bluuebunny/crossref_metadata_2025_split huggingface dataset:
939. Barriers and facilitators in the implementation of ASP in Mexico and the impact of COVID-19
Authors: Cortés-Ortíz María Alejandra , Dreser Anahí , Hegewisch-Taylor Jennifer , Romero-Mónico Julián , Quiroz Jorge 
Published: December 2022

Abstract

Background
Hospital antimicrobial stewardship programs (ASP) involve a continuous effort by health institutions to monitor and optimize the use of antimicrobials. In this study, we aimed to explore barriers and opportunities in the implementation of ASP perceived by personnel of Mexican hospitals, as well as their views on the impact of COVID-19 in ASP activities.

Methods
An online survey was applied to a purposive sample of 40 hospitals that perform regular antimicrobial stewardship activities in Mexico, during the last trimester of 2021.

Results
A total of 40 hospitals (62.5% public and 37.5% private) in 13 states in Mexico responded to the survey. Regarding the perception of barriers, they identified the overload of activities (73%), hospital reconversion due to COVID-19 (65%), the scarcity of human resources, and resistance of personnel to new procedures (63% each). The main perceived facilitators were the support by hospital authorities (60%) and the commitment by the ASP team and health professionals in the implementation of ASP (48%). Only 15% of hospitals reported that support by health authorities or other hospitals were factors favoring implementation. The main reported changes due to COVID-19 were: temporary suspension of ASP activities (60%); greater workload due to increased prescription of antimicrobials (33%); involvement in interventions (such as education and guidelines) directed to improve antimicrobial use in COVID-19 patients (18%), as well as implementation of new protocols in pharmacy (44%) and microbiology laboratory (51%). 18% reported no changes in ASP.

Conclusion
Implementation of ASP in Mexican Hospitals could be strengthened by the inclusion of sufficient human resources with protected time for ASP activities, the active involvement of hospital authorities, as well as encouraging the training and leadership of ASP teams. The impact of COVID-19 was two-way: the stagnation of the program in some hospitals, as well as the active participation in the response to the emergency, in other hospitals.

Disclosures
Anahí Dreser, PhD, MSD: Grant/Research Support.
943. Cross-Sectional Survey of Antibiotic Stewardship Activities Across Kansas Healthcare Settings including Hospitals, Ambulatory Centers and Long-Term Care Facilities
Authors: Jegede Olujimi , Wark Kellie , Kimball Joanna 
Published: December 2022

Abstract

Background
Kansas ranks as the second-worst state nationally for inpatient antibiotic stewardship core element implementation. Based on the Center for Disease Control and Prevention's 2020 National Healthcare Safety Network (NHSN) Annual Survey, Kansas hospitals reporting at 17% below the national average. We sought to investigate and characterize the stewardship activities healthcare facilities including hospitals, ambulatory centers, long-term care settings, among others, are engaging in, regardless of whether a formal stewardship program exists or not.

Methods
A survey was drafted based on the NHSN Annual Facility Survey for hospitals and long-term care settings. The survey was distributed to antibiotic stewardship experts and revised based on input. Surveys were distributed electronically from December 2021 through April 2022 via direct communication through Kansas Department of Health and Environment contacts, and partner organization dissemination.

Results
A total of 95 programs responded to the survey. Facilities from 55 of 106 counties responded. 52 of the 95 responses were from critical access hospitals. The facility representation is shown in Fig 1. 33% facilities reported not having a formal ASP. Thirty-five percent of those with formal ASP have had it for 2 years or less. 53% of respondents found it challenging to establish an ASP. About 58% of respondents felt their facility leadership was committed to improving antibiotic use. Accountability amongst all respondents was poor with only 55% reporting a physician/surgeon/dentist leader responsible for ASP activities. The most common activities implemented were clinical decision pathways and audit, and feedback (19% each), followed by guidelines (15%), dosing or duration optimization strategies (13%), with the least implemented being peer comparison (8%), prophylactic guidelines (5.5%) and pre-authorization (5.5%) as seen in figure 2. Figure 1- Number of responses per facility typeFigure 2:Actions reported (all healthcare facilities)

Conclusion
There have been ongoing endeavors to start ASPs, but these appear to have been hampered by the COVID-19 pandemic, lack of adequate support from facility leadership and lack of leadership representation in antibiotic stewardship. Further efforts are needed in developing and supporting antibiotic stewardship activities across facilities in Kansas.

