bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1711. Evaluation of Microbiology and Antibiotic Prescribing Behavior of Foot Puncture Wound Infection: An Opportunity for Antimicrobial Stewardship
Authors: Kim Brian , Arab Niki , Jeng Arthur 
Published: January 2025

Abstract

Background
The primary pathogen(s) of soft tissue infections, including those of the foot, are β-hemolytic Streptococci and Staphylococcus aureus (SA). Pseudomonas aeruginosa (PsA) has been implicated as a cause of foot infections after sustaining a nail puncture wound through a sneaker, historically leading to recommendations for prescribing empiric anti-PsA antibiotics (abx). At Olive View-UCLA Medical Center (Sylmar, CA), we evaluated the microbiology and empiric abx prescribing behavior of foot puncture wound infections.

Methods
Retrospective chart review on adults (≥ 18 years) admitted with an ICD-10 code for puncture wound from January 1, 2017 to December 31, 2023. Inclusion criteria included foot infection after sustaining nail, screw, staple, thumbtack, or razorblade puncture. Non-foot puncture wound and puncture from an object other than those listed in the inclusion criteria were excluded. Anti-PsA abx was defined as either piperacillin-tazobactam, cefepime, ceftazidime, or ciprofloxacin.

Results
58 cases were reviewed and 45 met inclusion criteria. The majority of puncture wound was due to nail (n=34, 76%) followed by screw (n=6, 13%) [Table 1]. Empiric anti-PsA abx was prescribed in the emergency department in 41/45 (91%); empiric anti-PsA abx was prescribed or continued by the admitting physician in 19/45 (42%). Anti-PsA abx average days of therapy (DOT) was 2 days [IQR 2-3]. Wound culture was obtained in 44 cases, with no isolation of PsA. The majority of pathogens consisted of methicillin-susceptible SA (26/44 cases, 59%) and Streptococcus agalactiae (19/44, 43%) [Figure 1]. Infection involving both SA and Streptococcus spp. was seen in 15 cases (34%). Subsequent foot infection with PsA within 30 days of puncture wound infection did not occur in any cases.

Conclusion
PsA was not isolated in any cases of foot puncture wound infections, although the majority were started on an empiric anti-PsA abx, per historical recommendations. The primary pathogen(s) were SA and/or Streptococcus spp. Therefore, current evidence shows that PsA is not a significant pathogen of foot puncture wound infections, and this represents an opportunity for antimicrobial stewardship services to prioritize empiric abx against SA and Streptococcus spp., and not against PsA, for this infection type.

Disclosures
All Authors: No reported disclosures
P-1712. Comparison of Vancomycin vs Linezolid for Treating Adult Patients with sCAP Admitted to the ICU
Authors: Viñán Garcés André Emilio , Sanabria-Herrera Natalia , Duque-Vallejo Sara , Garcia-Gallo Esteban , Reyes Luis Felipe F 
Published: January 2025

Abstract

Background
Community-acquired pneumonia (CAP) remains the leading cause of infectious mortality worldwide. Regarding its etiology, Staphylococcus aureus has been associated with its development and a higher mortality risk than other microbiological etiologies. Current recommendations allow empiric use with either vancomycin or linezolid in patients with risk factors for MRSA, although no consensus exists on which therapy is more beneficial. This study aims to determine if there is a difference in mortality and survival between patients treated with these antibiotics.
Comparison between general characteristics of patients receiving vancomycin and linezolid.

Methods
Data from adult patients with CAP and ICU admission with either linezolid or vancomycin administration for at least 72 hours were extracted from the prospective MIMIC-IV database. A univariate analysis was employed to determine the differences between the patients who received each treatment. Subsequently, a survival analysis adjusted by infection severity using a Cox proportional hazards model was conducted.
Survival analysis for both in-hospital and one-year mortality. A. Kaplan-Meier for One-year Survival Probability; B. Kaplan-Meier for In-hospital 28-day mortality

Results
A total of 2457 adult patients were included, with 98% (2412/2457) receiving vancomycin and 2% (45/2457) Linezolid. The mean age was 68 (56-79), and 56.5% (1389/2457) were male. The most frequent comorbidities in both treatment groups included chronic pulmonary disease (40.9% vs 51.1%; p= 0.169) and congestive heart failure (37.9% vs 42.2%; p=0.55). Both groups presented similar severity of infection, physiological values at admission, and outcomes (Table 1). Survival analysis demonstrated a higher one-year survival probability in the patients receiving Linezolid group. Cox regression analysis revealed a significant association between SAPS II score and mortality (HR = 1.024, 95% CI: 1.02 - 1.028, p &lt; 0.001) (Figure 1). However, when adjusting the survival analysis by disease severity, we did not find ny statistical differences.

