bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1751. Why do we call in the Blues (and Purples)? Critical Result Reporting of Gram Stains for Gram Positive Cocci in Blood Cultures
Authors: Fischer Julia , Lorenzo Michael , Schimmel Jennifer 
Published: January 2025

Abstract

Background
Gram positive cocci (GPC) in blood cultures (BLCX) can represent pathogens or contaminants. Many laboratories notify care teams of a positive BLCX with the gram stain as a critical results report (CRR). However, PCR results about 90 minutes later and can provide useful information to distinguish a contaminant from a pathogen. The present study describes healthcare utilization surrounding CRR of gram stain result without the PCR result.

Methods
Retrospective observational study of patients with positive BLCX. Patients were excluded if their BLCX had yeast, polymicrobial growth, a gram-negative organism, or were &lt; 18 years of age. Clinical and healthcare utilization information was collected using the electronic medical record. We defined the following as “true pathogens” (TP): MRSA, MSSA, Enterococcus, Streptococcus pyogenes, Streptococcus agalactiae and Streptococcus pneumoniae. We also defined TP as a coagulase-negative staphylococcus or other Strep species with 2/2 positive BLCX with intraarticular or endovascular hardware present and with 4 SIRS criteria. A “likely contaminant” (LC) was defined as coagulase negative staphylococcus or Strep species (not included in the initial TP definition) with 1-2 BLCX positive, with or without intraarticular or endovascular hardware present, and &lt; 4 SIRS criteria.

Results
Of 94 patients with BLCX positive for GPC, 54 were categorized as TP, and 40 as LC. 36 (67%) of patients with a TP on BLCX received vancomycin (VAN) before CRR and 19 (35%) received VAN after CRR. 12 (30%) patients with a LC on BLCX received VAN before CRR and 11 (28%) received VAN after CRR. For those not on VAN before CRR and were placed on VAN after the call, 10 (24%) had TP and (28%) had LC identified. Repeat BLCXs were performed in 93% of patients with TP and 83% of patients with LC. Infectious Disease (ID) consults were placed in 63% of TP and 73% for LC. Echocardiograms were performed in 57% for TP and 60% for LC.

Conclusion
Workup and treatment for GPC identified in BLCX were similar for TP and LC. VAN is being over-utilized for LC which could lead to patient harm. Unnecessary resources are being expended in the workup of LC. Using PCR results instead of the gram stain as the CRR may provide more complete information to providers to inform decision making.

Disclosures
All Authors: No reported disclosures
P-1764. Point Prevalence Study of Antibiotic Appropriateness and Economical Cost in a Tertiary Care Trauma Hospital of Northern India to Tailor Antibiotic Stewardship Interventions
Authors: Garg Rahul , Wankhade Archana B , Banerjee Tuhina 
Published: January 2025

Abstract

Background
Conducting Point prevalence surveys (PPSs) is challenging, especially in developing countries, in the absence of electronic records, lack of dedicated resources and high patient load. This survey was conducted to provide background data for strengthening antimicrobial stewardship(AMS) practices and estimate the economic cost of antimicrobial resistance per antibiotic consumed in a tertiary care trauma hospital in India.
Summary of Quality indicators of antibiotic prescribing (in %)

Methods
The survey included all inpatients admitted in wards and intensive care units of the hospital (300 beds) during World Antibiotic Awareness Week 2023. Standardised modules were adopted from the Global PPS for collecting data on patient demographics, prescribed antimicrobial agents with dosage, indication(s) and duration of treatment, and microbiolgical results. Further, the cost minimization analysis was carried out to assess the treatment cost and variations in costs arising due to generic or branded prescribing.

Results
Among the 254 patients admitted, the patients treated with at least one antimicrobial was 88.6% (N=225). The median (IQR) day of hospitalization was 7 (3.75) days. The highest prevalence of antimicrobial use was in the ICU (100%), followed by Emergency medicine (97.5%). The majority of patients received empiric than targeted antimicrobial therapy. Antimicrobial prescription was mostly for surgical prophylaxis (49.04%). Among patients for &gt;7 days on treatment, microbiological culture were sent in 16.7% (5/30) patients. Antibiotic quality indicators such as reason in notes and documentation of review date were comparatively lower (Figure-1). Treatment costs varied significantly with prescriptions of maximum and minimum-priced brands, ranging from 69.81%-1490%. Branded therapy were three times costlier than generic therapy in 36 (52.9%) regimens.

