bluuebunny/crossref_metadata_2025_split huggingface dataset:
1208. Impact of Selected Antimicrobial Stewardship and Infection Control Strategies in Carbapenem Resistance in a Third Level Public Hospital in Colombía.
Authors: MUÑETON G E R A R D O A , SOLORZANO C A R L O S A , CARDENAS J U L E I M A , CASTRO E L E N A V , MORALES J E S S I C A L 
Published: November 2023

Abstract

Background
Antimicrobial Stewardship (AMS) Programs and Infection prevention and control (IPC) strategies have been shown to effectively reduce antimicrobial resistance. The resources required for the implementation of these programs in low-resource settings could be limited. This study aimed to assess the impact of a few AMS and IPC strategies on carbapenem resistance in a third-level public hospital in Colombia.

Methods
A retrospective before-and-After study was completed. The baseline period consisted of 6 months (January 2021-Jun 2021) and the intervention period consisted of 18 months (July 2021-December 2022) The AMS intervention consisted of the implementation of prospective audits on prescriptions of meropenem, cefepime, and piperacillin-tazobactam, along with educational seminars. The IPC intervention consisted of screening for carbapenemase-producing-Enterobacterales (CPE) through rectal swabs for every patient transferred to the ICU and weekly for all patients in the ICU. A cohorting area with 24 beds was also established to isolate CPE colonized/infected patients

Results
During the intervention period, 886 prospective audits were made. We suspended 208, 111, and 55 prescriptions of Meropenem, piperacillin-tazobactam, and cefepime respectively. The length of therapy was shortened in 239, 290, and 99 prescriptions of Meropenem, piperacillin-tazobactam, and cefepime respectively.
The antimicrobial consumption was lower in the intervention period for meropenem (24,8 DDD/100 patients-days Vs 74.3 DDD/100 patients-days baseline period). Figure 1
The prevalence of positive rectal swabs showed a downward trend during the intervention period. Figure 2. The prevalence of CPE also decreased and was 0,45 during the baseline period and 0,28 during the last semester of the intervention period. Figure 3
The carbapenem resistance K. pneumoniae laboratory-confirmed bloodstream infection rate also decreased during the intervention period, going from 15.4/10.000 patients-days to 1.17/10.000 patient-days. Figure 4

Conclusion
The implementation of selected AMS and IPC strategies in a resource limited third level hospital reduced the prevalence of carbapenemase-producing Enterobacterales and the rate of Carbapenem-resistant K. pneumoniae bloodstream infections.

Disclosures
GERARDO A. MUÑETON, Infectious diseases and Internal Medicine Specialist, PFIZER: Advisor/Consultant
1213. Application of Short Course Criteria for Community-Acquired Pneumonia (CAP) Among Patients Admitted Within a 17-community Hospital Telehealth Antimicrobial Stewardship Program (Tele-ASP)
Authors: Rasmussen Aunalia , May Stephanie Shealy , May Stephanie Shealy , Veillette John J , Vento Todd J , Webb Brandon J 
Published: November 2023

Abstract

Background
A recent randomized controlled trial by Dinh et al. found three days of antibiotics was appropriate for certain community-acquired pneumonia (CAP) patients, but the real-world applicability of this study remains to be evaluated. In February 2022, a telehealth antimicrobial stewardship program (Tele-ASP) intervention was implemented across 17 small community hospitals to identify patients meeting clinical stability criteria used by Dinh et al. for short course therapy (3 days). An alert was implemented to notify the infectious diseases telehealth (Tele-ID) pharmacist of patients on room air for whom an antibiotic was ordered for pneumonia.

Methods
This IRB-approved study aimed to evaluate feasibility and impact of the intervention. Patients with severe or complicated CAP, known immunosuppression, or who were transferred were excluded. The primary outcome was total antibiotic duration. Secondary outcomes included whether the total duration was greater than 5 and 7 days and total IV antibiotic duration. Continuous antibiotic duration endpoints were assessed using Mann Whitney U and Fisher's Exact tests were used for categorical endpoints.

Results
Of 480 patients screened, only 148 (31%) patients met early clinical stability criteria. The primary reason for not meeting criteria was requirement of supplemental oxygen on Day 3 or greater on antibiotics (n=145). This proportion is far lower than previous studies, including that by Dinh et al., which found 60-70% patients met stability criteria. Of the 90 patients included, 27 patients had a Tele-ID review. Patients with an intervention were less likely to receive &gt; 5 days of antibiotics (59% vs 73%) and &gt; 7 days of antibiotics (19% vs. 32%), although these differences were not statistically significant.

