bluuebunny/crossref_metadata_2025_split huggingface dataset:
1268. A retrospective observational study to evaluate the efficacy of antimicrobial time-out for optimizing the duration of antimicrobial administration in emergency abdominal surgery patients
Authors: Suenaga Takahiro , Hata Hiroaki 
Published: November 2023

Abstract

Background
Appropriate use of antibiotics is important for the prevention of antimicrobial-resistant organisms. However, prolonged administration of broad-spectrum antimicrobial agents is frequently used in surgery, especially in emergency surgery with infection. The low rate of the appropriate use of antimicrobial agents is regarded as a worldwide problem. In order to promote the proper use of antimicrobials, our department has administered daily antimicrobial time-outs to surgical patients as part of the Antimicrobial Stewardship Program since January 2018. This study investigates whether the Antimicrobial Time-out has led to appropriate use of antibiotics.

Methods
Patients aged 18 years and older who underwent emergency abdominal surgery in our department from May 2017 to August 2018 were included. Pre- and postoperative clinical information was extracted from the medical records.

Results
56 and 66 patients were treated before and after the introduction of antimicrobial time-out, respectively. The mean duration of antimicrobial use was 3.8 and 3.3 days before and after the introduction of antibiotic time-out. No significant difference was observed, but a 13.7% decrease was observed (P=0.51). Limiting the analysis to patients who received a minimum of two days of antimicrobial therapy, treated patients were 23 and 27, and the mean duration of antimicrobial use was 7.8 and 6.6 days(P=0.38) before and after the introduction of antibiotic time-out, respectively.
There were also no significant differences in the incidence of complications (Clavien-Dindo classification Grade II or higher) (28.6% vs. 25.8%, P=0.73) or length of hospital stay (17.2 vs. 14.0 days, P=0.38).

Conclusion
Antibiotic time-out in surgical practice may contribute to a reduction in antimicrobial use without increasing complication rates or length of hospital stay.

Disclosures
All Authors: No reported disclosures
1273. Use of an algorithm-based electronic application in the management of penicillin allergies
Authors: Vijayaraghavan Nimal , Otome Ohide 
Published: November 2023

Abstract

Background
Penicillin allergy "de-labelling" has shown to improve antibiotic stewardship. Knowledge gaps of antibiotic allergies amongst healthcare workers are well known. We attempt to evaluate the use of an algorithm-based electronic application as a point of care (POC) decision making tool in penicillin allergy management.

Methods
A 4 week prospective, randomized case-control study was conducted on healthcare workers in a tertiary care centre. Local general practitioners were included. Participants were randomized to the control and experimental arms. Both were required to complete a set of 8 case-based questions specific to penicillin reactions. The former was given access to an electronic application, while the latter were permitted to use alternative educational tools. Time of completion in one sitting and total number of correct answers of both groups were obtained and compared. The experimental arm's overall impressions of the electronic algorithm were defined by completion of an optional satisfaction survey. The assessment tools were created using REDcap software.
Algorithm-based electronic application
The algorithm-based electronic application was made available to the experimental arm to aid in completion of the questionnaire.
Case-based questionnaire
All candidates in the study were required to complete an assessment composed of 8 scenario-based questions (16 questions total) to evaluate the clinical understanding of antibiotic allergies.

Results
Only 68 out of 347 eligible healthcare workers responded to the invite to the study and questionnaire. From the selected group, 31 and 37 participants were randomized to the control and experimental arms respectively. Majority of participants were hospital-based practitioners (85%). A higher completion rate of the questionnaire was observed in the experimental group (73% vs 65%). The experimental arm completed 86% of the total allocated questions (516 out of 592) compared to 78% (386 out of 496) in the control (p&lt; 0.001). Further observation revealed that the experimental group achieved correct answers in 69% (351) of the total attempted questions in contrast to 59% (228) correct answers in the control (p&lt; 0.01). No statistically significant difference in mean times of completion were observed between the groups (p = 0.25). With regards to the survey, 96% found the electronic application useful, 84% would strongly recommend it to their peers, 88% would like to have access to it to support them in their POC decisions.

Conclusion
In this study, we demonstrate that an electronic POC allergy delabelling application may have the potential to support clinicians in the management of patients reporting penicillin allergy.

