bluuebunny/crossref_metadata_2025_split huggingface dataset:
1771. End-of-Life Use of Antibiotics in Pediatric Patients
Authors: LLoyd Patrick , Toia Jacquie , Lust Hannah , Shteynberg Emily , Newman Anders , Patel Sameer 
Published: December 2022

Abstract

Background
Antibiotic use at the end of life is common in adult patients but little is known about children. While important to treat and prevent infection in these vulnerable populations, unnecessary antibiotic exposure may result in adverse events and selection of antimicrobial resistant organisms. The purpose of this study was to describe clinical features of pediatric patients who receive antibiotic use at the end of life, quantify antibiotic utilization, and determine indications for antibiotic use.

Methods
We performed a retrospective review of antibiotic use in the last 30 days of life who had palliative care consultation at a tertiary care pediatric hospital from June 2012 to February 2020. Demographic characteristics, primary diagnosis, do not resuscitate (DNR) status, and hospice status were assessed. Days of antibiotic therapy were recorded.

Results
Of the 151 patients identified, 67 (44%) were female, and the median age at death was 3.5 years (IQR: 0.50-13.8 years). Of the causes of death, 133 (88%) had chronic progressive illness, 13 (8.7%) had a chronic static illness, 5 (3.3%) and had an acute illness. The most common primary diagnoses were oncologic (n=56, 37%), cardiac (n=32, 21%), genetic metabolic (n=19, 13%), and neurological (n=16, 11%). DNR status was recorded for 109 (72%) patients, and 11 (7.2%) had documented hospice status. Antimicrobial use was most common for a known organism (n=75, 50%), followed by no documented indication (n=33, 22.8%), empiric therapy (n=31, 20.5%), and prophylaxis only (n=2.7%). Of the 2126 total days of therapy of antibiotic use, the most common agents were vancomycin (n=379), meropenem (n=254), ceftazidime (n=171), and cefepime (n=143). The median number of unique antibiotics received in the last 30 days of life was 2 (IQR 0-5).

Conclusion
Antibiotic exposure was common in pediatric patients at the end of life, particularly for vancomycin and meropenem, even without documented infection. Opportunities for future interventions include better discussion of goals of care between providers and parents and risk of adverse events, particularly if suspicion of infection is low.

Disclosures
All Authors: No reported disclosures.
1772. Evaluating the Impact of a Pilot Structured Antimicrobial Stewardship Prospective Audit and Feedback Program in Emergency General Surgery in a Community Hospital
Authors: Nisenbaum Rosane , Tsang Melanie , Langford Bradley J , Wan Michael , Downing Mark , Chan April J 
Published: December 2022

Abstract

Background
The benefits of prospective audit and feedback (PAF) are established in critical care settings but not in the surgical population. We piloted once-weekly structured face-to-face PAF with the Acute Care Surgery (ACS) Service surgeon(s) and compared outcomes to usual care which comprised of ad-hoc PAF on targeted antimicrobials once or twice weekly with recommendations made to ACS surgeon(s) using written or verbal methods.

Methods
Interrupted time series segmented negative binomial regression analysis was used to evaluate the change in the primary outcome of antimicrobial usage measured in Days of Therapy/1000 patient days (DOT/1000-PD) for all systemic and targeted antimicrobials ordered by the ACS team. The structured PAF period was from August 1, 2017- April 30, 2019 while the ad-hoc PAF period was from May 1, 2019-January 31, 2021. Targeted antimicrobials included 3rd generation cephalosporins, piperacillin/tazobactam, carbapenems and clindamycin. Secondary outcomes included C. difficile infections, length of stay and readmission within 30 days. The first two secondary outcomes were analyzed using a logistic regression model while a negative binomial regression model was used to evaluate readmission within 30 days.

Results
There were 776 ACS patients in the structured PAF period with 783 patients in the ad-hoc PAF period. = No significant changes in level or trend of the primary outcome of DOT/1000-PD in both periods was found for all and targeted antimicrobials. However, there was a trend to small reduction in DOT/1000-PD of 0.9% per month (rate ratio 1.0, CI 0.99-1.02) for all antimicrobials and 0.3% per month (rate ratio 1.0, CI 0.98-1.03) for targeted antimicrobials in the ad-hoc PAF period. Similarly, there were no significant differences with respect to any of the secondary outcomes. There was a trend of 10% increase in length of stay (rate ratio 1.07, CI 0.98-1.17) and 13% reduction in 30-day readmission (OR 0.87, CI 0.56-1.35) in the ad-hoc PAF period.

