Prescription Of Antibiotic Prophylaxis Research Articles

236 Post-Splenectomy Patients: Reaudit of Current Practice at Living Well Partnership PCN

Abstract Aim Post-splenectomy patients are at increased risk of sepsis and overwhelming post-splenectomy infection (OPSI). This reaudit aimed to look at a primary care network’s (PCN) compliance with established immunisation guidelines and antibiotic prophylaxis post-splenectomy. Method A retrospective study of 29 splenectomy or asplenia patients between 2018-2022 was conducted within a primary care network. Hospital and GP records were reviewed for antibiotic prescriptions (prophylactic and emergency), vaccination records, electronic splenectomy alert and admission for infection. Interventions included a 15-minute patient intervention GP consultation and correction of EMIS coding. Results The 2018 audit showed that a proportion of splenectomy patients were not appropriately prescribed antibiotics. There was lack of patient insight into their condition (asplenia v splenectomy). An active, patient-centred intervention was employed to improve rates of antibiotic prescribing, perform counselling on regular recommended vaccinations and ensure correct clinical coding for follow up. Compliance to audit criteria increased across all measures between the 3 PDSA cycles. Antibiotic prophylaxis prescription increased from 53% (2018) to 71% in 2022. Emergency antibiotic prescription increased from 6% (2018) to 39% in 2022. Influenza vaccination rates increased from 71% (2018) to 82% in 2022. Following the intervention consultation, 85% of patients had appropriate antibiotic prophylaxis prescription and 64% had appropriate emergency antibiotics prescribed. Conclusions Prescription for emergency and prophylactic antibiotics, and correct coding for annual and 5-year vaccinations were improved for this cohort of splenectomy and asplenia patients. Patients valued a structured consultation leading to improved understanding and self-management.

Oral Postoperative Antibiotic Prophylaxis for Outpatient Total Hip and Knee Arthroplasty: Describing Current Practices

BackgroundDespite an increase in outpatient total hip arthroplasty (THA) and total knee arthroplasty (TKA), large-scale data are lacking on current practice for antibiotic prophylaxis prescribing. We aimed to describe current oral antibiotic prophylaxis practices nationally for outpatient THA and TKA. MethodsThis nationwide retrospective cohort study included primary outpatient THA or TKA procedures in patients aged 18 to 64 years from 2018 to 2021 using a national claims database. Oral antibiotic prescriptions filled perioperatively (defined as 5 days before to 3 days after surgery) were extracted; these were categorized and assumed to represent postoperative prophylaxis. Multivariable logistic regression measured associations between patient and surgery characteristics and perioperative oral antibiotic prophylaxis. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) are reported. ResultsOral antibiotic prescriptions were filled in 16.5% of 73,015 outpatient THA and TKA (18.4% of 24,857 THAs, 15.5% of 48,158 TKAs) procedures. Prescriptions were most often for cephalosporins (74.3%), with cephalexin (52.8%), and cefadroxil (19.1%) being the most common. Non-cephalosporin antibiotics prescribed were mainly clindamycin (6.8%), sulfamethoxazole-trimethoprim (6.7%), and doxycycline (6.2%). The odds of receiving oral antibiotic prophylaxis were higher for THA compared to TKA (OR 1.13, 95% CI 1.09 to 1.18, P < .001) and in the presence of obesity, diabetes, and autoimmune conditions (OR 1.08 to 1.13, P < .001 to .01). Ambulatory surgery center procedures also had significantly increased odds of prophylaxis compared to hospital-based outpatient surgeries (OR 2.62, 95% CI 2.51 to 2.73, P < .001). Additionally, regional and time-based variations were noted. ConclusionsPerioperative oral antibiotic prophylaxis prescriptions were filled in only 16.5% of outpatient THA and TKA cases, with variation in the type of antibiotic prescribed. The receipt of any prophylaxis and specific medications was associated with demographic, clinical, and procedure-related characteristics. Follow-up research will evaluate associations with infection risk reduction.

