bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1773. Impact of a Pharmacist-driven Antipseudomonal Antibiotic Time-out
Authors: Diaz Carina , Landayan Alice Margulis , Porras Lorenzo , Samsundar Sonia , Murillo Jorge , Gauthier Timothy 
Published: January 2025

Abstract

Background
Antipseudomonal antibiotics are key weapons in the fight against antimicrobial resistance but misuse can contribute to numerous adverse effects. It is imperative to identify opportunities to further implement strategies for sustained improvement in antipseudomonal antibiotic utilization. The purpose of this quality improvement project was to evaluate the impact of a pharmacist-driven antipseudomonal antibiotic time-out.

Methods
This was a single-center retrospective evaluation of adults that received piperacillin/tazobactam, cefepime, aztreonam, ciprofloxacin, or levofloxacin while hospitalized. Patients were excluded if pregnant, incarcerated, taking chronic suppressive or prophylactic antimicrobial therapy, receiving hospice care, or on comfort measures only. The primary outcome was the proportion of target antipseudomonal versus all other systemic antibiotic days of therapy adjusted to days present in evaluated units January through February 2023 (pre-implementation) versus January through February 2024 (post-implementation). Qualitative secondary outcomes evaluated for the post-implementation group included pharmacist antibiotic intervention detail, intervention acceptance rate, antipseudomonal agent duration of therapy, incidence of Clostridioides difficile infection, and length of hospital stay. The project was Institutional Review Board approved.

Results
The proportion of target antipseudomonal versus all other systemic antibiotic days of therapy adjusted to days present was 234/898 (26%) for the pre-implementation group versus 210/1321 (16%) for the post-implementation group (p &lt; 0.001). Demographics are listed in table 1. In the post-period 537 patients were reviewed, with 200 patients intervened on and a total of 255 interventions performed with a 99% acceptance rate. The most common types of interventions were antimicrobial de-escalation, order stop date modification, and antimicrobial discontinuation. Pharmacist intervention details are shown in table 2. Other secondary outcomes are displayed in table 3.

Conclusion
Implementation of a pharmacist-driven antibiotic timeout can drive meaningful reductions in antipseudomonal antibiotic use with high provider acceptance rates without unfavorable clinical outcomes.

Disclosures
Jorge Murillo, MD, Paratek Pharma: Advisor/Consultant Timothy Gauthier, PharmD, BCPS, BCIDP, AbbVie Pharma: Advisor/Consultant|Antimicrobial Therapy, Inc: Advisor/Consultant|Ferring Pharma: Advisor/Consultant|Firstline Mobile Health: Advisor/Consultant|Gilead Pharma: Advisor/Consultant|GoodRx: Advisor/Consultant|GSK Pharma: Advisor/Consultant|Melinta Pharma: Advisor/Consultant|Pattern Biosciences: Advisor/Consultant|Pfizer Pharma: Advisor/Consultant|ProCE: Honoraria|WWW.LearnAntibiotics.com: Ownership Interest
P-1775. Impact of a Stewardship Intervention Targeting Prolonged Antibiotic Use ( &gt;15 Days) on Antibiotic Utilization, Resistance Patterns, and Costs
Authors: Heo Eunjeong , Lee Yeonju , Kim Hyung-Sook , Lee Ju-Yeun , Choi Seong Jin , Moon Song Mi , Kim Hong Bin , Kim Eu Suk , Song Kyoung-Ho 
Published: January 2025

Abstract

Background
Inappropriate antibiotic use, particularly prolonged courses, is a significant driver of antibiotic resistance. This study aimed to evaluate the impact of a targeted antimicrobial stewardship program (ASP) intervention on antibiotic utilization, resistance, and costs in patients receiving antibiotics for more than 15 days.
Monthly changes in DOT per 1000 patient-days over the span of 5 years

Methods
We employed an intervention targeted adult inpatients receiving antibiotics for more than 15 days since August 2018. An ASP team of pharmacists and infectious disease physicians implemented interventions through direct communication via messengers, visits, and EHR records. The intensive intervention period lasted seven months (August 2018 - February 2019) and continued alongside other stewardship activities afterward. We assessed the changes in antibiotic utilization (days of therapy per 1000 patient-days; DOT, length of therapy per 100 discharges; LOT), length of stay (LOS), resistance rate, and antibiotic costs before (January 2016 - July 2018) and after (August 2018 - January 2020) the intervention, using Interrupted time series analysis, retrospectively.

