bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1702. Evaluation of Prescribing Practices and Treatment Failure in Obese Patients Diagnosed with Purulent Skin and Soft Tissue Infections in Outpatient Settings Across Michigan
Authors: Miller Mackenzie , Hughson Destiny , Blower Noah , Jameson Andrew , Dumkow Lisa E 
Published: January 2025

Abstract

Background
Obesity has been associated with increased risk of antibiotic treatment failure in skin and soft tissue infections (SSTI), however optimal treatment of SSTIs in obesity is unclear with limited data available. The goal of this analysis was to assess prescribing practices and risk factors for treatment failure in obese patients treated for purulent SSTI with oral antibiotics in the outpatient setting.

Methods
This retrospective, multicenter cohort study evaluated patients treated for purulent SSTI from February 1, 2020 - August 31, 2023, at Michigan outpatient locations within a health system. Patients ≥ 18 years with a body mass index (BMI) ≥ 30 kg/m2 and creatinine clearance ≥ 30 mL/min who received a ≥ 5-day course of oral antibiotics for purulent SSTI were included. Key exclusion criteria were chronic infections, antibiotic treatment within the past 30 days, and those requiring hospital admission. The primary endpoint was to describe prescribing practices. Secondary endpoints included comparing risk factors for treatment failure, revisit, or admission within 30 days between patients with treatment success (Tx-S) and treatment failure (Tx-F). Treatment failure was defined as a recurrence of infection or need for re-treatment within 30 days.

Results
200 patients were included (Tx-S, n = 100; Tx-F, n = 100). Baseline characteristics were similar between groups. Patients received 11 different antibiotic regimens with 26 dosing variations. Cephalexin monotherapy was most commonly prescribed (30%); 67% of patients received MRSA-active therapy, however, no patient received linezolid. Treatment failure was similar between those appropriately dosed (46.4%) vs. under-dosed (54.4%) (p=0.256), those who received 5-7 days of therapy (47.1%) vs. 10-14 days (54.4%) (p=0.311), and those who received MRSA-active therapy (52.2%) vs. no MRSA therapy (45.5%) (p=0.367). Patients treated with clindamycin were more likely to experience treatment failure (73.7% vs 47.5%, p=0.030) and had a higher rate of 30-day revisit (68.4% vs 47%, p=0.075).

Conclusion
Antimicrobial prescribing for outpatient treatment of purulent SSTIs in obese patients was heterogenous across a Michigan health system. Opportunities exist to optimize agent selection, dosing, and duration of therapy in this population.

Disclosures
All Authors: No reported disclosures
P-1704. Impact of an Empiric Antibiotic Pocket Guide on Rates of Guideline-concordant Empiric Regimens for Inpatient Community-acquired Pneumonia at a Community Hospital
Authors: Bernauer Elizabeth , Brenneman Martin , Johnson Taylor H 
Published: January 2025

Abstract

Background
Community-acquired pneumonia (CAP) is a common cause of hospital admissions and studies have shown concordance with guideline recommendations improves outcomes. Antibiotic pocket guides (PG) have been shown to increase use of preferred agents in urinary tract and intra-abdominal infections, but their impact on inpatient CAP treatment has not yet been evaluated. This study sought to evaluate the impact of a newly introduced empiric antibiotic PG (introduced May 2023) on rates of guideline-concordant empiric CAP regimens within 24 hours of admission.

Methods
This retrospective, pre-post, quasi-experimental study conducted at a 300-bed community hospital included adult inpatients initiated on antibiotics with order indication of pneumonia (+/- sepsis) within 24 hours. Patients were excluded if other indications were selected, if they had severe β-lactam allergies precluding use of all recommended agents, or if initiated on azithromycin or doxycycline alone. Included patients were randomly stratified 1:1 from pre-PG (Jul–Sep 2022) and post-PG (Jul–Sep 2023). The primary outcome was the rate of guideline-concordant empiric antibiotic selection for CAP between the two time periods. Secondary outcomes included total duration of therapy and C. difficile rate within 60 days of admission. Length of stay and all-cause mortality within 30 days of discharge were exploratory safety outcomes.

