bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1762. Assessing the Clinical Impact of Carbapenem Pre-authorization in a High ESBL Prevalence Setting: A Focus on the Middle East
Authors: Nuaman Amna , El Lababidi Rania M , El Nekidy Wasim S , Abidi Emna 
Published: January 2025

Abstract

Background
Hospitals commonly employ preauthorization as a strategy to optimize carbapenems utilization. However, there is paucity of data regarding carbapenem restriction in environments with a high prevalence of extended-spectrum beta-lactamase (ESBL) organisms. This study aims to assess the impact of implementing a preauthorization policy for carbapenems on patient clinical outcomes and appropriateness of use.

Methods
An observational retrospective cohort study comparing data collected for patients from pre-restriction period between December 2021 and May 2022, and post-restriction period between June 2022 and December 2023 who were prescribed carbapenems including ertapenem or meropenem. The restriction policy was implemented in June 2022. We included adult patients ( &gt; 18 years old) with active infections in acute care units (ACU).

Results
A total of 244 patient were included in the study with 131 in pre implementation period and 113 in post implementation period. The appropriate indication of carbapenems use was significantly higher in the post-restriction group 69.9% (79) vs the pre-restriction group 55.7% (73) (P=0.025). No significant difference was found between the two groups in terms of appropriateness of treatment duration (P=0.425). Antibiotic de-escalation was significantly higher in the pre-restriction group 60.3% (79) vs the post-restriction group 35.4% (40) (P&lt; 0.001). The 30-day all cause mortality was significantly lower in the post-restriction group 7.1% (8) vs the pre-restriction group 19.8% (26) (P=0.005). Length of hospital stay (LOS) was significantly lower in the post-restriction group compared to the pre-restriction group; 6 vs 9 days (P=0.002). Furthermore, the 30-day readmission rate was 32.1% (42) of patients in the pre-restriction group vs 20.4% (23) in the post-restriction group (P=0.043).
Table 2

Conclusion
Despite ESBL high prevalence, preauthorization policy for carbapenems prescription showed efficacy to optimize their use in terms of, both, appropriateness, and duration. Lower 30-day mortality, LOS and readmissions within ACU patients also confirmed better clinical outcomes. Larger studies are needed to corroborate these findings.

Disclosures
All Authors: No reported disclosures
P-1767. Understanding Antibiotic Prescribing Practices by utilizing WHO's AWaRe Criteria in a tertiary care hospital in South India: A Prospective Observational study
Authors: Dorairajan Suresh Kumar , Roshni M , Hassan Suhail , Dharan Rithik , Narayanan Sathya , Angel jenifer F 
Published: January 2025

Abstract

Background
Antibiotic resistance is a significant threat globally and the inappropriate use of antibiotics leads to subsequent rise in the antimicrobial resistance causing challenge in antimicrobial stewardship programs [AMS]. Assessment of Antimicrobial use by using World health organization [WHO] categorization of Antibiotics into ACCESS, WATCH, RESERVE [AWaRe].

Methods
The prospective Observational study was conducted in a tertiary care hospital in the period of one month APRIL [01.04.24 -30.04.24] using a tool containing patient’s demographic data, AWaRe classification, their indications, culture reports and prescribing practices in hospitalized patients

Results
out of 1236 hospitalized patients 246 patient receive antibiotics. The results of the collected data in the following table
ANTIBIOTIC CATEGORY- ACCESS – (33.3%)WATCH – (63.4 %)RESERVE – (3.25%)DoxycyclineMetronidazole6.9%2.1%CeftriaxoneCefuroximePiperacillin - TazobactumCefoperazone – SulbactumMeropenem28.1%24.8%22.4%13.8%7.3%FosfomycinTigecyclineLinezolid0.81%0.4%0.4%ID REFERENCEYes26.3%No74.6%INDICATIONSEmpirical30.5%Definitive16.3%Prophylaxis48.9%Empirical to Definitive6

Conclusion
The data indicates a predominance use of antibiotics in the "Watch" category, with Ceftriaxone (28.1%), Cefuroxime (24.8%), and Piperacillin-Tazobactam (22.4%) being the most commonly used antibiotics and most of the antibiotics are given Empirically (30.5%) . A quarter of antibiotics are referenced in Infectious Disease. This highlights the importance of careful antibiotic stewardship to combat antimicrobial resistance and ensure effective treatment.

