bluuebunny/crossref_metadata_2025_split huggingface dataset:
2245. Appropriate use of antibiotics in patients with osteomyelitis due to decubitus ulcers
Authors: Dattadeen Jaraad , Aslam Sadaf 
Published: November 2023

Abstract

Background
Decubitus ulcers are a costly and challenging problem in the healthcare system, with an estimated 2.5 million pressure ulcers treated annually in the United States at a cost of $11 billion. Patients with decubitus ulcers may present with evidence of infection or sepsis, but the source is rarely the ulcer itself. Recent guidelines recommend evaluating patients for curative management before pursuing further testing or empiric antimicrobial treatment. This study aimed to assess the appropriateness of antibiotic usage in patients admitted to the hospital with decubitus ulcers, and to determine the rate of appropriate antibiotic use.

Methods
This study involved a retrospective review of 1678 patients records with decubitus ulcers to assess the appropriate use of antibiotics during their inpatient stay. Appropriateness was determined by one of three criteria. The 1st criteria included patients who met systemic inflammatory response syndrome with suspected infection from osteomyelitis; 2nd criteria included patients who received antibiotics due to another infection (pneumonia, urinary tract infection or bacteremia) and 3rd criteria included use of antibiotics as a bridge therapy to surgical intervention (flap closure or Incision and Drainage). The rate of consultation for infectious disease and plastic surgery was also investigated.

Results
Of the total 1678 patients, the median age was 70 yrs (IQR=21), of that 51 % were males. Based on the criteria for appropriateness, there were a significant difference in gender (p= 0.000) females were more likely to receive inappropriate antibiotics (Table 2). Similarly, the rate of inappropriate use of antibiotics was 15.9% with ID consults as compared with 84.1% who didn’t receive ID consult (p=0.000) as seen in table 1.
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Conclusion
This study contributes to a better understanding of appropriate antibiotic usage in patients with decubitus ulcers. The findings favor the importance of ID consults in the appropriate use of antibiotics. Additionally, there may be some underlying bias with prescribing antibiotics to females compared to males. Thus, the study provides clinicians with tools in order to make evidence-based decisions on the management of these patients, and for healthcare systems to optimize resource allocation

Disclosures
All Authors: No reported disclosures
2948. Pediatric Clinical Outcomes of MRSA PCR Utilization for Anti-MRSA De-escalation
Authors: Demirhan Salih , Escobar Lee Kiriam , Lee Philip J , Sy Sharlene , Anosike Brenda I 
Published: November 2023

Abstract

Background
Methicillin resistant Staphylococcus aureus (MRSA) remains a major infectious disease challenge often requiring empiric therapy. Rapid identification methods, such as MRSA polymerase chain reaction (MRSA PCR) have been increasingly utilized as a stewardship tool for antimicrobial de-escalation in adults. More recently, a growing, albeit small, number of pediatric studies have demonstrated similar promise. However, there remains a paucity of data evaluating clinical outcomes of using MRSA PCR as a stewardship tool in pediatrics.

Methods
Retrospective cohort study of nasal MRSA PCRs collected from hospitalized patients ≤ 21 years of age between November 1, 2021, and February 28, 2023. Indications for testing were categorized into 4 clinical syndromes defined a priori: pneumonia; skin and soft tissue infections (SSTI); head and neck infections (HNI); and bacteremia. Each MRSA PCR test was counted per single episode. Inclusion: all those who started on an anti-MRSA agent and discontinued ≤48 hours of a negative PCR. Primary endpoint: any adverse clinical outcome defined as restarting an anti-MRSA agent in 7 days (14 days for SSTI), readmission for same indication in 30 days, escalation of ventilatory support, new inotropic support and/or transfer to intensive care unit (ICU) -all in 7 days; and in-house mortality in 30 days.

Results
Total of 145 patients with 156 episodes met inclusion criteria; demographic and clinical characteristics are shown in Table 1. Pneumonia (39.1%) and SSTI (24.4%) were the most common indications for testing. 58.3%) were in the ICU at the time of testing; 48.7% received respiratory support. Vancomycin (57.0%) was the most used antibiotic. Clinical characteristics of episodes are shown in Table 2. Fifteen patients (9.6%) had any of the adverse outcomes (negative predictive value =90.4%, [95%CI: 84.6-94.5]); only 3 were restarted on an anti-MRSA agent (Table 3).

