bluuebunny/crossref_metadata_2025_split huggingface dataset:
321. Early Intervention: Readmission Reduction Efforts in OPAT via Early Patient Contact
Authors: Swartwood Michael , Schranz Asher J , Farel Claire E , Mavrogiorgos Nikolaos , Fabricio Julia B , Bowman M C , Oosterwyk Teresa M , Boerneke Renae 
Published: November 2023

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) leverages the expertise of a multidisciplinary Infectious Diseases (ID) team to provide antimicrobial therapy at home in a safe and cost-effective manner. To reduce adverse events (AE) and hospitalizations among patients receiving OPAT, we implemented two initiatives: early care coordination phone calls (CCPC) and short-term ID follow-up appointments after OPAT initiation. The difficulties with hospital discharge are well described. Our efforts were designed to prevent these before they resulted in a hospital readmission.

Methods
In March 2019, we implemented an early CCPC after hospital discharge. The content of these conversations were chosen to identify or reduce potential reasons for readmission. Patients at potentially increased readmission risk were prioritized via specific criteria.
In October 2020, we aimed to shorten the interval between hospital discharge and ID follow-up. Historically, these had taken place at the end of OPAT therapy. By shortening this interval, we hoped to leverage ID expertise to identify potential rehospitalization during OPAT.

Results
For patients completing OPAT therapy in 2021, 82% received a CCPC. While the call content was clinically beneficial in many cases, the readmission rate was static.
For 2020, the median days until ID follow-up was 28 days and decreased to 16 days in 2022. The percentage of visits via telehealth increased from 15% in 2020 to 30% in 2022.
During 2015-2019, the readmission rate during OPAT was 19%. In 2022, UNC OPAT achieved a readmission rate of 14%. This was a 9% readmission rate for reasons unrelated to OPAT and a 5% readmission rate for OPAT-related causes.
The reduction in negative patient outcomes was not limited to readmissions. For patients completing OPAT in 2022, we saw a decrease in the rate of patients experiencing several AE’s.

Conclusion
We piloted two interventions to decrease hospitalizations during OPAT. While early CCPC had qualitative benefits, it did not correlate with a decrease in hospitalizations. Early ID appointments did correlate with a large reduction in on-treatment readmissions. These findings are consistent with numerous studies showing that early ID clinician involvement is linked to favorable outcomes for patients and health systems.

Disclosures
Asher J. Schranz, MD, MPH, WoltersKluwer: Honoraria
324. The Impact of Adding Staff-performed Telephone Call Reminders to Automated Call Reminders in An Infectious Diseases Outpatient Practice
Authors: Deeb Mery , Hadeel Zainah 
Published: November 2023

Abstract

Background
Automated text message service reminders have been shown to increase show-up rates in outpatient practices. Furthermore, automated telephone call service reminders also decrease the no-show rates; however, no-show rates have decreased even further when telephone call reminders were done by health-care personnel. We sought to demonstrate the benefit of telephone call reminders done by clinic staff when added to the automated call reminders on improving show-up rates.

Methods
This was a quality improvement project, which was conducted by performing prospective data collection from our outpatient Infectious Diseases (ID) practice between May 2021 and May 2022. The outpatient ID practice served a 359-bed community hospital. There were two providers in the ID practice. The automated call reminder system was utilized for all patients’ visits. Starting November 2021, our medical assistant performed a telephone call reminder one day prior to the visit. We compared the rates of no-shows between May 2021 to November 2021 to those between November 2021 and May 2022

Results
In a period of 6 months, there were 277 patients scheduled for outpatient visits. The automated call reminders were being utilized routinely. There were 18 patients (7.93%) who did not present to the scheduled appointments. In the following 7 months, after incorporating staff reminder calls, 21 of 321 scheduled patients (6.54%) did not show up to the visits. There was a decrease of 1.39 % in the no-show rate after the staff call implementation (P-value of 1). The No-show rate was different between the two providers. No-show rate decreased from 6.76% to 5.68% for provider A (P-value: 0.8), compared to a decrease from 10.13% to 7.59% for provider B (P-value: 0.6).

Conclusion
When done one day prior to the appointment, staff-performed call reminders did not improve show-up rates when added to the automated call reminders in the Infectious Diseases outpatient practice. Further studies are needed to evaluate the impact of adding staff-performed call reminders at a different interval from the scheduled appointments.