Conclusion
This study relied on accuracy of oxygen charting, which may partly explain relatively lower proportion of patients meeting strict clinical stability criteria and likely limits feasibility of a scalable intervention. A pragmatically modified approach for this Tele-ASP intervention (i.e. allowance for no more than 1 unmet criterion) is an important area for further exploration and could improve the feasibility of a scalable telehealth intervention.

Disclosures
All Authors: No reported disclosures
1953. Impact of Baseline Nutritional Status on Tuberculosis Severity in India: a multicenter prospective cohort analysis
Authors: Du Xinyi , Ponnuraja Chinnaiyan , Gupte Nikhil , Sarkar Sonali , Gupta Amita , Christopher Devasahayam J , Kornfeld Hardy , Viswanathan Vijay , Ellner Jerrold , Horsburgh C Robert , Padmapriyadarsini Chandrasekaran , Sinha Pranay 
Published: November 2023

Abstract

Background
India bears a quarter of the global tuberculosis (TB) burden. Previous studies have shown that more than 50% of persons with TB in India are undernourished and that undernutrition is associated with increased risk of unfavorable TB outcomes and mortality. The effect of nutritional status may be explained by its effect on other factors associated with poor outcomes. In this study, we assessed the impact of undernutrition at TB detection on markers of TB severity.

Methods
We analyzed prospectively collected data for persons with TB aged ≥ 18 years from five Regional Prospective Observational Research for Tuberculosis (RePORT) - India sites. We built multivariable regression models to assess relationships between undernutrition at TB detection (baseline body mass index (BMI), kg/m2) and markers of severity. We used logistic regression for lung cavitation and high-grade sputum smear positivity (defined as smear grade ≥ 2+), and linear regression for percentage of lung affected and time to positivity of Mycobacteria Growth Indicator Tube (MGIT; weeks). The models included age, sex, symptom duration a priori and all variables with p&lt; 0.2 in univariate analysis.

Results
We had baseline BMI on 2898 persons with TB and 1132 (39.06%) of participants had moderate-severe undernutrition (BMI&lt; 17kg/m2) at treatment initiation. After adjusting for age, sex, symptom duration, income, HIV status, diabetes, smoking, and alcohol misuse (defined as having an AUDIT-c score ≥ 3 for females and ≥ 4 for males), baseline BMI&lt; 17kg/m2 was associated with increased odds of lung cavitation (aOR 1.67, 95% confidence interval [CI]: 1.32, 2.10), increased odds of high bacillary sputum grade (aOR 1.33, 95%CI: 1.12, 1.60), an average 7.13% (95%CI: 5.11, 9.16) more lung affected, and an average 0.045 (95%CI: -0.024, 0.11) longer time to liquid culture positivity.

Conclusion
To our knowledge, this is the largest prospective cohort study evaluating the association between undernutrition and markers of TB severity. While our analysis cannot account for the bidirectional relationship between TB disease and nutritional status, it does highlight the impact of systematic nutritional assessment in persons with TB.

Disclosures
Devasahayam J. Christopher, DNB, FRCP, Abbot, India: Honoraria|Astra Zeneca: Honoraria|Cipla, India: Honoraria|JB Chemicals: Honoraria|Lupin pharmaceuticals: Honoraria|Pfizer: Honoraria|Zydus Cadila: Honoraria
1235. A Retrospective Review of Antimicrobial Stewardship Audit and Feedback: Assessing Acceptance of Stewardship Recommendations During the COVID-19 Pandemic
Authors: Colaluca Melissa A , Korson Michelle , Wiskirchen Dora E , Abrantes-Figueiredo Jessica 
Published: November 2023

Abstract

Background
Antimicrobial stewardship is an underutilized strategy to mitigate the impact of antimicrobial resistance. It is well documented that many Antimicrobial Stewardship Programs (ASPs) were tasked with assisting healthcare teams in navigating the COVID-19 pandemic, leaving less time/fewer resources for day-to-day ASP activities. The aim of this study was to evaluate the acceptance of stewardship recommendations during a season when the ASP had less time to perform regular educational activities and handshake stewardship.