Results
300 patients were included,150 per group. Baseline demographics and risk factors were similar between groups except for higher rates of ICU-admission and recent hospitalization with IV antibiotics in the pre-PG group (Table 1). Patients received a guideline-concordant regimen more frequently post-PG than pre-PG, but this did not reach statistical significance (44.7% vs 35.3%, p = 0.099). No difference in appropriate duration was observed. 30-day all-cause mortality was significantly higher in the pre-PG group (p = 0.015). Other details on management and outcomes can be seen in Table 2 and Figures 1-2.

Conclusion
Introduction of an antibiotic pocket-guide did not result in a significant change in guideline-concordant empiric CAP treatment in this study. Though no evidence of harm was observed, other interventions may be needed to improve guideline-concordant inpatient CAP treatment.Figure 2.Hospital Length of Stay

Disclosures
Martin Brenneman, PharmD, BCIDP, Cardinal Health, Inc.: Stocks/Bonds (Public Company)|Dexcom, Inc: Stocks/Bonds (Public Company)|Insulet Corp.: Stocks/Bonds (Public Company)|Johnson & Johnson: Stocks/Bonds (Public Company)|Medtronic Plc: Stocks/Bonds (Public Company)
P-1705. Infectious Diseases Pharmacist Curbsides: Questions Infectious Diseases Providers Ask Infectious Diseases Pharmacists
Authors: Davis Matthew , Kufel Julia , Kufel Wesley D , Ross Jennifer , Oleksiuk Louise-Marie , Ours Rachael , Smith Ethan A , Pham Christine , Trisler Michael J , Tverdek Frank 
Published: January 2025

Abstract

Background
Infectious Diseases (ID) consult services, typically led by ID physicians, benefit significantly from the support of ID pharmacists. These pharmacists, with specialized training in ID pharmacotherapy through post-graduate residencies or fellowships, play a crucial role in advising on the selection, dosing, duration, and monitoring of antimicrobials. While the contribution of ID pharmacists to antimicrobial stewardship programs is well described, their impact in supporting ID consult services remains underdocumented. This report explores the clinical inquiries made by ID physicians and advanced practice providers (APP) to ID pharmacists on consult services, detailing how these interactions influence patient treatment and monitoring plans.Figure 1ID Pharmacist Curbside Question Categories (Categories with 2+ Submissions)

Methods
Ten ID residency- or fellowship-trained clinical pharmacists practicing in various practice settings documented questions they received from ID providers (attendings, fellows, and APPs) for patients on their respective ID consult service over a 6-month period. The impact of the conversations was documented if the pharmacist recommending a new drug, dose, duration, or monitoring plan which resulted in a change in care. Additional information was captured on the time spent answering questions, category of question, and pertinent microbiology or organism phenotype to describe areas of highest need for ID pharmacist support.Figure 2Questions Leading to Therapeutic Change

Results
Over the first three months of documentation, 782 questions were asked by ID providers to ID pharmacists. Total direct time spent answering questions was 8,937 minutes. The top three question categories were gram-negative resistance, antifungal therapy, and antimicrobial allergies. Seven hundred and three (89.8%) questions resulted in a clinical change in management as recommended by the ID pharmacist. The most common clinical change category was recommending a new dose which occurred in 57.4% of questions followed by new antimicrobial 50.4%, new monitoring plan 24.2% and new duration of therapy 8.8%.

Conclusion
ID pharmacists offer critical support that frequently changes management on ID consult services. Integrating their expertise into a multidisciplinary ID team is essential for achieving optimal patient safety and treatment outcomes.