Conclusion
Poor transition from empiricism to rationalism, continuation of surgical prophylaxis for more than one day and underutilization of microbiological tests were noted. There was large variations in treatment cost of infections depending on regimen chosen. Adherence to local antibiotic policy, optimal dosing and regular audit with positive feedback of antibiotic use to treating physician can be useful approaches to implement the AMS Program in the study centre.

Disclosures
All Authors: No reported disclosures
P-1781. Development of an Inpatient Pharmacist-Driven Penicillin Allergy De-Labeling Protocol
Authors: Anderson Brandon , Herstine Emily , Gens Krista 
Published: January 2025

Abstract

Background
Up to 10% of the US population reports a penicillin allergy. However, when further tested, over 95% of these patients could tolerate a penicillin. Unnecessary avoidance of penicillins results in more broad antibiotic treatment, leading to several worsened patient outcome, including increases in resistance, C. difficile rates, mortality, cost, and more.
Example Inpatient Penicillin Allergy De-Labeling Protocol
Visual representation of an example penicillin allergy de-labeling protocol

Methods
Key penicillin allergy de-labeling protocol development steps included assessment of local penicillin allergy prevalence, identification of key stakeholder groups, effectively communicating why de-labeling is important, and incorporating feedback from each stakeholder group into protocol language. Operational considerations included creation of standardized order sets and documentation tools, as well as defining scope and prioritization of patients by determining who is most likely to benefit from de-labeling. The last step was development of educational materials for pharmacists and nurses to effectively use the protocol, as well as patient education materials.

Flowsheet outlining documentation requirements, including standardized allergy comments, progress note templates, and after visit summaries

Results
The Allina penicillin allergy de-labeling protocol was developed through collaborative efforts of pharmacy, infectious disease, allergy, and nursing. Within the protocol, patients with penicillin allergies listed in their charts are interviewed by a pharmacist, who calculates a PEN-FAST risk score. Patients with reactions that are consistent with intolerance rather than allergy may have their allergy removed without further testing. If reactions are consistent with allergy, but their PEN-FAST risk score is low (0-2), patients are eligible to complete an oral amoxicillin challenge. If PEN-FAST risk score is moderate to high (3-5), patients are eligible for referral to outpatient allergy for further testing.
De-Labeling Protocol Development Process
Example roadmap that can be used to develop a penicillin allergy de-labeling protocol in nearly any healthcare setting

Conclusion
The penicillin allergy de-labeling protocol was approved system-wide through pharmacy and nursing committees and will soon be rolled out to individual sites. This example may serve as a roadmap for development of penicillin de-labeling programs in other health systems and could be adapted as needed to work effectively in many healthcare settings.

Disclosures
All Authors: No reported disclosures
P-1791. Low Utilization of Methicillin-Resistant Staphylococcus aureus Screening in Orthopedic Surgeries
Authors: Huerta-Vera Genesis S , Green Lauren , Parimi Kavya , Chaudhary Nabihah A , Wein Megan , McCormick Pamela J , Pursglove Marci L , Arbulu Ricardo 
Published: January 2025

Abstract

Background
Guidelines recommend screening for methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization to identify patients undergoing orthopedic implants who may benefit from perioperative vancomycin. Culture-based MRSA screening may take days to result, yet it is the only technique available in many centers, including ours. Therefore, we investigated the proportion of cases in which MRSA screening results are available at time of orthopedic implants at our center, and explored the rationale for perioperative choice when this information is absent.

Methods
We conducted a retrospective chart review of all consecutive patients 18 years or older who underwent orthopedic implant procedures for the calendar year 2023 at UPMC Mercy, Pittsburgh, PA. Patients undergoing multiple procedures within 24 hours were counted once. We report a preliminary analysis for 44% of the total population. Data was analyzed by MRSA screening status.

