bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1681. Determining Appropriateness of Pneumonia Treatment in Long-Term Care Facilities Pilot Project
Authors: Adre Cullen , Patel Dipen , Wren Callyn , Dao Quynh Nhu , Wilson Christopher , Evans Christopher D 
Published: January 2025

Abstract

Background
In 2019 IDSA updated the guidelines for community-acquired pneumonia (CAP). To date there are limited AU data in long-term care facilities (LTCFs). The Antimicrobial Appropriateness for Pneumonia in LTCFs (AAPL) Project was developed to determine which antibiotics are most used and their appropriateness in treating pneumonia (PNA) in TN LTCFs using a modified National Antimicrobial Prescribing Survey (NAPS) tool.

Methods
We recruited five LTCFs to collect retrospective PNA data from January 2023 to February 2023. Pharmacy students collected data for residents meeting a proposed PNA surveillance definition or with a written PNA diagnosis and entered into a REDCap database. Cases were reviewed and scored by two independent reviewers with an appropriateness score based on the NAPS tool (5 = not assessable, 3/4 = inappropriate, and 1/2 = appropriate). Descriptive statistics were used to analyze AAPL data and analyses performed on SAS Version 9.4.

Results
Thirteen cases were identified and reviewed; two were excluded due to no antibiotics received in the LTCF. Every chart had a written PNA diagnosis with 54.6% CAP and 18.2% HAP. 17.7% of cases had positive chest X-ray, 15.7% had acute decline in at least one daily living activity, and 11.8% had leukocytosis. 84.6% of cases (n=10) had MRSA risk factors). The most common antibiotics used were amoxicillin/clavulanate, ceftriaxone, and levofloxacin. The average duration of therapy was 7 days. 54.5% of antibiotics were appropriate (n=6), 36.4% were inappropriate (n=4), and 9% were not assessable (n=1). Nine cases had agreement on appropriateness, while two cases needed a third adjudicator to review.

Conclusion
The most common antibiotics used reflect current PNA guidelines, however only 54.5% were labeled as appropriate. Average duration was found to be longer than 2019 guideline recommendations (5 days of treatment with clinical stability). The data and experience from the pilot can be used to focus stewardship efforts on shorter durations with clinical stability, improve the survey tool, and build facility specific reports to improve prescribing practices with current PNA guidelines.

Disclosures
All Authors: No reported disclosures
P-1696. Antibiotic consumption and resistance among admitted patients with urinary tract infection in the Philippines: Results from a longitudinal Global Point Prevalence Survey
Authors: De los Reyes Mari Rose Aplasca , Garcia Jemelyn , Pauwels Ines , Versporten Ann , Bo Rhenalyn V , Vlieghe Erika 
Published: January 2025

Abstract

Background
Urinary Tract Infection (UTI) is a common diagnosis among hospitalized patients for which Escherichia coli (E.coli) is the most common etiologic agent. Recently, increasing antimicrobial resistance of E. coli to common antibiotics has been reported in the Philippines. We describe the prevalence of antimicrobial use for UTI in Philippine hospitals from 2017-2022 and compare this with the antimicrobial resistance pattern of urinary E. coli generated by the Department of Health, Antimicrobial Resistance Surveillance Program.

Methods
Since 2017, the Philippines has been conducting point prevalence surveys (PPS) on antimicrobial consumption using the standardized and validated methodology of the Global-PPS. All admitted patients on antimicrobials at 8 AM on the day of the survey were included. Type of infections and their corresponding antimicrobial prescriptions were recorded.

Results
Data were collected in 62 hospitals in the Philippines. Overall, three percent (N= 2242; 3.3%) of patients admitted in Philippine hospitals on the day of the PPS were treated with antimicrobials for UTI (lower UTI: 1,8%, upper UTI:1.5%). Ceftriaxone, cefuroxime, piperacillin-tazobactam, ciprofloxacin and meropenem were the top five antibiotics used (table 1), all of which are classified under the WATCH list of the WHO AWaRe classification. Seventy-seven percent of all antibiotics were prescribed empirically. Based on the antimicrobial surveillance data of the Department of Health, the resistance rates of E. coli to these antibiotics were high with on average more than 40% resistance to cefuroxime, ceftriaxone and ciprofloxacin (figure 1).

Conclusion
There is an opportunity to strengthen hospital antimicrobial stewardship programs, with particular emphasis on pre-authorization and audit and feedback strategies. Consideration may be given to placing ceftriaxone, cefuroxime, and ciprofloxacin under restricted categories requiring approval by the AMS clinician prior to empiric use. Importantly, local antibiograms should be reviewed on a regular basis and should be used as a basis for empiric antimicrobial recommendations in hospitals. Repeated point prevalence surveys are needed to measure the impact of interventions implemented by hospital AMS committees.