Results
A total of 193,492 patients were admitted and 587 interventions were conducted over the study period. The intervention resulted in a sustained decrease in DOT (-3.02 DOT; 95% CI: -3.71 to -2.33) and LOT (-1.32 LOT; -1.72 to -0.92). Additionally, a significant reduction was observed in the use of broad-spectrum antibiotics, including third-generation cephalosporins (-0.74 DOT; -1.1 to -0.38) and carbapenems (-0.48 DOT; -0.63 to -0.33). Furthermore, the significant upward trend (0.3% per month; 0.2 to 0.4) in the resistance rate of E. coli and Klebsiella to third-generation cephalosporins waned (-0.03% per month; 0 to -0.03). Finally, antibiotic costs decreased by $695.9 per 1000 admissions (-889.1 to -502.7). However, no significant change in LOS was associated with the intervention.

Conclusion
This study demonstrates that an ASP intervention focusing on optimizing antibiotic duration can effectively reduce the utilization of broad-spectrum antibiotics, the burden of resistance, and antibiotic costs in a hospital setting.

Disclosures
All Authors: No reported disclosures
P-1776. Impact of Sepsis Recognition Tools and Pharmacy Workflow on Sepsis Management and Outcomes
Authors: Abdelmahab Salma , Dubrovskaya Yanina , Marsh Kassandra , Merchan Cristian , Siegfried Justin , Papadopoulos John , Smalley Samantha 
Published: January 2025

Abstract

Background
CDC 2023 Hospital Sepsis Program Core Elements prioritizes protocolized care, timely and effective antibiotics and de-escalation. At NYULH, robust sepsis tools integrated into Epic since July 2021 include the Sepsis Indicator Column on the Emergency Department (ED) Track Board for patient identification, nurse and physician-driven Best Practice Advisory (BPA), ED Sepsis Quick List for antimicrobial orders, and Sepsis Guidelines. Sepsis antibiotics in the ED are administered as IV push over 3 minutes followed by IV piggyback since March 2021.

Methods
We conducted a retrospective review of adult patients with community-onset sepsis and confirmed bacteremia who presented to ED between 9/2022 and 5/2023. The primary outcomes were time to antibiotics and the percent of patients with ineffective empiric antibiotics. Secondary outcomes included time to de-escalation and sepsis outcomes. As a process measure, we evaluated sepsis guidelines adherence and pharmacy interventions.

Results
During 9/2022 to 8/2023, 1682 ED sepsis cases were recorded, and 22% had bacteremia. Among 109 included patients, median Charlson Comorbidity Index was 6 (IQR 3-8) and Pitt bacteremia score 0 (IQR 0-1). Median time from ED sepsis recognition to antibiotic verification by pharmacy was 9 min (IQR 0-27) with median time to antibiotic administration of 29 min (IQR 15-50). Ineffective initial therapy occurred in 11% of cases with median time to effective antibiotics at 24 h. De-escalation was seen in 84% of cases with median time of 2 days for both MRSA and atypical coverage discontinuation and 4 days for Pseudomonas coverage. Initial therapy adhered to guidelines in 70.6% of cases, and deviation primarily occurred due to the administration of vancomycin in the absence of MRSA risk factors. Antibiotic-related pharmacy and stewardship (ASP) recommendations were made in 40% of patients while in ED and 96% of patients during hospital stay. In-hospital mortality, ICU admission, 30-day infection related re-admission and C. difficile infection within 6 months were 8.3%, 42.2%, 8.3% and 1.8%, respectively.

Conclusion
The integration of Epic sepsis recognition tools with ASP and pharmacy workflows led to high rates of timely and effective antibiotic administration in the ED and de-escalation during hospitalization.

Disclosures
All Authors: No reported disclosures
P-1778. Factors Underlying Infection-Related Mortality: Learnings from an Academic Institution with Antimicrobial Stewardship Practices
Authors: Issac Aleena , Sreeraj V , Puthoor Deljo , Adarsh A K , Sabu Tabitha Merium , Prathibha V K , Geethalakshmi V , Thomas Maridas Tom , Joseph Thomas , Mohan Gopika P , Johnson Mariya , Thomas Alga P , Santhosh Sneha , Lubaina P R 
Published: January 2025

Abstract

Background
Limited research has explored the efficacy of Antimicrobial Stewardship (AMS) interventions in reducing Infection-Related Mortality (IRM). This study aims to evaluate the impact of AMS practices on IRM and its associated factors.

