bluuebunny/crossref_metadata_2025_split huggingface dataset:
1206. A Quality Improvement Project Utilizing Clinical Decision Support (CDS) to Optimize Outpatient Antibiotic Prescribing
Authors: Mason Matt , Shapiro Craig , Chan Shannon 
Published: November 2023

Abstract

Background
Antimicrobial resistance remains one of the greatest threats to public health. A major contributing factor is overuse of antibiotics, with most prescribing occurring in the outpatient setting. CDS in the outpatient setting can improve antibiotic use by optimizing durations of therapy. The primary objective of this study was to assess the impact of CDS on prescribing of amoxicillin (AMX) and amoxicillin-clavulanate (AMC) for treatment of acute otitis media (AOM). The secondary objective was to assess prescribers’ perception of the CDS.

Methods
The Nemours Children’s Health Antimicrobial Stewardship Program (ASP) developed antibiotic order panels (OPs) available for ambulatory care providers. The OPs provided guidance for drug formulation, dose, and duration. Providers were notified of implementation through email. Prescribed durations for AMC and AMX for AOM were compared for 3 months pre- and post-implementation. A 14-question survey was emailed to primary care providers to assess perceptions of the OPs and the impact on prescribing practices.

Results
The OP utilization rate for AMC from February to April 2022 was 27.7%. In patients ≥2 years, OP utilization resulted in a decreased average duration of therapy compared to no OP utilization, 7.6 vs 9.8 days, respectively. The OP utilization rate for AMX for AOM from April to June 2022 was 15% (342/2356). In patients ≥2 years old, 5-day and 7-day prescriptions increased from 1.7% (8/472) and 9.5% (45/472) to 11.4% (193/1688) and 12.3% (207/1688), respectively. There was a 40% response rate to the survey; 75% reported awareness of the OPs and 72.7% reported routine use. The OPs were most helpful in selection of correct dose (83.3%), duration of therapy (81.3%), and indication (77.1%). Most providers reported improved efficiency (77.1%) and agreed that the OPs led to shorter durations of therapy (81%).

Conclusion
Development of antibiotic specific OPs with defaulted durations can be an effective strategy to improve outpatient prescribing of antibiotics. Providers are open to CDS to improve prescribing practices. Education and evidence-based support for the recommended changes in prescribing could further maximize providers’ engagement and implementation of these changes.

Disclosures
All Authors: No reported disclosures
1218. Retrospective Audit of Vancomycin Utilization after Initiation of Methicillin Resistant Staphylococcus aureus (MRSA) Screening in Hematology and Bone Marrow Transplant (BMT) Patients.
Authors: Swaminathan Neeraja , Cowman Kelsie , McCort Margaret E , Nori Priya , McSweeney Terrence D , Guo Yi , Bartash Rachel 
Published: November 2023

Abstract

Background
Inappropriate vancomycin use in patients with febrile neutropenia (FN) can contribute to emergence of resistant organisms, acute kidney injury, and infusion related adverse effects. Methicillin resistant Staphylococcus aureus (MRSA) nares Polymerase Chain Reaction (PCR) testing has a high negative predictive value for invasive MRSA infections and therefore, offers a rapid tool to help avoid or de-escalate anti-MRSA therapy. In this study, we aimed to assess the impact of MRSA nares PCR on the utilization of vancomycin in a hematology/bone marrow transplant (BMT) unit.

Methods
Our hematology/BMT unit is a closed 32-bed unit with patients undergoing BMT, receiving care for complications related to BMT or undergoing chemotherapy for hematologic malignancies. Nasal MRSA PCR testing was added to our institutional FN treatment protocol in September 2021 to help guide antibiotic use for this patient population. As part of our antimicrobial stewardship program’s audit and feedback and antimicrobial utilization monitoring, we measured the use of intravenous (IV) vancomycin on the unit before (August 2020-August 2021) and after (October 2021-March 2023) updating our guidelines to include MRSA PCR. Vancomycin utilization, which was obtained from data submitted to National Healthcare Safety Network (NHSN), was measured using unit-level days of therapy (DOT) per 1000 days present. The incidence density rates were compared using the NHSN statistics calculator.

Results
Mean IV vancomycin use pre-MSRA PCR implementation was 91.27 DOT per 1000 days present, compared to 52.69 DOT per 1000 days present post MRSA PCR implementation (p &lt; 0.001) (Figure 1). The monthly trend of vancomycin DOT per 1000 days present is shown in Figure 2.

