bluuebunny/crossref_metadata_2025_split huggingface dataset:
1643. Journey Mapping Penicillin Allergies in Children: Parental Experiences, Care Gaps, and Suggestions Offered by Parents to Address Unmet Needs
Authors: Carter Eileen J , Baron Kate , Davies Ellen , Pogorzelska-Maziarz Monika , Monsees Elizabeth , Manning Mary Lou , Pagoto Sherry 
Published: November 2023

Abstract

Background
Penicillin allergies are commonly reported in children but rarely true and perpetuate the use of alternative antibiotics. Leading allergy societies recommend a proactive approach to penicillin allergy delabeling. We use patient journey mapping to identify opportunities to improve the delabeling of penicillin allergies in children before, during, and after a child’s initial reaction to penicillin.

Methods
Mapping was conducted via a secondary analysis of a qualitative study consisting of 18 interviews with parents recruited via social media reporting a penicillin allergy in their child. Two researchers coded interviews using a directed content analysis to capture parent’s experiences before, during, and after their child’s penicillin reaction. We describe the common experiences of parents ( &gt;9 participants).

Results
Pre-reaction, parents reported a lack of awareness regarding potential reactions children may experience when taking penicillin. Intra-reaction, parents reported their child’s provider suspected their child’s reaction was due to a penicillin allergy, wrote the child’s reaction in the medical record, and suggested or advised that penicillin be avoided in the future without mention of the availability of penicillin allergy testing. Post-reaction, parents remained unaware of the availability of penicillin allergy testing and uninformed of the implications of penicillin allergies on their child’s care. To better engage parents in penicillin allergy testing, participants suggested that providers inform parents of: 1) potential reactions their child may experience at the time of penicillin prescription (pre-reaction); 2) the availability of penicillin allergy testing to confirm the presence of true allergy (intra-reaction); and 3) penicillin allergy testing procedures and the benefits of penicillin allergy testing for their child’s health (post-reaction), see Table 1.

Conclusion
Using patient journey mapping, we describe the common experiences of parents concerning their child’s penicillin allergy, gaps in care parents experienced, and suggestions offered by parents to address their unmet care needs. These findings may inform future efforts to improve the delabeling of penicillin allergies in children.

Disclosures
Sherry Pagoto, PhD, Astellas Pharmaceuticals: Scientific Advisor|Weight Watchers, International,: Scientific Advisor
1646. Optimizing Antibiotic Durations of Therapy in Pediatric Community-acquired Pneumonia
Authors: Cook Gregory , Sarkar Shubho 
Published: November 2023

Abstract

Background
Several recent high-quality studies have shown similar efficacy for a shorter, 5-day duration of antibiotics instead of the prior standard, 10 days, in pediatric community-acquired pneumonia (CAP). Despite high-quality literature support, implementing short courses into routine clinical practice remains challenging. This study aimed to assess the impact on the duration of antibiotics for CAP of a pilot clinical pharmacist discharge antibiotic prescription review and departmental education supporting short-course antibiotics for CAP.

Methods
This was a single-center retrospective cohort study for patients admitted with an order for any antimicrobial for CAP. Patients were excluded if they were admitted to the pediatric intensive care unit or transferred during their course of care. The pre-intervention period was from June 2021 to June 2022, and the postintervention group was from August to October 2022. A one-time education session was hosted with the Pediatric Hospital Medicine department summarizing the literature supporting short courses. Statistical analysis included ANOVA, Fisher’s Exact, and Mann-Whitney U test as appropriate.

Results
One hundred twenty-four patients were included, 85 in the pre-intervention and 39 in the post-intervention groups. The median age was two years old in both groups (p=0.2). No differences were present in the median length of stay, penicillin-allergy status, or vaccination status. Patients had a positive viral test 56% and 59%, respectively (p=0.8). Discharge attendings did differ and impact the total length of therapy (p&lt; 0.001). Overall median antibiotic duration for CAP decreased from 8 to 5 days (p&lt; 0.01). Inpatient median durations remained the same at 2 days (p=0.5), while outpatient durations fell from 6 to 4 days (p&lt; 0.01). Patients that received over seven days for CAP decreased from 62% to 10% (p&lt; 0.01). Treatment failure at 30 days occurred in 2 and 8% (p=0.16), respectively.