Rates by Time Using Negative Binomial Models for All and Targeted Antimicrobials

Conclusion
Structured PAF showed similar clinical outcomes to ad-hoc PAF for the Acute Care Surgery Service at our institution. Other antimicrobial stewardship interventions can be explored to better support judicious antimicrobial use in General Surgery.

Disclosures
All Authors: No reported disclosures.
1778. Veterans’ Perceptions and Categorial Constructs Regarding Antibiotics for Upper Respiratory Tract Infections (URIs)
Authors: Reasoner Kaitlyn , Pellegrino Rachael , Gettler Erin , Johnson Morgan C , Hulgan Todd , Roumie Christianne L , Grijalva Carlos G , Dittus Robert S , Staub Milner B 
Published: December 2022

Abstract

Background
To reduce antibiotic prescribing, antimicrobial stewards must understand patient knowledge, attitudes, and perceptions (KAP) around antibiotics for URIs. Validated patient KAP surveys are scarce and for Veteran patients, nonexistent. We aimed to explore if published results of an exploratory factor analysis (EFA) of a KAP survey in emergency department (ED) patients and an online sample would approximate results in outpatient Veterans.

Methods
After cognitive testing in Veterans and healthcare providers, we omitted 13 of the 46 questions from the published KAP survey deemed confusing or with low factor loadings. We mailed the 33-item survey to Veterans seen for URI at 18 Veterans Affairs clinics from January 2018 to December 2019. We excluded Veterans not evaluated in-person, with documented dementia, or who died prior to study start. We excluded surveys with &gt; 3 unanswered questions.
We used principal component factor analysis (PCFA) with orthogonal varimax rotation (Fig. 1) to assess Veteran responses and Cronbach’s alpha to assess each factor’s internal consistency. We removed questions to reach alpha of &gt;0.7 (Fig. 2). We repeated PCFA and compared results to published EFA factors and loadings for the ED patients and online sample.

Results
Of 1329 eligible Veterans invited, 474 (36%) returned the survey; 407 met inclusion criteria (Table 1). PCFA of Veterans’ responses yielded 7 Factors (Fig 2). Like ED patients and the online sample, Veteran responses about side effects clustered together. Veteran responses about “antibiotics help” and “antibiotics don’t hurt” clustered together like ED patients. They grouped separately in the online sample. Veteran responses about safety and efficacy (Factors 3 & 5) and knowledge about viruses and bacteria, (Factors 4 & 5) clustered separately (Fig. 2). For ED patients and the online sample, safety and efficacy and virus and bacteria responses clustered together, respectively (Fig. 1).

Conclusion
While Veterans did share some KAPs around antibiotics for URIs with ED patients and the online sample, this study shows they also have distinct views. Further testing in Veteran and non-Veteran populations should validate and assess reliability of this survey as an antimicrobial stewardship tool.

Disclosures
Carlos G. Grijalva, MD, MPH, AHRQ: Grant/Research Support|Campbell Alliance/Syneos Health: Grant/Research Support|CDC: Grant/Research Support|FDA: Grant/Research Support|Merck: Advisor/Consultant|NIH: Grant/Research Support|Pfizer: Advisor/Consultant|Sanofi: Grant/Research Support|Sanofi-Pasteur: Advisor/Consultant Milner B. Staub, MD, MPH, Gilead: Stocks/Bonds|Johnson & Johnson: Stocks/Bonds.
1782. Antimicrobial Stewardship Opportunities in Gram-Negative Bacteremia Treatment at a Community Teaching Hospital
Authors: Ficinski Matthew , Laguio-Vila Maryrose R 
Published: December 2022

Abstract

Background
Gram Negative Bacteremia (GNB) is frequently encountered among hospitalized patients. In contrast to traditional 14-day lengths of treatment (LOT), recent literature supports a shorter (7-day) LOT for uncomplicated GNB with adequate source control, and the effectiveness of oral antibiotics. The goal of the following is to outline current practices of GNB treatment and identify opportunities for antibiotic stewardship (AS).