Methods
A retrospective case-cohort study was conducted on inpatients who expired during hospitalization between May 1, 2022, and April 30, 2023, in a tertiary hospital. The case group comprised patients with infection-related mortalities, defined as deaths caused by any potential life-threatening infection, such as sepsis, pneumonia, infective endocarditis, peritonitis, encephalitis, abscesses, meningitis, empyema, pyelonephritis, and cholecystitis. Patients who expired without such infections constituted the control group. The primary exposure variable was adherence to AMS practices during the hospital stay. A Binomial Logistic Regression model was employed to identify risk factors (e.g., age, sex, recent multi-drug-resistant organism culture positivity) for infection-related mortality in both AMS-adherent and non-adherent groups.

Results
Among the 1225 total mortalities, 41.3% (=506) represents the case group. It was found that only recent multi-drug resistant organism culture positivity has a significant association with AMS adherence (odds ratio =0.328 & p =0.003). The statistical modeling of both groups depicted in figure 1&2.

Conclusion
Despite adherence to AMS practices, the presence of multi-drug-resistant organism culture positivity predisposes individuals to infection-related mortality.

Disclosures
All Authors: No reported disclosures
P-1780. Compliance Assessment of Antimicrobial Stewardship Program Activities within a Long Term Acute Care (LTAC) System
Authors: Hobbs Athena L V , VanCura Jennifer , Shea Katherine M 
Published: January 2025

Abstract

Background
Long Term Acute Care (LTAC) hospitals encounter a unique challenge in that despite fewer resources, they are required to comply with CMS and TJC antibiotic stewardship programs (ASPs) Conditions of Participation for hospitals. In June 2023, completion of an antimicrobial stewardship gap analysis survey was required throughout a national LTAC system to assess compliance and identify areas for improvement.

Methods
This was a 173 question, multi-site survey consisting of four phases with questions about implementation of progressively more difficult ASP interventions; regulatory (n=55 questions), basic (n=45 questions), intermediate (n=41 questions), and advanced (n=32 questions) interventions. Compliance was defined as a “yes” or a “not-applicable” response. A chi-square test was used to assess responses between different phases and average monthly acute patient days (APD).

Results
All 26 LTAC hospitals in the system completed the survey. The average compliance within all hospitals was 84% for phase one, 86% for phase two, 73% for phase three, and 62% for phase four. There was a significant difference in compliance between the phases (p&lt; 0.0001) and based on APD per facility (Table 1, p&lt; 0.0001). When assessing compliance with individual questions, a total of 13 questions (7.5%) had low compliance (less than 50%), which were flagged as particular areas for opportunity. Low compliance questions were grouped based on CDC Core Elements, six of which pertained to Action, three to Tracking, two to Education, and one each to Reporting and Hospital Leadership Commitment. As expected, the majority (n=8) of low compliance questions were in phase four.

Conclusion
This standardized survey was used as a tool to ensure regulatory compliance and identify additional opportunities for ASP advancement in a system of LTACs. Overall, we report high rates of compliance, especially in the regulatory phase 1, likely due to support from a System ASP and dedicated ID pharmacist. Our evaluation suggests that smaller or less busy facilities with fewer average monthly APDs may have more resources to ensure compliance with ASP initiatives. It is important to recognize that some phase 4 advanced ASP interventions may not be feasible in the LTAC setting.

Disclosures
Katherine M. Shea, PharmD, BCIDP, T2 Biosystems: Advisor/Consultant
P-1782. Antimicrobial Stewardship Program Resourcing across Hospitals over Time: A Repeated Cross-Sectional Study
Authors: Leung Valerie , Thomas Sera , Brown Kevin , Daneman Nick , Schwartz Kevin , Langford Bradley J 
Published: January 2025

Abstract

Background
Antimicrobial stewardship programs (ASP) are a crucial component of an overarching One Health approach to mitigate antimicrobial resistance (AMR). Adequate resourcing is a predictor of success for hospital ASPs. To understand the progress of hospital ASPs, we conducted periodic surveys tracking the level of resourcing over time.

