bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1732. Evaluating the Impact of a Gram-Negative Bacteremia Treatment Guideline Combined with Antimicrobial Stewardship Pharmacist Intervention
Authors: Peterson-Weber Alex , Donohoe Kendall , Chapin Ryan W , Al Lawati Hawra J , Lee Matthew S , McCoy Christopher 
Published: January 2025

Abstract

Background
Gram-negative rod (GNR) bloodstream infections (BSIs) in hospitalized patients are associated with significant morbidity and mortality if not treated appropriately. By contrast, use of overly broad antibiotics or long durations of therapy for GNR BSIs may increase risk for antimicrobial resistance and C. difficile infection. The purpose of this study was to evaluate outcomes of GNR BSI treatment before and after implementation of an institutional practice guideline paired with real-time antimicrobial stewardship (AS) review.

Methods
A before-and-after quasi-experimental study was performed at our large academic medical center. Patients were identified for inclusion using a third-party pharmacovigilance platform based on presence of at least one blood culture with GNRs. Exclusion criteria included age less than 18 years, identified source of the GNR BSI was an infection requiring a prolonged duration of therapy (e.g., osteomyelitis, endovascular infection, etc.), or if the patient expired or was placed on comfort measures prior to BSI treatment completion. The primary endpoint was time to directed therapy, defined as susceptibility-directed tailoring of therapy. Secondary endpoints included time to optimal therapy (TOT), defined as narrowest effective therapy or step down to oral therapy, total duration of therapy, rate of step down to oral therapy, and acceptance of AS interventions.

Results
A total of 175 patients met inclusion criteria between November 2022 and April 2024. Eighty-four patients in the pre-guideline group and 91 patients in the post-guideline with AS review group were included. Baseline characteristics are described in table 1. The median time to directed therapy was 46.9 hours (IQR; 0, 72) in the pre-guideline group and 36.9 hours (IQR; 0, 58.9) in the post-guideline group. Additional endpoints are described in table 2.

Conclusion
The GNR BSI guideline with AS review led to faster tailoring of therapy but no change in TOT. A high prevalence of Infectious Diseases consults was observed in this population, thus AS interventions were mostly directed at patients without formal Infectious Diseases consultation. Additionally, ability to make timely AS interventions was limited by the resources available to our AS program.

Disclosures
All Authors: No reported disclosures
P-1733. Effectiveness of a Clinical Pharmacist-Led Electronic Medical Record-Based Antimicrobial Stewardship Intervention in Reducing the Overuse of Meropenem During Transition of Care: Evidence from a Tertiary Care Hospital in India
Authors: Nair Aravind R 
Published: January 2025

Abstract

Background
In tertiary care hospitals, the overuse of broad-spectrum antibiotics like meropenem contributes to the rise of antimicrobial resistance, posing a significant public health concern, particularly in countries like India. Addressing this issue, this study evaluates the effectiveness of a clinical pharmacist-led electronic medical record-based antimicrobial stewardship intervention in curbing meropenem overuse during transitions of care at a tertiary care hospital in India.

Methods
A prospective interventional study was conducted over six months at the tertiary care hospital. Trained clinical pharmacists led the intervention. Upon patients' transition from intensive care units (ICUs) to medical/surgical units, an active meropenem order triggered an alert in the EMR system. Pharmacists reviewed the order and liaised with the primary medical team for approval to continue meropenem therapy, documenting all communications and actions in the patient's EMR. Data on meropenem days of therapy (DOT) and related outcomes were collected pre- and post-intervention. Statistical analysis was performed to assess the impact of the intervention.

Results
Out of 280 patients, 130 were in the pre-intervention group and 150 in the post-intervention group, with similar baseline characteristics. Pre-intervention, median meropenem DOT after transition was 4 days (IQR: 3-6), decreasing to 2 days post-intervention (IQR: 1-3) (p &lt; 0.001), a 50% reduction. Median doses decreased from 8 (IQR: 6-10) to 5 (IQR: 3-7) post-intervention (p &lt; 0.001). Total meropenem DOT significantly decreased post-intervention, from 600 to 375 days (p &lt; 0.001). Furthermore, the acceptance rate of recommendations for de-escalation or discontinuation of meropenem therapy increased post-intervention, with 70% acceptance compared to 45% pre-intervention.

