bluuebunny/crossref_metadata_2025_split huggingface dataset:
1766. Application of Defined Daily Dose to Antibiotic Prescribing in Massachusetts Jails
Authors: Szewczyk Bart , Campion Maureen , Bylsma Tara , Vazquez Gabriela Andujar , Doron Shira , Wurcel Alysse Gail 
Published: December 2022

Abstract

Background
Minoritized populations experience increased risk of antimicrobial resistant infections in the community and are subjected to further risk of infections because of mass incarceration. At highest risk for infections are criminal-legal involved older adults, who experience increased social vulnerability and are often high users of medical care. Antimicrobial stewardship is recommended by the IDSA to reduce unnecessary or suboptimal antibiotic use but is rarely implemented in carceral settings. The defined daily dose (DDD) per 1000 patient days is a frequently used metric of calculating antibiotic prescriptions that can be used to benchmark and track impact of interventions. The goal of this research was to apply the DDD metric as related to 1000 jail inhabitants to 2021 antibiotics prescribing in Massachusetts jails.

Methods
After receiving approval from the Massachusetts Sheriffs Association, we requested de-identified antibiotics prescription records from the State Office of Pharmaceutical Services for 2021. We followed the World Health Organization guidance for DDD calculation. We grouped antibiotics into 7 categories. We estimated the yearly number of people incarcerated by monthly capacity and the average length of incarceration.

Results
We found heterogeneity in antibiotic use patterns at the jails (Figure 1). Certain jails (e.g., Jail 1) were high users of antibiotics, while other jails (e.g., Jail 6) were low users. We also found significant heterogeneity in the classes of antibiotics used across the jails. Certain jails appear to prefer cephalosporins (e.g., Jail 1) while others (e.g., Jail 8) frequently use fluoroquinolones.

Conclusion
Applying the DDD metric is feasible in the novel setting of jails and may be utilized to benchmark antibiotic usage. This proof of concept can inform future antimicrobial stewardship interventions in carceral settings.

Disclosures
Tara Bylsma, MD, Takeda Pharmaceuticals: My husband was employed by Takeda June-Aug 2021 as a summer MBA intern Shira Doron, MD, Sunovion: Advisor/Consultant.
1769. Characterizing Antibiotic Prescribing for Nursing Home Residents with SARS-CoV-2 Infection, April 2020-November 2021
Authors: Gouin Katryna A , Clouse Ronald M , Mandley Cameron C , Lawal Olakunle , Yi Sarah H , Li Qunna , Boehmer Tegan , Hicks Lauri A , Kabbani Sarah 
Published: December 2022

Abstract

Background
Increased prescribing of antibiotics commonly used for respiratory infections, including azithromycin, ceftriaxone, and doxycycline was observed in nursing homes (NH) during the COVID-19 pandemic however antibiotic prescribing was not linked to resident diagnosis. Therefore, our objective was to characterize antibiotic prescribing in residents with SARS-CoV-2 infection in a large cohort of US NHs.

Methods
We conducted a retrospective cohort study using PointClickCare (PCC) data containing longitudinal NH electronic health records. We included 4,891 NHs that reported ≥1 medication order/month from April 2020-November 2021. We identified the first onset of SARS-CoV-2 infection using ICD-10-CM diagnosis code U07.1. To validate the number of SARS-CoV-2 infections per facility captured in PCC, we compared the total number of SARS-CoV-2 infections documented in PCC to those reported to the National Healthcare Safety Network (NHSN). Antibiotic orders were determined to be associated with a SARS-CoV-2 infection if 3 days before or ≤7 days after diagnosis. We characterized the proportion of residents with a SARS-CoV-2 infection with an associated antibiotic by month.

Results
We included 2,086 (43%) NHs that had ≤20% difference in total number of SARS-CoV-2 infections documented in PCC and reported to NHSN. From April 2020-November 2021, a total of 118,180 residents with a SARS-CoV-2 infection were identified and 24% had an associated antibiotic prescription (N=27,972). The highest prescription rate (30%, 95% Confidence Interval [29%-31%]) was observed in April 2020 and varied by less than 8% from May 2020-November 2021 (Fig.1). The most commonly prescribed antibiotics were azithromycin (53%), doxycycline (13%) and ceftriaxone (10%).

