bluuebunny/crossref_metadata_2025_split huggingface dataset:
1001. Comparison of Periodic In-Person ID Care to Daily Tele-ID Care at a Community Hospital
Authors: Nanjappa Sowmya , Volpe Peter , Gupta Nupur , Li Sui Kwong , Perez Christian , Gass Kate , Oelkers Keith , Overly Shannon , Mellors John W , Abdel-Massih Rima 
Published: December 2022

Abstract

Background
Access to ID specialists is absent in most US counties. Remote access to ID specialists via telemedicine is a potential alternative to in-person ID care, although comparative data are lacking. We compared outcomes between periodic in-person and daily remote ID care.

Methods
Retrospective EHR analysis of 200 patients at a 164-bed community hospital, which historically had access to an in-person ID specialist every 3rd day with limited telephonic follow-up. In May of 2020, access to a team of Tele-ID specialists was provided through live audio-visual and e-consults, with telephonic consults after hours and on weekends. Outcomes for 100 consecutive patients cared for by the in-person physician from 01/2019 to 11/2019 were compared to the first 100 patients care for via Tele-ID from 05/2020 to 08/2020.

Results
Of the 100 patients seen via Tele-ID, 73 were live initial consults and 27 initial e-consults. These 100 consults occurred over 4 months compared with 11 months for the 100 in-person ID consults, revealing greater utilization. Most patients were Caucasian, male, and &gt;60 years old (Table 1). Tele-ID patients had significantly higher Charlson Comorbidity Index (CCI) scores (5.3 vs 4.5, p=0.047), shorter LOS (7.5 vs 9.08 days, p=0.003), less frequent discharge on IV antibiotics (34% vs 51%, p=0.007), and more frequent discharge on PO antibiotics (39% vs 23%, p=0.014; Table 2). There were no significant differences in the frequency of transfer to tertiary care (13% vs 14%, p=0.84) or in-hospital mortality (2% vs 2%). The 30-day readmission rate was higher for Tele-ID (11% vs 1%, p&lt; 0.01); however, only one readmission was ID-related (a new C.difficile). The diversity of ID diagnoses made was not different (Figure 1). Table 1.Patient DemographicsTable 2.OutcomesFigure 1.Diagnoses

Conclusion
A Tele-ID service with daily availability increased utilization of ID care at a community hospital. Despite higher CCI scores in Tele-ID patients, LOS was shorter and discharge on IV antibiotics was less frequent compared with the In-person service with no difference in ID related readmissions or in-house mortality. These findings support remote Tele-ID care as a solution where access to ID expertise is limited.

Disclosures
John W. Mellors, MD, Abound Bio: Multiple|Abound Bio: Ownership Interest|Gilead Sciences: Advisor/Consultant|Infectious Disease Connect: Advisor/Consultant|Infectious Disease Connect: Ownership Interest Rima Abdel-Massih, MD, Infectious Disease Connect: Co founder and Chief Medical Officer|Infectious Disease Connect: Ownership Interest.
1002. Complex Outpatient Antimicrobial Therapy (COpAT) Program at a Rural Academic Medical Center: Evaluation of First 100 Patients
Authors: Juskowich Joy J , Ward Andrew , Spigelmyer Amy E , Howard Catessa A , Slain Douglas , Guilfoose John A , Edmond Michael B , Sarwari Arif R 
Published: December 2022

Abstract

Background
Literature shows early intravenous (IV) to oral (PO) antimicrobial transition for infective endocarditis (IE) and bone and joint infection (BJI) is noninferior to prolonged IV antimicrobial therapy. COVID-19 pandemic peaks resulted in critical shortages of staffed hospital beds spurring innovation. Outpatient parenteral antimicrobial therapy (OPAT), a well-established program using prolonged IV antimicrobials, faces challenges such as infusion resource needs and social circumstance limitations. Complex outpatient antimicrobial therapy (COpAT) uses PO in place of IV antimicrobials. We hypothesized rapid adoption of COpAT would decrease hospital length of stay and open beds while retaining satisfactory clinical outcomes.