Methods
This study retrospectively reviewed all cases of uncomplicated GNB at a 528-bed community teaching hospital in Rochester, NY from January 2021 through March 2022. Demographic, laboratory, microbiologic, antibiotic therapy data, results of follow-up blood cultures (FUBC), hospital length of stay and 30-day readmission were collected. Exclusions were complicated or polymicrobial bacteremia, deaths during treatment, or prolonged hospitalization due to other medical factors. Influences of Infectious diseases (ID) or AS consult on treatment and outcomes were compared to cases with no consult. Continuous variables were analyzed using unpaired t-tests; categorical variables were analyzed using Fischer’s exact test and Chi-square as appropriate.

Results
133 cases met inclusion criteria. Demographic and laboratory data are in Table 1. The frequency of bacteria isolated and source of infection are in Figure 1 and Figure 2. ID was significantly more often consulted for central line infections (17% vs 3%, p=0.01), and significantly less frequently involved in urinary tract infections (39% vs 69%, p=0.009). While total LOT were similarly longer than current literature supports (11.7 vs 12.5 days, p=0.2644), cases without ID consultation received significantly more days of oral treatment (4.7 vs 7.1 days, p=0.0275). There were no significant differences between receipt and no receipt of AS recommendations.

Conclusion
GNB continued to receive longer LOTs than current literature recommends, with longer IV durations recommended by ID consultants compared to those without ID consult. Educational initiatives regarding the safety of shorter LOT for GNB, including the efficacy of oral antibiotics, are needed and should include ID specialists.

Disclosures
All Authors: No reported disclosures.
1786. Characterizing Antibiotic Use in Patients with Hematologic and Oncologic Malignancies Transitioned to Comfort Measures Only (CMO) During Hospital Admission
Authors: Chan Michelle , Pepe Dana , Mehrotra Preeti 
Published: December 2022

Abstract

Background
Antimicrobial treatment at the end of life is common. However, there is limited evidence on whether antimicrobial use during hospice care provides symptom palliation or contributes to discomfort. We sought to further investigate antimicrobial use at the transition to CMO in immunocompromised patients with active malignancies.

Methods
We conducted a retrospective cohort study of patients with active malignancies over 18 years of age admitted to Beth Israel Deaconess Medical Center from 3/1/2018 to 3/1/2021, who were transitioned to CMO. From hospital databases and from subsequent chart review, we examined: receipt of antimicrobials at any point in the admission; indication for antimicrobials; timing of CMO order; underlying hematologic/oncologic diagnosis; and concomitant COVID-19 diagnosis. Among the patients who received antimicrobials, we identified patients on antibiotics 48 hours prior to and after CMO order placement. Patients were excluded if CMO orders were reversed.

Results
384 patients met study criteria. The mean age was 67 years, and 50.5% patients were female. 31.8% of patients carried a hematologic malignancy diagnosis while the remaining had solid tumor diagnoses. 88% patients received antimicrobials at any point during their hospitalization. Of the patients who received antimicrobials during their admission, 84% received them in the 48 hours prior to transition to CMO and 15.3% continued receiving antimicrobials after CMO transition. Patients received a mean of 5.7 antibiotics. Most common indications for antimicrobials included pneumonia (22.2%), intra-abdominal infections (13.6%), sepsis (13.3%), and prophylaxis (3.5%), but most (39.8%) received antimicrobials for more than one infection or indication.

Conclusion
Hospitalized patients with active malignancy at the end of life are heavily exposed to antimicrobials. The majority of patients transitioned to CMO receive antimicrobials during their last hospital admission, and a significant subset (15.3%) continue antimicrobials after placement on CMO. Further studies are needed to investigate the potential benefits and harms of continuing antimicrobials in CMO patients, as decisions are complex and individualized.

Disclosures
All Authors: No reported disclosures.
1787. County Level Association Between the Rate of Fluoroquinolone-Resistance Gram Negative Bacteria and Fluoroquinolone Utilization in Kansas
Authors: Fulmer Robert D , Wark Kellie 
Published: December 2022

Abstract

Background
Kansas ranks as the 8th-worst state nationally for outpatient antibiotic prescribing, with a rate of 690 antibiotic prescriptions per 1000 population. The statewide rate of fluoroquinolone (FQ) is disproportionately higher than other antibiotic drug classes. Statewide antibiograms can be developed by health departments for antimicrobial stewardship monitoring. The purpose of this study was to investigate the correlation between the FQ resistance rate of gram-negative bacteria to FQ consumption.