Disclosures
All Authors: No reported disclosures
333. How the COVID-19 Pandemic Accelerated Development of our Complex Outpatient Oral Antimicrobial Therapy (COpAT) Program
Authors: Juskowich Joy J , Thompson Jesse M , Sarwari Arif R 
Published: November 2023

Abstract

Background
At our university medical center, we have well established programs for outpatient parenteral antimicrobial therapy (OPAT) and inpatient multidisciplinary antimicrobial infusions for patients with substance use disorder. Complex outpatient oral antimicrobial therapy (COpAT) uses oral (PO) in place of intravenous (IV) antimicrobials. Despite evidence supporting early IV to PO antimicrobial transition for serious infections, COpAT Programs are not widely incorporated in clinical practice. COVID-19 pandemic’s impact on inpatient bed scarcity triggered COpAT’s accelerated implementation at our institution. A Nov 2020 CEO email served as the catalyst and by Aug 2022 an Infectious Diseases (ID) Pharmacist was hired. By Oct 2022, an ID Physician at 0.5 FTE was assigned COpAT Medical Director. We hypothesized IV to PO antimicrobial transition increased as our COpAT Program developed.

Methods
Retrospective cohort study on 380 COpAT patients discharged Jan 2021 to Apr 2023 categorized in 2 groups: Early Discharge: Short course IV antimicrobials &lt; 2 weeks followed by COpAT (n= 115); Traditional: Longer course IV antimicrobials ≥ 2 weeks followed by COpAT (n= 265). Demographic, clinical, and outcomes data were compared.

Results
Proportion of patients in Early Discharge group increased significantly (19 to 47%, p&lt; 0.001) (Image 1). Traditional group had higher rates of injection drug use and bacteremia. While gram positive organisms predominated in both groups, Traditional group had a higher rate of monomicrobial infection (Image 2). Early Discharge group had a greater proportion of oral antimicrobial days (86 vs. 36%, p&lt; 0.05) and shorter length of stay (8 vs. 24 days, p&lt; 0.05) but higher overall and COpAT-related 30-day readmission rates (15 vs. 6 and 7 vs. 2%, p&lt; 0.05). Both groups avoided inpatient hospital days and had high clinical cure rates (Image 3). COpAT Program ROI was 10.9.

Conclusion
COVID-19 pandemic accelerated development and maturation of our COpAT Program supported by 0.5 FTE ID Physician and 1.0 FTE ID Pharmacist. While readmission rates in both groups were low, possible association between shorter length of stay and increased readmission rates needs further evaluation. COpAT Program investment pays for itself in less than 2 months, mainly through inpatient days avoided.

Disclosures
All Authors: No reported disclosures
334. The devil is in the details: Systematic evaluation of antimicrobial allergy at an academic medical center in Japan
Authors: Adachi Katayama Maho , Okamoto Koh , Okamoto Koh , Kawase Kyotaro , Yamaguchi Ryo , Kitaura Satoshi , Ukai Kohei , Miwa Toshiki , Wakimoto Yuji , Oyabu Tatsunori , Jubishi Daisuke , Hashimoto Hideki , Harada Sohei , Okugawa Shu , Tsutsumi Takeya 
Published: November 2023

Abstract

Background
Antimicrobial allergy is common and encountered by healthcare providers. Inaccurate or incomplete information on antimicrobial allergy leads to inappropriate antimicrobial selection. In the electronic health record (EHR), antimicrobial allergy is not only documented as free text but also listed in the EHR allergy section (EHR-AS). However, its quality has not been well studied.

Methods
This was an observational study at an academic medical center in Tokyo, Japan. We included hospitalized patients who received infectious disease consultations from April 2022 to March 2023. Antimicrobial allergy was assessed through structured interview and review of allergies documented free-text in the provider’s note in the EHR (referred to systematic assessment hereafter). We evaluated the potential for de-labeling. We then compared it with the information in the EHR-AS.

Results
A total of 1,179 patients were included. Systematic assessment revealed 148 (148/1179, 13%) patients had allergy histories related to 214 antimicrobials (Table). Of these, 38 patients (38/148, 26%) had a history related to more than one antimicrobial. Beta-lactam antibiotics accounted for 58% (125/214). Of 214 antimicrobials, allergy histories were documented in 70%, 53%, and 41% of notes written by primary team physicians, nurses, and pharmacists, respectively. In total, 71% (152/214) of antimicrobials in 107 patients found through systematic assessment could have been candidates for de-labeling; 21 for direct de-labeling, 19 for supervised oral rechallenge, and 112 for skin testing followed by oral rechallenge. The remaining 62 antimicrobials were deemed not candidates for de-labeling because of their high-risk features. Out of 214 antimicrobials, 126 (59%) were listed in the EHR-AS and the details were NOT described for 50 antimicrobials (50/126, 40%).