Conclusion
A pilot discharge prescription review by clinical pharmacists and education supporting short courses for CAP effectively reduced the duration of antibiotic therapy. Consideration should be given to discharge antibiotic prescription reviews when adopting short courses for common pediatric infections.

Disclosures
Shubho Sarkar, MD, Abbott Laboratories: Stocks/Bonds|Abbvie INC: Stocks/Bonds|Bristol-Myers Squibb: Stocks/Bonds|CVS Health Corp: Stocks/Bonds|Johnson & Johnson: Stocks/Bonds
1653. Cost effectiveness of Levofloxacin Vs Amoxicillin/Clavulanate And Ciprofloxacin In The Outpatient Management Of Low-Risk Febrile Neutropaenia In Children With Cancer: A Randomised Control Study.
Authors: Khedr Reham , Abdelaziz Ebtihal , mahellawy hadir Al , El-Deen Nashwa Ezz 
Published: November 2023

Abstract

Background
outpatient management of low-risk fever and neutropenia should be implemented if close monitoring is accessible and patient compliance is feasible.In this study, we aimed to assess the efficacy and safety of single-agent Levofloxacin versus the Augmentin /ciprofloxacin regimen used in our institute.

Methods
This is a randomized prospective interventional 2 arm study of low-risk febrile neutropenia patients presenting to the emergency department at the National Cancer Institute, Cairo University starting from December 2021 to July 2022. Eligible patients were children&lt; 18 years with Low-risk febrile neutropenia without an aetiological diagnosis.Patients were randomized to double-agent ciprofloxacin and amoxicillin-clavulanic acid in comparison to single-agent levofloxacin. Follow up of the outpatient cases on; Day 1, Day 3, and Day 7 for Resolution of infection and stopping of antibiotics regardless of neutropenia. Drug-related side effects encountered in both arms of the study were reported. A decision analytic model was created to compare the two different treatment strategies Outcome measures were quality-adjusted FN episodes, costs, and incremental cost-effectiveness ratios (ICER). The clinical parameters of the model were derived mainly from data collected at National Cancer Institute. Health effects were expressed in terms of QALY gain.One-way sensitivity analysis (DSA) was conducted.

Results
200 patients (100 in each group) were enrolled. 100% of patients achieved marrow recovery in both arms by D7. Fever subsided in 100% on the Levofloxacin arm compared to 60% in the other group. only 1 patient on the double agent arm was upgraded to HR.Levofloxacin was tolerable in all patients with no significant side effects, while patients in the double agent arm; 4 had diarrhea, 2 nausea, and 2 complained of a bad drug taste. Levofloxacin is the dominant strategy versus Augmentin/ciprofloxacin with incremental QALY 0.0001and lower cost 62.4996 L.E in the treatment of home-based care of febrile neutropenia with a willingness to pay threshold of 77,520 LE per QALY (1 GDP/CAPITA)

Figure 1

Conclusion
Levofloxacin is cost effective and can be administered safely in children with low-risk FN, however close follow-up for long-term side effects and emerging bacterial resistance is warranted.

Disclosures
All Authors: No reported disclosures
1660. Harnessing Handshake Rounds for Infection Prevention: Interventions and Great Catches in the First Year
Authors: Martinez Kathleen , Weber Matthew J , MacBrayne Christine , Parker Sarah K , Nyquist Ann-Christine 
Published: November 2023

Abstract

Background
There are national calls to engage Infection Preventionists (IPs) as antimicrobial stewards (AS), but it is unknown how this is translated into action and measurable outcomes. The Association of Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA) 2012 joint position paper states that IPs can benefit ASPs. The paper summarizes key actions for IPs as promoting compliance with standard and transmission-based precautions, care bundle, hand hygiene, and educating staff, patients, and visitors. However, an initial review of the literature did not find any publications outlining IP actions or outcomes as participants in AS.

Methods
In August 2022 an IP was added as available to the existing handshake stewardship rounding team. During rounds the IP observed units for safe infection control practices, asked staff if there were any questions about IC policies or practices, and shared information about circulating illness and COVID-19 policy updates.