Methods
Public Health Ontario’s Hospital ASP Landscape survey is conducted every 2-3 years, beginning in 2016 and most recently in 2023. This online survey is disseminated using a targeted distribution list to reach antimicrobial stewardship practitioners in acute care and complex continuing care & rehabilitation hospitals. Descriptive analysis was performed at an aggregate level and by hospital type. Full-time equivalent (FTE) staffing ratios were compared to Association of Medical Microbiology and Infectious Disease (AMMI) Canada recommendations for 2021 & 2023.

Results
In 2023, the survey response rate was 70% (90/129) of hospitals with 98% reporting the presence of a formal ASP. Response rate of previous surveys ranged from 55-78%. In 2023, the proportion of organizations reporting any designated resources to support their program was 60%; this was 50% in 2016, 57% in 2018 and 53% in 2021. The proportion of hospitals meeting the AMMI resourcing recommendations for physician and pharmacist FTE in 2023 was 10% and 21% compared with 7% and 13% in 2021. For teaching hospitals, the average physician FTE/100 beds was 0.045 in 2023 and 0.044 in 2021; the average pharmacist FTE/100 beds was 0.183 in 2023 and 0.173 in 2021. For large & medium hospitals, average physician FTE/100 beds was 0.049 in 2023 and 0.046 in 2021; the average pharmacist FTE/100 beds was 0.261 in 2023 and 0.210 in 2021. For small & rehabilitation hospitals, the average physician FTE was 0.009 in 2023 and 0.024 in 2021; the average pharmacist FTE was 0.113 in 2023 and 0.071 in 2021. (Table 1)

Conclusion
The proportion of hospitals reporting any designated resources to support their ASP is relatively unchanged since 2016. Resource allocation continues to be below national recommendations for physician and pharmacist FTEs, especially for smaller institutions.

Disclosures
All Authors: No reported disclosures
P-1803. Why We Do What We Do: A Survey of ID Providers About Oral Antibiotics
Authors: Witt Lucy S , Suchindran Sujit , Winkler Marisa 
Published: January 2025

Abstract

Background
Multiple studies have shown the efficacy of oral antibiotics for serious infections. Despite this, many infectious disease (ID) providers continue to solely use intravenous (IV) antibiotics. To understand current practices among ID providers in our healthcare system, we conducted a survey to observe practice patterns, comfort level, and beliefs around oral antibiotics.Table 1.Respondent Demographics and Responses

Methods
Our survey was distributed via email to 137 local ID providers at nine hospitals. The survey included questions about demographics, practice characteristics, and comfort with as well as barriers to prescribing oral antibiotics. Also included were five clinical cases for which respondents were asked to choose definitive therapy from a selection of IV and oral options. Based on responses, providers were classified as either high- or low-oral antibiotic prescribers (HOAP or LOAP). Categorical variables were analyzed using chi-square or Fischer’s exact test as appropriate.Table 2.Respondent Answers to Clinical Cases

Results
A total of 60 clinicians (44%) completed our survey. 87% were academic affiliated (52/60), while 13.3% (8/60) identified as private practice (Table 1). Half of respondents were categorized as LOAP. All respondents chose an oral step-down therapy for a case of E. coli bacteremia, while only one provider chose an oral option for step-down therapy for left-sided native valve endocarditis caused by E. faecalis (Table 2). 73.3% of HOAP chose oral antibiotics as definitive therapy for the case of an uncomplicated MSSA central line associated bloodstream infection compared to no LOAP (Table 2). The only statistically significant predictor of LOAP was type of practice; with all private practice providers classified as LOAP. HOAP were more likely to cite supervisor concerns with oral antibiotics as a barrier to prescribing oral antibiotics. Interestingly, similar numbers of HOAP and LOAP expressed they had no concerns about prescribing oral antibiotics.

Conclusion
In this survey of ID providers regarding oral antibiotics, most demographics did not predict HOAP or LOAP. Certain clinical scenarios, such as Gram-negative bacteremia, led to oral antibiotic use in both LOAP and HOAP. This information can be used by stewardship programs to target interventions to encourage oral antibiotic step-down therapy in LOAP.