Conclusion
While there is no definitive consensus regarding the superiority of empirical anti-MRSA treatments, these results support the idea that linezolid is associated with better outcomes in terms of mortality in patients with sCAP. However, this protective effect was not observed after adjusting by disease severity. Further prospective studies are needed to support these conclusions.

Disclosures
All Authors: No reported disclosures
P-1729. Implementation of a Vancomycin AUC and Trough-based Dosing Policy Across a Large Health-system Reduced Trough Levels, Acute Kidney Injury Events, and Hospital Length of Stay
Authors: Christensen Alyssa , Nelson Zachary , Peglow Rebecca 
Published: January 2025

Abstract

Background
Vancomycin dosing guidelines recommend area-under-the-cure (AUC) over trough-based dosing for severe MRSA infections. Optimal dosing of non-severe or non-MRSA is unknown. Conflicting data exists on the real-world benefits of implementing AUC-based dosing methods.

Methods
A standardized vancomycin dosing policy was implemented across an 8-hospital healthsystem in MN and WI. Prior to implementation, most hospitals targeted troughs between 15-20 for severe MRSA infections. The new policy recommended AUC-based dosing for patients with known or suspected severe MRSA infections and lower trough goals (10-15) for all other patients. DoseMeRx was used to calculate AUC and adjust doses. Vancomycin levels, AKI-coded diagnoses, and length of hospital stay (LOS) were compared 6 months pre and post intervention. An approximate and conservative $7,000 cost avoidance was assigned per AKI event based on a literature review.

Results
8,458 patient encounters were included over the 12 month study period (4084 pre, 4,374 post) representing 7,142 patients (3,517 pre, 3,825 post). Average cumulative vancomycin doses were lower in the post group by 401 mg (4,838mg vs 4,435mg). The number of trough levels greater than 15 was significantly reduced post-intervention (56.9% vs 40.6%, p &lt; 0.001). There was a 25% relative reduction in AKI-coded encounters (13.0% vs 9.6%, p &lt; 0.001) and reduction in average LOS (7.8 vs 7.2 days; p &lt; 0.001 ). The number of encounters with S.aureus positive blood cultures was the same between groups (13.0%). The number of patients who received at least one dose of piperacillin/tazobactam was higher in the post-group (36.0% vs 39.7%). The reduction in AKI events was associated with a $1,029,000 cost avoidance.

Conclusion
A system vancomycin dosing policy that incorporated both AUC and trough-based dosing methods was associated with a significant reduction in trough levels &gt; 15, AKI events, and LOS. This represented a significant cost-avoidance of approximately $1,029,000 over a 6-month implementation period.

Disclosures
All Authors: No reported disclosures
P-1774. Order sets paired with facilitation training to effectively reduce postoperative surgical prophylaxis
Authors: McKay Virginia , McGovern Collin , Saito Jacqueline M , Rangel Shawn , Bono Kelly , Newland Jason G , Malone Sara 
Published: January 2025

Abstract

Background
Inappropriate surgical antibiotic prophylaxis occurs in up to 40% of cases, primarily reflecting unnecessary postoperative doses ( &gt;24hrs) in clean or clean-contaminated cases. It accounts for approximately 20% of all inappropriate use in children’s hospitals. We described order set outcomes from the Operatic Trial to compare two strategies, order set changes versus order set change with facilitation, to reducing excessive postoperative prophylaxis.Figure 1.Stepped-wedge trial design comparing order set change only (control) versus order set change plus a facilitation workshop (intervention) attended by the ASP team at the beginning of each step. Nine children’s hospitals were randomized to 1 of 3 cluster. Each cluster included 3 hospitals and each step was 6 months in duration.

