bluuebunny/crossref_metadata_2025_split huggingface dataset:
1252. Penicillin Allergy Reassessment for Treatment Improvement (PARTI): A Dental Office Tool to Support Appropriate Penicillin Allergy Labeling
Authors: Coyne Ashlan J Kunz , Holger Dana , Kennedy Erinne , Connell Mackenzie , Binienda Juliann , Giuliano Christopher , Bailey Elaine 
Published: November 2023

Abstract

Background
Dentists routinely review patient allergy histories and prescribe penicillin. Dental visits offer an opportunity to identify patient candidates for PCN allergy reassessment. Aim: to collect and evaluate clinician and patient feedback on a PCN Allergy Reassessment for Treatment Improvement (PARTI) tool created for patient-clinician communication about PCN allergy labels, and ultimately, to delabel patient EHR records, as appropriate.

Methods
A mixed methods pilot study was conducted January-March 2023. We administered a semi-quantitative questionnaire to interdisciplinary clinicians and performed semi-structured focus groups of patients with a PCN allergy label for tool feedback. The questionnaire and focus group guide were developed to focus on the three tool components: (1) steps for PCN allergy reassessment, (2) general patient-centered PCN allergy information, and (3) a follow-up checklist for updating EHR allergy records. Deductive thematic analysis was used for the focus group data.

Results
In total, 50 clinicians completed the questionnaire and 15 patients participated in focus groups. Both groups included individuals from 5/5 U.S. regions. Survey respondents included mostly pharmacists (30%) and dentists (20%). PARTI steps 1, 2, and 3 were rated as “very important” or “important” for 81%, 67% and 93% of clinicians, respectively. Inclusion of the patient information section was supported by 100% of clinicians and 94% thought the PARTI tool was at an appropriate literacy level. Stated barriers to using the PARTI tool included patient follow-through and provider comfort with evaluating PCN allergies. Regarding the PARTI tool itself, focus group participants indicated that the tool was a conversation starter, easy to understand, included helpful patient-centered allergy information, and that the follow-up checklist for EHR record updates was useful. Stated patient barriers to the PARTI tool included patient follow-through and clinician hesitancy to update allergy records.

Conclusion
Patients and clinicians were receptive to using the PARTI tool for PCN allergy reassessment. Data herein will be used to address clinician and patient feedback to further develop the PARTI tool in preparation for its use in a national, multidisciplinary pilot study.

Disclosures
All Authors: No reported disclosures
1257. The Impact of Communication Type on Acceptance Rates of Antimicrobial Stewardship Interventions
Authors: Morado Faiza , Nanda Neha 
Published: November 2023

Abstract

Background
While face-to-face communication (ie. “handshake stewardship” (HS)) has been shown to improve antimicrobial stewardship program (ASP) intervention acceptance rates, this strategy is resource intensive. Therefore, systems unable to conduct HS must identify the optimal mode of communication for ASP recommendations. This study evaluated the effects of communication type on ASP intervention acceptance.

Methods
An infectious disease physician and ASP pharmacist met Monday through Friday to assess appropriateness of select antimicrobials. ASP recommendations were delivered through direct communication via telephone conversations or passive communication via text-page. A text page consisted of a message limited to 240 characters sent directly to the primary team. We performed a retrospective review of all interventions and associated acceptance rates, antimicrobials and antimicrobial indications between January 1st, 2023 to March 31st, 2023. The primary outcome evaluated was ASP intervention acceptance rate.

Results
Recommendations were delivered through telephone conversations in 267/454 (58.8%) cases compared to 187/454 (41.2%) cases in which recommendations were provided via text-page. We found that direct communication delivered telephonically resulted in a significant increase in ASP intervention acceptance rate compared to passive communication via text page (82.8% vs 73.8%, respectively; p=0.02). This resulted in 884 and 552 days of antimicrobial therapy saved in the telephonic and text-page group, respectively (p=0.64). Significant differences in baseline characteristics included: antimicrobial indications of intraabdominal, respiratory, sepsis and febrile neutropenia; having a broad differential; and an intervention category of de-escalation.

Conclusion
Direct communication with clinicians (eg. telephonically) improves ASP intervention acceptance rates compared to passive communication styles (eg. text-page). Direct communication with the prescriber encourages shared decision making, increases visibility of ASP, and allows for education to modify prescribing behavior. The success of an ASP relies heavily on provider relationships, which direct communication can further promote.

