Antimicrobial Principles Research Articles

Comparative Antimicrobial Activity and Bioactive Constituents of Oils from Rhizomes of Zingiber Officinale Roscoe Obtained by Different Extraction Methods

Ginger, known for its rich array of bioactive compounds, holds significant therapeutic potential due to its diverse medicinal properties. This study investigated the antimicrobial activity and bioactive principles present in ginger rhizome oils obtained using three different extraction methods viz: liquid-liquid extraction, cold maceration, and soxhlet extraction. The oils’ bioactive principles were identified by Gas Chromatography Mass Spectrometry (GC-MS) while their antimicrobial activity was determined by agar well diffusion technique. The GC-MS analysis revealed the presence of thirty compounds in each of the oils from liquid-liquid extraction and cold maceration, and fifty four compounds in the soxhlet-extracted oil. The most predominant compound in both liquid-liquid (31.13%) and cold maceration (16.99%) oils was oleic acid whereas the Soxhlet-extracted oil contained predominantly linoleic acid methyl ester (9.27%). Some bioactive compounds identified in these oils include δ-elemene, isoborneol, α-Bisabolol oxide, stearic acid, undecanone, palmitic acid, α-copaene, zingiberene, aromadendrene, farnesol, 2-methylhexane and farnesene which possess antioxidant, antibacterial, antifungal, antiviral, anti-inflammatory, anti-ulcer, anti-cancer, hypolipidemic, mosquito repellant, antimicrobial, and antidiabetic activities. Additionally, the oils exhibited promising antimicrobial potential against the test organisms with Staphylococcus aureus showing the least susceptibility to all the samples. Staphylococcus aureus and Candida albicans were completely resistant to the oil obtained by Soxhlet extraction at all tested concentrations. Meanwhile, Klebsiella pneumoniae (20 mm), Proteus vulgaris (18 mm), and Pseudomonas aeruginosa (17 mm), were most susceptible to the oil obtained by liquid-liquid extraction, cold maceration and soxhlet extraction, respectively. The study highlighted the significance of extraction methods on the chemical composition and antimicrobial activity of ginger rhizome oils, underscoring the importance of choosing appropriate extraction techniques to optimize the oils' therapeutic properties for specific medicinal applications.

Treatment of infections caused by multidrug-resistant Gram-negative bacilli: A practical approach by the Italian (SIMIT) and French (SPILF) Societies of Infectious Diseases

The emergence of multidrug-resistant Gram-negative bacilli and the development of new antibiotics have complicated the selection of optimal regimens. International guidelines are valuable tools, but are limited by the scarcity of high-quality randomized trials in many situations. A panel of experts from the French and Italian Societies of Infectious Diseases aimed to address unresolved issues in clinical practice based on their experience, an updated literature review and open discussions. The panel reached consensus for the following 'first choices': (i) cefepime for ventilator-acquired pneumonia due to AmpC β-lactamase-producing Enterobacterales; (ii) the β-lactam/β-lactamase inhibitor combination most active in vitro, or cefiderocol combined with fosfomycin, and aerosolized colistin or aminoglycosides, for severe pneumonia due to Pseudomonas aeruginosa resistant to ceftolozane-tazobactam; (iii) high-dose piperacillin-tazobactam (including loading dose and continuous infusion) for complicated urinary tract infections (cUTIs) caused by extended-spectrum β-lactamase-producing Enterobacterales with piperacillin-tazobactam minimum inhibitory concentration (MIC) ≤8 mg/L; (iv) high-dose cefepime for cUTIs due to AmpC β-lactamase-producing Enterobacterales other than Enterobacter spp. if cefepime MIC ≤2 mg/L; (v) ceftolozane-tazobactam or ceftazidime-avibactam plus metronidazole for intra-abdominal infections (IAIs) due to third-generation cephalosporin-resistant Enterobacterales; (vi) ceftazidime-avibactam plus aztreonam plus metronidazole for IAIs due to metallo-β-lactamase-producing Enterobacterales; (vii) ampicillin-sulbactam plus colistin for bloodstream infections (BSIs) caused by carbapenem-resistant Acinetobacter baumannii; (viii) meropenem-vaborbactam for BSIs caused by Klebsiella pneumoniae carbapenemase-producing Enterobacterales; and (ix) ceftazidime-avibactam plus fosfomycin for neurological infections caused by carbapenem-resistant P. aeruginosa. These expert choices were based on the necessary balance between antimicrobial stewardship principles and the need to provide optimal treatment for individual patients in each situation.

Understanding antibiotic knowledge, attitudes, and practices: a cross-sectional study in physicians from a Colombian region, 2023.