Shared decision making for perioperative antibiotic use during Mohs micrographic surgery on the lower extremities

While there is a higher risk of surgical site infection (SSI) on the lower extremities following Mohs micrographic surgery (MMS), antibiotic prophylaxis (AP) is debated. To determine the role of shared decision making (SDM) in guiding AP usage during MMS on the lower extremities. A prospective observational study was conducted whereby patients received a standardized SDM discussion or routine counseling. Patient satisfaction quantified by the shared decision-making questionnaire (SDMQ9) survey, rate of SSI, and rate of AP prescription were recorded. In total, 51 patients were included. While there were less antibiotics prescribed in the treatment group (20% versus 50%, P=.025), this did not affect incidence of SSI (8% in treatment group versus 7.7% in control group, P=.668). Patient satisfaction was statistically greater in SDM group (4.73 versus 2.18 in control (P<.001). Patient satisfaction scores were higher among the patients who received SDM. While the usage of AP was lower in the SDM group, this did not affect incidence of SSI. This study allows the opportunity to apply SDM in the setting of MMS, which to our knowledge has not yet been attempted in the field of dermatologic surgery.

Effectiveness of integrated prophylactic antibiotics prescription in patients undergoing radiofrequency and microwave ablation of liver tumors: a retrospective cohort study

An institutionalised in-house antibiotic prophylaxis (AP) guideline was developed in May 2019 to standardize AP prescription. This retrospective cohort study evaluated the effectiveness and clinical outcomes of the newly launched AP guideline on patients undergoing radiofrequency (RFA) and microwave (MWA) ablation of the liver from November 2018 to March 2020. Patients without high risk of biliary tree contamination were recommended a single dose of 2g IV cefazolin (or 600mg IV clindamycin in cases of beta-lactam allergy). Univariate analysis was conducted to evaluate the clinical outcomes.&#x0D; &#x0D; The study included 87 patients who underwent 93 procedures consisting of 18 RFAs and 75 MWAs for liver tumours. Concordance with AP guidelines improved significantly (38.5% vs. 87.0%; p&lt;0.001). There were no ablation-related infections and mortality within 30 days post-ablation, and post-procedural nausea and vomiting were significantly reduced (15.4% vs. 1.9%; p=0.020). No significant difference in post-procedural fever (7.7% vs. 5.6%; p-value=0.693), chest and/or abdominal pain (5.1% vs. 7.4%; p=1.000) were noted.&#x0D; &#x0D; The newly implemented in-house antibiotic prophylaxis guideline streamlined AP prescribing in patients undergoing RFA and MWA. Additional research is needed to determine the effects on infection and mortality in patients with high-risk factors such as bile duct stents, sphincterotomies, and biliary-enteric anastomoses.

Evaluation of Antibiotic Prophylaxis Prescriptions for Infectious Endocarditis Before Oral Procedures Between Cardiologists and Dentists

Evaluation of Antibiotic Prophylaxis Prescriptions for Infectious Endocarditis Before Oral Procedures Between Cardiologists and Dentists

Prescription of antibiotic prophylaxis in implant placement among Portuguese dentists: A web survey.

This study aims to assess whether antibiotic prophylaxis for dental implant placement is commonly used by dentists in Portugal. This cross-sectional survey study was based on a web survey with 22 questions divided into 5 parts. The 1st part focused on demographic details, work experience, and academic expertise, whereas the 2nd and 3rd parts were about the pre- and postoperative antibiotic prescriptions. The 4th and 5th parts focused on dentists' motivation for using/avoiding antibiotic prophylaxis and the use of a protocol, respectively. Data interpretation included descriptive analysis and statistical inference via cross-tabling with chi-square adjusted standardised for residual effects. Of the 204 valid surveys, at least one was received from every large Portuguese city which ensured the national coverage of the survey. Most respondents are not specialist dentists (72%). Sixty-four percent of the respondents always use antibiotic prophylaxis, while 29% adopt it only when grafting materials are employed. Most respondents use both pre- and postoperative regimens (55%). Amoxicillin 875 mg + clavulanic acid 125 mg is the most prescribed antibiotic (57%). Finally, the risk reduction of postoperative infection is the most frequent justification for the use of antibiotic prophylaxis (60%). The results highlight that most of the respondents do not follow the consensual international guidelines for prophylactic antibiotherapy in dental implant placement surgeries. This finding should serve as a rationale to increase the dissemination of those guidelines.