Results
Between August 2022 and March 2023, there were 201 interventions. The largest categories included environmental, education, and expired product. 42 (21%) were categorized as a “great catch”, defined as likely to have system-wide impact. Secure chat data was also collected as a baseline to assess change over time.
IP interventions during ASP Handshake Rounds

EHR Secure Chats to on call Infection Preventionists

Conclusion
The impact of including an IP during handshake stewardship was great. Impact includes environmental interventions: cleaning and disinfection processes, laundry, waste, damaged structures, construction, and ventilation issues. Educational impact: teaching providers how to access policies, answering questions about isolation and PPE, and the importance of standard precautions and policy changes surrounding COVID-19. Identifying and disposing of expired products and guidance on isolation precautions and PPE. Examples of a great catch included upgrading isolation status, identifying multiple expired products, correcting incorrect PPE or IC in real time, and educating large groups of staff members on critical IC topics. Health care teams and leadership expressed appreciation of education and support provided by the IP during rounds. Integration of IP into Handshake Stewardship will improve IC practices and Joint Commission readiness.

Disclosures
All Authors: No reported disclosures
1661. Incorporating Infection Prevention and Nursing into Antimicrobial Stewardship Handshake Rounds
Authors: Martinez Kathleen , Weber Matthew J , Nyquist Ann-Christine , Parker Sarah K , Ziniel Sonja I 
Published: November 2023

Abstract

Background
Antimicrobial Stewardship Programs’ (ASP) “handshake stewardship” rounds are used in many hospitals to review patient antibiotic prescribing and use in real time. Historically, handshake rounds at our organization have consisted of Infectious Disease providers and pharmacists but have not included infection prevention (IP) and nursing. While recent literature suggests the value of including infection prevention and nurses in ASPs, information is lacking on practical implementation and assessment of such inclusion. The objective of this study was to understand the perceived value of adding IP and nursing to existing “handshake stewardship” rounds lay the groundwork for sustained implementation to improve both antimicrobial stewardship and infection prevention practices hospital wide.

Methods
Surveys to assess provider and nursing perceptions were developed with infection control, nursing, stewardship, and survey specialist input. Data was collected in REDcap from 1,030 physicians and advanced practice providers (APP) and 170 nurses on units where “handshake stewardship” rounds occur daily.

Results
276 respondents completed the 12-question survey (response rate: 23%). 52% of physicians and nurses rated the potential inclusion of an IP as “very useful” or “pretty useful”. 52% of physicians and 48% of nurses responded that including nurses in ASP rounds would be “very useful” or “pretty useful”. Free responses were analyzed for themes.Table 1Survey Results
Survey Question: Would it be useful to include Infection Prevention and Control an ASP Rounds?
Table 2 Survey Results
Survey Question: Would it be useful to include RNs in ASP rounds?

Conclusion
Our results demonstrate a mismatch between literature recommendations and survey participants’ perceptions. Despite mixed perceptions of value, nurses’ free text comments reflect interest in learning more about this nursing role. While the usefulness of including IPs was viewed positively in only over 50% of respondents, opportunities for improvement were reflected in the high number of nurses and providers who lacked confidence in knowing IP policies. Results suggest the opportunity for education on the potential contributions of nursing in antimicrobial stewardship and infection prevention, facilitated by IP presence on Handshake Stewardship rounds. The ASP rounding tool can be harnessed to ensure successful integration of nurse and IP specific processes. Tools to assess the success of this initiative are in progress.

Disclosures
All Authors: No reported disclosures
1665. Assessment of Documentation of Adverse Effects of Oral Antibiotics for Pediatric Acne Vulgaris
Authors: Scardina Tonya , Brady Kai , Sun Shan , Vivar Karina , Parzen-Johnson Simon , Li Caitlin , Patel Sameer 
Published: November 2023

Abstract

Background
Oral antibiotics (OA) are frequently prescribed for acne vulgaris (AV). However, adverse effects (AE) associated with OA are likely underappreciated. We investigated the assessment of documentation of AE and prescribing trends of OA for AV among pediatric patients in the outpatient setting.

Methods
A random sample of patients prescribed OA for AV with at least one follow-up dermatology clinic visit between 1/1/19 and 1/1/22 were selected. Patients were excluded for non-compliance to OA therapy. Patients with multiple follow-up visits were included once. Data collected included prescriber type (OA initiated by dermatologist at our institution or outside provider), severity of AV, prescribed OA agent, duration of OA, documentation of assessment of AEs, and reported AEs. Chi-square, Kruskal Wallis, or Wilcoxon rank-sum tests were used to analyze non-parametric data. General linear regression model was conducted to examine multivariate impact on the duration.