Conclusion
An antibiotic prescription was linked to up to a quarter of NH residents with SARS-CoV-2 infection, highlighting potential opportunities for avoiding unnecessary antibiotic prescribing for viral infections in NHs. Appropriate antibiotic prescribing in NH populations is important to reduce potential harm when antibiotics offer no treatment benefit to the resident. Identifying facility-level characteristics that lead to variability in antibiotic prescribing is a next step to inform antibiotic stewardship interventions.

Disclosures
All Authors: No reported disclosures.
1776. Overcoming barriers and expanding an existing Antimicrobial Stewardship Program: Allergy Collaboration to de-label Penicillin allergy
Authors: Adenew Ayne , Liappis Angelike P , Gillion Amanda , Barcelo Michelle , Vanlancker Janine , Sheth Dipa 
Published: December 2022

Abstract

Background
The pandemic placed barriers to face-face visits and repurposed Antimicrobial Stewards. During the pandemic, our existing Antimicrobial Stewardship Program: Allergy PCN or beta-lactam de-labeling program (PDLP) collaborated with a medical center within our network to adopt an existing EMR-based screening tool and CDSS tracking system to overcome barriers.

Methods
Between April 2021-March 2022 we expanded our PDLP by off-loading the workload through EMR beta-lactam assessment (BLA) notes targeting inpatient PharmDs. The ability to de-label was expanded by ‘chart’ delabeling using a BLA note template adopted from the Memphis VAMC. The BLA allowed historical allergy (duration, tolerability of other beta-lactams) or drug-related side effect to be challenged. Referrals to allergy were identified using the BLA; ASP Pharmacists conducted PharmD training and fielded referrals to either de-label with BLA vs PCN testing. BLA notes were tracked over time in CDSS (TheraDoc, DSS Inc) and after evaluation, the EMR was updated to reflect PCN allergy status post-assessment.

Results
Over one year the new BLA note was used in 113 patients; assessments were completed by the targeted audience (Inpatient Medicine PharmD) by the 3rd month of the adoption period; subsequently BLA use increased 180% compared to the 3 month lead-in period. BLAs gave inpatient providers guidance on drug selection, referral for formal PCN-testing or Pharmacist/Allergy review, a “chart only” de-label . With pandemic constraints few patients (17/113, 15%) were referred for skin testing with 65% of those successfully de-labeled. Among those not requiring PCN testing, when EMR records demonstrating tolerability to other beta-lactam agents, non-allergic reactions were clarified and/or patients were well enough during the hospital stay to provide accurate historical information nearly a third of those patients (19/66, 29%) were successfully de-labeled.

Conclusion
The pandemic provided clinical barriers, however we successfully adopted an EMR-based BLA tool. Engagement and buy-in from providers resulted in chart documentation and allergy de-labeling. Allergy working with ASPs can leverage both EMR and CDSS tools to de-label allergies to beta-lactams.

Disclosures
All Authors: No reported disclosures.
1788. COVID-19 and Antibiotic Prescriptions in the United States: A County-level Analysis
Authors: Hamilton Alisa , Poleon Suprena , Cherian Jerald , Cosgrove Sara E , Laxminarayan Ramanan , Klein Eili Y 
Published: December 2022

Abstract

Background
Declines in outpatient antibiotic prescribing were reported during the beginning of the COVID-19 pandemic in the United States; however, the overall impact of COVID-19 cases on antibiotic prescribing remains unclear.

Methods
We conducted an observational, ecological study to assess the impact of COVID-19 cases and pandemic-related, non-pharmaceutical interventions (NPIs) (e.g., school closures and facemasks) on antibiotic prescribing from February to December 2020 in the US. A random effects panel regression of county-level monthly reported COVID-19 case data and corresponding systemic antibiotic prescription data from IQVIA was used. The model controlled for county demographics, NPIs, and prior years’ prescribing.

