bluuebunny/crossref_metadata_2025_split huggingface dataset:
1791. Leveraging EMR Alerts for Vancomycin Time Outs
Authors: Lusardi Katherine , Bailey Brett , Awad Ramez , Jenkins Mitchell , Rico Crescencio Juan Carlos , Horak Matthew , Dare Ryan K 
Published: December 2022

Abstract

Background
Vancomycin represented the most used antibiotic at our academic medical center from 2014-2022. To enhance compliance with the “antibiotic time out” part of the CDC Core Elements for Stewardship, we designed an electronic medical record (EMR) best practice alert (BPA) to assist providers in identifying patients eligible for vancomycin discontinuation.

Methods
This is a single center, retrospective pre (06/01/14-2/24/20)/post (02/25/20-03/31/22) comparison of vancomycin utilization after the introduction of a locally validated automated vancomycin time-out. The BPA alerted on patients who had received vancomycin for 72h, had no microbiological evidence of methicillin resistant S. aureus, and had no infectious diseases consult. While other vancomycin reduction strategies had previously been implemented as part of the stewardship program, no other intervention debuted during the same time period. An interrupted time series analysis was performed to assess immediate and ongoing trend changes of institutional vancomycin use. Wilcoxon rank sum and chi2 analyses were also performed.

Results
There were 36,817 inpatient vancomycin orders placed. The BPA triggered during 1,881 (15.7%) orders in the post-BPA period, which was 49.6% of the 3,794 orders still active at 72h. After BPA introduction, there was an immediate decrease in vancomycin days of therapy (DOT)/1000 patient days (PD) ±SE (-8.5 ±3.6; P = 0.021) followed by a significant decrease in the monthly trend relative to the pre-intervention trend (-0.7 DOT/1000 PD ±0.2; P&lt; 0.001). Median vancomycin DOT/1000 PD decreased from 145.9 (IQR 140.2-153.0) to 117.3 (IQR 107.7-122.6) in pre and post periods respectively (P&lt; 0.001). Length of therapy (LOT) decreased, orders were more commonly discontinued by day 5, and orders were more likely to be discontinued prior to discharge. Separate analysis including only orders with &gt;72h showed similar results (Table 1). Table 1Vancomycin length of therapy (LOT) pre and post-BPA Time Out.Figure 1Vancomycin days of therapy per 1000 patient days (DOT/1000PD) trends pre and post-BPA Time Out.

Conclusion
Introduction of an EMR automated vancomycin time out was an effective tool to decrease vancomycin utilization at an academic medical center.

Disclosures
All Authors: No reported disclosures.
1807. Tracking antibiotic de-escalation using a novel metric, days of antibiotic spectrum coverage (DASC)
Authors: Suzuki Hiroyuki , Heintz Brett , Livorsi Daniel J , Perencevich Eli N , Goto Michihiko 
Published: December 2022

Abstract

Background
In the United States, days of therapy (DOT) is the currently preferred method for measuring antibiotic consumption. A major disadvantage of DOT is that it does not account for the antimicrobial’s spectrum. Antibiotic de-escalation is therefore not well-captured by DOT. To overcome the limitation of DOT, we recently proposed a new metric, days of antibiotic spectrum coverage (DASC). DASC is calculated by multiplying DOT and the antibiotic spectrum coverage (ASC) score, which was assigned based on the activities of each antibiotic agent for 11 wild type bacteria and 5 acquired resistance patterns. Here we evaluate the performance of DASC using antibiotic consumption data where the main antimicrobial stewardship program (ASP) activity is daily prospective audit-and-feedback of all inpatients on antibiotics.

Methods
We analyzed the retrospective cohort of inpatient antibiotic use at Iowa City VA Health Care System from 2017 to 2021. Total monthly DOT was the aggregation of monthly DOT for each antibiotic. DASC for each antibiotic was calculated by multiplying ASC for each antibiotic to DOT. DASC for each antibiotic was aggregated to total monthly DASC. Days-present was used as a denominator for both metrics. Trends of total monthly DOT and DASC were analyzed by simple linear regression.

Results
There was no significant trend in monthly DOT (Figure A: beta= 0.30, 95%CI: -0.67 to 1.27, p=0.55), but there was a significant downward trend in monthly DASC (Figure B: beta= -6.89, 95%CI: -12.7 to -0.98, p=0.03).