Methods
The operatic trial was a stepped-wedge cluster randomized control trial with nine US children’s hospitals (11/1/2020-10/31/2023), with 6 steps lasting 6 months each (Figure 1). Antimicrobial stewardship teams were recruited and enrolled. After 6 months of all hospitals starting in control (step 0) of changing order sets, 3 hospital ASP teams in steps 1-3 participated in a virtual facilitation workshop (int). Facilitation is a strategy that supports people in health services organizations develop the means to change the structure and processes within settings, and clinicians can be educated on the skills and expertise to become an effective facilitator. Hospital ASP teams were surveyed every 2 months to evaluate order set changes.

Results
Approximately 75% of order set changes attempted were completed (65/85). Table 1 describes completed order set changes demonstrating a variety of specialties targeted and a focus on reducing prophylaxis duration. Importantly, only 4 were initiated and completed in the pre-intervention period, while the remaining were either initiated pre-intervention and completed post-intervention or initiated and completed post-intervention suggesting that facilitation training supported order set change completion. The median time to complete an order set change was 5 months. Individuals also reported other activities to support change, for example data dashboards and paper-based guidance.

Conclusion
Changing order sets is an effective approach to reduce excess antibiotic use in children’s hospitals. Facilitation played a role in the successful completion of order sets, including potentially assisting teams to complete order set changes that were initiated prior to facilitation training.

Disclosures
Jason G. Newland, MD, MEd, Moderna: Grant/Research Support|Pfizer: Grant/Research Support
P-1822. Management of Patients with a History of Penicillin Allergy: A Retrospective Observational Study from Saudi Arabia
Authors: Alhifany Abdullah A 
Published: January 2025

Abstract

Background
It has been estimated that 8 to 25% of populations studied globally are labeled penicillin-allergic. However, almost 90% of these patients may not have a true allergy upon work-up, which led prescribers to substitute β-lactams unnecessarily with other broadspectrum antibiotics. Therefore, the aim of this study was to describe how patients with a history of penicillin allergy are treated for infectious diseases, and determine the cost associated with alternative antibiotics.Table I.Baseline characteristics of patients with a documented history of penicillin allergy.

Methods
A retrospective observational study conducted in a tertiary-care teaching hospital in Riyadh, Saudi Arabia. Approval was obtained from the Institutional Review Board, and electronic health records (EHRs) of patients were included if they were 18 years old and older, labeled to have penicillin allergy, and were admitted in medical wards or treated as outpatients.

Results
Among the 235 included patients, the type and severity of allergy reactions were not reported in the majority of patients 200 (85%) and were described in only 35 (15%) patients, which 27 (12%) of them had IgE-mediated allergic reactions (angioedema, anaphylaxis, bronchospasm, and urticaria). None of the cases were referred to an immunologist. Most common antibiotic indications included surgical prophylaxis 81 (33%), followed by respiratory 64 (27%) and gastrointestinal infections 40 (17%). For patients with documented penicillin allergy, macrolides were the most used alternative antibiotics followed by clindamycin, cephalosporins, and fluroquinolones in 63 (26%), 56 (24%), 50 (21%), and 30 (12%) patients, respectively.

Conclusion
This study reveals that mislabeling penicillin allergies in Riyadh's tertiary hospital leads to using less effective antibiotics, increasing adverse reactions, infections, and healthcare costs. It emphasizes improving allergy verification to enhance antibiotic use and reduce expenditures.

Disclosures
All Authors: No reported disclosures
P-1853. Peripheral blood monocytes pro-inflammatory and anti-inflammatory cytokine release in elderly patients with heart failure with reduced ejection fraction
Authors: Mitsuke Yasuiko , Itoh Kazuhiro , Iwasaki Hiromichi 
Published: January 2025

Abstract

Background
Heart failure with reduced ejection fraction (HFrEF) has benn reported to characterize by sub-clinical inflammation status. There are few reports about changes in selected biomarkers of inflammation concomitant with the release of pro-inflammatory and anti-inflammatory cytokines by monocyte in elderly patients with HFrEF.

Methods
We measured plasma levels of the cytokines in 62 elderly Japanese HFrEF patients (aged 85.8 ± 2.7 years, left ventricular ejection fraction 33.7 ± 3.5%) and 20 healthy controls. Peripheral blood monocytes (PBM) obtained from HFrEF patients were stimulated by LPS (10 μg/ml) in the absence or the presence of adenosine (10 μmol/l). After 6hr incubation, the cytokines levels in the culture supernatants were measured by ELISA.