Disclosures
All Authors: No reported disclosures
1275. Impact of a bundled antimicrobial stewardship intervention leveraging frontline pharmacist response to rapid blood culture diagnostics at an academic medical center and community hospital
Authors: Bajer Kevin , Bertram Christie M , Weslander Erin , Qi Chao , Moore William J , Polisetty Radhika S , Postelnick Mike , Zembower Teresa , Wronkiewicz Stephanie , Rhodes Nathaniel J , Kling Kendall , Sutton Sarah 
Published: November 2023

Abstract

Background
Rapid Blood Culture Identification (BCID) panels have been shown to improve patient outcomes, including mortality and length of stay, when paired with antimicrobial stewardship (ASP) intervention. We report the results of a quality improvement initiative to expand to 24/7 pharmacist response to BCID results in a large academic medical center and a community hospital within the same health system.

Methods
A pre/post review was performed following a bundled stewardship intervention. Prior to the intervention, BCID results were addressed by the antimicrobial stewardship team Monday through Friday between 8am and 4pm. The bundled ASP intervention consisted of standardized treatment guidance, clinical education on result interpretation, frontline pharmacist evaluation of BCID results during off-peak hours to provide 24/7 response, and electronic health record documentation at each site. Clinical and microbiological data were collected for all patients. The primary outcome was time to optimal therapy (TTOT) for patients with a positive BCID within the first 72 hours of hospital admission. The secondary outcome assessed observed to expected length of stay (O/E LOS) ratios based on Vizient® Clinical Database estimates. The pre-intervention period included patients with a positive BCID between 1/1/2021 and 10/14/2022. The post-intervention period included patients with a positive BCID between 1/3/2023 and 3/31/2023.

Results
Clinical data and outcomes are reported in Table 1. During the first three months following ASP intervention, TTOT decreased at the academic medical center (15.0 to 6.4 hours) but did not change at the community hospital (25.9 to 25.1 hours). The O/E LOS ratio decreased for the academic medical center from 0.92 to 0.78 while the O/E LOS remained similar (0.85 to 0.83) for the community hospital.

Conclusion
A bundled ASP intervention utilizing frontline, non-ASP pharmacist review and prescriber outreach of BCID results quickly adopted. The intervention demonstrated benefit in the academic medical center, including quicker time to appropriate therapy and reduced length of hospitalization. Additional interventions may be needed for community sites depending on existing resources, staffing models and pharmacist/physician experience.

Disclosures
Nathaniel J. Rhodes, PharmD MS, Third Pole Therapeutics: Advisor/Consultant
1279. Vertebral Osteomyelitis due to Serratia spp: A Rare Entity Emerges as an Infection Linked to Injection Drug Use
Authors: Castillo Briana , Madeline McCrary L , Schranz Asher J 
Published: November 2023

Abstract

Background
Serratia spp. are environmental gram-negative bacilli known to cause invasive infection in the setting of injection drug use (IDU), but uncommonly associated with orthopedic infections. In recent years, in the setting of rising IDU, there have been mounting reports of bacteremia and endocarditis due to Serratia spp. Vertebral osteomyelitis (VO), another condition associated with IDU, has rarely been reported due to Serratia spp, with the largest published series reporting three cases. Given the rise of invasive Serratia infections and IDU, we characterized experience caring for VO due to Serratia spp. (S-VO).

Methods
This was a retrospective review of adults with S-VO admitted to UNC Health, a hospital network in North Carolina, from 4/2014 to 6/2022. We utilized EMERSE, a program that searches free text in the electronic medical record, to identify charts with the terms ‘Serratia’ and ‘vertebral osteomyelitis.’ We identified 31 patients and included 10 in the final analysis (Fig 1). Chart review was performed to confirm the presence of S-VO and to obtain demographic and clinical data.
Figure 1

Results
Cases overall increased over time; there were 0-1 per year until 6/2019, but 2 per year since (Fig 2). The median age was 45 years and 90% were White (Table 1). IDU was the main risk factor (8 of the 9 with risk factor information). There was a predilection for the thoracic spine (70%) and 50% were associated with epidural or paravertebral abscess. Although half had concomitant bacteremia, only one had concurrent endocarditis. The predominant species was S. marcescens (8 of the 9 with species-level identification), and the majority were monomicrobial. Most received ceftriaxone or fluoroquinolone monotherapy, and 30% underwent surgical management (Table 2). There were two confirmed failures or relapses and one death at 90 days after discharge.
Figure 2

Conclusion
Although considered a rare entity, we identified ten cases of vertebral osteomyelitis due to Serratia spp. within one health system over eight years. S-VO was largely linked with IDU, typically occurred in the absence of endocarditis and was frequently managed with a third-generation cephalosporin or fluoroquinolone. Further multicenter data is needed to define trends and elucidate management strategies for orthopedic infections due to Serratia spp.