Utilization of Prophylactic Antibiotics for Cardiac Patients Undergoing Dental Procedures in Saudi Arabia: A Retrospective Study.

This study aimed to determine the characteristics of antibiotic prophylaxis (AP) utilization and the level of adherence of King Saud University Medical City (KSUMC) staff to the latest American Heart Association (AHA) guidelines for AP for infective endocarditis (IE) in cardiac patients undergoing dental procedures. The study was conducted as a retrospective cohort study to investigate the relationship between AP in dental procedures and cardiac patients admitted in the surgical wards of KSUMC between 2015 and 2021. All cardiac patients who underwent dental procedures were included in the study. We excluded patients with long-term or concurrent antibiotic use for other indications. Overall, 170 (69.4%) cardiac patients received AP before undergoing a dental procedure. The most common comorbidities were hypertension (39.1%) and diabetes (34.2%). Most of the low-risk (69.4%) and moderate-risk (70.5%) patients received AP, despite the guideline's recommendation to limit AP to high-risk patients only. Moreover, only 53.8% of high-risk patients were prescribed AP. In total, 95.9% of the 170 patients who received AP did so without following the recommendations. Only one patient developed IE during the 1-year follow-up. Tooth extraction was the only significant predictor of AP prescription in our study (P = 0.001; OR: 3.73; 95% CI; 1.678-8.298). There was an exceeding level of inconsistency (95.9%) in AP utilization by cardiac patients in our sample compared with the recommendations of the latest AHA guidelines.

Comparison of guideline concordant antibiotic prophylaxis in Veterans Affairs and non-Veterans Affairs dental settings among those with cardiac conditions or prosthetic joints

BackgroundNo research has been conducted to assess whether antibiotic prophylaxis prescribing differs by dental setting. Therefore, the goal of this study was to compare the prescribing of antibiotic prophylaxis in Veterans Affairs (VA) and non-Veterans Affairs settings.MethodsThis was a retrospective study of veteran and non-veteran dental patients with cardiac conditions or prosthetic joints between 2015–2017. Multivariable log binomial regression analysis was conducted to compare concordant prescribing by setting with a sub-analysis for errors of dosing based on antibiotic duration (i.e., days prescribed).ResultsA total of 61,124 dental visits that received a prophylactic antibiotic were included. Most were male (61.0%), and 55 years of age or older (76.2%). Nearly a third (32.7%) received guideline concordant prophylaxis. VA dental settings had a lower prevalence of guideline concordant prescribing compared to non-VA settings in unadjusted results (unadjusted prevalence ratio [uPR] = 0.92, 95% CI: 0.90–0.95). After adjustment, prevalence of guideline concordant prescribing was higher in those with prosthetic joints in the VA setting (adjusted prevalence ratio [aPR] = 1.73, 95% CI: 1.59–1.88), with no difference identified in those without a prosthetic joint (aPR = 0.99, 95% CI: 0.96–1.01). Concordance of dosing was higher in VA compared to non-VA settings (aPR = 1.11, 95% CI: 1.07–1.15).ConclusionsVA has a higher prevalence of guideline concordant prescribing among those with prosthetic joints and when assessing dosing errors. Though the presence of an integrated electronic health record (EHR) may be contributing to these differences, other system or prescriber-related factors may be responsible. Future studies should focus on to what extent the integrated EHR may be responsible for increased guideline concordant prescribing in the VA setting.

