bluuebunny/crossref_metadata_2025_split huggingface dataset:
1739. An Exploratory Analysis to Examine Urgent Care Antibiotic Prescribing Inequities in a Vertically Integrated Healthcare System
Authors: Seibert Allan M , Stanfield Valoree K , Fino Nora , Gwiazdon Matthew , Hersh Adam , Stenehjem Edward A 
Published: December 2022

Abstract

Background
Previous studies have shown antibiotic prescribing differences based on patient demographics which may represent inequitable care. Our objective was to perform an exploratory analysis of antibiotic prescribing rates for respiratory conditions to better understand possible inequities and identify disparities in our health system.

Methods
This was a retrospective cohort study of urgent care encounters for respiratory conditions in the Intermountain Healthcare (IH) network from July 1st 2018 – June 30th 2019. Individual respiratory encounters were identified using a validated methodology based on ICD10 codes. Overall antibiotic prescribing rates and rates for Tier 1 (antibiotics indicated), 2 (sometimes indicated), and 3 (not indicated, eg bronchitis) conditions were assessed. Prescribing rates for categories in which inequities might exist, including age, weight, patient race/ethnicity, preferred language, provider type, and provider/patient gender combinations, were examined. We considered an absolute percentage difference between groups within a category of ≥5.0% to represent a potential disparity.

Results
93,588 (48.5%) of 193,107 respiratory urgent care encounters were associated with an antibiotic prescription. Overall antibiotic prescribing rates (Results Image 1) were higher in white compared to non-white patients (49.0% vs 38.2%) and in those reporting non-Hispanic ethnicity compared to Hispanics (49.1% vs 43.2%). Patients over 18 years-old were prescribed antibiotics more frequently than younger patients. Among Tier 3 encounters male providers prescribed antibiotics more frequently for male patients than female providers did for female patients (20.8% vs 15.6). Overweight and obese patients with Tier 3 diagnoses received antibiotic prescriptions more frequently than non-obese patients (22.8% vs 15.3%). Minimal differences between patients who preferred English and those who preferred non-English languages were observed. Results Image 1 - Table 1
Overall antibiotic prescribing rates and antibiotic prescribing rates for Tier 3 conditions for urgent care respiratory condition encounters July 1st, 2018 – June 30th, 2019*¥. *Tier 3 codes are those where antibiotics are not indicated (eg bronchitis). ¥Absolute differences of ≥5.0% between groups within each category are indicated in bold.

Conclusion
Antibiotic prescribing rates for respiratory conditions in urgent care encounters in our system differed based on race, ethnicity, age, obesity, and gender. These differences may represent biases contributing to inequities in care and may serve as potential targets for improved stewardship efforts.

Disclosures
All Authors: No reported disclosures.
1741. Antibiotic Prescribing Practices in Pediatric Acute Respiratory Illnesses in Northern Vietnam
Authors: Nguyen-Tran Hai D , Nguyen Nam , Ngo Long N , Nguyen Trang , Do Nga , Olson Daniel , Lewycka Sonia 
Published: December 2022

Abstract

Background
Antimicrobial resistance (AMR) is a global challenge and influenced by several factors including antibiotic overprescribing. Antibiotics are frequently prescribed in Vietnam, especially in pediatric acute respiratory illnesses (ARIs). Understanding prescribing practices for pediatric ARIs is important to help identify areas for improved practices to prevent overprescribing and AMR.

Methods
We performed a retrospective review of pediatric patients aged 0-15 years with an ARI diagnosis based on ICD-10 codes from January 1-December 31, 2019 in 112 primary care centers in Northern Vietnam. Variables collected included age, sex, district, antibiotic prescribed, World Health Organization access, watch, reserve classification (WHO AWaRe), symptomatic agents prescribed, and signs and symptoms. Data was analyzed using descriptive statistical analysis.

Results
A total of 35,679 encounters were reviewed. Of all encounters, 34,018 (95.3%) received antibiotics, and 1,650 (4.9%) of these received &gt;1 antibiotic (Table 1). According to WHO AWaRe classification, 19.3% of children 0 to &lt; 5 years received a watch antibiotic compared to 10.4% in those 5 to15 years. The most frequent diagnosis was acute pharyngitis (21,270 encounters, 59.6%) and 20,496 (96.4%) of those encounters received antibiotics. Common signs and symptoms reported included cough (76.3%), fever (40.9%), and erythematous pharynx (33.1%). Though acute pharyngitis was the most common diagnosis, only 168 (0.5%) and 59 (0.2%) of encounters described lymphadenopathy and exudate, respectively.