Disclosures
All Authors: No reported disclosures
P-1701. Impact of a Clinical Pharmacist-Led Antimicrobial Stewardship Program on Antibiotic Utilization and Resistance Patterns in a Medical Intensive Care Unit: A Cohort Study
Authors: James Leena 
Published: January 2025

Abstract

Background
Antimicrobial resistance presents a formidable challenge in medical intensive care units (MICUs), where the overuse of broad-spectrum antibiotics is closely associated with the rise of drug-resistant bacteria. This study aimed to evaluate the impact of implementing a robust Antimicrobial Stewardship (AMS) program in a medical ICU setting.

Methods
From February 2022, an AMS program was initiated in the medical ICU which involved consistent involvement from both a clinical pharmacist and an infectious disease physician who conducted ongoing assessments and offered feedback. To gauge the effectiveness of the AMS program, outcomes were compared between the AMS period and the six months preceding its implementation (pre-AMS period). Primary metrics included the utilization of antibacterial agents, such as broad-spectrum beta-lactam antibiotics effective against Pseudomonas aeruginosa.

Results
The study included a total of 275 patients during both the AMS and pre-AMS periods, ensuring a balanced comparison. There were no significant disparities between the groups regarding disease severity and mortality rates. Noteworthy findings during the AMS period included a substantial decrease in the empirical use of broad-spectrum beta-lactam antibiotics targeting Pseudomonas aeruginosa (42.18% during AMS vs. 63.27% pre-AMS, p &lt; 0.001) and in multi-drug resistant organism (MDRO) infections (10.18% during AMS vs. 17.82% pre-AMS, p &lt; 0.001). Additionally, there was notable improvement in appropriate antimicrobial de-escalation for MDRO-positive patients during the AMS period (37.45% during AMS vs. 20.36% pre-AMS, p = 0.001). The utilization of polymyxin also decreased during the AMS period (17.09% during AMS vs. 34.55% pre-AMS, p = 0.034). Furthermore, there was a significant increase in the susceptibility of Gram-negative Bacilli isolates to broad-spectrum beta-lactam antibiotics effective against Pseudomonas aeruginosa during the AMS period.

Conclusion
The implementation of a comprehensive clinical pharmacist-led AMS program resulted in a substantial reduction in antibacterial agent utilization within a medical ICU setting.

Disclosures
All Authors: No reported disclosures
P-1703. Evaluation of Antibiotic Use for Dental Infections in Dental Clinics Associated with an Academic Safety Net Institution
Authors: Deaney Michael A , Cooper Margaret M , Jenkins Timothy C , Meyers Kimberly A , Shihadeh Katherine C 
Published: January 2025

Abstract

Background
In 2019, the American Dental Association (ADA) issued guidance on diagnostic criteria and appropriate antibiotic regimens for dental pain and swelling. Limited data exists on adherence to these guidelines. This study aimed to evaluate adherence to these guidelines within outpatient dental clinics.
Figure 1
A flowchart for assessing antibiotic indication, selection, dose and duration adapted from the 2019 American Dental Association (ADA) guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling

Methods
We electronically identified all antibiotic prescriptions written by dentists in seven outpatient dental clinics in Denver Health, an integrated academic safety net institution, from July 2022 to November 2023. Detailed medical record review was performed for 200 randomly selected patients who were prescribed an antibiotic to examine antibiotic indication, selection, dose, and duration. Assessment of whether the prescribed regimens adhered to guidelines was conducted using a flowchart adapted from the ADA guidance (Figure 1).

Results
Forty-nine dentists dispensed a total of 1,874 prescriptions at 114,231 clinic visits (1.6% of visits). In the 200 patients whose medical records were reviewed, common prescription indications were irreversible pulpitis (15.8%), pulp necrosis with apical abscess (14.3%), caries (14.3%), and concern for post-operative infection (12.8%). Pain was noted in 85.2% of cases, with a median pain scale score of six. Due to incomplete documentation, 46.9% of prescriptions were deemed as "indeterminate" for guideline-directed indication. Only 5.6% of the documented cases met full indication criteria for antibiotic use per ADA guidance. Antibiotic selection was consistent with ADA guidance in 81.6% of cases; amoxicillin was the most prescribed antibiotic (79% of cases), followed by clindamycin (9.5%) and amoxicillin-clavulanate (8%). Durations of therapy were longer than recommended in ADA guidance in 23% of cases. In total, only 3.1% of prescriptions adhered to ADA guideline-directed antibiotic indication, selection, dose, and duration.