Conclusion
Vancomycin utilization significantly decreased after the implementation of MRSA nares PCR as a part of the neutropenic fever workup. This study highlights its utility as a tool to guide therapy specifically in immunocompromised patients with significant antibiotic exposure.

Disclosures
All Authors: No reported disclosures
1225. Optimization of Antimicrobial Therapy for Extended-Spectrum β-Lactamase-Producing Enterobacterales (ESBL-E) Bloodstream Infections Through Laboratory-Based Interventions
Authors: Yazdi Mona , Wang Rebecca , Martin Isabella W 
Published: November 2023

Abstract

Background
In 2020, the Infectious Diseases Society of America (IDSA) published clinical practice guidance recommending up-front treatment with an IV carbapenem for severe infections with extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (EB).1 This single-center, observational study sought to optimize adherence to IDSA guidance through two laboratory-based interventions.

Methods
On 12/29/2021, the laboratory initiated the first intervention: suppression of piperacillin-tazobactam results for EB isolates with ceftriaxone resistance, a surrogate for ESBL production.2 On 5/16/2022, the laboratory adopted the second intervention: implementation of a new rapid sepsis diagnostic assay (from BCID to BCID2, BioMerieux). BCID2 detection of blaCTX-M was accompanied by a report footnote recommending up-front carbapenem therapy. To determine the impact of these interventions, patients with blood cultures positive for ceftriaxone-resistant EB between 1/1/2019 and 11/7/2022 were identified. Chart review was performed to determine demographic data, antimicrobial use, and clinical outcomes. The time period between the first and second interventions was excluded. The primary endpoint was use of an IV carbapenem within 24 hours of available phenotypic antimicrobial susceptibility test results.

Results
During this time period, a total of 44 unique ceftriaxone-resistant EB were isolated in blood culture. Of these, 34/44 (77.3%) were Escherichia coli, 6/44 (13.6%) were Klebsiella pneumoniae, and 4/44 (9.1%) were Klebsiella oxytoca. The primary endpoint was observed in 19/33 (57.6%) patients prior to the interventions and 11/11 (100%) patients after.

Conclusion
Through serial laboratory-based interventions, we successfully improved institutional adherence to IDSA guidance for treatment of ESBL-EB bloodstream infections. The findings of our study may inform collaborative microbiology-stewardship efforts at other facilities.

Disclosures
All Authors: No reported disclosures
1241. Outcomes of a Novel Antimicrobial Handshake Stewardship Service in the Immunocompromised Population at an Academic Medical Center
Authors: Gomez Keven , Guerrero-Wooley Richelle , McLeod Caleb C , Msdi Abdulwhab Shremo , Chang Sandy , Arcobello Jonathan T , Zhou Anna 
Published: November 2023

Abstract

Background
Prospective audit and feedback (PAF) is integral to antimicrobial stewardship programs (ASP) and is typically conducted electronically. Handshake stewardship (HS) is a form of in-person PAF advocated by the CDC and IDSA. There is scarce data regarding successful ASP interventions within the immunocompromised (IC) population, and even less data on the impact of HS. The objective of this study was to describe the outcomes of a novel HS service on the IC population and identify ASP interventions that may be generalizable.

Methods
This is a retrospective study of hospitalized adult patients (≥ 18 years old) with IC conditions on pre-determined antimicrobials for at least 72 hours between May 1st, 2022 and January 31st, 2023. IC patients included those with active malignancy on chemotherapy or with functional immunosuppression, solid organ transplant (SOT), and rheumatological conditions on active immunosuppressants. The ASP team comprised of 1 infectious disease (ID) physician and 1 ID pharmacist who provided all recommendations to the intensive care unit (ICU), transplant, and oncology services. Primary outcomes included recommendation acceptance and recommendation types. Additional outcomes included incidence of C. difficile, resumption of antibiotics after discontinuation, lengths of stay (LOS), and 60-day readmission and mortality. Descriptive statistics were performed.

Results
Twenty-nine patients with IC conditions were identified. Majority were White (41.4%) or Hispanic/Latino (44.8%). The median age was 57 years old (IQR 22-78). Fifteen patients had active malignancy, 11 were SOT recipients, and 3 had rheumatologic disorders. Primary teams accepted 45/51 (85%) of recommendations for 27/29 (93.1%) patients. Common recommendations included discontinuation of empiric therapy for febrile neutropenia or for non-infectious etiologies, de-escalation, or escalation to ID consults. Primary teams only resumed antibiotics in 1 patient after early discontinuation. The median LOS was 14 days with 2 patients testing positive for C. difficile and only 1 patient readmitted due to infection.

