bluuebunny/crossref_metadata_2025_split huggingface dataset:
1755. Interactive Provider Dashboards for Comparison of Outpatient Antimicrobial Prescribing for Respiratory and Otic Conditions in Urgent and Quick Care Clinics
Authors: Percival Kelly M , de Blois Michael R , Kinn Patrick M , Weiner Lukasz , Ince Dilek 
Published: December 2022

Abstract

Background
Due to antibiotic overutilization, development of antimicrobial stewardship (AMS) in the outpatient setting has become a necessary focus for AMS programs. The cornerstone of AMS is utilization of antimicrobial prescribing data to provide feedback to individual providers and compare providers to each other in order to promote improved prescribing practices. Respiratory infections, especially conditions that never require antimicrobials, are a common target for this feedback. We aimed to create interactive data visualization dashboards of end-users prescribing for these respiratory and otic conditions in order for AMS and urgent/quick care program staff to identify potential areas of intervention.

Methods
A multidisciplinary work group consisting of data analysts, infectious diseases physicians, urgent/quick care physicians, and infectious diseases pharmacists determined dashboard content, layout, and comparison charts. Graph types were tested to determine optimal visual output. Using the electronic medical record ICD10 and antimicrobial prescription data was extracted for the encounter with focus on ICD10 codes for respiratory and otic conditions which never require antimicrobials. Rates were calculated as number of antimicrobial prescriptions over total number of visits for these conditions.

Results
A multi-faceted dashboard was developed in Tableau® to view antimicrobial prescribing rates. Dashboard capabilities include the option to view individual provider prescribing rates compared to other de-identified providers, overall clinic prescribing rate, or individual rate compared to clinic rate. This allows for quick direct comparison of antimicrobial prescribing on the same graph by clinic to identify outliers (Figure 1) and allows visualization of trends in prescribing rates by clinics and providers over time (Figures 2,3).
Never Antimicrobial Prescribing Rate Comparison
Scatter plot comparing individual prescribers rate of prescribing for never antimicrobial events
Clinic Antimicrobial Prescribing Rate Trend
Clinic prescribing rate trend over time for never antimicrobial events
Prescriber and Clinic Antimicrobial Prescribing Rate Trend
Individual prescriber rate compared to clinic rate over time for never antimicrobial events

Conclusion
We developed an interactive outpatient AMS dashboard to visualize prescribing of antimicrobials for never respiratory and otic conditions. These dashboards can be used by providers along with AMS and clinic leadership to determine areas of intervention in the urgent/quick care setting.

Disclosures
Kelly M. Percival, PharmD, Gilead Sciences Inc: Advisor/Consultant Patrick M. Kinn, PharmD, MPH, Gilead Sciences: Advisor/Consultant Dilek Ince, MD, Evergreen: Member of data monitoring board|Gilead Sciences: Grant/Research Support|Leidos: Grant/Research Support|Moderna: Grant/Research Support.
1759. Risk Factors for OPAT-Related Adverse Drug Events: A Case-Control Study
Authors: Burke Elysia , Croteau Desiree , Dutcher Lauren , Hamilton Keith W , Degnan Kathleen , Lee Tiffany , Saw Steve , Patel Sonal , Binkley Shawn , Athans Vasilios 
Published: December 2022

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) offers numerous clinical advantages, though adverse drug events (ADEs) are a common and potentially preventable challenge that may contribute to 30-day readmissions and other negative outcomes. In January 2021, our OPAT program began documenting all significant ADEs using an electronic template. The purpose of this study was to characterize significant OPAT ADEs and to identify potential risk factors for their development.

Methods
Outpatient parenteral antimicrobial therapy (OPAT) offers numerous clinical advantages, though adverse drug events (ADEs) are a common and potentially preventable challenge that may contribute to 30-day readmissions and other negative outcomes. In January 2021, our OPAT program began documenting all significant ADEs using an electronic template. The purpose of this study was to characterize significant OPAT ADEs and to identify potential risk factors for their development.

