bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1801. Optimizing Antimicrobial Therapy in Gram-Negative Bloodstream Infections: Insights from a Pharmacist-Driven Intervention Leveraging Molecular Rapid Diagnostic Testing
Authors: Caniff Kaylee E , Coyne Ashlan Kunz , Judd Chloe , Orzol Carolina , Al Musawa Mohammed , Bleick Callan , Scipione Marco R , Rybak Michael J 
Published: January 2025

Abstract

Background
Molecular rapid diagnostic tests (mRDT) expedite pathogen and antimicrobial resistance gene detection in bloodstream infections (BSI), facilitating the prompt initiation of targeted therapy. However, mRDT has the greatest benefit to patients and public health when integrated with antimicrobial stewardship. This study describes a pharmacist-driven mRDT antimicrobial stewardship intervention in Gram-negative BSI, its associated outcomes and its applicability to public health partners.Table 1.Patient demographics, infection and management characteristics.

Methods
At an urban medical center in Detroit, Michigan, USA, trained pharmacists received an alert page for positive mRDT results. Subsequently, they conducted chart review and provided antimicrobial recommendations to the medical team per site protocol. This is a retrospective, descriptive analysis of patients ≥ 18 years old with Gram-negative BSI who received a pharmacist intervention from 5/2023-4/2024. Patient characteristics and intervention outcomes, including time to pharmacist review and recommendation type, are described.Table 2.Pharmacist intervention and clinical outcomes.

Results
Sixty-six patients were included; mean (SD) age was 63 (16) years and patients were predominantly Black (68.2%). The most common primary infection source was urinary (40.9%). Escherichia coli and Klebsiella pneumoniae were most frequently identified in blood culture; 31.8% of isolates possessed CTX-M. Pharmacists reviewed mRDT results at a median (IQR) of 20 (6-97) minutes post-alert. There was no difference in time to effective therapy when mRDT alerts occurred afterhours vs. daytime hours (9 [IQR 0-22] vs. 17 [IQR 0-20] hours, p = 0.66). Sixteen patients were on ineffective empiric therapy; a pharmacist successfully adjusted therapy in 13 of these patients; two patients did not have a resistance marker identified on the initial mRDT report and the pharmacist recommendation was rejected in one patient. Twenty-two patients received empiric anti-Pseudomonal therapy who could have potentially been de-escalated upon mRDT result.Figure 1.Pharmacist workflow for mRDT alert.

Conclusion
Pharmacists facilitated the attainment of effective therapy in those with Gram-negative BSI with mRDT resistance marker detection. Opportunities for de-escalation highlight the potential for pharmacists to further impact patient care and public health broadly through antimicrobial stewardship.Figure 2.Institutional Gram-negative therapy protocol.

Disclosures
Kaylee E. Caniff, PharmD, BCIDP, T2Biosystems: Honoraria Michael J. Rybak, PharmD, PhD, MPH, Abbvie, Melinta, Sionogi, Merck, T2Biosystems: Advisor/Consultant|Abbvie, Melinta, Sionogi, Merck, T2Biosystems: Grant/Research Support|Abbvie, Melinta, Sionogi, Merck, T2Biosystems: Speaker
P-1808. Strategies for Antimicrobial Stewardship Program Resiliency During the COVID-19 Pandemic
Authors: Schwei Rebecca , Griffin Meggie , Ikenberry Helena , Kaur Ashleen , Scalzo Sarah , Pop-Vicas Aurora E , Schulz Lucas , Werner Nicole , Pulia Michael 
Published: January 2025

Abstract

Background
The COVID-19 pandemic was an unprecedented stress test for hospital-based antimicrobial stewardship (AMS) programs. The purpose of this study was to characterize strategies for AMS program resiliency during the COVID-19 pandemic.

Methods
Using a national dataset, we identified hospitals according to three criteria: 1.) significant COVID-19 burden; 2.) appropriate antibiotic prescribing patterns before the pandemic; and 3.) maintenance of appropriate antibiotic prescribing patterns during the pandemic. We conducted semi-structured interviews with pharmacists, physicians and quality leaders involved in AMS during the pandemic from identified hospitals. Interview guides were developed using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Transcribed interviews were analyzed iteratively using content analysis directed by the SEIPS model.

