bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1589. Characterization of Blood Culture Ordering Practices at a Single Veterans Affair Medical Center
Authors: Stegall Cassidy J , Dao Tina H , Liang Nicholas , Bowden Jarred , Mitchell Anna , Yn Louis , Zhang Peter , Bennett Jessica G 
Published: January 2025

Abstract

Background
Blood culture (BCx) is the gold standard for definitive diagnosis of bacteremia and fungemia, but there is limited guidance for ordering practices. Unnecessary BCx increases the risk of false positives which can lead to increased length of stay, antibiotic use (AU), and additional testing. Diagnostic stewardship aims to optimize the use of diagnostic tests to improve patient management and outcomes. This study aimed to describe the current practice of BCx ordering at a single facility and identify areas for intervention.

Methods
This was a retrospective review of BCx ordered from 11/01/23 to 12/31/23. BCx were excluded if there was no encounter 5 days before or 2 days after BCx collection or initial BCx were drawn at another facility. Labs, vitals, BCx order date/time, ordering provider, location and results, AU and antibiotic indication were extracted from the Corporate Data Warehouse. Indications for BCx and endovascular infection risk were determined via chart review. Appropriateness of BCx was determined by an algorithm denoting low, intermediate, or high risk of bacteremia associated with an infectious disease state (Figure 1). Intermediate and high risk were deemed appropriate. Endpoints were analyzed with descriptive statistics.

Results
243 BCx were evaluated and 215 were analyzed. 156/215 (73%) were ordered in the Emergency Department (ED) (Table 1). 113/215 (53%) of BCx were appropriate with the most common indications including sepsis, intra-abdominal infection, and severe community acquired pneumonia (CAP) (Table 2). The rate of appropriateness was similar across clinical departments (Figure 2). For inappropriate BCx, 41 had no suspected infection documented, and CAP, cellulitis, and cystitis were the most documented indications (Table 2). 17/215 (8%) of BCx were positive, 6/102 in low risk, and 11/113 in intermediate/high risk group. 4/6 in the low risk were identified as contaminants.

Conclusion
This study found ∼50% of BCx were ordered unnecessarily, and there was both low positivity rate and false positives in this group reflecting current literature. Similar BCx ordering practices were identified across services. These findings highlight the need for intervention system wide to promote strong diagnostic stewardship and appropriate BCx ordering practices.

Disclosures
All Authors: No reported disclosures
581. Enhancing Diversity, Equity, Inclusion, Access, and Justice (DEIAJ) Teaching in Infectious Diseases: Current State and Future Directions in Faculty Development
Authors: Nielsen Hailee , Abdoler Emily 
Published: January 2025

Abstract

Background
Infectious Diseases (ID) clinicians occupy a unique position at the interface of clinical medicine and social justice. Medical education in ID therefore presents a rich opportunity for trainees to cultivate critical consciousness in Diversity, Equity, Inclusion, Access, and Justice (DEIAJ). Research has focused on improving DEIAJ education for ID fellows and attendings (Gleeson et al., 2023, Vasishta et al., 2023 ), but little is known about ID faculty members’ perceptions of DEIAJ teaching. We aim to explore ID faculty members’ attitudes and experiences discussing DEIAJ topics when teaching clinically.

Methods
Clinical ID attendings at the University of Michigan were invited to complete an anonymous survey. Open-ended questions assessed which ID-related DEIAJ topics faculty members believe are most important for students to learn. Likert-style questions evaluated comfort and preparedness regarding DEIAJ teaching, while multiple choice questions explored barriers to covering this content and faculty development preferences.

Results
Survey response rate was 81% (22/27), with a 63% completion rate. Faculty comfort with DEIAJ teaching was high, while reported preparedness was only moderate (Figures 1, 2). Common perceived barriers to DEIAJ teaching were lack of facilitation skills (50%) and fear of trainee criticism (42%). Preferred modes for faculty development were DEIAJ integration in conferences (85%), facilitation training (57%), and access to DEIAJ teaching cases (50%). Respondents identified common and important DEIAJ teaching topics that arise in ID clinical practice (Figure 3).

Conclusion
This single-institution study reveals that ID attendings are comfortable addressing DEIAJ topics in their clinical teaching despite not feeling optimally prepared. Identifying this comfort-preparation gap in our division, as well as preferred faculty development modalities and prioritized DEIAJ topics within ID, is the first step in creating integrated professional development opportunities that capitalize on faculty members’ dedication to DEIAJ teaching. Exploration of this issue on a national scale could support development of a customizable professional development toolkit for the broader ID community.