Conclusion
HS was well received and most recommendations targeting the IC population were accepted and did not lead to poor patient outcomes.

Disclosures
Anna Zhou, PharmD, BCIDP, Melinta Therapeutics: Honoraria
1245. Knowledge, Attitudes, and Practices of Healthcare Workers towards Antimicrobial Stewardship in Dr. Paulino J. Garcia Memorial Research and Medical Center: A Cross Sectional Study
Authors: Hernandez Maria Kim 
Published: November 2023

Abstract

Background
Antimicrobial resistance, a challenge faced by the public health sector, occurs when pathogens are no longer susceptible to common medicines used to treat them. Several studies have shown that reduction in antibiotic prescription could be done successfully through behavioral intervention. It is important to ensure that antimicrobials are prudently used to preserve its efficacy and enable maximum therapeutic effect. This study assessed the knowledge, attitudes, and practices of healthcare workers towards antimicrobial stewardship at Dr. Paulino J. Garcia Memorial Research and Medical Center in Nueva Ecija, Philippines.

Methods
Cross-sectional design was used in this study. Stratified random sampling and proportional allocation to each stratum was used. Healthcare workers including physicians who routinely prescribed antibiotics; nurses assigned at the wards, and pharmacists were included. Questionnaires were self-administered. Kruskal-Wallis H Test and Dwass-Steel-Critchlow-Fligner pairwise comparisons were used in data analysis.

Results
There were a total of 142 participants. Significant differences were noted on actual knowledge between physicians and nurses, on hand hygiene between physicians and nurses and nurses and pharmacists, on perceived knowledge between surgical area and family medicine and medical area and family medicine. There was also a significant difference between physicians and nurses on attitudes towards antimicrobial stewardship. There were no significant differences noted in the practices of healthcare workers.

Conclusion
Healthcare workers are essential in the fight against antimicrobial resistance. Physicians, nurses, and pharmacists had overall good knowledge, attitudes, and practices towards antimicrobial stewardship but despite this, attention must be given to subsets of the study garnering a poor or moderate level of knowledge. This must be addressed by reinforcing previous known concepts and conducting regular trainings and seminars. Factors affecting the knowledge and practice of antimicrobial stewardship program must also be explored.

Disclosures
All Authors: No reported disclosures
1247. Going Viral with Antimicrobial Stewardship
Authors: Jenkins Abi , Ahmed Jubeyr , Bosworth Andrew , Michael Kidd I , Osman Husam , Atabani Sowsan F 
Published: November 2023

Abstract

Background
Historically, antimicrobial stewardship (AMS) has considered the judicious use of antibiotics. AMS is widely adopted across Europe and the US; recently antifungal AMS is gaining momentum but antiviral AMS has been little described. Here we report findings following introduction of AMS virology reviews at University Hospitals Birmingham (UHB); a novel concept and an opportunity to broaden the beneficial aspects of AMS to virology.

Methods
In June 2022, a UK supply issue with aciclovir (ACV) injection was announced. In order to review and preserve ACV injection for those in greatest need, UHB virologists implemented a specialist review for all patients prescribed &gt; 48 hours of treatment. Additionally, we collected data on the advice offered, whether it was accepted, and time required completing the review.

Results
ACV usage had no seasonal pattern. Over the shortage period of 10 weeks, AMS virology rounds were conducted twice weekly either face-to-face or remotely via the Electronic Patient Management System. During these 10 weeks, IV ACV administered to patients for more than 48 hours of treatment was reduced by 51%. Depending on the patient complexity, ward rounds lasted between 60 and 120 minutes (n=24) with advice given to cease treatment (n=8), IV-to-oral switch (n=5), to continue IV ACV (n=8) and/or to undertake further sampling and diagnostic testing (n=6). Advice offered by the clinical virologists to the host clinicians was accepted in all cases.

