bluuebunny/crossref_metadata_2025_split huggingface dataset:
1775. Interns and Residents’ Knowledge and Perspective on Appropriate Use of Antibiotics for Urinary Tract Infections and Skin and Soft Tissue Infections in the Hospital Setting
Authors: Motoa Gabriel , Borick Joseph , Bhatia Monisha , Bjork Lauren , Lichtenberger Paola 
Published: December 2022

Abstract

Background
Antibiotic resistance is recognized as a significant threat to public health worldwide. The rate of inappropriate use of antibiotics in hospitals has been reported as high as 50%. Exposure to suboptimal antibiotic therapy is associated with higher risk of infections with multidrug-resistant organisms and worse clinical outcomes. In academic hospitals, interns and residents are frontline worker who diagnose and treat infectious diseases (ID). The treatment of urinary tract infections (UTIs) and skin and soft tissue infections (SSTIs) is a common clinical scenario managed by these trainees.

Methods
A structured, anonymous questionnaire was sent via institutional email to internal medicine interns and residents rotating in three academic hospitals in Miami, FL. The 23-item questionnaire included knowledge questions on rational use of antibiotics and duration of therapy for complicated and uncomplicated UTIs, SSTIs, correct renal dosing of frequently used antibiotics and antivirals, and perception of confidence in antibiotic prescription. Data were entered to Microsoft Excel spreadsheet, then analyzed using JMP Pro software.

Results
A total of 36 preliminary and categorical interns, and 38 second-and third-year residents completed the initial questionnaire. The mean correct knowledge score on the treatment of UTIs was 52.8% (19/36) for interns and 76.3% (29/38) for residents, respectively. For SSTIs, the scores were 38.9% (14/36) and 65.8% (25/38); and for correct renal dosing of antibiotics, the scores were 47.2% (17/36) vs. 73.7% (28/38). Most of the interns (58.3%, 21/36) did not feel confident prescribing antibiotics for these conditions compared with 18.4% (7/38) of the residents.

Conclusion
In this cross-sectional study, interns had lower correct knowledge scores and confidence when prescribing antibiotics for UTIs and SSTIs compared to residents. There is room for improvement in advanced years of training. Further studies are necessary to assess the impact of implementing educational strategies to promote the appropriate use of antibiotics. We plan to address this through a pre-/post implementation We will compare antibiotic prescribing patterns and patient outcomes for these indications at one of our three clinical training sites.

Disclosures
All Authors: No reported disclosures.
2309. Ceftaroline for Central Nervous System and Ocular Infections
Authors: Siegrist Emily A , Sassine Joseph 
Published: December 2022

Abstract

Background
Ceftaroline is increasingly used in combination therapy for methicillin resistant Staphylococcus aureus (MRSA) bacteremia. Animal models suggest ceftaroline penetrates the central nervous system (CNS) and vitreous humor; however, there are limited data which describe outcomes of patients treated with ceftaroline for infections with CNS or ocular involvement.

Methods
This was a single-center, retrospective study at an academic medical center. The primary objective was to describe outcomes in patients treated with ceftaroline for CNS or ocular infections. Patients who received ceftaroline from January 2015 to February 2022 were identified. Patients &gt; 18 years who received &gt; 48 hours of ceftaroline and had evidence of CNS or ocular involvement were included. Descriptive statistics were used.

Results
Ten patients met the inclusion criteria: six with CNS and four with ocular infections. The cohort was predominantly white (90%) and male (70%). The most common comorbidities were hypertension (70%) and diabetes (40%) (Table 1). Nine patients were treated for MRSA and one patient was treated for methicillin resistant Staphylococcus epidermidis (Table 2). Ceftaroline was salvage therapy in nine patients (90%), often following vancomycin and used as part of combination therapy (Table 3).
Of the four patients with ocular infections, all had MRSA bacteremia. Two patients (50%) had positive vitreal cultures and received intra-vitreal injections (Table 2). Most of these patients (75%) died during admission (Table 4). Of the six patients with CNS infections, injection drug use was more common than in patients with ocular involvement (33% vs 0%), as was immunocompromise (50% vs 0%) and the presence of endocarditis (33% vs 0%). Of the patients with CNS involvement, three had abnormal lumbar punctures and the remainder were diagnosed by CNS imaging (Table 2). Four patients with CNS involvement survived hospital stay (67%), and one of these had recurrence of CNS infection within 90 days (Table 4).

Conclusion
Although patients with CNS or ocular involvement represent a severely ill subset of staphylococcal infections, ceftaroline is a promising agent in combination therapy. Comparative data is needed to validate these findings.