Disclosures
Asher J. Schranz, MD, MPH, WoltersKluwer: Honoraria
1280. Retrospective Chart Review of Diabetic Foot Infection Microbiologic Data at UnityPoint Health Des Moines
Authors: Clouse Alexis , Blackmer Sydney , Holte Nathaniel , Olstinke Kayla , Passet Alivia , Bushman Amanda , Best Leyla Alexandra 
Published: November 2023

Abstract

Background
Foot infections are a common and serious complication in people with diabetes. Pseudomonas aeruginosa has traditionally been considered a common pathogen in diabetic foot infections (DFI). However, newer data has not found this to be true in clinical practice. In addition, the 2012 Infectious Diseases Society of America guideline for DFI states that “empiric therapy directed at Pseudomonas aeruginosa is usually unnecessary except for patients with risk factors for true infection with this organism”.

Methods
This study is a retrospective chart review of patients presenting with diabetic foot infections at regional teaching hospitals in the Midwest between August 1, 2021 and August 1, 2022. All the patients had either a bone, tissue, or wound culture obtained by podiatric medicine. Descriptive statistics were used to determine relationships between variables and the frequency of P. aeruginosa in culture. The primary objectives of this study were to quantify the prevalence of and determine predictors of pseudomonas DFI.

Results
There were 460 cultures reviewed in the specified time period with 168 cultures meeting criteria for inclusion in the final review. The most commonly isolated organisms were streptococci (29.8%) and methicillin-susceptible Staphylococcus aureus (26.2%). Pseudomonas was isolated in 21 of the 168 cultures reviewed (12.5%), with 17 of them being from non-bone cultures and 3 from bone cultures. The risk for pseudomonas appeared to increase with recurrent or relapsed diabetic foot infections (90.5%), having a previously isolated gram-negative pathogen in the last year (38%), and having a known pseudomonas colonization within one year (33.3%).

Conclusion
Streptococcus and Staphylococcus remain the most common organisms in DFI. Pseudomonas is a less common organism in DFIs; however, our study suggests rates of PSAR may be higher than previous studies have discovered. Risk factors for pseudomonas in our study appear to be recurrent or relapsed diabetic foot infections, having a previously isolated gram-negative pathogen in the last year, and having a known pseudomonas colonization within one year. Though some individualized risk factors can be useful, local epidemiology and resistance patterns remain essential for antibiotic treatment considerations.

Disclosures
All Authors: No reported disclosures
1281. Ongoing Transmission of Clonal Strains of Invasive Nontypeable Haemophilus influenzae Disproportionately Affecting Persons with HIV in Metropolitan Atlanta, 2019—2022
Authors: Collins Lauren F , Sefton Samantha , Thomas Stepy , Tunali Amy , Bombin Andrei , Read Timothy D , Satola Sarah W , Farley Monica M 
Published: November 2023

Abstract

Background
Nontypeable Haemophilus influenzae (NTHi) is a genetically diverse pathogen that typically causes mucosal infections or invasive NTHi (iNTHi) disease in persons at the extremes of age. In 2017-2018, we reported a significant increase in incident iNTHi in Atlanta among virally-suppressed persons with HIV (PWH) and identified two clonal strains associated with septic arthritis/polyarthritis among Black men who have sex with men.

Methods
Surveillance data from the CDC-funded Georgia Emerging Infections Program was used to assess interim iNTHi epidemiology in adults ≥ 18 years old in metropolitan Atlanta, including the potential for continued transmission of clonal strains in adults 18-55 years old. Overall incidence of iNTHi and by HIV status from 2019-2022 was determined and compared with prior years; and demographic and clinical data were collected. Whole genome sequencing assessed genetic relatedness of isolates, which were categorized as belonging to cluster 1 or 2 (C1, C2) or non-clustered (NC).