Methods
COpAT protocols (Image 1) and guidelines by infection type and isolated organism (Image 2) were created. Hospitalized patients including persons who inject drugs (PWID) were evaluated for IV to PO antimicrobial transition by an infectious diseases (ID) physician and then followed by an ID physician-pharmacist team. Demographic, ID, and clinical outcome data for the first 100 COpAT patients between December 2020 and February 2022 were obtained by retrospective chart review. Image 1.COpAT Inpatient and Outpatient Protocols
Image 2. COpAT Guidelines by Infection Type and Isolated Organism
MSSA = methicillin-susceptible Staphylococcus aureus; MRSA = methicillin-resistant Staphylococcus aureus; spp. = species; TMP/SMX = trimethoprim-sulfamethoxazole; DS = double strength; SSTI = skin and soft tissue infection; CAP = community-acquired pneumonia

Results
PWID accounted for 78% of COpAT patients. BJI followed by mixed infection (IE and BJI) was most prevalent (Image 3) with bacteremia in 53% of cases. Staphylococcus aureus was most frequently isolated (Image 4). Oral linezolid and fluoroquinolones, often in combination, were most commonly used. IV and PO antimicrobials were taken for a median 28 and 14 days, respectively. The COpAT program saved 1425 IV antimicrobial and 1363 hospital days. Assuming daily inpatient cost of $2050, cost avoided was $2,794,150. COpAT patients participated in ID follow-up and adhered to PO antimicrobials with low 30-day readmission rates (Image 5). Image 3.Infection TypeImage 4.Isolated Organism CoNS = coagulase-negative staphylococci Image 5.Clinical Outcomes

Conclusion
In a sample of 100 COpAT patients including PWID, IV to PO antimicrobial transition safely saved hospital days and mitigated critical bed shortages during pandemic peaks. A successful COpAT program requires a multidisciplinary group: close ID physician-pharmacist collaboration extending to OPAT and antimicrobial stewardship teams. With a COpAT program in place, even earlier IV to PO antimicrobial transitions should be studied.

Disclosures
All Authors: No reported disclosures.
1007. Impact of an Interdisciplinary Outpatient Parenteral Antimicrobial Therapy (OPAT) Clinic During the COVID-19 Pandemic
Authors: Zaki Amir , Xu Teena H , Khan Parisa , Ahmed Amna , Breaux Katharine 
Published: December 2022

Abstract

Background
At the Michael E. DeBakey Veterans Affairs Medical Center, an interdisciplinary outpatient parenteral antimicrobial therapy (OPAT) clinic was developed in August 2020 during the COVID-19 pandemic (Figure 1). Standardized weekly safety monitoring and clinical follow-up was implemented via tele-OPAT visits by an infectious diseases (ID) pharmacist or ID PA with ID physician oversight. This study aimed to describe the practices implemented through initiation of our OPAT clinic, and its impact on clinical outcomes. Figure 1:Description of intervention and clinic model

Methods
This retrospective cohort study compared clinical outcomes of veterans receiving home OPAT one year pre- and post-implementation of a dedicated OPAT clinic. OPAT episodes initiated during the intervention period, prescribed for less than 7 days, not completed at time of analysis, administered with hospice services, or at a hemodialysis center, infusion suite, skilled nursing facility or long-term care facility were excluded. The primary endpoint was treatment failure during or within 30 days of OPAT completion defined as requiring repeat OPAT course for the same infection, unplanned admission, unplanned surgical intervention or procedure for additional source control, or death from any cause.

Results
A total of 191 OPAT episodes were included in the analysis (pre-intervention group, n= 76 vs. post-intervention, n=115). The most common indications for OPAT included bone/joint infections (34%), bacteremia (24%), and endocarditis (13%). Treatment failure was lower in the post-intervention vs. pre-intervention group (29% vs 46%, p = 0.01) with a median time to treatment failure of 24 days. Treatment failures in both groups were primarily driven by unplanned hospital admissions (Table 3). The median time to ID follow-up from OPAT initiation was shorter in the post-intervention vs. pre-intervention arms (6 days vs. 9 days, p&lt; 0.001). The adverse event rate was higher (13% vs. 4%, p= 0.06), and modifications were made more frequently in the post-intervention (49% vs. 29%, p=0.007). Table 1:Demographics and baseline characteristicsTable 2:OPAT indications, antimicrobials, and microbiologyTable 3:OPAT follow-up, complications, and treatment failure

Conclusion
Implementation of an interdisciplinary OPAT clinic led to shorter time to ID follow-up, more frequent OPAT modifications, and reduced treatment failure. The median time to treatment failure suggests the need for ongoing surveillance beyond the initial 2 weeks of OPAT.

Disclosures
All Authors: No reported disclosures.
1011. Outcomes Associated with the Creation of a Pharmacy-led Outpatient Parenteral Antimicrobial Therapy (OPAT) Service to Facilitate Transitions of Care
Authors: Manning Kyle B , Certain Laura , Tritle Brandon , Fong Karen , Newman Mike , Benefield Russell J 
Published: December 2022

Abstract

Background
We previously demonstrated that standardizing the documentation of the outpatient parenteral antimicrobial therapy (OPAT) plan led to improved post-discharge outcomes. This study investigated whether centralizing the OPAT documentation to an infectious diseases (ID) pharmacist would lead to improved documentation quality and further improvements in post-discharge outcomes.

