bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1595. Short Interval Repeat Testing with a Multiplex Pneumonia Panel is Low Yield- A Case for Diagnostic Stewardship
Authors: Wilber Eli , Fitts Eric , Burd Eileen , Witt Lucy S 
Published: January 2025

Abstract

Background
Multiplex molecular panels have emerged as a tool for the rapid identification of potential pathogens and resistance markers for multiple syndromes including pneumonia. The BioFire® FilmArray® Pneumonia panel (PPP) is a multiplex molecular test that can rapidly detect 33 targets (including bacteria, viruses, and some common resistance genes) from respiratory samples. The role of this test in patient care is evolving and the role of repeat testing is not well described.Figure 1:Results of Repeat Pneumonia Pathogen Panel within 48 Hours

Methods
We conducted a retrospective chart review of all PPPs conducted at the Emory University Hospital Clinical Microbiology Lab which supports seven academic-affiliated hospitals during the period 3/13/2023-3/14/2024. Patients with a PPP test result within 48 or 168 hours of a previous test result were identified and reviewed for interval changes in the detected targets.Figure 2:Results of Repeat Pneumonia Pathogen Panel within 168 Hours

Results
There were 2307 PPPs resulted during the study period with a numerical trend of increasing use over time. For the study period, 73 (3.2%) of tests were repeats within 48 hours and 206 (8.9%) were repeats within 168 hours of a previous PPP test. For tests repeated within 48 hours (Figure 1), 46/73 (63.0%) returned the exact same results as the initial test, 7/73 (9.6%) detected fewer pathogens, 18/73 (24.7%) detected at least one additional pathogen. 6/18 (33.3%) of tests detecting a new pathogen detected a common respiratory virus. For tests repeated within 168 hours (Figure 2), 123/206 (59.7%) returned the exact same results, 35/206 (17.0%) detected fewer pathogens, and 45/206 (22.3%) detected at least one additional pathogen.

Conclusion
Repeat testing with the PPP was common during the study period and almost nine percent of the annual testing volume was repeat testing within one week of a previous result. Short interval repeat testing with the PPP typically returns a result with no additional potential pathogens detected and thus may be unlikely to affect clinical management. Ordering restrictions that include a “lockout period” may be a valid diagnostic stewardship approach to improve the use of this test.

Disclosures
Eli Wilber, MD, Elsevier: Advisor/Consultant|Roche Diagnostics: Advisor/Consultant
P-1613. Blood Culture Contamination Mitigation: Sustained Stewardship Successes Seen Systemwide
Authors: Povroznik Mark D 
Published: January 2025

Abstract

Background
Contamination prevention, when sampling blood for culture, relies on an operator impeccably adhering to skin preparation routines and attentively avoiding cross-contamination opportunities until laboratory personnel attain specimen possession. Operator-reliant diagnostic integrity was challenged throughout the COVID-19 pandemic, which placed unexpected environmental pressures on personnel to the documented detriment of antimicrobial stewardship endeavors and patient outcomes. Clinician interest in shifting some operator burdens to assistive technology subsequently flared; in accordance with literature reports of successful blood culture contamination mitigation when initial-specimen diversion devices were co-opted into protocol, the National Quality Forum and the Centers for Disease Control and Prevention backed a Clinical and Laboratory Standards Institute revision to blood culture sample collection guidelines, recommending their use. This tech-centric tenet was hypothesized to be necessary to sustaining the successful mitigation of blood culture contamination through the stressor-heavy situations wherein education-focused endeavors alone were struggling to substantiate significance.
Antimicrobial Stewardship Intervention Outcome
Data reflects approximately 36,000 blood cultures drawn each quarter.

Methods
Intervention began in 2020, prior to which a 3.6% blood culture contamination rate was observed systemwide. Seventeen facilities among nineteen that share a data system co-opted initial-specimen diversion device technology alongside value analysis and cultural curation in a trifurcate strategy to reduce contamination events.

Results
Consistent, real-time communication with caretakers on outcomes enabled year-over-year interventive technology utilization increases [currently approximately 85% systemwide]. The systemwide blood culture contamination rate for the first quarter of 2024 was 1.64% [586 contamination events among 35,750 total blood cultures], down from 1.9% across 2023, 2.8% across 2022, and 3.2% across 2021.

Conclusion
Tech-facilitated closure of contaminant pathways, when paired with communication channels connecting individual contributions to stewardship successes, sustained the year-over-year systemwide reduction in blood culture contamination events observed herein.

