Use Of Antibiotics In Patients Research Articles

Enabling antibiotic allergy evaluations and reintroduction of first-line antibiotics for patients with cystic fibrosis

BackgroundPatients with cystic fibrosis (CF) often have a history of antibiotic adverse drug reactions (ADRs) that pose a barrier to receiving recommended first-line treatment. Targeted antibiotic allergy evaluations are increasingly recognized as an important strategy for optimization of antimicrobial stewardship. ObjectiveTo improve first-line antibiotic use in patients with CF with antibiotic ADRs by streamlining access to antibiotic allergy evaluations and standardizing documentation of plans for antibiotic reintroduction. MethodsWe incorporated allergy evaluations into a multidisciplinary CF clinic and used telemedicine when allergy evaluations could not be performed during CF clinic. Standard documentation of antibiotic allergy plans was used to enable safe reintroduction of first-line antibiotics by CF providers. ResultsStrategies used in this study allowed 81.3% (26 of 32) of patients with CF to receive allergy evaluations and antibiotic allergy plans for prioritized antibiotics (penicillin, cephalosporin, sulfonamide), with removal of 41.0% (16 of 39) of prioritized antibiotic ADRs. Only 5.1% (2 of 39) of prioritized antibiotic ADRs evaluated required strict avoidance after evaluation. There were 9 patients who received at least 1 prioritized antibiotic, with 66.6% (6 of 9) of these patients given the antibiotic after only 1 allergy evaluation visit. Furthermore, these strategies allowed allergy evaluations of 23 nonprioritized antibiotics to occur, with removal of the ADR in 39.1% (9 of 23) and use of 77.8% (7 of 9) of nonprioritized antibiotics after removal. ConclusionIncorporating allergy evaluations into a multidisciplinary CF clinic can liberalize first-line antibiotic use in patients with CF. Standard documentation of antibiotic allergy plans allowed antibiotic reintroduction to occur even before complete removal of documented antibiotic ADRs.

Antibiotic use in patients with Coronavirus disease 2019 (COVID-19): outcomes and associated factors

ABSTRACT Objectives To characterise the factors, outcomes and infections associated with antibiotic use in COVID-19 patients. Methods Records of patients with RT-PCR-confirmed COVID-19, hospitalized at the CHU Charleroi (Belgium) between 11 March and 3 May 3 2020, were retrospectively reviewed. Factors associated with antibiotic treatment, outcomes and bacterial infections were analysed. Results Among the 164 hospitalized COVID-19 patients (median age 60.5 years [IQR] 46–79), twenty-five (15.2%) were admitted to the ICU. Twenty-six (15.9%) died in the hospital. One hundred (61%) received antibiotic treatment. Combination therapies with macrolides were more common in the early part of the study period (26/67, 38.8%). Twenty-eight patients (17.1%) had a confirmed infection, mostly of the urinary tract (18/28, 64.3%). Only 2 (1.2%) had a documented respiratory coinfection. Six of the 7 ICU infections (85.7%) were superinfections. Gram-negative bacteria were most frequently isolated. In multivariate analysis, six factors were associated with antibiotic use: being hospitalized in the ICU (OR: 4.59; 95% CI 1.07–19.71), age > 65 years (OR: 4.16; 95% CI 1.72–10.05), arrival from a nursing home (OR: 4.59; 95% CI 1.11–19.71), diabetes (OR: 4.35; 95% CI 1.26–14.93), bilateral consolidation on chest CT (OR: 9.92; 95% CI 2.40–41.06) and a C-reactive protein level > 60 mg/L (OR:2.46; 95% CI 1.13–5.37). Antibiotic treatment did not reduce the length of stay or the mortality rate. Conclusion Antibiotics have been overused during the COVID-19 pandemic, despite a low rate of coinfections . Integrating the antimicrobial stewardship (AMS) programme into the COVID-19 response is essential.

Self-prescribing of antibiotics by patients seeking care in Indian emergency departments.

