bluuebunny/crossref_metadata_2025_split huggingface dataset:
2297. COVID-19 Vaccine Effectiveness Among Pregnant People
Authors: Zerbo Ousseny , Thomas Ray G , Goddard Kristin , Layefsky Evan , Fireman Bruce , Klein Nicola P 
Published: December 2022

Abstract

Background
COVID-19 presents a serious health risk to pregnant people and pregnancy outcomes. However, pregnant people were not included in pivotal phase III COVID-19 vaccine efficacy trials.

Methods
We used Cox regression models in a cohort study to determine hazard ratios (HR) of a PCR positive test (“infection”) comparing vaccinated with unvaccinated pregnant persons in Kaiser Permanente Northern California. HRs were adjusted for age, race/ethnicity, type of insurance coverage, geographical area, BMI, preexisting diabetes, hypertension, parity, time since pregnancy onset and smoking status. Vaccine effectiveness (VE), calculated as 1 minus adjusted HR, was estimated for fully vaccinated &lt; 150 and ≥ 150 days prior to infection. VE was estimated for before and during Delta, and Omicron. We also calculated incidence rates of COVID-pneumonia associated hospitalization by vaccination status.

Results
Among 68836 pregnancies between 12/15/2020 and 3/31/2022, 21834 (31.7%) were fully vaccinated and 5980 (8.7%) were boosted by the end of pregnancy. Compared with unvaccinated persons, the HRs of infection for fully vaccinated &lt; 150 days prior were 0.13 (95% CI: 0.07 – 0.23; VE=87% [77% - 93%]) before Delta; 0.25 (CI: 0.20 – 0.30; VE=75% [70% - 80%]) during Delta and 0.76 (CI: 0.61 – 0.94; VE= 24% [16% - 39%]) during Omicron. The HRs for ≥ 150 days prior were 0.38 (CI: 0.31 – 0.46; VE=62 % [54% - 69%]) during Delta and 1.04 (CI: 0.89 – 1.22; VE= -0.04% [-0.22% – 0.11%]) during Omicron. The HRs for boosted persons were 0.10 (CI: 0.04 – 0.25; VE= 90% [75% - 96%]) during Delta and 0.42 (CI: 0.34 – 0.52; VE=58% [48% - 66%]) during Omicron periods.
Incidence rates (IR) per 1000 person-years for hospitalization before delta were 0.75 among unvaccinated and zero among vaccinated. During Delta, the IR was 6.64 for unvaccinated and zero for fully vaccinated and boosted. During Omicron, the IR was 10.27 for unvaccinated, zero for fully vaccinated &lt; 150 days prior, 2.48 for fully vaccinated ≥ 150 days prior and zero for those boosted.

Conclusion
COVID-19 vaccines protect against infection and hospitalization among pregnant people. However, vaccine effectiveness against infection wanes over time and was lower during Omicron. Booster doses are necessary for continuous protection.

Disclosures
All Authors: No reported disclosures.
1721. In Vitro Activity of Cefiderocol against IMP-Producing Enterobacterales Isolated in Japan
Authors: Yamashiro Hidenori , Nakai Ryuichiro , Takemura Miki , Yamano Yoshinori 
Published: December 2022

Abstract

Background
Beta-lactam resistance is a major worldwide concern. Metallo-β-lactamases (MBLs) are a group of enzymes that can inactivate most commonly used β-lactam antibiotics including carbapenems and are not affected by new β-lactamase inhibitors. Therefore, treating infections caused by MBL producing strains is difficult. Imipenemase (IMP) type MBL is a rare family of acquired carbapenemases detected from Enterobacterales globally, however, it has been detected and become a major therapeutic concern in clinical settings mainly in East Asia including Japan [1]. Cefiderocol (CFDC) is a novel injectable siderophore cephalosporin antibiotic with potent activity against a wide variety of carbapenem resistant strains including both serine- and metallo-type carbapenemase-producers. We evaluated in vitro activity of CFDC and comparator agents against IMP-producing Enterobacterales isolated in Japan.

Methods
A total of 150 IMP-producing strains consisting of 48 Escherichia coli, 34 Klebsiella pneumoniae, 29 Klebsiella oxytoca, 21 Enterobacter cloacae, 7 Citrobacter freundii, 7 Serratia marcescens, 2 Providencia rettgeri, 1 Klebsiella aerogenes, and 1 Morganella morganii were tested. The minimum inhibitory concentrations (MICs) were determined for CFDC, ceftazidime-avibactam (CZA), ceftolozane-tazobactam (C/T), imipenem-relebactam (I-R), meropenem (MEM), and amikacin (AMK) by broth microdilution according to CLSI guidelines. CFDC was tested in iron-depleted cation-adjusted Mueller-Hinton broth.