Conclusion
In conclusion, the clinical pharmacist-led electronic medical record-based antimicrobial stewardship intervention effectively mitigated meropenem overuse during care transitions, highlighting its potential to optimize antibiotic utilization and combat antimicrobial resistance in Indian tertiary care settings.

Disclosures
All Authors: No reported disclosures
P-1734. Pharmacist-Led Antibiotic Deprescribing for Negative Urine Cultures in the Emergency Department
Authors: Teter Ashley , Hurley Evan 
Published: January 2025

Abstract

Background
Inappropriate antibiotic use in EDs, often due to empiric prescribing before urine culture results are available, poses significant challenges. This study evaluates the impact of a pharmacist-led intervention to deprescribe antibiotics for patients with negative urine culture results.
Intervention

Methods
Conducted from May 1, 2023, to March 31, 2024, this study employed a two-phase approach involving a retrospective review and a prospective intervention. Inclusion criteria were patients prescribed antibiotics for a UTI with subsequent negative urine culture results during an ED visit. Exclusion criteria included patients admitted for inpatient treatment or transferred to other healthcare facilities. In Phase I (May to July 2023), a clinical pharmacist in the ED adjusted antibiotic therapy based on culture susceptibility results on weekdays. Phase II (January to March 2024) expanded to include antibiotic deprescribing in patients with negative results. The primary outcome was the number of ED readmissions within 30 days after antibiotic discontinuation for UTI symptoms or serious infection. Secondary outcomes included total antibiotic days saved, antibiotic days prescribed per patient at ED discharge, and post-intervention antibiotic days per patient. Statistical analyses utilized the Fisher Exact Test and Mann-Whitney U Test.
Patient Characteristics

Results
The study included 78 patients: 27 in the retrospective phase and 51 in the prospective phase. Among the initial 51 patients, follow-ups with 17 revealed no continued UTI symptoms. There were no readmissions in our prospective intervention group compared to two in the retrospective group (P=0.117). Antibiotic days were significantly reduced from a pre-intervention average of 7.2 to 5.2 days per patient post-intervention (P=0.000468), saving a total of 82 antibiotic days.
Results

Conclusion
Pharmacist-led deprescribing of antibiotics in patients with negative urine cultures significantly reduced total antibiotic days per patient without increasing ED readmissions for urinary tract infection symptoms. These findings demonstrate the feasibility and safety of deprescribing in a clinical ED setting and suggest potential changes in clinical practice, advocating for the expansion of pharmacist roles in antibiotic stewardship programs.
Results Continued

Disclosures
All Authors: No reported disclosures
P-1738. Effectiveness of Clinical Pharmacist-Driven Antimicrobial Stewardship (ASP) in Bacteremic Patients in India
Authors: Kumar Prasanna , Rupali Priscilla , Jose J Franklin , Selvakumar J 
Published: January 2025

Abstract

Background
Antimicrobial resistance is a prevalent problem, especially in low-middle-income countries. Infectious disease physicians are a scarce commodity and are unable to fully shoulder the complete responsibility of antimicrobial stewardship implementation in a health care setting. Thus, we set out to assess the utility of a Clinical pharmacist-led ASP in optimising antimicrobial use in bacteremic patients.
SOURCE OF INFECTION

Methods
This is a prospective audit and feedback of bacteremic patients led by a clinical pharmacist with minimal input and sign-off from an ID specialist. A month of observation (July 2023) was followed by a 3-month intervention period from August to October 2023 in the medical and surgical speciality departments of a large tertiary care hospital in Southern India.
RECOMMENDATION ACCEPTANCE RATE

Results
103 and 218 patients were noted to be bacteremic during baseline and intervention, respectively. The mean age was 48.2, and 66% were male. The majority of positive blood cultures were from Haematology (19%), Hepatology(15%), Nephrology(14%) and others (52%). The average length of stay was 19 days and 16.6 days in baseline and intervention phases, respectively. The predominant organisms were carbapenem-resistant and extended-spectrum beta-lactamase-producing enterbacteriaceae and coagulase-negative staphylococci (CoNS). The common sources of bacteremia were central line-associated bloodstream infection (CLABSI) and gut translocation during febrile neutropenia. (Table 1). The DOT in the observation phase was 1517/1000 Patient-Days (PD), and the intervention phase's average DOT was 1326/1000PD, and there was a significant reduction in antibiotic utilisation in the intervention (P=0.003). The length of therapy was 16.6 and 11.06 days, with in-hospital mortality of 13.6% and 8% in the observation and intervention phases, respectively. Clinical pharmacist recommendations were either fully or partially accepted in 75% of the cases in the intervention phase (Table 2).