Study objectiveAntibiotic resistance is a global health threat. India has one of the highest rates of antibiotic use in the world. The objective of this study was to evaluate the prevalence of self‐prescribed antibiotic use of patients presenting with febrile and infectious disease‐related complaints to Indian emergency departments.MethodsThis was a prospective observational study conducted at 6 Indian emergency departments (EDs) between January 1, 2019 and December 31, 2019. Adult patients who presented with a chief complaint of febrile illness or infectious disease complaints were included. Our principal outcomes of interest were self‐prescribed use of antibiotics within the prior 6 months or for the presenting complaint. We queried respondents about source of antibiotics as well as about demographic characteristics that influenced use.ResultsA total of 1421 patients were enrolled. Sixty percent (n = 856) of respondents reported using antibiotics in the prior 6 months or for their current complaint. Those who reported self‐prescribing antibiotics either in the past or currently had at least some college education (P < 0.001), tended to use the pharmacy (P < 0.001) or the ED (P = 0.001) for their care when sick, and were more likely to have some comorbid conditions (P = 0.014) as compared to the group that did not self‐prescribe antibiotics. The most common reason respondents reported self‐prescribing antibiotics was because they did not want to wait to see their doctor (n = 278, 33%). Thirty‐five percent of patients who were self‐prescribed antibiotics before presentation did not receive and were not prescribed antibiotics in the ED, at discharge, or both.ConclusionsSelf‐prescribing of antibiotics occurs commonly in India. This use increases the risk for resistance due to inappropriate or unnecessary use. Promotion of antibiotic stewardship is needed to curtail such use.

Use of antibiotics is associated with worse clinical outcomes in patients with cancer treated with immune checkpoint inhibitors: A systematic review and meta-analysis

ObjectivesObservational and experimental studies suggest that the use of antibiotics close to administration of immune checkpoint inhibitors (ICI) can have a negative effect on tumour response and patient survival, due to microbiome dysbiosis and the resultant suppression of host immune response against neoplastic cells. MethodsA systematic search of PUBMED and EMBASE was undertaken for studies published between 1 January 2017 and 1 June 2020, evaluating the association between the use of antibiotics and clinical outcomes in patients with cancer treated with ICIs. A meta-analysis of the association between the use of antibiotics and clinical outcomes was also performed. ResultsForty-eight studies met the inclusion criteria (12,794 patients). Use of antibiotics was associated with shorter overall survival [hazard ratio (HR) 1.88, 95% confidence interval (CI) 1.59–2.22; adjusted HR 1.87, 95% CI 1.55–2.25] and progression-free survival (HR 1.52, 95% CI 1.36–1.70; adjusted HR 1.93, 95% CI 1.59–2.36), decreased response rate [odds ratio (OR) 0.54, 95% CI 0.34–0.86] and more disease progression (OR 2.00, 95% CI 1.27–3.14). The negative association between the use of antibiotics and progression-free survival was stronger in patients with renal cell carcinoma or melanoma compared with lung cancer. Only antibiotic administration >1 month prior to ICI initiation was associated with increased disease progression. Heterogeneity was substantial for all outcomes. ConclusionsRecent use of antibiotics in patients with cancer treated with ICIs was associated with worse clinical outcomes. Such patients may benefit from dedicated antimicrobial stewardship programmes.

Formation of Autoimmune Lesions Is Independent of Antibiotic Treatment in NOD Mice.

The relationship between autoimmunity and changes in intestinal microbiota is not yet fully understood. In this study, the role of intestinal microbiota in the onset and progression of autoimmune lesions in non-obese diabetic (NOD) mice was evaluated by administering antibiotics to alter their intestinal microenvironment. Flow cytometric analysis of spleen cells showed that antibiotic administration did not change the proportion or number of T and B cells in NOD mice, and pathological analysis demonstrated that autoimmune lesions in the salivary glands and in the pancreas were also not affected by antibiotic administration. These results suggest that the onset and progression of autoimmunity may be independent of enteral microbiota changes. Our findings may be useful for determining the appropriate use of antibiotics in patients with autoimmune diseases who are prescribed drugs to maintain systemic immune function.

