bluuebunny/crossref_metadata_2025_split huggingface dataset:
928. The Cost-effectiveness of the Pediatric Antimicrobial Stewardship Program in a Non-Freestanding Children’s Hospital
Authors: Lien Tsung-Chi , Ip Alice , Covarrubias Laurie , Husted Harlan , Sidhom Alexander , Doctor Medical , Rongkavilit Chokechai , Doctor Medical 
Published: December 2022

Abstract

Background
Improper utilization of antimicrobials has impacted clinical outcomes in patient care and economical costs. Pediatric antimicrobial stewardship (Ped ASP) lowers healthcare costs by promoting efficient and judicious use of antimicrobials which improves patient outcomes and amends resource utilization. The objective of this study is to evaluate the cost-effectiveness of a Ped ASP in a non-freestanding children’s hospital within an adult-centered tertiary hospital.

Methods
We conducted a cost-effective analysis of our Ped ASP within a 685-bed, adult-centered medical center. Impacted by the COVID pandemic, the pediatric services reduced from 21 to 14 beds with 10 general pediatrics (PED) and 4 pediatric intensive care (PICU) beds. Our Ped ASP activities include thrice-weekly chart reviews followed by handshake rounds and quarterly reviews of documented interventions. The preset values of antimicrobial-specific interventions in the Electronic Medical Record system were utilized. An average cost savings of $732 (range: $2.5 - $2,640) per patient as determined by previous studies was used to calculate the annual cost savings.

Results
During years 2020 to 2021, antibiotic days of therapy per 1000 patient days (DOT) decreased from 290.4 to 100.2 in PED but increased from 433 to 569.1 in PICU. The ratio of broad to narrow-spectrum antibiotics decreased from 0.46 to 0.20 in PED and 0.69 to 0.63 in PICU. In 2020, 286 reviews were completed of 155 patients which projected an average cost savings of $113,460 (range: $387.5 - $409,200). In 2021, 256 reviews of 116 patients projected an average cost savings of $84,912 (range $290 - $306,240). An estimated overall annual cost-savings was $99,186. The total number of ASP-specific interventions in 2020 and 2021 were 172 and 146 with projected pharmacy intervention values of $26,354 and $19,170 respectively.

Conclusion
Our Ped ASP effectively reduces the usage of broad-spectrum antibiotics in both PED and PICU demonstrating cost savings. Implementing antibiotic time-out reports on specific broad-spectrum antibiotics based on local susceptibility data may further enhance the safety and appropriateness of antimicrobial therapy.

Disclosures
All Authors: No reported disclosures.
936. Antimicrobial Stewardship Assessments in De-labeling Beta-lactam Allergies
Authors: Fahmy Nicole , Morado Faiza , Nanda Neha 
Published: December 2022

Abstract

Background
Unnecessary use of broad-spectrum antibiotics due to false antibiotic allergy labels leads to an increase in drug resistant and health care associated infections. Therefore, allergy assessments to de-label patients not truly allergic is an important antimicrobial stewardship (AMS) tool. The purpose of this study was to assess the effectiveness of a pharmacy-led questionnaire and AMS rounds in improving the accuracy of beta-lactam allergy labels (BLA).

Methods
AMS piloted BLA de-labeling rounds three times a week from November 1, 2021 to April 1, 2022. Rounds consisted of an infectious disease physician and an AMS pharmacist that reviewed allergy questionnaires conducted by trained pharmacy personnel. The questionnaire was provided to patients 18 years or older with a documented BLA and an admission stay of two or more nights. Patients were excluded if unable to participate or did not have a representative available for interview. The primary outcomes evaluated were: (i) direct de-labelling (ii) future de-labeling upon patient consent (iii) allergy profile changes. The secondary outcomes were potential days of therapy (DOTs) saved for anti-MRSA agents (vancomycin, linezolid, clindamycin) and fluoroquinolones (ciprofloxacin, levofloxacin) and PEN-FAST scores for those with a penicillin-specific allergy.

Results
93 of 96 patients interviewed (96.9%) had their allergy profile updated to include type, severity, or timing of reaction. 82 of 96 patients (85.4%) were classified as low-risk allergies in which 11 patients (13.4%) were successfully de-labeled and 18 patients (22.0%) were eligible for de-labeling upon patient consent. The remaining patients were eligible for further interrogation with an oral challenge (Figure 1). Potential DOTs saved were 131 and 67 days for anti-MRSA agents and fluoroquinolones, respectively. Average PEN-FAST scores for those de-labeled and eligible for oral challenge was 0.5 (SD 0.85) and 1.08 (SD 1.20), respectively.