Recurrent Urinary Tract Infection in Adult Patients, Risk Factors, and Efficacy of Low Dose Prophylactic Antibiotics Therapy

BackgroundRecurrent urinary tract infection (UTI) occurs in sizable percentages of patients after a single episode and is a frequent cause of primary healthcare visits and hospital admissions, accounting for up to one quarter of emergency department visits. We aim to describe the pattern of continuous antibiotic prophylaxis prescription for recurrent urinary tract infections, in what group of adult patients they are prescribed and their efficacy.MethodsA retrospective chart review of all adult patients diagnosed with single and recurrent symptomatic urinary tract infection in the period of January 2016 to December 2018.ResultsA total of 250 patients with a single UTI episode and 227 patients with recurrent UTI episodes were included. Risk factors for recurrent UTI included diabetes mellitus, chronic renal disease, and use of immunosuppressive drugs, renal transplant, any form of urinary tract catheterization, immobilization and neurogenic bladder. E. coli infections were the most prevalent organism in patients with UTI episodes. Prophylactic antibiotics were given to 55% of patients with UTIs, Nitrofurantoin, Bactrim or amoxicillin clavulanic acid. Post renal transplant is the most frequent reason to prophylaxis antibiotics (44%). Bactrim was more prescribed in younger patients (P < 0.001), in post-renal transplantation (P < 0.001) and after urological procedures (P < 0.001), while Nitrofurantoin was more prescribed in immobilized patients (P = 0.002) and in patients with neurogenic bladder (P < 0.001). Patients who received continuous prophylactic antibiotics experienced significantly less episodes of urinary tract infections (P < 0.001), emergency room visits and hospital admissions due to urinary tract infections (P < 0.001).ConclusionDespite being effective in reducing recurrent urinary tract infection rate, emergency room visits and hospital admissions due to UTI, continuous antibiotic prophylaxis was only used in 55% of patients with recurrent infections. Trimethoprim/sulfamethoxazole was the most frequently used prophylactic antibiotic. Urology and gynecological referral were infrequently requested as part of the evaluation process for patients with recurrent UTI. There was a lack of use of other interventions such as topical estrogen in postmenopausal women and documentation of education on non-pharmacological methods to decrease urinary tract infections.

Effects of a management team training intervention on the compliance with a surgical site infection bundle: a before–after study in operating theatres in the Netherlands

ObjectivesTo assess the effects of a quality improvement (QI) team training intervention, by measuring the intervention fidelity and the compliance with a surgical site infection (SSI) bundle in the operating...

Incidence of postpartum infections and outcomes associated with antibiotic prophylaxis after normal vaginal birth.

Antibiotic consumption accounted for approximately 15–20% of total drug costs in Thailand. From 2017 to 2018, 24.86% of Thai women who experienced vaginal delivery during normal term labour received antibiotics for postpartum infection. The Thai national practice guidelines set the target use of antibiotic prophylaxis in women following vaginal delivery of normal term labour to be no more than 10%. This study aimed to determine the incidence of postpartum infections and the outcomes and factors associated with antibiotic prophylaxis in women following vaginal delivery. The prospective cohort study was collected from 909 eligible patients who delivered infants in 7 secondary hospitals in Chiang Mai from July 2020 to February 2021. Antibiotic prescribing data and infections in women experiencing vaginal delivery during normal term labour were collected. The incidence of postpartum infections was calculated at 2 periods, 48 h and 6 weeks, after labour. Factors associated with the prescription of antibiotic prophylaxis in vaginal delivery were analysed using multivariate logistic regression. The results showed that the prevalence of antibiotic prescribing was 12.87% in a cohort of 117 patients. Postpartum infection was reported in 3 of 117 patients with antibiotics prophylaxis and 11 of 792 without antibiotics, with no statistically significant difference (RR: 1.04, 95% CI: 0.26–4.14; p = 0.956). Postpartum hygiene self-care practices were collected in the 6th week. The results found that there were no statistical differences in mean scores for all questions on postpartum hygiene self-care practices between the infected and non-infected groups (p-value > 0.05). One of the factors associated with antibiotic prophylaxis was third to fourth degree of tear and episiotomy (OR: 7.72, 95% CI: 1.13–52.75; p = 0.037 and OR: 2.41, 95% CI: 1.24–4.70; p = 0.010, respectively). There was no significance difference in postpartum infection among patients receiving antibiotic and those who did not receive antibiotics. Third to fourth degree of tear and episiotomy were significantly factors related to antibiotic prophylaxis in women with vaginal delivery after labour. This study supports practice guidelines and helps healthcare team to be assured on the use of antibiotics in no more than 10% of women experiencing normal vaginal delivery.