Results
In 251 surgeries performed in 247 patients, MRSA screening within one year prior to surgery was available only in 63 (25.1%). An additional 43 (17.1%) had results older than one year, while 145 (57.8%) had no MRSA screening. Patients that had MRSA available within a year did not defer from those with older or absent results in the proportion of emergent surgeries, types of surgeries, or perioperative prophylactic antibiotics received (Table 1). Only 43 (17.3%) patients had MRSA screen collected during the admission.
Only four patients received perioperative vancomycin, only one had a clear indication for this choice (Table 2). Of six patients with an indication for perioperative vancomycin, none received this antibiotic.

Conclusion
In patients undergoing orthopedic implants, MRSA screening results were available at time of surgery in less than half of cases, screening was infrequently ordered during the admission for surgery, and the results did not seem to affect the antibiotic choice. Non-systematic input from the three orthopedic surgeons with the highest volume at our center suggests this low utilization is due to: a. questioning the value of the screening and vancomycin prophylaxis, b. lack of systematization (of ordering, reviewing), and c. the perception that the results are unlikely to be available at the time of surgery.

Disclosures
All Authors: No reported disclosures
P-1792. Impact of Integrated Interventions of Prescriber Education and De-escalation Strategies on Implementing WHO Access: Watch Targets: Insights from a South Indian Tertiary Care Setting
Authors: Leelarani Martinraj Jasper Victoria , Samuel Bibila , Thomas Feba Mary , Senthil Harini , George Keren Ann 
Published: January 2025

Abstract

Background
The study aims to determine the Access: Watch ratio, as recommended by the WHO AWaRE guide 2022, to regulate antimicrobial prescribing practices, highlighting the importance of educational sessions for successful AMS interventions.Table 1:Quantification of antibiotic use during the study periodBased on Days of therapy (DOT), an AMS metric.

Methods
The study analyzed antimicrobial usage data from 360 patients from March to July 2023. It quantified DOT by comparing Access and Watch group antibiotics. The first three months focused on auditing antimicrobial prescribing practices, followed by a session on rational prescribing and an educational survey. The second two months focused on feedback on the impact of educational interventions.Figure 1:Trend of Access:Watch ratio of antibiotics during the study period

Results
The use of Cefoperazone + Sulbactam, a broad-spectrum watch class antibiotic, was high in April and May (48.7 and 50.7, respectively) but decreased to 19.3 and 18.1 in the subsequent months following educational interventions. Optimization of de-escalation practices through audit and feedback strategies, emphasized in the continuing medical education sessions, contributed to this reduction. The Access: Watch Ratio increased from 0.45 to 0.52 over the study period, indicating a reduction in Watch antibiotic use. Pre-survey results showed 88.9% of prescribers considered de-escalation safer, increasing to 100% post-intervention. Various case-scenarios presented to prescribers showed improved understanding and adoption of rational antibiotic prescribing and de-escalation strategies after the educational session.

Conclusion
Integrated interventions, including prescriber education and de-escalation strategies, were effective in achieving the WHO Access: Watch target in our South Indian tertiary care setting. The reduction in Watch antibiotic use and the increase in the Access: Watch ratio demonstrate the impact of these interventions on antimicrobial prescribing practices. Ongoing education and support for rational antibiotic use are critical in addressing antimicrobial resistance.

Disclosures
All Authors: No reported disclosures
P-1793. Revitalizing Antibiotic Selection Through De-labeling of Outdated Antibiotic Allergies: Insights to Improving Antimicrobial Stewardship from South India
Authors: Leelarani Martinraj Jasper Victoria , Dorairajan Sureshkumar , Amargeeth Surendhar , Pooja P , Shanmugam J 
Published: January 2025

Abstract

Background
Self-reported drug allergies need to be revised or re-assessed, often. Therefore, this study aims to assess self-reported drug allergies among patients and identify potential candidates for de-labeling outdated or inappropriate antibiotic allergies, as part of antimicrobial stewardship interventions promoting rational antibiotic prescribing, as they facilitate the use of overly-broad spectrum antibiotics contributing to increased risk of antimicrobial resistance and adverse effects.Table 1:Antibiotic allergies and Potential candidates for de-labeling in the study

Methods
This observational study was conducted in three tertiary care hospitals in South India from October to November 2023. Patients with drug allergy labels underwent thorough interviews utilizing the PEN-FAST clinical decision rule, adopted for risk stratification of all antibiotic allergies. The rule employed a score &lt; 3 to identify low-risk penicillin allergies, potentially eligible for allergy de-labeling. Self-reported drug allergies were documented in an Excel sheet, with descriptive statistics were applied for analysis.