Conclusion
AMS BLA assessments can decrease the prevalence of false BLA labels and prescribing of unnecessary broad-spectrum agents. PEN-FAST scores less than 2 suggests that allergy assessments help identify patients with low-risk penicillin allergies.

Disclosures
All Authors: No reported disclosures.
937. Appropriateness of using a Mobile Application for Choosing Antibiotic Therapy in Hospitalized Patients at Siriraj Hospital
Authors: Chaloernnpoj Kanthon , Wangchinda Walaiporn , Koomanachai Pornpan , Thamlikitkul Visanu , Rattanaumpawan Pinyo 
Published: December 2022

Abstract

Background
Development of facility-specific clinical practice guidelines and incorporation of computerized clinical decision support have been recommended as the effective antimicrobial stewardship strategies. The DigitalAMSTM is a mobile-based application used to guide choosing empirical antibiotics. Before the hospital-wide implementation of DigitalAMSTM, the appropriateness and limitation of such an application needs to be evaluated.

Methods
A retrospective cross-sectional study of hospitalized adult patients who received at least one dose of antibiotic and had at least one documented site of infection were enrolled between 1 Jan and 31 Jun 2018. All necessary data was obtained via chart review. The antibiotic regimen that was prescribed by the ward physician (WARD), the regimen recommended by the DigitalAMSTM (APP), the regimen recommended by the independent infectious disease (ID) physicians before and after knowing the culture results (Emp-ID and Def-ID) were compared.

Results
A total of 401 patients of the targeted infections i.e. 98 subjects with pneumonia, 103 subjects with urinary tract infection (UTI), 98 subjects with bacteremia and 102 subjects with skin and soft tissue infection (SSTI) were enrolled. The percent agreement between the APP and the WARD was less than half in all sites of infection. The APP regimen provided approximately 80% agreement with the Emp-ID regimen among subjects with UTI (78.6%), bacteremia (85.7%) and SSSI (85.2%), while the percent agreement of the WARD regimen and the Emp-ID was approximately half in all sites of infection. The lowest percent agreement between the APP regimen and the Emp-ID regimen was found among subjects with pneumonia (59.1%). Univariate analysis did not reveal any association between subjects who received the antibiotic regimen matching to the APP recommendation and the 28-day mortality.

Conclusion
Our study confirmed that the DigitalAMSTM application could improve appropriateness of antibiotic regimens for empirical therapy for four common infections among adult hospitalized patients at Siriraj Hospital. However, some revisions need to be done to improve the appropriateness of antibiotic regimens in the APP, especially for subjects with pneumonia.

Disclosures
All Authors: No reported disclosures.
941. Clinical Outcomes of Vancomycin Area-Under-the-Curve Monitoring: A Quasi-Experimental Study Interim Analysis
Authors: Flynn Ryan , Tucker Natalie , Foreman Jena K 
Published: December 2022

Abstract

Background
The 2020 Infectious Diseases Society of America vancomycin guidelines recommend the use of area-under-the-curve (AUC) monitoring instead of trough concentration monitoring. These guidelines changed due to evidence showing decreased rates of nephrotoxicity and lack of correlation between vancomycin troughs and patient treatment outcomes. Two common methodologies of calculating AUC exist in clinical practice, including two level kinetic calculations and Bayesian software programs. Previous studies used two levels for calculating the AUC. The purpose of this study is to evaluate if the same reduction in acute kidney injury (AKI) is achieved while using a Bayesian software program.

Methods
This retrospective quasi-experiment was performed at two sites within the same health system. The primary objective of this study was to assess the rate of AKI, as defined by the Acute Kidney Injury Network (AKIN) criteria, between patients receiving vancomycin dosed by trough monitoring as compared to AUC monitoring. Secondary objectives include mean daily dose of vancomycin, number of vancomycin levels, and severity of AKI. Patients were included in the study if they were 18 years or older, with at least one vancomycin concentration drawn. Patients were excluded if they had a baseline serum creatine greater than 2 mg/dL, received renal replacement therapy of any type, or received &gt; 1 doses of vancomycin prior to admission. After screening for inclusion criteria, patients were matched 1:1 based on APACHE II score and vancomycin indication.