Decreased antibiotic exposure using a procalcitonin protocol for respiratory infections and sepsis in US community hospitals (ProCommunity)

Objective Antibiotic overuse leading to antimicrobial resistance is a global public health concern. Clinical trials have demonstrated that procalcitonin-based decision-making for antibiotic therapy can safely decrease inappropriate antibiotic use in patients with respiratory infections and sepsis, but real-world data are scarce. This study sought to assess the impact of a procalcitonin-based antibiotic stewardship program (protocol plus education) on antibiotic use in community hospitals. Methods An observational, retrospective, matched cohort study was conducted. Eligible patients treated in hospitals with a procalcitonin-based protocol plus education (Procalcitonin cohort hospitals) were matched to patients admitted to facilities without procalcitonin testing (Control cohort hospitals) using a 1:2 ratio. The Control hospitals were facilities where procalcitonin testing was not available on site. Patient matching was based on: (1) age, (2) gender, (3) admission diagnosis code using groupings of the International Classification of Diseases, 10th Revision, (4) whether patients were admitted to the intensive care unit, and (5) whether a blood culture test was performed. Procalcitonin cohort hospitals implemented a quality improvement initiative, where procalcitonin was available, used regularly, and clinicians (physicians and pharmacists) were educated on its use. Results After adjustment, patients in the Procalcitonin cohort had 1.47 fewer antibiotic days (9.1 vs. 8.5 days, 95%CI: −2.72; −0.22, p = .021). There was no difference in length of stay or adverse clinical outcomes except for increase in acute kidney injury (odds ratio = 1.26, 95%CI: 1.01; 1.58, p = .038). Conclusions Patients with respiratory infections and sepsis in hospitals utilizing a procalcitonin-based protocol coupled with education received fewer days of antibiotic therapy.

Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial.

C-reactive protein (CRP) point-of-care testing can reduce antibiotic use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in primary care, without compromising patient care. Further safe reductions may be possible. To investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in primary care. Secondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care (the PACE trial). Clinicians collected participants' demographic features, comorbid illnesses, clinical signs, and symptoms. Antibiotic prescribing decisions were made after participants were randomised to receive a point-of-care CRP measurement or usual care. Multivariable regression models were fitted to explore the association between patient and clinical features and antibiotic prescribing, and extended to further explore any interactions with CRP measurement category (CRP not measured, CRP <20 mg/l, or CRP ≥20 mg/l). A total of 649 participants from 86 general practices across England and Wales were included. Odds of antibiotic prescribing were higher in the presence of clinician-recorded crackles (adjusted odds ratio [AOR] = 5.22, 95% confidence interval [CI] = 3.24 to 8.41), wheeze (AOR = 1.64, 95% CI = 1.07 to 2.52), diminished vesicular breathing (AOR = 2.95, 95% CI = 1.70 to 5.10), or clinician-reported evidence of consolidation (AOR = 34.40, 95% CI = 2.84 to 417.27). Increased age was associated with lower odds of antibiotic prescribing (AOR per additional year increase = 0.98, 95% CI = 0.95 to 1.00), as was the presence of heart failure (AOR = 0.32, 95% CI = 0.12 to 0.85). Several demographic features and clinical signs and symptoms are associated with antibiotic prescribing in AECOPD. Diagnostic and prognostic value of these features may help identify further safe reductions.

Evaluasi Penggunaan Antibiotik pada Pasien Rawat Inap di Bangsal Penyakit Dalam RSUD. Dr. H. Abdul Moeloek Provinsi Lampung