Disclosures
All Authors: No reported disclosures.
1780. Analysis of Appropriate Outpatient Prescriptions based on Diagnosis Codes, Tennessee, 2020
Authors: Ouedraogo Youssoufou , Evans Christopher D , Wilson Christopher , Staub Milner B , Katz Sophie E 
Published: December 2022

Abstract

Background
In the US, approximately 60% of antimicrobial prescriptions (Rx) are written in the outpatient setting, and roughly 30% of those are unnecessary. The Tennessee Department of Health (TDH) previously described outpatient antimicrobial use in 2016 and 2018. TDH acquired additional data from the IQVIA Longitudinal Prescription and Medical Claims datasets. We sought to link antimicrobial Rx to diagnosis claims from preceding outpatient office visits to measure appropriateness of statewide antimicrobial Rx.

Methods
IQVIA medical claims data and antimicrobial Rx data for calendar year 2020 were used in this study. A unique patient ID was used to track antimicrobial Rx over time. Prescriptions filled within 7 days after a patient’s medical visit were included. Diagnoses codes from the medical visits were categorized as Tier 1 (diagnoses that always require antimicrobial therapy) and Tier 3 (diagnoses that never require antimicrobial therapy). Tier 2 diagnoses were excluded. We compared Tier 1 prescriptions versus Tier 3 Rx volume.

Results
We identified 2.3 million Rx linked to a preceding outpatient office visit within 7 days; 70.5% were filled within 3 days of the corresponding office visit, 14.1% within 4–5 days, and 15.4% within 6–7 days. Of all included Rx, 16.4% were prescribed following a pure Tier 1 diagnosis, and 83.6% were prescribed following a pure Tier 3 diagnosis. Diagnoses for respiratory conditions accounted for 38.4% of the pure Tier 3 visits, urinary tract conditions for 17.7%, gastrointestinal conditions for 16.2%, and skin and soft tissue conditions for 15.8%. For the respiratory conditions, viral upper respiratory infection accounted for the highest percent of antimicrobials prescribed (27.1%), followed by asthma/allergy indications (17%), and bronchitis (8.9%).

Conclusion
A significant number of antimicrobials prescribed in Tennessee in 2020 were able to be linked to office visit diagnosis codes. Most Rx were prescribed for indications that do not require antimicrobial therapy. Respiratory conditions accounted for the highest percentage of visits resulting in antimicrobial therapy that did not require treatment. Continued educational efforts and provider feedback of these data are planned to combat unnecessary overprescribing in Tennessee.

Disclosures
Milner B. Staub, MD, MPH, Gilead: Stocks/Bonds|Johnson & Johnson: Stocks/Bonds.
1784. Appropriateness of Intravenous Vancomycin in a Canadian Acute Care Hospital
Authors: Glassman Heather , Ismail Arif , Smith Stephanie W , Stewart Jackson J , Lau Cecilia , Kabbani Dima , Chen Justin Z 
Published: December 2022

Abstract

Background
Intravenous (IV) vancomycin is a commonly prescribed antimicrobial. However, there is limited literature assessing IV vancomycin appropriateness. The objective of the study was to assess the appropriateness of IV vancomycin prescriptions in a Canadian acute care hospital.

Methods
Prospective audit and feedback (PAF) was conducted on all new IV vancomycin prescriptions in hospitalized adults (age ≥ 18 years) at the University of Alberta Hospital from January 17 to February 11, 2022. Appropriateness was assessed against institutional prescribing guidelines (Bugs & Drugs® and Alberta Health Services Formulary Prescribing Guidelines). Verbal and written feedback were provided to the attending teams.

Results
A total of 109 prescriptions were audited. Median age was 57 (IQR 43-72) years and 42% were female. 65 (60%) were admitted to Medicine, 18 (17%) to Surgery, and 26 (24%) to Intensive Care units. MRSA colonization was present in 32 (29%) patients, β-lactam allergy recorded in 21 (19%), and acute kidney injury (AKI) in 21 (19%). Infectious Diseases consultation (IDC) occurred in 29 (27%). The top indications were skin and soft tissue, pulmonary, and bloodstream infections (Table 1); 70% of prescriptions were empiric in nature.
Overall, 43 (39%) prescriptions were assessed to be suboptimal. Antimicrobial Stewardship program (ASP) recommendations were made in 56 prescriptions, totaling 63 unique recommendations. Vancomycin was recommended to be discontinued in 24 (43%) cases or changed to a different agent in 15 (27%). Regimen optimization (duration or frequency change) was recommended in 4 (7%). ASP recommended investigations in 8 cases and IDC in 12. Full or partial acceptance was achieved in 49 cases (88%).
IDC was associated with greater appropriateness (83% vs 53%, p=0.004) as was MRSA colonization (75% vs 55%, p=0.047), but AKI was not (62% vs 60%, p=0.888). Adjusting for age, AKI, and MRSA colonization, IDC remained a significant predictor of vancomycin appropriateness (OR=4.27, [95%CI 1.44-12.70]; p=0.009).