Results
One hundred and thirty patients met inclusion criteria at the interim analysis. Overall, baseline characteristics were similar between groups. No statistical difference was detected regarding the rate of acute kidney injury between the vancomycin trough group and AUC group (12% vs 14% p=0.971). The mean total daily doses of vancomycin were 1642 mg per day in the AUC group and 1838 mg per day in the trough group (p=0.08).

Conclusion
No statistical difference in rates of AKI were detected at the interim analysis, likely due to small sample size. Further data collection is ongoing to meet power and full results will be presented.

Disclosures
All Authors: No reported disclosures.
942. Comparison of Antibiotic Susceptibility Across Minnesota Hospitals in 2019 and 2020 Using a New Statewide Antibiogram
Authors: Anderson Jadyn C , Hirsch Elizabeth B , Rivers Jennifer , Beaudoin Amanda , Spaulding Alicen B 
Published: December 2022

Abstract

Background
Surveillance is imperative to successful antibiotic stewardship, but active surveillance is resource-intensive. Regional antibiograms provide a supplementary method of surveillance while conserving resources. We developed the first statewide antibiograms to track susceptibility across the state of Minnesota and compared 2019 and 2020 data.

Methods
Hospital antibiograms for 2019 and 2020 were submitted to the Minnesota Department of Health in January 2022. Twelve organisms (Enterococcus faecalis, Enterococcus faecium, methicillin-resistant Staphylococcus aureus, methicillin-susceptible S. aureus, S. aureus, Acinetobacter spp., Enterobacter spp., Escherichia coli, Klebsiella aerogenes, K. oxytoca, K. pneumoniae, and Pseudomonas aeruginosa) were selected for analysis against 32 drugs, leading to a total of 142 unique organism/agent combinations. The number of isolates and percent susceptibility from each antibiogram were used to calculate a weighted average percent susceptibility as the state-level susceptibility. Chi-square analysis compared the proportion of susceptible to non-susceptible isolates between the years.

Results
Submitted antibiograms (n=40) represented 30% of Minnesota hospitals. The total number of isolates reported decreased by 5% from 2019 (n=85,010) to 2020 (n=80,781), with E. coli having the greatest proportion (2019=41.7%, 2020=39.5%) of the total isolates. Significant changes in susceptibility proportions occurred in 33% of analyzed organism/agent combinations, with 68% of these showing increased susceptibility in 2020 compared to 2019. All antibiotics tested against P. aeruginosa demonstrated a statistical increase in susceptibility from 2019 to 2020 (Figure 1). Figure 1
Statewide susceptibility profile of P. aeruginosa in Minnesota, 2019 and 2020. Antimicrobial agents grouped by class from narrow spectrum to broad spectrum, cephalosporins ordered by generation. *denotes statistical significance (p&lt;0.05).

Conclusion
Analysis of statewide antibiograms for 2019 and 2020 demonstrated overall stability in antimicrobial susceptibility, with two-thirds of organism/agent combinations showing no significant changes. In those with significant changes, the majority exhibited an increase in susceptibility. Susceptibility changed more frequently in gram-negative organisms than gram-positive organisms. Ongoing collection of antibiograms will be used to assess regional and statewide susceptibility trends across Minnesota.

Disclosures
Elizabeth B. Hirsch, PharmD, FCCP, FIDSA, Melinta: Advisor/Consultant|MeMed: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support.
945. Development of Antimicrobial Stewardship Programs in Central and South America
Authors: Fabre Valeria , Cosgrove Sara E , Lessa Fernanda C , Patel Twisha S , Patel Payal K , Quiros Rodolfo E 
Published: December 2022

Abstract

Background
There is a need to assess current development of hospital Antimicrobial Stewardship Programs (ASPs) in Latin America.

Methods
Cross-sectional evaluation of ASPs using a standardized and previously validated self-assessment tool derived from the Centers for Disease Control and Prevention Core Elements of Antibiotic Stewardship (AS). The assessment was deployed to 40 hospitals in Panama, Guatemala, Ecuador, Colombia, and Argentina in 3/2022 through a regional research network. The assessment included 94 questions, with each question including a graded response (meets criteria, partially meets criteria, does not meet criteria, and in some, not applicable).