The high prevalence of infectious disease in Indonesia causes increased use of antibiotics. It has serious consequences since it can cause germicidal resistance rapidly increased, significant morbidity and mortality, as well as high additional medical costs per year. This study aims to evaluate the appropriateness of antibiotic use inpatients in the internal medicine ward of Dr. H. Abdul Moeloek in Lampung Province. This research was observational (non-experimental) with a descriptive evaluative research design. The data were obtained from the retrospective tracing of medical records that collected by a purposive sampling technique on July-December 2017. A total of 163 inclusion samples are analyzed qualitatively and quantitatively. The qualitative analysis uses standard guidelines for the use of antibiotics and quantitative analysis uses the anatomical therapeutic chemical (ATC)/Defined Daily Dose (DDD) method. The results showed that out of 168 medical records, 19 types of antibiotics were used with a 118.57 DDD value of 100 patient days. The most widely prescribed was ceftriaxone (49.09%). The highest number of infections was diabetic ulcers with an incidence of 42 cases (25%). Out of 168 evaluated cases, 166 cases (98.8%) were appropriate indication, 168 cases (100%) were appropriate patients, 150 cases (89,29%) were appropriate medication, and 89 cases (52,97%) were appropriate dosage. These results indicated that the use of antibiotics inpatients in the internal medicine ward of Dr. H. Abdul Moeloek in Lampung Province were rational but it was necessary to consider selectivity regarding the choice of antibiotic use for infected patients.

Peripheral muscle strength is associated with aerobic fitness and use of antibiotics in patients with cystic fibrosis.

Individuals with cystic fibrosis (CF) may develop muscle abnormalities, although little is known on its clinical and functional impact. This study aimed to evaluate the association of peripheral muscle strength with aerobic fitness, habitual physical activity, lung function and the use of antibiotics (ATB) in patients with CF. A cross-sectional study where individuals aged ≥6years underwent peripheral muscle strength evaluation (biceps, quadriceps and hamstrings) and performed a cardiopulmonary exercise test. Demographic, anthropometric, genetic, lung function and total days of ATB use within 1year of tests were also collected. Correlation was found for biceps (r=.45; P=.002) strength with the peak oxygen consumption (VO2 peak). Muscle strength (biceps and quadriceps) also correlated with the ventilatory equivalent for oxygen consumption (VE /VO2 ) at anaerobic threshold (AT) and with the ventilatory equivalent for carbon dioxide production (VE /VCO2 ) both at AT and peak exercise. Negative correlations were found for quadriceps (r=-.39) and hamstrings (r=-.42) with the total days of ATB use in the following year. Patients needing to use ATB presented lower biceps strength (P=.05) and individuals with VO2 peak lower than 37mL·kg-1 ·min-1 presented lower muscle strength for both biceps (P=.01) and quadriceps (P=.02). The results have shown that peripheral muscle strength is associated with aerobic fitness and the use of antibiotics in patients with CF.

EVALUASI PENGGUNAAN ANTIBIOTIK PADA PASIEN INFEKSI SALURAN PERNAFASAN DI PUSKESMAS RAWAT JALAN KECAMATAN SIULAK MUKAI KABUPATEN KERINCI TAHUN 2018

Respiratory infections a major health problem that is commonly found in Indonesia. The height prevalence of respiratory tract infections and their effects have consequences high consumption of over the counter medicines and antibiotics. This research aims to evaluating the use of antibiotics which includes the right patient, the right indication of the drug, the right dose, and the interaction of the drug in patients with respiratory infections in outpatien health centers in the district of Siulak Mukai in Kerinci District in 2018. This study is a observational research is descriptive in nature by collecting data on records medical outpatients retrospectively according to age inclusion criteria 25 years, patients with a diagnosis of respiratory tract infections in outpatient health centers in the district of Siulak Mukai, Kerinci Regency in 2018, complete medical record data and analyzed with the guidelines of Pharmaceutucal Care 2005 with descriptive methods. The results of evaluating the use of antibiotics in patients with respiratory tract infections in outpatient clinics in the district of Siulak Mukai in Kerinci Regency in 2018, showed that 100 % apporopriate treaments, as well as the incidence of antibiotic drug interactions by 2 events.