Results
Plasma levels of TNF-alpha, IL-6, IL-10, and IL-12p40 were significantly greater in HFrEF patients than in controls. Plasma IL-12p40 levels of HFrEF patients showed significant correlations with IL-6 and IL-10. In vitro study, adenosine inhibited the generation of pro-inflammatory cytokines from LPS-stimulated PBM (TNF-alpha: 764.2±32.3 to 242.5±55.3pg/ml, IL-6: 82.3±13.5 to 21.4±4.2 pg/ml, IL-12p40: 164.8±23.5 to 18.2±5.1, all p&lt; 0.01), while it augmented IL-10 generation (29.2±6.1 to 54.9±7.8pg/ml, p&lt; 0.01) significantly.

Conclusion
Our data indicated plasma levels of pro-inflammatory and anti-inflammatory cytokine were elevated in eldely patients with HFrEF relating. Adenosine may represent a new pharmacological intervention in such HFrEF patients,the clinical significance of these findings deserves further investigation

Disclosures
All Authors: No reported disclosures
P-1867. Under-Recognized Medication Loss with the Administration of Small-Volume Intermittent Infusions
Authors: Dave Aamir S , Saunders-Hao Patricia , Jain Sumeet , Graci Michele , Luo Evelyn 
Published: January 2025

Abstract

Background
Most antimicrobials administered via intermittent intravenous (IV) infusion are diluted in 50 to 100 mL of diluent. The primary infusion set for a smart pump can hold 25 mL of volume in its tubing, which can contribute up to a 50% drug loss if residual volume is present after administration is complete. For antimicrobials, this may lead to significant underdosing, contributing to poor treatment outcomes and antimicrobial resistance. Many organizations lack departmental policies and procedures (P&P) to ensure complete administration of small-volume intermittent infusions (SVIIs). Previous studies propose several recommendations, such as adding carrier fluids and flushing the line, but there is no easy fix to this common issue.

Methods
Our aim was to implement new guidance in 2 pilot patient units (an ICU and non-ICU) to address the administration of SVIIs and evaluate its effect on medication administration. This was an observational quality improvement initiative assessing the new guidance established for the administration of SVIIs to the current practices at North Shore University Hospital. The new guidance consisted of nursing education to reinforce proper administration techniques and to adjust infusion volumes for overfill. This study was IRB exempt. The primary outcome of this study was the incidence of residual drug volume in IV line before the air-detector, IV bag, or IV vial. This was done through direct observation and data was collected through a survey. Chi-square tests were used to analyze the primary outcomes.

Results
In total, 203 IV administrations were observed, 86% were antimicrobials. There were 124 IV administrations observed before policy guidance initiation, and 79 after initiation. There was a significant reduction in the incidence of fluid remaining in the IV line before the air-detector (85% vs 27%; p-value &lt; 0.001), the IV bag (59% vs. 7.6%; p-value &lt; 0.001), and in the IV vial (47% vs. 24%; p-value &lt; 0.001).

Conclusion
The interventions significantly decreased the incidence of fluid remaining in the IV line, presumably decreasing medication loss. Since most medications were antimicrobials, this may improve clinical outcomes. This will be used to update P&P to standardize IV administration practices and improve patient care.

Disclosures
All Authors: No reported disclosures
P-1872. Dalbavancin workflow for inpatient discharges: a multidisciplinary model
Authors: Baldino Maria , Hanretty Alexandra , Kludjian Geena , Pedroza Lisa , Nahra Raquel 
Published: January 2025

Abstract

Background
The role of dalbavancin (DAL) for the treatment of deep-seated infections is of growing interest. The long half-life, extensive tissue distribution, and ease of administration makes it ideal for use in populations that have physical or social barriers to treatment with standard antibiotics for infections such as endocarditis, septic arthritis, and osteomyelitis. A workflow for DAL in high-risk populations has previously not been well described. Our aim is to describe the multidisciplinary approach to DAL on discharge and describe impact on readmissions, length of stay and adherence.Figure 1:Dalbavancin inpatient to discharge workflow