Disclosures
All Authors: No reported disclosures
P-1596. Procalcitonin: A Promising Tool in Post COVID-19 Antibiotic Prescribing at a Community Teaching Hospital
Authors: Nothdurft Elizabeth , Philip Nirmol , Giblin Brenden 
Published: January 2025

Abstract

Background
A rise in antibiotic use was universally observed during the COVID-19 pandemic. Use of procalcitonin (PCT) in understanding the bacterial burden of disease both in the context of COVID-19 and other infections continues to be associated with much debate. Our hospital saw a precipitous rise in antimicrobial use during COVID-19, despite ongoing efforts of antimicrobial stewardship. We looked to PCT to help curb antibiotic overprescribing following the COVID-19 pandemic.
Hospital wide SAAR

Methods
This was a single-center, before and after study to evaluate the impact of PCT implementation at a 500-bed community teaching hospital on antimicrobial usage. Education was provided to all providers before and during PCT implementation. A lab order was added to the existing sepsis clinical pathway and a pocket card detailing the appropriate use of PCT for approved indications (lower respiratory tract infections and sepsis) was provided to clinicians.
For the primary outcome, we evaluated the standardized antimicrobial administration ratio (SAAR) before and after PCT implementation. Secondary outcomes included antibiotic consumption as described by days of therapy (DOT) per 1000 days present (DP), change in antimicrobial cost, appropriateness of testing and adherence to the PCT prescribing algorithm included in the pocket guide.
ICU SAAR

Results
Since becoming available at our hospital, PCT has been ordered on average 583 times per month. On average, monthly SAARs were 8.4% lower during post-PCT period (1.06 vs 0.98; p=0.0011) (Figure 1). A decline was observed in both intensive care units (ICU) as well as non-ICU inpatient wards (Figure 2, 3). Total antimicrobial utilization decreased by 8.5% (550 vs 503 DOT/1000 DP), which translated to a 19.3% reduction in antimicrobial spending. Appropriateness of the initial PCT testing was 74% and appropriate discontinuation of antibiotics based on PCT algorithm was 80% during 18-months of PCT use.
Non-ICU SAAR

Conclusion
Our findings suggest that appropriate use of PCT added to antimicrobial stewardship can be a valuable tool in both ICU and non-ICU settings.

Disclosures
Elizabeth Nothdurft, PharmD, BCPS, BCIDP, Abbvie: Honoraria Nirmol Philip, MD, MPH, Nestle: Honoraria
P-1599. Evaluating the Impact of Pneumococcal Urinary Antigen on Antibiotic Prescribing in an Urban Safety Net Health System
Authors: Bhatia Mehak , Kim Paul , Inampudi Jyothik , Shapoo Mazhar , Scipione Marco R , Dhar Sorabh , Monday Lea 
Published: January 2025

Abstract

Background
Pneumococcal urinary antigen (UAg) testing is for certain high-risk community acquired pneumonia (CAP) patients. Prior studies evaluating antibiotic de-escalation practices in patients with positive UAg are mixed1,2.

Methods
We performed a retrospective cohort study of adult patients admitted with CAP who had a UAg test result over a 2-month period. Patients with an alternative diagnosis or with risk factors for healthcare associated infections that would impact de-escalation were excluded (Fig1). Patients with and without a positive UAg test result were compared. Rates of empiric versus final antibiotic prescribing and duration of empiric coverage for Pseudomonas and Methicillin-resistant Staphylococcus aureus (MRSA), were recorded. Primary outcome was whether UAg positivity impacted antibiotic de-escalation practices.

Results
268 CAP patients were included in the analysis (235 UAg negative and 33 UAg positive). Cohorts were evenly matched in terms of illness severity, comorbidities, and readmission rates (Table 1). Empiric coverage for Pseudomonas and MRSA was above 40% in both cohorts. Patients started on empiric azithromycin, doxycycline, vancomycin, cefepime, or any anti-pseudomonal ß-lactam were often de-escalated, regardless of whether UAg was positive or negative (P&lt; 0.05 in both cohorts) (Fig2). Empiric quinolones were more often de-escalated in UAg positive patients, though sample size was small (P=0.021). Definitive use of a narrow spectrum penicillin (PCN) or ß-lactam was low, even in UAg positive patients (Fig2). Duration of empiric anti-pseudomonal use was lower in UAg positive versus negative patients (median 2.5 versus 5 days, respectively)( P=0.0391). Shorter empiric Anti-MRSA durations were also seen in UAg positive patients (median 1 versus 4 days, respectively) (P=0.0201).