Disclosures
All Authors: No reported disclosures
P-1769. Improving Surgical Prophylaxis for Patients with Penicillin Allergy Label
Authors: Sharara Sima L , Dzintars Kate , Klein Eili , Fabre Valeria , Cosgrove Sara E 
Published: January 2025

Abstract

Background
Patients with a penicillin allergy label (PAL) have an increased risk of surgical site infection when receiving a β-lactam alternative for surgical prophylaxis. The updated 2022 Drug Allergy Parameters support the use of cefazolin for patients with a penicillin allergy history including anaphylaxis. We evaluated antibiotic use for surgical prophylaxis in a large academic center.

Methods
We performed a quality improvement intervention to decrease inappropriate use of non-β-lactam antibiotic surgical prophylaxis in patients with PAL at a 1091-bed tertiary hospital. Beginning in 10/2018, we provided education at anesthesia grand rounds and surgical safety meetings regarding preferential use of cefazolin in patients without severe PAL. In 12/2023, we updated institutional guidelines to recommend cefazolin use in all patients except those with history of anaphylaxis to cephalosporins, isolated hives to cefazolin, and β-lactam-associated severe cutaneous drug reactions. This was communicated to anesthesia and surgery stakeholders. Peri-operative antibiotic prophylaxis alert cards were hung in the operating rooms (Figure 1) and clindamycin and gentamicin were removed from OR medication-dispensing machines (ORMD).

Results
There was a significant decrease in clindamycin use from 11.2% in the pre-education period to 6.2% after education, further reduced to 1.7% since updating institutional guidelines and removing clindamycin and gentamicin from ORMD. Concurrently, cefazolin use increased from 9.0% to 26.0% to 39.5% in the same periods (Figure 2). This was seen across surgical services (Figure 3). Decreases were also seen in gentamicin use. There was no significant change IV vancomycin use as an alternative for patient with PAL. There was no increase in episodes of perioperative anaphylaxis related to these interventions.

Conclusion
There remains significant opportunity to optimize surgical prophylaxis for patients with PAL. QI efforts such as acquiring stakeholder support and development and dissemination of teaching materials were effective in reducing suboptimal perioperative antibiotic prophylaxis. Informative posters at point of care and removal of clindamycin and gentamicin from OMRD further reduced inappropriate surgical prophylaxis in patients with PAL.

Disclosures
All Authors: No reported disclosures
P-1770. Antimicrobial Stewardship: Usage of AWaRe Classification for justification of antibiotic therapy in a tertiary care hospital in South India
Authors: Hassan Suhail , Roshni M , Dharan Rithik , Narayanan Sathya 
Published: January 2025

Abstract

Background
Antibiotic resistance, a consequence of the overuse and inappropriate use of antibiotics, poses a significant global health threat, endangering our ability to effectively treat bacterial infection. Utilizing the WHO,s categorization of antibiotics into Access, Watch, and Reserve (AWaRe) for justification provides a structured approach for assessing antimicrobial use, thereby facilitating the identification of areas for improvement and the implementation of effective antimicrobial stewardship programs (AMS).

Methods
This Prospective Observational study was conducted in a Tertiary care hospital in South India in the month of APRIL 2024 using a tool containing patient’s demographic data, drug chart , indications, culture reports and justification column.

Results
Out of 1046 patients 246 patient were receiving antibiotics in which the study revealed that a majority of antibiotics fell into the WATCH (63.4%), followed by ACCESS (33.3%) and RESERVE (3.25%) categories. Among the antibiotics prescribed, Ceftriaxone (28.1%), Cefuroxime (24.8%) and Piperacillin-Tazobactam (22.4%) were most frequently used. Conversely, Fosfomycin, Tigecycline, and Linezolid were prescribed less frequently, each constituting less than 1% of prescriptions. Analysis showed that 164 patients (66.6%) received antibiotics without justification, while 84 patients (33.4%) received justified therapy. Regarding patient referral, 26.3% were referred with an ID reference, while the majority (74.6%) were not. Indications for antibiotic use varied, with empirical treatment being the most common (30.5%), followed by prophylaxis (48.9%), and definitive treatment (16.3%). A smaller percentage of cases transitioned from empirical to definitive treatment (6.2%).