Conclusion
A clinical pharmacist-led ASP showed a reduction in significant antimicrobial use with 75% acceptance of recommendation and no difference in mortality even in bacteremic patients.

Disclosures
All Authors: No reported disclosures
P-1745. Development and Use of a System Antimicrobial Stewardship Dashboard
Authors: Borkowski Jaime , Weslander Erin , Moore William Justin , McGuire Nicole , Tatti Megha , Postelnick Michael 
Published: January 2025

Abstract

Background
Obtaining data has been an ongoing challenge for antimicrobial stewardship programs. With the creation and recent update of the Joint Commission antimicrobial stewardship standards, an increased focus has been placed on acting on relevant data to improve antimicrobial use. We describe the development and use of a systemwide dashboard to help track meaningful outcomes and identify areas of opportunity for our Antimicrobial and Diagnostic Stewardship Program (ADSP).

Methods
A list of all potential pieces of data we may want to be able to compare was made, including demographic information, metrics, and important outcomes. Examples of dashboards already in use in our organization were reviewed to see what types of metrics were included and how they were displayed. The Enterprise Data Warehouse was used to pull data out of the electronic health records within Epic® and to house the dashboard.

Results
The dashboard contains three main views. The default view is the executive summary. This view contains performance and outcome metrics. These include adherence to guidelines, length of stay (LOS), 30-day readmission rate, and mortality rate. There is also a section below the overall summary that breaks out site-specific data. The second view includes population demographics and a breakdown of provider- and specialty-specific outcomes. The third view includes graphic representations of more granular detail broken out by treatment indication. In addition, we are able to filter each view by various details such as date, the ordering department, antimicrobial, treatment indication, and ADSP team intervention. One example of how we have used this dashboard so far is in the assessment of a systemwide initiative to improve empiric antibiotic prescribing for urinary tract infections. We were able to see increased guideline-consistent prescribing, decreased need for interventions, and no significant increase in LOS, readmission or mortality.

Conclusion
This dashboard allows us to obtain data that would have previously required much time to gather and analyze. The inclusion of important patient-centered outcomes allows us to see the impact of ADSP interventions on our patients. It also aids in obtaining multiple pieces of data that TJC has outlined in the Antimicrobial Stewardship Standard.
This graphic shows an example of how we are able to use our dashboard. Here we show a pre-post review of outcomes related to a systemwide initiative targeting empiric treatment of urinary tract infections. We saw an increase in guideline-consistent prescribing, a decreased need for ADSP intervention, and no significant increase in important outcomes including length of stay, readmission rate, or mortality (p&gt;0.05 for readmission and mortality).

Disclosures
All Authors: No reported disclosures
P-1785. A nationwide survey of Antimicrobial Stewardship Infrastructure and CDC Core Elements in the Dominican Republic
Authors: Castillo Elianet , Ali Arzina Aziz , Rojas-Fermin Rita A , Reyes Yeison , Blanco Claudia , Villegas Antonio M , Mena Lora Alfredo J 
Published: January 2025

Abstract

Background
Antimicrobial resistance (AMR) poses a critical global health threat, escalating the need for widespread implementation of antimicrobial stewardship programs (ASPs) to monitor and promote appropriate use of antimicrobials. Despite the growing concern for AMR, particularly in low and middle-income countries, data on the implementation of ASPs in these regions remain scarce. This study aims to describe the presence and practices of ASPs in the Dominican Republic (DR).
Figure 1
Population density of the Dominican Republic and geographic distrubution of hospitals surveyed

Methods
We performed an anonymous survey of infectious diseases (ID) specialists in acute care hospitals in the DR. A survey based on the CDC Infection Control Assessment and Response (ICAR) tool for antimicrobial stewardship was distributed via professional society listervs between March 4 and April 24, 2024. Data was tabulated and descriptive statistics performed.
Figure 2
CDC Antimicrobial Stewardship Core Elements met by hospitals in the DR