Conclusion
Patients treated for CAP in an urban safety net hospital often had their empiric antibiotics de-escalated regardless of pneumococcal UAg result. However, positive UAg likely facilitated sooner discontinuation of anti-MRSA and anti-Pseudomonal coverage since median durations were lower in this group. Efforts to increase use of a narrow spectrum PCN or ß-lactam in such patients are an opportunity for future stewardship interventions.

Disclosures
All Authors: No reported disclosures
P-1618. Real-world Evaluation of Multiplex Pneumonia Panel Performance and its impact on Antibiotic Utilization
Authors: Swaminathan Neeraja , Imlay Hannah , Earl Ali , Fong Karen , Spivak Emily S 
Published: January 2025

Abstract

Background
Gaps exist in understanding how molecular syndromic testing aligns with culture-based diagnostics and if clinicians use this information to optimize antimicrobial use. The Biofire FilmArray® Pneumonia panel (PN-panel) includes 15 bacterial, 3 atypical, and 8 viral targets as well as antimicrobial resistance genes. We assessed performance and utilization of this panel in the absence of antimicrobial stewardship program (ASP) oversight post-implementation.Figure 1Antibiotic de-escalation criteria

Methods
We audited 79 specimens (49 bronchoalveolar lavage & 30 endotracheal aspirates) from 67 patients (August 1, 2023, to November 30, 2023). Demographics, pneumonia panel testing, and concurrent respiratory culture results were recorded. Concordance between PN-panel and culture was defined as identical organisms or dominant organism matching. Instances where culture showed normal oral flora/no growth while PN-panel was negative were also considered concordant. We categorized pre- and post- PN-panel antibiotic selection as escalation, no change, or degrees of de-escalation (defined in Figure 1). De-escalation was evaluated between three infectious disease clinicians to reach consensus.Figure 2Performance of PN-panel compared to culture-based diagnostics

Results
The mean age was 57 years, with 67% male and 34% female. PN-panel testing was positive in 30/79 patients including 11 polymicrobial specimens, 5 with viral targets and 5 with resistance gene detections. 20.3% (16/79) of specimens had positive cultures. Concordance of PN-panel and culture results was 86.1% (68/79) with PN-panel demonstrating a PPV of 53.3% and an NPV of 100% (Figure 2). Analysis of antibiotic prescribing post- PN-panel was done separately for immunocompromised and non-immunocompromised cohorts (Table 1), revealing significant opportunity for de-escalation in both groups, particularly prominent in the non-immunocompromised subset. Even after exclusion of patients with other microbiologically confirmed infections, only 41.6% of eligible non-immunocompromised patients de-escalated antibiotics.Table 1Analysis of post PN-panel Antibiotic prescribing

Conclusion
Despite the PN-panel’s high sensitivity and NPV, antibiotic de-escalation occurred only in a minority of patients. Collaboration with ASP teams is likely to enhance its clinical utility by guiding result interpretation and antibiotic management.

Disclosures
All Authors: No reported disclosures
P-1629. Reduction in Clostridioides difficile Over-diagnosis Following Suppression of C. difficile Target from Multiplex Molecular Stool Assay in a Pediatric Healthcare System
Authors: Most Zachary M , Sceeles Kayla , Filkins Laura , Kidd Mehgan 
Published: January 2025

Abstract

Background
Clostridioides difficile testing by polymerase chain reaction (PCR) does not differentiate asymptomatic colonization from infection, and children are frequently colonized with toxigenic strains of C. difficile. Over-diagnosis of C. difficile infections can lead to adverse patient outcomes and poorer quality metrics for hospitals.Figure 1:C. difficile PCR orders following change in GI PCR Panel, Interrupted Time Series

Methods
In January 2023 our pediatric health system enacted multimodal changes to the electronic ordering of stool tests for C. difficile and other gastrointestinal pathogens. A multiplex PCR test for stool was updated to suppress testing for toxigenic C. difficile. The only remaining method to test for C. difficile by PCR in house was a C. difficile toxin gene specific PCR. Additionally, appropriate clinical criteria with a hard stop were added to the C. difficile PCR order (all of: no laxatives in the past 24 hours, at least 3 liquid stools in the past 24 hours, at least one risk factor for C. difficile infection, and patient at least one year old). If providers still sought C. difficile testing without meeting these criteria, infectious disease specialist approval was required. We analyzed the effect of this intervention using interrupted time series analysis and pre-post aggregate rates from January 2019 through February 2024.Figure 2:C. difficile positive rate following change in GI PCR Panel, Interrupted Time Series