Disclosures
All Authors: No reported disclosures
1270. Impact of a Multidisciplinary Antimicrobial Stewardship Program (ASP) on Antibiotic Utilization and Clinical Outcomes at Tertiary Hospital in Saudi Arabia: A Quasi-experimental Study
Authors: Sarkhi Khadijah , Thabit Abrar K , Eljaaly Khalid , Kaki Reham , Bahamdan Rahaf , Alghamdi Sultan A , Baharith Mohammed O 
Published: November 2023

Abstract

Background
The concept of antimicrobial stewardship has been introduced for over a decade in response to the rapid global emergence and spread of antimicrobial resistance. To measure the impact of ASP interventions, several ASP metrics were developed. Very limited studies from Saudi Arabia have evaluated the impact of ASP interventions on antibiotic use and clinical outcomes of non-ICU patients. Therefore, we aimed to assess the impact of this ASP intervention on various ASP metrics by comparing the data of the post-intervention phase to that of the pre-intervention phase.

Methods
A quasi-experimental study was performed on patients admitted to non-ICU wards for whom a restricted antibiotic was ordered. Prospective audit and feedback (PAF) were already in place; however, on September 1st, 2020, a bundle of changes was introduced to improve the intervention making it a multifaceted intervention. These included the involvement of an infectious diseases clinical pharmacist, review of orders by attending (consultant) infectious diseases physicians, utilization of electronic resources instead of paperwork, and improvement of documentation. The primary outcomes were antibiotic utilization measures as defined daily dose per 100-patient days (DDD/100PD) and days of therapy per 100-patient days (DOT/100PD). Secondary outcomes were clinical outcomes of patients.

Results
A total of 402 episodes were evaluated for 167 and 188 unique patients in the pre- and post-intervention phases, respectively. DDD/100PD and DOT/100PD in the pre phase vs the post phase were 1.75 vs. 2.54 and 16.13 vs. 44.93, respectively (P &lt; 0.001 for both comparisons). Antibiotic de-escalation and clinical cure rates were significantly higher in the post phase than in the pre phase (62% vs. 40.6% and 83.5% vs. 65.8%; P &lt; 0.001 for both comparisons). In-hospital mortality and 30-day readmission rates were lower in the post phase than in the pre phase (13% vs. 20.8%; P = 0.037 and 20.5% vs. 33.8%; P = 0.003, respectively). Length of stay in both hospital and ICU were shorter in the post phase (14 vs. 22 days and 3 vs. 9 days, respectively; P &lt; 0.001 for both comparisons).

Conclusion
Our study demonstrates that the ASP intervention was associated with significant improvement in antibiotic utilization and patients’ clinical outcomes.

Disclosures
Khalid Eljaaly, PharmD, MS, BCPS, BCIDP, FCCP, Reckitt Benckiser Healthcare International Ltd, UK: Member of the Global Respiratory Infection Partnership, supported by unrestricted educational grant from Reckitt Benckiser Healthcare Ltd
1282. Evaluation of Opportunities for Implementing OVIVA Criteria on Patients with Bone and Joint Infections (BJIs) in Outpatient Parenteral Antimicrobial Therapy (OPAT)
Authors: Crawford Garrett , Wasan Michelle , Brenon Jessa , Soto Caitlin , Wright William F , Keller Sara C 
Published: November 2023

Abstract

Background
Historically, long term intravenous (IV) antimicrobial therapy has been considered superior to oral (PO) for the management of BJIs. In recent years, this concept has been challenged with studies showing similar efficacy and safety between PO and IV therapy. The purpose of this study is to evaluate areas for improvement within Johns Hopkins Medicine (JHM) in utilizing oral antibiotics for the treatment of BJIs as outlined in the OVIVA trial.

Methods
A multicenter, retrospective study was performed of adult patients with BJIs discharged from The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center followed by the JHM OPAT Service between February 1, 2021 and February 1, 2022. The following was collected on all patients: demographics, comorbidities, site of infection, OPAT-related adverse events (AEs), 30-day readmissions, emergency department (ED) visits, source control, microbiological data, antibiotic regimen, and treatment outcomes. The primary outcome is the proportion of patients treated for BJIs with OPAT who would have qualified for oral antibiotics according to OVIVA trial criteria. Secondary outcomes include the rate of OPAT-related AEs and treatment outcomes (30-day readmissions and ED visits, 6-month treatment failure, early IV to PO transitions, and durations of therapy). Descriptive statistics were used to summarize demographics and the primary and secondary outcomes.