Conclusion
While a significant downward trend was seen using monthly DASC, no trend was observed using monthly DOT. In contrast to DOT, which captures antibiotic consumption without considering the spectrum, DASC captures both antibiotic consumption and spectrum, suggesting DASC can add another dimension in tracking inpatient antibiotic use. DASC is easily calculated if DOT for each antibiotic is available. Metrics that don’t capture antimicrobial spectrum may not be able detect improvements in avoiding unnecessary use of broad-spectrum antimicrobials, an important target of ASPs.

Disclosures
Daniel J. Livorsi, MD, Merck & Co.: Grant/Research Support Michihiko Goto, MD MSCI, Merck & Co.: Grant/Research Support.
2312. Utility of Intrathecal Antibiotic Administration in the Reduction of Ventriculoperitoneal (VP) Shunt Infections in our Urban Referral Health Center
Authors: Abalos Charmaine Clarisse D , Jaber Tariq M , Bangash Salman , Jacobs Max W , Turk Michael , Bhanot Nitin , Min Zaw , Abdulmassih Rasha 
Published: December 2022

Abstract

Background
Infection is one of the primary causes of VP shunt failure, with an incidence rate of 7%-14%. Systemic antibiotics, administered intravenously (IV), are considered the standard of care (SOC) for perioperative prophylaxis. Prophylactic intrathecal (IT) administration of antibiotics, in addition to SOC, is practiced by some surgeons at our institution. Our objective was to study the impact of this modality on VP shunt infections.

Methods
A retrospective review of all VP shunt procedures at our institution from 2018–2020 was performed. Patients with active VP shunt infection were excluded. We compared the incidence of 90-day postoperative shunt infection in patients who received IT and SOC antibiotics (intervention group) to patients who only received SOC IV antibiotics (control group). Data collection included demographics, comorbidities, prophylactic antibiotics used, and pathogens implicated in shunt infections. T-test or Mann-Whitney U test was used for comparison of continuous variables; chi-square or Fisher’s exact test was used to assess the relationship between categorical variables. A value of p &lt; 0.05, on two-tailed testing, was considered statistically significant.

Results
A total of 112 patients were included in the study. Control and intervention arms comprised 54 (48.2%) and 58 patients (51.8%), respectively. All patients received parenteral perioperative antibiotics. The most commonly used agent was cefazolin (83.9%). Patients in the intervention arm received 4 mg of gentamicin and 5 mg of vancomycin intrathecally.
Baseline characteristics were not statistically different between the groups.
Among the 112 patients, 12 (10.7%) developed shunt infection; 4 in the intervention and 8 in the control arm. Infection rates were not statistically different in these groups (χ2 (1) =1.83, p= 0.176). However, there was a statistically significant association between history of prior shunt (uninfected) placement and post-operative shunt infection (Fisher’s exact test, p = 0.025).

Conclusion
Our study did not reveal additional benefit of prophylactic IT antibiotic use in decreasing VP shunt infections. History of prior shunt placement was identified as risk factor, however. Limitations include relatively small sample size, retrospective, and a single-center study.

Disclosures
All Authors: No reported disclosures.
1811. Use of Procalcitonin and Antimicrobial Stewardship Intervention to Limit Antibiotic Utilization in Patients Admitted to a Community Hospital with SARS-CoV-2 Infection
Authors: Politis Paula A , Oravec Michael J , Hoisington Lisa , Tan Michael J , Agarwal Shanu , File Thomas M 
Published: December 2022

Abstract

Background
Patients admitted to the hospital with SARS-CoV-2 infection are often treated with antibacterial agents in addition to antivirals, although bacterial co-infection in this population is uncommon. Overuse of unnecessary antibiotics can lead to suboptimal outcomes, including increased bacterial resistance, adverse events, and costs. Our Antimicrobial Stewardship (AS) Program routinely provides recommendations for appropriate therapy based on molecular/microbiologic tests, clinical findings, and procalcitonin (PCT). PCT can assist in differentiating bacterial from viral respiratory infections, and can be useful in the decision to discontinue antibiotic therapy if viral monomicrobial infection is suspected. The purpose of our quality improvement project was to review the appropriateness of antibiotics utilized for patients admitted with SARS-CoV-2 and to promote optimal patient care and AS at our institution.

Methods
We performed a retrospective review of SARS-CoV-2 patients from our institution’s COVID-19 registry for patients hospitalized from March 2020-April 2021. We compared patients with PCT &lt; 0.25 ng/mL to those with PCT &gt; 0.25 ng/mL and assessed differences in patient characteristics and disease presentation, including: age, gender, WBC, serum creatinine, culture results, disease severity, patient location, duration of antibiotics, length of stay, 30 day readmission and mortality. Characteristics were compared using descriptive statistics and appropriate inferential statistics.