Improvement of patient care through hirudotherapy and the management of leeches from their reception to their disposal in France

ObjectiveMedicinal leech therapy — known as hirudotherapy (HT) — is an empirical medical technique that has become popular again in reconstructive surgery. However, at each step of leech management there...

Antibiotic prophylaxis in total joint arthroplasty – the usual practice and variability among joint replacement surgeons in Hong Kong

Background Perioperative antibiotics is a well established measure to prevent periprosthetic joint infection (PJI). However, the usual practice of prescription vary from surgeon to surgeon. This study aims to investigate and compare the usual practice and variability of prescribing antibiotic prophylaxis among different joint replacement surgeons in Hong Kong. Methods An online questionnaire was prepared and sent to members of the Adult Joint Reconstruction (AJR) Chapter of the Hong Kong Orthopaedic Association (HKOA). The questionnaire consists of a total of 15 questions in 3 categories: choice of antibiotics, dose of antibiotics and duration of antibiotics prescribed by the surgeon. Results A total of 25 responses were received and data collected. Participants were from a diverse background from different hospitals with variable years of experience. Results showed a general consensus on the choice of antibiotics, but also a wide variability on the actual prescription, particularly about the weight-adjusted dose and total duration of antibiotics given. Conclusion There is a wide variability among surgeons regarding the actual prescription of antibiotic prophylaxis. Correlation between rate of PJI and specific aspects of antibiotic prescription is needed to give recommendations to surgeons regarding perioperative antibiotic usage in total joint arthroplasties.

Factors that affect dentists’ use of antibiotic prophylaxis: Findings from The National Dental Practice-Based Research Network questionnaire

BackgroundLittle is known about factors that influence dentists’ decision making concerning antibiotic prophylaxis (AP) prescribing. The objective of this study was to determine factors that influence dentists’ AP prescribing habits in patients at risk of developing infective endocarditis and prosthetic joint infections. MethodsA questionnaire was administered to 3,584 dentist members of The National Dental Practice-Based Research Network. In addition to descriptive statistics, ordinal regression models were used to determine the factors most likely to impact dentists’ decisions to prescribe AP. ResultsOverall, 2,169 (61%) dentists in The National Dental Practice-Based Resesarch Network responded. Responders’ decisions to prescribe antibiotics were influenced primarily by official guidelines, scientific literature, and physician or medical specialist opinion. Regarding potential risks, the greatest level of concern was for the development of infective endocarditis or prosthetic joint infections. Although litigation was deemed problematic, more than 90% of responders indicated a strong concern for the best course of action for the patient’s health. Dentists also indicated a high level of concern about the potential for generating antibiotic-resistant bacteria with AP use and increased risk of adverse drug reactions. ConclusionsDentists’ AP decision making seems most influenced by official guidelines, scientific literature, and advice from a physician or medical specialist. Practical ImplicationsThese results suggest that one of the most effective means for promoting concordance of dentists clinical practice with the scientific basis for AP is to emphasize the importance and clarity of American Heart Association and American Dental Association recommendations and antimicrobial stewardship regarding prevention of infective endocarditis and prosthetic joint infections.

Revue de l’utilisation de l’antibioprophylaxie en chirurgie pédiatrique dans un centre hospitalier universitaire mère–enfant