Conclusion
In this single center study of pediatric patients who had a negative MRSA PCR nasal swab, none grew MRSA from cultures. Though limited, early discontinuation of anti-MRSA antibiotics was not associated with high rates of any adverse outcome suggesting the role of MRSA PCRs as a useful clinical stewardship tool in children. Larger/prospective studies are still needed.

Disclosures
All Authors: No reported disclosures
2254. Asymptomatic Bacteriuria Underestimates True Inappropriate Prescribing for Non-Urinary Tract Infections
Authors: Hartlage Whitney , Chan Jeannie D , Bajenov Maria , Castillo Alyssa , Lynch John B , Martinez-Paz Natalia , Bryson-Cahn Chloe , Escobar Zahra 
Published: November 2023

Abstract

Background
Unnecessary treatment of asymptomatic bacteriuria (ASB) is an important target for antimicrobial stewardship efforts. However, patients with urine colony counts &lt;105 colony-forming units (CFU)/mL or no growth are often excluded due to not meeting the definition of bacteriuria. We evaluated inappropriate treatment among patients without urinary tract infection (UTI) symptoms who underwent urine testing, regardless of the significance of growth in culture.

Methods
Patients who underwent urine testing during September 8, 2022 - March 11, 2023, were reviewed across ten critical access hospitals participating in the University of Washington Center for Stewardship in Medicine. Culture growth was categorized as no growth, ≤10,000 CFU/mL, 11,000-50,000 CFU/mL, 51,000-100,000 CFU/mL or &gt;100,000 CFU/mL. Asymptomatic for UTI was defined as the absence of documented signs or symptoms of UTI, per the National Hospital Safety Network definition and Infectious Diseases Society of America Guidelines. We assessed the number of patients with a positive UA (leukocyte esterase, WBC &gt;10, or nitrites) treated with antibiotics and the association of urine colony cutoffs on inappropriate antibiotic prescribing. Variables were compared using Mantel-Haenszel chi square test. A two-sided p-value of &lt; 0.05 was considered statistically significant.

Results
The analysis included 616 patients- 249 were classified as asymptomatic for UTI (40%). Patients with asymptomatic pyuria (n=188) were more likely to receive treatment than those without pyuria (n=42) (79% vs 43%, p&lt; 0.001). One hundred seventeen patients with urine colony counts &lt; 105 CFU/mL lacked signs or symptoms of UTI. Among these 117 patients, 72 (62%) were treated with antibiotics. There was a significant trend that treatment in asymptomatic patients increases with colony count in urine culture (p&lt; 0.001).

Conclusion
Treatment of ASB alone inadequately captures the total number of patients receiving unnecessary antibiotics for suspected UTI. A more comprehensive means of quantifying unnecessary UTI treatment may be capturing all patients who undergo urine cultures-including those with asymptomatic pyuria or asymptomatic nitrituria, even with low growth on culture.

Disclosures
All Authors: No reported disclosures
2949. Emergency Department (ED) Discharge Antibiotic Prescription Review by Hospital Pharmacists at a Large Academic Medical Center
Authors: Dubrovskaya Yanina , Merchan Cristian , Marsh Kassandra , Siegfried Justin , Major Vincent J , So Jonathan , Rodriguez James , Jhala Pradyuman , Iturrate Eduardo , Papadopoulos John , Mazo Dana , Smalley Samantha 
Published: November 2023

Abstract

Background
Direct patient discharge from the Emergency Department (ED) presents an ideal time to promote antimicrobial stewardship (AS). On March 1, 2021 we initiated a pilot program where ED pharmacists conduct a review of discharge antibiotic prescriptions (abx Rxs). The aim of this program is to ensure appropriate discharge abxs. Willow Pharmacy Epic Analysts, ED and AS pharmacists collaborated on this program which included Epic integration of Rx Discharge Track Board, ED Discharge InBasket, ED Discharge Rx iVent and AS-led education sessions.