Methods
A multidisciplinary approach at a tertiary academic healthcare system included nursing, antimicrobial stewardship (ASP), infectious diseases (ID) and addiction medicine (AM) to develop a workflow to identify DAL patients and improve adherence (figure 1). Patients had to be clinically stable with evidence of deep-seated infection from confirmed or strongly suspected Gram-positive organisms with plausible susceptibility to DAL and lack of any reliable oral antibiotic options (feasibility, drug toxicity, drug-drug interactions, resistance, or inability to comply with oral medication due to socioeconomic barriers). DAL had to be recommended by ID or ASP. Patients on buprenorphine (BUP) had their second dose aligned with an AM appointment. Patients were excluded if they left against medical advice prior to DAL, had lack of source control, persistent bacteremia, severe vancomycin allergy, or were discharged to a rehab or skilled nursing facility.Table 1:Patient Demographics

Results
Seventy patients were treated with DAL; six patients via the AM pathway and 64 via the standard pathway. In total, 57 patients (81.4%) completed the recommended treatment. In patients who had two doses prescribed, there was 67% completion. In total, 1691 hospital days were avoided. There were 14 readmissions, none were due to DAL failure. Two patients experienced anaphylaxis with their 2nd dose.
Table 2: Patient Outcomes

Conclusion
This approach demonstrates that in high-risk populations, DAL can be an effective treatment strategy for invasive infections resulting in high rates of treatment completion. Our data is limited as it does not evaluate outcomes in comparison to standard of care.

Disclosures
Alexandra Hanretty, PharmD, Abbvie: Advisor/Consultant
P-1874. Impact of Compromised Host AntimicRobial Management Service (CHARMS) on All Cause Readmission in Solid Organ Transplant Patients Discharged on Intravenous Antimicrobials
Authors: Footer Brent W , Bartelt Luther A , Friedland Anne , Lachiewicz Anne , Seña Arlene C , Andermann Tessa , Arant Elizabeth C , Bowman Mary Catherine , Deyo Zack , van Duin David 
Published: January 2025

Abstract

Background
The Compromised Host AntimicRobial Monitoring Service (CHARMS) was created to support safe, efficient, streamlined care for immunocompromised patients discharged on outpatient parenteral antimicrobial therapy (OPAT). However, outcome data for OPAT programs in solid organ transplant (SOT) is lacking and to our knowledge no published literature specific to this patient population exists. The purpose of this study is to evaluate the effect of CHARMS on hospital readmission in SOT patients discharged on OPAT.Table 1.Baseline Characteristics at Start of OPAT Course*Includes patients with multiple organs and/or multiple transplants of the same organ

Methods
This study utilized a quasi-experimental study design with pre- and post-CHARMS implementation periods of 1/1/23-6/30/2023 and 9/1/23-4/30/24, respectively. No patients were enrolled during the two-month period of CHARMS implementation. All adult SOT patients seen in consultation by infectious diseases and discharged from UNC Medical Center on IV antimicrobials were included. The primary endpoint was 30-day all cause hospital readmission. Secondary endpoints were all cause hospital readmission over the entirety of the OPAT course and central venous catheter (CVC) complications.Table 2.Baseline Infection Related Characteristics

Results
30 and 43 OPAT courses were included in the pre- and post-CHARMS cohorts, respectively. There were minimal differences in baseline characteristics with no difference in the median duration of IV antimicrobials (Table 1). Approximately 25% of patients in each group were treated for bacteremia and more patients in the pre-intervention group were treated for cytomegalovirus (13.3% vs. 2.3%, p=0.067) (Table 2). More patients in the post-intervention group received &gt;1 IV antimicrobial (39.5% vs. 20%, p=0.036) (Table 3). In terms of outcomes, 30-day all cause hospital readmission was decreased in the post-intervention group (pre: 36.7% vs. post: 25.6%, p=0.310). Similarly, a decrease in all cause hospital readmission over the entirety of the OPAT course was observed in the post-intervention group (pre: 43.3% vs. post: 25.6%, p=0.112). CVC complications did not differ between the groups (pre: 10% vs. post: 11.6%, p=0.827).Table 3.Antimicrobials Received During OPAT

Conclusion
There was trend towards decreased 30-day all cause readmission in SOT patients managed by a dedicated compromised host OPAT service. Additional patients are needed to evaluate the full impact of the program.

Disclosures
David van Duin, MD, PhD, Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Qpex: Advisor/Consultant|Roche: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support