Conclusion
IV vancomycin prescriptions were suboptimal in 39% of cases. IDC was associated with increased appropriateness. This pilot informs the need for antimicrobial stewardship intervention and the importance of IDC at our center.

Disclosures
Dima Kabbani, MD, MSc, AVIR Pharma: Grant/Research Support|AVIR Pharma: Honoraria|GSK: Honoraria|Merck: Grant/Research Support.
1789. Current Antibiotic Prescription Practices in Hospitalized Patients with Acute Myeloid Leukemia (AML) and Febrile Neutropenia of Unknown Origin (FN-FUO): Data from a Large Tertiary Community Hospital
Authors: Portales-Castillo Carlos , Laguio-Vila Maryrose R 
Published: December 2022

Abstract

Background
Optimal duration of empiric antibiotic therapy in hospitalized patients with febrile neutropenia of unknown origin (FN-FUO) remains controversial. Emerging evidence suggests that early discontinuation of antibiotics at 48-72 hours of apyrexia is safe regardless of neutrophil count. However, in the U.S., the adoption of this and other antibiotic use practices in these patients remains unstandardized and understudied, particularly in community hospitals. In this pilot study, we sought to evaluate current antibiotic prescription practices in our large community hospital in admitted patients with AML and FN-FUO.

Methods
We conducted a retrospective cohort study from January 1st, 2020 to December 16th, 2021. All patients admitted with a diagnosis of AML and febrile neutropenia (FN) were screened and those with FN-FUO, defined as no microbiological growth on blood, respiratory or urine cultures at 48 hours of first fever were included. Data on initial antibiotic choices, use of vancomycin and its congruence with IDSA guidelines, mean days of therapy (DOT), mean days of “excess” therapy (DOET), defined by days of antibiotics after &gt;72 hours of apyrexia and total DOET were obtained by medical record review and descriptive analysis was performed.

Results
A total of 65 patients with FN were screened. After screening, 27 patients met criteria for inclusion and data from their hospital stay was obtained (Table 1). Cefepime was the preferred choice of initial intravenous β-lactam in 85% of cases and piperacillin-tazobactam was used in the remainder of cases. Vancomycin was used initially in 55% of cases out of which its use was considered to be incongruent with IDSA guidelines in 25% of cases. The most common reason for IDSA incongruent use of vancomycin was lack of documentation for its use. Mean DOT was 10 and mean DOET was 3 (Table 2). In total, we identified 87 excess days of antibiotic therapy in this cohort.

Conclusion
Little is known about antibiotic prescription practices in high risk FN-FUO patients in community hospitals. Our findings highlight potential concrete antibiotic stewardship targets and shortening this knowledge gap may help guide the development of interventions that have been previously shown to improve clinical outcomes in this overall underrepresented population.

Disclosures
All Authors: No reported disclosures.
1790. Dethroning Vancomycin: A Multifaceted Stewardship Approach to Reduce Vancomycin in an Academic Medical Center
Authors: Lusardi Katherine , Bailey Brett , Rico Crescencio Juan Carlos , Awad Ramez , Jenkins Mitchell , Dare Ryan K 
Published: December 2022

Abstract

Background
Vancomycin is a broadly used antimicrobial, and from 2014-2022 represented the most used antibiotic at our academic medical center. Since 2015, the stewardship program has introduced several measures to optimize vancomycin use including pharmacy consultation, addition of MRSA nares PCR testing, embedding MRSA nares PCR order into vancomycin order panel, and introducing an electronic medical record (EMR) best practice alert to assist providers in identifying patients eligible for vancomycin discontinuation. The impact of each of these interventions are described.