Disclosures
Marisa Winkler, MD, PhD, Element Iowa City (JMI Laboratories) was contracted to perform services in 2023 for &gt; 30 biotech and pharmaceutical companies: Grant/Research Support
P-1821. Patient-Derived Airway Organoids for Modelling and Modulating Rhinovirus infection
Authors: Merenda Alessandra , Ehsani Nilofar , Gkogkou Foteini , Pott Johanna , Bezhaeva Taya , Vries Robert G J , Boj Sylvia F 
Published: January 2025

Abstract

Background
HUB’s patient-derived organoids (PDOs) are unique in vitro 3D models derived from adult stem cells that closely resemble the architecture and physiology of the tissue of origin. PDOs established from the airway epithelium are instrumental in investigating the pathogenesis of respiratory infections as well as testing strategies to counter such diseases. Because in vivo pathogens attack the luminal surface of the epithelium, HUB has established monolayers from airway PDOs, where the luminal side is accessible for mimicking host-pathogen interactions.
Viruses such as Rhinovirus type 16 (RV16) are among the most common respiratory pathogens affecting the airway tract. As an entry receptor, RV16 recognises the intercellular adhesion molecule-1 (ICAM-1) on the surface of epithelial cells, making it an attractive target for inhibiting RV16 infection.

Methods
In this study we conducted experiments to assess the effect of an anti-ICAM-1 monoclonal antibody (mAb) on RV-16 infection. PDO-derived monolayers were pre-treated with different mAb concentrations before infection with RV16. Transepithelial electrical resistance (TEER) and monolayer integrity were monitored daily, and the viral titre was quantified at different time points post-infection (PI) by calculating the 50% tissue culture infectious dose (TCID50). Production of IP-10, an inflammatory cytokine released by the epithelium in response to infections, was also measured at 48 h PI.

Results
Our data showed that viral titre increased over time when no pre-treatment was applied, indicating that RV16 could propagate in airway PDO monolayers. A significant decrease in viral titre was observed in monolayers treated with the highest ICAM-1 mAb doses. Such an inhibitory effect on viral titre was accompanied by a total suppression of IP-10 release upon mAb treatment, suggesting a potential role for ICAM-1 inhibition in immune response modulation during RV16 infections.

Conclusion
Overall, this study not only revealed the value of PDO-derived monolayers as a platform for gaining insights into viral infection mechanisms but also demonstrated the potential of preclinically testing novel antiviral strategies. This findings have significant implications for the development of effective treatments for respiratory infections.

Disclosures
All Authors: No reported disclosures
636. Pneumocystis Pneumonia Outcomes in Solid Organ Transplant Recipients and Patients Living with HIV: A Population-Based Study Over 20 Years (2002-2022) in Ontario, Canada
Authors: Lo Carson , Fridman Daniel , Kwong Jeffrey , Hosseini-Moghaddam Seyed M 
Published: January 2025

Abstract

Background
While it is well established that HIV-positive and non-HIV immunocompromised patients are susceptible to Pneumocystis pneumonia (PCP), comparing PCP outcomes between patients with different underlying immunocompromising conditions is critically important to optimize chemoprophylaxis strategies.

Methods
In this population-based cohort, we determined contributing factors to 90-day all-cause mortality following PCP diagnosis among patients living with HIV (PLWH) and solid organ transplant recipients (SOTRs) hospitalized in Ontario, Canada between Apr/1/2002 and Dec/31/2022. We linked data from provincial health administrative databases using unique encoded identifiers and included all adult patients hospitalized with PCP based on diagnostic codes from hospital discharge abstracts. We used logistic regression models to estimate unadjusted and adjusted odds ratios (uOR and aOR) and 95% confidence intervals (95%CI) for the associations between underlying immunocompromising conditions and PCP outcomes.

Results
A total of 879 patients were hospitalized with PCP, including 121 SOTRs (13.7%) and 758 PLWH (86.2%). 90-day mortality rates were 19.8% in SOTRs and 13.2% in PLWH. In the unadjusted model, 90-day mortality was not significantly associated with organ transplantation (OR=1.58; 95%CI, 0.96-2.62) or HIV infection (OR=0.62; 95%CI, 0.38-1.03). Comparing HIV patients to liver SOTRs, liver SOTRs experienced higher mortality (uOR=8.54, 95%CI=3.11-23.46). In the adjusted model, liver transplantation was associated with an increased risk of 90-day mortality (aOR=4.36; 95%CI, 1.40-13.59). Among SOTRs, in the unadjusted analysis, liver transplant recipients had an increased risk of 90-day mortality (uOR=9.18; 95%CI, 3.00-28.09).

Conclusion
Among SOTRs, liver transplant recipients are at particularly higher risk of mortality following PCP diagnosis. Our findings may prompt a re-evaluation of current PCP prophylactic strategies in liver transplant patients.

Disclosures
All Authors: No reported disclosures