Conclusion
An antibiotic was prescribed in &lt; 2% of dental clinic visits; while this rate aligns with previous literature, there is opportunity to improve adherence to ADA guideline-directed therapy for dental infections. Evaluation of effective stewardship interventions reinforcing these guidelines is warranted.

Disclosures
All Authors: No reported disclosures
592. Immunogenicity and Safety of High-dose versus Double-dose Quadrivalent Inactivated Influenza Vaccine in Adult Kidney Transplant Recipients: A Randomized Controlled Trial
Authors: Arayanumas Thanachote , Boonnak Kobporn , Kantachuvesiri Surasak , Boongird Sarinya , Kiertiburanakul Sasisopin , Bruminhent Jackrapong 
Published: January 2025

Abstract

Background
Both high-dose and double-dose inactivated influenza vaccines have been shown to better elicit a greater immune response compared to standard-dose influenza vaccine in solid organ transplant (SOT) recipients. However, a direct comparison between high-dose (HD) and double-dose (DD) quadrivalent inactivated influenza vaccine (QIIV) has not been explored.

Methods
From June to December 2023, we conducted an open-label randomized controlled trial to compare the immunogenicity and safety of the 2023 southern hemisphere HD QIIV at 60 ug (Effluelda, Sanofi) versus double standard-dose QIIV at 30 ug (Fluarix tetra, Sanofi) in adult kidney transplant (KT) recipients. Pre-immunization and 4-week post-immunization sera underwent strain-specific hemagglutination inhibition assays, and safety profiles were assessed.

Results
Eighty-four eligible KT recipients were randomly assigned to receive either HD QIIV or DD QIIV (42 each). Among them, 50 (59.5%) were male, with a mean age (SD) of 46 (11) years old, and 50 (60.7%) participants received kidneys from deceased donors. Common immunosuppressive regimens included mycophenolate mofetil (65.5%), tacrolimus (77.1%), and prednisolone (100%). SC to at least 1 strain was significantly greater in the HD QIIV group (95.2%) compared to the DD QIIV group (69%) (P = 0.006). The SC rate for A/H1N1, A/H3N2, B/Victoria, and B/Yamagata strains was higher in the HD QIIV group compared to the DD QIIV group, with the following percentages: 69.1% vs 52.4%, 52.4% vs 38.1%, 52.4% vs 42.9%, and 61.9% vs 40.5% (P = 0.118, P = 0.188, P = 0.382, and P = 0.049, respectively). In multivariate analysis, SC to at least 1 vaccine strain was significantly associated with the use of HD vaccine (OR 17.59, 95% CI [2.10, 147.22], P=0.008) and receiving the vaccine after 1-year post-KT (OR 34.76; 95% CI [2.59–454.45], P=0.007). There were significantly fewer occurrences of pain at the injection site and muscle ache in the HD QIIV group compared to the DD QIIV group, with the following percentages: 4.8% vs 19.0%, and 0% vs 9.5% (P = 0.040 and P = 0.043, respectively).

Conclusion
HD QIIV could marginally elicit a more pronounced immune response, alongside a comparatively reduced occurrence of adverse reactions, in adult SOT recipients when compared with DD QIIV. TCTR20230510005.

Disclosures
All Authors: No reported disclosures
P-1716. Assessing Appropriateness of Cephalosporins Prescription in a Tertiary Care Hospital in South India
Authors: Dharan Rithik , Dorairajan Suresh Kumar , Hassan Suhail , Roshni M 
Published: January 2025

Abstract

Background
Cephalosporins plays a vital role in empirical therapy. Unfortunately the misuse & underuse of 3rd Generation Cephalosporins (3GCs) has triggered a concerning rise in ESBL-producing Enterobacterales, with resistance rates as high as 80-85% in India. If this ongoing misuse continues, it poses a serious threat to the efficacy of these vital antibiotics. This cross-sectional study aims to evaluate the appropriateness and utilization of Cephalosporins in a tertiary care hospital in South India.Table 1:Factors for the initiation of Cephalosporins

Methods
In April 2024, a cross-sectional study was conducted by Pharm D interns assisted with Infectious Disease Specialists. Patients admitted as IP who received Cephalosporins until discharge are included. Patients receiving other than Cephalosporins are excluded from the study. Therapy appropriateness was determined using the Sanford Antimicrobial Guide 2022. Simple statistics are done in Excel for analysis.Table 2:Assessment of the initiated Cephalosporins