Disclosures
All Authors: No reported disclosures.
947. Evaluating the Outcomes of Infectious Diseases Consultation on methicillin susceptible Staphylococcus aureus Bacteremia
Authors: Viteri Alina , Tucker Natalie , Barnstable Sara 
Published: December 2022

Abstract

Background
In 2014, an institutional project was completed assessing outcomes of beta-lactams versus vancomycin in patients with MSSA bacteremia. This research led to the development and implementation of a new standard of care for Staphylococcus aureus bacteremia using a bundle set that included ID consultation. The purpose of this research is to evaluate the impact mandatory ID consultation had on patient outcomes since this bundle set was implemented at our institution.

Methods
This was a quasi-experimental, single center study of adults with MSSA bacteremia admitted from April 1, 2018 to August 31, 2021. In the instance of patients with multiple admissions with MSSA bacteremia, data from only the first admission was included in the final analysis. Patients were excluded if they had polymicrobial bacteremia or expired within 48 hours of admission. Patients were identified by utilizing reports generated from the pharmacy clinical decision support software of patients with at least one blood culture positive for MSSA. Patients in this list were further screened through manual chart review for inclusion and exclusion criteria. The primary endpoint of this study is inpatient mortality in the setting of MSSA bacteremia with and without an ID consultation. Inpatient mortality was defined as death by any cause during hospital admission. Secondary endpoints included time to bacterial clearance, ID consultation, and mortality.

Results
Of the patients included, only 42 percent of patients in the pre-bundle set group were treated with MSSA targeted therapy (beta-lactam), in comparison to 86 percent in the post-bundle set group. The difference in secondary outcomes was not statistically significant. For the primary outcome of inpatient all-cause mortality, a 10 percent difference was found between the pre and post-bundle set groups, 18% vs. 8% (p = 0.01). The multivariate regression analysis also confirmed that the presence of an ID consult had a significant relationship with decreased mortality (p = 0.01).

Conclusion
The all-cause mortality rate of adult patients with MSSA bacteremia significantly decreased after implementation of the Staphylococcus aureus bacteremia bundle set requiring an ID consultation.

Disclosures
All Authors: No reported disclosures.
949. Impact of Antimicrobial Stewardship Pharmacist Participation in Pediatric Infectious Diseases Rounds on Prospective Audit and Feedback Recommendations
Authors: Bio Laura , Puckett Lauren M , Joerger Torsten , Schwenk Hayden T 
Published: December 2022

Abstract

Background
Prospective audit and feedback (PAF) is a core strategy of antimicrobial stewardship programs (ASPs). To improve communication of PAF recommendations to the inpatient pediatric infectious diseases (ID) consult service, the ASP pharmacists at our hospital were integrated into ID rounds. The purpose of this study was to assess the impact of ASP pharmacy participation in ID rounds on the rate of ASP recommendations.

Methods
Prior to implementation of the ASP pharmacist rounding service, the ASP pharmacist did not routinely attend rounds or communicate PAF recommendations directly to the ID consult service. Starting 1/3/22, the ASP pharmacists had daily (M-F) in-person discussions with the ID team regarding their patients’ antimicrobials. Audits performed between 1/4/21-12/30/21 and 1/3/22-4/29/22 on patients with an ID consult were included in the non-rounding cohort (NRC) and rounding cohort (RC), respectively. We compared PAF recommendation rates, characteristics, and acceptance rates between the two cohorts.