Conclusion
Antibiotics are frequently prescribed for pediatric ARIs in Northern Vietnam. Most antibiotics prescribed were WHO AWaRe access antibiotics; however, 14% were watch antibiotics or not recommended. Though acute pharyngitis was the most common diagnosis, only a few of the encounters reported signs or symptoms that would be more suggestive of acute bacterial pharyngitis warranting antibiotics. Further investigation of the appropriateness of antibiotic prescriptions are needed to help identify targeted areas of improvement in prescribing practices and help decrease the burden of AMR.

Disclosures
Daniel Olson, MD, Pfizer: Grant/Research Support|Roche: Grant/Research Support.
1744. Association Between Antibiotic Prescribing for Urinary Tract Infection (UTI) and UTI Severity of Illness Upon Admission to Hospitals in New York State
Authors: Nero Alexa , Weber Mckayla , Carreno Joseph 
Published: December 2022

Abstract

Background
It has been previously demonstrated that county-level antibiotic prescribing (CP) and resistance (AR) influence urinary tract infection (UTI) severity of illness upon hospital presentation in New York State (NYS, Grillo et al. IDWEEK 2021). However, previous investigations were geographically limited to the most densely populated regions of NYS. This study builds on the previous study by evaluating additional NYS regions and outcomes.

Methods
Retrospective, cross-sectional study, combining data from NYS Statewide Planning and Research Cooperative System (SPARCS) and previously published data on CP for UTI in female Medicare beneficiaries. Eligibility criteria: female patients admitted to a NYS inpatient setting in 2017, UTI (CCS 159), Medicare insurance. New York county (Manhattan) county was excluded. CP was the primary exposure. “Low” or “high” CP was based on the statewide median. Severe infection (All-patient refined severity of illness on admission ≥ 3, SI) was the primary outcome. Association between CP and SI, hospitalization costs, were evaluated using chi-square, logistic regression, Mann-Whitney U test. Log-rank test assessed time to discharge, censoring those that went to hospice or died inpatient.

Results
13,173 patients were included, 4,250 (32.3%) low CP, 8,923 (67.7%) high CP. Baseline demographics (Figure 1) that differed between groups included age, race, ethnicity, and emergency admission (P &lt; 0.001, χ2 test). In the multivariable logistic regression analysis low CP was associated with increased odds for severe urinary tract infection after adjusting for potential confounders (aOR: 1.08 [1.003 – 1.163]). Additional factors associated with severe infection are presented in Figure 2. Median (IQR) hospital costs were similar but statistically significantly lower in the low CP group (Figure 3), median (IQR) time to hospital discharge was 4 days in each group (P &lt; 0.001). Figure 1.Adjusted Odds Ratios for Severe Urinary Tract InfectionFigure 2.Hospital Costs

Conclusion
Low CP may be a risk factor for severe initial presentation to the hospital in UTI. Further research is needed to examine the effects of prescribing patterns and additional factors that may influence severity of infection in this setting.

Disclosures
Joseph Carreno, PharmD, MPH, Accelerate Diagnostics: Advisor/Consultant|IDbyDNA: Advisor/Consultant.
1754. Implementation of a targeted antimicrobial stewardship clinical decision support system on outpatient fluoroquinolone prescribing
Authors: Smith Savanna , Weihs Sayo , Fanizza Teri 
Published: December 2022

Abstract

Background
Fluoroquinolones are broad spectrum antibiotics with several Food and Drug Administration (FDA)-issued black box warnings. Due to these risks, the FDA recommends reserving fluoroquinolones for situations with no alternatives. Beginning in 2020, the Joint Commission required outpatient antimicrobial stewardship activities due to overprescribing and growing resistance to antimicrobials. The role of this study was to implement a clinical decision support system (CDSS) targeting inappropriate outpatient fluoroquinolone prescribing.

Methods
This was a single center, quasi-experimental study evaluating patients prescribed oral fluoroquinolones in an outpatient ambulatory care setting between December 1, 2020-February 28, 2021 and December 1, 2021-February 28, 2022. Patients included in this study were divided into Pre-CDSS and Post-CDSS groups if they received oral antibiotics for pre-determined indications (see table 2 for the list of indications). The primary outcome was overall reduction in outpatient fluoroquinolone prescribing. Secondary objectives were reduction in outpatient fluoroquinolone prescribing by indication, orders by provider type, appropriate fluoroquinolone dosing per renal function and incidence of an emergency department (ED) visit or hospitalization within 90 days consistent with a fluoroquinolone adverse drug reaction.