Methods
A retrospective design utilizing 2018-2019 county level FQ-resistant Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa was categorized by county level based on the Kansas statewide antibiogram. Outpatient FQ utilization data was obtained from IQVIA and categorized into county level FQ rate based on prescriptions dispensed per 1000 population. Linear regression was used to compare antibiotic resistance (AR) to FQ utilization by county.

Results
Sixty-six of 123 facilities contacted for antibiogram data responded with results. Of these, 47 were critical access hospitals, and the rest were acute care hospitals or clinics. A total of 31,573 E. coli isolates, 5,942 K. pneumoniae and 5,017 P. aeruginosa isolates were represented. All 106 counties had FQ prescription data. Of the 49 counties with AR reported, FQ rates ranged from 4.6 to 105.6/1000 population. There was no statistical significance associated between counties for FQ-resistant E. coli, K. pneumoniae or P. aeruginosa with FQ-utilization rates (p=0.184, 0.572, 0.352, respectively). Comparing urban and rural regions was also compared for each AR-FQ use combination. There was statistical significance for urban P. aeruginosa FQ-resistance and FQ utilization (p=0.025), but not for urban E. coli (p=0.120) or urban K. pneumoniae (p=0.331).

Conclusion
A strong correlation was demonstrated between FQ consumption and rates of FQ-resistant P. aeruginosa within urban counties. No significant correlations were found between FQ consumption rates and other organisms. This study demonstrates additional applications for state-level antibiogram data, particularly when paired with antibiotic use data.

Disclosures
All Authors: No reported disclosures.
1794. Evaluation of Antimicrobial Susceptibility Patterns for Patients Admitted from Post-Acute Care Facilities in the Philadelphia Region
Authors: Vijapurapu Sandhya , Maguire Christina , Binkley Amanda , Binkley Shawn , Lamore Raymond 
Published: December 2022

Abstract

Background
Antimicrobial resistance is a rapidly emerging threat and antibiograms are a key component in guiding empiric antimicrobial selection. Patients admitted from post-acute care facilities (PACF) are at a heightened risk for infections from multi-drug resistant organisms, posing a challenge for clinicians selecting empiric therapy. It is uncommon for antibiograms to differentiate between sources of admission. This study aimed to characterize culture proven infections and the appropriateness of empiric antimicrobial regimens for patients admitted from PACF in the Philadelphia region.

Methods
This was a retrospective quality improvement study that included patients admitted from Philadelphia PACF from August 2020 to June 2021. Patients were included if they had at least one positive culture within 72 hours of admission. Appropriate therapy was determined based on a comparison of empiric antimicrobial selection and susceptibilities that resulted from collected cultures. Descriptive statistics were employed for data analysis.

Results
A total of 106 patients and 154 cultures were evaluated during the study period. The majority of patients received initial empiric coverage for Pseudomonas aeruginosa (79%) and methicillin-resistant Staphylococcus aureus (59%). Over 50% of all cultures had been obtained from urinary sources. Enterococcus spp. were the most commonly isolated gram positive organism (61%) and Escherichia coli was the most common gram negative organism (33%). A portion of patients (32.7%) did not receive appropriate empiric therapy. Discrepancies in susceptibility patterns between our internal antibiogram and PACF patients were most notable for gram negative organisms including decreased levofloxacin susceptibilities to P. mirabilis isolates (89% vs 45%). Other notable discrepancies include decreased meropenem susceptibilities to P. aeruginosa isolates (88% vs 65%). Select susceptibility patterns are reported in Figure 1.

Conclusion
Antimicrobial susceptibility was discordant amongst patients admitted from PACF in the Philadelphia region compared to our general antibiogram. The increased resistance identified supports a need to re-evaluate empiric prescribing guidelines for this specific population.

Disclosures
All Authors: No reported disclosures.
1795. Evaluation of Appropriate Daptomycin Usage in an Academic Medical Center
Authors: Daoud Nour A , VanNatta Mollie , Koppada Satya , Alam Mohammad , Khan Muhammad 
Published: December 2022

Abstract

Background
The usage of daptomycin at our institution has steadily increased, with a threefold increase from Jan 2020 to Jan 2022 according to Days of Therapy Data. The increased usage prompted this study to determine whether daptomycin use at our institution is appropriately indicated and supervised by the infection disease service.