Conclusion
In summary, the majority of prescriptions fell under the WATCH category (63.4%), with common antibiotics like Ceftriaxone and Cefuroxime being frequently prescribed. A significant portion (66.6%) of prescriptions lacked justification, highlighting the need for improved antimicrobial stewardship. The low rate of infectious disease referrals suggests potential gaps in consultation. Targeted interventions are necessary to rationalize prescribing practices and address the threat of antimicrobial resistance.

Disclosures
All Authors: No reported disclosures
630. Sustained reduction of meropenem use in a tertiary-care pediatric service in Medellín, Colombia
Authors: Diaz Diaz Alejandro , Echavarria-Gil Adriana M , Jimenez Carolina , Gonzalo Mesa-Monsalve Juan 
Published: January 2025

Abstract

Background
Carbapenems are the widest spectrum antibiotics, categorized as a Watch group in the AWaRe classification tool by the World Health Organization, which recommends limiting its use only to certain specific infections. In settings where circulation of multidrug resistant Gram-negative organisms is common, overuse of carbapenems might occur which leads to additional costs and harm. Antibiotic stewardship programs (ASP) have demonstrated impact on antibiotic use in the hospital setting. We describe the impact of the ASP in meropenem use in children at a large public hospital.
P: period; DOT: days of therapy

Methods
Single-center (largest regional public hospital: 450-bed (110 pediatric (55 NICU + neonatal ward – 55 PICU + pediatric ward), retrospective observational study. ASP was established in late 2014. Initial strategies included weekly hand-shake antibiotic rounds led by a pediatric infectious disease physician. Multimodal ASP was implemented hospital-wide in 2016. During 2017 to 2019 a surge in resistant Enterobacter spp invasive infections occured in the NICU, which affected antibiotic treatment temporarily. Hence, we divided Observation period from 2015 – 2023 in four periods (P): P1 2015-2017: ASP establishment; P2 2017-2019: increase in invasive infections caused by Enterobacter spp resistant to cephalosporins; P3 2020: COVID-19 pandemic; P4 2021-2023: post-pandemic (figure 1). Meropenem consumption was measured with days of therapy (DOT). We used descriptive statistics for analysis.

Results
Meropenem use increased significantly during P1 (DOT 9.05 [5.8-16] and P2 (DOT 19.5 [15.2-24.3]; p&lt; 0.01). Reinforcement of infection control measures and updated antibiotic guidelines with restricted meropenem indications with pre-authorization by the ID team led to sustained decrease of meropenem use after P2. This trend was not affected by COVID-19 pandemic (P3 DOT 10.7 [6.8-12-8] and P4 DOT 1.1 [0-3]; p ≤ 0.01). The number of highly resistant Enterobacter isolates also decreased over time while ESBL rates remained unchanged (Figure 2 & 3).
ESBL: Extended spectrum beta-lactamase

Conclusion
ASP and infection control policies led to a significant and sustained decrease in meropenem use in our pediatric service. Leadership, administrative support, teamwork, and continued education are important to achieve goals in antibiotic consumption.

Disclosures
All Authors: No reported disclosures
P-1794. Evaluating the Impact of a Pharmacy Technician in an Antimicrobial Stewardship Program
Authors: Onsrud Jennifer , Hammer Katie Lynn , Kelly Susan , Davidson Lisa , Pasquale Tim , Bear Susan 
Published: January 2025

Abstract

Background
The use of a Certified Pharmacy Technician (CPhT) in clinical roles can optimize and expand pharmacy services. Across our integrated health care system, ceftriaxone is the most utilized inpatient antibiotic. Traditional antibiotic stewardship program (ASP) pharmacists focus on more broad-spectrum agents. To increase review of ceftriaxone, we implemented a novel ASP workflow with a CPhT conducting prospective audit of ceftriaxone.