Results
A total of 2,447 (1,105 in Pre-CDSS vs. 1,342 in Post-CDSS) were included for analysis. Fluoroquinolone prescribing significantly decreased in Post-CDSS group compared to Pre-CDSS group (4.9% vs. 3.4%; p = 0.03). There was a significant reduction in fluoroquinolone prescribing in abscess (8.5% vs. 4.9%; p = 0.003), dental abscess (4.4% vs. 0%; p &lt; 0.00001), sinusitis (2.4% vs. 0.2%; p &lt; 0.00001) and soft skin tissue infections (5.3% vs. 0.8%; p &lt; 0.00001). In the fluoroquinolone subgroups, prescribing per provider type and appropriate dosing per renal function were similar, and there were no adverse events leading to an ED visit or hospitalization within 90 days.

Conclusion
Implementation of a CDSS resulted in a reduction of overall and targeted indication inappropriate fluoroquinolone prescribing.

Disclosures
Teri Fanizza, Pharm.D., BCPS, BCIDP, Merck & co inc: Stocks/Bonds|Pfizer Inc: Stocks/Bonds.
1757. Regional distribution of Escherichia coli antibiotic resistance among outpatients in Washington state, 2013-2019
Authors: Fenelon Hannah T , Rabinowitz Peter M , Salm Ann , Kapoor Hema , Hawes Stephen E , Radcliff Jeff 
Published: December 2022

Abstract

Background
Escherichia coli is the predominant pathogen of urinary tract infections in the United States. Understanding regional patterns of uropathogenic E. coli antimicrobial resistance (AMR) may help further the practice of antibiotic stewardship through the creation of region-specific antibiograms. In this study, we analyzed regional patterns of uropathogenic E. coli AMR among outpatients in Washington state.

Methods
Deidentified results from antibiotic susceptibility tests performed by Quest Diagnostics on Washington state outpatient isolates from 2013 through 2019 were analyzed. Only the first E. coli isolate from each patient was included in the analyses. We conducted separate relative risk regressions with robust standard errors for five antibiotics (ampicillin [AMP], ciprofloxacin [CIP], ceftriaxone [CRO], gentamicin [GEN], and trimethoprim/sulfamethoxazole), classified as “susceptible” or “non-susceptible.” The state is divided into nine Public Health Emergency Preparedness Regions (PHEPRs), which served as the exposures for the analysis, with adjustment for sex, year of isolate collection, and age group (0-18, 19-50, &gt; 50).

Results
We included 40,865 isolates in the study (93% female, mean age 47 years). Compared to the Central PHEPR (containing Seattle), most other regions had significantly lower adjusted relative risks (aRR) of AMR; no regions had significantly higher aRR of resistance for any of the five antibiotics. Differences in resistance between Central and other regions varied by antibiotic. Regional AMR differences were largest for CRO (low aRRs compared to Central) and smallest for AMP. Other patterns observed include a lower aRR of AMR for females compared to males for AMP, CIP, CRO, and GEN; higher aRR of AMR for CRO for recent years (2015-2019) compared to 2013; and higher AMR with age for CIP and CRO.

Conclusion
Given the differences in resistance across Washington’s PHEPRs, antibiograms should be tailored to provide the most regionally accurate information to prescribers. The emergent situation surrounding AMR calls for more specific outpatient antibiograms to enable healthcare providers to improve health outcomes and mitigate emerging resistance to antibiotics among outpatients.

Disclosures
Ann Salm, PhD, Quest Diagnostics Inc.: Employed and own stock in Quest Diagnostics Inc.|Quest Diagnostics Inc.: Stocks/Bonds Hema Kapoor, MD, D(ABMM), Quest Diagnsotics: Stocks/Bonds Stephen E. Hawes, PhD, InBios International: Advisor/Consultant Jeff Radcliff, B.S., Quest Diagnostics: Employee|Quest Diagnostics: Stocks/Bonds.
2301. Neurodevelopment in Infants with Antenatal or Early Neonatal Exposure to SARS-CoV-2
Authors: Mulkey Sarah B , Williams Meagan E , Jadeed Nadia , Zhang Anqing , Israel Smitha , DeBiasi Roberta L 
Published: December 2022

Abstract

Background
Antenatal and neonatal viral exposure may put the developing brain at risk for abnormal neurodevelopment. A clinical follow-up program was created in the Congenital Infection Program at Children’s National Hospital to follow infants with in utero or early life exposure to SARS-CoV-2. The aim of this study was to determine if infants with early SARS-CoV-2 exposure have abnormal neurodevelopment in infancy.