Results
There were 4426 stool PCR tests performed for C. difficile in the pre-intervention period and 622 in the post-intervention period. The mean (± sd) age of those tested was 7.8 years (± 6.1 years). After the intervention, there was an immediate 61% decrease in C. difficile testing incidence (95% CI [53% - 67%], Figure 1) and 51% decrease in C. difficile diagnosis incidence (95% CI [26% - 67%], Figure 2). There was no significant immediate change or change in slope in the C. difficile antibiotic treatment incidence or HFO C. difficile incidence, but there was a trend towards lower rates of healthcare facility onset C. difficile after the change (aggregate rate 4.13 per 10,000 non-NICU patient-days prior to intervention vs. 3.39 after, P = .28).

Conclusion
Removing C. difficile from multiplex PCR assays and adding required clinical criteria to the electronic order reduces the number of C. difficile tests and diagnoses in a pediatric health system.

Disclosures
Laura Filkins, PhD, Avsana Labs: Board Member|Avsana Labs: Stocks/Bonds (Private Company)|Biofire Diagnostics: Grant/Research Support
P-1631. Implementing an Effective Antibiotic Prescribing Feedback Intervention in a Large Primary Care Network with Emphasis on Bacterial Sinusitis
Authors: Pomakov Alexander , Venci Jineane V , Lopa Samia H , Fortuna Robert J , Yamshchikov Alexandra 
Published: January 2025

Abstract

Background
Education and feedback interventions are a key aspect of antibiotic stewardship in outpatient settings. We examined effectiveness of an antibiotic prescribing feedback intervention in a large primary care network with emphasis on bacterial sinusitis.Figure 1.Letter Template for Prescribing and Benchmarking Feedback to Primary Care Network Providers

Methods
We examined prescriptions written by 237 network primary care clinicians between 9/1 -11/31/2022 (baseline n=23048) and 12/1/2023 -2/29/2024 (post intervention n=18885). Feedback was given via individualized letters (Fig 1) comparing providers’ antibiotic prescribing rates and guideline concordant prescribing for sinusitis against network peers and national data. Guideline concordance was defined from local antibiograms and national guidelines. Primary outcomes were rate of antibiotic prescriptions and percentage of guideline concordant sinusitis prescriptions. Data were analyzed in GraphPad and SAS v9.4 with generalized linear mixed model to account for correlation between repeated provider data.Table 1.Rates of Antibiotic Prescriptions by Provider Designation Before and After Feedback Intervention

Results
Average rates of antibiotic prescriptions before and after intervention were 13.9 and 13.4/100 visits, a 0.5% absolute reduction and 4.0% relative reduction (p = 0.13). Among providers with baseline &gt;1 standard deviation (SD) antibiotic utilization, average prescribing decreased from 27.7 to 19.7/100 visits (p=0.0002), with increase among those with lowest (&gt; 1 SD) utilization, 5.3 to 7.16/100 visits (p = 0.0048). Physicians’ rates remained lower than non-physician providers (p&lt; 0.0001), and reduction post intervention was similar in both provider groups (p = 0.87, Table 1). Bacterial sinusitis remained most common antibiotic indication (Fig 2). Guideline concordant sinusitis prescriptions pre and post intervention were 69.7% and 83.2% respectively, a 13.5% absolute increase and 19% relative increase (p = &lt; 0.0001) Degree of increase did not differ by provider group (p = 0.76). Antibiotic distribution shifted away from azithromycin, with increases in amoxicillin and doxycycline (Fig 3).Figure 2.Most Common Indications for Prescribing Antibiotics within URMC Primary Care Network Before and After Feedback Intervention

Conclusion
A prescription feedback intervention in a large primary care network reduced antibiotic prescription rates and non-guideline concordant prescriptions for bacterial sinusitis. The impact of the intervention was most pronounced in prescribers with highest antibiotics utilization pre-intervention.Figure 3.Characterization of Most Common Antibiotics Prescribed by PCN Providers Before and After Feedback Intervention

Disclosures
All Authors: No reported disclosures
585. Effects of Legislation Restricting Reproductive and LGBT+ Rights on Infectious Disease Fellowship Match Rates
Authors: Chen Michael Z , Hutchison Alan L , Hazra Aniruddha , Czapar Anna 
Published: January 2025