Conclusion
While a majority of antimicrobial allergies could have been candidates for de-labeling when evaluated thoroughly, much fewer allergies were listed in the EHR-AS, often without details. Standardizing the evaluation of antimicrobial allergy and entry to the EHR-AS may facilitate selection of appropriate antimicrobials.

Disclosures
Satoshi Kitaura, MD, PhD, FUJIFILM Toyama Chemical Co. Ltd.: S.K., during graduate school studies, conducted antiviral research involving favipiravir, which was provided by FUJIFILM Toyama Chemical Co. Ltd.
335. Factors Associated with Loss to Follow-Up in Outpatient Parenteral Antimicrobial Therapy: A Retrospective Cohort Study
Authors: Kaul Christina M , Haller Matthew , Yang jenny , Solomon Sadie , Khan Maria , Pitts Robert , Phillips Michael 
Published: November 2023

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) has long been utilized to treat infectious conditions in the outpatient setting, particularly for those conditions requiring prolonged courses of antimicrobials. It is well-known that follow-up with Infectious Diseases can reduce hospital readmission. However, factors associated with loss to follow-up are not well-studied. We sought to understand factors associated with an increased risk to loss of follow-up with Infectious Diseases in OPAT patients.

Methods
This was a retrospective cohort study conducted at NYU Langone Health (NYULH). The study was approved and granted a waiver of authorization and informed consent by the NYU IRB. All OPAT episodes for patients at least 18 years of age initiated during admission from January 1, 2017 to December 31, 2020 were screened.
Data were analyzed using SPSS v.28 and Microsoft Office Excel 2019. Descriptive statistics were used. A multivariate logistic regression model was used to examine factors associated with risk of loss to follow-up.

Results
1,846 instances qualifying OPAT courses were identified. 1,528 (82.7%) of patients were recommended for follow-up with ID. 1,110 (72.6%) patients were seen, while 418 patients (27.4%) were not. Of the patients seen by ID, 981 (88.4%) were seen by the physician, and 129 (11.6%) were only seen by the NP. Patients were seen or contacted by the ID physician a median of two times during their follow-up period (IQR 1-3). The median follow-up period for those patients not lost to follow-up was 21 days (IQR 10-36).
The model was adjusted for chronic medical condition, hospital of admission, and follow-up duration. There was a significant association noted between loss to follow-up with ID and discharge to SAR (OR 3.242, p &lt; 0.001) or LTC (OR 5.906, p &lt; 0.001). There was also an association between the use of federal insurance and loss to follow-up (OR 1.493, p = 0.029).

Conclusion
Discharge to SAR and LTC are strongly associated with loss to follow-up with Infectious Diseases. This work underscores the importance of maintaining links to patients discharged to sub-acute healthcare facilities. Transitions of care remain a weakness in healthcare delivery, and must be improved upon in OPAT.

Disclosures
All Authors: No reported disclosures
348. Impact of Substance Use Disorders on Outcomes of Medically Insured Persons Receiving Multiweek Outpatient Parenteral Antimicrobial Therapy
Authors: Rogers Daniel , Chastain Daniel B , Zhao Lingyu , Zhan Duna , Chen Xianyan 
Published: November 2023

Abstract

Background
Catheter complications, misuse, nonadherence, safety, and legal concerns often prohibit persons with a history of substance use disorder (SUD) from receiving outpatient parenteral antimicrobial therapy (OPAT). However, single center studies in the U.S. found similar rates of readmission and adverse events among patients receiving OPAT regardless of SUD history. As such, we compared outcomes and complications between patients with and without a history of SUD who were treated with multiweek OPAT using claims data from multiple years across the U.S.

Methods
We used data from the IBM MarketScan Databases to identify patients who were ≥ 18 years and treated with intravenous vancomycin, daptomycin, nafcillin, oxacillin, or cefazolin for ≥ 7 days after hospital discharge between July 1, 2016 and July 31, 2020. Those with a history of end stage renal disease or Clostridioides difficile infection were excluded. Patients were separated into two cohorts based on a history of SUD using ICD-10-CM diagnosis codes prior to hospital discharge. The rates of adverse events including drug overdose and catheter complications during OPAT, all-cause readmissions within 90 days after completion of OPAT, and infection-related readmissions within 90 days after completing OPAT were compared between groups.