The main objective was to evaluate the surgical antibiotic prophylaxis's compliance rate. The secondary objectives were to evaluate the tools designed to help the surgical antibiotic prophylaxis's prescription, and evaluate the surgical site infection rate. This retrospective study was done in a university hospital on a random selection of 125 pediatric patients having undergone a surgery (cardiac, general, neurological, ENT, orthopedic or plastic). Compliance to the current recommendations has been assessed. Out of the 125 studied patients (2 exclusions), the indication was compliant at 87% (107/123). The perioperative document included an intention to use antibiotic prophylaxis in 24% of cases (29/123). The compliance for the presence of the standard order set for antibiotic prophylaxis was only 15% (19/123). The compliance for the preoperative administration varied: antibiotic choice (94%, 63/67), dose (91%, 61/67), route (99%, 66/67), timing (30%, 20/67). The compliances for intra- and postoperative administrations were respectively 75% (57/76) and 89% (68/76). The surgical site infection rate was 4% (5/123). The use of a standard order set for antibiotic prophylaxis and the timing of the preoperative administration were sub-optimal. A better dissemination and use of the administrative tools and the implementation of a coordination system with the members of anesthesia services would improve these important aspects of the surgical antibiotic prophylaxis. The establishment of a digital perioperative document is planned.

Antibiotic prophylaxis prescriptions prior to dental visits in the Veterans' Health Administration (VHA), 2015-2019.

To determine prophylaxis appropriateness by Veterans' Affairs (VA) dentists. A cross-sectional study of dental visits, 2015-2019. Antibiotics within 7 days before a visit in the absence of an oral infection were included. Appropriate antibiotic prophylaxis was defined as visits with gingival manipulation and further delineated into narrow and broad definitions based on comorbidities. The primary analysis applied a narrow definition of appropriate prophylaxis: cardiac conditions at the highest risk of an adverse outcome from endocarditis. The secondary analysis included a broader definition: cardiac or immunocompromising condition or tooth extractions and/or implants. Multivariable log-linear Poisson generalized estimating equation regression was used to assess the association between covariates and unnecessary prophylaxis prescriptions. In total, 358,078 visits were associated with 369,102 antibiotics. The median prescription duration was 7 days (IQR, 7-10); only 6.5% were prescribed for 1 day. With the narrow definition, 15% of prophylaxis prescriptions were appropriate, which increased to 72% with the broader definition. Prophylaxis inconsistent with guidelines increased over time. For the narrow definition, Black (vs White) race, Latine (vs non-Latine) ethnicity, and visits located in the West census region were associated with unnecessary prophylaxis. Variables associated with a lower risk were older age, prosthetic joints, immunocompromising condition, and rural location. Of every 6 antibiotic prophylaxis prescriptions, 5 were inconsistent with guidelines. Improving prophylaxis appropriateness and shortening duration may have substantial implications for stewardship. Guidelines should state whether antibiotic prophylaxis is indicated for extractions, implants, and immunocompromised patients.

Appropriateness of Antibiotic Prophylaxis Before Dental Procedures, 2016–2018

Prescribing antibiotic prophylaxis is common yet unnecessary for many dental visits. In this analysis, our objective was to assess whether the appropriateness of antibiotic prophylaxis has improved over time. A retrospective cohort study was conducted using dental visits from 2016 to 2018 (data analyzed in 2021) using medical and prescriptions claims data of patients from the U.S. with commercial dental insurance. Antibiotic prophylaxis was defined as a ≤2 days' supply prescription dispensed within 7 days before a dental visit. Appropriateness of prophylaxis was defined on the basis of the manipulation of the gingiva/tooth periapex or oral mucosa perforation in patients with appropriate cardiac diagnoses. Associations between patient and visit characteristics and appropriateness of antibiotic prophylaxis were assessed using multiple Poisson regression. Unnecessary antibiotic prophylaxis was highly prevalent in this cohort, ranging from 77.0% in 2016 to 78.5% in 2018. In the adjusted analysis, factors associated with unnecessary antibiotic prophylaxis included younger age, female sex, geographic region, rurality, type of antibiotic, and certain dental procedures. The factors associated with the highest risk of unnecessary prophylaxis in the adjusted analysis were orthodontic procedures and having a history of a prosthetic joint. Notably, the risk of unnecessary antibiotic prophylaxis decreased over time in the adjusted analysis. Unnecessary prescription of antibiotic prophylaxis by dentists continues to be common. Antimicrobial stewardship strategies are needed to improve prescribing by dentists.