Results
MIC50 and MIC90 of CFDC were 0.25 and 1 µg/mL, respectively. MICs of CFDC for all tested strains ranged from ≤ 0.03 to 4 µg/mL, which showed all strains were susceptible to CFDC based on the CLSI breakpoint (≤ 4 µg/mL). On the other hand, MIC90s of CZA, C/T, I-R, MEM, and AMK were &gt; 32/4, &gt; 32/4, 8/4, &gt; 32, and 4 µg/mL, respectively. The susceptibilities were 98.0% for AMK, 66.0% for I-R, and &lt; 10% for CZA, C/T and MEM.

Conclusion
CFDC had potent in vitro activity against IMP-producing Enterobacterales collected from Japan, indicating CFDC has high potential for treating infections caused by these difficult-to-treat strains.
Reference: 1. Logan, LK. et al., J Infect Dis. 2017 Feb 15;215(suppl 1):S28-S36.

Disclosures
Hidenori Yamashiro, Shionogi & Co., Ltd.: Employee Ryuichiro Nakai, n/a, Shionogi TechnoAdvance Research CO., LTD.: Employee Miki Takemura, n/a, Shionogi: Employee Yoshinori Yamano, PhD, Shionogi: Employee.
1743. Antimicrobial and Diagnostic Stewardship Targeting Urinary Tract Infections in the Emergency Department: A Pharmacist-driven Quality Improvement Project at a Tertiary Military Treatment Facility
Authors: Ayalew Memar , Admassu Hellena , Ressner Roseanne , Williams Robin , Crull Paulette , Brooks Daniel 
Published: December 2022

Abstract

Background
With the increasing interest in ambulatory stewardship, we designed a quality improvement project to enhance guideline concordant antimicrobial and diagnostic stewardship practices targeting urinary tract infections (UTI) in the ED of a Military Treatment Facility. Between two data collection phases (P1, P2), we provided education on national guidelines, local protocols and antibiograms, modified order-sets, and implemented enhancements targeting urine collection. The primary outcome was a change in guideline-concordant practices between P1 and P2.

Methods
This prospective pharmacist-driven study had two 3-month data collection periods including ED encounters that resulted in a urinalysis (UA), urine culture (UCx) and antibiotics for UTI upon discharge. We collected data on participant demographics, clinical course and therapy details via chart review. Culture callback and corresponding interventions were made within 72 hours. Based on P1 results, we broadened our scope in P2 to include a diagnostic stewardship arm (Figure 1). This project was IRB approved under a non-research determination.

Results
There were no significant changes in guideline-concordant prescribing or diagnostic practices between P1 and P2 (Figure 2). Inappropriate antibiotic selection was primarily due to use of cephalosporins and FQs as first line agents (Table 1). The primary pharmacy intervention was discontinuation of therapy (P1 29.1%, P2 39.8%). One-third of patients receiving antibiotics were asymptomatic, a majority of which had a positive UA (P1 68.4%, P2 73.3%). There was a high rate of UCx contamination which improved in P3 but did not reach statistical significance (P1 25.6%, P2 17.2%, p=0.19). Across all P2 encounters, 51.4% of UCx were deemed inappropriate.

Conclusion
Significant guideline-discordant prescribing persisted despite interventions. An overreliance on UA findings results in treatment of asymptomatic bacteriuria. Education and order-set modification alone are insufficient for a lasting impact on prescribing practices especially where there is a high rate of provider turnover. An EMR with embedded clinical and alert-based decision support capabilities are likely to make a sustained impact in curbing inappropriate treatment of asymptomatic bacteriuria.

Disclosures
All Authors: No reported disclosures.
1749. Nursing Home Providers’ Empiric Antibiotic Choices for Residents with Urinary Tract Infections: A National Survey
Authors: Taylor Lindsay , Irvine Jessica , Wilson Brigid , Massey Justin , Singh Mriganka , Jolles Sally , Kowal Corinne , Bej Taissa A , Furuno Jon P , Nace David , Jump Robin L , Crnich Christopher J 
Published: December 2022

Abstract

Background
Urinary tract infections (UTIs) are the most common indication for antibiotic prescriptions in nursing homes (NHs) and frequently result in fluoroquinolone (FQ) prescriptions. We performed a vignette-based survey of NH providers to better understand empiric UTI treatment decision-making.