EVALUASI PENGGUNAAN ANTIBIOTIK PADA PASIEN INFEKSI SALURAN PERNAFASAN DI PUSKESMAS RAWAT JALAN KECAMATAN SIULAK MUKAI KABUPATEN KERINCI TAHUN 2018

Respiratory infections a major health problem that is commonly found in Indonesia. The height prevalence of respiratory tract infections and their effects have consequences high consumption of over the counter medicines and antibiotics. This research aims to evaluating the use of antibiotics which includes the right patient, the right indication of the drug, the right dose, and the interaction of the drug in patients with respiratory infections in outpatien health centers in the district of Siulak Mukai in Kerinci District in 2018. This study is a observational research is descriptive in nature by collecting data on records medical outpatients retrospectively according to age inclusion criteria 25 years, patients with a diagnosis of respiratory tract infections in outpatient health centers in the district of Siulak Mukai, Kerinci Regency in 2018, complete medical record data and analyzed with the guidelines of Pharmaceutucal Care 2005 with descriptive methods. The results of evaluating the use of antibiotics in patients with respiratory tract infections in outpatient clinics in the district of Siulak Mukai in Kerinci Regency in 2018, showed that 100 % apporopriate treaments, as well as the incidence of antibiotic drug interactions by 2 events.

Antibiotic use towards the end of life: development of good practice recommendations

ObjectivesDevelopment of evidence-based good practice recommendations for clinicians considering the use of antibiotics in patients towards the end of life.DesignA multiprofessional group of experts in end-of-life care and antimicrobial stewardship...

Association between prophylactic antibiotic use for transarterial chemoembolization and occurrence of liver abscess: a retrospective cohort study

ObjectivesClinical evidence on prophylactic antibiotics for transarterial chemoembolization (TACE) to prevent liver abscess is limited because liver abscess is a rare event. This study aimed to analyse the association between prophylactic antibiotic use for TACE and the occurrence of liver abscess after TACE. MethodsUsing the nationwide Diagnosis Procedure Combination database in Japan, we retrospectively identified patients who underwent TACE for hepatic cancer between July 2010 and March 2017. The primary outcome was liver abscess requiring procedural intervention within 30 days of TACE. Secondary outcomes included 30-day in-hospital mortality and length of stay. Propensity score matching was performed to adjust for potential confounding factors and compare outcomes between patients with and without prophylactic antibiotics. ResultsAmong 167 544 eligible patients, 134 712 received antibiotics and 32 832 did not. In the matched cohort of 29 211 pairs, the proportion of patients with liver abscess requiring procedural intervention was significantly lower in the antibiotics group than in the no-antibiotics group (0.08% vs. 0.22%, p 0.001; relative risk (95% confidence interval), 0.35 (0.22–0.57); absolute risk reduction, 0.0014 (0.0008–0.0021); and number needed to treat, 696 (476–1223)). There was no significant difference in 30-day in-hospital mortality between the groups. The length of stay was longer in the antibiotics group than in the no-antibiotics group (median, 10 vs. 9 days, p < 0.001). ConclusionsProphylactic antibiotic use in patients undergoing TACE was associated with a reduced occurrence of liver abscess requiring procedural intervention.

The use of Lactobacillus casei DG\xae prevents symptomatic episodes and reduces the antibiotic use in patients affected by chronic bacterial prostatitis: results from a phase IV study

PurposeTo evaluate the efficacy of Lactobacillus paracasei CNCM I-1572 (L. casei DG®) in both prevention of symptomatic recurrences and improvement of quality of life in patients with chronic bacterial prostatitis (CBP).MethodsPatients with CBP attending a single Urological Institution were enrolled in this phase IV study. At enrollment, all patients were treated with antibiotics in agreement with EAU guidelines and then were treated with L. casei DG® (2 capsules/day for 3 months). Clinical and microbiological analyses were carried out before (enrollment, T0) and 6 months (T2) after the treatment. Both safety and adherence to the treatment were evaluated 3 months (T1) after the enrollment. NIH Chronic Prostatitis Symptom Index (CPSI), International Prostate Symptom Score (IPSS) and Quality of Well-Being (QoL) questionnaires were used. The outcome measures were the rate of symptomatic recurrence, changes in questionnaire symptom scores and the reduction of antibiotic use.ResultsEighty-four patients were included. At T2, 61 patients (72.6%) reported a clinical improvement of symptoms with a return to their clinical status before symptoms. A time dependent improvement in clinical symptoms with significant changes in NIH-CPSI, IPSS and QoL (mean difference T2 vs T0: 16.5 ± 3.58; − 11.0 ± 4.32; + 0.3 ± 0.09; p < 0.001), was reported. We recorded that L. casei DG® treatment induced a statistically significant decrease in both (p < 0.001) symptomatic recurrence [1.9/3 months vs 0.5/3 months] and antibiotic use [− 7938 UDD]. No clinically relevant adverse effects were reported.ConclusionsL. casei DG® prevents symptomatic recurrences and improves the quality of life in patients with CBP, reducing the antibiotic use.