Results
Of 5903 patients included, 18% (n = 1058) had a history of SUD. Those with a history of SUD were younger than individuals without a history of SUD (47 ± 12 vs 53 ± 15 years, P &lt; 0.0001) and there were fewer male patients in the SUD group (52% vs 56%, P = 0.02). Type 2 diabetes mellitus (43% vs 52%, P &lt; 0.0001), arrhythmias (33% vs 31%, P = 0.152), and depression (49% vs 30%, P &lt; 0.0001) were most common among both groups. More patients in the SUD group experienced at least one adverse event during OPAT (8% vs 5%, P = 0.004). All-cause readmissions and infection-related readmissions within 90 days after completion of OPAT were more common among patients with a history of SUD (40% vs 32%, P &lt; 0.0001 and 27% vs 22%, P = 0.02, respectively).

Conclusion
Patients with a history of SUD experienced higher rates of adverse events during OPAT and were more likely to require readmission for any reason, including readmissions due to infection, within 90 days after completion of OPAT.

Disclosures
All Authors: No reported disclosures
381. Effect of Ceftriaxone+sulbactam+disodium EDTA Combination in Treatment of Complicated Urinary Tract Infections Caused by Metallo Beta-lactamase Producing Enterobacterales: An Open Label Randomized Controlled Trial
Authors: Samantaray Subhashree , Kumar Deepak , Bohra Gopal Krishana , Meena Durga Shankar , Agarwal Ashwini , Chaudhary Gautam Ram , Tak Vibhor , Sharma Ankur , Garg M K 
Published: November 2023

Abstract

Background
Ceftriaxone+sulbactam+disodium EDTA (CSE) is a novel antibiotic-adjuvant combination, approved by Drug Controller General of India (DCGI) against Extended Spectrum Beta-lactamase (ESBL) producing Gram-negative bacilli. Though randomized controlled trials (RCTs) have been conducted to prove efficacy of this combination against ESBL producers, there are only few in-vitro and retrospective studies supporting its role in treating Metallo-Beta Lactamase (MBL) producers. We conducted this RCT with an aim to find out the efficacy of CSE combination against the cUTI cases caused by MBL producing Enterobacterales.
Analysis of Primary End-points in Modified Intent-to-Treat Population
Table 1

Methods
Adult patients aged ≥18 years meeting the USFDA criteria of cUTI, were randomized 1:1 to receive either intravenous CSE (1000 mg ceftriaxone/500 mg sulbactam/37 mg disodium EDTA) every 12 hours or best alternative treatment (BAT) as per hospital policy (injectable colistin or polymyxin B with or without meropenem or ceftazidime-avibactam with or without aztreonam). Primary objective was to show noninferiority of CSE to BAT at the test-of-cure (TOC) visit by a margin of 10%.

Results
Of 66 randomized patients with cUTI growing MBL producing Enterobacterales in culture, 24 of 33 and 31 of 33 were treated with CSE and BAT, respectively. From outcome analysis, it was observed that the non-inferiority criteria for CSE to BAT was not met at pre-defined primary endpoints.(Table 1)

Conclusion
Our findings do not support the use of CSE as a carbapenem-sparing treatment for cUTI patients caused by MBL producing Enterobacterales.

Disclosures
All Authors: No reported disclosures
388. Evaluating Rates of Co- and Secondary Infections in Pediatric Patients with COVID-19 Infections in Relation to Antibiotic Prescribing: An Observational Study
Authors: Allen Brian S , Firmani Sarah E , Prokesch Bonnie C 
Published: November 2023

Abstract

Background
All ages have been greatly impacted by the Coronavirus disease 2019 (COVID-19) pandemic. While many patients with COVID-19 are prescribed antibiotics, there is often little microbiologic evidence for concurrent or secondary bacterial infection. Such prescribing practices may lead to increased antimicrobial resistance. The purpose of this study is to evaluate the number of microbiologically confirmed bacterial co- and secondary infections in pediatric patients with COVID-19 and characterize associated antimicrobial use at a large academic medical center.