Results
Shown in Table 1. If prescribed antibiotics, median duration of antibiotic therapy was significantly reduced in the PCT &lt; 0.25 group vs. the PCT &gt; 0.25 group (2 days vs. 4.1 days). Median WBC, SOFA score, serum creatinine, and length of stay were significantly lower in the PCT &lt; 0.25 group compared to the PCT &gt; 0.25 group. Severity adjusted models showed significantly decreased duration and overall likelihood of antibiotic use for PCT &lt; 0.25 vs. PCT &gt; 0.25. 30 day readmission and 30 day mortality were significantly lower in the PCT &lt; 0.25 group vs. the PCT &gt; 0.25 group.

Conclusion
Antibiotic utilization was reduced in patients admitted with SARS-CoV-2 infection and PCT &lt; 0.25, and if prescribed antibiotics, duration was significantly shorter vs. those in the PCT &gt; 0.25 group.

Disclosures
Michael J. Tan, MD, FACP, FIDSA, Pfizer: Honoraria|Thermo Fisher Scientific: Honoraria Thomas M. File, Jr., MD, MSc, MACP, FIDSA, Nabriva Therapeutics: Advisor/Consultant|Nabriva Therapeutics: Honoraria.
1812. Impact of removing ESBL testing report on the selection of antibiotics for the treatment and 30-day mortality of patients infected with ESBL-producing organisms
Authors: Waeuseng Sofia 
Published: December 2022

Abstract

Background
The rising burden of carbapenem-resistant organisms is well recognized as a global crisis. Several studies have identified preceding carbapenem use as a risk factor for the subsequent development of infections with carbapenem-resistant, gram- negative organisms. We characterized the impact of removal of the ESBL designation from microbiology reports on inpatient antibiotic prescribing.

Methods
A historical control study, interventional analysis study was conducted at Ramathibodi Hospital) to compared 1 year before removal ESBL designation (period1, August 1, 2019 to July 31, 2020) and 1 year post removal ESBL designation (period 2, August 1, 2020 to July 31, 2021) on inpatient antibiotic prescribing. Categorical variables were compared using the Fisher exact test. Continuous variables were evaluated using the Wilcoxon rank-sum test. All statistical tests were 2-tailed, and a P &lt; .05 was considered statistically significant.

Results
The primary outcome definitive prescribing of carbapenems decreased from 56.5% to 41.3% afterward (P= .01). Prescription of cefepime was also decreased from 13.6% to 3.5% (P&lt; .05), respectively. Whereas piperacillin-tazobactam use significantly increased from 10.4% to 28.7% (P&lt; .05). Trimethoprim-sulfamethoxazole was prescribed more frequently, i.e., increased from 0 to 2.8%, but this change was not statistically significant. The secondary outcome 30-day mortality from any cause was no different between the two groups, with 22 of 154 patients (14.3%) in group 1 and 24 of 143 (16.8%) in group 2 (P = .55).

Conclusion
Definitive prescribing of carbapenems was decreased and β-lactam–β-lactamase inhibitor combination was increased after removal ESBL report. Our findings confirm the importance of collaboration between microbiology and antimicrobial stewardship programs.

Disclosures
All Authors: No reported disclosures.
1825. Comparative Effectiveness of Ampicillin versus Vancomycin or Daptomycin for the Treatment of Ampicillin-Susceptible Enterococcus spp. Bloodstream Infections
Authors: Chua Hubert C , Phe Kady 
Published: December 2022

Abstract

Background
Treatment options against Enterococcus spp., a common nosocomial pathogen, are limited due to intrinsic resistance to multiple antibiotics. Ampicillin is considered drug of choice if susceptible, but data comparing outcomes between ampicillin, daptomycin, and vancomycin for ampicillin-sensitive Enterococcus spp. bacteremia are limited.

Methods
This was a single-center retrospective cohort study of adults with confirmed ampicillin-sensitive Enterococcus spp. bloodstream infection (BSI) who received definitive treatment with intravenous ampicillin, daptomycin, or vancomycin from January 2013 to December 2021. Polymicrobial BSI were excluded. Definitive treatment was defined as the active antibiotic used for more than 50% of the total treatment duration following availability of susceptibility results. The primary outcome was 28-day all-cause hospital mortality; secondary outcomes were 90-day readmission due to microbiological recurrence and all-cause hospital mortality. Multivariate Cox regression analysis was performed to identify independent risk factors for 28-day hospital mortality.