Results
Total antibiotic prescriptions fell 26.1% between March and December 2020 compared to this period from 2017 to 2019. Prescribing rates dropped most among children (Figure 1). A 1% increase in county-level monthly COVID-19 cases was associated with a 0.9% increase (95% CI 0.7%, 1.1%; p&lt; 0.01) in monthly prescriptions dispensed to adults and a 1.2% decrease (95% CI -1.7%, -0.8%; p&lt; 0.01) in prescriptions dispensed to children (Table 1). Counties with schools open for in-person instruction were associated with a 4.4% increase (95% CI 2.3%, 6.4%; p&lt; 0.01) in prescriptions among children compared to counties that closed schools. Internal movement restrictions and requiring facemasks were also associated with lower prescribing among children. Figure 1A) Total prescriptions per 100,000 population by month (2017-2020). B) Mean prescriptions per 100,000 population for seven age groups (2017-2019 vs 2020).Table 1

Conclusion
Though the number of antibiotic prescriptions in 2020 was lower than previous years, the positive association of COVID-19 cases with prescribing for adults and the negative association for children indicates increases in prescribing occurred primarily among adults. The rarity of bacterial co-infection in COVID-19 patients suggests a large fraction of these prescriptions may have been inappropriate. Facemasks and school closures were correlated with reductions in prescribing among children, likely due to the prevention of other upper respiratory infections (e.g., the cold and influenza). Despite reductions, the strongest predictors of prescribing were prior years’ prescribing trends, suggesting the possibility that behavioral norms are an important driver of prescribing practices.

Disclosures
Sara E. Cosgrove, MD, Basilea: Member of Infection Adjudication Committee Ramanan Laxminarayan, PhD, HealthCubed: Board Member|HealthCubed: Ownership Interest.
2310. Clinical Characteristics of Patients with Calcified Parenchymal Neurocysticercosis and Perilesional Edema in a large non-endemic cohort
Authors: Berto Moreano Cesar G , Coyle Christina , Machiavello Francisco J 
Published: December 2022

Abstract

Background
Perilesional edema (PLE) around calcified parenchymal neurocysticercosis (NCC) lesions is a transient inflammatory event that accounts for recurrent symptoms in NCC. Previous reports in endemic regions suggest that 50% of seizures in NCC are due to PLE. Its occurrence in non-endemic regions is largely unexplored.

Methods
A retrospective review of medical records of patients with confirmed NCC followed at Jacobi Medical Center (Bronx, NY) from 1993 to 2021 was performed. Epidemiological, clinical and radiological data were obtained.

Results
180 patients were identified with calcified parenchymal NCC at any time during their course. PLE was documented in 37/180 patients (20.5%). Of these, 27 patients (72.9%) had PLE on presentation; ten patients presented with PLE after a median follow-up of 16.5 (9–36) months. 28 patients (75.6%) with PLE had only calcified parenchymal disease; the remaining 9 patients had mixed forms of NCC concurrently (viable parenchymal, subarachnoid or intraventricular NCC). 8 patients (21.6%) had more than 1 PLE episode with a median number of 3 (2–4) episodes; interval to recurrence was 9 (3.5–11) months. In 6 patients, the recurrence occurred in a calcification different to that of the first PLE episode. 2 patients had multiple calcifications simultaneously displaying PLE. 86.5% of PLE episodes were symptomatic; seizures were the most common symptom (70.3%). Clinical manifestations of PLE often varied during recurrent episodes, with only 2 patients displaying the same symptoms. 10 patients were treated with steroids, and 6 recurrent episodes of PLE occurred during a taper of steroids started for a prior PLE occurrence.

Conclusion
PLE was a frequent phenomenon among NCC patients in our non-endemic cohort. Its clinical course is variable, occurring as a presenting feature in calcified disease. Treatment with steroids may not always be warranted given recurrence during taper periods. Many experts think this may be due to antigens "leaking" from the calcified lesion leading to inflammation, but the true pathophysiology is not known. Further studies are needed to elucidate the etiology and natural history of PLE in NCC patients.

Disclosures
All Authors: No reported disclosures.
1792. Different Patterns of Antibiotic Use in Different Administrative Categories: An Overview of 10 years (2009/2018) of a Statewide Surveillance Program in Sao Paulo, Brazil
Authors: Assis Denise , Madalosso Geraldine , Boszczowski Icaro , Piastrelli Filipe 
Published: December 2022

Abstract

Background
To describe intensive care unit (ICU) antibiotic use in different administrative categories based on data reported to the Nosocomial Surveillance System of the State Health Department (SHD) in the State of Sao Paulo.