Results
22 public and 16 private hospitals completed the assessment (95% response rate), 10% and 25% of which were small hospitals (&lt; 110 beds), respectively. 82% were academic, and all have an Infection Prevention and Control program/committee. &gt;70% of ASPs have a physician and pharmacist involved, although 65% reported no salary support for AS activities. Only 13% and 29% of AS pharmacists and physicians, respectively, met recommended full-time equivalent/bed ratios; and 76% lacked information and technology (IT) support. 50% indicated the AS committee did not meet regularly, and another 50% reported not including non-AS physicians in the committee. Most hospitals have implemented prior-authorization and post-prescription review and feedback, with much fewer reporting a process to alert of duplicate therapy and use of auto-stops. 89% reported regular access to new antibiotics. While most hospitals monitor antibiotic consumption, few evaluate trends and/or appropriateness of use. Treatment guidelines for most common infections were missing in up to 50% of hospitals, especially in public hospitals. Most respondents indicated their hospitals promote teamwork, and in the vast majority, recommendations from AS are valued. Stratification of results by private and public hospitals in Table. Table:Results of a self-assessment of antimicrobial stewardship activities at the facility level in 38 hospitals in Latin America.

Conclusion
We found several opportunities for improvement, which differed between private and public hospitals. Common barriers to both settings include access to IT support; better pharmacist and physician resource allocation, education, and monitoring of process and outcomes measures.

Disclosures
Sara E. Cosgrove, MD, Basilea: Member of Infection Adjudication Committee.
952. Implementation of Antimicrobial Stewardship Weekend Coverage within a Community Hospital with a PGY2 Infectious Diseases Pharmacy Resident
Authors: Worden Lacy , Dumkow Lisa E , Ryan Tomlin C , Egwuatu Nnaemeka 
Published: December 2022

Abstract

Background
Antibiotic use contributes to antibiotic resistance affecting individual patients and communities. Important antimicrobial stewardship program (ASP) strategies, such as prospective audit and feedback, may be limited to peak weekday hours in many institutions. Currently, a lack of data exists to support expansion of ASP beyond peak hours in community hospitals. The goal of this study was to describe the impact of expanding inpatient ASP weekend coverage with a newly established PGY2 infectious diseases pharmacy resident program.

Methods
This retrospective cohort study was approved by the Institutional Review Board and conducted using the pharmacist documentation function within the electronic health record of weekend interventions taking place between July 1, 2021 and December 31, 2022. The primary objective was to describe the impact of expanding weekend AMS coverage with a PGY2 ID pharmacy resident through quantification of inpatient antimicrobial stewardship interventions. Secondary endpoints included comparing the PGY2 resident’s weekend stewardship activities based on intervention quantity, type, and impact, to weekends without PGY2 ID resident coverage. Comparator groups included: 1) A single experienced clinical pharmacist, 2) Two new PGY1 pharmacy residents (first 6 months of residency), and 3) Two experienced PGY1 pharmacy residents (final 6 months of residency).

Results
8 weekends of interventions were collected for each group. Significantly more interventions, including low-, medium-, and high-impact interventions were made by an ID-PGY2 pharmacy resident compared to a clinical pharmacist and both PGY1 groups. The median number of interventions made by each group are outlined in Table 1. Additionally, significantly more interventions were made per protocol as well as interventions that required communication with providers.

Conclusion
Expansion of ASP services to include weekend clinical coverage with an ID PGY2 pharmacy resident significantly increased weekend ASP interventions in a community teaching hospital. Specialty pharmacy residency training programs may offer a high-value opportunity to expand ASP coverage.

Disclosures
All Authors: No reported disclosures.
953. Implementation Outcomes in an Antibiotic Stewardship Program (Kicking CAUTI) in Four Veterans Hospitals Correlated with Clinical Outcomes
Authors: Amenta Eva , Grigoryan Larissa , Ramsey David J , Kramer Jennifer , Walder Annette , Chou Andrew , Van John , Sales Anne , Naik Aanand , Trautner Barbara 
Published: December 2022

Abstract

Background
One of the major barriers to scale up of antibiotic stewardship interventions is the difficulty of engaging already overtaxed personnel. As part of a multisite antibiotic stewardship project to decrease antibiotics treatment of asymptomatic bacteriuria, we explored how to measure local implementation efforts, and what dose of the intervention was necessary to improve clinical outcomes.