Methods
We conducted a retrospective descriptive study on 74 patients who were selected randomly from a total of 234 pts who received daptomycin at our facility in Northwest Louisiana over the past two years. We studied the patient's age and gender, type of infection, indications, empiric versus targeted therapy, culture results, infectious disease consultation, and reason for early discontinuation.

Results
Seventy-four pts were included in the analysis. The median age was 53.50 (22-90 yrs), and 47 pts (63.5%) were male. The most common infections were bone and joint (37, 50.7%), followed by bacteremia (22, 30.1%), followed by infective endocarditis (4, 5.5%). The infectious disease service was consulted before administration of daptomycin in 87.3% (62 patients). In 70.3% (52 patients), daptomycin was used as targeted therapy. MRSA was the most common bacteria for which daptomycin was used (29, 42.6%), followed by Enterococcus faecalis (10, 14.7%) and Coagulase-negative staphylococcus (8, 11.8%). Fifty-five pts (74.3%) received vancomycin before switching to daptomycin. The most common indications was MRSA with vancomycin MIC ≥ 2 mcg/ml (25, 33.8%), followed by as an alternative to vancomycin in acute renal failure (14, 18.9%), followed by clinical or/and microbiological failure on the previous antibiotic regimen (10, 13.5%). Thirty-six pts (48.6%) completed their course, 20 (27%) pts had early discontinuation, 11 pts (14.9%) were lost to follow-up, 4 pts (5.4%) were still on daptomycin at the time of data collection, and 3 pts (4.1%) died during hospitalization. The most common cause of early discontinuation was the culture growing pathogen necessitating discontinuation of daptomycin (7 patients, 35%), followed by insurance issues that account for 15%.

Conclusion
Most daptomycin usage in our institution was wisely indicated under the supervision of the infectious disease service and was primarily used as targeted therapy.

Disclosures
All Authors: No reported disclosures.
1796. Evaluation of Asymptomatic Bacteriuria in Critical Access Hospitals
Authors: Hartlage Whitney , Chan Jeannie D , Martinez-Paz Natalia , Lynch John B , Jain Rupali , Pottinger Paul , Bryson-Cahn Chloe , Castillo Alyssa Y , Castillo Alyssa Y , Kassamali-Escobar Zahra 
Published: December 2022

Abstract

Background
The University of Washington Tele-Antimicrobial Stewardship Program (UW-TASP) provides antimicrobial stewardship education and training to rural and critical access hospitals (CAHs) in the United States through collaborative tele-mentoring. In 2021, UW-TASP implemented a pilot stewardship cohort to reduce antibiotic treatment of asymptomatic bacteriuria (ASB). We sought to quantify the overall prevalence of ASB and proportion treated in participating hospitals.

Methods
Patients undergoing urine testing were identified through local electronic medical records and microbiology data. CAHs adjudicated their own cases and reported demographics, symptoms of urinary tract infection, systemic inflammatory response symptoms (SIRS), location at the time of culture, laboratory results, and antibiotic treatment through a RedCap collection tool. The data form was created and analyzed by UW-TASP faculty. This study was waived by the University of Washington institutional review board.

Results
Nineteen CAHs in 5 states participated in this pilot. Eight submitted urine analysis and culture data for 417 patients. Seventy-seven percent of patients were female and the median age was 70. The emergency department was the most common culture collection location (274/417, 66%), followed by ambulatory care clinics (111/417, 27%), and nursing facilities (13/417, 3%). SIRS criteria and/or organ dysfunction were present in 149/417 patients (36%). Two hundred sixty patients (62%) had a positive culture with Escherichia coli being the most common implicated organism (167/260, 64%). ASB was identified in 69/260 patients (27%), and antibiotics were prescribed for 53/69 (77%) of those with ASB. Oral antibiotics were prescribed for 311 (75%) patients. Of those, 22% were prescribed a fluoroquinolone. Median treatment duration was 7 days (range, 1-14).

Conclusion
Although the prevalence of ASB was only 27% among 417 patients, treatment of ASB was high at 77%. High numbers of culture collections from the emergency department and ambulatory care settings identify these locations as future foci for stewardship interventions in CAHs. Low hanging fruit for intervention include reducing unnecessary fluoroquinolone use and reducing duration of antibiotic therapy.

Disclosures
Chloe Bryson-Cahn, MD, Alaska Airlines: Advisor/Consultant.