Methods
This ecological study describes at an aggregated level the antibiotic use in adult ICU reported to São Paulo SHD, from 2009 to 2018. ICUs were categorized by hospital administrative category (private, public, and philanthropic). Public hospitals were subdivided into two administrative sub-categories as Social Health Organization (SHO), which administration is private but public funded, or direct public administration (DPA). Resistance phenotype incidence and antibiotic use correlation was calculated for meticilin-resistant Staphylococcus aureus (MRSA) and glycopeptide use, third generation cephalosporin (3GC)-resistant Enterobacterales and carbapenem use, carbapenem-resistant gram-negative bacilli (CR-GNB) and polymyxins use.

Results
The average number of hospitals reporting annual data on antibiotic use was 386. A total of 17.490.966 patient-days were included. Total antibiotic use in ICUs increased from 588.16 in 2009 to 943.12 DDD/1000pd in 2018 (p&lt; 0,01). The DDD (defined daily dose) of antibiotic was higher in public hospitals (mean 889.11 DDD/1000pd), than in the private hospitals (mean 849.07 DDD/1000pd) and in the philanthropic hospitals (mean 48 785.12 DDD/1000pd) (p&lt; 0.05). Positive correlations were detected between glycopeptide use and MRSA incidence, polymyxins use and CR-GNB incidence. A weak negative correlation between carbapenems use and 3GC-resistante Enterobacterales incidence were found. Figure I:Antimicrobial use by therapeutic class between 2009 and 2018 in DDD / 1000 patient-daysTable I:Antibiotic use by therapeutic class by administrative type in DDD/1000 patients-dayTable II:Antibiotic use in public hospital by subgroup between 2009 and 2018 in DDD/1000 patients-day

Conclusion
We found higher use of antibiotics in public hospitals than in private and philanthropic. Differences in antibiotic use were observed among SHO e DPA public hospitals. These data provide important information for formulating hypotheses and public health strategies to improve antimicrobial prescription.

Disclosures
All Authors: No reported disclosures.
1797. Evaluation of Intravenous vs Oral Antibiotic Therapy at Discharge for the Treatment of Urinary Source Gram-Negative Bacteremia
Authors: Yan Xuping , Song Matthew , Moore Sarah E , Swingler Elena A , Wilde Ashley M , Bohn Brian C 
Published: December 2022

Abstract

Background
Retrospective studies demonstrate similar efficacy between oral (PO) and intravenous (IV) antibiotics at discharge for gram negative bacteremia (GNB), with reduced duration of hospitalization, hospital costs, and duration of therapy with PO. Understanding current physician discharge practices can help guide future antimicrobial stewardship initiatives.

Methods
A multicenter, retrospective cohort study was conducted on adult inpatients admitted between July 1, 2020 and June 30, 2021 with urinary source GNB. Patients with both blood and urine cultures positive for Escherichia coli, Klebsiella species, or Proteus mirabilis and a PO antibiotic available at discharge were included. The primary outcome was the percentage of patients discharged on PO antibiotics. Secondary outcomes included duration of hospitalization, total length of therapy, and 30-day readmission secondary to clinical failure or therapeutic complication in the IV and PO at discharge groups.

Results
Of the 157 included patients, 128 (82%) were discharged on PO antibiotics. Patients discharged on IV and PO had similar median quick Pitt bacteremia scores [1(IQR, 0 – 2) vs. 1 (IQR, 0 – 1), p=0.420]. Mean duration of hospitalization for patients discharged on IV vs. PO therapy was 5 (SD, 2.91) days vs. 4 (SD, 2.75) days, p=0.001, respectively. Mean total length of antibiotic therapy was 21.6 (SD, 13.80) days as compared to 13.5 (SD, 4.94) days, p=0.017, for the IV vs. PO arms, respectively. Thirty–day readmission rates were 11/29 (38%) and 23/128 (18%), p=0.035, in the IV and PO arms, respectively. Notably, 21/29 (72%) of the IV arm had an organism from blood culture that was susceptible to trimethoprim-sulfamethoxazole (TMP-SMX).

Conclusion
Most patients with urinary source GNB were discharged on PO antibiotics. Patients discharged on IV antibiotics were more likely to be readmitted within 30 days. Future efforts to decrease IV antibiotic use may focus on increasing TMP-SMX use at discharge.