Methods
This is a retrospective, single academic center, comparison of vancomycin utilization over time, following the introduction of various stewardship measures. Each intervention remained in place during subsequent periods. Wilcoxon rank sum was used for analysis. Period 1 (P1): 4/2015-12/2016 vancomycin pharmacy consultPeriod 2 (P2): 1/2017-6/2019 pharmacists authorized to order Nasal MRSA PCRPeriod 3 (P3): 7/2019-2/2020 embed nasal MRSA PCR into consult panelPeriod 4 (P4): 2/2020-3/2022 addition of automated EMR time-out

Results
Each period of vancomycin optimization was associated with a statistically significant decrease in vancomycin length of therapy (LOT) in days, when compared to the period before it (P1 vs P2, p&lt; 0.0001; P2 vs P3, p&lt; 0.0001; P3 vs P4, p&lt; 0.0001). Overall institution vancomycin consumption, expressed as monthly days of therapy (DOT)/1000 patient days (PD) also decreased over time, starting with period 3 (P1 vs P2, p=0.4812; P2 vs P3, p=0.0003; P3 vs P4, p=0.0019) (Table 1). Table 1Vancomycin utilization trends over 4 periods of stewardship intervention.

Conclusion
Decreasing vancomycin at an academic medical center is challenging and takes a multifaceted approach with continued efforts over time to maintain a steady downward trend for utilization. These combined efforts have led to vancomycin no longer being the most commonly prescribed antibiotic at our institution.

Disclosures
All Authors: No reported disclosures.
1793. Evaluation of Ambulatory Antibiotic Use in Children and Adult Patients of a Healthcare System in Bolivia Using the AWaRe Classification
Authors: Quiros Rodolfo E , Escobar Elvio D , Tapia Juan Carlos , Cosgrove Sara E , Fabre Valeria 
Published: December 2022

Abstract

Background
The World Health Organization (WHO) has established the AWaRe (Access, Watch and Reserve) classification based on the impact of different antibiotics on antimicrobial resistance. For ambulatory patients, WHO recommends Access antibiotics to represent &gt;60% of all prescriptions, and an Access to Watch (AW) index of ≥1.5. The use of Access and Watch antibiotics has not been evaluated in ambulatory patients in Latin America. The aim of this study was to describe antibiotic use among members of two health plans within a private health insurance in Bolivia.

Methods
We retrospectively evaluated antibiotic use among 8,405 members of a private healthcare system in Santa Cruz de la Sierra, Bolivia, between Jan-2017 and Dec-2018. Antibiotic use was calculated as defined daily doses (DDD) per 1,000 member-days, and compared between two plans, one a Health Maintenance Organization (HMO) (2,419 members) and the other a Preferred Provider Organization (PPO) (5,986 members). In the HMO plan, members have a general practitioner (GP) as the primary point of care, whereas in the PPO plan, members can access specialists directly without a referral from the GP. Differences between groups were calculated using Byar test with 95% confidence intervals (CI).

Results
Antibiotic use in DDD/1,000 member-days for the study period was 8.31 in ambulatory, 10.7 in the Emergency Department, and 0.72 in the hospital. Ambulatory antibiotic use in the HMO plan was lower than the PPO plan (6.95 vs. 8.89 DDD/1,000 member-days; diff. –1.94, 95%CI –2.15 to –1.72) (Table). Of all ambulatory antibiotics, 55% were Access and 45% were Watch (AW index: 1.24). By patient group, 52% of pediatric and 58% of adult prescriptions were Access; diff. –6%; p&lt; 0.001 (AW index: 1.07 and 1.39, respectively). By health plan, 62% of HMO and 53% of PPO antibiotics were Access; diff. 9%; p&lt; 0.001 (AW index: 1.13 and 1.67, respectively).

Conclusion
Ambulatory antibiotic use in this cohort was high. Overall use of Access antibiotics was lower than the recommended by WHO; however, we found less broad-spectrum antibiotic use in the HMO plan compared to the PPO plan. These findings highlight the urgent need for antibiotic stewardship in the ambulatory setting, and the important role of GPs in appropriate antibiotic prescribing.

Disclosures
Sara E. Cosgrove, MD, Basilea: Member of Infection Adjudication Committee.
1804. Quality Improvement Project to improve empiric antibiotic therapy for skin and soft tissue infections using the nasal MRSA PCR
Authors: Kasule Sabirah N , Gupta Simran , Klyver John , Chan Lynn , Seville Teresa 
Published: December 2022

Abstract

Background
Large cohort studies from the Veteran’s Administration support the negative predictive value of the methicillin resistant Staphylococcus aureus (MRSA) nasal polymerase chain reaction (PCR) swabs for skin and soft tissue infection (SSTI). We investigated the use of the nasal MRSA PCR swab to reduce the inappropriate empiric use of vancomycin and piperacillin-tazobactam for SSTI at our institution.