COVID19 pandemic is a «pandemic» of antimicrobial therapy

The article presents a critical analysis of antibiotic usage tactics in the treatment of patients with COVID-19 existing in Russian and foreign healthcare, and discusses the possible causes of unjustified antibiotic aggression in this category of patients. The potential negative consequences of the widespread use of antibiotics in patients carrying a new coronavirus infection are analyzed: life-threatening cardiotoxicity in patients with the simultaneous administration of such a «popular» candidate etiologic therapy as a combination of azithromycin and hydroxychloroquine, the potential development of other serious adverse drug reactions (in particular, the development of an antibiotic-associated pseudomembranous colitis, etc.), the expected dramatic increase in the secondary drug resistance of potentially pathogenic microorganisms to widely and often prescribed antibiotics.

1412. The utility of respiratory viral panel testing for nosocomial fever in the neonatal intensive care unit

BackgroundPatients in the neonatal intensive care unit (NICU) often develop fevers during their inpatient stay. Many neonates are empirically started on antibiotics due to their fragile clinical status. We sought to evaluate whether the respiratory viral panel (RVP) PCR test is associated with use of antibiotics in patients who develop a fever in the NICU.MethodsWe conducted a retrospective chart review on patients admitted to the Level 4 NICU of the University of Maryland Medical Center from November 2015 to June 2018. We included all neonates who developed a fever 48 hours into their admission. We collected demographic information and data on length of stay, fever work-up and diagnostics (including labs, cultures, RVP), and antibiotic use. Descriptive statistics, Fisher exact test, linear regression, and Welch’s ANOVA were performed.ResultsAmong 347 fever episodes, the mean age of neonates was 72.8 ± 21.6 days, and 45.2% were female. Out of 30 total RVP samples analyzed, 2 were positive (6.7%). The most common causes of fever were post-procedural (5.7%), pneumonia (4.8%), urinary tract infection (3.5%), meningitis (2.6%), bacteremia (2.3%), or due to a viral infection (2.0%). Antibiotics were started in 208 patients (60%), while 61 neonates (17.6%) were already on antibiotics. The mean length of antibiotics was 7.5 ± 0.5 days. Neonates were more likely to get started on antibiotics if they had a negative RVP compared to those without a negative RVP (89% vs. 11%, p-value < 0.0001). Patients with a positive RVP had a decreased length of stay compared to those without a positive RVP (30.3 ± 8.7 vs. 96.8 ± 71.3, p-value 0.01). On multivariate linear regression, a positive RVP was not associated with length of stay.ConclusionNeonates with a negative respiratory viral PCR test were more likely to be started on antibiotics for fevers. Respiratory viral PCR testing can be used as a tool to promote antibiotic stewardship in the NICU.Disclosures All Authors: No reported disclosures