Results
A total of 20 hospitals completed our survey, of which 16 were from Santo Domingo and 1 from La Romana, San Cristobal, San Pedro, and Santiago (Figure 1). Eighteen were tertiary centers. ASP was absent in 50% (10), present in 35% (7), and in the process of development in 15% (3). Compliance with CDC core elements for ASP varied, with accountability and action present in all hospitals with ASP, leadership commitment and tracking both at 85.7%, and education at 71.0% (Figure 2). Pharmacy expertise and reporting were 57.0% and 42.8% respectively. The most frequently adopted ASP interventions were 'Documentation of indication' and 'Center Specific Treatment guidelines', both present at 71% (5) of hospitals. PAF and 'Pre-authorization' were also common, each at 57% (4/7) (Figure 3). The less frequent interventions included 'Antibiotic timeout' and 'Assessing Penicillin allergy', both at 14% (1/7), and 'Review of outpatient parenteral antibiotic therapy' at 29% (2/7).
Figure 3
Antimicrobial steewardship interventions by hospitals in the DR

Conclusion
Our survey provides a snapshot of the current state of ASP in the DR. While there has been notable progress in implementing ASPs, half of the hospitals still lack such programs, underscoring the urgent need for broader implementation. Additionally, adherence to the CDC’s core elements among existing programs varies, highlighting specific gaps and areas for improvement. It is crucial to address these deficiencies to enhance ASP effectiveness and combat the growing threat of AMR.

Disclosures
Rita A. Rojas-Fermin, MD,FIDSA, Gilead: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria
P-1789. Implementation of Pathogen Independent Model Informed Precision AUC-based Dosing of Vancomycin at University Hospital Wuerzburg (UKW)
Authors: Gundlach Laura C , Surat Güzin , Kunkel Mareike , Scherf-Clavel Oliver 
Published: January 2025

Abstract

Background
The IDSA guideline concerning monitoring vancomycin in MRSA infections, published in March 2020, recommends model informed precision AUC based dosing for vancomycin. The application of pharmacometrics software with Bayesian calculating is recommended. The summary of product characteristics of vancomycin, issued by EMA (European Medicines Agency), includes also details regarding model informed precision dosing for vancomycin therapies, irrespective of targeted or identified pathogens. Due to the low prevalence of MRSA infections at UKW, model informed precision AUC-based dosing has been instituted for all parenteral vancomycin therapies.

Methods
The target for vancomycin AUC/MIC (minimum inhibitory concentration) is a range of 400 – 600 mg*h/L over 24 hours. Individual patient covariates, personal dosing information and vancomycin concentrations were converted into dosing recommendations with InsightRX. In order to record the effect of the intervention, the target attainment and the occurrence of AKI (acute kidney injury, defined as an increase in serum creatinine of ≥ 0.3 mg/dL within 48 h) is recorded 18 months before and 12 months after the implementation of the new dosing strategy.

Results
Since October 2022, a workflow for model informed AUC-based dosing has been launched across 12 wards - mainly intensive care units - encompassing 215 beds. In the conventional dosing strategy according to trough dosing, AKI occurred in 60 of 216 therapies, while AKI was detected in 8 out of 57 AUC-guided vancomycin therapies resulting in an odds ratio of 2.32 [CI 95 % 1.08 – 5.59]. Significantly more AUC guided therapies were in the therapeutic range of 400 – 600 mg*h/L after 120 hours than trough-based vancomycin therapies reached the target [55.1 % vs 70.2 %, OR 0.52, CI 95 % 0.27 – 0.97]. Additionally, more trough-based therapies were in a supratherapeutic range than AUC guided therapies [24.5 % vs 8.8 %, OR 3.23, CI 95 % 1.35 – 9.98]

Conclusion
The unique concept of pathogen independent model-informed AUC-based dosing of vancomycin was successfully integrated into the clinical routine work. Early dose individualization due to AUC-based dosing can contribute to increase drug therapy safety and improved patient safety for vancomycin therapies.

Disclosures
All Authors: No reported disclosures
P-1799. Impact of coronavirus disease 2019 on infectious disease treatment and infection control: Multicenter study in Japan
Authors: Kakeya Hiroshi , Kakuno Shigeki , Imoto Waki , Shintani Ayumi 
Published: January 2025

Abstract

Background
The coronavirus disease 2019 (COVID-19) pandemic impacted infection control practices such as hand hygiene and antimicrobial use, but its specific effects remain unclear. Thus, in this multicenter study, we aimed to determine the pandemic's effect on these factors by comparing pre- and post-COVID-19 periods.
(A) The number of inpatients by month during the study period. (B) The amount of hand sanitizer used per inpatient by month during the study period.
The two solid lines show the regression lines in the pre- and post-COVID-19 periods. The dashed line in the post-COVID-19 period is an extension of the regression line in the pre-COVID-19 period.

