days preceding treatment, received prophylactic antifungals, or were neutropenic. In addition, patients who expired within 96 hours of EAT initiation were excluded from the primary outcome analysis. Patients were grouped according to receipt of EAT for ≤ 4 days (short duration) or &gt; 4 days (long duration). The primary outcome was 30-day all-cause mortality. Secondary outcomes included time to mortality, hospital and ICU length of stay (LOS), vasopressor-free days over 14 days, and 30-day new proven fungal infection.

Results
Of 135 included patients, 79 patients received short course EAT vs. 56 patients long course (Figure 1). Baseline variables were well balanced between groups apart from older age and lower body weight observed in the short duration group (Table 1). The primary outcome, evaluable in a total of 114 patients, was observed in 33 (56.9%) patients who received a short duration and 26 (46.4%) patients who received a long duration (p=0.263; OR 1.52, 95% CI [0.73 – 3.19]). There were no significant differences in all-cause inpatient mortality or time to mortality (Figure 2). Among patients who were discharged alive, there were no significant differences in secondary outcomes with the exception of fewer vasopressor-free days in the short course group (Table 2).

Conclusion
Most clinical outcomes were not significantly different between patients with sepsis or septic shock who received a short versus long course of EAT. Duration of EAT is an important target for stewardship programs. This study adds to knowledge in the area, though a randomized trial may be necessary to substantiate our findings.

Disclosures
All Authors: No reported disclosures
P-1740. Impact of a System Wide Antimicrobial Stewardship Intervention Bundle to Improve Guideline Directed Antibiotics for Urinary Tract Infections
Authors: Weslander Erin , Borkowski Jaime , Moore William Justin , Bertram Christie M , Rhodes Nathaniel J , Chang Stephanie , Shah Rishita , Oliver Aaron , Dickens Michael , Johnicker Kyle , Polisetty Radhika S , Park Jong , Sutton Sarah , Postelnick Michael 
Published: January 2025

Abstract

Background
Urinary tract infections (UTIs) are one of the common reasons for antibiotic use across healthcare settings. Across an eleven-hospital system, common urinary pathogens (E. coli, Proteus species, and Klebsiella species) had greater than 80% coverage with cefazolin, which was within 0-8% of ceftriaxone coverage based on the local antibiograms. With increased risk of C. difficile infection and resistance development seen with ceftriaxone, cefazolin was promoted as first line for empiric UTI coverage.Table 1:Outcomes

Methods
An interrupted time series analysis was performed comparing a pre-intervention group to two phases of stewardship intervention (figure 1). The first intervention included an updated guideline, education, and pharmacist intervention upon order verification recommending guideline directed therapy. Guideline directed options and guideline non-compliant options are highlighted on green and red respectively, on figure 3. The second intervention was cascade reporting (figure 2) for urine culture Enterobacterales susceptibility, which was implemented across sites between 9/2023-1/2024. A generalized linear model with Poisson link was fit to the data. Compliant orders were regressed vs. the denominator of all UTI orders. Multiple models were considered, and the final model selection was based on likelihood ratio testing and the rule of parsimony.Figure 1:Interrupted Time-SeriesWhite = pre-intervention; light gray = intervention 1; dark gray = intervention 2

Results
In the four pre-intervention months, guideline compliance across the system was 38.1% (1674/4393), compared to 61.9% (6749/10,903) after intervention 1 was implemented (table 1). The final model suggested that intervention 1 was associated with a nearly 1.5-fold increase in compliance which was sustained over time and suggested that the compliance rate over time increased modestly at around 5% per quarter (figure 1). There was no change in length of stay, risk adjusted length of stay, or 30-day all-cause readmission (table 1).Figure 2:Microbiology Cascade Reporting Workflow

Conclusion
Guideline update, education, and frontline pharmacist intervention were significantly impactful in improving guideline directed treatment for UTIs. Cascade reporting on urine cultures may help reinforce guideline directed therapy but did not result in substantially different compliance rates from education with frontline pharmacist intervention.Figure 3:Percent of Patients with Empiric Guideline Directed Therapy Orders

Disclosures
Nathaniel J. Rhodes, PharmD MS, Apothecademy, LLC: Advisor/Consultant
P-1742. Isavuconazole Therapeutic Drug Monitoring and Association with Adverse Events
Authors: Huang Emily , Wittenberg Rebecca , Dray Joy Vongspanich , Thompson George R , Fine Jeffrey , Wilson Machelle , Chee Melissa 
Published: January 2025

Abstract

Background
Therapeutic drug monitoring (TDM) is often recommended with triazole antifungals. Isavuconazole TDM is currently not uniformly recommended due to its high oral bioavailability, modest drug-drug interactions, and linear pharmacokinetics; however, an assessment of serum levels and toxicity has not been reported.
This study aimed to explore the exposure-toxicity relationship for isavuconazole. The primary outcome was the threshold isavuconazole serum level most predictive of toxicity. Secondary outcomes included percentage of patients who developed adverse events and identification of adverse event profile.Table 1:Isavuconazole Adverse Event BreakdownThis table details the exact number and percentage of patients who experienced each type of adverse event reported by the patient sample with isavuconazole

Methods
This retrospective study analyzed adult patients who received oral isavuconazole and collected isavuconazole serum levels at our institution from 1/1/2015 to 10/4/2023. T-test and Fischer’s exact test were used to compare patients with and without adverse events, while Youdin’s index was used to identify a serum level most predictive of toxicity.