240. Reduction of antibiotic use in children admitted with viral respiratory tract infections

BackgroundViral respiratory tract infections (VRTI) accounts for a significant proportion of hospitalized children and contributes to a substantial use of health care resources and costs. American Academy of Pediatrics (AAP) recommends against using antibiotics in uncomplicated viral respiratory infections in children. Overuse of antibiotics ranges between 29–80%. The goal of an Antibiotic stewardship programs (ASP) is to decrease antibiotic misuse, lower costs, and prevent emergence of antibiotic resistance in the community.Proportion of children with Viral respiratory tract infections on antibiotics MethodsOur smart aim was to reduce antibiotic use by 25% in admitted children with VRTI between October 2019-March 2020. Our outcome measure was to reduce inappropriate antibiotic use during the 2019–20 season by 25%. Process measures included percentage of antibiotic used in viral RTI, antibiotic days of therapy and appropriate audit-feedback from the ASP team to facilitate discontinuation or de-escalation of antibiotics based on culture data. Our balance measure included readmission rates in patients in whom antibiotics were discontinued or de-escalated. Several PDSA cycles implemented with predominant emphasis on communication between ASP team and primary providers.ResultsNo differences were noted in patient demographics including sex, age, ethnicity between the viral season in 2018–19 and 2019–2020. In our previous study in 2018–2019 RSV season, there was 40.7% antibiotic use in patients admitted with RSV bronchiolitis. In 2019–2020 season we included all patients admitted with viral RTI. Of the 213 patients evaluated between October 2019 through Dec 2020, 40% of the patients received antibiotics. 100% of the antibiotics were justified, based on independent review of antibiotic data by the team. Most common cause of antibiotics were community acquired pneumonia, rule out sepsis and otitis media. Antibiotic discontinuation and de-escalation were achieved in over 90% of the justified antibiotics.ConclusionThough antibiotic usage was still at 40% at our institution, 100% of antibiotic use was deemed appropriate and significant proportion were discontinued or deescalated by the ASP team.The ASP team played a crucial role in communicating with the primary providers to advocate for appropriate antibiotic use in the children.Disclosures All Authors: No reported disclosures

237. Inpatient and Discharge Antibiotic Use for Hospitalized Patients Growing Multi-Drug Resistant Bacteria in Urine Cultures

BackgroundMultidrug resistant organism (MDRO) infections are a threat to public health. Urinary tract infections (UTIs) are the most common MDRO infection and are responsible for a significant proportion of antibiotic use. Studies demonstrate both duration and type of antibiotics prescribed to patients with MDRO UTI are inappropriate, and that asymptomatic MDRO bacteriuria is inappropriately treated. In addition, antibiotics prescribed at hospital discharge are inappropriate in ~70% of patients. We sought to characterize inpatient and outpatient antibiotic durations to describe burden of antibiotic use for patients with an MDRO isolated from a urine specimen during a hospitalization.MethodsThis retrospective study was conducted at Barnes-Jewish Hospital, a 1266-bed academic medical center in St. Louis, Missouri from 11/7/12-11/7/17. Patients ≥ 18 years of age were included if they had an MDRO isolated from a urine specimen and no other positive bacterial cultures during their hospitalization. Demographics, comorbidities, cultures, and antibiotics were collected via data pulls and chart review. MDROs were defined according to European and US Center for Disease Control and Prevention guidelines. Antibiotic use was described as percentages of all antibiotics used.ResultsA total of 1052 patients had MDROs in urine cultures. Of these patients, 747 (71.0%) were discharged on oral antibiotics for a mean duration of 6.7 days, while 135 (12.8%) were discharged on IV antibiotics for a mean of 10.9 days. The five most commonly administered inpatient antibiotics after urine culture results were available (% prescribed) were IV ceftriaxone (43.0%), IV vancomycin (26.0%), PO ciprofloxacin (25.6%), IV cefepime (24.5%), and PO trimethoprim-sulfamethoxazole (17.6%). The five most commonly prescribed antibiotics at discharge were PO ciprofloxacin (22.3%), PO trimethoprim-sulfamethoxazole (17.8%), PO nitrofurantoin (8.4%), PO cephalexin (6.2%), and PO doxycycline (5.0%).ConclusionPatients with MDROs in urine cultures receive prolonged durations of inpatient and outpatient antibiotics, longer than what is recommended by current evidence and guidelines.Disclosures Dustin Stwalley, MA, AbbVie Inc (Shareholder)Bristol-Myers Squibb (Shareholder) Margaret A. Olsen, PhD, MPH, Merck (Grant/Research Support)Pfizer (Consultant, Grant/Research Support)

89. Construction of an Electronic Algorithm to Efficiently Target Antimicrobial Stewardship Efforts for Adults Hospitalized with Community-acquired Pneumonia