Methods
The CPhT underwent training for ceftriaxone audits, documentation, and communication. Daily chart audits of ceftriaxone were completed with a clinical checklist (Figure 1) and eligible patients were sent to an ASP pharmacist who completed prospective audit and feedback. The primary outcome measure was inpatient administrations of ceftriaxone in days of therapy per 1,000 patient days present (DOT). The secondary outcomes were monthly CPhT audits, audits sent to a pharmacist, related interventions, and total interventions.
Figure 2

Results
The primary outcome is seen in Figure 2. Although not statistically significant, prior to intervention ceftriaxone use was rising and after intervention, rate of utilization stabilized. Secondary outcomes of monthly CPhT audits, audits sent to a pharmacist, and related interventions can be seen in Figure 3. The monthly average of 452 CPhT audits sent to a pharmacist resulted in 185 related interventions Total interventions in the ASP program during this one-year timeframe were 25,704, which is an 45% increase from the year prior. Using a conservative assumption of 5 mins of pharmacist time avoided per audit by using a CPhT, 62 hours of pharmacist time was saved each month.
Figure 3

Conclusion
Inclusion of a CPhT into a clinical role in ASP resulted in an increase in prospective audit and feedback of ceftriaxone and total interventions. The use of a CPhT optimized workflow and promoted stewardship of resources. In our experience, a CPhT can be a valuable member of an ASP team and may represent a new clinical role for further consideration. Further evaluation will focus on how this role can be expanded to further optimize stewardship metrics.
Figure 4

Disclosures
All Authors: No reported disclosures
P-1795. Antimicrobial Stewardship Knowledge, Attitudes, and Practices (KAP) Among Health Care Providers in a Community Hospital Network
Authors: Bouchard Jeannette , Dyer April , Johnson Melissa D , Davis Angelina , Anderson Deverick J , Ashley Elizabeth Dodds 
Published: January 2025

Abstract

Background
Drivers of inappropriate antimicrobial use (AU) and antimicrobial resistance (AMR) can be linked to deficiencies in prescribers’ knowledge, attitude, and practice (KAP) regarding antibiotics. Currently, KAP information in community hospitals throughout the United States (US) is not well known, and survey information is not standardized. Understanding clinicians’ KAP regarding AU and AMR may provide valuable information for improving antimicrobial stewardship (AS) efforts.Figure 1

Methods
Prescribers, pharmacists, nurses, and administrators at 40 community hospitals within the Duke Antimicrobial Stewardship Outreach Network (DASON) were invited to take an anonymous, voluntary, 41-question web-based IRB-approved AS KAP survey. This survey is an internationally validated tool translated for use in the US (www.oucru.org/wp-content/uploads/2023/10/KAP_tool.pdf). Responses were collected via REDCap from Feb – Apr 2024.Figure 2

Results
A total of 167 survey responses were received from 24 hospitals; 77 (46%) were pharmacists, 62 (37%) were nurses, and 16 (10%) were physicians. Respondents had a median of 15 years (15.3) of experience in their current healthcare profession and 8.5 years (14.3) in their current institution. Most respondents were familiar with AS (74.3%), strongly agree that antimicrobial overuse can cause harm (79.6%), and that appropriate antibiotic use can reduce AMR (74.3%) (Fig 1). More than half of the respondents who prescribe antibiotics agreed that education and feedback via peer comparison or direct feedback would improve their prescribing (Fig 2). Prescribing respondents also agreed that AS teams impact their antibiotic decisions (87.5%). 63% of prescribers and 46% of non-prescribers agreed antibiotics are overused at their institution. Providers were the most likely to agree AMR is a problem at their institutions (Fig 3).Figure 3

Conclusion
Healthcare workers within DASON were aware of the importance of AS and its effect on AMR and patient outcomes. Prescriber feedback was seen as a valuable educational tool, as most prescribers valued AS feedback and agreed feedback would improve antibiotic selection.

Disclosures
Melissa D. Johnson, PharmD MHS AAHIVP, Biomeme: Licensed Technology|Scynexis, Inc: Grant/Research Support|UpToDate: Author Royalties Elizabeth Dodds Ashley, PharmD, MHS, HealthtrackRx: Advisor/Consultant|UpToDate: Royalties
P-1797. Implementation of a Handshake Stewardship Pilot for Inpatient General Medicine Teams at an Academic Medical Center
Authors: Stromberg Joseph , Marx Ashley H , Mavrogiorgos Nikolaos 
Published: January 2025

Abstract

Background
Handshake stewardship is an approach to antimicrobial stewardship that relies on in-person discussions between ASP teams and primary inpatient teams. This model has been implemented in pediatric and intensive care settings, and outcomes have been described in observational studies. In November 2023, UNCMC implemented a handshake stewardship pilot with crossover design for select inpatient general medicine teams.