Conclusion
Antiviral AMS rounds halved IV ACV consumption, compared to pre or post intervention levels, with more than half of patients advised to stop or switch to oral therapy. Diagnostics and sampling guidance was offered in one quarter of reviews, whilst the remaining interventions were more stewardship focused. In all cases stewardship advice was readily accepted by clinical teams. Antiviral AMS rounds provide an opportunity to optimise sampling, diagnosis and improve patient management. Introduction of regular antiviral AMS rounds at UHB are at advanced planning.

Disclosures
All Authors: No reported disclosures
1982. GLP-1 Receptor Agonists Promote Weight Loss Among People with HIV
Authors: Nguyen Quynh P , Wooten Darcy , Duren Kye , Moreno Manuel , Promer Katherine , Hien Tan Matthew , Tang Michael E , Rajagopal Amutha V , Hill Lucas , Yin Jeffrey , Toperoff Will 
Published: November 2023

Abstract

Background
Weight gain and associated metabolic complications are increasingly prevalent among people with HIV (PWH), especially those initiating second-generation integrase strand transfer inhibitors (INSTIs). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are incretin-based therapies for diabetes that have been shown to result in substantial weight loss; however, studies of their efficacy in PWH are limited. We aimed to describe the prescribing practices and clinical outcomes of GLP-1 RA use among PWH.

Methods
We conducted a retrospective cohort study among PWH who were prescribed GLP-1 RAs at University of California, San Diego between 2/1/2021and 2/1/2023. Patients who were prescribed but never took GLP-1 RAs or those for whom weight data were not available after GLP-1 RA initiation were excluded. We collected baseline clinical data and calculated changes in weight, body mass index (BMI), and hemoglobin A1C (A1C) before and during receipt of GLP-1 RA. We conducted logistic regression to identify variables associated with more than 5% of total body weight loss.

Results
227 patients met our inclusion criteria. Baseline characteristics are shown in Table 1. Ninety-nine patients (43%) were prescribed GLP-1 RAs for weight management alone without concurrent diabetes. Patients had received on average 15.2 months of GLP-1 RA therapy, with 92 (40.5%) achieving the maximum GLP-1 RA dose. On average, GLP-1 RA therapy resulted in a loss of 12 pounds, decrease in BMI by 1.8, and decrease in A1C by 0.5 among all patients and by 1.2 among patients with an A1C &gt; 6.5 at baseline. In the multivariable analysis, higher baseline BMI [OR 1.07 (1.02-1.3)] and longer treatment duration of GLP-1 RA therapy [OR 1.04 (1.01-1.07)] were significantly more likely to be associated with &gt;5% weight loss, whereas receipt of dulaglutide significantly decreased the likelihood of &gt;5% weight loss compared to other GLP-1 RAs [OR 0.33 (0.17-0.66)]. Age, sex assigned at birth, race, ethnicity, ART regimen, baseline CD4 cell count, HIV viral load, and presence of diabetes were not predictive of weight change.Table 1.Baseline Patient Characteristics (N = 227)Table 2.Mean weight, BMI, and A1C before and during GLP-1 RA therapy for PWH

Conclusion
Use of GLP-1 RAs led to improvements in weight, BMI, and hemoglobin A1C among PWH and offers an additional strategy to address weight gain and related metabolic complications.

Disclosures
All Authors: No reported disclosures
1256. Changes in Antimicrobial Stewardship (AS) Core Element Implementation among Oregon Hospitals following the COVID-19 Pandemic
Authors: McGregor Jessina C , Iguchi Lisa , Breitenstein Elizabeth 
Published: November 2023

Abstract

Background
The CDC established core elements for effective hospital AS programs, which includes a team with dedicated effort and appropriate experience. CDC further identified that AS leadership with infectious disease specialty training enhances quality and impact of AS. Since the COVID-19 pandemic, facilities have reported widespread challenges to maintaining healthcare worker staffing. Our objective was to compare AS core element implementation in Oregon hospitals before and after the pandemic.

Methods
We performed a secondary analysis of 2019 and 2022 NHSN annual facility survey data from acute care and critical access hospitals in the state of Oregon. The frequency of implementation of core elements was compared between time frames using the chi-square test. Secondary analyses were performed among acute care and critical access hospitals.