Methods
We conducted a single-center, retrospective study to evaluate outcomes associated with the centralization of the OPAT plan documentation to an ID pharmacist. The study was a multiphase quality improvement study consisting of a pre-intervention period and two intervention periods on each of the General ID consult services (first on Team 1 then on Team 2). The scope of the intervention was focused on the timeliness and completeness of OPAT note documentation, while other workflow processes involving OPAT remained unchanged. The primary objective was to compare hospital length of stay (LOS) between patients with OPAT Notes documented by an ID pharmacist versus ID providers. Secondary objectives were to compare post-discharge outcomes.

Results
A total of 350 patients met inclusion criteria; baseline characteristics were similar between the pharmacist and provider groups (Table 1). OPAT note documentation quality improved during the pharmacist intervention phases for each General ID team (Figure 1). The median LOS was 7.9 days in the pharmacist documentation group compared to 6.8 days in the provider group [Median difference, 1.1; 95% Confidence Interval (CI), -0.4 - 3.7]. Laboratory monitoring within 10 days of discharge, 30- and 60-day death or readmission rates, and late ID visit cancellations between the two groups were comparable (Table 2). ID clinic no show appointments occurred less often in the pharmacist documentation patients. Table 1:Baseline DemographicsFigure 1:Control Chart Comparisons of OPAT Notes Without All “Perfect Care” ElementsTable 2:Post-discharge outcomes for pharmacist compared to provider documentation patientsa: Pharmacist note patients are the reference for all comparisonsb: Adjusted for discharge destination and primary payorc: Adjusted for Charlson comorbidity indexd: Adjusted for age and primary payor

Conclusion
Improved OPAT note documentation did not translate into shorter hospital LOS. Post-discharge outcomes were similar between pharmacist and provider patients, although no show visits occurred less often when pharmacists documented the OPAT plan.

Disclosures
Russell J. Benefield, PharmD, BCPS-AQ ID, Paratek Pharmaceuticals: Grant/Research Support.
1012. Outcomes of a Quality Improvement Initiative: Multi-Disciplinary Team for Infective Endocarditis Improves the Numbers of Patients Who Undergo Surgery
Authors: Crosby Haley W , Pierce Robert P , Regunath Hariharan 
Published: December 2022

Abstract

Background
In a prior study we identified leverage points for improving infective endocarditis (IE) outcomes at an academic medical center¹. We aimed to improve the rate of surgery for those with guideline-based indications for surgery by 50%.

Methods
We recorded outcomes and surgical indications for patients with IE from December 2018 to June 2020 and compared to our prior published data from January to December 2016, using similar criteria.¹ Changes implemented in the interim period included development of a multidisciplinary team (MDT) for IE that provided recurring conferences, participated in heart valve team case discussions, and promoted the use of a home-grown algorithmic clinical care pathway within the electronic health record to guide providers on the next steps in management. Primary outcomes were surgery or transfer to a higher center for surgery, and in-hospital death. Odds ratios were calculated using a multivariate logistic regression model including age and sex covariates.

Results
We identified 31 IE patients with guideline indications for surgery. Of those patients, 15(48.39%) were female, 15(48.4%) were 18 - 44 years of age, 8(25.8%) were 45 - 64 years, 8(25.8%) were &gt;64 years, 28(90.3%) white, 2(6.4%) black, 1(3.2%) East Asian, 17(54.8%) were intravenous drug users. Prior to the intervention, 6 of 21 (28.6%) patients with indications underwent surgery or were transferred outside for surgery and 6 (28.6%) patients died. Post-intervention, 17 of 31 (54.8%) patients with indications underwent or were transferred for surgery, and 5 (16.1%) died. After adjustment for age and sex, compared to the pre-intervention period, the odds of surgery or transfer for surgery for patients in the post-intervention period was 4.88 (95% CI 1.20, 19.79, p=.027). The odds ratio for death among patients in the post-intervention period was 0.40 (95% CI 0.09, 1.69, p=0.21).
Pre- and post-intervention outcomes for infective endocarditis patients

Conclusion
MDT team with continued educational and health IT interventions improved the number of surgeries performed for IE.
1. Regunath H, Vasudevan A, Vyas K, et al. A Quality Improvement Initiative: Developing a Multi-Disciplinary Team for Infective Endocarditis. Mo Med. 2019;116(4):291-296.