Methods
We performed a retrospective review of all infants evaluated in the follow-up program between 3/2020 – 11/2021. Demographic details, SARS-CoV-2 infection/testing data, pregnancy/birth data, and specialty consult and NICU records were extracted from infants’ medical charts. Infants were divided into 3 SARS-CoV-2 exposure groups: 1) antenatal exposure to symptomatic mother, 2) antenatal exposure to asymptomatic mother, 3) neonatal infection.
All infants received a neurologic exam and developmental screening with the Ages and Stages Questionnaire (ASQ) in 5 domains (Communication, Gross Motor, Fine Motor, Problem Solving, Personal-Social) during their evaluation. The ASQ accounts for prematurity.
Outcomes of interest were an abnormal neurologic exam or ASQ scores close to or below suggested cut-offs. Multivariate analysis was used to study correlations between exposure group and neurodevelopmental outcomes.

Results
Thirty-five infants were seen for up to 3 outpatient visits. Most infants (83%) were exposed in utero – 16 to symptomatic mothers (Group 1) and 12 to asymptomatic mothers (Group 2); 1 chart did not have symptom data. Six were exposed only as a neonate (Group 3).
Group 1 had abnormal neurologic exams at mean (SD) age 112 (24) days (Table 1) and ASQ scores close to or below cut-offs for all domains (Fig. 1) more frequently than Groups 2 or 3.
Group 1 was more likely to score below any ASQ cutoff compared to Group 2 (P=.04); of the 5 domains, differences were significant for Fine Motor (P=.01) and Personal-Social (P=.02).

Conclusion
Early SARS-CoV-2 exposure may impact infant development, especially among those exposed in utero to a symptomatic mother. Vaccination and other precautions to reduce spread and symptoms may protect against early neurodevelopmental delays. Future work should prioritize longitudinal follow-up of children with early SARS-CoV-2 exposure.

Disclosures
All Authors: No reported disclosures.
1762. A Review of Antibiotic Outcomes Data Utilizing the Multidisciplinary OPTIONS-DC Conference for PWUD
Authors: Douglass Alyse H , Mayer Heather , Young Kathleen , Streifel Amber C , Franklin Heather , Strnad Luke , Makadia Jina T , Sikka Monica K 
Published: December 2022

Abstract

Background
Persons who use drugs (PWUD) admitted for serious infections face many challenges when long courses of intravenous (IV) antibiotics are recommended. OPTIONS-DC is a structured multidisciplinary care conference used to navigate some of these challenges with harm reduction principles to consider patient preferences, decrease length of stay when safe, and support successful completion of antibiotics1. We aimed to describe antibiotic course outcomes 4 years after implementation of OPTIONS-DC.

Methods
We conducted a retrospective review of patients who had an OPTIONS-DC from February 2018 to February 2022. Any PWUD diagnosed with a serious infection requiring &gt; 2 weeks of IV antibiotic treatment were eligible for an OPTIONS-DC. Data was collected via a REDCap database. R version 3.3.2 (R Core Team, 2016) was used for statistical analysis.

Results
144 conferences were included, for 129 unique patients. The mean age was 39.4 with 56.3% being male. The most common infections were bacteremia (52.8%) endocarditis (36.1%), and osteomyelitis (47.9%) with a mean recommended treatment duration of 5.62 weeks (Table 1). 87 (60.4%) patients with any substance use initiated medication assisted therapy (MAT) during admission including 74.5% (79/106) of those with opioid use disorder. 112 (77.8%) antibiotic courses were completed with 71 (63.4%) completed outpatient. Of those who initiated or continued MAT during admission, 83 (74.1%) completed antibiotic therapy. Course completion was similar for those discharged home at 84% (21/25) or to a Skilled Nursing Facility (SNF) 81.8% (9/11). All 18 patients who received antibiotics via home infusion vendor and 17 (81%) via infusion center completed their course. 39 (39.8%) patients received long acting IV antibiotics and 23 (23.5%) received oral antibiotics to complete their course. Average out of hospital antibiotic days for those who completed their course were 30.5. Table 1.OPTIONS-DC Table 1Table 1.OPTIONS-DC Table 1 continued

Conclusion
The OPTIONS-DC model continues to be a useful tool by incorporating harm reduction principles and patient preferences for PWUD at our hospital. Our completion rate of 77.8% and outpatient completion rate of 63.4% are higher while the patient directed discharge rate of 8.3% is lower than what is generally reported in literature for this population2-5.