Results
We conducted 30 interviews from 19 unique high-performing health care systems across the country. We interviewed 17 pharmacists, 12 physicians and 1 infection prevention nurse. Resilient AMS strategies in place pre-pandemic included positive hospital wide AMS culture (organization); system-wide AMS programs (organization); decentralized antimicrobial stewardship (organization); strong interprofessional relationships (organization & person); infectious disease involvement (person); protocols to facilitate pharmacist autonomy (organization & tools and technology) and automated tools to facilitate AMS program activities (tools and technology). Additionally, the following strategies were implemented during the pandemic to withstand increased workload and the rapidly evolving pandemic: prioritization of highest yield stewardship interventions (organization & task); and organizational flexibility (organization).

Conclusion
Using a systems engineering informed qualitative approach, we characterized work system strategies to promote resiliency among AMS programs during the COVID-19 pandemic which should inform future efforts to promote AMS program resiliency during periods of health system stress.

Disclosures
All Authors: No reported disclosures
P-1810. Implementation of the Core Elements of Hospital Antibiotic Stewardship Programs and the Priorities for Hospital Core Element Implementation in Long-term Acute Care Hospitals Reporting to the National Healthcare Safety Network, 2014 and 2023
Authors: Gouin Katryna , Kabbani Sarah , O’Leary Erin , Srinivasan Arjun , Neuhauser Melinda M 
Published: January 2025

Abstract

Background
The Centers for Disease Control and Prevention (CDC) defines the 7 Core Elements of Hospital Antibiotic Stewardship Programs as a framework for antibiotic stewardship implementation. In 2022, CDC released 6 Priorities for Hospital Core Element Implementation to enhance the quality and impact of existing antibiotic stewardship programs. Acute care hospitals reported 97% uptake of the 7 Core Elements and 10% uptake of the 6 Priorities in 2022 as per reporting to the National Healthcare Safety Network (NHSN) Annual Hospital Survey. However, stewardship implementation in long-term acute care (LTAC) hospitals has not been widely assessed. The objective of this analysis was to assess the uptake of the 7 Core Elements and 6 Priorities in LTAC facilities in 2023 and compare Core Elements uptake to 2014.Table 1.Facility Characteristics of Long-Term Acute Care (LTAC) Hospitals Reporting to the National Healthcare Safety Network Annual Facility Survey for LTAC, 2014 and 2023

Methods
We used the NHSN Annual Facility Surveys for LTAC hospitals (4/1/2024 data pull) for survey years 2014 and 2023 to characterize facility characteristics and self-reported responses to antibiotic stewardship program survey questions. We mapped stewardship survey questions to corresponding Core Elements and Priorities to describe the reported uptake of the 7 Core Elements and 6 Priorities.Figure 1.Reported Implementation of the Priorities for Hospital Core Element Implementation by Priority in Long-Term Acute Care (LTAC) Hospitals (N=337), 2023

Results
In 2014 and 2023, 489 and 337 LTAC hospitals completed the annual survey. In 2023, most LTAC facilities were for-profit (79%), free-standing (58%), part of multi-facility organizations (47%), and in the South (50%) (Table 1). From 2014 to 2023, the number of facilities reporting uptake of all 7 Core Elements in LTAC hospitals increased from 60% to 98%. In 2023, 2% of LTAC hospitals reported meeting the 6 Priorities and 44% reported meeting 4-5 Priorities. The highest reported uptake of Priorities across LTAC hospitals was Pharmacy Expertise (81%) and Leadership (77%). The lowest reported uptake of Priorities was Tracking (7%) and Reporting (42%) (Figure 1).

Conclusion
LTAC hospitals reported uptake of the Core Elements of Antibiotic Stewardship increased from 2014 to 2023, on par with the increase acute care hospitals reported for Core Elements implementation. Engagement with LTAC hospital leadership and leveraging pharmacy expertise are important to support antibiotic stewardship Priorities, especially tracking & reporting of antibiotic use.

