bluuebunny/crossref_metadata_2025_split huggingface dataset:
1738. A Needs Assessment and Tailored Webinar Series to Extend Antimicrobial Stewardship Practices to a Skilled Nursing Facility Collaborative Network
Authors: Choudhury Rebecca L , Nori Priya , Stark Allison , DiPalo Katherine 
Published: December 2022

Abstract

Background
The CDC’s Core Elements (CDCCE) of Antimicrobial Stewardship outline best practices for antimicrobial stewardship programs (ASP) in skilled nursing facilities (SNFs). We conducted a needs assessment based on the CDCCE and applied the results to creating an educational webinar series.

Methods
A needs assessment based on the CDCCE Checklist was electronically distributed in 10/2021 to members of the Montefiore Health System SNF Collaborative: 33 Bronx and Hudson Valley facilities. A follow-up assessment was performed 2/2022. Responses were aggregated using Google Forms and Microsoft Excel. A 3-part webinar series addressing respiratory, urinary, and skin infections using AHRQ materials was then delivered via Zoom in 4/2022.

Results
Fifteen facilities responded to the initial assessment. Thirteen facilities reported the director or assistant director of nursing as an ASP leader, with 8 reporting the facility medical director as ASP leader, corresponding to the CDCCE of “Leadership Commitment” and “Accountability.” Fourteen facilities implemented policies to improve antibiotic use (AU), corresponding to “Action.” Corresponding to “Tracking,” all facilities used electronic medical records and monitored at least 1 AU metric, with 11 also monitoring at least 1 adverse outcome related to AU. Fourteen facilities shared AU data with staff, corresponding to “Reporting.” Eighteen facilities responded to the follow-up assessment. Facilities perceived “Action” (7 responses), “Reporting” (4), “Tracking” (2) and “Accountability” (2) as the main areas of weakness in their ASP, despite fulfilling these criteria per the CDCCE Checklist. Facilities expressed interest in education on best AU practices (9) and antibiotic stewardship education for nursing staff (7). Clinical syndromes of interest were pneumonia (5) and wound infections (5). There were 55 participants in the webinar series, from 22 of 33 facilities. Thirty were nurses, 17 were physicians, and 8 were administrators. Figure 1Responses from the follow up needs assessment in February 2022

Conclusion
Online communication platforms such as Zoom can be a useful tool for providing education about improving antibiotic use in SNFs. Further investigation is needed to determine best strategies to implement, evaluate, and improve ASP in SNFs, considering structural challenges unique to this setting.

Disclosures
All Authors: No reported disclosures.
1740. Antibiotic Allergy Delabeling in Pediatric Infectious Disease Clinic: Missed Stewardship Opportunities
Authors: Vermilye Katherine , Tesini Brenda L , Stern Jessica 
Published: December 2022

Abstract

Background
Reported beta lactam antibiotic allergies are common, with up to 10% of individuals carrying a penicillin [PCN] allergy label and approximately 1% carrying a cephalosporin allergy label. However, &gt;90% of patients with a PCN allergy label can safely tolerate penicillins. Incorrect antibiotic allergy label can contribute to increases in antibiotic resistance and medication side effects. Appropriate medication allergy history taking is necessary and sometimes sufficient to effectively remove inappropriate allergy labels. We aimed to evaluate opportunities for addressing inappropriate PCN allergy labels in a pediatric infectious diseases clinic.

Methods
Electronic medical records (EMRs) for patients seen in an academic outpatient pediatric infectious diseases clinic from January 1, 2021 through April 30, 2021 were reviewed for presence of documented antibiotic allergy at time of visit, antibiotic class (PCN, cephalosporin [Ceph.], or non-beta lactam), reaction type, documentation of full reaction history needed to stratify for potential delabeling, and whether or not potential allergy delabeling was addressed during the visit.

Results
Antibiotic allergy labels were present in the EMR in 18% (n=16) of the 90 encounters reviewed, representing 19% (n=15) of patients seen. Beta lactam antibiotic reactions accounted for 69% (11/16) of documented allergies; 8 PCN class (73%), 2 Ceph. class (18%), 1 with both PCN and Ceph. class allergy (9%). Reactions included rash (6 visits; 54%), hives (3; 27%), nausea/vomiting (1; 9%), diarrhea (1; 9%), swelling (1; 9%), and none recorded (2; 18%). [Sum &gt;100% due to multiple reactions listed]. No additional reaction history was obtained for any patient during the visits. Antibiotic allergy delabeling or assessment by an allergist was only addressed during 1 of the 16 visits with documented antibiotic allergy (6.3%).