Disclosures
Wesley D. Kufel, Pharm.D., BCPS, BCIDP, Merck & Co.: Grant/Research Support|Shionogi, Inc: Grant/Research Support Jennifer Ross, PharmD, BCIDP, Shionogi Inc.: Advisor/Consultant Frank Tverdek, PharmD, Merck: Advisor/Consultant
P-1706. Understanding Facility Bed Size Changes in NHSN over the COVID-19 Public Health Emergency
Authors: Arar Olivia , Iguchi Lisa , Breitenstein Elizabeth , Zhang Alexia Y , Tallman Gregory B , Tran Dat , McGregor Jessina C 
Published: January 2025

Abstract

Background
Antimicrobial use surveillance data within National Healthcare Safety Network (NHSN) uses patient care location mapping data to define locations and inform risk adjustment. During the COVID-19 public health emergency, many hospitals changed how beds were utilized. This study compares location mapping changes over time within a statewide hospital antimicrobial stewardship collaborative during the COVID-19 public health emergency.Figure 1.Frequency of Facilities by Change in Total Beds from 2019
In this analysis, each facility's change in total bed count was subtracted from the 2019 value to classify the change as an increase, decrease, or no change in each year of analysis. The figure demonstrates that total bed counts varied in the direction of change; there was no significant difference in the direction of change across years (p=0.63) .

Methods
We utilized facility survey data from facilities who submitted data from 2019-2022 to the Oregon Antimicrobial Stewardship Network (ORASN) NHSN group. Annual total bed and ICU bed counts were compared to 2019 data for each facility. Changes in bed counts were also categorized as increases, decreases, and no change and compared using the Fisher’s exact test.Figure 2.Frequency of Facilities by Change in ICU Beds from 2019
In this analysis, each facility's change in ICU bed count was subtracted from the 2019 value to classify the change as an increase, decrease, or no change in each year of analysis. The figure demonstrates that ICU bed counts increased in all years; there was no significant difference in the direction of change across years (p&gt;0.99) .

Results
Nineteen hospital facilities contributed sufficient data and were included in analysis. Overall, there was a mean decrease in total bed count in 2020 (-8.16 ± 26.68) and 2021 (-4.16 ± 29.3) but an increase in 2022 (27.89 ± 68.39) when compared to 2019 baseline total bed counts at each facility. The total bed counts decreased in 8.77% of facilities in 2020 and 8.77% in 2021; while increases were observed among 21.05% in 2022 (p = .63; see Figure 1). There was a mean increase in the total number of ICU beds in 2020 (3.95 ± 9.51), 2021 (4.47 ± 10.89), and 2022 (4.63 ± 10.05) when compared to 2019 baseline data. The ICU bed counts increased in 8.77% of facilities in 2020, 8.77% in 2021, and 10.53% of facilities in 2022 (p &gt; .99; see Figure 2).

Conclusion
The data suggest that location mapping changed meaningfully across the COVID-19 public health emergency with no clear trend. Interpretation of the antimicrobial use data over time and risk adjusted metrics must consider these shifts. Further efforts are needed to understand NHSN location mapping changes in the context of actual historical bed utilization during this time frame.

Disclosures
All Authors: No reported disclosures
P-1707. A Comparative Analysis of Clindamycin versus Linezolid as Adjunctive Anti-toxin Therapy for Invasive Group A Streptococcal Infections
Authors: Jagannathan Megha , Jordan Tamara , Kinsey Daniel , Kenney Rachel M , Veve Michael , Shallal Anita , Suleyman Geehan 
Published: January 2025

Abstract

Background
Group A Streptococcus (GAS) is an important pathogen that can cause life-threatening disease. Clindamycin (DA) and linezolid (LZD) have been used as adjunctive antitoxin (AT) therapy in high-inoculum GAS infections to inhibit bacterial protein synthesis. However, there is concern about DA efficacy in the era of increasing DA resistance, where LZD may have a role. We evaluated outcomes of patients with invasive GAS infection who received DA or LZD.Table 1.Comorbidities and clinical syndromes of patients receiving Clindamycin vs. Linezolid (n=158)

Methods
Retrospective cohort study comparing patients with positive blood cultures (BC) for GAS from June 2013-Dec 2023 treated with DA or LZD ≥ 48 hours. We identified patients using a data query for positive BC for GAS through Microsoft SQL. Patients aged &lt; 18 years, or those with polymicrobial bacteremia, receipt of both AT therapies, incomplete data, or enrolled in hospice/died within 48-hours of admission were excluded. Collected variables included: demographics, infection characteristics, microbiologic data, adjunct therapy (surgical, immunoglobulin), and clinical outcomes (treatment-associated adverse events, 30-day all-cause mortality and infection-related readmission).Table 2.Severity of illness and adjunctive therapies of patients receiving Clindamycin vs Linezolid (n=158)