Results
Overall, 59 of 60 Oregon hospitals responded to the 2019 facility survey and 58 to the 2022 survey. In 2019, 76% reported having implemented all core elements compared to 95% in 2022 (p &lt; 0.01; Figure 1). Among acute care hospitals, implementation of all elements was 77% (27/35) in 2019 and 100% (33/33) in 2022; among critical access hospitals, it was 75% (18/24) and 88% (22/25) respectively. Significantly more hospitals implemented the education core element in 2022 (100%) compared to 2019 (80%; p &lt; 0.01). Hospitals, overall, had a decreased frequency of physician/pharmacist co-led AS programs in 2019 vs. 2022 (75% vs 66%, p = 0.28). Decreases of co-led programs were mainly observed in critical access hospitals (71% vs. 44%; p = 0.06), where both pharmacist (21% vs. 32%; p = 0.38) or physician-led programs (4% vs. 13%; p = 0.32) increased. The proportion of pharmacist leads/co-leads with infectious diseases specialty training also increased non-significantly (29% vs 36%, p = 0.39; Figure 2).Figure 1.Implementation of Antimicrobial Stewardship Core Elements in Oregon HospitalsFigure 2.Characteristics of Antimicrobial Stewardship Leadership

Conclusion
Despite challenges stemming from the COVID-19 pandemic, hospital commitment to antimicrobial stewardship increased as indicated by greater implementation of the core elements. Yet gaps persist for critical access hospitals; further efforts are needed to support to full implementation in this setting.

Disclosures
All Authors: No reported disclosures
1267. Implementation and Outcomes of Beta-lactam Allergy Management Protocol at a Comprehensive Cancer Center
Authors: Khalak Sohanabanu , So Wonhee , Ho Stephanie , Ross Justine Abella , Dadwal Sanjeet S , Puing Alfredo , Nanayakkara Deepa D , Taplitz Randy , Kaur Avneet , Dickter Jana 
Published: November 2023

Abstract

Background
Beta-lactam allergy (BLA) is associated with increased broad-spectrum antibiotic (Br-ABX) use, worse clinical outcomes, and higher costs. Our hospital-wide BLA protocol (BLA-P) was launched in 7/2021 with following categories: intolerance, low-risk (urticaria only &gt;5 years ago, mild rash, remote childhood reaction with limited details), and high-risk (angioedema, anaphylaxis, severe rashes). Delabeling was done directly based on antibiotic history/interview alone (direct-delabeling), or via graded challenge for low-risk patients. We evaluated the delabeling rate and its impact on Br-ABX usage.

Methods
Hospitalized patients ≥ 18 years old with listed BLA during 10/2021-12/2022 were eligible. Exclusion criteria were critically ill, surgical, hospice or comfort care, or non-verbal patients. Assessment was counted each time a pharmacist evaluated BLA; multiple assessments could occur in case of prolonged hospital stay or multiple admissions. Interventions were categorized as no further action (due to high-risk allergy, patient refusal for any update, clinical status), updated allergy label, or delabeled. Missed assessments were reported due to logistical issues. Br-ABX usage was compared in the delabeled patients: the empiric antibiotic use 90 days post-intervention versus pre-intervention using McNemar test (SPSS).

Results
A total of 700 assessments in 631 unique patients with BLA were identified (Figure 1). 556 assessments in 489 unique patients (median age 63 years, 41% male, 46% hematological cancer) met inclusion criteria. In this cohort, the assessments revealed 8% intolerance, 54% low-risk, 17% high-risk and 21% unknown allergy. Interventions resulted in no further action 7%, updated label 72%, and delabeling 21%. 65% of the delabeling was done via direct-delabeling and 35% via graded challenge (Figure 1). Passing rate with graded challenge was 97%. The use of aztreonam and meropenem decreased significantly in delabeled patients compared to pre-delabeling while cefepime and piperacillin-tazobactam usage increased (Table 1).

Conclusion
Implementation of BLA-P led to 21% delabeling, which resulted in increased use of preferred Br-ABX and a significant decrease in meropenem and aztreonam use.

Disclosures
Sanjeet S. Dadwal, MD, FACP, FIDSA, Allovir: Advisor/Consultant|Allovir: Grant/Research Support|Ansun Biopharma: Grant/Research Support|Aseptiscope, Inc: Stocks/Bonds|Astellas: Honoraria|Karius: Grant/Research Support|Matinas Biopharma: Stocks/Bonds|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer/Amplyx: Grant/Research Support|Takeda: Advisor/Consultant|Takeda: Honoraria|Viracor: Honoraria Randy Taplitz, MD, Karius: Advisor/Consultant|Merck: Advisor/Consultant|SNIPR biome: Advisor/Consultant