bluuebunny/crossref_metadata_2025_split huggingface dataset:
897. Criteria Restricting Inappropriate Meropenem Empiricism (CRIME): A Quasi-Experimental Carbapenem Restriction Pilot at a Large Academic Medical Center
Authors: Wells Drew , Johnson Asia , Lukas Jack , Mason Darius , Cleveland Kerry O , Bissell Aaron , Hobbs Athena L V 
Published: December 2022

Abstract

Background
Carbapenems’ broad spectrum of activity may make these agents appealing for empiric use; however, their use is associated with development of Clostridioides difficile infection (CDI) and multi-drug resistance. Selective use of carbapenems is vital in maintaining their effectiveness. Our study aimed to examine the impact of meropenem restriction criteria on utilization and patient outcomes.

Methods
This single-center, quasi-experimental study was conducted at an academic medical center where an initial medication use analysis found frequent inappropriate meropenem utilization. The antimicrobial stewardship team developed restriction criteria and implemented a pilot in February 2022. Investigators aimed to determine how restriction criteria affected meropenem utilization across 8 weeks in the pre-implementation period compared to the post-implementation period. The primary outcome was to compare the inappropriateness of meropenem utilization. Secondary outcomes included comparison of days of therapy per 1000 patient-days (DOT/1000 PD), hospital length of stay (LOS), frequency of CDI, and acquisition cost.

Results
Across the 8 week timeframes, reductions in inappropriate meropenem use (64.5% vs 12.8%; p&lt; 0.001), duration of therapy (5.8 [3.2-7.3] vs. 2.4 [1.0-5.5] days, p&lt; 0.0001), and utilization (30.5 vs. 8.3 DOT/1000 PD, p=0.04) in the pre- and post-implementation periods, respectively, were observed. Total number of meropenem orders decreased by 65% (p&lt; 0.001). Implementation of restriction criteria also resulted in decreased median hospital LOS between periods (11.9 [7.8-20.4] vs. 9.2 [5.4-15.2] days, p=0.05). There was no difference in frequency of CDI (2 vs. 0, p=0.99). Projected annual cost savings was approximately $57,300.

Conclusion
Implementation of antimicrobial stewardship-initiated restriction criteria can reduce inappropriate utilization of meropenem, overall number of orders, and total duration of therapy.

Disclosures
Kerry O. Cleveland, MD, AbbVie: Honoraria|Cumberland: Honoraria|Merck: Honoraria|Pfizer: Honoraria.
919. Let’s GO PO: Impact of Monthly Feedback on a Longitudinal Intravenous to Oral Antimicrobial Conversion Initiative
Authors: Hayes Jillian E , Carr Amy L 
Published: December 2022

Abstract

Background
Timely conversion of antimicrobials from intravenous (IV) to oral (PO) route has been shown to decrease costs and length of stay (LOS) without compromising safety and efficacy of therapy. Use of oral antimicrobials may additionally prevent complications related to IV catheters, such as infection, emboli, and patient discomfort. An approved IV to PO policy allowed pharmacists to convert orders for fourteen included antimicrobials and eligible patients at time of order verification.

Methods
This single-center, retrospective, comparative study was conducted at AdventHealth Orlando, a 1,368-bed community teaching hospital in central Florida. In November 2020, six clinical pharmacist teams began receiving monthly feedback on IV to PO conversion rates in the form of a RePOrt Card, containing IV to PO conversion rates compared to other clinical teams, individual antimicrobial conversion rates, and comparison to prior team progress (Figure 1). RePOrt Cards were provided through October 2021. This study compared pre-intervention days of therapy (DOTs) of antimicrobials from November 2019-October 2020 to post-intervention DOTs from November 2020 to March 2022. The primary objective of this study was to assess the impact of monthly, team-based feedback on percentage of antimicrobials administered orally during a pharmacist-driven IV to PO stewardship initiative. Figure 1Example RePOrt Card

Results
Significantly more DOTs were administered orally in the post intervention group (62% vs 67%, p=0.0012). Positive change in oral conversion rates was observed for all agents except linezolid, minocycline, and voriconazole (Table 1). The largest increase in percentage of DOT administered orally was observed for azithromycin (20%), rifampin (14%), and metronidazole (10%). Estimated monthly and total cost differences are available in Table 2. Minocycline represents the largest opportunity missed; while oral conversion rates remained the same, an increase in overall drug use creates opportunity to continue to prioritize oral conversion due to high cost.

Conclusion
Monthly, team-based feedback positively impacted IV to PO conversion rates. Opportunities remain to optimize cost benefits in high-cost agents such as linezolid, minocycline, and voriconazole.