Results
Among the 350 patients with BJIs, 221 patients met inclusion criteria. For the primary outcome, 169 (76.4%) met oral eligibility criteria with sulfamethoxazole-trimethoprim, tetracyclines, and cephalosporins being the most common PO options. There were 35 total OPAT-related AEs (24 [14.2%] in the PO eligible group and 11 [21.2%] in the PO ineligible group). There were 15 readmissions (11 [6.5%] in the PO eligible group and 4 [7.7%] in the PO ineligible group) and 17 ED visits (13 [7.7%] in the PO eligible group and 4 [7.7%] in the PO ineligible group). For 6-month treatment failure, there were 29 total occurrences (23 [13.6%] in the PO eligible group and 6 [11.5%] in the PO ineligible group).

Conclusion
Based on OVIVA trial criteria, the majority of evaluated patients could have utilized oral antibiotics, which could have resulted in fewer OPAT-related AEs, readmissions, and ED visits.

Disclosures
Sara C. Keller, MD, MPH, MSPH, Pfizer: Advisor/Consultant
1289. Assessing the Safety and Efficacy with Prolonged Use of Tedizolid in Orthopedic Patients
Authors: Garza Daniel E , Maguire Christina , Binkley Amanda , Weinstein Erica J , Silibovsky Randi 
Published: November 2023

Abstract

Background
Bone and joint infections (BJI) often require 4 to 6 weeks of treatment with oral or intravenous antimicrobials. To aid in achieving clinical cure, oral agents should be highly bioavailable, have a wide therapeutic index, and ideally penetrate bone tissue well. Data is available for linezolid’s use in BJIs but uptake is limited given its propensity to cause thrombocytopenia with long term use. Tedizolid, however, is associated with less side effects but little remains known about its use for longer treatment durations in BJIs.

Methods
This study is a single center, retrospective cohort study. It evaluated individuals 18 years or older that received tedizolid for 14 days or more for treatment or suppression of BJIs with available follow up lab data monitoring between 2014 and 2022. The primary outcome was occurrence of grade 2 or higher hematological or hepatic National Institute of Health defined adverse drug events during the course of therapy. Secondary outcomes included treatment success defined by no recurrence of infection within 3 months of completing therapy or sustaining suppressive therapy identified by microbiological, clinical or histological evidence.

Results
Thirty-three patients were included in this study and two (6%) patients experienced a safety event, both due to worsened anemia during treatment. Tedizolid also showed efficacy with 26 (90%) of 29 patients completing treatment without recurrence of infection within 3 months. One (25%) of 4 patients failed suppression therapy but are now re-suppressed on tedizolid.

Conclusion
Tedizolid used for 14 days or greater for BJI treatment or suppression was well tolerated and associated with a favorable treatment outcome. Our findings align with other data available highlighting safety of long-term use of tedizolid for non-orthopedic indications.

Disclosures
Christina Maguire, PharmD, Viiv: Advisor/Consultant Amanda Binkley, PharmD, BCIDP, AAHIVP, Viiv: Advisor/Consultant
1293. Efficacy of Doxycycline in Staphylococcal Prosthetic Joint Infection Treated with Debridement, Antibiotics and Implant Retention (DAIR) or Revision with Destination Spacer Placement
Authors: Jang Timothy , Hewlett Angela , Cortes-Penfield Nicolas W 
Published: November 2023

Abstract

Background
Prosthetic joint infection (PJI) is common, limb-threatening, and often warrants extended antibiotic durations. Intravenous (IV) glycopeptide, lipopeptide, and beta-lactam antibiotics have been the de facto US standard of care for staphylococcal PJI for decades, while the preponderance of (mostly European) published clinical data for PJI involves fluoroquinolone and rifampin combinations. However, these antibiotic strategies carry substantial adverse effects. In contrast, tetracyclines are less-studied for treatment of staphylococcal PJIs, but offer ease of administration and a favorable side effect profile.