Methods
A retrospective study of patients receiving antimicrobial therapy at Saint Francis Hospital during 12/30/2020-10/01/2022, for which audit and feedback by the ASP was conducted. A well-established ASP existed prior to the pandemic. Independent variables included the reason for intervention, type of infection by organ system, and type of intervention. Interventions included recommendations to stop antibiotics, de-escalation, duration of therapy, ID consultation, or change the route of administration. The primary outcome was the audit and feedback acceptance rate, and the secondary outcome was whether the intervention resulted in infectious disease consultation.

Results
297 patients underwent audit and feedback. Interventions most accepted by providers included changing the route of administration (100%) and consulting ID formally (92%). Adjusting the duration of therapy was the least accepted intervention at 78%. Regardless of intervention, 33% of providers requested a formal ID consult. The number of interventions varied sporadically, coinciding with periods of decreased availability by the ASP team and during peak waves of the COVID-19 pandemic.

Conclusion
Our ASP team, despite decreased resources while battling an ongoing pandemic, were still able to perform audit and feedback to providers with a good acceptance rate of recommendations, consistent with current literature. Having not only an existing but robust ASP prior to the pandemic, allowed continued success with ASP intervention acceptance rates, despite less dedicated time for typical ASP activities during the pandemic. Fostering good relationships between providers and ASP teams, as well as continued support and funding from hospital leadership, are vital to ongoing success.

Disclosures
All Authors: No reported disclosures
1243. Acceptable susceptibility thresholds reported in hospital antibiograms for Gram-negative rod infections: a survey and contingent valuation study of infectious diseases providers
Authors: Hasegawa Shinya , Perencevich Eli N , Dukes Kimberly , Goto Michihiko 
Published: November 2023

Abstract

Background
Clinical guidelines recommend an antibiogram as a key component when making empiric therapy decisions. However, little is known about how clinicians utilize antibiograms. We aimed to assess the interpretation thresholds of hospital antibiograms among infectious diseases (ID) providers when making empiric therapy decisions for Gram-negative rods (GNRs) infections.Figure 1.Relationship between randomly generated percentages on antibiograms in each scenario and the distribution of participants willing to accept the threshold.Abbreviations: GNR-BSI, Gram-negative rod bloodstream infection; ICU, intensive care unit; UTI, urinary tract infection.

Methods
We conducted an email-based survey of ID providers practicing at Veterans Health Administration (VHA) facilities. We included four scenarios: i) a patient with urinary tract infection (UTI) in an outpatient setting, ii) a patient with UTI in an inpatient setting, iii) a patient with GNR bloodstream infection (GNR-BSI) in a non-intensive care unit (ICU) setting, and iv) a patient with GNR-BSI in an ICU setting. Each scenario randomly assigned antibiogram percentages and asked providers if they would feel comfortable selecting a hypothetical empiric therapy agent with the given value. Contingent valuation analyses were done by logistic regression models to evaluate the relationship between the percentages offered to providers and their willingness to use offered agents.

Results
In the preliminary analysis, 112 of 599 providers (18.7%) responded and 104 provided effective responses. Hospital antibiograms are generally used infrequently, and only 30.8% of providers indicated that they use antibiograms more than once a month. The estimated median interpretation thresholds, meaning half of the ID providers would prescribe the hypothetical antibiotic in each case with the values given on antibiograms, were significantly higher for patients with more severe illnesses (85.6% [95% confidence interval [CI] 83.1-88.1] for an inpatient with UTI vs 74.1% [95%CI 69.7-77.6] for an outpatient with UTI; 86.0% [95%CI 83.1-89.4] for a patient with GNR-BSI in ICU vs 77.9% [95%CI 74.2-81.2] for a patient with GNR-BSI in non-ICU) (Figure 1).

Conclusion
This study demonstrated that ID providers rarely utilized antibiograms and the median thresholds for hospital antibiograms influencing empiric antibiotic selection ranged from 74-86%, depending on the severity but not by the type of infection (UTI vs. BSI). Further analyses after we receive more responses will be completed.

Disclosures
Michihiko Goto, MD MSCI, Merck & Co.: Grant/Research Support
1249. Stealth Stewardship: Compliance with Antimicrobial Restriction Processes at an Academic Medical Center
Authors: Kim Jihye , Greenfield Adam , Deja Erin N , Lee Kimberly B , Rittmann Barry , Bearman Gonzalo , Sastry Sangeeta 
Published: November 2023

Abstract

Background
The 2023 Joint Commission Elements of Performance (EPs) for Antibiotic Stewardship (ASP) document includes a new requirement to implement preauthorization for antimicrobial use in hospitals. At VCUHS, a preauthorization process for restricted antimicrobials has existed since 2000. Prescribers must obtain formal approval for dose and duration of antimicrobials from an ASP or Infectious Diseases (ID) team member to allow inpatient pharmacy to dispense the drug. We employed a stealth stewardship strategy to assess compliance to the antimicrobial preauthorization process and identified opportunities for improvement.