Conclusion
Antibiotic allergy labels are common in pediatric infectious diseases clinic patients. However, appropriate medication allergy histories and the potential for allergy delabeling were not documented for the majority of patients with antibiotic allergy labels. This represents a significant missed opportunity for antibiotic allergy delabeling and a target for future antimicrobial stewardship opportunities.

Disclosures
All Authors: No reported disclosures.
1742. Antibiotic Use in the Podiatry Clinic: Antimicrobial Stewardship Setting Foot in Uncharted Territory
Authors: Oh Elizabeth , Bollam Rahul , Yadlapalli Mownika , Levin Joel , Arbulu Ricardo 
Published: December 2022

Abstract

Background
Podiatrists independently manage diabetic foot ulcers (DFU), often complicated by diabetic foot infections (DFIs). The prevalence of DFU is 40 - 60% and guidelines vary in their recommendations for DFI, creating a target for antimicrobial stewardship. However, the prevalence and appropriateness of antibiotics prescribed by podiatrists has not been reported. We describe both variables among patients with DFU in a podiatry clinic.

Methods
We conducted a retrospective chart review of all consecutive patients &gt; 18 years of age with DFUs, infected or not, who had at least one visit to the UPMC Mercy Wound Clinic (Pittsburgh, PA) in 2020. We defined severity of infection using the PEDIS score and diagnosis of osteomyelitis (OM) (Figure 1). We collected data on antibiotics prescribed by podiatry in the clinic or by any provider during a hospitalization for DFI. Figure 2 shows our appropriateness criteria. Figure 1:Stratification of Severity of Diabetic Foot InfectionFigure 2:Criteria for Appropriateness of Antibiotic Use in Diabetic Foot Ulcers

Results
Of 72 patients with DFU, 32 (44.4%) received an antibiotic. Compared to those who did not receive antibiotics, patients who did were more likely male (86.2% vs. 63.6%), had a higher PEDIS score (2.03 vs. 1.49), and were more frequently diagnosed with OM (71.9% vs. 26.8%). (Table 1). Table 2 shows the most common antibiotics.
Among the five patients with no to mild infection, none received appropriate treatment (Table 3). Two patients in that category received IV antibiotics (when hospitalized for DFI), and neither received an Infectious Diseases (ID) consult. The other three were considered inappropriate due to durations &gt; 7 days. The mean length of treatment for patients with mild infection was 12.6 (4.56). The two patients with moderate infection who received antibiotics had “inappropriate” courses; however, both had complicated Staphylococcus aureus bacteremia, and therefore 4-6 weeks courses were justified. All 12 inappropriate courses in severe infections were due to courses &gt; 42 days.

Conclusion
Prescription of antibiotics among patients with DFU was common. Our findings suggest potential targets for antimicrobial stewardship: unnecessarily long courses an IV antibiotic use in patients with mild or no infection. Our criteria can be refined to recognize situations in which prolonged therapy may be justified, and larger studies are warranted.

Disclosures
All Authors: No reported disclosures.
1745. Drilling Down on Antibiotic Use in Dental Clinics
Authors: Son Andrea H , Boland Brendan P , Harsh Nicholas C , Hecker Michelle T 
Published: December 2022

Abstract

Background
Dentists are the third highest prescribers of antibiotics in outpatient settings in the US with reported suboptimal prescribing rates between 30 and 85%. The 2019 American Dental Association guidelines provide guidance for antibiotic use based on the presence of dental pain and/or swelling and whether definitive conservative dental treatment is immediately available. Our primary objective was to assess the appropriateness of systemic antibiotic use in our institution’s dental clinics based on these guidelines. Our secondary objectives were to describe antibiotic choice, duration of therapy, and use of non-first line antibiotics.

Methods
From January 2021 through December 2021 data on antibiotics prescribed during all patient encounters in our institution’s dental clinics were abstracted from the electronic medical record. Detailed review was performed on a randomly generated sample of 120 unique patient encounters (10 each month). First line antibiotics included penicillin, amoxicillin, and amoxicillin-clavulanate.