Results
A total of 199 patients (ampicillin, n = 141; daptomycin, n = 17; vancomycin, n = 41) were evaluated. Overall in-hospital all-cause mortality was 15.1% (n = 30). Twenty-eight-day hospital mortality was numerically lower with ampicillin and daptomycin compared to vancomycin (9.2%, 11.8%, and 22%, respectively; p = 0.088). Ninety-day readmission due to microbiological recurrence (4.3%, 5.9%, and 7.3%; p = 0.722) and all-cause hospital mortality (12.8%, 17.6%, and 22%; p = 0.335) were not significantly different between treatment groups. Independent risk factors for 28-day hospital mortality included age (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.02 to 1.09; p = 0.003), E. faecium BSI (HR 3.94, 95% CI 1.39 to 11.1; p = 0.010), and definitive treatment with vancomycin (HR 2.54, 95% CI 1.04 to 6.21; p = 0.040).

Conclusion
Vancomycin used as definitive therapy for ampicillin-sensitive Enterococcus spp. bacteremia was found to be an independent risk factor for 28-day mortality. Further studies evaluating the role of daptomycin in this setting are warranted.

Disclosures
All Authors: No reported disclosures.
1827. Comparison of clinical outcomes for glycopeptides and beta-lactams in methicillin-susceptible Staphylococcus aureus bloodstream infections
Authors: La Yeon Ju , Kim Hye Rim , Oh Dong Hyun , Ahn Jin Young , Kim Yong Chan 
Published: December 2022

Abstract

Background
Several studies demonstrated the inferiority of glycopeptides as definitive antibiotics for MSSA BSI compared to anti-staphylococcal beta-lactam antibiotics. However, almost all of them were retrospective observational studies and no randomized controlled. Therefore, there remains the problem of bias in treatment selection and the possibility of residual confounding factors. In this study, we compare the therapeutic effects of glycopeptides and anti-staphylococcal beta-lactams in the treatment of MSSA BSI using inverse probability of treatment weighting (IPTW) analysis.

Methods
This is a retrospective cohort study performed in double-center from January 1, 2010 to December 31, 2018. Patients (age ≥18 years) with MSSA identified in the blood culture were included. Patients were classified into two groups according to definite antibiotics used, the beta-lactam (nafcillin or cefazolin) group and the glycopeptide (vancomycin or teicoplanin) group. Figure 1.Flow chart of the study population

Results
During the study period, 643 patients had MSSA bacteremia. Among them, 203 were treated with beta-lactam group and 156 were treated with glycopeptide group as definite therapy. (Figure 1). Comparison of clinical characteristics of patients between the beta-lactam and glycopeptide groups are shown in Table 1. After IPTW, baseline characteristics of the two groups were well balanced except for the primary focus of bacteremia. Although persistent bacteremia was less common in glycopeptide group (17.9% vs 4.0%; OR, 0.28; 95% CI, 0.14 – 0.60; P &lt; 0.001), the glycopeptide group had higher overall mortality rate (15.9% vs 39.6%, P = 0.024), 7-day mortality rate (2.1% vs 14.1%, P &lt; 0.001), and 28-day mortality rate (7.7% vs 30.9%, P = 0.012) (Table 2) than those of the beta-lactam group. When IPTW was augmented by multivariable logistic regression analyses to minimize remnant confounding, glycopeptide use for the treatment of MSSA BSI was associated with significant risk for 28-day mortality (adjusted OR, 3.37; 95% CI, 1.71–6.61; P &lt; 0.001) (Figure 2). Figure 2.Adjusted ORs and 95% CIs for the primary end point in main analysis and various subgroups
Abbreviations: CI, confidence interval; OR, odds ratio; IPTW, inverse probability of treatment weighting.
aUnadjusted OR

Conclusion
Definitive therapy with beta-lactams in patients with MSSA BSI was associated with lower 28-day mortality when compared with definitive therapy with glycopeptides. This study provides compelling evidence of anti-staphylococcal beta-lactam use for MSSA BSI treatment.