Methods
Pharmacy orders for adult hospitalized patients who received at least one dose of select restricted antimicrobials between August 1, 2022 and October 31, 2022 were reviewed for a documented formal approval in the electronic medical record (EMR). Orders were excluded if not subject to antimicrobial restriction; placed at VCUHS satellite campuses or during de-restricted overnight hours. Stealth use of antimicrobials was defined as the use of a restricted agent without a formal ASP or ID approval.

Results
A total of 179 restricted antimicrobial orders were reviewed during the study period. Of those, 43 (24%) lacked documented approval in the EMR. Of these orders, 20/43 (46.5%) were for patients seen by the ID service, 16/43 (37.2%) were restricted agents continued beyond the initial approval duration, 5/43 (11.6%) were prophylactic antifungal agents approved during prior admissions, and 2/43 (4.7%) were home antimicrobial agents (Fig 1).

Conclusion
With a stealth stewardship review of restricted antimicrobials, we identified gaps in our stewardship process. Surprisingly, 46% of undocumented restricted antimicrobial use was under the guidance of the ID service. High staff turnover rates, frequent pharmacy and prescriber hand-offs, and lack of persistent education on the restriction process are probable drivers of noncompliance. These breaches in our approval process highlight opportunities for heightened education and feedback. We encourage other institutions to consider similar strategies to evaluate their established processes and ensure compliance with the current Joint Commission requirements.

Disclosures
All Authors: No reported disclosures
1253. Optimization of empiric gram-negative infections with the combination antibiogram
Authors: Leung Anthony K , Harrington Susan , Dumford Donald , Shrestha Kasturi , Mistry Bhavin , wong Ken 
Published: November 2023

Abstract

Background
Anti-pseudomonal beta-lactam drugs such as aztreonam (AZR), cefepime (CEF), piperacillin-tazobactam (P/T), meropenem (MER) are drugs used for empiric gram-negative (GN) infections. They are used with other drugs as empiric combination therapy (CT) for patients with sepsis. The antibiogram is used to provide data for empiric therapy and gauge susceptibility pattern shifts over time. Combining different classes of drugs might enhance the susceptibility to various pathogens. This project assessed which empiric combination of drugs will yield optimal coverage for various GN pathogens from different sources.

Methods
In 2022 antimicrobial susceptibility data from 8288 isolates from blood, respiratory, wound and urine sources were collected and analyzed. Percent susceptibility was calculated for 11 gram-negative species with &gt;30 isolates. Susceptibility testing was done by BD Phoenix™ automated identification and susceptibility testing system. A threshold of &gt;90% susceptibility was used to indicate optimal coverage for the antimicrobial agents. CT is calculated as the % susceptible to either of two antibiotics.

Results
In respiratory sources AZR, CEF and P/T were the lowest at 73%, 83% and 77% susceptible. MER had the best overall coverage for all specimen types. Adding either an aminoglycoside (AG) or fluoroquinolone (FQ) increased susceptibility in all sources. AGs had a slightly better coverage than FQs. For blood isolates &gt; 90% susceptibility was attained for single antibiotics without combination. CT was often required to achieve optimal coverage for respiratory sources, specifically for Pseudomonas, Enterobacter, E coli, Klebsiella and Proteus species.Figure 1.Combination antibiogram for beta-lactam agents for gram-negative respiratory isolates as monotherapy or in combination with ciprofloxacin, gentamicin, or tobramycin.*All gram-negative isolates included Serratia and Providencia species that were not included in the subgroups.

Conclusion
Using &gt; 90% susceptibility as cut-off, monotherapy AZR and P/T are suboptimal for empiric coverage for certain GN respiratory infections. Blood specimens may not require CT. Adding either AGs or FQs enhanced susceptibility coverage to all tested pathogens but not uniformly. AGs enhancement was slightly better than FQs. Respiratory infections with Pseudomonas, Enterobacter cloacae, E coli, Proteus and Klebsiella species all showed enhanced coverage with CT especially for P/T and AZR. Every hospital should create a combination antibiogram to gain insight into whether empiric coverage with CT is needed.