Methods
Data for 2022 ED patients with discharge abx Rxs and iVents were extracted via Epic Reports. The first encounter per patient was included. We compared discharge abx Rxs and patient outcome data in Pharmacy vs No Pharmacy Review Groups (PRG, NPRG). Pharmacy iVents were used as a process measure.

Results
Among 5747 ED adult patients with discharge abx Rxs, 2638 (46%) were reviewed by pharmacy (PRG). PRG and NPRG had similar prevalence of chronic pulmonary disease (12% vs. 13%), diabetes mellitus (9% vs. 10%), malignancy (8% vs. 9%), peripheral vascular disease (6% vs. 8%), renal disease (4% vs. 5%), and HIV (1% vs. 2%) despite a difference in mean Charlson Comorbidity Index (0.64 vs 0.75, p&lt; 0.01). The primary ED diagnosis was skin and soft tissue, urinary, intra-abdominal infections and pneumonia (25 vs 23%, 18 vs 17%, 8 vs 9%, 5 vs 6%, respectively all p=NS). In PRG, discharge abxs demonstrated an increase use of penicillin (26 vs 24%, p=0.017) and 2nd generation cephalosporin (17 vs 14%, p&lt; 0.001). The PRG also decreased use of 3rd generation cephalosporin (11 vs 12%, p=NS), quinolones (6 vs 7%, p=NS) and clindamycin (1.7 vs 2.4%, p=NS). There was no difference in ED length of stay (LOS 4.8h in each group), C. difficile infection (CDI) within 8 weeks (0.1 vs 0.2%, p=NS), and 30 days repeat ED visit or inpatient admission with the same diagnosis as index ED encounter (2.8 vs 2.6%, p=NS). Pharmacists intervened in 10% (272/2638) of ED abx Rxs with 92% (249/272) acceptance rate. The top 3 pharmacy interventions were recommending alternative abx (42%), dose optimization (31%) and abx duration (6%).

Conclusion
Engaging pharmacists in ED discharge Rxs review resulted in use of narrower spectrum abx with lower CDI risk without any negative impact on ED LOS and clinical outcomes.

Disclosures
All Authors: No reported disclosures
2261. Impact of Antimicrobial Stewardship Program on Klebsiella pneumoniae and Escherichia coli Antimicrobial Resistance
Authors: Ferreiro Jose Luis Lamas , Otero Judith Alvarez , Rivo Ana Sanjurjo , de Salamanca Holzinger Ignacio Enriquez , Soneira Maria Fernandez , de Miguel Bouzas Jose Carlos , Conde Irene Rodriguez , Cavero Jorge , Aguado Javier de la Fuente 
Published: November 2023

Abstract

Background
A decrease in antimicrobial stewardship activities has been observed in our hospital since the beginning of the pandemic. The study aim was to evaluate the impact of decrease in antimicrobial stewardship activities in Klebsiella pneumoniae and Escherichia coli acquired multidrug-resistance.

Methods
The quarterly percentage of broad-spectrum antibiotic prescriptions evaluated by antimicrobial stewardship team (AMST), the quarterly consumption of broad-spectrum antimicrobials and the quarterly proportion of multidrug-resistant K. pneumoniae and E. coli were assessed between October 2016 and December 2022, with 2 periods of time, before the pandemic (October 2016-March 2020) and after the pandemic (April 2020-December 2022).Time series analysis was performed with ARIMA models to evaluate the association between decrease in AMST activities with multidrug-resistance in K. pneumoniae or E. coli. Correlation between broad-spectrum antibiotic prescriptions reviewed by AMST with broad-spectrum antimicrobials consumption and proportion of multidrug-resistance in K. pneumoniae or E. coli in urine cultures was assessed using the Pearson correlation coefficient.