Methods
Three pairs of matched inpatient general medicine teams at UNCMC were selected, with one team from each pair included in a three month intervention period. After three months, the teams were switched. The intervention consisted of twice weekly meetings of ASP physician and/or pharmacist and primary teams, during which antimicrobial regimens of all patients were reviewed except those with an ID consult. The intervention was delivered via in-person meetings for the two pairs of teams located at UNCMC, and via teleconference for a pair of teams located on a separate campus. The remote teams withdrew from the pilot during the intervention period. Recommendations made were catalogued as iVents in the Epic EMR and electronic surveys were circulated to primary team providers.

Results
287 patients were reviewed across 95 meetings to date, yielding 73 recommendations. Common themes included narrowing coverage and transitioning to oral agents, although in some cases ASP teams recommended broadening therapy or a formal ID consult (Figure 1). 93% of recommendations were implemented. Survey data from 23 participants showed positive attitudes (Figure 2), with many valuing the opportunity to discuss patients that didn’t require a formal ID consult. Survey feedback from the virtual team included frustration with cessation of in-person ID consults at the site (unrelated to this pilot).

Conclusion
Handshake stewardship with in-person meetings has been well-received at UNCMC based on logged interventions and provider surveys, although the virtual component was unsuccessful. A planned crossover comparison between teams and paired controls will be helpful in assessing whether this has had an impact on antimicrobial use. Facilitating successful virtual handshake ASP will require improved coordination of meeting times and ensuring adequate access to in-person ID consults.

Disclosures
All Authors: No reported disclosures
P-1798. Acceptability and Feasibility of Inpatient Group-Level Feedback to Prescribers About Antibiotic Appropriateness for Community-Acquired Pneumonia: A Survey Study
Authors: Chiotos Kathleen , Dutcher Lauren , Lautenbach Ebbing , Neuhauser Melinda M , Hamilton Keith W , Grundmeier Robert , Gerber Jeffrey S , Szymczak Julia E 
Published: January 2025

Abstract

Background
Feedback on antibiotic prescribing is less commonly used in inpatient settings than outpatient. Our objective was to evaluate the acceptability and feasibility of group-level feedback on antibiotic appropriateness for community-acquired pneumonia (CAP) in two United States hospitals.

Methods
We conducted a cross-sectional survey of medicine and pediatrics prescribers who received monthly feedback on antibiotic selection and duration for patients with CAP shared in meetings and by email. The survey was administered from April 2023 to March 2024 and included the validated acceptability of intervention measure (AIM) and feasibility of intervention measure (FIM). Each consists of 4 items scored 1-5 and is reported as a mean total score (5-20), with higher scores indicating greater acceptability and feasibility. Data were analyzed using descriptive statistics.

Results
Of 289 eligible prescribers, 36 (12.5%) completed the survey: 28 (77.8%) physicians and 8 (22.2%) advanced practice providers. Engagement with reports was high: 30/35 (85.7%) looked at the reports, and 22/35 (62.8%) attended meetings discussing the report. The majority (25, 69.4%) liked the feedback reports, while 3 (8.3%) disliked the reports, 4 (11.1%) were unsure and 4 (11.1%) did not recall. The majority (n = 26; 76.5%) trusted the reports accurately captured performance. Thirty-four respondents (94.4%) believed the metrics were clinically meaningful, and the majority found them easy to understand: 34 (94.4%) understood choice, while 36 (100%) understood duration. Twenty respondents (55.6%) believed the reports changed how they prescribed, while 9 (25.0%) were unsure. Sixteen respondents (44.4%) believed the reports changed how their colleagues prescribe, while 17 (47.2%) were unsure. Mean totals (SD; range) for acceptability and feasibility were AIM, 17.2 (3.5; 8-20) and FIM, 17.7 (3.1; 8-20).

Conclusion
Although the low response rate may limit generalizability, inpatient clinicians perceived that group-level feedback on antibiotic appropriateness for inpatients with CAP was acceptable and feasible to implement. Clinicians who responded to the survey understood the metrics, found them clinically meaningful, and some felt they influenced prescribing.

Disclosures
All Authors: No reported disclosures