Results
Ninety-five patients, corresponding to 219 serum levels total (UPLC/MS), were analyzed. Thirty-seven patients (38.9%) developed adverse events, most commonly transaminitis (29.7%), diarrhea (24.3%), and nausea (18.9%) (Table 1). According to Youdin’s index, a serum level of 5.86 mcg/mL corresponded to a threshold that balances sensitivity and specificity for determining the risk of adverse events. Per multivariable logistic regression analysis, each one-unit increase (mcg/mL) in serum level was associated with a significantly increased odds risk of developing toxicity by 26%. All 24 patients who had isavuconazole dose-reduction secondary to adverse events demonstrated resolution of symptoms. Fifteen out of those 24 patients rechecked serum levels following dose reduction, yielding a mean serum level of 3.3 mcg/mL post-reduction, compared to 6.3 mcg/mL pre-reduction.

Conclusion
Our findings identify an exposure-toxicity relationship for isavuconazole. TDM may be beneficial for those on long-term isavuconazole therapy, especially in those who develop toxicity. Additionally, in patients with serum levels above 5.86 mcg/mL who show intolerable symptoms consistent with possible adverse drug effects, dose reduction is recommended.

Disclosures
George R. Thompson, III, MD, Astellas: Advisor/Consultant|Cidara: Advisor/Consultant|Cidara: Grant/Research Support|F2G: Advisor/Consultant|F2G: Grant/Research Support|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Pfizer: Advisor/Consultant
P-1758. Evaluation of Real-Life Application of Multi-plex PCR Pneumonia Film-array Panel as an Antibiotic Stewardship Tool, a Prospective Investigation
Authors: Maryam Hera , Kim Brian , Arab Niki , Freites Christian Olivo , Furukawa Daisuke , Gallardo-Huizar Oscar , Huang Glen , Jeng Arthur 
Published: January 2025

Abstract

Background
Selecting empiric antibiotics (abx) for community-acquired and hospital-acquired pneumonia (CAP, HAP) on admission can be challenging, given the variety of possible pathogens. Per IDSA guidelines, broad spectrum antibiotic(s) are recommended, based on pneumonia type, risk of prior abx exposure/drug resistance, and disease severity. In this study, by using the BioFire® multi-plex PCR film-array (FA) on sputa, we prospectively investigated the time to pathogen identification in CAP and HAP, time to providing optimal abx, and types of change this strategy allowed.

Methods
Single center, prospective, observational study from January 1, 2021 to January 31, 2024. All admitted patients with CAP or HAP, with satisfactory sputa or bronchioalveolar lavage (BAL) cultures, were considered for inclusion by the Antimicrobial Stewardship service (ASP), whereby FA was performed on the sample. Exclusion criteria consisted of poor sample (≥ 10 epithelial cells/lpf), sputa previously ordered within 7 days, concurrent non-pneumonia infections and non-infectious pulmonary conditions. FA results and its respective abx recommendations were communicated to the patient’s clinician by ASP.

Results
148 samples met study criteria (Table 1). FA detected bacterial pathogens in 65% (n=96) and viruses in 16% (n=23) (Table 2). FA resulted in 2.9 hours (H) [IQR 1.75-2.87] after gram stain, whereas time to culture finalization was 90.5 H [IQR 45-82] (Figure 1). An average of 2 empiric abx days were saved per case [IQR 1-2]. Time to first modification of abx was 6.1 H [IQR 0.15-2.9]. 84% of abx courses were modified due to ASP intervention from FA, of which 86% resulted in de-escalation of empiric abx (Figure 2). 62% (n=92) had no growth on culture, and of those cases, 48% (n=44) had pathogen detected by FA. 50% (n=74) of bacterial culture results were congruent to FA, 19% (n=28) were partially congruent, with more bacteria detected on FA than culture.

Timeline

Conclusion
FA reduced time to pathogen identification compared to traditional culture in CAP and HAP, allowing ASP to provide rapid interventions to optimize abx treatment and save days of less optimal empiric abx. FA detected more pathogens compared to culture, including when negative, leading to abx changes in majority of cases. FA serves as a valuable tool for ASP.

Type of Intervention

Disclosures
All Authors: No reported disclosures