Results
From 2019-2022 in Atlanta, there were 157 iNTHi cases in adults ≥ 18 years old (median age 56 [Q1-Q3 36-72] years, 59% male, 44% Black), including 29 in PWH. The iNTHi incidence among PWH in 2019-2022 was lower than in 2017-2018 (18.8 vs 41.7 cases per 100,000, respectively, p&lt; 0.01), and higher than in 2008-2016 (9.6 per 100,000; p&lt; 0.01) (Figure). Among iNTHi cases 18-55 years old (2019-2022), 94/95 had isolates available for cluster analysis: 7/94 (7%) and 18/94 (19%) were identified as C1 and C2, respectively. Characteristics of cases differed by clonal status (Table 1): among C1, C2, and NC cases, 6/7 (86%), 7/18 (39%), and 15/69 (22%) involved PWH, respectively; and septic arthritis was present in 1/7 (14%), 8/18 (44%), and zero, respectively. Table 2 provides detailed data on PWH with clonal strains.

Conclusion
Ongoing transmission of two clonal NTHi strains that are associated with a relatively high prevalence of joint involvement in invasive disease and disproportionately affect Black men and PWH was noted in Atlanta. The C2 clonal strain became more prevalent in 2022. Additional studies are needed to better understand modes of transmission, geographic distribution of clones, and to explore the unusual clinical manifestations to optimize prevention and treatment measures.

Disclosures
Lauren F. Collins, MD, MSc, Curio Science: Honoraria
1304. Early Surgical Procedures and Clinical Outcomes Among Children Hospitalized with Acute Hematogenous Osteomyelitis
Authors: Searns Justin B , Hall Matt , Birkholz Meghan C , Hubbell Brittany , Kern-Goldberger Andrew S , Kronman Matthew , Markham Jessica , Rolsma Stephanie L , Shah Samir S , Wang Marie E , O’Leary Sean , Dominguez Samuel R , Parker Sarah K 
Published: November 2023

Abstract

Background
Surgical biopsy and drainage may have diagnostic and therapeutic benefits for children with acute hematogenous osteomyelitis (AHO). However, it remains unknown whether routinely expediting surgical procedures improves clinical outcomes compared to a “wait-and-see” approach. We aimed to determine whether hospitals that frequently perform early surgery for AHO have improved clinical outcomes compared to hospitals that rarely perform early surgery.

Methods
Admissions for AHO at 48 hospitals were identified in the Pediatric Health Information System from 1/2015 through 10/2022 for patients 6 months to 18 years with a discharge diagnosis of osteomyelitis using a previously validated algorithm to exclude chronic osteomyelitis, non-hematogenous infections, and significant comorbidities. Encounters assigned a surgical procedure code on hospital day 0 or 1 were classified as undergoing “early surgery” and hospitals were stratified based on proportion of AHO patients receiving early surgery. Clinical outcomes at the 16 hospitals with the lowest rates of early surgery (rare group) were compared to those from the 16 hospitals with the highest rates of early surgery (frequent group). Categorical variables were compared using chi-square tests and continuous with Wilcoxon Rank-Sum tests.

Results
There were 2102 encounters in the rare group and 2040 encounters in the frequent group. Median proportion of AHO patients undergoing early surgery was 20% in the rare group compared to 37% in the frequent group (Range 10% to 54%). Length of stay in the frequent group was marginally lower (4.4 vs 4.1 days, P &lt; 0.001), as was length of intravenous antimicrobials (4.5 vs 4.3 days, P&lt; 0.001). Patients were more likely to be critically ill at frequent early surgery hospitals (1% vs 5%, P&lt; 0.001), more likely to have a central line placed (8% vs 11%, P=0.002), and more likely to have a pathogen identified (50% vs 59%, P&lt; 0.001). Cost per admission was slightly higher in the frequent group ($12960 vs $13759, P&lt; 0.001).

Conclusion
Frequency of early surgical procedures for pediatric AHO varies across institutions. Clinical outcomes and resource utilization for children with AHO are similar between institutions that rarely and frequently expedite surgical procedures.

Disclosures
Samuel R. Dominguez, MD, PhD, Biofire Diagnostics: Advisor/Consultant|Biofire Diagnostics: Grant/Research Support|Cobio Diagnostics: Board Member|Karius: Advisor/Consultant|Pfizer: Grant/Research Support
1314. Missed Opportunities for Early Treatment and Prevention of Community Acquired Bacterial Meningitis
Authors: Beard Glenn H , Hasbun Rodrigo 
Published: November 2023

Abstract

Background
Community acquired bacterial meningitis (CABM) is a life-threating infection with high rates of mortality and chronic neurological sequela. These rates increase significantly if antibiotic and steroid therapies are delayed. As such, taking every opportunity to quickly diagnosis and rapidly treat CABM is paramount to improving patient outcomes.