141. Effectiveness of a Multipronged Approach to Improve Prophylactic Antibiotic Prescribing in Patients Undergoing Trans-Arterial Chemoembolization

BackgroundIn our institution, the significant use of broad-spectrum antibiotics for antibiotic prophylaxis (AP) in trans-arterial chemoembolization (TACE) was operator dependent and not evidence based. Hence, an AP guideline was developed with the Department of Vascular and Interventional Radiology and launched in May 2019, following department roadshows and creation of user-friendly electronic AP order sets. We analyzed the effectiveness and outcomes of our multipronged approach towards improving the standardization of AP prescribing.MethodsThis was a retrospective study of TACE procedures from November 2018 to March 2020, pre and post guideline implementation (Figure 1). Single IV cefazolin 2g dose (or IV clindamycin 600mg in the setting of β-lactam allergy) before TACE in patients with an uncompromised sphincter of Oddi was recommended. Patients with active infections prior to TACE were excluded. AP was deemed inappropriate if it deviated from guidelines (antibiotic choice and/or duration). Primary outcome was AP appropriateness and 30-day TACE related infections.Figure 1. Timeline of our multipronged approach ResultsSeventy patients were included. There were no differences in baseline demographics pre and post implementation (Table 1). Following guideline implementation, there was a significant improvement in AP used for TACE. AP appropriateness pre-implementation and post-implementation was 14/31 (45.2%) and 37/39 (94.9%) respectively (p< 0.001). Guideline compliant antibiotics were selected more frequently (14 [45.2%] vs 38 [97.4%], p< 0.001), and more patients received single dose AP (22 [71.0%] vs 38 [97.4%], p=0.004). Of the 18 patients who did not receive guideline recommended AP, 16 (88.9%) received IV ceftriaxone and metronidazole, 1 (5.6%) IV amoxicillin/clavulanic acid, and 1 (5.6%) IV ciprofloxacin. Ten patients received a prolonged course of AP with a median duration of 6 days (IQR 4.3, 6.5). There were no significant differences in 30-day TACE related infections (1 [3.2%] vs 2 [5.1%], p=1.000) and 30-day mortality (1 [3.2%] vs 1 [2.6%], p=1.000). No patient had surgical site skin infection. ConclusionOur multipronged approach improved AP prescribing in patients undergoing TACE. Single dose IV cefazolin prophylaxis for TACE did not compromise safety outcomes in the post implementation review.Disclosures All Authors: No reported disclosures

Trends in quality of care among children with sickle cell anemia.

For decades, it has been recommended that children with sickle cell anemia (SCA) receive antibiotic prophylaxis to prevent serious infections and undergo transcranial Doppler (TCD) screening to identify those at highest risk of overt stroke. We assessed recent temporal trends in antibiotic prophylaxis prescription fills and TCD screening among children with SCA using validated quality measures. Using validated claims-based definitions, we identified children with SCA who were enrolled in Michigan or New York State (NYS) Medicaid programs (2011-2018). Among recommended age groups, two outcomes were assessed yearly: (a) filling of ≥300days of antibiotics, and (b) receipt of greater than or equal to one TCD. The proportion of children with each outcome was calculated by state. Temporal trends in each preventive service were assessed using generalized linear models. A total of 1784 children were eligible for antibiotic prophylaxis (Michigan: 384; NYS: 1400), contributing 3322 person-years. Annual rates of filling ≥300days of antibiotics ranged from 16% to 22% and were similar by state. There was no change in rates of antibiotic filling over time in Michigan (p-value: .10), but there was a decrease in NYS (p-value: .02). A total of 3439 children with SCA were eligible for TCD screening (Michigan: 710; NYS: 2729), contributing 10,012 person-years. Annual rates of TCD screening ranged from 39% to 45%, were similar by state, and did not change over time (p-values >.05). Most children with SCA do not receive recommended antibiotic prophylaxis and/or TCD screening. New, sustainable, and coordinated interventions across preventive services are urgently needed.

Awareness of Antibiotic Prophylaxis Prescription for Patients with Prosthetic Joint Undergoing Dental Implant Placement

Awareness of Antibiotic Prophylaxis Prescription for Patients with Prosthetic Joint Undergoing Dental Implant Placement