Abstract

Background
Over the last decade, infectious disease (ID) fellowship match rates have declined despite increasing workforce need. Many factors may influence rates, including effects of local political climate. Since 2022, many states have restricted reproductive and/or LGBT+ rights. As 43% of ID physicians identified as women in 2021 (AMA) and 6% of graduating medical students entering medicine residencies identified as lesbian, gay, or bisexual from 2016-2019 (Mori, 2021), there is a need to examine impact of local politics on match rates.Table 1.Match Rates of Programs in States with and without Restrictions on Reproductive and LGBT+ Rights

Methods
Match rates for ID fellowship programs from 2019-2024 were tabulated by state based on publicly available NRMP data. States were categorized as reproductively-restrictive if they enacted laws limiting abortion and/or LGBT+ restrictive if they enacted laws limiting gender expression, LGBT+ healthcare or curriculum after 2022 based on reporting from the NYTimes and the Trevor Project. States without any laws were categorized as permissive. Differences in match rates in states with both restrictions, one restriction, or no restrictions were compared using two-sample z-tests of proportion.

Results
From 2019-2024, overall ID fellowship match rates declined from 81% to 68%, but permissive states (n = 121) consistently had higher match rates than restrictive states (n = 76) (Table 1). Match rates were significantly higher in LGBT-permissive states than restrictive ones in 2021 (p = .034) (Fig 1), in reproductively-permissive states than restrictive ones from 2021-2023 (p = .022, .015, .014) (Fig 2), and in states without any restrictions than states with both restrictions from 2021-2023 (p = .032, .025, .017) (Fig 3). There were no significant differences in match rates when comparing programs based on restrictions in 2019, 2020, and 2024.

Conclusion
Significant differences in match rates from 2021-2023 between programs in states with and without restrictions of rights suggests that political climate may have a measurable impact. However, all match rates converged at their lowest in 2024 regardless of program location. This may indicate a basal match rate across states, and political climate may influence match rates above this level. Longitudinal study of application volumes and match rates and surveys to assess applicant attitudes are warranted.

Disclosures
Aniruddha Hazra, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|ViiV Healthcare: Advisor/Consultant
P-1636. Real World Outpatient Utilization of Novel Anti-MRSA Antimicrobials: Patterns in Prescribing and Cost of Oral and Long-Acting Injectable Anti-MRSA Therapies in United States Medicaid Beneficiaries
Authors: O’Neil Jessica C , Lautenbach Ebbing 
Published: January 2025

Abstract

Background
Methicillin Resistant Staph Aureus (MRSA) isolates with resistance to traditional oral anti-MRSA antimicrobials represent a major public health concern. Since 2014, the United States (US) Food and Drug Administration (FDA) approved three oral (tedizolid [2014], delafloxacin [2017], omadacycline [2018]) and two long-acting injectable (LAI) antimicrobials (dalbavancin [2014], oritavancin [2014]) with potent activity against MRSA. Little has been reported about the real-world outpatient utilization and cost of these important therapies.

Methods
We conducted a retrospective analysis of utilization and cost of these 5 antimicrobials between January 1st, 2014 and December 31st, 2022 in the Medicaid State Drug Utilization Database (SDUD). The SDUD contains all covered outpatient medications excluding those reimbursed under bundled services and suppresses medication data for years with fewer than 11 prescriptions. Annual cost was calculated as the sum of Medicaid and non-Medicaid reimbursement. We approximated the annual per prescription cost (APPC) as the quotient of total cost and prescription count.

Results
Trends in utilization, total cost and APPC are depicted in Figures 1, 2 and 3 respectively. There was a 1–2-year lag between FDA approval and utilization. Dalbavancin utilization and cost rose from 13 prescriptions and $26,224 in 2014 to 4970 prescriptions and $16,403,304 in 2022, while oritavancin increased from 27 to 566 prescriptions and from $62,309 in $944,657costs. The dalbavancin APPC increased over the study period ending in 2022 at $3,300 while the oritavancin APPC declined to $1669 in 2022. Of the oral antimicrobials, tedizolid utilization and total cost peaked in 2019 at 755 prescriptions and $3,193,571, after which total cost and utilization fell to 283 prescriptions and $1,773,238 by 2022. Delafloxacin utilization and total cost remained low while omadacycline had an increasing trend in utilization, total cost and APPC in the three years it was included.

Conclusion
Utilization and total cost of dalbavancin rose substantially over the study dwarfing that of oritavancin and the novel oral antimicrobials by the latter half of the study period. Omadacycline, the newest approved antimicrobial included, demonstrated a prompt rise in utilization and total cost.

Disclosures
All Authors: No reported disclosures