Results
Cumulative ADE incidence was 11%, and median time-to-ADE was 13 days after discharge. During the study period, 54 ADE patients vs. 100 control patients were identified. The most common ADEs attributed to OPAT were kidney injury (50%), rash (10%), and leukopenia (9%) (Table 1). Most ADEs resulted in an OPAT regimen change (33%), dosage adjustment (29%), or early cessation of OPAT (21%) (Table 2). In the final logistic regression model, receipt of vancomycin, use of empiric therapy for culture-negative infection, and OPAT duration ≥ 28 days were associated with increased ADE risk, whereas African American race and receipt of ceftriaxone were protective (Table 3).

Conclusion
Several modifiable risk factors may increase the likelihood of an ADE during OPAT and should be carefully considered prior to hospital discharge. Based on these data, OPAT programs should consider employing vancomycin alternatives, diagnostic stewardship, and strategies to minimize duration of therapy.

Disclosures
Kathleen Degnan, MD, Gilead: Grant/Research Support.
1765. Antibiotic Consumption in a Healthcare System in Bolivia During the First Wave of COVID-19 Pandemic
Authors: Quiros Rodolfo E , Escobar Elvio D , Tapia Juan Carlos , Fabre Valeria 
Published: December 2022

Abstract

Background
Several countries in Latin America reported an increase in antibiotic use during the first wave of the COVID-19 Pandemic.

Methods
We retrospectively evaluated antibiotic use among 10,752 members of a private healthcare system in Santa Cruz de la Sierra, Bolivia, between Jan-Dec 2019 (pre-pandemic) and Jan-Aug 2020 (pandemic). Antibiotic use was calculated as daily defined doses (DDD) per 1,000 member-days, per 100 ambulatory visits, and per 100 inpatient-days, and categorized using the World Health Organization classification (Access, Watch, and Reserve), based on the impact of different antibiotics on antimicrobial resistance. In April 2020, the antibiotic stewardship team developed COVID-19 treatment guidelines for ambulatory and hospitalized patients and provided recommendations on all patients hospitalized due to COVID-19. Due to the nature of the network, guideline use is usually high. During the pandemic period and due to local restrictions, patient interactions were mostly limited to COVID-19 presentations. Differences with 95% confidence intervals (CI) between groups were estimated.

Results
Pandemic and pre-pandemic antibiotic use in DDD/1,000 member-days was 8.48 and 18.37, respectively (diff. –8.89, 95%CI –10.11 to –9.67). Outpatient DDD/100 ambulatory visits was 67.68 vs. 86.20 (diff. –18.52, 95%CI –19.94 to –17.1), and hospital DDD/per 100 inpatient-days was 39.79 vs. 61.71 (diff. –21.92, 95%CI –26.2 to –17.68) for pandemic and pre-pandemic periods, respectively. During the pandemic period, an overall reduction in macrolides use was also observed (–3.13 DDD/100 ambulatory visits, 95%CI –3.84 to –2.44, and –2.05 DDD/per 100 inpatient-days, 95%CI –2.88 to –1.26). Additionally, an increase in Access antimicrobials (83.3% vs. 79.5%; diff. 3.8%, 95%CI 0.3% to 7.4%) and a reduction in the Watch group (16.7% vs. 20.5%; diff. –3.7%, 95%CI –7.4% to –0.1%) were observed for pandemic and pre-pandemic periods, respectively.

Conclusion
In this closed network, we observed a reduction in antibiotic use both in ambulatory and inpatient settings. Although, multifactorial, we believe the enhanced antibiotic stewardship approach on COVID-19 patients played a role in limiting antimicrobial use in this private healthcare system.

Disclosures
All Authors: No reported disclosures.
1767. Because I Could Not Stop for Death, They Gave Me Antibiotics? Perceptions And Reality of Antibiotic Prescribing When Patient Care Is Transitioned to CMO at an Academic Medical Center
Authors: Larnard Jeffrey , Blackshear Leslie , Lee Matthew S , Buss Mary , Stead Wendy 
Published: December 2022

Abstract

Background
Little is known about antimicrobial prescribing when patient care is transitioned to comfort measures only (CMO). We used a multi-disciplinary survey and retrospective chart review to gain insight into antimicrobial prescribing in this population at an academic medical center.