Results
Among 857 patients analyzed, 58 (74.3%) patients reported antibiotic allergies. Penicillin and Sulfa allergy labels were the most prevalent allergy labels. Notably, 62.5% patients with low-risk Penicillin allergy and a vast majority of patients with Sulfa and Quinolone allergy are potential candidates for de-labeling, after employing the validated tool assessing the timeframe, severity and characterization of allergic reactions.

Conclusion
In summary, The results of the study underscores the importance of adopting validated tools to revitalize antibiotic selection, de-labeling of &gt; 60% inappropriate or outdated allergies and hence, enabling the use of first-line antibiotics in approximately 50-100% of the patients labeled with antibiotic allergies.

Disclosures
All Authors: No reported disclosures
P-1813. Improving Adherence to an Antibiotic Pre-Authorization Protocol at a Community Academic Medical Center
Authors: Sutton Spencer , Yan Xuping , Tandon Richa , Colgrove Robert 
Published: January 2025

Abstract

Background
Preauthorization is integral to antimicrobial stewardship and is associated with decreased utilization of restricted antimicrobials, lower cost, and reduced development of antimicrobial resistance. Implementation of such a program is resource-intensive and dependent on the skill of the approving provider. The aim of this quality improvement project was to update the preauthorization program at a community hospital and increase protocol adherence from 23.8% to 85% by September 1st, 2023.Figure 1:Adherence to the Preauthorization Process presented as a P-chart, representing the rate of the desired outcome with variable sample size over time. Statistical significance identified through mean-line shift, based on 8 consecutive data points above or below a previous mean line.

Methods
A community academic medical center developed a workgroup of infectious diseases (ID) pharmacists and physicians to optimize the existing antibiotic preauthorization policy. Baseline data were collected over a one month period, based on policy requirements for approval prior to implementation of improvement initiatives. Updates implemented an ID pharmacist into the approval process, streamlined request communication, and standardized documentation of approval. Requests were considered adherent to protocol if the process metrics of appropriate use were met. This included following the off-hours pathway appropriately and completion of standardized documentation prior to order verification. Balancing metrics included duration of restricted antimicrobial utilization. Data were extracted through a query of electronic medical records with manual chart review of patients who received at least one dose of a restricted antimicrobial. Data were analyzed through descriptive statistics pursuant to the Institute of Healthcare Improvement’s Model for Improvement or Wilcoxon Rank-Sum, where appropriate.

Results
Between September 2022 and September 2023, 701 restricted therapies were ordered. Of these, 410 were not associated with an infectious diseases consult. Mean protocol adherence increased from 23.8% (5/18) to 86.2% (307/356) [Fig. 1]. Median duration of restricted antimicrobial therapy decreased from 4.0 days to 3.0 days (p=0.0025).

Conclusion
The implemented updates to the preauthorization program markedly increased protocol adherence and decreased duration of restricted antimicrobial therapy. This work demonstrates the feasibility and quality impact of implementing antimicrobial stewardship initiatives in a community hospital setting.

Disclosures
All Authors: No reported disclosures
P-1815. Estimation of the cases with suspected community-acquired pneumonia where antibiotic intervention could occur after 48 hours: Application of an electronic algorithm for real-time screening
Authors: Kim Bongyoung , Klein Eili , Fabre Valeria , Cosgrove Sara E 
Published: January 2025

Abstract

Background
Timely identification of unnecessary antibiotics (abx) started for suspected community-acquired pneumonia (CAP) is vital for antibiotic stewardship programs (ASPs). We estimated potential opportunities for ASP intervention among patients flagged as potentially having CAP by an electronic algorithm using electronic health record data that allows for real-time case detection.

Methods
We screened all adult patients admitted to Johns Hopkins Hospital (1,150 beds) between 12/2023-2/2024 using the algorithm which is based on the following variables: i) abx targeting CAP ≥48h, ii) respiration rate ≥24/min, iii) white blood cell (WBC) &gt;12,000/mm3, and iv) natural language processing (NLP)-derived radiology results compatible with pneumonia. Patients admitted to oncology or with sickle cell disease were excluded. Manual chart review was performed to adjudicate true CAP, defined as the presence of signs/symptoms of pneumonia with corresponding radiographic findings, while excluding alternative diagnoses, based on the clinical course observed within 48 h. We characterized factors associated with patients without CAP, particularly radiological interpretation, and the proportion eligible for ASP intervention at 48 h of admission.