Results
There was an increase in PAF recommendation rate in the RC compared to NRC (188/485 [39%] vs 359/1234 [29%], p &lt; 0.001). Antibiotics were the antimicrobial category mostly likely to have a recommendation and the rate of antibiotic PAF recommendations was higher in the RC compared to the NRC (132/341 [39%] vs. 271/934 [29%], p = 0.001) (Table 1). The most common recommendation types in both cohorts were to optimize the antimicrobial dose and antimicrobial discontinuation. Recommendations were more frequently communicated to the ID team in the RC compared to NRC (125/188 [66%] vs. 107/359 [30%], p &lt; 0.001). The recommendation acceptance rate was similar between the two cohorts (159/188 [85%] RC vs. 290/359 [81%] NRC, p = 0.29).
CNS: Central nervous system; IV: Intravenous; NRC: Non-rounding cohort; PAF: Prospective audit and feedback; PO: Per os, oral; RC: Rounding cohort; SSTI: Skin and soft tissue infection; UTI: Urinary tract infection.

Conclusion
Implementation of a pediatric ASP pharmacist rounding service increased the PAF recommendation rate and improved recommendation communication with the pediatric ID consult service. Participation in rounds may better inform ASP pharmacist PAF recommendations. Future studies describing the potential benefit to the ID team by having an ASP pharmacist present on rounds are warranted. ASPs should consider formal integration of ASP pharmacists as part of the ID consult service to further improve the quality of antimicrobial prescribing.

Disclosures
All Authors: No reported disclosures.
956. Improving Understanding and Utilization of the Antibiogram among Medical Residents
Authors: Cooper Stephen J , Vivekanandan Renuga , Destache Christopher 
Published: December 2022

Abstract

Background
The antibiogram is a powerful tool for providers when selecting empiric antibiotic coverage. Its use is recommended by the Infectious Disease Society of America, Center for Disease Control, and clinical decision support resources to aid in antibiotic stewardship and patient care. Antibiograms are a key component of antimicrobial stewardship programs. A quality improvement project was implemented for the family medicine, internal medicine, and surgery residency programs at Creighton University to assess and improve early trainees' comfort with, utilization of, and understanding regarding antibiograms.

Methods
Forty-two first year residents making up 100% of the post graduate year one classes of the family medicine, internal medicine, and surgery residency programs at a Midwest Academic institution were interviewed in April 2021. Questions collected data regarding the function of, knowledge regarding, comfort and personal experience with antibiograms, as well as past exposure to infectious disease training. Antibiogram training lectures, informational posters, and new methods of accessing the antibiogram were implemented in July 2021. Post implementation of these interventions thirty-seven second year residents and forty first year residents, consisting of 100% of the respective classes of the three residency programs, were interviewed in January 2022.
Survey Questionnaire
Nine-question survey to gather data regarding residents knowledge and use of antibiograms.
Educational Poster
Information about how to use an antibiogram and quick response codes to access institutions antibiogram. Posters were displayed in all residency team rooms.

Results
Our efforts resulted in statistically significant increase in resident reported understanding, utilization, and comfort with the antibiogram. A total of 24/42 of the 2021 residents and 69/77 of the 2022 residents surveyed reported correct understanding of the antibiogram (p &lt; 0.001). Residents who reported knowing how to access the antibiogram increased from 24% to 78% (p &lt; 0.01) and use of the antibiogram in patient care increased by 19% (p = 0.027). The average reported comfort level increased from 2.3 to 4.2 out of 5 (p &lt; 0.01).

Conclusion
Previous literature documents that many residents are not comfortable with using antibiogram data. This quality improvement project demonstrates that simple inexpensive measures can improve physician's comfort, access, and utilization of the antibiogram.

Disclosures
Renuga Vivekanandan, MD, MDstewardship: Ownership Interest Christopher Destache, Pharm D, Shionogi Inc: Honoraria.
958. Is Dalbavancin a Reliable Treatment Option in Socially Challenged Populations?
Authors: Askar Wajih , Bedoya Federico Palacio , Liao Siyun 
Published: December 2022

Abstract

Background
Dalbavancin (DAL) is a lipoglycopeptide antibacterial that was granted full FDA approval for the treatment of acute bacterial skin and skin structure infections (ABSSSI) in 2014. Due to its long terminal half-life of 14.4 days, DAL has been used off-label to treat infections that require a prolonged duration of treatment, especially in patients with challenging social situations. We aimed to evaluate the differences in outcomes and clinical effectiveness of DAL, primarily in deep-seated infections in an academic health system.