Methods
A survey focusing on antimicrobial prescribing during the transition to CMO was electronically distributed to providers in Infectious Disease, Pulmonary/Critical Care, Hematology/Oncology, Palliative Care, and Hospital Medicine, and responses were compared across divisions. A retrospective chart review was performed of patients admitted to Beth Israel Deaconess Medical Center in 2020 who were on antimicrobials in the 48 hours prior to CMO. We investigated the frequency of patients on antimicrobials after the transition to CMO and provider rationale for continuing antimicrobials.

Results
We received 113 survey responses for a response rate of 35%; 111 were included for analysis. 41% of respondents indicated that they “sometimes” or “often” continued an antimicrobial during the transition to CMO. Of the 546 patient charts reviewed, 140 (26%) patients were alive 48 hours after CMO order, and 19 (14%) of those patients remained on antimicrobials (Figure 1).
Patient/family preference was the most common factor when deciding whether to continue antimicrobials in patients on CMO, identified by 77% of respondents (Figure 2). 5/19 (26%) patients who were alive on antimicrobials 48 hours after CMO had documentation that antimicrobials were continued due to patient/family preference.
Symptom palliation was the second most common factor when deciding whether to continue antimicrobials in patients on CMO, identified by 62% of respondents. For patients already on symptom directed medications, many providers perceived antibiotics to be helpful to palliate symptoms, though there were inter-division differences (Table 1). 5/19 (26%) patients who were alive on antimicrobials 48 hours after CMO had documentation that antimicrobials were continued for palliation of symptoms.
Perceived Helpfulness of Antimicrobials for Specific Symptoms by Division
Number/percentage of survey responses indicating antimicrobials were at least somewhat helpful for specified symptoms in patients already on symptom directed medications. Divisions compared using Kruskal-Wallis Tests.

Conclusion
Even after transition to CMO, a substantial number of patients remain on antimicrobials. Patient/family preference and symptom palliation are important factors when continuing antimicrobials in this population.

Disclosures
All Authors: No reported disclosures.
1773. Evaluation of Fluoroquinolone Prophylaxis in Preventing Bacterial Infection in Neutropenic Afebrile Patients Without Leukemias or HSCT: A Systematic Review
Authors: Yazdi Mona T , Avula Divya 
Published: December 2022

Abstract

Background
Per 2010 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer, routine use of fluoroquinolone (FQ) chemoprophylaxis in low-risk populations (defined as those with solid tumors or lymphoma undergoing chemotherapy) is not recommended to prevent febrile neutropenic episodes as it was not found to impact all-cause mortality. Since these guidelines were published, there have been additional randomized trials (RCTs) of FQ chemoprophylaxis in patients with cancer.
Our objective was to assess the efficacy of FQ vs placebo in preventing probable or confirmed bacterial infection in patients with cancer who did not have leukemias or hematopoietic stem cell transplant (HSCT). Secondary outcomes of interest included febrile episodes, mortality, and adverse effects of antibiotic use.

Methods
Medline via PubMed, The Cochrane Central Register of Controlled Trials, and SCOPUS from inception through 2/17/2022 were searched. We included RCTs in English comparing FQ to placebo in preventing neutropenic fever and bacterial infections in patients with cancer who did not have leukemias or HSCT.

Results
We included 5 RCTs (N= 3158). The rates of probable or confirmed bacterial infection in patients with cancer revealed 541/1562 (34.6%) infections in the FQ group and 679/1560 (43.5%) in the placebo group (OR: 0.68, 95% CI:0.59,0.79, I2 = 57%, p=0.002). In evaluating development of febrile episodes, 300/1566 (19.2%) events were noted in the FQ group and 407/1555 (26.2%) in the placebo group (OR: 0.58, 95% CI:0.41,0.83, I2 = 0%, p&lt; 0.001). Mortality events in the FQ group were 113/1597(7.1%) and 124/1508 (8.2%) in the placebo group (OR: 0.76, 95% CI:0.53,1.1, I2 = 7%, p=0.15). Adverse events associated with antibiotic use in the studies were more frequent in the FQ group. Figure 1Forest Plot of Mortality in included studiesFigure 2Results on Development of Fevers in included studies.Figure 3Forest plot of Probable or Proven Infection in included studies.