Methods
Between July and August 2021, we educated Hospital Internal Medicine (HIM) and Internal Medicine Residents (IMR) on the basics of SSTI management and the utility of a negative nasal MRSA PCR swab. Data on empiric use of vancomycin and piperacillin-tazobactam for SSTIs were collected 3/1/2021 to 7/1/2021 (pre-intervention) and 8/30/2021 to 12/29/2021 (post-intervention). We excluded patients who didn’t have an SSTI, weren’t managed by IMR or HIM, and whose empiric antibiotics were for another indication. To account for antibiotics started in the emergency department (ED), a patient was regarded as having received appropriate empiric antibiotics if they were de-escalated in the first 24 hours of being admitted to IMR or HIM.
Example of education material. These fliers were distributed to resident rooms following a series of noon conferences

Results
Pre-intervention there were 106 patient encounters. In 56 of these (52.8%), patients were placed on inappropriate empiric antibiotics. Post-intervention, there were 72 patient encounters. In 23of these (31.9%), patients were placed on inappropriate empiric antibiotic for an absolute risk reduction (ARR) of 20.9% with a statistically significant 95% CI (6.522 - 35.249) and a number needed to treat (NNT) of 4.78. Nasal MRSA PCR testing increased from 40.6% to 56.9%. The ARR among the HIM teams was 21.3% and was statistically significant with a 95% CI (4.24 - 38.394). Their proportion of MRSA testing increased from 41.5% to 50%. The IMR teams had an ARR of 14.8%, which was not statistically significant (95% CI, -11.339 to 40.884). Their MRSA nasal PCR testing increased from 37.5% to 72%.

Conclusion
Education on SSTI treatment coupled with use of the MRSA nares PCR appeared to improve empiric antibiotic choices. Residents stated that the nasal MRSA PCR facilitated empiric antibiotic choice. Positive ARR was seen in whole and sub-group analyses of physician teams. We theorize that the lack of statistical significance in the IMR group was related to a small sample size.

Disclosures
All Authors: No reported disclosures.
1806. The gap in the amount of monthly antimicrobial use according to the data source: Electronic Health Record Data vs. National Health Insurance Claim Data in Korea
Authors: Kim Bongyoung , Chae Jung Mi , Kim Dong-Sook , Woo Hyunki , Kim Changhui , Bin Kim Hong , Kim Hyung-Sook , Park Sun Hee , Jeong Su Jin , Uh Young , Ahn Song Vogue , Park Yoon Soo , Choi Jun Yong 
Published: December 2022

Abstract

Background
Korea has single health insurance system and insurance claim information on almost all medical practices in Korean hospitals is collected and processed by the Health Insurance Review and Assessment Service (HIRA). Since information about prescription of almost all hospitals is available in National Health Insurance (NHI) claim data, recently established the Korea National Antimicrobial Use Analysis System (KONAS) has been using NHI claim data as data source. The purpose of this study is to validate the accuracy of NHI claim data.

Methods
Data on all antimicrobial agents prescribed in four tertiary-care hospitals in Korea between January 2019 and December 2019 were obtained using NHI claim data extracted by HIRA and data extracted by common data model based on electronic health record (EHR) in each hospital. Antibiotics and antifungal agents according to the Anatomical Therapeutic Chemical class J01 and J02 were included while antiviral, antitubercular, antiparasitic, and topical antimicrobial agents were excluded. Antimicrobial consumption was measured as days of therapy (DOT) and standardized to per 1,000 patient-days. The ratio of monthly antimicrobial consumption calculated using the NHI claim data compared to that calculated using the common data model was demonstrated (HIRA/EHR ratio).

Results
The monthly HIRA/EHR ratio of broad-spectrum antibiotics predominantly used for hospital-onset infections was 1.08-1.12 and that of broad-spectrum antibiotics predominantly used for community-acquired infections was 1.11-1.21. The monthly HIRA/EHR ratio of other antimicrobial classes are as follows: antibacterial agents predominantly used for resistant gram-positive infections 1.15-1.31, narrow-spectrum beta-lactam agents 1.00-1.05, antifungal agents predominantly used for invasive candidiasis 1.00-1.27, and antibacterial agents predominantly used for extensive antibiotic-resistant gram-negative bacteria 0.70-1.09.

Conclusion
The monthly antimicrobial consumption calculated using NHI claim data differs from that calculated using EHR data by up to 30%. It would be desirable to establish a system that can analyze and monitor antimicrobial consumption using EHR data in each hospital in Korea in the future.

Disclosures
Hyunki Woo, BS, Evidnet Inc.: Employee changhui Kim, BS, Evidnet Inc.: Employee.