Methods
We performed a retrospective review of all the adult patients ( &gt;18 years old) with DAL orders within our health care system between January 1st, 2016, and July 16th, 2021. Baseline characteristics were collected, including age, gender, race, history of illicit drug use disorder (IDUD), diagnosis, and recommended DAL regimen. Follow-up data, including completion of treatment, outpatient visits to infectious diseases clinic, and recurrence of infection within six months, were also collected.

Results
A total of 50 patients were identified during the study time frame. The median age was 45.5 years, 62% were male, 82% were white, and 62% had a history of IDUD (Table 1). DAL was used predominantly to treat bone and joint infections (e.g., osteomyelitis, septic arthritis), followed by bacteremia, endocarditis, and ABSSSI (Table 1). The most common regimen used is 1500 mg weekly for two doses. Patients with a history of IDUD are less likely to complete the recommended treatment regimen (64.5% vs. 100%; p=0.003), and less likely to follow in the infectious disease clinic (16.1% vs. 52.6%, p=0.016) when compared to patients with no history of IDUD. Twelve patients had either objective evidence or clinical suspicion for recurrence within six months. Although there was a trend for higher recurrence among patients with IDUD (29% vs. 16%), there was no statistical difference with a p-value of 0.332 (Table 2). In addition, DAL was well-tolerated among most patients. Table 1.Baseline characteristics of the study population.
Table 2. Outcomes of patients with dalbavancin orders.

Conclusion
Although DAL is a safe and convenient antimicrobial option, more efforts should be made to establish consistent treatment regimens for its off-label use. Those with social barriers such as IDUD might benefit from additional measures to ensure treatment completion and proper follow-up.

Disclosures
All Authors: No reported disclosures.
960. Optimizing the report of antimicrobial resistance in Mexican hospitals: An unfinished business.
Authors: Hegewisch-Taylor Jennifer , Dreser Anahí , Alejandra Cortés-Ortíz María , Romero-Mónico Julián 
Published: December 2022

Abstract

Background
One of the aims of antimicrobial stewardship programs (ASP) in hospitals is to make an efficient use of the available infrastructure to enhance surveillance and antimicrobial resistance (AMR) reporting. In this study, we aimed to explore specific AMR reporting mechanisms in ASPs in Mexican hospitals in order to highlight potential areas of improvement.

Methods
An online survey was applied to a purposive sample of 40 hospitals who performed regular antimicrobial stewardship activities in Mexico. Answers regarding a subset of questions on antimicrobial susceptibility monitoring and reporting practices were provided by ASP professionals.

Results
A total of 39 hospitals (14 private and 25 public hospitals) in 13 states in Mexico answered the subset of the survey. Thirty-three of those (85%) expressed that their databases allowed periodically monitoring of changes in susceptibility and resistance patterns for specific pathogens. As many as 17 hospitals (44%) reported to two external national academic networks and none reported to international ones. Only 10 reported to the National Hospital Network for Epidemiological Surveillance (RHOVE) in charge of AMR data (29%). Thirty hospitals (77%) declared reporting their AMR consolidated results internally to either the epidemiology department, an ASP leader, or other hospital committee. Twenty percent of the surveyed hospitals issued AMR reports to two entities, an additional 10% of them to 3 entities and 5% more to 4 different entities; reporting to &gt;3 entities was observed only in public hospitals. Two hospitals (5%) declared not submitting AMR reports at all.

Conclusion
The adoption of reporting commitments without guiding national AMR policies derives into the duplicity of processes (reporting to different networks or entities) requiring additional human and financial resources. It also reflects the unavailability of a functional national reporting system allowing all hospitals to monitor and access the reported information nationally or internationally (GLASS). Optimizing AMR surveillance and reporting in Mexico must incorporate the simplification and standardization of reporting processes into an articulated system in line with the National Strategy against AMR.