Results
158 patients were included; 117 patients received DA and 41 patients LZD. Baseline characteristics were similar among groups except for chronic kidney disease, which was more common in the LZD group (Table 1). The most common clinical syndrome accompanying bacteremia in both groups was abscess/cellulitis; bone and joint infection was more prevalent in the LZD group. 55 (33.5%) of GAS isolates were DA resistant. There was no significant difference in severity of illness, surgical interventions, or duration of therapy between the two groups (Table 2). Duration of bacteremia was significantly longer in the LZD group. There was no significant difference in readmission (10.3% vs 12.2%, p=0.77) or all-cause mortality within 30 days (17.1% vs 7.3%, p=0.13) in the DA versus LZD groups. Treatment-associated adverse events were low across both groups [Figure 1].

Conclusion
Despite increasing DA resistance at our facility, there was no significant difference in outcomes between patients treated with LZD vs DA plus standard therapy, consistent with prior literature. Further studies are needed to determine optimal therapy for invasive GAS.

Disclosures
Rachel M. Kenney, PharmD, BCIDP, Medtronic Inc: Spouse is an employee, stockholder
593. Randomized, Double-Blinded, Placebo-Controlled, Phase 1 Study of the Safety of BPL-1357, A BPL-Inactivated, Whole-Virus, Universal Influenza Vaccine
Authors: Tudor Giurgea Luca , Han Alison , Czajkowski Lindsay , Ann Baus Holly , Mak Gregory , Adao Kimberly , Bellayr Ian , Cervantes-Medina Adriana , Gouzoulis Monica , Sherry Jenna , Athota Rani , Callier Viviane , Hunsberger Sally , Park Jaekeun , Taubenberger Jeffery , Memoli Matthew J 
Published: January 2025

Abstract

Background
Better influenza vaccines are needed, not just for seasonal strains but for future pandemic viruses. BPL-1357 is a whole-virus, β-propiolactone-inactivated vaccine containing four wild-type, low-pathogenicity avian influenza viruses (H1N9, H3N8, H5N1, and H7N3). In mice and ferrets, BPL-1357 provided robust protection against challenge with a diverse set of influenza A viruses, including completely heterosubtypic strains.

Methods
A phase 1, randomized, placebo-controlled, double-blinded, study was performed in volunteers 18 to 55 years of age using a single dose-level of vaccine given twice 28-days apart, either intramuscularly (IM) or intranasally (IN). Forty-five participants were block randomized (1:1:1) to receive IM BPL-1357 and IN placebo (IM group), IM placebo and IN BPL-1357 (IN group), or IM placebo and IN placebo (placebo group). Adverse events (AEs) were solicited using a questionnaire for 7 days after each vaccination and volunteers had medical follow-up for 182 days after the second vaccine (V2D182). Solicited AEs were presented visually as proportions. AEs were compared using tests of proportions at day 28 (V2D28) and V2D182.

Results
Forty-five participants were enrolled between June 27, 2022 and November 9, 2022 and randomized into each group (n=15,15,15). Two participants (placebo group) delayed or missed their second dose because they developed COVID-19. No serious AEs were observed. Most AEs were mild. Injection site pain was the most common AE, which occurred in 87%/67% of the IM group after each vaccine dose respectively, but only in 33%/0% of the IN group, and 13%/21% of the placebo group. Other AEs, such as fatigue and headache, were similarly observed across the three groups. There was a severe AE possibly related to the IN vaccine (fever 39-40°C) which occurred after the first dose, but not the second. When comparing intervention-related AEs, only injection site pain was found to occur more frequently in the combined IM+IN group relative to placebo.

Conclusion
BPL-1357 was safe and well-tolerated. Pain at the injection site was commonly seen in the IM group, though was mostly mild. Other AEs were similar in frequency between vaccine and placebo groups. Further work to determine the immunogenicity and efficacy of BPL-1357 is underway.