Methods
The intervention was implemented in 4 different sites from February 2019 through May 2020. We chose 3 measures of implementation: the number of intervention delivery sessions (adoption), total number of health care professionals reached (penetration), and minutes spent in delivery of the intervention (adoption). Local site champions kept activity logs. Antibiotic prescriptions were included if ordered within one calendar day prior or two days after a urine culture was ordered on the same patient. Correlation between implementation measures and clinical outcomes (number of urine cultures ordered, days of antibiotic treatment (DOT), and length of antibiotic treatment (LOT)) was calculated using the mixed linear models method.

Results
Overall, the minutes spent in delivery ranged from 2567 minutes at the most engaged site to 679 in the least engaged site (Figure 1). The number of healthcare professionals reached ranged from 798 to 433, and the number of sessions delivered ranged from 240 to 45. Minutes spent in delivery was inversely correlated with two of our three clinical metrics, DOT (R -0.3, P=0.04) and LOT (R -0.3, P=0.02); minutes spent and urine cultures were not significantly correlated (Table 1). We did not find a significant relationship between the number of intervention delivery sessions or total number of health care professionals reached and any of the clinical outcomes. Figure 1Total Minutes Spent in Delivery of the Intervention Across Four Intervention Sites
Table 1 Correlation Coefficients (with p-values) Comparing Implementation Outcomes with Clinical Outcomes (bolded results are statistically significant)

Conclusion
We found a significant inverse correlation between the number of minutes a local site champion spent delivering the antibiotic stewardship intervention and antibiotic use, both DOT and LOT. In other words, more time spent delivering the intervention locally was associated with a decrease in antibiotics ordered. Our implementation metric (adoption) is scalable and readily adaptable to large antibiotic stewardship dissemination projects.

Disclosures
Larissa Grigoryan, MD, PhD, Rebiotix Inc: Grant/Research Support Barbara Trautner, MD, PhD, Genetech: Advisor/Consultant.
954. Implementing UTI Stewardship in Critical Access Hospitals Through A Collaborative Tele-Antimicrobial Stewardship Program: One Size Fits One
Authors: Kassamali-Escobar Zahra , Hartlage Whitney , Martinez-Paz Natalia , Lynch John B , Chan Jeannie D , Jain Rupali , Pottinger Paul , Castillo Alyssa Y , Castillo Alyssa Y , Bryson-Cahn Chloe 
Published: December 2022

Abstract

Background
Critical access hospitals (CAHs) in the United States service nearly one fifth of the US population, predominantly in rural areas. CAHs are required to provide antimicrobial stewardship (AMS) services, however, access to infectious diseases and antimicrobial stewardship expertise is limited. We assessed the feasibility of implementing a tele-AMS intervention in CAHs.

Methods
We piloted a one-year, biphasic, intensive quality improvement collaborative of self-selected CAHs to address asymptomatic bacteriuria (ASB). In phase 1, we engaged multidisciplinary teams from participating hospitals, facilitated goal-setting, and implemented a monthly curriculum to train local stewards regarding appropriate diagnosis and management of urinary tract infections (UTIs). In phase 2, we focused on quality improvement education and data collection. We discussed stewardship strategies and addressed barriers identified on a one-on-one basis.

Results
Nineteen CAHs in five states across the Western region participated in this pilot. Nine of 19 attended all 8 monthly didactic sessions. The median number of one-on-one sessions attended per site was 3 (range, 1-4). Eighteen of 19 hospitals set a goal and documented it in a Plan-Do-Study-Act framework. Six CAHs set a goal related to staff and/or patient education, 10 CAHs focused on workflow and processes surrounding identification of UTI including reflex of urine analyses to urine culture, and 2 CAHs set goals to prospectively review cases of ASB treated with antibiotics and provide feedback to prescribers. Commonly encountered barriers included turnaround time for urine culture data, difficulty obtaining data from the electronic medical record, resistance to change among personnel, high staff turnover, limited time and availability to perform stewardship, and short duration of the collaborative.

Conclusion
We successfully launched a tele-stewardship training program to mentor CAH antimicrobial stewards to identify and manage ASB and use quality improvement tools. A standardized approach to address asymptomatic bacteriuria or other AMS goals are unlikely to be successful in CAHs without significant tailoring to fit specific site and process needs.

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