Disclosures
All Authors: No reported disclosures
P-1814. Say it Ain't Steno - Impact of a Microbiology Nudge Comment on Treatment of Respiratory Colonization
Authors: Boettcher Stormmy , Kenney Rachel M , Arena Christen J , Beaulac-Harris Amy , Tibbetts Robert , Shallal Anita , Suleyman Geehan , Veve Michael 
Published: January 2025

Abstract

Background
Stenotrophomonas maltophilia (SM) is a known colonizer of the respiratory tract, in which treatment is not required. Microbiological comment “nudges” have been successful as passive stewardship interventions. The study objective was to describe the effect of a targeted SM respiratory culture nudge on antibiotic use in patients with colonization.

Methods
IRB approved quasi-experiment of adult patients with a SM respiratory culture between 01/01/2022-01/27/2023 (pre-nudge) and 03/27/2023-12/31/2023 (post-nudge). Patients with criteria for active community/hospital/ventilator-acquired pneumonia or on targeted antibiotics prior to culture were excluded. Nudge comment implemented 2/2023: “S. maltophilia is a frequent colonizer of the respiratory tract. Clinical correlation for infection is required. Colonizers do not require antibiotic treatment.” The primary outcome was absence of SM therapy; secondary outcomes were SM therapy &gt; 72 hours, hospital and ICU length of stay (LOS), and in-hospital all-cause mortality. Safety outcomes included antibiotic-related adverse events.

Results
94 patients were included: 53 (56.4%) pre- and 41 (43.6%) post-nudge. Most patients were men (53, 56.4%), had underlying lung disease (61, 64.8%), and required invasive ventilatory support (70, 74.5%). 11 (11.7%) patients were admitted from a long-term care facility. The absence of SM therapy was observed in 13 (23.1%) pre- vs 32 (78.0%) post-nudge patients (P&lt; 0.001). There were no differences in SM therapy &gt; 72 hours (36/40 [90%] vs. 8/9 [88.9%], P=1.0), mortality (11 [20.8%] vs. 7 [17.5%], P=0.69), median (IQR) hospital LOS (24 [10-49] vs. 16 [8-29]), P=0.37), and median (IQR) ICU LOS [15 [2-35] vs. 11 [3-25], P=0.40) between pre- and post-nudge groups, respectively. Safety outcomes of patients treated &gt; 72 hours (n=41); elevated SCr 12 (29.3%), fluid overload 18 (43.9%), hyponatremia 17 (41.5%), and hyperkalemia 5 (12.2%). After adjustment for confounders, post-nudge was associated with 11-fold increased odds of the absence of SM therapy (Table 1).

Conclusion
A targeted SM nudge was associated with a reduction in treatment of SM colonization. Patient outcomes, including length of stay and all-cause mortality, were comparable between the two groups.

Disclosures
Rachel M. Kenney, PharmD, BCIDP, Medtronic Inc: Spouse is an employee, stockholder
P-1816. Stepwise Implementation of an Antimicrobial Stewardship Prospective Audit and Feedback Intervention at a Large Academic Center in Canada
Authors: Zeggil Teagan , Cervera Carlos , Smith Stephanie W , Kabbani Dima , Bains Serena , Lau Cecilia , Fong Karen G , Stewart Jackson J , Doucette Karen , Chen Justin 
Published: January 2025

Abstract

Background
Effective implementation strategies for establishing antimicrobial stewardship (AMS) program inpatient interventions are not well described. We describe a methodology for prospective audit and feedback (PAF) implementation at a large Canadian hospital and report its outcomes.

Methods
A PAF intervention targeting restricted antibiotics (carbapenems, daptomycin, linezolid, and tigecycline) was launched in March 2018. Stepwise implementation by inpatient programs was prioritized by collaboration readiness as immediate site-wide implementation was deemed unfeasible. New prescriptions were assessed by the antimicrobial stewardship team. Prescription, prescriber, intervention type, and acceptance data were collected through March 2024.