Disclosures
All Authors: No reported disclosures
P-1715. Antibiotic Stewardship based on the usage of Non- FDA Approved Fixed Dose Combination of Antibiotics in a Secondary Care Hospital South India
Authors: Nitheeshwar C , Dorairajan Suresh Kumar 
Published: January 2025

Abstract

Background
In developing countries, the widespread use of non-FDA (Food and Drug Administration) approved fixed-dose combinations of antibiotics in secondary care hospitals is a concern. Despite cautions from infectious disease specialists, comprehensive studies on this practice are lacking. Our research aims to investigate indications for prescribing these combinations in a South Indian secondary care hospital and develop stewardship strategies to reduce the use of it.TABLE 1:Indication for the Usage of non FDA Approved Fixed Combination of Antibiotics

Methods
The study conducted was a Prospective observational study at a secondary care hospital in South India over a 4-month period from December 2023 to March 2024. Data collection utilized a validated audit tool capturing details of non-FDA approved fixed dose antibiotic combinations prescribed to patients. Statistical analysis was conducted using MS Excel, employing simple descriptive statistics.

Results
CIPROFLOXACIN (500mg) + TINIDAZOLE (600mg) and CEFEXIME (200mg) + OFLOXACIN (200mg) are commonly prescribed for various conditions such as acute gastroenteritis, ear pain, and other ailments like fissures, cysts, and vaginal white discharge. However, these combinations lack FDA approval and randomized controlled trials (RCTs) to support their efficacy in treating conditions like otitis media and loose stools. The addition of antiparasitic agents in these combinations lacks evidence of effectiveness. Therefore, caution is advised in their prescription until further scientific validation is available.

Conclusion
In conclusion, our antibiotic stewardship efforts led to the removal of CIPROFLOXACIN (500mg) + TINIDAZOLE (600mg) and CEFEXIME (200mg) + OFLOXACIN (200mg) from our hospital formulary. Physicians were informed that these combinations lack scientific rationale for treating specific conditions. This action aligns with evidence-based prescribing practices to optimize patient care and combat antimicrobial resistance.

Disclosures
All Authors: No reported disclosures
P-1727. Impact of Four-Day Automatic-Stop Orders on the Duration of Antibiotic Treatment
Authors: Oliver Aaron , Quinn Andrea , Ries Amanda , Weslander Erin , Malkowicz Katarzyna 
Published: January 2025

Abstract

Background
Implementation of automatic antibiotic stop orders is an antimicrobial stewardship intervention that encourages timely antibiotic order re-evaluation for potential discontinuation, spectrum de-escalation, transition to oral therapy, or spectrum escalation if warranted based on emerging diagnostic results. This pre-post study was designed to evaluate the impact of a four-day automatic-stop order on antibacterial orders for patients admitted at a single community hospital site.

Methods
A single-center, retrospective pre-post study was conducted to compare outcomes following the re-introduction of a four-day automatic-stop order on antibacterial orders. The primary outcomes were hospital length of stay and median duration of antibiotic therapy. Secondary outcomes included hospital readmission within 30 days and the occurrence of C. difficile infections within 30 days. Data was compared between 2 non-consecutive weeks in the pre-implementation of the automatic-stop order policy with data from 2 non-consecutive weeks in the post-implementation of the automatic-stop order policy to ensure prescriber variability and prescribing practices. Patients admitted for fewer than 4 days, or who had orders with indications for meningitis, bacteremia, prosthetic material infection, bone and joint infections, endocarditis, C. difficile treatment, prophylaxis, or documented uncontrolled source were excluded to align with exclusions in the policy.

Results
The study included 362 patients in total, 167 in the pre-implementation group and 195 in the post-implementation group. The median hospital length of stay was 8.2 days in the pre-implementation group and 7.1 days in the post-implementation group (p=0.536). The median total treatment duration of antibiotic therapy was 6.2 days in the pre-implementation group and 5 days in the post-implementation group (p=0.02). Incidence of c. difficile was 3% in the pre-implementation group, compared to 1% in the post-implementation group (p=0.256).

Conclusion
An antimicrobial automatic stop policy of four days was associated with decreased antimicrobial days of therapy per patient, without differences in hospital length of stay. There were no safety concerns identified with this intervention.

Disclosures
All Authors: No reported disclosures