Methods
Study participants were recruited nationally through professional organizations and snowball sampling from December 2021 to February 2022. Clinical vignettes depicting four UTI presentations in NH residents (1. simple cystitis, 2. pyelonephritis with cephalosporin allergy, 3. catheter-associated UTI and 4. cystitis with history of resistant organism) were developed and distributed via electronic survey. Respondents provided free-text antibiotic choice, which two physicians independently reviewed and implicitly determined if a preferred or not-preferred antibiotic was selected. A panel of three physicians adjudicated discrepancies between the primary reviewers. Analysis was performed in R.

Results
Of 86 respondents, 74% were physicians and 26% were advanced practitioners. Half of respondents (50%) had &gt;10 years NH experience, 41% were geriatrics trained, and none were infectious disease trained. Figure 1 details antibiotic choices and preferred agents for each case. Overall, 70% of antibiotic choices were deemed preferred antibiotics, with the least number of preferred choices observed for case 3 depicting catheter-associated UTI (53%). FQs (43%) and nitrofurantoin (14%) were the most frequent non-preferred choices. Case 2 received the greatest proportion of FQ prescriptions (38%), but this was a preferred agent. In cases where FQs were not a preferred choice, they comprised 17% of antibiotic choices. There was no difference in FQ or preferred prescribing choices by role. Providers with &gt;10 years NH experience, however, prescribed fewer FQs over the four cases than those with less NH experience (0.7 vs. 1.1, p=0.04).
Antibiotic Choice and Preferred Agents per Case
Antibiotic choices are ordered from highest to lowest cumulative frequency.

Conclusion
This sample of NH providers made mostly preferred empiric antibiotic choices, however, FQ use remained high, particularly in providers with less NH practice experience. Further exploration of decision-support tools for empiric antibiotic prescribing in this setting may improve antibiotic stewardship.

Disclosures
Robin L. Jump, MD, PhD, Merck: Grant/Research Support|Pfizer: Advisor/Consultant.
1764. Accuracy of Penicillin Allergy Risk Severity Documentation in Surgical Patients
Authors: Stickler Michelle , Heil Emily L , Noval Mandee 
Published: December 2022

Abstract

Background
Clinical guidelines for antimicrobial prophylaxis recommend use of cefazolin for most surgical procedures. Patients who are labeled penicillin (PCN) allergic are often prescribed second line agents, though cross-reactivity is less than 1%. PCN allergic patients have significantly higher rates of readmissions and healthcare-associated infections. Allergy documentation in the medical record is often incomplete or inaccurate, and many allergies can be de-labeled through history alone. Our study aimed to investigate accuracy of allergy risk assessment in PCN allergic patients and the impact on surgical antibiotic prophylaxis for quality improvement.

Methods
This was a retrospective observational cohort study among adult patients with a reported PCN allergy who underwent a surgical procedure from 3/2019-2/2020 at a single academic institution. The primary outcome was incidence of appropriate documentation of allergy risk severity. Secondary outcomes included receipt of beta-lactam for surgical prophylaxis and incidence of documentation to reflect tolerance. Allergy risk classification was considered appropriate if it aligned with institutional guidelines (Table 1).

Results
Of 2647 patients who underwent surgical procedures, 330 (12%) reported PCN allergy. Allergy risk severity was appropriately documented in 136 (41%) patients. 150 (45%) were mislabeled as “high” or “unknown” risk compared to reported reaction. 191 (58%) patients with reported PCN allergies received beta-lactam antibiotics peri-operatively. Allergy history had been updated to reflect tolerance in only 6% of patients who received cefazolin for surgical prophylaxis and in 21% who had received beta-lactams previously (Table 2). Table 2:Primary and Secondary Outcomes

Conclusion
Inaccurate documentation of allergy risk results in decreased first-line antimicrobial use in patients with reported PCN allergies. Documented PCN allergy risk severity was often incorrect and over 100 additional patients could have been labeled “low risk” based on reported reaction. 72% of patients could have received first-line beta-lactam prophylaxis per institutional guidelines. Interventions targeting allergy history documentation alone could positively impact antibiotic selection.

Disclosures
All Authors: No reported disclosures.
1768. Characteristics and Impact of Penicillin Allergy Mislabeling Among People with HIV
Authors: Sonners Christine , Hill Eddie , Kim Alexander , Wooten Darcy 
Published: December 2022

Abstract

Background
Rates of penicillin allergy mislabeling (PAM) are prevalent and lead to suboptimal antibiotic selection. However, data regarding PAM are lacking for people with HIV (PWH). We aimed to characterize the penicillin allergy labels for PWH at the University of California, San Diego’s (UCSD) HIV primary care clinic, evaluate the impact of penicillin allergy labels on treatment choice for syphilis and gonorrhea, and implement a quality improvement project to address PAM.