Results
Of 1376 patients, 428 (31.1%) patients received antimicrobial therapy of that Cephalosporins were prescribed to 226 patients (52.8%) for various indications. The most commonly prescribed was Ceftriaxone 139 (61.5%) prescriptions, followed by Cefuroxime 67 (29.6%), Cefixime 5 (2.2%), Cefazolin 5 (2.2%) & others 10 (4.4%). Reasons for initiating cephalosporins and analysis are given in Table 1 & Table 2. 3GCs are the most frequently used empirical antibiotic. A significant proportion (37.6%) of cephalosporin prescriptions lacked clinical infections. Empirical therapy continued beyond the 5th day 5.8 ± days following negative cultures, Duration of surgical prophylaxis exceeded than the recommended guidelines.

Conclusion
From the findings, Ceftriaxone dominated 61% of prescriptions for various indications, with one-third administered inappropriately via parenteral till discharge, mean duration 5.8 ± days. 37.6 % of the 3GC administered have been inappropriate also which has added additional costs to the patient. A knowledge gap among clinicians in discontinuation should be addressed by educational interventions with clinical pharmacists actively engaging to de-escalate cephalosporins. This single-centric study suggests the need for RCTs providing alternatives to cephalosporins for infections to prevent the risk of increasing ESBL resistance in India.

Disclosures
All Authors: No reported disclosures
P-1731. Assessing The Impact of an Electronic Health Record Embedded Treatment Algorithm and Order Set on Antipseudomonal Antibiotic Use in Diabetic Foot Infections
Authors: Acbo Antoinette M , McSweeney Terrence D , Bao Hongkai , Cowman Kelsie , Nori Priya , Guo Yi , Chang Mei H 
Published: January 2025

Abstract

Background
An opportunity to improve diabetic foot infection (DFI) management was identified based on institution-specific epidemiology and antibiotic use (AU) data. Pseudomonas aeruginosa prevalence was &lt; 15% upon review of 6,749 unique DFI cultures. However, skin and soft tissue infections were a leading indication for antipseudomonal antibiotics at our institution, driven by DFI. In response, a multidisciplinary team implemented an electronic health record (EHR)-embedded treatment algorithm and order set for DFI treatment.

Methods
This multicenter, quasi-experimental study was conducted at an urban, academic healthcare system in the Bronx, NY. Patients were included if they were 18 years of age or older on antibiotics for DFI admitted to vascular surgery or medical floors. Exclusion criteria included duplicate patients, concomitant infection, or transfer from outside hospital. The primary outcome was antipseudomonal AU rate defined as days of therapy (DOT) per 1000 days present. Secondary outcomes included empiric antipseudomonal use, length of stay (LOS), 30-day readmission, 30-day mortality, amputation rates, and C. difficile infection (CDI).

Results
The pre-intervention group included 70 patients, while the post-algorithm and post-order set groups included 35 patients each. Baseline characteristics are listed in Table 1. Antipseudomonal AU was significantly lower in the EHR-embedded treatment algorithm group compared to the pre-intervention group (333 vs 503, p &lt; 0.001); the post-order set group had the lowest antipseudomonal use (289 vs 503, p &lt; 0.001). Empiric antipseudomonal use decreased from 85.7% pre-intervention to 62.9% post-algorithm and 65.7% post-order set (Table 2). Hospital LOS, 30-day mortality, and amputation within 30 days were similar between groups. No CDI occurred. The most frequently isolated bacteria from DFI cultures were Staphylococcus aureus and Streptococcal species (Figure 1).

Conclusion
EHR-embedded clinical decision-making tools can effectively reduce antipseudomonal AU for the treatment of DFI without increased risk of 30-day mortality or amputation.

Disclosures
All Authors: No reported disclosures
P-1741. The CArbapenem Sparing Antimicrobial Stewardship (CASAS) Project: an innovative approach to reduce carbapenem consumption in low-users hospital settings
Authors: Bongiovanni Marco , Barda Beatrice , Di Benedetto Caroline , Elzi Luigia , Mombelli Matteo , Ramponi Niccolò , Bernasconi Enos 
Published: January 2025

Abstract

Background
One of the main objective of the Antimicrobial Stewardship programmes (ASp) is the optimization of antibiotic use, reducing the use of broad spectrum antibiotics when unnecessary. In this context, the close monitoring of carbapenem consumption is mandatory.