Results
Two-hundred and forty-eight patients met inclusion criteria. Median age was 16 years (range: 11 -21). Most patients were White (49.6%), non-Hispanic/Latinx (68%) and female (57%). 99% of patients had OA initiated by a dermatologist at our institution. Doxycycline was prescribed for 71% of patients. Each one month increase in age was associated with a one day increase in duration of OA (p=0.005). There was no correlation between duration of OA and severity of AV (p=0.16). There was no documentation of assessment of AEs for 48% of patients. Severity of AV and duration of OA were not associated with the incidence of assessment of an AE (p=0.18 and 0.84, respectively). After adjusting for the severity of AV, age, and documentation of assessment of AEs, doxycycline and sulfamethoxazole-trimethoprim were found to be prescribed for a longer duration than minocycline and cephalexin (p=0.02).

Conclusion
Nearly half of pediatric patients prescribed an OA for AV did not have documentation of assessment of AE. Severity of AV and duration of OA did not impact assessment of AE. Given AEs and duration of OAs prescribed for AV, antibiotic stewardship opportunities exist to improve documentation of tolerance.

Disclosures
Tonya Scardina, PharmD, American Society of Health-System Pharmacists: Advisor/Consultant
1668. Antibiotic Usage Trends Following Implementation of Handshake Stewardship at a Tertiary Care Children's Hospital
Authors: Weiner Lukasz , Auerbach Sarah , Kinn Patrick M 
Published: November 2023

Abstract

Background
Antimicrobial stewardship was implemented at the University of Iowa Stead Family Children’s Hospital in November 2018 principally through handshake stewardship with pediatric intensive care and hospitalist teams. We sought to evaluate the impact of this intervention on the use of select antibiotics targeting P. aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA).

Methods
Use of select anti-pseudomonal (cefepime, piperacillin/tazobactam and meropenem) and anti-MRSA (vancomycin, linezolid and daptomycin) agents within our pediatric intensive care unit (PICU) and pediatric wards (L9 and L10) was retrospectively reviewed. Mean days of therapy (DOT) per 1000 patient days (PD) was aggregated and trended annually from January 2018 until December 2022. Simple linear regression analysis was conducted to detect significant changes in antimicrobial use over time.

Results
Use of anti-pseudomonal and anti-MRSA agents in the PICU declined by 40% and 29%, an absolute reduction of 99 and 60 DOT/1000 PD, respectively (P-value: 0.0366 and 0.0210, respectively) (Figure 1). Use of anti-MRSA agents on L10 declined by 52% (absolute reduction of 53 DOT/1000 PD; P-value: 0.0263), but only declined by 6% on L9 (Figure 2, Figure 3). Use of anti-pseudomonal agents on L10 declined by 56% (absolute reduction of 44 DOT/1000 PD; P-value: 0.0522), but only declined by 10% on L9 (Figure 2, Figure 3).
Figure 1: Mean Days of Therapy Per 1000 Patient Days of Anti-Pseudomonal and anti-MRSA Usage in the PICU Figure 2: Mean Days of Therapy Per 1000 Patient Days of Anti-Pseudomonal and anti-MRSA Usage on L9 Figure 2: Mean Days of Therapy Per 1000 Patient Days of Anti-Pseudomonal and anti-MRSA Usage on L10

Conclusion
Implementation of a handshake stewardship intervention strategy was associated with decreasing DOT of select antibacterial agents. The inability to significantly impact antimicrobial usage on L9 was potentially impacted by this being a mixed unit with subspecialty and surgical services. Expansion of handshake stewardship to subspecialty and surgical services may further reduce usage on mixed units.

Disclosures
All Authors: No reported disclosures
1670. It Is Likely Not HSV: Decreasing Empiric Acyclovir Use In Low-Risk Infants
Authors: Junquera Guillermo Yepes , Taveras Jeanette , Watson Joshua R , Abdel-Hadi Malak , Erdem Guliz 
Published: November 2023

Abstract

Background
Neonatal HSV infection is a rare but potentially devastating disease. Institutional practices regarding which neonates must be treated empirically with acyclovir varies. While some centers elect to treat all neonates presenting with fever or hypothermia, some treat only those considered at risk. Our goal was to decrease empiric acyclovir use in low-risk neonates admitted to the Infectious Disease (ID) ward.