Methods
We conducted a cross-sectional study of PWH with a penicillin allergy label in their medical record who were seen in our clinic between 2018 and 2022. We collected demographic information, type of allergic reaction listed, whether patients tolerated other beta-lactam antibiotics, whether patients were referred for formal Allergy consultation, and, where relevant, what treatment they received for syphilis and/or gonorrhea.

Results
Among the 4,702 people with HIV receiving care in our clinic between 2018 and 2022, 427 (9.1%) had a penicillin allergy label in the medical record. This cohort reflected the demographics of the general clinic population (Table 1). Even though the majority of allergic reactions (327, 77%) were labeled as IgE-mediated, 282 (66%) patients tolerated another beta-lactam antibiotic (Table 2). Referrals to Allergy Clinic were rare (52, 12%). The majority of patients with syphilis (91/140, 65%) received 2nd line therapy with doxycycline. However, most patients with gonorrhea (65/88, 74%) were treated with a preferred ceftriaxone-based regimen. When relevant, we updated penicillin labels for 209/268 (77.9%) patients to indicate that they had tolerated other beta-lactam antibiotics and created a tiered referral process to prioritize the highest-risk patients for Allergy Clinic referral (Figure 1).

Conclusion
Penicillin allergy labels were prevalent in our cohort of PWH and often resulted in receiving 2nd line therapy for treatment of syphilis. We updated allergy labels for a substantial number of patients and created a triage system to refer patients to Allergy clinic for further testing based on risk in order to decrease PAM.

Disclosures
All Authors: No reported disclosures.
1781. Antibiotic Prescription Trends of Patients with COVID-19: Analysis of National Health Insurance Data in Republic of Korea
Authors: Choi Yunsang , Kang Minsun , Shin Dong Hoon , Jung Jongtak , Choi Seong Jin , Kim Nak-Hyun , Moon Song Mi , Song Kyoung-Ho , Kim Eu Suk , Jung Jaehun , Kim Hong Bin 
Published: December 2022

Abstract

Background
Although COVID-19 is a viral infection, it is known that antibiotics are often prescribed due to concerns about combined bacterial infection. Therefore, we aimed to analyze how many patients with COVID-19 received the antibiotic prescription as well as what kinds of factors contributed to it using the National Health Insurance database.

Methods
We retrospectively reviewed claims data for adults 19 years of age and older hospitalized for COVID-19 from December 1, 2019 to December 31, 2020. According to severity classification of the National Institutes of Health guidelines, we calculated not only the proportion of patients receiving antibiotics but also days of treatment per 1000 patient days. In addition, we investigated the factors contributing to antibiotic use by linear regression analysis.

Results
Of the 55,228 patients, 47% were male, 55% were older than 50 years of age, and most patients (89%) had no underlying diseases. The majority (84%, 46,576) were classified as having mild to moderate illness, with 11% (6,168) and 5% (2,484) having severe and critical, respectively. Antibiotics were prescribed in a total of 27% (15,081). While 74% of patients with severe illness and 88% of those with critical illness received antibiotic treatment, even 18% of mild to moderate cases were prescribed antibiotics. Fluoroquinolones were the most commonly prescribed antibiotics (8,348), followed by third generation cephalosporins (5,729) and beta-lactam/beta-lactamase inhibitors (3,822) as shown in Figure 1. Older age, severity of disease and underlying medical conditions contributed to overall prescription rates as well as days of antibiotic use significantly (Table 1).

Conclusion
Although most of COVID-19 patients had mild to moderate illness, more than a quarter were prescribed antibiotics. Judicious use of broad-spectrum antibiotics is necessary for COVID-19 patients, considering the severity of disease and the risk of bacterial co-infection.

Disclosures
All Authors: No reported disclosures.
1783. Appropriateness of antibiotics use for patients with asymptomatic bacteriuria or urinary tract infection: A retrospective observational multicenter study in Korea
Authors: Jung Jongtak , Kim Bongyoung , Kim Dong Youn , Lee Mi Suk , Park Se Yoon , Kim Tae Hyong , Lee Myung Jin , Park Ji Young , Jo Hee Bum , Lee Woo Joo , Kim Jin Yong , Mi Moon Song , Song Kyoung-Ho , Park Jeong Su , Suk Kim Eu , Kim Min Hyung , Park Yoon Soo , Kwak Yee Gyung , Kim Ji-Yeon , Park Jeanno , Kim Young Keun , Jeong Hye Won , Park Sun Hee , An Joon Hwan , Lee JaeHoon , Park Kyung-Hwa , Bae Sohyun , Chang Hyun-Ha , Kim Si-Ho , Son Deog-Hyeon , Lee HoJin , Moon Chisook , Heo Sang Taek , Jung Jaehun , Bin Kim Hong 
Published: December 2022