Disclosures
All Authors: No reported disclosures
P-1617. Clinical and microbiologic outcomes associated with implementation of MALDI-TOF on patients with anerobic, fungal, and non-lactose fermenting specimens
Authors: Boda Martina , Mercuro Nicholas J , Connolly Kristina Rokas , Diekema Daniel , Yen Christina , Myatt Raymond 
Published: January 2025

Abstract

Background
MALDI-TOF is a rapid-diagnostic technology that improves the speed and accuracy of organism identification. Using it to identify resistant pathogens and fastidious organisms is a high impact diagnostic stewardship opportunity. This study aims to evaluate its effect on the management of infections caused by non-lactose fermenting (NLF) Gram-negative rods (GNRs), anaerobes, and yeast from sterile sites.Figure 1.Screening Process

Methods
This was a single center, quasi-experimental study of patients with NLF GNRs in respiratory specimens and anaerobes and/or yeast from sterile sites before and after the implementation of MALDI-TOF from 2021-2023. There were no changes in antimicrobial stewardship culture review or audit and feedback processes during the study period. The primary outcome was time to organism identification. Secondary endpoints were time to antimicrobial adjustment, inpatient antibiotic duration, and in-hospital mortality. Categorical descriptive data was expressed as percentages and as median/interquartile range (IQR) if continuous. Chi-squared/Fisher’s Exact test and Mann-Whitney-U were used as appropriate to compare endpoints between groups.Table 1.Patient characteristics and Secondary Endpoints by MALDI-TOF Identified Organism

Results
Of 225 patients screened, 108 were included (Figure 1). The median Charlson score was 3 (1-5). The overall length of stay was 30 (13-54) days; 75 (70%) patients had an ICU stay with a median ICU length of stay of 17 (4-31) days. The most common organisms identified were Pseudomonas aeruginosa, Bacteroides spp, Candida albicans, and Nakaseomyces glabratus (formerly C. glabrata) (Figure 2). Time from Gram-stain to organism identification was reduced from 77 (41-119) hours to 41 (26-56) hours (p&lt; 0.001) (Table 1). Time to antimicrobial adjustment and inpatient duration of antibiotics were not different between pre- and post- implementation of MALDI-TOF for infections caused by anaerobic and NLF GNRs but was reduced in patients with yeast in sterile sites. There was no difference in in-hospital mortality.Figure 2.Percentages of Organisms Identified by MALDI-TOF

Conclusion
Implementation of MALDI-TOF for identification of these organisms improved culture processing turn-around time, antimicrobial optimization, particularly for yeast, and stewardship efforts at our institution.

Disclosures
Daniel Diekema, MD, MS, D(ABMM), Affinity Biosensors: Grant/Research Support|bioMerieux, Inc: Grant/Research Support
P-1632. Living in an area with high burden outpatient antibiotic prescriptions, a risk factor for infection by ESBL producing Enterobacterales?
Authors: Stevens Michael T , Kinsella Patrick , Campbell Darien , Ponce Rafael , Gonzalez Andrea 
Published: January 2025

Abstract

Background
The increase in antibiotic resistance has been linked to antibiotic exposure. However, initiatives of antibiotic stewardship programs have been associated with decrease in antibiotic utilization but without a clear decrease in antibiotic resistance. We hypothesized that patients hospitalized with infections with ESBL producing Enterobacterales (ESBL-PE) live in areas with high outpatient antibiotic exposure.
Outpatient antibiotic prescriptions per zip code
Antibiotics prescribed in the outpatient setting per zip code of residence of the recipient of the prescription.

Methods
From March 2022 to March 2023 we evaluated antibiotic utilization in the outpatient setting of a healthcare system in central Georgia. Outpatient settings included urgent cares, emergency rooms, and primary care clinics. We estimated the antibiotic “burden” per zip code based on the residence of each patient receiving a prescription from these outpatient facilities.
During the same time period, we obtained all cultures processed in the hospital’s laboratory that isolated an ESBL-PE, and the zip code of residence from each patient’s sample.
Number of antibiotics per zip code was the independent variable and number of residents per zip code hospitalized with an ESBL-PE infection was the dependent variable. QGIS v3.8 was used for spatial analysis and SPSS 25 for statistical analysis.
Number of cases of an ESBL-PE infection per zip code of patient residence

Results
There were 61 070 outpatient prescriptions, representing 500 092 days of therapy. Prescriptions were given to residents of over 1000 different zip codes of nearly 20 states. 70% (42719) of these prescriptions were for residents of the state of Georgia, distributed among 634 zip codes. The zip code with the largest antibiotic burden received 4706 prescriptions in a one-year period, representing 161 antibiotic prescriptions per 1000 population.
396 Georgia residents had a culture with an ESBL-PE, and 308 (77.7%) of them were hospitalized for infections due to ESBL-PE. Linear regression model had an R2 of 0.79 with a p-value of &lt; 0.01.