Disclosures
Anahí Dreser, PhD, MSD: Grant/Research Support.
962. Pediatric Antimicrobial Stewardship at Colorado Hospitals
Authors: Parker Sarah K , Kronman Matthew , Czaja Christopher A , Matteson Caleb , Ziniel Sonja I , Dodson Daniel S 
Published: December 2022

Abstract

Background
Although antibiotics are essential to pediatric care, many pediatric antimicrobial prescriptions are inappropriate. Antimicrobial stewardship programs (ASPs) are implemented to mitigate these instances of inappropriate prescription, but little is known about how these programs are applied to pediatric care. To better understand extension of ASP to pediatric patients, barriers to pediatric stewardship, and desired resources for pediatric stewardship, we assessed stewardship practices as applied to pediatric patients and identified barriers to including this vulnerable population across Colorado hospitals.

Methods
We conducted a mixed-methods evaluation including a survey and semi-structured interviews with the objective of characterizing and assisting Colorado ASPs. Forty-one hospitals responded to the survey and 24 programs were interviewed, of 103 possible hospitals.

Results
Of the 41 hospitals responding to the survey and 23 hospitals interviewed, 35 (85%) and 23 (90%) cared for pediatric patients respectively. Of hospitals caring for neonatal and general pediatric patients, only 17% and 14% employed rigorous stewardship practices for the action, tracking, and reporting stewardship core elements for these populations (compared to 50% and 31% for their adult patients).
Notably, we found many programs inaptly combined adult and pediatric ASP efforts (18 hospitals, 81%), including frequent combining of adult and pediatric antibiotic use data, versus separating these patient populations (3 hospitals, 14%).
Barriers to priority pediatric stewardship included lack of pediatric expertise and perceived low priority for pediatric stewardship due to lower volumes. The most desired pediatric resources were clinical care guidelines and pediatric stewardship education.

Conclusion
Though most hospitals in Colorado care for pediatric patients, priority stewardship in pediatrics is rare. Resources to assist pediatric ASP are uncommon, and incentive to develop such resources may be low. Public health departments and pediatric hospitals can help combat antimicrobial resistance and improve pediatric care in community settings by providing easier access to pediatric expertise.

Disclosures
All Authors: No reported disclosures.
963. Perceived Antimicrobial Stewardship Roles of Pharmacists and Residents in US Intensive Care Units
Authors: Uttla Kruthika , Rynkiewich Katharina , Hojat Leila S 
Published: December 2022

Abstract

Background
Antimicrobial stewardship programs (ASPs) were developed as a way of addressing antibiotic resistance by promoting the judicious use of antibiotics. Pharmacist and resident perspectives of their own roles within antimicrobial stewardship are relatively unknown. An ethnographic study of intensive care units (ICU) was conducted to understand the perceptions and attitudes surrounding pharmacist and resident roles relative to stewardship.

Methods
A research assistant with medical anthropology training performed semi-structured interviews with intensive care pharmacy specialists and residents at a medical center in Cleveland, Ohio, USA between June 2021 and August 2021. Data analysis centered on the understandings of ASPs and antibiotic prescribing present in multidisciplinary groups where certain members are not primary antibiotic decision-makers. The data were analyzed using thematic coding aided by NVivo qualitative analysis software.

Results
Intensive care pharmacy specialists (N=5) and residents (N=6) were interviewed, accruing &gt; 518 minutes of semi-structured interview data. Pharmacy specialists described their contributing role as serving stewardship goals such as “decreasing mortality” and believed that they should have input in antibiotic decision making. Residents also emphasized the importance of consulting pharmacists before antibiotic decisions were made. Both groups felt limited in their ability to contribute to final antibiotic decisions. Pharmacists regularly referred to their input as a “recommendation” and described their actions as “suggestions”. Residents expressed that physicians were better suited to make decisions due to the residents’ limited experience, acknowledging that they “don’t know everything.” Table 1.Key Themes and Perceived Roles in Intensive Care

Conclusion
This study found that ICU pharmacists and residents have an awareness of stewardship that might aid in antimicrobial prescribing. Both groups expressed an appreciation for stewardship goals despite being bounded by hierarchies of medical practice. Providing these groups with greater autonomy over prescribing practices might improve ASP effectiveness. Future studies may focus on analysis on the social dynamics of hospital spaces and the corresponding impact on decision-making and expert practices.

Disclosures
All Authors: No reported disclosures.