Disclosures
All Authors: No reported disclosures.
1015. Real World Use of Dalbavancin and Oritavancin for Optimized Outpatient Antimicrobial Therapy in Patients Inappropriate for Standard Therapy
Authors: Weichman Brittani , Bushman Amanda , Aarhus Angela , Terrero Salcedo David A , Drake Ty C 
Published: December 2022

Abstract

Background
Dalbavancin and oritavancin are long acting lipoglycopeptide antibiotics (LaLGP) approved for treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by susceptible gram-positive organisms. These antibiotics have shown promise in treatment of non-FDA approved gram-positive infections including bacteremia, endocarditis, pneumonia, and osteomyelitis. The aim of this review was to determine indication, length of therapy, treatment failures, and adverse drug events (ADE) in patients receiving LaLGP at our institution.

Methods
Retrospective study of adult patients that received LaLGP within an integrated health system consisting of 3 hospitals and 2 outpatient infusion centers, between July 2016 and February 2022. Data collection included dosing regimen specifics for both LaLGP and non-LaLGP, indication and justification for LaLGP use, culture results, labs, ADE, incidence of readmission and Emergency (ED)/Urgent Care presentation, and treatment failure defined as readmission or return to the ED/Urgent care within 90 days of therapy completion.

Results
36 patients received LaLGP during the study period. A majority of patients received LaLGP for an indication other than ABSSSI (64%)(Table 1). Four patients were lost to follow-up but included in analysis of indication and justification for LaLGP use. Staphylococcus aureus (30% MRSA, 26% MSSA) was the most commonly identified pathogen in patients who received LaLGP for non-ABSSSI indications.
Justification for use of LaLGP over standard therapy is shown in Table 2. The median duration of standard therapy prior to transitioning to LaLGP was 7 days.
Table 3 shows agent selection, number of doses, and outcomes for ABSSSI indications vs non-ABSSSI indications. ABSSSI patients received a maximum of 2 doses; non-ABSSSI indications received 1-8 doses. Re-admission rates were higher in the ABSSSI group compared to non-ABSSSI while ED/Urgent care presentations were higher in non-ABSSSI indications.

Conclusion
LaLGP is a viable option for therapy completion after improvement is seen while on standard therapy in patients where daily outpatient antimicrobial therapy is not feasible. While LaLGP is currently only approved for ABSSSI, they appear to be safe and effective for other indications.

Disclosures
All Authors: No reported disclosures.
1016. Real-World Use of Omadacycline in Physician Office Infusion Centers (POICs)
Authors: Van Anglen Lucinda J , Schroeder Claudia P , Couch Kimberly A 
Published: December 2022

Abstract

Background
Omadacycline (OMC) is approved for the treatment of community-acquired bacterial pneumonia and acute bacterial skin and skin structure infections. Real-world data on the use of OMC are limited. We present a multicenter observational review of OMC outpatient use in Infectious Disease POICs.

Methods
Medical records of patients (pts) receiving intravenous OMC from May 2019 to April 2022 from 5 POICs were included in this ongoing study. Data included demographics, diagnosis, medical history, microbiology, OMC regimen, adverse events (AEs), health care utilization and clinical outcomes. Clinical success was defined as complete or partial symptom resolution at completion of OMC with oral antibiotics as needed. Persistent or recurrent infection and premature discontinuation of OMC were deemed non-success. Indeterminate outcomes were excluded in outcome assessment. Chi Square, Fisher’s exact, and t-test were used to identify characteristics associated with clinical outcome.

Results
Overall, 37 pts (mean age: 61±13 yrs, 65% male) were identified. Infections treated were 62% bone and joint (BJI), 24% complicated skin and skin structure infections (CSSSI), 11% pulmonary nontuberculous mycobacterial (NTM) and 3% diverticulitis. A total of 61 pathogens were identified in 30 pts of which 83% had ≥1 Gram-positive isolate. Polymicrobial pathogens were reported in 13/30 pts (43%). Ten pts (27%) received concomitant IV antibiotics. Median duration of OMC therapy was 38 days (IQR, 21-47). OMC was initiated in the POIC without prior hospitalization in 62% of pts. Overall clinical success was 75% (24/31). Non-success due to persistent infection was reported in 5 pts (3 BJI, 2 CSSSI), of which 4 were hospitalized. Three additional pts were deemed non-successful due to early discontinuations (2 difficulty with administration, 1 AE) (Fig 1). Six pts were non-evaluable for outcome. Ten pts reported 14 AEs, most commonly nausea (4 pts) and elevated liver function tests (3 pts). Figure 1.Clinical outcome of omadacycline by infection type

Conclusion
These real-world results support the outpatient use of omadacycline in additional, difficult to treat, complicated infections, including bone and joint infections.