Results
Over a 2-year period, site wide stepwise implementation occurred in 16 discrete phases. Over the study period, 5185 prescriptions were evaluated; 3789 (73%) were empiric, and 1396 (27%) culture directed from which 3604 (70%) were optimally prescribed (evaluated by agent, regimen, and duration). Of empiric prescriptions, 636 (17%) were not guideline-concordant by indication, 1102 (29%) did not follow guidelines but was reasonable by expert opinion, and 2051 (54%) were guideline-concordant.
ASP recommendations included: 3604 no change (70%), 864 change agent (17%), 535 change regimen (10%), 172 discontinue antibiotic (3%), and 10 other (0.2%). The recommendation acceptance rate was 91% (1581 cases evaluable).
Infectious diseases (ID) were involved in 1466 (28%) prescriptions. With ID involvement, higher guideline-concordant empiric prescribing (64% vs 51%, p&lt; 0.001) and regimen appropriateness (85% vs 65%, p&lt; 0.001) was observed. ASP suggested no changes more often with ID involvement (84% versus 62%, p&lt; 0.001).

Conclusion
Stepwise implementation allowed evolution and implementation of ASP processes and workflow. 30% of prescriptions audited resulted in intervention, suggesting a possible role for further education, guidelines, or restriction. ID involvement was associated with more optimal prescribing. A stepwise implementation of an antimicrobial stewardship PAF intervention is a viable strategy.

Disclosures
All Authors: No reported disclosures
P-1820. Can a Tele-Mentoring Program for Antimicrobial Stewardship Contribute to Program Satisfaction and Staff Retention?
Authors: Kassamali-Escobar Zahra , Chan Jeannie D , Hartlage Whitney , Bajenov Maria , Martinez-Paz Natalia , Jain Rupali , Lynch John B , Bryson-Cahn Chloe 
Published: January 2025

Abstract

Background
Rural and critical access hospitals (CAHs) serve 20% of the United States population. Fewer than 10% of US physicians practice in rural areas and workforce shortages and staff turnover are a constant threat. The University of Washington Center for Stewardship in Medicine (UW CSiM) supports a tele-antimicrobial stewardship (AMS) program (UW TASP ECHO) in small, rural, and CAHs, primarily in the western U.S. with education, mentoring, organizational capacity building, and a community of peers.

Methods
UW CSiM distributes an annual program evaluation survey to participating hospitals. In 2022, 2 questions were added to the survey and measured with a Likert scale from 1 (strongly disagree) to 5 (strongly agree): 1) Participation in UW-TASP increased my job satisfaction; 2). Participation has increased the likelihood that I will continue working in my institution. Respondents had the option to add free-text comments. Results were summarized descriptively.

Results
In 2023, 53/80 (66%) of hospitals responded, 44 (83%) met the definition of CAH. Response rate was 60% in 2022. In 2022 and 2023, 85% and 83% agreed or strongly agreed that participation in UW-TASP increased their job satisfaction. Seventy three percent (2022) and 64% (2023) agreed or strongly agreed that participating in UW-TASP increased the likelihood of continuing to work with their current institution. Comments included:
“It's easy to feel "alone" out here in a rural area. Having TASP makes me feel very much a part of a community that I can share my barriers/struggles with and get ideas for how I can do more with my program.”
“Knowledge is power, TASP provides knowledge to make us effective leaders and give the best patient care. That is what gives me job satisfaction, knowing I am helping patients with best practice.”

Conclusion
UW-TASP’s impact expands beyond checking a box that mandates AMS in every acute care hospital. We found establishing and maintaining a relationship with participants allowed us to build a community with and among rural and critical access hospital partners. This study is limited by self-reported survey data but demonstrates that engagement within UW-TASP is associated with increased job satisfaction and rural healthcare worker retention. Further qualitative studies are needed to further explore this.

Disclosures
All Authors: No reported disclosures
P-1824. AI-Powered Differential Diagnosis: Distinguishing MIS-C from Kawasaki Disease
Authors: Basu Aditya , Basu Surupa 
Published: January 2025

Abstract

Background
Distinguishing Multisystem Inflammatory Syndrome in Children from COVID-19 (MIS-C) from Kawasaki Disease (KD) can be challenging due to several overlapping clinical presentations. Clinical management of these conditions can vary. Hence, timely and accurate diagnosis is essential. We evaluated the potential of laboratory findings in the differentiation using machine learning (ML) models.