Conclusion
The geographic reach of antibiotic prescriptions by outpatient facilities is of concern. The antibiotic burden in surrounding communities is higher than areas further away. Living in an area with high outpatient antibiotic prescription burden explained almost 80% of the variance for hospitalization with an infection due to ESBL-PE. Efforts to decrease antibiotic resistance should also include interventions in outpatient facilities.

Disclosures
All Authors: No reported disclosures
P-1637. Four-year Experience on Ambulatory Antibiotic Prescribing for Viral Respiratory Infections
Authors: Huang Joanne , Bryson-Cahn Chloe , Buck Cameron , Hori Mike , Lin David , Rizzo Tanya , Zhang Yilin , Kassamali-Escobar Zahra 
Published: January 2025

Abstract

Background
In 2019, our institution implemented the MITIGATE (a Multifaceted Intervention to Improve Prescribing for Acute Respiratory Infection for Adult and Children in Emergency Department and Urgent Care Settings) Toolkit, a multimodal antimicrobial stewardship strategy using education, data, and feedback to reduce unnecessary antibiotic prescribing for viral respiratory infections (RTIs) in ambulatory care settings.

Methods
This was a single center observational study. Prescribers in emergency department (ED), primary care (PC), and urgent care (UC) were notified of their individual unnecessary antibiotic prescribing from 9/2019 - 3/2022 via email. We reduced rate of feedback from notifying all prescribers, to half after the first year, and none after 2 years and observed the impact on antibiotic prescribing. Prescribers were labeled as a top performer or not a top performer compared to their peers. Unnecessary antibiotic prescribing for RTI was evaluated 4 years after the intervention began.

Results
In 2019 Pre-toolkit intervention, 14,247 patient visits had a qualifying viral RTI. 17.9%, 9.8%, and 6.4% received an antibiotic unnecessarily in the ED, PC, and UC, respectively. After 2-years of direct feedback, antibiotics were prescribed in 13.4%, 4.3% , and 4.7% , in the ED, PC, and UC (N = 48,192) (p&lt; 0.001). In 2023, after feedback stopped, unnecessary prescribing remained lower in ED (14.4%, p&lt; 0.001) and PC (5.8%, p&lt; 0.001), but not UC (7.2%, p=0.015), N =53,496.

Conclusion
Rates of unnecessary antibiotic prescribing for viral RTI dropped most significantly following two years of varying degrees of direct feedback. Although prescribing rates in the ED and PC remain lower after 4 years compared to pre-intervention, current data demonstrate an uptrend. Although labor-intensive, this supports that feedback with peer comparison is an instrumental intervention. Strategies to ensure successful intervention maintenance should be considered when implementing outpatient stewardship.

Disclosures
All Authors: No reported disclosures
P-1642. The Devil's in the details: Developing metrics for discharge antibiotic stewardship
Authors: Hawkins Marten R , Prasad Ritika , Mische Leah , Esadah Esther , Mui Emily , Pourali Samaneh , Ha David R , Holubar Marisa 
Published: January 2025

Abstract

Background
International Classification of Diseases, Tenth Revision codes (ICD-10s) are commonly used to identify antibiotic indications but may not reflect clinician intent. We investigated concordance of different antibiotic indication sources in the electronic health record (EHR) with clinician intent upon discharge.Figure 1:Indication choices for inpatient antibiotic orders

Methods
In this quality improvement project, we included prescriptions for patients discharged on oral antibacterials from January 2022-March 2023, including patients with &gt; 1 admission. We excluded those with &gt;90 days duration and those for dapsone or rifaximin. We randomly selected 100 prescriptions and performed manual chart review to obtain the discharge summary antibiotic indications which we categorized into syndromes (Table 1.) We compared discharge indication with other EHR indication sources: last inpatient antibiotic order indication (is required, Figure 1), ICD-10s from separate fields ( “principle”, “encounter”, “billing”) and “composite ICD-10” which included all ICD-10s from any field. We compared each indication source with the associated discharge indication (considered most accurate) and report concordance.Table 1:Syndrome Categories and associated ICD-10 codes