Methods
Data on hand sanitizer use, antimicrobial use, positive blood cultures, and antimicrobial-resistant (AMR) organism detections were collected monthly from April 2015 to March 2023 at four Japanese hospitals. The pre-COVID-19 period data (April 2015 to March 2020) were compared to the post-COVID-19 period data (April 2020 to March 2023).

Results
Compared to pre-COVID-19, hand sanitizer use per inpatient and antimicrobial use, particularly broad-spectrum antimicrobials, increased significantly post-COVID-19. The proportion of positive blood cultures increased, but AMR organism detections remained unchanged, suggesting increased contamination rather than infection.

Conclusion
Ongoing antimicrobial use monitoring, hand hygiene education, and promotion of effective infection control and antimicrobial stewardship by infection control teams are crucial for prevention of future pandemics.
(A) Total DOT (combined with all antimicrobials extracted in this study) by month. (B–F) DOT of individual antimicrobial agents by month.
The two solid lines show the regression lines in the pre- and post-COVID-19 periods. Other antimicrobial agents are shown in Appendix Figure A.1.
Abbreviations: CFPM, cefepime; CI, confidence interval; CTRX, ceftriaxone; DOT, days of therapy; MEPM, meropenem; SBT/ABPC, sulbactam/ampicillin; TAZ/PIPC, tazobactam/piperacillin.

Disclosures
Hiroshi Kakeya, MD, PhD, Asahikasei Phrma: Honoraria|GSK: Honoraria|MSD: Honoraria|Pfizer: Honoraria|Shionogi: Honoraria|Sumitomo Parma: Honoraria
P-1800. Antimicrobial Stewardship Compliance with Accreditation Requirements within a Hospital Pharmacy Organization
Authors: Shea Katherine M , Hobbs Athena L V , Lundquist Steve , Sun Jessica 
Published: January 2025

Abstract

Background
Between 2022 and 2023 the Center for Medicare and Medicaid Services and The Joint Commission updated requirements and/or guidance related to antibiotic stewardship programs (ASPs). In June 2023, an antimicrobial stewardship gap analysis survey was required within all Cardinal Health pharmacy managed facilities to assess for compliance with accreditation requirements and identify areas for improvement.

Methods
This was a 55 question multi-site survey assessing compliance with accreditation requirements for hospital ASPs. Participants responded to questions as yes, no, or not applicable. Compliance was defined as a “yes” or “not applicable” response. A chi-square was used to assess responses between hospital types and average daily census (ADC).

Results
122 hospitals completed the survey (41 hospitals, 17 critical access, 27 long-term acute care (LTAC), 29 rehabilitation, 8 LTAC/rehabilitation). Most facilities had an ADC of &lt; 50 (&lt; 26: 46, 26-50: 44, 51-100: 17, 101-200: 7, 201-500: 8). The mean (+ STD) compliance within all hospitals was 81.7% (+ 5.1%). A significant difference in compliance with accreditation requirements was found based on hospital type (p&lt; 0.001) and ADC (p&lt; 0.001). Rehabilitation and LTAC hospitals had the highest compliance rates of 89% and 83%, respectively. When assessed by ADC, the lowest compliance rates were found in hospitals with less than 26 beds (78.8%).
The top five needs with &lt; 75% compliance included documentation of program outcomes, documentation of evidence-based use of antibiotics in all departments and services of the hospital, reporting progress towards antibiotic stewardship goals and initiatives to hospital leadership, evaluating adherence to an evidence-based guideline, and providing competency-based education to hospital staff.

Conclusion
This standardized survey identified ASP gaps based on accreditation requirements and identified key areas for improvement. Interestingly, LTACs and rehabilitation hospitals had the highest compliance rates of all facility types; however, the largest post-acute system within the pharmacy managed hospitals, which accounted for 84.4% of all LTAC and rehabilitation hospitals, has a system-level antimicrobial stewardship committee as well as a dedicated infectious diseases pharmacist.

Disclosures
Katherine M. Shea, PharmD, BCIDP, T2 Biosystems: Advisor/Consultant