Methods
Patient demographics (Age, Sex) and laboratory data were compared between MIS-C and KD. Simultaneous CBC and routine biochemistry tests were evaluated. ML models were created using PyTorch, scikit-learn, Pandas, NumPy, and Matplotlib libraries. Specifically, Naive Bayes Classifier, KNN, Logistic Regression, SVC, Random Forest Classifier, XGBoost, GBM and LightGBM models were created and the model performances of the classifiers were evaluated with accuracy percentages. The confusion matrix of every learning model was also generated. K-fold CrossValidation was also performed to evaluate the predictive models. ROC and feature importance analysis were also performed. Identification of the disease as MIS-C or KD based on both regressive (Eg: Total Protein) and binary features (Eg: Sex) is posed as a binary classification ML problem. Train and test datasets were created using a couple of train-test splits (0.2 and 0.25).

Results
209 paediatric patients with MIS-C (n=140), and KD (n=69) were included.
• The accuracy performances of the models in the test set were determined as 67.8, 73.8, 75.9, 76.8, 79.9, 80.4, 81.0, 81.1%, respectively.
• The area under curve (AUC) values of the LightGBM, GBM, XGBoost, were determined as 79.1, 79.5 and 78%, respectively.
• Permutation importance analysis of the LightGBM model showed that elevated platelets, neutrophil count, SGPT, WBC levels, Creatinine, and NT ProBNP had influenced the model’s explainability.

Conclusion
Although four years have passed since the onset of COVID-19, the early diagnosis of MIS-C is still crucial. In addition to clinical findings, laboratory tests may contribute to the fight against the disease by providing early diagnosis of MIS-C and KD. Explainable ML models can help determine the appropriate markers for this purpose.

Disclosures
Aditya Basu, Bachelor of Technology, Triomics Healthcare: Stocks/Bonds (Private Company)
P-1825. Investigating the Impact of Immunomodulatory Drugs on Severe COVID-19 Through Transcriptomic Analysis
Authors: Kim Jeong Yeon , Sung Yoo Jin , Hong Eujin , Kim Hyun Uk , Yoon Young Kyung 
Published: January 2025

Abstract

Background
The Coronavirus disease (COVID-19) has highlighted the role of hyperinflammatory states and cytokine storms in severe SARS-CoV-2 infections, leading to extensive research into immunomodulatory drugs previously used for autoimmune diseases. Despite their promising effects, the mechanisms underlying their efficacy remain unclear. This study aims to elucidate these mechanisms through RNA-sequence data analysis.Table 1.Clinical characteristics of 30 COVID-19 patient cohort

Methods
Bulk RNA sequencing data from PBMC samples of COVID-19 patients was used to identify two sets of differentially expressed genes (DEGs). The first set was made by comparing COVID-19 patient data to healthy individuals using public datasets, while the second set involved DEGs from samples treated with immunomodulatory drugs versus untreated samples. Comparative analysis focused on genes with opposite expression changes, particularly those showing contrasting fold changes between COVID-19 and drug-treated samples.Figure 1.DEG array

Results
All COVID-19 patients met the criteria for severe or critical illness, requiring at least a high-flow nasal cannula. The median age was 66.5 years. Clinically, 46.7% underwent mechanical ventilation and the mortality rate stood at 46.7%. By arraying the table with all the samples combined from COVID-19 patient samples and immunomodulatory drug samples, DEGs that show opposite fold change signs were selected as having potential significance in COVID-19 pathways and being affected by immunomodulatory drugs. Specifically, 18 genes were upregulated in response to COVID-19 yet downregulated in immunomodulatory drug use, including key inflammatory and immune response genes such as FAP, RGS16, and IDO1. Conversely, 39 genes showed downregulation in response to COVID-19 but were upregulated in immunomodulatory drug use, featuring genes like DUSP1, TOB1, and RGMA.Table 2.List of genes found in DEG array

Conclusion
Through transcriptomic analysis and differential expression screening between COVID-19 and medication-treated samples, 57 were found to exhibit reversed fold changes in expression. Further investigation of these genes is expected. This research aims to uncover the shared biological mechanisms between autoimmune diseases and COVID-19, which could lead to effective drug repurposing strategies for treating COVID-19.

Disclosures
All Authors: No reported disclosures