Results
Percentage of broad-spectrum antimicrobials evaluated by AMST was 77% in first period and 29% in second period. The mean of broad-spectrum antibiotics consumption in first period was 13.02 DDD/100 bed-days and 15.35 DDD/100 bed-days in second period. Decrease of AMST activities was associated with an 37% increase in multidrug-resistant K. pneumoniae in second period compared with first period (p=0.02). No differences were found in E. coli. Correlation between percentage of AMST-reviewed broad-spectrum antibiotics with consumption of these antibiotics was good (correlation coefficient -0,7; p&lt; 0,01). Correlation between ASMT-reviewed broad-spectrum antibiotics and multidrug-resistant K. pneumoniae was moderate (correlation coefficient -0.44; p=0,02). No correlation between ASMT-reviewed broad-spectrum antibiotics and multidrug-resistant E. coli (correlation coefficient 0,09; p=0,6) was found.

Conclusion
Decrease in antimicrobial stewardship activities was associated with high isolation of multidrug-resistant K. pneumoniae in urine cultures.

Disclosures
All Authors: No reported disclosures
2264. Shorter Duration of Visit Associated with Inappropriate Antibiotic Prescribing for Respiratory Tract Infections in a National Sample of Ambulatory Visits, 2009 - 2016
Authors: Mendoza Vidal M , Strey Kelsey , Reveles Kelly 
Published: November 2023

Abstract

Background
Due to the reported decrease in the duration of primary care visits, it is important to assess provider adherence to guidelines when treating respiratory infections that are unlikely to necessitate antimicrobial treatment. This study aimed to investigate the relationship between the duration of visit and unnecessary antibiotic prescribing while considering patient and provider factors, including age, sex, race, and diagnosis.

Methods
This retrospective, cross-sectional study used outpatient, office-based data from the National Ambulatory Medical Care Survey from 2009 to 2016. All patients with a primary diagnosis of bronchitis, viral respiratory tract infection, influenza, and viral pneumonia were included for analysis. Patients with diagnoses that almost always require an antibiotic were excluded. Diagnoses were identified using ICD-9 or ICD-10 codes. Inappropriate antibiotic use was identified using multum codes and defined as at least one prescribed oral antibiotic during the visit. Provider status was defined as physician only or other provider. Multivariate logistic regression was used to determine predictors of inappropriate antibiotic prescribing. Data weights were applied to all analyses to generate national estimates.

Results
A total of 226,250,589 patient visits were included in the analysis, of which 83,404,484 (36.9%) resulted in an inappropriately prescribed antibiotic. Patients prescribed antibiotics were older (median age 42 vs. 13 years) and more often White (82.4% vs. 79.6%). After adjustment for covariates, time spent with provider less than 15 minutes (aOR 1.866, 95% CI 1.862-1.869), patient age 18-64 years (aOR 2.408, 95% CI 2.406-2.410), other provider types only (aOR 1.790, 95% CI 1.785-1.794), and viral pneumonia diagnosis (aOR 68.432, 95% CI 66.691-69.936) were most strongly associated with inappropriate antibiotic prescribing.

Conclusion
This study found that patients who spent less time with providers, had viral pneumonia, and were aged 18-64 years old were more likely to receive inappropriate treatment. Further investigation is necessary to determine reasons for inappropriate antimicrobial prescribing among outpatients.

Disclosures
Kelly Reveles, PharmD, PhD, Ferring Pharmaceuticals: Advisor/Consultant|Ferring Pharmaceuticals: Honoraria
2265. Immunocompromised Patients, Compromised Guidelines? Practice Patterns of Managing Asymptomatic Bacteriuria in Immunocompromised Patients
Authors: Moore Jacqueline , Villanueva Daphne-Dominique , Stewart Logan 
Published: November 2023

Abstract

Background
Asymptomatic bacteriuria is an issue that plagues the field of medicine. Current guidelines set by the Infectious Diseases Society of America (IDSA) recommend against screening for and treating asymptomatic bacteriuria (ASB) in immunocompromised hosts. However, practice patterns of physicians may deviate from these guidelines. The goal of this study was to gather information on the practice patterns of providers in the fields of transplantation and infectious diseases and determine how closely they follow the recommended approach on managing ASB in immunocompromised hosts.