Conclusion
Although evidence does not show that FQ prophylaxis provides mortality benefit, it did show a decrease in development of bacterial infections and febrile episodes. This suggests that treatment may still provide clinical benefit to this population of patients, but must be weighed against risks and consequences of long-term antibiotic use, which were not reported by the included studies.

Disclosures
All Authors: No reported disclosures.
2311. Long-term prognosis and risk factors for overall mortality in patients with progressive multifocal leukoencephalopathy
Authors: Kim Jinnam , Kim Chang Hyup , Lee Jung Ah , Lee Se Ju , Lee Ki Hyun , Kim Jung Ho , Ahn Jin Young , Jeong Su Jin , Ku Nam Su , Choi Jun Yong , Yeom Joon-sup , Song Young Goo 
Published: December 2022

Abstract

Background
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system (CNS) caused by reactivation of JC virus, almost in patients with immunosuppressive conditions. PML is a fatal infection with a reported 3-month mortality rate of 30–50% and a 2-month mortality rate of up to 90% in the non-human immunodeficiency virus (HIV) population. Despite high mortality, studies on PML are still lacking due to its low prevalence and incidence. Therefore, this study aimed to figure out long-term prognosis of PML and prognostic factors for mortality through a long observation period.

Methods
We retrospectively reviewed 68 PML patients with admitted to two tertiary hospitals in South Korea from 1999 to 2021. A total of 47 PML patients were finally enrolled after exclusion. The primary endpoint was long-term overall mortality. For survival analysis, Kaplan-Meier curve and Cox proportional hazards model were used. Each patient was followed up until death or until the end of the study period, whichever came first.

Results
The median follow-up duration was 20 (interquartile range [IQR], 3–79) months. The median age was 46 years, 27 (57.4%) were diagnosed with HIV, 19 (40.4%) were using immunosuppressive drugs. The median last follow-up modified Rankin Scale (mRS) was higher in non-HIV PML patients group (5 [IQR, 4–6] vs 4 [IQR, 2–5], p=0.020). The median survival duration was 184 (IQR 74–1,566) days in the non-HIV group and 1,564 (IQR 254–3,444) days in the HIV group. The overall mortality rate of PML patients was significantly higher in non-HIV group (80.0% vs 40.7%, p=0.007), also confirmed by the Kaplan-Meier curve and log-rank test (p=0.007). Initial mRS (HR 1.685, 95% CI: 1.028–2.762, p=0.038), HIV patients with highly active antiretroviral therapy (HAART) (HR 0.374, 95% CI: 0.172–0.815, p=0.013) had a significant effect on overall mortality.

Conclusion
With the widespread adoption of HAART, the survival duration of HIV patients with PML has been extended, but the mortality rate is still high. Also, the prognosis for PML in non-HIV patients is still frustrated. Initial mRS is a significant risk factor for long-term overall mortality in PML patients. Early detection of PML and early initiation of HAART in HIV patients may improve the patient's prognosis.

Disclosures
All Authors: No reported disclosures.
1800. Impact of Updated ATS/IDSA CAP Guidelines on Duration of Antibiotics
Authors: Petty Lindsay A , Vaughn Valerie , Malani Anurag N , Younas Mariam , Osterholzer Danielle , Bernstein Steven , Ratz David , McLaughlin Elizabeth , Czilok Tawny , Horowitz Jennifer , Flanders Scott A , Gandhi Tejal N 
Published: December 2022

Abstract

Background
In 10/2019, revised ATS/IDSA community-acquired pneumonia (CAP) guidelines removed healthcare-associated pneumonia (HCAP), expanding patients eligible for a 5-day antibiotic course. Using data from 46 hospitals in the Michigan Hospital Medicine Safety Consortium, we quantified the impact of removing HCAP on antibiotic duration for CAP.