Disclosures
All Authors: No reported disclosures
1269. Prospective Evaluation of a Machine Learning Model that Guides Indication for Antibiotics in Lower Respiratory Tract Infections
Authors: Tang Sarah , Chlebicki Maciej Piotr , Chung Shimin Jasmine , Chin De Zhi , Chang Daniel , Kwa Andrea 
Published: November 2023

Abstract

Background
Over-prescribing of antibiotics for suspected acute bacterial lower respiratory tract infections (abLRTI) is prevalent. A classification model that can identify instances when antibiotics should be initiated or withheld was previously developed with promising results (80% accuracy). This, however, was based on a retrospective dataset. We conducted a prospective evaluation of this model in the hospital antimicrobial stewardship unit (ASU) to validate its performance and compare its effectiveness against current ASU strategies.

Methods
Inpatients audited by the hospital ASU between 10 January and 23 March 2023 (twice weekly) were enrolled into this study. Relevant patient information (e.g., clinical notes, radiology reports, vital signs) was extracted from our hospital’s electronic data repository for model inference. The presence of abLRTI as determined by the model, the patient’s primary care team and ASU review were compared. Cases that saw differing opinions between any of the three operators were subsequently reviewed by an independent Infectious Diseases physician, who provided the ground truth for that case.

Results
A total of 851 cases were included, of which 235 (27.6%) had true abLRTI. The model was most accurate in determining the presence versus absence of abLRTI (734/851, 86.3%), while ASU review and primary care team were correct in only 698 (82.0%) and 677 (79.6%) cases respectively. Primary care team demonstrated greatest sensitivity in the suspicion for abLRTI (91.9%); unfortunately, it also over-diagnosed abLRTI in 155 (42%) patients. Among these false-positive cases, the model rightly rejected presence of abLRTI in 126 (81.3%) patients whereas only 66 (64.1%) of them were identified by ASU. ASU outperformed the model in having a lower false-negative rate when abLRTI is suspected (17.3% vs. 22.0%).

Conclusion
The model displayed consistent performance in a prospective cohort. Findings support its value in guiding decisions on antibiotic initiation for suspected abLRTI. Deploying this model to augment current ASU capabilities should be strongly considered.

Disclosures
All Authors: No reported disclosures
1291. Malignant Otitis Externa With Facial Nerve Paralysis : Comparative Analysis
Authors: Hammami Fatma , Koubaa Makram , Rekik Khaoula , Chakroun Amal , Smaoui Fatma , Marrakchi Chakib , Jemaa Mounir Ben 
Published: November 2023

Abstract

Background
Malignant otitis externa (MOE) is a life-threatening invasive infection of the external auditory canal with varying outcomes. Facial nerve paralysis (FP) is usually a sign of progression of the disease. We aimed to compare the characteristics and prognosis of patients with MOE with and without FP.

Methods
We conducted a retrospective study including all patients hospitalized for MOE in the infectious diseases department between 2000 and 2022.

Results
We encountered 114 cases among which 17 had a FP (14.9%). Median C-reactive protein levels (36[30-81] mg/L vs 14[7-37] mg/L ; p=0.002) and white blood cells count (9600[7800-11300] /mm3 vs 8270[7037-10070] /mm3 ; p=0.04) were significantly higher among patients with FP. Otalgia (94.1% vs 87.6% ; p=0.688), otorrhea (64.7% vs 71.1% ; p=0.593) and cephalalgia (47.1% vs 49.5% ; p=0.854) were the revealing symptoms among patients with or without FP, with no significant difference. Otoscopic examination revealed the presence of polyp in the external auditory canal more frequently among patients with FP (47.1% vs 21.6% ; p=0.036). Bone osteolysis was significantly more frequent among patients with FP (88.2% vs 54.2% ; p=0.008). Fungal species were isolated more frequently among cases with FP (70.6% vs 40.2% ; p=0.020). Complications were significantly more frequent among patients with FP (64.7% vs 26.8% ; p=0.002). Favorable evolution of the disease was more frequent among patients without FP (87.2% vs 62.5% ; p=0.024).

Conclusion
MOE with FP, caused more often by fungal species, were characterised by higher inflammatory markers, the presence of polyp in otoscopic examination and bone osteolysis on imaging results. FP worsened the prognosis of the disease. Prompt and aggressive diagnosis and management are crucial.

Disclosures
All Authors: No reported disclosures