Disclosures
Lucinda J. Van Anglen, PharmD, Merck & Co.: Grant/Research Support|Paratek: Grant/Research Support.
1019. The Future is Embedded in the Present - Characterizing Pharmacist Interventions in an Infectious Diseases Clinic
Authors: Depcinski Shawn , Bhargava Ashish 
Published: December 2022

Abstract

Background
Incorporating clinical pharmacists into the outpatient care setting can improve patient outcomes; however, the focus has mostly been on primary care. In 2021, Ascension Specialty Pharmacy embedded clinical pharmacists into clinics prescribing specialty medications to increase prescription capture and improve patient care. The clinical pharmacist incorporated into the Ascension St. John Infectious Diseases clinic provides patient outreach, care coordination, financial and prior authorization assistance, medication reconciliation and counseling, and clinical interventions. This study characterizes the pharmacist interventions provided during a six month timeframe.

Methods
As of September 2021, the clinical pharmacist’s interventions were consistently captured in a documentation system. Each patient encounter that resulted in one or more interventions were entered as one documentation event, which captures type of problem, recommendation category, intervention acceptance, and estimated time spent. If more than one problem within the same type occurred on a patient, it could only be recorded as one problem. A report was pulled over a six month period of September 2021 through February 2022.

Results
During the timeframe reported, infectious disease specialty prescriptions filled at Ascension Specialty Pharmacy had nearly doubled from before embedding the pharmacist (monthly average, 115 vs. 66). During the study period, 316 patient encounters resulted in clinical pharmacist interventions, which included 594 problem types. The frequency of problem types included under-treatment (32%), medication monitoring needed (28%), suboptimal drug (18%), sub-optimal dosing/duration/frequency/administration (12.52%), nonadherence (5.92%), and adverse drug event (4.74%). Pharmacist interventions were accepted 90% by physicians and 81% by patients. The pharmacist time spent on interventions was estimated at 203 hours during the study period.

Conclusion
Despite limitations in how interventions are documented and reported, this study demonstrates the significant impact a clinical pharmacist embedded into an infectious diseases clinic can have on optimizing patient care.

Disclosures
Shawn Depcinski, PharmD, bioMérieux: Honoraria.
1023. Thrice is Nice: Thrice Weekly Ertapenem Versus Daily Ertapenem in Patients on Hemodialysis
Authors: Mulugeta Surafel , Procopio Vince , Mannino Ii Andrew C , Aref Nada , Kwiatkowski Shaina 
Published: December 2022

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) has challenges: venous access complications, cost, and non-adherence. Venous line preservation is an added concern for patients on hemodialysis (HD). While ertapenem is dosed 500 mg daily post-HD, there is limited data on dosing it as 1 gm thrice weekly. This study compares disposition and outcome in patients treated with these two regimens.

Methods
IRB approved, retrospective cohort study. Inclusion: adult patients on intermittent HD, admitted 6/1/20 to 7/31/21, and discharged with ertapenem either with daily (daily group) or thrice weekly (TIW group) dosing. Data were reported using descriptive statistics and bivariate analysis. Primary endpoints: discharge delay after medical stability. Secondary endpoints: efficacy (readmissions, alterations in antibiotics, and mortality) and safety (line or drug – related adverse events including line infection and seizure).

Results
33 patients included: 10 daily and 23 TIW. Baseline characteristics were similar. Median (IQR) age: 57 (48-64) daily and 63 (47-70) TIW, P=0.552. Both groups had a high median Charlson index (IQR): 5 (4-5) daily and 4 (2-5) TIW, P=0.287. Primary reason for ertapenem use was infection from extended-spectrum beta lactamase producing organism: 60% daily and 52% TIW. The TIW group had significantly fewer lines placed (80% daily vs. 22% TIW, p=0.05). Median (IQR) length of stay in days was similar: 7 (6–15) daily and 8 (6-8) TIW, P=0.773. Discharge delays were similar (10% daily vs 9% TIW, P=1.0). Most patients were discharged home (60%). More patients received ertapenem at the dialysis center or infusion clinic in the TIW group (78% TIW vs 30% daily, P=0.016). There was no difference in safety and efficacy endpoints including readmission, mortality, alternation in antibiotics, and line infection.

Conclusion
In this study’s cohort, ertapenem thrice weekly dosing led to a decrease in line placement without compromising efficacy and safety.

Disclosures
All Authors: No reported disclosures.