Disclosures
Amy L. Carr, PharmD, BCIDP, Shionogi: Advisory Board.
920. Leveling Up: Evaluation of IV vs. PO Linezolid Utilization and Cost after an Antimicrobial Stewardship Program Revision of IV to PO Conversion Criteria within a Healthcare System
Authors: Jaggar Jessica H , Cleveland Kerry O , Twilla Jennifer D , Patterson Shanise , Hobbs Athena L V 
Published: December 2022

Abstract

Background
Intravenous (IV) to oral (PO) conversion is specifically listed as a pharmacy-based intervention in the CDC’s Core Elements of an Antimicrobial Stewardship Program (ASP). Due to linezolid’s high PO availability and high IV cost, it is used as a marker for pharmacist-driven IV to PO conversion within our healthcare system, which remained low despite the existence of a pharmacist-driven IV to PO protocol. The system ASP implemented an intervention aimed at improving rates of IV to PO conversion of antimicrobials.

Methods
This retrospective, observational cohort was conducted within a healthcare system composed of 5 adult acute care facilities. The system ASP reviewed and revised the conversion eligibility criteria November 30, 2021 (Table 1). Education was conducted, and a compulsory computerized training module was assigned to every pharmacist in the system. Two follow-up emails reporting results were also sent to the system ASP pharmacy leaders during the post-intervention period, and leaders were encouraged to share results with their departments. The primary objective of this study was to determine if there was a difference in PO linezolid utilization reported as days of therapy per 1000 patient days (DOT/1000 PD) between the pre- and post-intervention periods. Secondary objectives included IV linezolid utilization and cost savings.

Results
The average DOT/1000 PD for PO linezolid in the pre-intervention period (February-November 2021) was 38.9 compared to 58.8 for the post-intervention period (December 2021-March 2022), p&lt; 0.01 (Figure 1). This reflected an increase in the average percentage of PO use from 42.9 to 62.4% for the pre- and post-intervention periods, respectively (p&lt; 0.01, Figure 2). Inversely, the average DOT/1000 PD for IV linezolid fell from 52.1 to 35.4 in the pre- and post-intervention periods, respectively (p&lt; 0.01). A cost savings analysis revealed a monthly post-intervention savings of $7,091.34 with a projected total annual cost savings of $85,096.09 for the system.

Conclusion
An ASP intervention that revised criteria for IV to PO conversion, educated pharmacists, and tracked and reported results led to significantly more PO linezolid use and reduced overall cost in a large healthcare system.

Disclosures
Kerry O. Cleveland, MD, AbbVIe: Honoraria|Merck: Honoraria.
931. All Hands on Deck: Incorporation of Infectious Diseases Pharmacy Trainees in a Community Hospital Antimicrobial Stewardship Program
Authors: Herald Fischer , Drwiega Emily N , Drwiega Emily N , Griffith Nikki , Burgos Rodrigo M , Mena Lora Alfredo J 
Published: December 2022

Abstract

Background
Community hospitals may have challenges implementing core elements of antimicrobial stewardship (ASP) due to lack of ID trained pharmacists (PharmD). The COVID-19 pandemic compounded these challenges with constrained resources and staffing. The pandemic also saw a rise in antimicrobial use (AU) and brought forth novel therapeutics, thus increasing the need for robust ASP. We established a community ASP rotation for ID PharmD fellows during the COVID-19 pandemic.

Methods
A community ASP rotation was established at a 151-bed community hospital. ID PharmD trainees rotated with the ID clinician and were responsible for daily prospective audit and feedback (PAF) under close supervision of the ID clinician. Fellows were involved in pandemic response, including protocol development and restrictions for COVID-19 therapeutics.

Results
A community ASP rotation was successfully implemented (Figure 1). For PAF activities, the most common indications were CAP (19%), HAP (3%), IAI (24%), SSTI (22%) and UTI (19%). Average DOT/1000 was 340.4 per quarter with increases each COVID-19 surge (Figure 2). Empiric AU was protocol adherent 77% of the time and 23% required ASP changes. ASP Interventions included change to protocol (23%), bug drug mismatch (2%), de-escalation (15%), duration change (25%), IV to PO (16%), discontinuation (19%). Fellows successfully developed protocols and managed restrictions for remdesivir, baricitinib, and anti-SARS-CoV-2 monoclonal antibodies in coordination with the ID clinician and assisted in mass vaccination campaign protocols.