Methods
We retrospectively evaluated the characteristics and outcomes of patients with staphylococcal PJI treated with doxycycline from March 2019 to April 2021 who received some period of outpatient parenteral antibiotic therapy (OPAT) and were included in our medical center’s OPAT database. We included patients with hip, knee, or shoulder PJIs managed with either debridement, antibiotics and implant retention (DAIR) or revision to a permanent “destination” spacer who received doxycycline within the first 12 weeks of therapy. Diagnosis of staphylococcal PJI was based on the documentation of the treating ID team plus identification of staphylococci in surgical tissue or synovial fluid cultures. Our primary outcome of interest was treatment failure, defined as reoperation for infection in the affected joint within one year of initial surgery.

Results
Of 24 patients switched to doxycycline after a mean 42 days, 17 underwent DAIR and 7 had destination spacers placed. 15 of 17 patients (88.2%) who underwent DAIR and 7 of 7 patients (100%) who received destination spacers remained free of treatment failure at one year; two patients had recurrent infections and none died.

Conclusion
These findings suggest that doxycycline is a safe and efficacious option for treatment of PJI. A key limitation of this study is patient identification via the OPAT database, meaning patients with short IV lead-in therapy (i.e. switch to PO at discharge) were not included, and that the efficacy of doxycycline is likely exaggerated by immortal time.

Disclosures
Angela Hewlett, MD, MS, Forcast Orthopedics: Advisor/Consultant|Mapp Biopharmaceutical: Grant/Research Support
1302. Impact of Insurance Coverage on the Route of Antibiotic Treatment for Forefoot Osteomyelitis
Authors: Ritter Austin , Ovalle Anais , Hadeel Zainah 
Published: November 2023

Abstract

Background
Recent studies suggest oral antibiotics can be a non-inferior alternative to intravenous antibiotics for treating bone and joint infections. In this study, we aimed to investigate whether insurance type affects the choice of antibiotic treatment routes and whether the route of antibiotic treatment influences the delivery of home health services.

Methods
We conducted a retrospective chart review of non-bacteremic patients who underwent amputations for forefoot osteomyelitis with residual signs of infection on proximal bone cultures and were discharged home from the hospital. Of 461 patients scheduled for hospital follow-up visits for bone and joint infections in our community practice infectious diseases clinic from January 2019 to December 2022, 40 met the inclusion criteria. Results were analyzed with multivariable logistic regression, selecting models with the lowest Akaike Information Criterion.

Results
The placement of PICC lines decreased significantly over time (OR 0.34, 95% CI: 0.14 - 0.71, p = 0.01), mirroring national trends favoring increased oral antibiotic use. After controlling for the year of treatment, we observed a trend towards patients with Medicaid insurance more frequently receiving IV antibiotics (OR 4.8, 95% CI: 1.0 - 29, p = 0.06). We found no evidence that the antibiotic administration route led to differences in the delivery of home health services at the time of discharge (p = 0.99).
PICC Placement Percentage by Year and Insurance
Percentage of PICC line Placement by year in patients with and without Medicaid Insurance during hospital encounter
PICC Placement Frequency by Insurance and Home Nursing
Frequency of PICC placement in patients during hospital encounters based on (A) if a patient has Medicaid insurance and (B) if home nursing is ordered at discharge
Organisms Cultured by Year
Frequency of organisms cultured on proximal bone cultures by year of study

Conclusion
Our findings suggest a trend towards patients with Medicaid insurance more frequently receiving IV antibiotics, despite the higher direct and indirect costs. It remains unclear whether this trend is due to differences in the severity of infections or microbiological resistance patterns. Future studies should assess the interaction of psychosocial and microbiological factors in influencing shared decisions regarding the route of antibiotic treatment outside of clinical trial settings.
Organisms Cultured by Antibiotic Route, Insurance Type, and Home Nursing Orders
Frequency of PICC line placement (A), Insurance coverage (B), and ordered for home nursing at discharge (C) by organisms cultured from proximal bone margins

Disclosures
All Authors: No reported disclosures
1309. Fungal Prosthetic Joint Infection - Case Series and Review of the Literature
Authors: Starnes Victoria , Duggan Joan , Hollingshead Caitlyn M 
Published: November 2023

Abstract

Background
The most effective treatment for fungal prosthetic joint infections remains unclear. Most cases are treated with two-stage revisions combined with systemic antifungal medications. To date, the largest studies of total hip arthroplasty and total knee arthroplasty fungal infections have included 37 and 45 patients, respectively.