Results
122 of the 152 cases (80.3%) identified by the electronic algorithm were adjudicated as non-CAP based on clinical criteria. Compared to CAP cases, non-CAP cases were less likely to have fever (40.0% vs. 9.8%, P &lt; 0.001) and cough/sputum (76.7% vs. 42.6%, P = 0.001). Common diagnoses for non-CAP cases were volume overload (19.7%), other pulmonary disorders (18.9%), chronic lung disease exacerbation (14.8%), and viral pneumonia (12.3%).
Most unnecessary abx were initiated in the emergency room (85.2%, 104/122); 60.6% (63/104) were continued for &gt;24 hours after admission, and 48.4% (59/122) could have been intervened upon at 48 hours of admission.
63.1% of non-CAP cases had radiographic interpretations suggesting CAP, with poor correlation between radiological interpretation and clinical diagnosis of true CAP (kappa 0.221).

Conclusion
ASP interventions to stop abx within 48 h of admission were indicated in ∼50% of non-CAP cases identified by the electronic algorithm.

Disclosures
All Authors: No reported disclosures
P-1857. S100B and other Fecal Biomarkers as Predictors of Clostridioides difficile Infection Severity and Recurrence are Influenced by Age
Authors: Doppalapudi Laasya , Behm Matthew , Costa Deiziane , Rodrigues-Jesus Mônica , Shin Jae Hyun , Warren Cirle A 
Published: January 2025

Abstract

Background
Clostridioides difficile infection (CDI) is an urgent threat in the US. Because disease severity is strongly correlated with intestinal inflammation, the aim of this study was to identify fecal biomarkers associated with poor outcomes and investigate how these biomarkers are influenced by clinical variables.

Methods
Fecal samples from patients diagnosed with CDI were collected from April 2021 to February 2022. Levels of biomarkers for intestinal inflammation (myeloperoxidase-MPO, lipocalin-2-Lcn2, calprotectin, S100 calcium-binding protein B-S100B, IL-6 and brain-derived neurotrophic factor-BDNF) were measured by ELISA. C. difficile isolates were tested for binary toxins gene, cdtA/cdtB, by qPCR.

Results
The majority of patients were females (54%, 88/149), infected by binary positive strain (59%, 88/149) and with mean age of 61.4, (range: 21 to 96 years old). 43.2% (64/148) of the patients exhibited severe disease, 29.7% (44/148) were recurrent CDI cases, and 19.4% (29/149) died post-infection. Increased fecal levels of S100B (p=0.0006) and IL-6 (p=0.03) were detected in severe disease. Compared to non-severe cases, severe first CDI cases exhibited higher levels of S100B (p=0.002), and IL-6 (p=0.04), while severe recurrent cases showed significantly higher levels of MPO, Lcn2, and calprotectin. In addition, increased levels of MPO, calprotectin, and S100B correlated positively with age. Increased fecal IL-6 (p=0.03) and S100B (p=0.01) were detected in middle-aged (40-64 years old) severe cases. Increased MPO (p=0.02), calprotectin (p=0.01), Lcn2 (p=0.006), and S100B (p=0.02) were also detected in middle-aged and oldest-old severe cases. Furthermore, patients infected by binary positive strains had significantly higher levels of fecal MPO, Lcn2, calprotectin, and IL-6. Recurrent cases also showed higher levels of fecal MPO, Lcn2, and calprotectin compared to first episode CDI cases. Fecal markers of inflammation were independent of gender.

Conclusion
Our findings indicate that fecal S100B is a marker of CDI severity in middle-aged, middle-old, and oldest-old patients independent of gender. Additionally, elevated fecal biomarkers (MPO, Lcn2, calprotectin, S100B, and IL-6) appear to correlate with binary toxin positivity and recurrence.

Disclosures
Jae Hyun Shin, MD, Ferring: Grant/Research Support Cirle A. Warren, MD, Ferring Pharmaceuticals: Site PI for ROAR