Methods
The CASAS Project started in January 2024 in 4 public Hospitals (for a total of approximately 1000 beds) in Southern Switzerland, a region with a low prevalence of multi-drug-resistant bacteria (MDR) and with a low use of carbapenem treatments (CAR-T). An electronic alert was sent to the Infectious Diseases (ID) Team after 96 hours of continuous CAR-T; at that point, an ID specialist review was performed in order to confirm or not the CAR-T. For patients who continued CAR-T ID consultation was repeated every 72 hours until stopping. Parameters included in the consultation were: empiric or targeted treatment, type of carbapenem (meropenem, imipenem or ertapenem) and duration, outcome (confirm CAR-T, stop or switch to other drug), microbiological results, septic shock, admission to ICU, hospitalization in the previous 3 months, source of infection and known colonization with MDR. A descriptive analysis of these parameters was performed and finally we compare the Defined Daily Dose (DDD) of each carbapenem in the first trimester of 2023 and 2024.

Results
A total of 290 consultations were performed between Jan 1 and Mar 31, 2024 (184 first and 106 follow-up visits). Meropenem was the most used CAR-T (n=151) for a median duration of 13 days (4-14). Table 1 summarizes the other parameters considered in the analysis. An overall reduction of DDD for carbapenems was observed (overall DDD: 2023: 2372.6; 2024: 2026.5, -14.6%). When splitting the results for the single carbapenem, the main reduction was observed for meropenem (DDD 2023: 1563.7; 2024: 1236.4, -20.9%); the reduction for imipenem and ertapenem was -2.3% and -2.4%, respectively.

Conclusion
ASp should include a close monitoring of wide-spectrum antibiotic treatment, including carbapenems. In our setting, the CASAS Project was associated with a rapid reduction in CAR-T also in low-users hospitals. The long-term implementation of similar projects could have a beneficial impact on the prevalence of multi-drug resistance infections.

Disclosures
All Authors: No reported disclosures
P-1747. Cost Avoidance Analysis of Outpatient Parenteral Antimicrobial Therapy (OPAT) Plan Reconciliation on Patients Enrolled in Value-Based Payment Models at an Academic Hospital
Authors: Ross Jennifer , Boeser Kimberly , Hordyk Matt , Manhani Bhupinder , Hirsch Elizabeth B , Evans Michael , Sieling William D , Kline Susan E , Galdys Alison 
Published: January 2025

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) has many potential benefits, including avoidance of hospitalizations, reduced length of stay, and prevention of hospital-associated conditions. However, suboptimal OPAT delivery can result in readmissions and emergency department (ED) visits—outcomes that are unfavorable for patients and disincentivized within value-based care (VBC) models. Structured OPAT programs have been shown to decrease unscheduled healthcare use. Total cost of care (TCOC) analyses for OPAT program justification have not been well described. We therefore analyzed TCOC for a cohort of OPAT recipients enrolled in VBC pre- and post-implementation of OPAT plan reconciliation in June 2020.

Methods
Unique, adult OPAT patients discharged to home or post-acute care facilities from an academic hospital between 6/2019 and 6/2022 were included. Infectious diseases (ID) pharmacist reconciliation of OPAT plans prior to hospital discharge launched on 6/14/2020; all OPAT recipients discharged on or after this date were included in the post-implementation cohort. Average one-year post-intervention TCOC avoidance per patient was calculated using patient charges, a proxy for payor cost. The percentage of patients enrolled in a VBC plan was determined to calculate implied TCOC reduction annually.

Results
Nine hundred sixty-two OPAT patients were included: 198 pre- and 764 post-implementation. Fewer patients were included in the pre-intervention group given unretrievable financial data due to archiving rules. In our cohort, 16.9% of patients were enrolled in a VBC plan. Both pre- and post-intervention cohorts showed an increase in TCOC after index OPAT hospitalization; pre-intervention at 155% and post at 29%. This yielded a post-intervention average one-year cost avoidance of $15,754.55/patient. Based on our institution’s historical OPAT volume of 950 patients cared for annually, these data equate to an implied TCOC reduction of $2,529,409/year.

Conclusion
Implementation of formal ID pharmacist reconciliation of OPAT plans generated significant cost avoidance amongst OPAT patients enrolled in VBC plans. This is evidence that outcomes incentivized by VBC models align with outcomes facilitated by structured OPAT programs.

Disclosures
Jennifer Ross, PharmD, BCIDP, Shionogi Inc.: Advisor/Consultant Elizabeth B. Hirsch, PharmD, FCCP, FIDSA, GSK: Advisor/Consultant|GSK: Honoraria