Results
We included 3,088 prescriptions and excluded 364. Of the 100 encounters reviewed, 62% patients were discharged from medicine services and 46% had a trainee involved in discharge. These encounters were associated with 184 unique ICD-10s and 132 (72%) representing non-infectious diagnoses; the most common infectious diagnosis was skin and soft tissue infections (12 (7%)) (Table 2.) Overall, 37% (30/100) of prescriptions had ICD-10s that were categorized only as non-infectious. Clinicians most commonly intended discharge antibiotics for genitourinary indications (32/108, 30%) (Table 2). Last inpatient antibiotic order indication matched clinician intent in 91% of cases, while composite ICD-10 matched clinician intent in 47% of cases. Any single ICD-10 field (principle, billing, encounter) matched clinician intent in only 1/3 of cases (Table 3.)Table 2:ICD-10 codes and Clinician Intent by Syndrome
Data from 100 chart reviews. A total of 184 unique ICD-10 were collected from 100 prescriptions. 8 discharge summaries included two indications.

Conclusion
Compared to ICD-10s, last inpatient antibiotic order indication more accurately matched clinician intent for antibacterial discharge prescriptions. This may be a useful and simple way to facilitate discharge prescription stewardship.Table 3:Agreement of different indication sources from EHR with ICD-10 code
“Composite ICD-10” includes all ICD-10s from “principle”, “encounter”, “billing” fields. And was considered to match clinical intent if any ICD-10 category was concordant with clinical intent.

Disclosures
All Authors: No reported disclosures
P-1643. Simply Scripting Success: Impact of Epic Preference List Changes on Antibiotic Prescribing in the Outpatient Setting
Authors: Smith Mary , Chang Amy , Ha David R , Holubar Marisa , Shepard John , Mui Emily , Alegria William 
Published: January 2025

Abstract

Background
Preference lists in electronic health records are commonly used to streamline ordering processes, including antibiotic orders. In July 2023, we revised our institution's primary care preference list to align with institutional guidelines for the management of skin and soft tissue infections (SSTI) and pneumonia (Figure 1). Here we evaluate the impact of this intervention on antibiotic prescribing practices.

Methods
We included all adult telemedicine and office visits associated with antibiotic orders from 2/2023 to 2/2024 at 8 academic primary clinics. We used International Classification of Diseases, 10th revision (ICD10) data to identify encounters for SSTIs and pneumonia (Table 1 ). We defined “pre-intervention” as 2/1 – 7/31/2023 and “post-intervention” as 8/1/2023– 2/28/2024. We extracted encounter date, location, order source, antibiotic selection, and duration. We defined guideline adherence as 1st line antibiotic selection and 5-day duration (Figure 1). There were no education or dissemination efforts to providers. This was deemed a non-human subjects research quality improvement project.

Results
We included 349 total (165 pre, 184 post) encounters for SSTI (263) and pneumonia (86). 102 (29%) were telemedicine (50 pre, 52 post). Of the 349 encounters, 73 % of antibiotic orders were from the preference list (136 pre; 117 post). Guideline concordant antibiotic selection improved in the post-intervention group for pneumonia (8% pre, 44% post) and SSTIs (47% pre, 58% post), but only for orders sourced from the preference list (Table 2, Graphs 1-2). There was also improvement in guideline concordant 5-day durations with preference list orders post-intervention for pneumonia (55% pre, 78% post) and SSTI (20% pre, 50% post) (Table 2, Graphs 1-2). Antibiotic orders not using the preference list for these syndromes showed no improvement during this time.

Conclusion
We found that a simple revision of the primary care order preference list led to improved guideline concordant antibiotic prescribing for SSTI and pneumonia. For common syndromes in which antibiotic selection is typically made empirically in clinic, like SSTIs and pneumonia, pre-selected durations and highlighted first-line selections for antibiotic orders can improve adherence to guideline recommendations.

Disclosures
All Authors: No reported disclosures
P-1646. Assessing Antibiotic Adverse Drug Events from Walk-In Clinics at an Academic Healthcare System
Authors: Patel Nishant , Zou Michael , Staub Milner , Nardone Emily W , Thomas Retha B , Zuill Angela , Shackelford Claude E , Zhang Jim , Onguti Sharon 
Published: January 2025

Abstract

Background
Outpatient antibiotic adverse drug event (ADE) rates are largely unknown. This project aimed to evaluate methods for collecting data on antibiotic ADEs and report antibiotic ADE data from 8 walk-in clinics (WICs) at Vanderbilt University Medical Center (VUMC), which represents a high-volume antibiotic prescribing outpatient setting.