Methods
An observational, retrospective review of pediatric patients ≤ 18 years admitted to Children’s Medical Center Dallas campus with COVID-19 infections from 5/01/2020 to 9/30/2022 was performed. Basic demographic, epidemiologic, laboratory, and microbiologic data was obtained upon admission and each new antibiotic course. Cultures and microbiologic data were reviewed for relevance. Antibiotic use was characterized based on drug selection, indication, and spectrum.

Results
Using the International Classification of diseases, tenth revision (ICD-10) code for COVID-19 pneumonia (U07.1) identified 229 patients, of which 164 met inclusion criteria. Within the included patient population, a total of 22 microbiologically-proven infections were found. Both co- and secondary infections were rare (8/164 (5%) and 8/164 (5%), respectively) and consisted of various organisms from differing sites (9 pulmonary, 9 bloodstream, 4 urinary tract, 1 Clostridiodes difficile infection). The most frequently identified organism was Staphylococcus aureus, followed by Escherichia coli and Pseudomonas aeruginosa. 102/164 (63%) children received antibiotics ≤ 48 hours of admission. There were 43 additional instances where antibiotics were started &gt; 48 hours after admission.

Conclusion
Both co- and secondary bacterial infections are rare in pediatric patients with COVID-19 pneumonia, but many hospitalized patients are given antibiotics. Antibiotics were continued in the absence of microbiologic data potentially increasing antimicrobial resistance. There is clearly a role for antimicrobial stewardship in pediatric patients with COVID-19 pneumonia.

Disclosures
All Authors: No reported disclosures
402. Multidisciplinary Management Model for Multisystem Inflammatory Syndrome in Children: A Comprehensive Approach for Improved Patient Outcomes
Authors: Gillen Sarah , Knutson Stacie , Strutt Jonathan , Fischer Gwenyth , Sharon Bazak , Boucher Alexander A , Steiner Marie E , Binstadt Bryce A , Marmet Jordan , Sadak Kate 
Published: November 2023

Abstract

Background
In the spring 2020, Multisystem Inflammatory Syndrome in Children (MIS-C) emerged as a serious threat to children. As case definitions and guidelines were being developed, pediatricians worldwide faced the challenge of identifying and managing this novel condition. Here, we describe our institution's approach to management of MIS-C and describe the outcomes of our patient cohort.

Methods
At the University of Minnesota, a team of specialists in infectious diseases, cardiology, hematology, rheumatology, intensive care, hospital medicine, emergency medicine, and primary care was formed to address emerging concerns. The group collaborated to draft clinical guidelines that were shared locally with clinics and emergency rooms [Figure 1]. The team established multidisciplinary rounds (“MIS-C calls“) which were held remotely via Zoom to facilitate acute care coordination and long-term management plans to be discussed among primary providers and specialists.
Figure 1

Results
Between May 2020 and January 2022, thirty-five children were admitted to the University of Minnesota Masonic Children’s Hospital and diagnosed with MIS-C [Figure 2]. Complications included myocarditis, coronary aneurysm, coagulopathy, acute kidney injury, and shock. Seventeen children required PICU admission. All patients received standardized and comprehensive care, including MIS-C calls, while hospitalized and coordinated ambulatory care after discharge. There were no deaths or long-term cardiovascular morbidity noted through longitudinal follow-up.
Figure 2
Demographic, clinical presentation, hospital course, and out-patient follow-up for a cohort of 35 children hospitalized with MIS-C at the University of Minnesota Masonic Children’s Hospital, between May 2020 and January 2022.

Conclusion
Our institution's multidisciplinary MIS-C model involved a collaborative effort among specialists from various disciplines. By designing and implementing clinical guidelines that were locally disseminated, and establishing daily multidisciplinary rounds, we were able to effectively identify MIS-C cases across our region and provide effective management at our hospital and clinics. Outcomes were favorable without mortality or significant morbidity as all patients fully recovered without any serious long-term sequelae. These findings highlight the importance of a multidisciplinary, comprehensive, and coordinated approach that is well communicated throughout clinical settings, in managing rapidly emerging medical crises.

Disclosures
Gwenyth Fischer, MD, Abiomed: Advisor/Consultant Alexander A. Boucher, MD, CSL Behring: Grant/Research Support Marie E. Steiner, MD, Medtronic: Teaching|Octapharma: Advisor/Consultant Bryce A. Binstadt, MD, PhD, Sobi: Grant/Research Support