Methods
From 11/2017 to 1/2022, data were abstracted from medical records of adult non-ICU medical patients admitted with pneumonia. Our primary outcome was percentage of patients who received 5-days of antibiotics out of those who, under the new CAP guidelines would be eligible for 5-days (including patients defined as HCAP prior to the 2019 guideline) [Table 1]. We evaluated using Chi-square, if the effect of the guidelines differed for patients defined as CAP based on the 2007 CAP guideline (pCAP) vs. HCAP. To assess the effect of the new guideline on 5-day therapy, we used segmented logistic regression accounting for hospital level clustering to look at changes at baseline and overtime before and after 10/2019.

Results
When applying the 2019 CAP definition to 34,810 patients admitted with pneumonia over the entire period, 41.2% (N=14,358) of patients were eligible for 5-day duration. Applying pre-2019 categorization to the entire period, 46.4% of pCAP (N=10,565/22,757) and 31.5% of HCAP (N=3793/12,053) were eligible for 5-day duration. Of those 5-day eligible, 34.4% (N=4,936) received 5 days (pCAP 35.5% N=3750; HCAP 31.2% N=1186, P&lt; .001). Before 10/2019, 29.5% (N=2,018) of patients with pCAP who were eligible received 5 days vs 23.6% (N=548) of HCAP (P&lt; .001). Post 10/2019, 46.5% (N=1,732) of patients with pCAP eligible received 5 days vs 43.5% (N=638) of HCAP (P=0.049). The improvement rate in 5-day therapy decreased after 10/2019, with similar decrements for both pCAP and HCAP [Figure 1].

Conclusion
Among patients hospitalized with pneumonia, two thirds received an excess antibiotic duration, with similar proportions for pCAP and HCAP. Prior to the new guidelines, the 5-day treatment rate was improving for HCAP and pCAP. However, the rate of improvement decreased after 10/2019 for both pCAP and HCAP, suggesting the 2019 guidelines did not have an added effect on improving antibiotic duration.

Disclosures
Valerie Vaughn, MD, MSc, Thermo Fisher Scientific: Honoraria.
1801. LVAD antimicrobial prophylaxis and infections, a 12-year experience
Authors: Mendoza Maria A , Ranganath Nischal , O’Horo John C , Stulak John , Shah Aditya 
Published: December 2022

Abstract

Background
The incidence of end-stage heart failure necessitating advanced cardiac therapy continues to increase in the United states. Implantable left ventricular assist devices (LVADs) represent an important modality that is utilized both as a bridge to heart transplant or as destination therapy. LVAD-associated infections, ranging from driveline exit site or pocket infections to endovascular infections, are a major complication with high mortality. Antibiotic prophylaxis at time of LVAD implantation is therefore an important strategy to mitigate infections. However, a clear surgical infection prophylaxis regimen and associated outcomes have not been reported.

Methods
We performed a single center, retrospective cohort study evaluating the impact of antimicrobial prophylaxis on risk of infection in patients who underwent LVAD implantation between February 2007 and June 2019 at Mayo Clinic. LVAD-specific and related infections were defined according to the International Society of Heart Lung Transplantation criteria. Single drug prophylaxis (SDP) included cefazolin only, vancomycin only, or cefazolin and vancomycin; multidrug (MDP) regimen includes either of the SDP regimens plus another antibiotic. We compared incidence of infection within 90-day and within one-year of implantation, as well as risk of C. difficile infections between the SDP and MDP cohorts.

Results
We reviewed 403 patients who received LVAD implantation (Table 1), 402 of had information on surgical prophylaxis. 307 (76%) patients received SDP and 95 patients (24%) received MDP. 14 patients developed an infection within 1 year of implantation (Table 2). There was no difference in the incidence of infections between SDP and MDP arms both at 90 days and 1-year post-implantation (p=0.11). The median time of infection since LVAD implantation was similar between SDP and MDP (p=0.37) arms. Incidence of C. difficile infection was not different between groups (p=0.10) (Table 3).

Conclusion
There was no significant difference in incidence or time to first infection, within 90-day and 1-year of implantation, between single- and multidrug antibiotic surgical prophylaxis regimens administered at the time of LVAD implantation. Future prospective trials are needed to develop a clear LVAD antibiotic prophylaxis protocol.

Disclosures
John C. O'Horo, Sr., MD, MPH, Bates college: Advisor/Consultant|MITRE corporation: Grant/Research Support|nferenec, Inc: Grant/Research Support.