Methods
To identify such opportunities we performed a multicenter retrospective analysis of patients who had been hospitalized for CABM in Houston, TX, from 5/2004 to 2/2023. Exact dates and times were collected for initial presentations, initiation of medications, and if the patient had been evaluated by a medical provider prior to hospitalization. Delayed antibiotics and steroids were defined as administration &gt; 6 hours after presentation. Steroids given after antibiotics were also classified as delayed. Patients lacking exact dates and times of these variables were omitted.

Results
100 CABM cases were reviewed and documentation showed that 36 patients (36%) were seen by a medical provider within 2 weeks prior to hospitalization. These patients’ chief complaints were most commonly ear pain, congestion, or dental pain. 12 patients received penicillins (4), fluoroquinolones (3), azithromycin (2), doxycycline (1), cephalosporin (1) and unspecified antibiotics (1). The other 24 patients were diagnosed with non-infectious causes (headaches, migraines, and muscle sprains).
Most hospitalizations had delayed antibiotics (53%) and steroids (73%). A significant number of patients did not receive steroids during their hospitalizations (21%). In total, 96% of patients missed opportunities for early interventions that improve outcomes.

Conclusion
It appears that there are many opportunities to improve early recognition of CABM and treatment of infections that lead to CABM in the outpatient setting. This is especially true when considering that this study is more likely to underestimate the number of patients who seek care prior to hospitalization. Regarding inpatient opportunities, increasing use of steroids in the acute workup phase of bacterial meningitis should be pursued given the high rate of delayed administration and severe neurological complications that are more likely to occur when it is not administered.

Disclosures
Rodrigo Hasbun, MD MPH FIDSA, BIOFIRE: Advisor/Consultant
1316. Clinical Utility of Pharmacogenomic Testing in Refractory Coccidioidal Meningitis
Authors: Blair Janis E , Kekic Adrijana , Grill Marie 
Published: November 2023

Abstract

Background
Coccidioidomycosis is an endemic fungal infection in the desert southwestern USA. Less than 1% of infections are complicated by coccidioidal meningitis (CM), which requires lifetime treatment, and has high morbidity. IDSA guidelines recommend high dose fluconazole (flu) as first line treatment, but up to 31% of CM patients (pts) fail flu. Guidelines have not yet articulated best subsequent therapy, but options include itraconazole (itra), voriconazole (vori), posaconazole and isavuconazole (isa). Excellent adherence to medications is imperative, and therapeutic fluconazole (flu) serum levels correlate with successful CM outcome. Many azoles are substrates of P450/CYP enzymes, and genetic alterations may influence medication levels. We have observed many CM pts who swear to adherence yet have low therapeutic azole levels. Our aim was to summarize our experience with pharmacogenomic (PGx) testing to guide treatment of CM.

Methods
We conducted a retrospective review of CM pts in our Coccidioidomycosis Clinic who underwent 1 of 2 targeted gene queries, either an internal 9-gene query or an external vendor 27 gene test. A PGx pharmacist interpreted results.

Results
From 1/1/2021 – 4/30/2023, we identified 6 pts with poorly controlled CM as manifested by repeated hospitalizations, progressively abnormal findings on lumbar puncture and/or magnetic resonance imaging of the central nervous system. Among the 6, 3 (50%) were male, 5 (83%) white, mean age 45 (28-71) years, with 34-month mean duration of illness. None were immunosuppressed. CM was complicated by strokes in 3, and hydrocephalus requiring ventriculoperitoneal shunt in 2. Five failed initial high dose flu and most had some low therapeutic levels without other medications acting as CYP inducers/inhibitors. 3 pts had the 9 gene test and 3 had the 27 gene test. Clinically relevant PGx abnormalities were identified in 5, including variants of CYP 2C19, 2C9, 3A4 and 3A5, which confer altered metabolism of vori, itra and isa, respectively. Following PGx, treatment was adjusted in 4 pts.

Conclusion
PGx testing is a potential adjunctive tool to avoid ineffective therapies or medication toxicity in an infection whose treatment success strongly depends on consistent therapeutic medication levels over a lifetime.

Disclosures
All Authors: No reported disclosures