Results
Of 14,381 dental clinic encounters, 2,413 (16%) resulted in one or more antibiotic prescriptions (total of 2788 prescriptions). Non-first line antibiotics accounted for 402 (14%) of all antibiotic prescriptions (Table). Sixty-nine (17%) of non-first line antibiotics were prescribed for patients with no documented beta-lactam allergy. Of the 333 non-first line antibiotics prescribed for patients with a documented beta-lactam “allergy”, a first line antibiotic or cephalexin could have been used in 120 (36%). Of 120 patient encounters undergoing detailed review, antibiotics were prescribed for treatment (not prophylaxis) in 115 (96%). Antibiotics were indicated in only 16 of 108 (14%) evaluable patients. The mean duration of therapy was 7.2 days. Eleven percent of prescriptions were longer than 7 days.

Conclusion
At our institution most antibiotics prescribed from our dental clinics were for treatment, were commonly not indicated, and were usually prescribed for 7 days or more. First line antibiotics and cephalexin could have replaced nearly half of the non-first line antibiotics prescribed. Developing a clinical pathway incorporating updated guidelines and management of patients with beta-lactam “allergies” may improve patient care.

Disclosures
All Authors: No reported disclosures.
1747. Emergency Department Antimicrobial Stewardship Intervention Bundle to Optimize Antibiotic Prescribing in Urinary Tract Infections and Skin and Soft Tissue Infections
Authors: Ducas Stephanie R , Cubillos Ashley L , Chandler Elisabeth , Saunders Mary Beth 
Published: December 2022

Abstract

Background
Emerging literature has demonstrated a positive impact of emergency department (ED)-focused antimicrobial stewardship initiatives on antibiotic prescribing. To date, the majority of interventions focus on urinary tract infections (UTI) and few evaluate electronic medical record (EMR) integration.

Methods
This retrospective, quasi-experimental study was conducted at five EDs within a large-community health system. An antimicrobial stewardship intervention bundle was implemented in February 2022, consisting of ED-specific discharge antibiotic order sets for UTI and skin and soft tissue infections (SSTI) and education to ED prescribers and pharmacists. Adult patients receiving an ED discharge antibiotic prescription associated with a UTI or SSTI ICD10 code were included. The primary outcome was the percentage of prescriptions matching discharge order set antibiotic regimens for UTI and SSTI in the 2-month pre- and post-implementation periods. Secondary outcomes included evaluation of primary outcome indications (UTI or SSTI), use of recommended agents or durations of therapy, use of combination therapy (SSTI only), and rate of 30-day hospital admission.

Results
The implementation of this multi-intervention stewardship bundle was associated with a significant initial improvement in the percentage of prescriptions matching discharge order set recommendations for UTI and SSTI (30.9% vs. 35%, P = 0.04). There was a significant improvement in UTI prescribing (54.9% vs. 61.7%, P = 0.01), but the same benefit was not demonstrated for SSTI (6.2% vs. 3.6%, P = 0.04). A significant improvement was also observed in the use of recommended durations of therapy (34% vs. 38.5%, P = 0.023). No significant difference was observed in use of indication recommended agents (75.7% vs. 77.1%, P = 0.43), use of inappropriate combination therapy for SSTI (31.7% vs.26.3%, P = 0.07), or 30-day hospital admission (6% vs. 5%, P = 0.33).

Conclusion
This novel multi-intervention ED antimicrobial stewardship bundle was associated with overall immediate improvements in antibiotic prescribing for discharged patients. Future directions of research will include evaluation of methods to improve SSTI prescribing, implementation of prescriber data feedback, and expansion to additional indications.

Disclosures
All Authors: No reported disclosures.
1748. Epidemiology and resistance patterns of nursing home uropathogens in four states, 2018-2019
Authors: Taylor Lindsay , Irvine Jessica , Jolles Sally , Bej Taissa A , Kowal Corinne , Podzorski Raymond , Jump Robin L , Crnich Christopher J 
Published: December 2022

Abstract

Background
Urinary tract infections (UTIs) are the most common indication for antibiotic treatment in nursing homes (NHs) and are often treated empirically before culture results return. A previous study of uropathogens from NH residents in Georgia revealed high resistance to commonly used antibiotics, including ciprofloxacin. Here, we describe the distribution and key resistance patterns of uropathogens recovered from residents of NHs in Wisconsin, Ohio, Kentucky, and Indiana.