Disclosures
Monica K. Sikka, MD, F2G: Site research investigator.
2308. A Nationwide Surveillance of the Clinical Presentation and Genomic Characteristics of Listeria monocytogenes Infections in Japan; Preliminary data
Authors: Shinohara Koh , Tsuchido Yasuhiro , Yukawa Satomi , Noguchi Taro , Yamamoto Masaki , Matsumura Yasufumi , Nagao Miki 
Published: December 2022

Abstract

Background
Listeria monocytogenes is the cause of listeriosis and is associated with foodborne outbreak and severe diseases in immunocompromised persons. However, the clinical and genomic characteristics of listeriosis remains unclear in Japan. We describe preliminary findings from a nationwide surveillance of patients and isolates of listeriosis in Japan over 11-year period.

Methods
We conducted a nationwide, multi-center retrospective study of consecutive cases with a confirmed diagnosis of listeriosis between 2011 and 2021. 25 hospitals participated in this study. Clinical characteristics, treatment and outcome were retrieved from the medical records. The preserved L. monocytogenes isolates were investigated with molecular analysis using whole genome sequencing.

Results
As of April 2022, a total of 113 cases from 16 hospitals and 26 isolates from 7 hospitals were included in this study. Sixty-one (54%) were male and median age was 74.0 (interquartile range: 64.0 – 82.0). Ten (9%) perinatal infections, 66 (58%) cases of bacteremia, 29 (26%) cases of neurolisteriosis, and eight (7%) other infections were included. In eight episodes with ten perinatal cases, four (50%) episodes experienced fetal loss or neonatal deaths. In 103 non-perinatal cases, 56 (54%) cases received immunosuppressive therapy and in-hospital mortality rate was 17.0%. In 29 neurolisteriosis cases, 13 (45%) cases were associated with poor outcome (mortality or neurological sequelae). In 26 isolates, from two perinatal infections, 13 bacteremia, 9 neurolisteriosis and two other infections, clonal complex (CC) 1, CC2 and CC3 were predominant and accounted for 18 (69%) isolates (Figure). CC1 (5/8 isolates) and CC3 (2/6 isolates) were predominantly found in neurolisteriosis. Variations of the presence of several virulence factors associated with adherence, invasion, and exotoxin were observed. CC1 and CC2 lacked ActA and Ami, whereas Listeriolysin S (LLS) were seen in CC1, CC3 and CC4.

Conclusion
In Japan, most cases of listeriosis are sporadically seen in elderly patients with co-morbidities, instead of foodborne outbreak. Outcomes of neurolisteriosis and perinatal listeriosis were poor. CC1 and CC3, which harbored LLS, were associated with neurolisteriosis.

Disclosures
All Authors: No reported disclosures.
1774. Impact of Dalbavancin as Step-Down or Salvage Therapy on Duration of Hospitalization Among People Who Inject Drugs
Authors: O’Rourke Emerald , Maguire Christina , Torgersen Jessie , Torgersen Jessie , Talati Naasha J , Binkley Amanda 
Published: December 2022

Abstract

Background
A well-known clinical dilemma complicating the management of infections in people who inject drugs (PWID) is the restriction of outpatient parenteral antimicrobial therapy. As a result, PWID experience prolonged hospitalizations to complete parenteral antimicrobial courses inpatient. This strategy is also associated with increased rates of patient-directed discharge (PDD). Dalbavancin, a long-acting lipoglycopeptide, serves two unique roles in this population: step-down therapy to decrease inpatient length of stay once clinically stable and salvage therapy in the setting of imminent PDD.

Methods
This retrospective review of PWID from November 2019 through October 2021 identified patients in which on- or off-label dalbavancin could be considered. Day of hypothetical dalbavancin administration was determined when both ≥7 days of therapy and ≥48 hours of clinical stability (non-critical unit, afebrile, resolved leukocytosis, and source control or negative blood cultures) were completed. Included patients had ≥7 days of therapy remaining at time of hypothetical dalbavancin administration. A one-time dalbavancin dose was considered to provide up to 14 days of antimicrobial coverage. Patients were included in either the step-down cohort (completed entire parenteral antimicrobial course inpatient) or salvage therapy cohort (PDD prior to completing course). The number of potentially preventable inpatient days with dalbavancin and readmissions due to infection progression were assessed in each cohort, respectively.

Results
Nineteen patients were identified as potential dalbavancin candidates. In the step-down cohort (n=11) a one-time dalbavancin dose prevented a maximum of 146 inpatient days. In the salvage cohort (n=8), hypothetical dalbavancin administration at time of PDD could have prevented six readmissions due to infection progression, associated with 36 additional inpatient days.

Conclusion
Inpatient administration of dalbavancin may bridge treatment disparities experienced by PWID by reducing unnecessary inpatient days for parenteral antibiotic administration and by preventing hospital readmissions attributable to inadequate antimicrobial course.

Disclosures
All Authors: No reported disclosures.