Conclusion
A community ASP rotation was successfully established and sustained during COVID-19. Fellows received hands on experience and performed PAF under close supervision. The program enhanced ID clinician capabilities while leveraging PharmD expertise at a time when staffing and resources were stretched thin. The rotation provided firsthand experience in pandemic preparedness and response. This educational opportunity assisted in maintaining a strong ASP in a community hospital setting while preparing trainees with experiences to assist them throughout their future careers.

Disclosures
All Authors: No reported disclosures.
933. Antibiotic Prescribing Changes in Adults During COVID-19 in Outpatient Patient-Centered Medical Homes (PCMH) in Arkansas
Authors: Johnson Jill , Peng Cheng , Dare Ryan K , Painter Jacob T , Maples Holly , Thomas Jeremy , Teeter Benjamin , Shoptaw Earnest , Golden William 
Published: December 2022

Abstract

Background
Outpatient antibiotic (OP Abx) prescribing in adults in Arkansas (AR) was among the country’s highest in 2019. AR Medicaid analyzed prescription (Rx) claims data and communicated the relative prescribing intensity as an informational metric to each patient-centered medical home (PCMH) beginning in 2020. We describe the Abx prescribing patterns in calendar years 2019 and 2020, during the COVID-19 pandemic.

Methods
Data from AR Medicaid paid claims for OP Abx Rxs in adult patients attributed to a PCMH practice for &gt; 6 months were analyzed. Annual Abx Rx claims per 1000 patients were calculated for rural or urban status and by 2019 prescribing rate histories, defined as the low-, middle-, and high-rate prescribers based on 1st, 2nd - 3rd, & 4th quartiles, respectively. The five most common classes in 2019 and fluoroquinolones were explored. A paired t-test, Wilcoxon signed rank test, and one-way ANOVA with post hoc least significant difference test were used to determine statistical significance.

Results
183 PCMHs qualified for analysis. There was a significant decrease in overall annual Abx claim rate, from 1034 to 910 (-12.0%, p&lt; 0.0001). Claim rates decreased in rural (-10.9%, p&lt; 0.0001) and urban areas (-13.3%, p&lt; 0.0001) with no difference between groups (p=0.240). Low-rate prescribers did not change practice from 2019 to 2020, with claim rates of 666 to 665 (-0.2%, p=0.957), while middle- and high-rate prescribers decreased, from 1032 to 897 (-13.1%, p&lt; 0.0001), and from 1404 to 1183 (-15.7%, p&lt; 0.0001), respectively. Claim rates significantly decreased for penicillins (-16.0%, p&lt; 0.0001), fluoroquinolones (-15.5%, p&lt; 0.0001), sulfonamides (-13.1%, p&lt; 0.0001), macrolides (-9.9%, p=0.0001), and tetracyclines (-6.3%, p=0.021). First-generation cephalosporins down trended (-7.9%, p=0.111).

Conclusion
OP Abx Rx claims significantly decreased from 2019 to 2020 in middle and high-rate prescribers. Low-rate prescribers maintained low Abx Rx claim rates throughout 2020. Future analyses are needed to highlight any rebound effect of Abx prescribing when the pandemic subsides, discerning the informational metric effect versus COVID-19, and informing the next steps for antimicrobial stewardship for PCMHs in AR.

Disclosures
Jill Johnson, Pharm.D., BCPS, Pew Charitable Trust: Pew provided financial support for authors, analysis, and presentation. Cheng Peng, MPA, MS, PhD, Pew Charitable Trust: provided financial support for the authors, analysis, and presentation. Holly Maples, Pharm.D., Wolters Kluwer-LexiComp: Advisor/Consultant Jeremy Thomas, Pharm.D., Pew Pew Charitable Trust: Grant/Research Support.
940. First situational diagnosis of the implementation of Antimicrobial Stewardship Programs in Mexican Hospitals, 2021
Authors: Dreser Anahí , Hegewisch-Taylor Jennifer , Cortés-Ortíz María Alejandra , Romero-Mónico Julián , Levy Gabriel 
Published: December 2022

Abstract

Background
The development of antimicrobial stewardship programs (ASP) can help to improve the quality of care and contain the growing problem of antimicrobial resistance (AMR). In Mexico, there is little evidence on the design, implementation and evaluation of hospital ASP. The objective of this study is to present a situational diagnosis of the ASP structure, processes implemented and monitoring of results obtained in a sample of Mexican hospitals.

Methods
An online survey directed to ASP teams was applied to a purposive sample of 40 hospitals that perform regular antimicrobial stewardship activities in Mexico, during the last trimester of 2021. The survey was based on the ‘core elements’ instruments developed by the CDC and WHO.