Methods
Quality improvement initiative aimed to decrease acyclovir exposure in neonates 15 to 28 days old hospitalized on the ID ward for fever/hypothermia without a focus, risk factors, or clinical signs for HSV (Figure 1). Interventions included development of a risk stratification algorithm (Figure 2), consensus building among Emergency Medicine and ID providers, and order set implementation. We reviewed all neonates with HSV infections for delayed acyclovir initiation as a balancing measure. The pre-study baseline period was 2019 to 2020, and the study period was 2020, to March 31, 2023. Control charts were used to assess the interventions.Figure 1Key Driver Diagram.Figure 2Risk stratification algorithm for HSV empiric treatment in low-risk infants.

Results
The mean acyclovir use per quarter in neonates who met low risk criteria decreased from 79% during the baseline period (7/2019-6/2020) to 30% in the post-intervention period (7/2020-3/2023) (p = &lt; 0.0001) (Figure 3). Most common reasons why patients failed low risk criteria were: CSF pleocytosis in the setting of a traumatic LP, minimally abnormal lab values (slightly increased ALT, slightly decreased platelets), no LP in well-appearing patient and alternative fever etiology (URI symptoms with positive respiratory infection array). There were no cases of delayed acyclovir initiation in patients with HSV disease. Only one patient with HSV disease fell within the age range but was admitted to the ICU following cardiac arrest and appropriately started on acyclovir therapy.Figure 3Control chart of empiric acyclovir use in low-risk infants.

Conclusion
Our algorithm, targeted to limit empiric acyclovir therapy in neonates with fever/hypothermia without a focus at low risk for HSV, led to a significant decrease in acyclovir exposure sustained for &gt; 2 years after implementation. Interestingly, it also led to decreased in acyclovir use in patients who failed low risk criteria, but this did not result in missed diagnosis of HSV disease, likely because our algorithm was conservative and HSV infection is rare.

Disclosures
All Authors: No reported disclosures
1671. Impact of COVID-19 Pandemic on Rates of Positive Blood Cultures and Contaminations in Children
Authors: Aiba Hiroyuki , Yamada Masaki , Matsui Toshihiro , Ogimi chikara 
Published: November 2023

Abstract

Background
The global COVID-19 pandemic has led to many changes in infection prevention policies and practices in healthcare settings. For example, healthcare providers need to use personal protective equipment during all procedures, including phlebotomy. Blood culture is a widely used test for diagnosing bloodstream infection, and a few publications have reported an increase in its contamination rate in the pandemic era. However, the changes in the culture contamination rate and bacteremia in children have barely been assessed. Hence, we performed a retrospective review of blood culture results during the COVID-19 pandemic era.

Methods
A retrospective, observational study was performed at a tertiary children's hospital in Japan.
The monthly numbers of blood cultures drawn and the blood culture results of the children aged ≤ 18 years who visited the emergency room (ER) at our center from January 2017 to December 2022 were collected using electronic medical records and a clinical database. Of note, all positive culture results were reviewed by pediatric infectious specialists and were interpreted whether the results were true positive (bacteremia) or contaminated. The study period was divided into two eras for comparison: the pre-COVID-19 pandemic era (January 2017-December, 2019) and the pandemic era (January, 2020-December, 2022). Mann-Whitney U test was used for analysis, with a p-value of less than 0.05 being significant.

Results
Overall, the number of pediatric patients presented to the ER was 83,224 in the pre-pandemic period and 57,742 during the pandemic period (Figure 1). The numbers of blood culture specimens were 12,571 and 9,409, respectively. The median (interquartile range) monthly numbers of blood cultures drawn per 1,000 patient visits were 148 (137–164) and 156 (144–173) (p = 0.12) (Figure 2). Similarly, the contamination rates were at 1.5 (0.8–2.1) and 1.7 (1.9–2.3) (p = 0.53), while the rates of patients with bacteremia were 2.1 (1.6–3.0), and 2.9 (2.1–4.3), the latter being significantly higher (p = 0.02).

January 2020 was defined as the COVID-19 pandemic.
Comparison by Mann-Whitney U test before and during the COVID-19 pandemic

Conclusion
The COVID-19 pandemic did not appear to increase the blood culture contaminants in the pediatric ER at a tertiary center. However, the rate of bacteremia increased during the pandemic. Explanations for this observation will continue to be investigated.

Disclosures
chikara Ogimi, MD, bioMerieux Japan Ltd.: Honoraria|Horiba: Honoraria|Pfizer: Honoraria