Abstract

Background
Antibiotic resistance threatens public health worldwide, and inappropriate use of antibiotics is one of the main causes. Antibiotic use for asymptomatic bacteriuria (ABU) has been defined as “antibiotics never events”, and urinary tract infection (UTI) is one of the most common infectious diseases for which antibiotics are prescribed in Korea. To establish an effective antimicrobial stewardship strategy, a qualitative assessment of antibiotic use in actual clinical syndrome is necessary.

Methods
Cases of positive urine cultures (≥105 CFU/ml), performed in inpatient, outpatient, and emergency departments in April 2021 were screened in 26 hospitals located throughout Korea. Cases were classified into ABU, lower UTI, and upper UTI. The appropriateness of antibiotic use was retrospectively evaluated by infectious disease specialists using quality indicators based on the domestic clinical guideline for ABU and UTI. Figure 1.Study flow diagram

Results
A total of 2697 cases of ABU or UTI were included. The appropriateness of antibiotic use was assessed in 1157 cases with asymptomatic bacteriuria, 677 and 863 cases with lower and upper UTI (Figure 1). Antibiotics were prescribed in 21.7% (251 of 1157) of ABU without appropriate indication. Of 66 ABU cases with appropriate indication in which prophylactic antibiotics were prescribed, the duration of antibiotics was adequate in only 34.8% (Table 1). For lower UTI, the appropriateness of empirical and definite antibiotics was 77.8% (527 of 677) and 68.0% (353 of 519). In terms of upper UTI, 86.3% (745 of 863) and 78.2% (583 of 746) was appropriate, respectively. The duration of antibiotics was adequate in 65.7% (421 of 641) of lower UTI and 77.9% (592 of 760) in upper UTI (Table 2, 3).

Conclusion
This nationwide qualitative assessment of antibiotic use in ABU and UTI revealed that a significant proportion of antibiotics were prescribed inappropriately and, furthermore the duration of antibiotics was prolonged unnecessarily. Interventions for appropriate antibiotic use in ABU and UTI at the national level are required.

Disclosures
All Authors: No reported disclosures.
1785. Assessment of Antimicrobial Prescription Trends Based on AWaRe Index Among COVID Patients as part of the Implementation of a Modified Antimicrobial Stewardship Audit for COVID Locations of Restricted Access in a South Indian Tertiary Care Center
Authors: Dipu T S , Kulirankal Kiran G , Mary Ann , Edathadathil Fabia , Raj Jina , Moni Merlin 
Published: December 2022

Abstract

Background
The advent of COVID pandemic disrupted routine antimicrobial stewardship(ASP) activities. We implemented a modified ASP audit in COVID locations using electronic stewardship forms inorder to monitor all antibiotics prescribed to COVID patients and assess them based on WHO AWaRe index.

Methods
Our prospective audit included all COVID inpatients who received antimicrobial prescriptions in 70 bedded covid area during the period from May 1st, 2021 to March 31st, 2022. All antimicrobial prescriptions were tracked using the daily review of the pharmacy consumption charts in Covid locations and prescriptions were categorised as per AWaRe index. For all reserve antimicrobial prescriptions link for REDCap based E – stewardship forms were sent to the physician in charge of the covid locations.

Results
Among 3484 COVID patients reviewed from May 1st 2021 to March 31st 2022, 2152 (61.7%) patients were prescribed with antimicrobials. The highest consumption of antimicrobials prescribed belonged to Watch group( 1937/2152, 90%) followed by Access (151/2152, 7.2%) and Reserve categories (64/2152, 3%) of WHO AWaRe index. Among the Watch group, the highest consumption was observed for Azithromycin (748/2152, 34.7%), followed by ceftriaxone(589/2152,27.3%) , piperacillin- tazobactam(400/2152,18.5%) and Meropenem(187/2152, 8.6%). Linezolid (22/2152, 1.0%) accounted for highest consumption among Reserve group, followed by Ceftazidime –Avibactam (17/2152, 0.7%) and colistin(14/2152, 0.6%).

Conclusion
The study successfully demonstrated the feasibility of implementing modified antimicrobial stewardship in Covid locations during the pandemic, especially in presence of unmet need for targeted strategies for driving antimicrobial stewardship

Disclosures
All Authors: No reported disclosures.