Disclosures
All Authors: No reported disclosures.
1828. Dalbavancin Utilization and Associated Clinical Outcomes: A Case-Series
Authors: Greckel Meagan N , Footer Brent , Christensen Alyssa , Christensen Alyssa , Tallman Gregory B , Edwards Lea 
Published: December 2022

Abstract

Background
Dalbavancin is an intravenous (IV) long acting lipoglycopeptide approved for use in acute bacterial skin and skin structure infections (ABSSSI). However, given the prolonged half-life, there is interest in using this agent as an alternative therapy for patients unable or unwilling to comply with conventional IV therapy. These include off-label treatment of deeper-seated infections such as infective endocarditis or osteomyelitis. This case series assesses the efficacy and safety of dalbavancin and its role as an alternative therapy in serious gram-positive infections.

Methods
Retrospective case series of hospitalized adult patients who received at least one dose of dalbavancin at one of the eight hospitals within the Providence Oregon health system between December 2019 through January 2022. Eligible patients had appropriate follow-up within the 90-day period after the last dose was given. Patients who received dalbavancin as empiric therapy or had a vancomycin-resistant isolate were excluded. Clinical cure was defined as no clinical, laboratory, or microbiological evidence of persistent or recurring infection during the 90-day follow-up period.

Results
110 patients were included in this analysis; 41% were IV drug (IVDU) users. The average age was 50.5 years, and the most common organism was Methicillin-sensitive Staphylococcus aureus (48.2%). Bacteremia occurred in 50% of the cases, and the most common infection site was osteomyelitis or native joint infections (31.8%). 30-day all-cause readmission, recurrence, and mortality occurred in 12.7% (2/110), 1.8% (14/110), and 0%, respectively. 30 to 90-day all-cause readmission, recurrence, and mortality occurred in 14.5% (16/110), 7.3% (8/110), and 1.8% (2/110), respectively. Adverse events occurred in 4.5% (5/110) of the cases, where infusion related reactions were most common. Presumed clinical cure occurred in 89% (98/110).

Conclusion
A high percentage of patients in this case series were bacteremic, which differs from prior reports. Overall, dalbavancin appears to be a safe and effective treatment alternative for deeper-seated infections, including those with concomitant bacteremia.

Disclosures
All Authors: No reported disclosures.
1829. Dalbavancin versus standard of care as directed therapy for Staphylococcus aureus bacteremia in patients unable to receive OPAT
Authors: Frazier J , Stoudenmire Laura , Wagner Jamie , Thomas Geren , Henao-Martínez Andrés F , Franco-Paredes Carlos , Chastain Daniel B 
Published: December 2022

Abstract

Background
The purpose of this study was to compare dalbavancin to standard of care (SOC) for patients with S. aureus bacteremia (SAB) who were unable to receive outpatient parenteral antimicrobial therapy (OPAT) and would otherwise remain hospitalized or require placement into post-acute care facilities.

Methods
This retrospective cohort compared readmission rates related to the index infection between patients treated with dalbavancin or SOC for SAB between January 1, 2016, and August 31, 2021. Patients at least 18 years old seen by the ID consult service who received at least one dose of dalbavancin or at least one week of SOC parenteral antibacterials as directed therapy for SAB at the time of discharge were included. The SOC group consisted of patients transferred from the main hospital to one of the post-acute care facilities in a surrounding county to complete parenteral antibacterials. Patients were excluded if they were treated for polymicrobial infections with organisms other than S. aureus, had a creatinine clearance less than 30 mL/min, or required renal replacement therapy. The primary outcome was readmission rates within 30 days after completion of therapy. Secondary outcomes included readmission rates within 90 days after completion of therapy as well as antibacterial regimen adherence defined as achieving goal duration of therapy deemed appropriate by the ID consult service.

Results
During the study period, 27 patients received dalbavancin, and 27 patients received SOC. Baseline demographics were comparable between groups, though more patients in the SOC group had indwelling prostheses or hardware (4% vs 22%). The majority of SAB was caused by MSSA in both groups (56% vs 59%). The most common source was osteoarticular (15% vs 30%) and source control was attempted in a higher percentage of the SOC group who had an identified source (53% vs 86%). Readmission rates in the dalbavancin group were similar to those in the SOC group within 30 days (15% vs 22%, p=0.484) and 90 days (19% vs 22%, p=0.735) after completion of therapy. However, adherence was significantly higher among patients treated with dalbavancin (85% vs 44%, p &lt; 0.05).

Conclusion
Dalbavancin offers similar clinical outcomes to SOC for patients with SAB who are unable to receive OPAT.

Disclosures
All Authors: No reported disclosures.