Methods
Results of urinary cultures from NH residents performed between 2018 and 2019 were obtained from contracting microbiology laboratories. Culture results were de-identified by an honest broker. Urine culture data was standardized across laboratories and years using key collision and nearest neighbor clustering methods. Non-pathogenic isolates were excluded. The 5 most common isolates were identified and mean susceptibilities to antibiotics commonly used for empiric treatment of UTIs were examined. Data standardization and analysis were performed in Open Refine and R.

Results
There were 11,007 urine cultures obtained from 5,642 NH residents living in 67 NHs. A total of 4,398 potentially uropathogens were identified (avg. per NH = 66; range = 2-279). Escherichia coli (43.1%), Klebsiella spp. (14.6%), Proteus spp. (14.3%), Enterococcus spp. (9.5%), and Pseudomonas spp. (4.6%) were the most commonly identified uropathogens. Resistance rates for the majority of evaluated bug-drug combinations (9/14) exceeded 20% (Figure 1). Nitrofurantoin was the only antibiotic with a resistance rate &lt; 20% for E. coli isolates. When resistance was assessed cumulatively across the top 5 organism, 48.5% of isolates were resistant to ciprofloxacin and 21.3% of isolates were resistant to ceftriaxone (when excluding isolates with intrinsic resistance).
Percentage of common urinary isolates resistant to most common antibiotics
R denotes intrinsic resistance. Abbreviation: species pluralis = spp.

Conclusion
Consistent with a recent study conducted in Georgia NHs, high levels of resistance to commonly used antibiotics amongst uropathogens recovered from NH residents in four states were identified in the current study. These suggest a need for NH-specific UTI treatment guidelines and tools to support empiric antibiotic decision-making at the local facility level.

Disclosures
Robin L. Jump, MD, PhD, Merck: Grant/Research Support|Pfizer: Advisor/Consultant.
2300. Neonates born to mothers with SARS-CoV-2 infection in pregnancy: a follow-up and serological study
Authors: Marsico Concetta , Gabrielli Liliana , Arcuri Santo , Vocale Caterina , Borgatti Caterina , Lazzarotto Tiziana , Corvaglia Luigi , Capretti Maria Grazia 
Published: December 2022

Abstract

Background
To evaluate the early and late clinical outcomes of neonates born to mothers with SARS-CoV-2 infection in pregnancy, the dynamics of maternal IgG trans placental transfer and its persistence during the first month of life.

Methods
Prospective study enrolling neonates born to mothers with SARS-CoV-2 infection in pregnancy at IRCCS Azienda Ospedaliero Universitaria di Bologna, Italy, between April 2020 and September 2021. Neonates born to women with infection onset before 2 weeks prior to delivery were enrolled in a 12-month follow-up, including clinical and laboratory evaluations, cranial ultrasound, fundoscopy evaluation. Quantitative IgG to S1/S2 subunits of spike protein were assessed in mother-neonate dyads within 48 hours post-delivery and during follow-up until negative. Transplacental IgG transfer ratio was assessed in relation to the type and trimester of maternal infection.

Results
One hundred and forty-five neonates were included. the rate of preterm delivery was similar between women with and without SARS-CoV-2 infection (6.2% versus 8.7%, P=0.53). No clinical, laboratory, cerebral and fundoscopy abnormalities were detected at birth or during follow-up, through 11 months (range 8–12). MedianIgG level at birth was not different between neonates born to asymptomatic or symptomatic mothers (18.5 AU/mL, IQR 12–49, versus 31.5 AU/mL, IQR 15–71, P=0.07) nor in relation to the trimester of maternal infection (Table 1), even though mothers with third trimester infections had higher IgG level at birth. Transplacental transfer ratio was higher following second trimester maternal infections and was the lowest following third trimester infections (Table 1). Maternally derived IgG were rapidly weaned, with most infants (115/140, 82%) seronegative by 4 months of age.

Conclusion
Early and later outcomes of infants born to SARS-CoV-2 infected mothers were favorable. IgG trans placental transfer was higher following second trimester maternal infections, which could be relevant to inform studies on appropriate vaccination strategies aimed at neonatal protection. Maternally derived IgG are rapidly weaned in the first months of life.