Results
Forty hospitals (62% public and 38% private) were surveyed in 13 states in Mexico regarding ASP basic elements. Infrastructure and Organization elements: on average 52% of these hospitals carry basic actions that refer to: written ASP document and annual plan (46%); allocated human resources (68%); availability of material resources (59%) and use of technological platforms (37%). Processes: development of hospital treatment guidelines (49%); educational interventions (40%); persuasive and feedback interventions (42%); and in greater proportion, restrictive interventions (77%). Monitoring activities: interventions (25%); antimicrobial consumption (73%) and AMR (85%)

Conclusion
This first diagnosis serves as a baseline to determine the current state of ASP implementation per hospital and in the country. It also reflects on the ASP heterogeneity, that should be addressed by national policies. The greatest challenge lies in the program governance, and the systematic monitoring of the implementation of ASP interventions.

Disclosures
Anahí Dreser, PhD, MSD: Grant/Research Support.
948. Impact of a Multi-pronged Approach to Antimicrobial Stewardship on the Vascular Ward at a Tertiary Hospital
Authors: Wong Maggie O , Bowles Wendy L , Lee Kevin , Afra Kevin 
Published: December 2022

Abstract

Background
Up to 50% of inpatient antibiotic use may be inappropriate, and guideline concordance for antibiotic prescribing in surgical wards tends to be lower than medical wards. As such, our study describes a multi-pronged approach to antimicrobial stewardship (AMS) targeting a vascular ward and its impact on improving antibiotic use.

Methods
This is a quality improvement study at a tertiary hospital in British Columbia, Canada. All patients admitted to the vascular surgery ward for any vascular related issues and who received piperacillin-tazobactam or a carbapenem were included. Patients were excluded if admitted to the ward for &lt; 48 hours. The primary outcome is appropriateness of carbapenem and piperacillin-tazobactam use in concordance with local policies. Secondary outcome is consumption of these agents.
The pre-intervention period was March 2020 to June 2020. The AMS team prospectively reviewed included patients to establish the baseline level of appropriate antibiotic use. The intervention period was from July 2020 to February 2021.
Aside from presentations to surgeons, the main intervention was regular audit and feedback to a nurse practitioner who rounds with the surgeons. Mandatory ID consultation for carbapenems was the last resort if AMS recommendations were not accepted.

Results
During the pre-intervention period, 19 out of 25 prescriptions (76%), either carbapenem or piperacillin-tazobactam, had appropriate indications. In the intervention period, 121 prescriptions were reviewed and the appropriateness level increased to 87% (Figure 1). Eleven mandatory ID consultations were generated. The mean days of therapy (DOT) per 1000 patient-days for carbapenem decreased from 94.6 to 56.6 for pre- and intervention periods, respectively. For piperacillin-tazobactam, the mean DOT per 1000 patient-days decreased from 209.9 to 138.5 for pre- and intervention periods. The reduced usage of piperacillin-tazobactam remained sustainable post-intervention (Figure 2). Figure 1:Summary of patient characteristics and outcomes during intervention period (July 2020 to February 2021)Figure 2:Usage of piperacillin-tazobactam from June 2019 to June 2021

Conclusion
A multi-pronged approach, consisting of education, prospective audit and feedback to the surgical team, and mandatory ID consult in selected cases, is effective in decreasing inappropriate broad-spectrum antibiotic use on the vascular ward at a tertiary centre.

Disclosures
All Authors: No reported disclosures.
950. Impact of the COVID 19 pandemic on antimicrobial stewardship program, broad-spectrum antibiotics consumption and Clostridioides difficile diarrhea incidence
Authors: Ferreiro Jose Luis Lamas , Otero Judith Álvarez , Rivo Ana Sanjurjo , de Salamanca Holzinger Ignacio Enríquez , Cavero Jorge , de Miguel Bouzas Jose Carlos , Soneira María Fernández , Conde Irene Rodríguez , Fernández Emilia Fernández , Vila Marta Costas , de la Fuente Aguado Javier 
Published: December 2022

Abstract

Background
The aim was to evaluate the impact of the COVID 19 pandemic on the antimicrobial stewardship program of our hospital, analyze changes in broad-spectrum antibiotics consumption, and analyze the evolution of the incidence of Clostridioides difficile (CD) diarrhea.