Methods
We attempted retrospective data collection of antibiotic ADE billing codes. After multiple trials, we recognized a need to understand how ADEs are documented (Tables 1 and 2) versus billed. To examine this, we conducted a retrospective chart review of patients prescribed antibiotics in selected WICs from 8/1/23 - 10/31/23 with WIC, primary care, or emergency department visits within 14 days after. We reviewed visit notes for antibiotic ADEs. If present, visit billing codes were collected and analyzed. To evaluate potential new antibiotic ADE data collection methods, especially ADEs reported via calls without a visit, we conducted prospective collection of antibiotic ADE calls or return visits within 14 days from patients prescribed antibiotics at selected WICs from 11/1/23-4/30/24 via voluntary REDCap survey reports by WIC providers. We used manual chart review to assess antibiotic appropriateness.

Results
From 8/1/23-10/31/23, we extracted 1059 unique visits with antibiotic prescriptions; 69 (6.5%) had antibiotic ADEs documented in subsequent visits. ADEs were secondary complaints in 30/69 (43.5%) visits. ADE billing codes were present in 17/69 (24.6%) visits (Figure 1).
From 11/1/2023-4/30/2024, 16,274 WIC visits had antibiotic prescriptions. Providers logged 45 calls and 3 return visits (48/16274, 0.3%); 6/48 (12.5%) antibiotics were unnecessary. When antibiotics were indicated, choice, dose, or duration was inappropriate in 13/42 (31.0%).Table 2:ICD-10 codes classified by organ system

Conclusion
This project showed outpatient antibiotic ADEs occur routinely. Utilizing voluntary reporting led to increased capture of antibiotic ADE patient calls but was not comprehensive. Additionally, ADE billing codes are currently underutilized, resulting in inaccurate estimates of antibiotic ADEs. Future studies are needed to determine an optimal approach to identify and extract antibiotic ADE data from electronic medical records.

Disclosures
Milner Staub, MD, MPH, Gilead: Stocks/Bonds (Public Company)|Johnson & Johnson: Stocks/Bonds (Public Company)
P-1648. Impact of Provider Education Versus Prospective Audit and Feedback on Outpatient Antibiotic Durations for Endodontic Infections at an Urban Veteran’s Affairs Medical Center
Authors: Kuhn Ryan , Dhar Sorabh , Natesan Suganthini Krishnan 
Published: January 2025

Abstract

Background
Despite evidence-based practice guidelines published by the American Dental Association, data indicates that antibiotic prescribing by dentists is often inappropriate. Optimal antimicrobial stewardship (AS) strategies to ensure appropriate antibiotic durations of therapy for endodontic infections are not well defined.

Methods
This single center, retrospective review evaluated the impact of provider education alone versus pharmacist-directed prospective audit and feedback (PAF) on outpatient antibiotic durations for endodontic infections. For the first phase of the intervention, staff dentists were educated regarding indications for antibiotic therapy and the recommended duration of therapy (3-7 days) for treatment of endodontic infections. For the second phase of the intervention, the Clinical Pharmacist used real-time electronic medical record alerts to perform PAF of antibiotic prescriptions for endodontic infections. The mean duration of antibiotic therapy and the number of antibiotic courses with a duration of 10 days or longer were collected. Data from the pre-intervention period (12/1/2018 to 11/31/2019), post-intervention period 1 (1/1/2022 to 12/31/2022) and post-intervention period 2 (4/1/2023 to 12/31/2023) were compared.

Results
Compared to the pre-intervention period, the mean duration of antibiotic therapy decreased from 7.8 days to 7.4 days and the number of treatment courses of 10 days or longer decreased by 40% (pre-intervention period, 22.5% [64/284]; post-intervention period 1,13.5% [52/384]; P =.003) in post-intervention period 1. Compared to post-intervention period 1, the mean duration of antibiotic therapy decreased from 7.4 days to 6.5 days and the number of treatment courses of 10 days or longer decreased by 84% (post-intervention period 1,13.5% [52/384]; post-intervention period 2, 2.2% [4/182]; P &lt; .001) in post-intervention period 2.

Conclusion
While provider education and pharmacist-directed PAF were both effective strategies to decrease inappropriate antibiotic durations of therapy for endodontic infections, PAF was the optimal AS strategy in this setting. Clinical Pharmacists play an essential role in outpatient AS programs and should be engaged with dental clinics to help to improve antibiotic prescribing.

Disclosures
All Authors: No reported disclosures