BackgroundAlthough antibiotic stewardship programs (ASPs) have had success in curtailing inappropriate antibiotic use, they remain time- and labor-intensive. To expand the reach of ASPs, approaches to more efficiently target ASP efforts are urgently needed. We developed and validated an electronic algorithm to identify inappropriate antibiotic use in patients hospitalized with community-acquired pneumonia (CAP).MethodsWithin the Hospital of the University of Pennsylvania (HUP) and Penn Presbyterian Medical Center (PPMC), we used ICD-10 diagnostic codes to identify inpatient patient encounters for pneumonia between 3/15/17 – 3/14/18 for which patients received a systemic antibiotic in the first 48 hours of hospitalization. Exclusion criteria included transfer from another facility, intensive care unit admission or death in first 48 hours, immunocompromising condition, or specific comorbidities. We randomly selected 300 subjects (150-HUP, 150-PPMC). Inappropriateness of antibiotic use based on chart review served as the basis for assessment of the electronic algorithm which was constructed using only data in the electronic health record (EHR). Criteria for appropriate prescribing, choice of antibiotic, and duration of therapy were based on established hospital and IDSA guidelines.ResultsOf 300 subjects, median age was 60, 53% were female, and median hospital stay was 4.25 days. Of the 300 subjects, 237 (79%) were admitted to general medicine, hospitalist, family medicine, or geriatrics services. On chart review, 295 (98%) subjects were correctly diagnosed with CAP. Of these subjects, the choice of initial antibiotic(s) was appropriate in 263 (89%). Of these 263 subjects, 222 (84%) had an appropriate duration of therapy. Test characteristics of the EHR algorithm (compared to chart review) are noted in the Table.ConclusionAn electronic algorithm for identifying inappropriate prescribing, antibiotic choice, and duration is highly accurate for patients hospitalized for CAP. This algorithm could be used to efficiently target ASP initiatives. The impact of interventions based on this algorithm should be tested in future studies.Test Characteristics of Electronic Algorithm for Inappropriate Prescribing, Agent, and Duration Disclosures All Authors: No reported disclosures

788. Evaluation of a Multiplex PCR Panel and Confirmatory Cytotoxin Testing on Clostridioides difficile at a Pediatric Hospital

BackgroundWith the introduction of gastrointestinal multiplex PCR (mPCR) tests, clinicians have received an increased number of positive tests for Clostridioides difficile. Patients who test positive via mPCR may not have a positive toxin assay indicative of true infection and may not need antibiotics. The goal of this study was to assess the symptoms of patients who test positive for C. difficile and determine the impact on antibiotic use at a pediatric hospital.MethodsA single-center, retrospective review was completed from May 2018 to March 2020. Initial C. difficile screening tests were performed via an mPCR test or a mono-PCR test. Patients > 1 year of age had a reflex cytotoxin assay performed. The primary outcome was the difference in symptoms between cytotoxin positive and negative patients. Secondary outcomes included co-pathogen detection on mPCR and C. difficile antibiotic days of therapy.ResultsFour hundred and sixty-one patients were included in our chart review. 49% of patients had a positive mPCR for a GI pathogen (n=229), and 18% (n=82) were positive for C. difficile. Cytotoxin was positive for 45% of patients that had C. difficile on mPCR. 34% of patients that had C. difficile detected on mPCR also had co-pathogens detected. No significant differences were present in symptomatology between cytotoxin positive and negative patients and no significant differences between white blood cell count (Table 1). There was a significant difference in the number of patients treated for the C. difficile between the cytotoxin populations (p-value< 0.05). The average duration of treatment with a negative test was significantly less than for positive cytotoxin test patients (7.5 vs 11 days, p-value< 0.05).Table 1: Comparison of cytotoxin production in pediatric patients with Clostridioides difficile. ConclusionOur results show a significant amount of antibiotic use for patients with cytotoxin negative C. difficile and no differences in symptomatology or white blood cell count based on cytotoxin positivity. Diagnostic stewardship of mPCR tests may be needed to effectively impact this unneeded antibiotic use, specifically the duration.Disclosures All Authors: No reported disclosures