Methods
Database with the following variables was created: monthly percentage of broad-spectrum antibiotic prescriptions that were evaluated by the antimicrobial stewardship team (AMST), monthly consumption of antimicrobials and monthly incidence of diarrhea due to CD. Pre-pandemic period was considered from March 1th, 2018 to February 29th, 2020 and the pandemic period from March 1th, 2020 to February 28th, 2022.
Time series analysis was performed with ARIMA models to assess the association of the pandemic period with a change in the monthly activity of AMST, in the monthly antibiotic consumption, and in the monthly incidence of CD diarrhea.
The correlation of the percentage of monthly broad-spectrum antibiotic prescriptions reviewed by AMST with the monthly broad-spectrum antimicrobials consumption was also evaluated, using the Spearman coefficient.

Results
During the pandemic period, there was a significant reduction in monthly percentage of broad-spectrum antibiotic prescriptions reviewed by the AMST (28% vs 82%; P&lt; 0.01). There was a 29% increase in consumption of broad-spectrum antibiotics in the pandemic period (15.7 vs 12.1 DDD per 100 bed-days; P=ns). The following antibiotics showed a significant increase in their consumption: antipseudomonal carbapenems (2 vs 1.4 DDD per bd; P&lt; 0.01), daptomycin (1.8 vs 0.5 DDD per bd; P&lt; 0.01), cefepime (1.1 vs 0.6 DDD per bd; P&lt; 0.01), aztreonam (0.4 vs 0.3 DDD per bd; P=0.04), antibiotics with anti-MRSA activity (35.6 vs 12.9 DDD per bd; P&lt; 0.01). There was a 41% increase in the incidence of nosocomial CD diarrhea (1.02 vs. 0.7 cases per 1000 bd; P=0.03). The percentage of broad-spectrum antibiotic prescriptions reviewed by the AMST correlated well with the consumption of this group of antibiotics (cc -0.63; P&lt; 0.01).

Conclusion
COVID-19 pandemic has had a significant impact on the antimicrobial stewardship program at our hospital, with an increase in broad-spectrum antimicrobials consumption and a significant increase in the incidence of Clostridioides difficile diarrhea.

Disclosures
All Authors: No reported disclosures.
957. Interactive Antibiogram Decision Support Tool Predicated Upon Infection Site and Probable Pathogens
Authors: Legenza Laurel , Zunenshine Jared , Safdar Nasia , Safdar Nasia , Guest Colin , Jadhav Harshvardhan , Fritsche Thomas R , Lee John D D 
Published: December 2022

Abstract

Background
Current methods for displaying summary antibiograms are static, have limited utility and are not user friendly. We present an interactive web application for visualization of antibiogram data.

Methods
Antibiotic susceptibility data for first, non-duplicate patient infection isolates with source/site data were collected from 2009–2018 at an integrated health system for the visualizations. Iterative user-centered design sessions were held with healthcare providers to guide prototype development, including assessment of source groupings and rational for aggregating data. Three providers participated in initial and follow-up sessions (6 total) with study personnel. Data were aggregated by agreed-upon infection-source and pathogen; antibiotic results with &lt; 30 isolates were excluded.

Results
The multi-year dataset included 119,333 non-duplicative isolates from 194 unique infection sites; nearly half were E. coli (n=50,404). Final infection source groupings with interactive data visualization fields are shown in Figure 1. First an infection source is selected; the visualization then shows pathogen prevalence in descending order. Providers can view susceptibility results for all antibiotics or deselect all and view only those under consideration, such as the four displayed in Figure 1. Resulting bar charts allow providers to view which pathogens tested have greater than 80% or 90% susceptibility to each antibiotic. Susceptibilities for multiple pathogens can also be visualized with the dodged feature (Figure 2). The large dataset collected supports source-specific susceptibility results (e.g. eye infections). The visualization allows providers to see how susceptibility by pathogen may cross clinically meaningful thresholds of 80% and 90% for different infection sources, such as urinary tract compared to bloodstream infections. Feedback from providers on the prototype was overwhelmingly positive. Figure 1.Visualization of urine isolates, E. coli and user selected antibiotics
Final source groupings: Urine, Skin/Soft Tissue, Blood, Respiratory Secretions, Fluid, Ear, Bone, Vaginal/Perianal, Eye, and Abscess. Figure 2.Selected antibiotic susceptibilities for multiple pathogens can be visualized simultaneously with the dodged feature.

Conclusion
Our interactive antibiogram data clinical decision support tool extends the utility of the traditional lab-generated antibiogram. Importantly, future iterations will include visualizing changes by year, by clinical setting (inpatient vs. outpatient) and an assessment of uptake of this tool in the clinical setting.

Disclosures
All Authors: No reported disclosures.