Disclosures
All Authors: No reported disclosures.
1750. Evaluation of Antibiotic Allergy in the Ambulatory Setting
Authors: Yi Sarah M , Barsanti-Sekhar Mary C , Wozniak Amy W , Santarossa Maressa , Adams Jenna , Albarillo Fritzie S 
Published: December 2022

Abstract

Background
It is not uncommon for patients to have a labeled allergy to antibiotics without thorough investigation of their adverse reactions. The adverse reactions described by some patients are not immune-mediated and these patients are incorrectly labeled as having an antibiotic allergy. As clinical testing for antibiotic allergy is expensive and time intensive, recent initiatives have successfully used patient interviewing to differentiate non-immune mediated reactions from true antibiotic allergies. We investigated the prevalence of patients with non-immune mediated reactions to antibiotics among patients with documented antibiotic allergy by using a standardized questionnaire in the outpatient setting.

Methods
Patients with a documented antibiotic allergy were identified and recruited from 2 clinics located in the greater Chicagoland area. Subjects completed one standardized questionnaire regarding each of their previous adverse reaction to antibiotics. We then evaluated the questionnaire responses to extricate the non-immune-mediated adverse reactions. The full symptom classification can be found in Table 1 and Table 2.

Results
98 patients were recruited with a total of 159 antibiotic questionnaires completed. At the patient level, 18 individuals had no immune-mediated reactions despite antibiotic allergy labels: 18.37% (95% CI: 10.7%, 26.3%). At the antibiotic level, 35 labels had corresponding clinical histories that were likely non-immune mediated: 22.0% (95% CI: 14.7%, 29.4%). Macrolides (8/11, 72.7%), nitrofurantoin (1/2, 50%), and amoxicillin/clavulanate (2/8, 25%) were the antibiotics with the highest percentage of corresponding clinical histories that were likely non-immune mediated (Figure 1). Penicillin was the most prevalently listed antibiotic allergy (43/159, 27.0%), followed by sulfonamides (25/159, 15.7%) and fluoroquinolones (21/159, 13.2%).

Conclusion
This study demonstrated the feasibility of using a standardized questionnaire to discern true antibiotic allergies from non-immune mediated adverse reactions. The improved accuracy of documented allergies allows for better optimization of antibiotic prescribing.

Disclosures
All Authors: No reported disclosures.
1760. Selection of appropriate inpatients for outpatient parenteral antimicrobial therapy (OPAT) during the COVID pandemic
Authors: McKnight Angela Y , Liappis Angelike P , Adenew Ayne 
Published: December 2022

Abstract

Background
Providing a safe discharge in patients appropriate for outpatient parenteral antimicrobial therapy (OPAT) became an important focus of the inpatient to outpatient transition during the pandemic. Hospital beds were needed for ill patients with COVID; transfers in and out of facilities and interfacility infection became issues for long-term care (LTCF) and short-term nursing facilities (SNFs) in the US during the pandemic. We examine the traditional barriers, including age, and outcomes of patients selected for OPAT initiation during the pandemic period.

Methods
Washington DC VAMC (WDVAMC) is an urban medical center with 220 acute and LTC beds. At the start of the pandemic, a multidisciplinary OPAT program was initiated and led by ASP Nurse Practitioner (NP), supported by ASP Pharmacist and ASP/ID Physician. OPAT included care continued at home, SNF, LTC and hemodialysis locations; the OPAT program focus was on appropriate selection, post-discharge safety monitoring, outpatient follow-up at completion, tracking and outcome determination (30D, 90D readmissions). OPAT related readmissions related to drug or opat-indicated infections.

Results
Between April 2020-2022, 157 unique OPAT discharges (10.4 OPAT/1,000 admissions 2020 and 4.8 OPAT/1,000 admissions 2021); the majority were offered OPAT at home (47%). Mean duration OPAT 22±13days over that period; most frequent indication osteomyelitis and BSI. OPAT related readmissions were infrequent at 30D (7%) and 90D (1%). The mean age was 67±13y with 5% &gt;90yrs, 21% &gt;75yrs and 58% &gt;65yrs. In the pandemic 92% completed OPAT; compared to younger group those &gt;75y, rates of completion (93% vs 92%, P=NS) and mean duration of OPAT were similar however a modest increase in 90D OPAT-related readmission (1.2% vs 0%, P=0.04). The only two deaths prior to completion of OPAT occurred in those &gt;75y.

Conclusion
Transitions to OPAT are required for serious infections in hospitalized patients of all ages, however transitions to SNF and LTC were limited at times during the pandemic. We found OPAT can be delivered safely, regardless of age during a pandemic state with careful coordination between stakeholders and a systematic process to monitor outcomes and track patients, particularly for the elderly.

Disclosures
All Authors: No reported disclosures.