Disclosures
Matthew Song, PharmD, BCIDP, Merck: Stocks/Bonds|ObsEva: Stocks/Bonds.
1798. Impact and Sustainability of Antibiotic Prescribing Feedback with Peer Comparison to Hospitalists in a Community Hospital
Authors: Jones Travis M , Patel Kevin , Birkhimer Amy , Spires Steven Shaefer , Ashley Elizabeth Dodds 
Published: December 2022

Abstract

Background
Antibiotic prescribing feedback with peer comparison has been shown to reduce antibiotic prescription rates in the outpatient setting, but data regarding its impact in community hospitals are lacking. We previously developed novel denominator metrics to control for differences between physician practices such as patient volume or workload. Using these metrics, we provided regular antibiotic prescribing feedback with peer comparison to hospitalists in a community hospital over four years and evaluated its impact on targeted antibiotic prescribing.

Methods
Antibiotic days of therapy (DOT) for all antibacterials and targeted agents (aztreonam, antipseudomonal beta-lactams, vancomycin, and the fluoroquinolones (FQ)) were obtained from electronic medication administration records and linked to the ordering hospitalist. Physician-specific shifts worked data by month were calculated from local administrative datasets. De-identified data were presented in DOT/shifts worked, and trends in facility-wide and hospitalist-specific antibiotic prescribing were evaluated.

Results
A total of 37,938 antibiotic DOTs were prescribed by hospitalists from January 2018 to March 2022. De-identified feedback was shared in-person (4/2018, 4/2019, 3/2020, 11/2021) or virtually (9/2020) in small group sessions, and education, including local antibiogram data and recommended alternatives, was provided for targeted agents. Of the 31 hospitalists that received feedback, trends in FQ use for 7 hospitalists with longitudinal data are shown (Figure 1). In the month following feedback sessions, hospitalist antibiotic use data demonstrated substantial reductions in FQ prescribing, and similar trends were observed among all targeted agents. A single hospitalist’s prescribing trend for targeted agents is shown in Figure 2. Facility-wide, targeted agent use decreased 31% from 2017 to 2021 and was primarily driven by reductions in use by hospitalists.

Conclusion
Regular antibiotic prescribing feedback with peer comparison and education was associated with a reduction in targeted agent prescribing by hospitalists at a community hospital.

Disclosures
All Authors: No reported disclosures.
1802. Off-label Use of Antimicrobial Agents at the University Hospital for Infectious Diseases, Zagreb, Croatia
Authors: Matković Iva , Santini Marija 
Published: December 2022

Abstract

Background
Antimicrobial agents' (AMAs) off-label use can be associated with the prescriber's education. Little is known about the AMAs' off-label use by infectious disease (ID) specialists. We have conducted research at the University Hospital for Infectious Diseases (UHID), Zagreb, Croatia, a 230-bed tertiary center where ID specialists primarily prescribe AMAs.

Methods
A retrospective cross-sectional analysis was conducted on the day with the highest hospitalization number, January 17, 2019. Any use of AMA not complying with the SmPC was considered off-label and evaluated regarding modality (indication, dose, regimen, route of administration, and age) and justification by institutional or/and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines.

Results
The study included 155 patients, 63 (40.6%) adults and 92 (59.4%) children. 61 (96.8%) adult patients had at least one AMA. There were 134 AMA prescriptions in adults, 42 (31.3%) off-label. AMAs were most frequently prescribed off-label regarding regimen (21), dose (17), and indication (14). Institutional guidelines justified off-label in 5 cases regarding dose, 4 regarding indication, and 2 regarding regimen. ESCMID guidelines justified off-label prescriptions in 5 cases regarding indication. The rest of the off-label was not supported by the existing guidelines. 60 (65.2%) pediatric patients had at least one AMA. There were 73 prescriptions, 31 (42.5%) off-label. AMAs were most frequently prescribed off-label regarding indication (19), dose (12), and age (2). Institutional guidelines justified 3 off-label cases regarding indication and 1 regarding dose. ESCMID guidelines justified no off-label in children. The lack of guidelines was the leading cause of the off-label AMAs use in children.

Conclusion
One-third of AMAs are prescribed off-label regarding SmPC by ID specialists. However, institutional and international guidelines can justify part of this use.

Disclosures
All Authors: No reported disclosures.