Methods
A retrospective record review of patients admitted in two health systems between January 1, 2007 and December 31, 2018 with prosthetic joints and a deep culture of the joint positive for fungal organisms was performed as well as a review of the literature. A Pubmed and Embase search of the English-language literature from Jan 1, 1980 to Jan 1, 2023 was performed with review of the pertinent references for cases meeting the following case definition: individual with prosthetic joint and positive deep tissue culture for fungus.

Results
159 patients fit criteria. 73 patients had knee replacements, 62 patients had hip replacements, and 5 had other joint involvement. 52% were female. 137 patients had yeast involvement, with Candida species being predominant, while 11 had mold and 11 with dimorphic infections. 55 patients were treated with two-stage revisions, 44 received one-stage revisions, 32 received debridement only or Girdlestone procedure, and 1 required amputation. 141 reported details on antifungal therapy. After performing multivariate analysis, polyene treatment was found to be associated with higher rate of recovery, p=0.042. However, there was a trend towards recurrence requiring surgical intervention in patients treated with polyenes, p=0.067. 22.6% had a poor outcome, including recurrence, amputation, or death.

Conclusion
Surprisingly, polyenes did not underperform when compared to other antifungal therapy. Prospective research assessing optimal surgical treatment modality and antifungal therapy is needed as this infection is associated with high morbidity and mortality.

Disclosures
All Authors: No reported disclosures
1988. Early Syphilis in Minnesota: Statewide and Regional Trends, 2018-2022
Authors: Dufort Elizabeth , Bo-Subait Khalid , Lehnertz Nicholas , Hadsall Candy , Dippmann Karmen , Lind Livingston Cindy , Lynfield Ruth 
Published: November 2023

Abstract

Background
Cases of syphilis have been increasing in the US for several years. We assessed the epidemiology of syphilis in MN.

Methods
Syphilis cases are reported to MN Dept of Health through electronic laboratory reporting and are interviewed by disease intervention specialists. We reviewed early syphilis case data (primary, secondary, or early non-primary/secondary) and evaluated demographics, geographic region, HIV infection and substance use.

Results
From 2018-2022 there was a 108% increase in early syphilis with a total of 4,306 cases; 76% males, 65% of whom identified as men who have sex with men (MSM). Median age was 33 (IQR 27-42) years. The average 5-year rates of early syphilis in those who identify as American Indian (AI) (162 per 100,000) and Black, Non-Hispanic (66.9 per 100,00) were 22.2-fold and 9.2-fold higher respectively, compared to White (7.3 per 100,000). 25% of early syphilis cases occurred in persons with HIV (PWH), a 68% increase from 2018-2022 (165 cases in 2018 to 276 in 2022). Substance use was reported in 23% of cases. Cases in females rose 267% (97 in 2018 to 344 in 2022) and in males 81% (478 in 2018 to 866 in 2022). Among early syphilis female cases, 30% were AI and 19% were Black. Congenital syphilis cases also increased from 10 cases in 2018 to 20 in 2022 (rate 15.1 to 31.7 per 100,000 live births).
Across 3 impacted MN regions over the 2018-2022 timeframe, case characteristics varied. In the Twin Cities Region (TCR: n=3154, 73% cases) 81% were male, of whom 73% identified as MSM. In the Duluth Region (DR: n=157, 4% cases), 71% were male of whom 54% identified as MSM. In TCR, 31% cases were PWH and in DR, 13% of cases were PWH. In the Northwest Region (NWR: n=352, 8% cases), 45% were male, of whom 6% identified as MSM. In NWR, 51% cases reported substance use, compared with 20% in TCR and 11% in DR.

Conclusion
Similar to other US areas, syphilis is increasing in MN and is disproportionately impacting AI and Black populations. These trends and the rise in female and congenital cases warrant accelerated public health action. Rather than one statewide syphilis approach, regional differences in epidemiology highlight the need for understanding root challenges, engaging effectively with communities to develop locally specific interventions, access to testing and prenatal screening, and access to care.

Disclosures
All Authors: No reported disclosures