Methods
We employed the use of a computer-based survey using the REDCap software, and then disseminated the survey to several target groups. The survey was distributed from March 2023 through April 2023. There were 145 total responses. The survey included a scale to assess what participants considered to be diagnostic of urinary tract infection (UTI) (Table 1). The survey presented clinical cases which appeared after a specialty was chosen to ensure each participant was shown cases relevant to their specialty.Table 1.Demographics and Likert scale in diagnosing UTI based on urinalysis components and symptoms

Results
Infectious disease accounted for 111 of the responses. When asked if they would routinely screen for UTI in patients on immunosuppression, 5.8% of participants said yes. Thirty nine participants agreed or strongly agreed that bacterial growth of ≥100,000 CFU on culture is diagnostic of UTI, regardless of symptoms. Seventeen participants saw foul-smelling urine and cloudy urine as symptoms of UTI, 41% of which were infectious disease specialists. A larger number of those practicing more than 10 years versus fewer than 10 years agreed or were neutral regarding foul smelling urine and cloudy urine as symptoms of UTI (Table 1). Figure 1 shows 14.2% of participants chose to treat an asymptomatic neutropenic patient. Of these, 93.8% were infectious disease specialists.
How would you manage a patient with breast cancer on chemotherapy with stable neutropenia who has asymptomatic bacteriuria?Figure 1.Sixteen out of 114 respondents chose to treat in this clinical case involving an asymptomatic patient with neutropenia

Conclusion
Practice patterns in managing asymptomatic bacteriuria in immunocompromised patients vary, despite latest guidelines. Many providers agreed that foul-smelling urine and cloudy urine are indicators of UTI, and many see bacterial growth as diagnostic. This survey demonstrates room for improvement in management of asymptomatic bacteriuria in immunocompromised patients and the need for further education of providers.

Disclosures
All Authors: No reported disclosures
2266. Microbiology and Predictors of Gram-Negative Infections in Persons Who Inject Drugs with Injection-Related Infections Requiring Hospitalization
Authors: Mulbah Jessica L , Morita Kazumi , Mentzer Laura , Schultz Sara K 
Published: November 2023

Abstract

Background
Intravenous drug use predisposes users to life-threatening bacterial infections primarily caused by gram-positive organisms. Studies have seen an uptrend in gram-negative injection-related infections in persons who inject drugs (PWID). Therefore, this study aimed to assess the microbiology of injection-related infections in PWID and evaluate risk factors that may predispose these patients to infections caused by gram-negative organisms.

Methods
This retrospective chart review of adult PWID hospitalized with an injection-related infection (skin & soft tissue infection, bacteremia, septic arthritis, endocarditis, epidural abscess, and osteomyelitis) included patients aged &gt;18 years with bacterial growth on specimens collected within 72 hours of admission from September 1, 2021, to March 31, 2022. Data analysis utilized descriptive statistics, chi-square tests, and Mann-Whitney U tests where appropriate.

Results
A total of 259 patients were included in the study. 243 (93.8%) patients grew gram-positive organisms, while only 16 (6.2%) grew gram-negative organisms. The majority of patients were male (60%), the median age was 38 (IQR [33-44]), and 10% had a prior infection with MRSA. The distribution of injection-related infections included SSTIs (79.9%), bacteremia (34.7%), septic arthritis (12%), infective endocarditis (10.4%), osteomyelitis (8.5%), and epidural abscess (3.5%). The most commonly observed organisms were MRSA (36%), S. pyogenes (43%), and MSSA (9%). The gram-negative organisms isolated are shown in Figure 1. Approximately 84% of patients received overtreatment with an anti-pseudomonal agent; however, only 2% required its use. SSTIs with lower extremity involvement were found to be associated with gram-negative infections within this cohort, as shown in Table 1.Figure 1.Distribution of gram-negative organisms isolated from cultures collected within 72 hours of admissionTable 1.Baseline characteristics and potential risk factors for gram-negative injection-related infections in PWID

Conclusion
In this study, despite less than 10% of patients growing gram-negative organisms on culture, approximately 80% received gram-negative treatment. Knowledge of the microbiology of infections in PWID can aid prescribers in optimizing empiric therapy for injection-related infections and preserving the core principles of antimicrobial stewardship.

Disclosures
Sara K. Schultz, MD FACP FIDSA, AbbVie: Advisor/Consultant