Antibiotic resistance has been identified as a global health threat. Knowledge, attitudes, and inappropriate prescription practices of antibiotics by physicians play a crucial role in this problem. In Colombia, research addressing this issue is scarce. A cross-sectional study involving 258 physicians was conducted. A scale with questions on sociodemographic aspects, level of education, satisfaction with antibiotic education received, and knowledge, attitudes, and practices was administered. The scale was designed for each item to be analyzed individually or as a total score ranging from 0 to 100 (0 being the lowest and 100 the highest). 31.5% of physicians rated the education received on antibiotics as fair to poor. The knowledge score was 80.1 (IQR 70.5-87.5); however, 25.2% agreed to some extent that amoxicillin is useful in treating most respiratory infections, and 15% agreed that antibiotics are effective in treating upper respiratory infections. Attitudes scored 80.2 (IQR 75.0-86.5), with 99% stating that bacterial resistance is a public health problem in Colombia, but only 56.9% considering it a problem affecting their daily practice. Practices scored 75.5 (IQR 68.8-81.2), and 71.7% affirmed that if they refuse to prescribe antibiotics to a patient who does not need them, the patient can easily obtain them from another physician. General practitioners were found to have lower scores in all three indices evaluated. The study reveals enduring misconceptions and concerning practices in antibiotic prescription, particularly among general practitioners. Enhancing knowledge necessitates the implementation of continuous medical education programs that focus on updated antibiotic guidelines, and resistance patterns. Fostering positive attitudes requires a culture of trust and collaboration among healthcare professionals. Practical enhancements can be realized through the establishment of evidence-based prescribing guidelines and the integration of regular feedback mechanisms. Moreover, advocating for the inclusion of antimicrobial stewardship principles in medical curricula is crucial, emphasizing the significance of responsible antibiotic use early in medical education.

Explainable and Interpretable Machine Learning for Antimicrobial Stewardship: Opportunities and Challenges

There is growing interest in exploiting the advances in artificial intelligence (AI) and machine learning (ML) for improving and \\monitoring antimicrobial prescriptions in line with antimicrobial stewardship principles. Against this background, the concepts of interpretability and explainability are becoming increasingly essential to understand how ML algorithms could predict antimicrobial resistance or recommend specific therapeutic agents, in order to avoid unintended biases related to the “black box” nature of complex models. In this commentary, we review and discuss some hot topics on the use of ML algorithms for antimicrobial stewardship interventions, highlighting opportunities and challenges with peculiar attention to interpretability and explainability of employed models. As in other fields of medicine, the exponential growth of AI/ML shows the potential for improving the efficacy of antimicrobial stewardship interventions, at least in part by reducing time-consuming tasks for overwhelmed healthcare personnel. Improving our knowledge about how complex ML models work could further help to achieve crucial advances in promoting the appropriate use of antimicrobials, as well as in preventing antimicrobial resistance selection and dissemination.

Antimicrobial zeolites and metal-organic frameworks.

The current surge in antibiotic resistance and the emergence of pandemics have created an urgent need for novel antimicrobial strategies. The controlled release of antimicrobial active principles remains the most viable strategy to date, and transition metal ions currently represent the main alternative to antibiotics. In this review, we explore the potential of two types of materials, zeolites and metal-organic frameworks (MOFs), for the controlled release of antimicrobial active principles, notably transition metal ions. These materials have unique crystalline microporous structures that act as reservoirs, enabling sustained bactericidal effects in various applications such as coatings, packaging, and medical devices. However, there are currently no convenient and standardised methods for evaluating their metal ion release and antimicrobial efficacy. This work discusses analytical techniques and the proposed mechanisms of action while highlighting recent advances in film, membrane, and coating technologies. By addressing the current limitations, microporous materials can revolutionise antimicrobial approaches, offering enhanced effectiveness and long-term sustainability.

A descriptive study of vancomycin use at Red Cross War Memorial Children's Hospital, Cape Town.

Antimicrobial stewardship principles guide the clinical use of antimicrobials, including vancomycin, but paediatric vancomycin prescribing practices have not been evaluated in South Africa. To document the use, prescribing practices and monitoring of intravenous vancomycin and the spectrum of bacteria isolated on microbiological culture in children treated with intravenous vancomycin during a 12-month period at Red Cross War Memorial Children's Hospital (RCWMCH). A retrospective audit of intravenous vancomycin use in children admitted to RCWMCH during 2019 was performed. All 158 vancomycin prescription episodes for 143 children were included. Overall usage of intravenous vancomycin was 63 days of therapy per 1000 patient days (interquartile range [IQR]: 38-72). The median starting dose was 15 mg/kg per dose (IQR: 14-15) and median daily dose was 45 mg/kg per day (IQR: 43-60). Vancomycin was prescribed as empiric (127/158, 80%) and directed (31/158, 20%) treatment. The median duration of treatment for the directed group (7 days) was longer than the empiric group (4 days) (p = 0.001). Vancomycin serum trough concentrations were performed in 65/98 (66%) episodes where vancomycin treatment exceeded 3 days, with only 16/65 (25%) of these samples obtained before the fourth dose. Prolonged antibiotic treatment of 14 days or more was not associated with Gram-positive bacteria on culture (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 0.17-4.2). Dosing errors, prolonged empiric treatment and inappropriate vancomycin monitoring were problems associated with vancomycin prescriptions. The study identified multiple opportunities for improved vancomycin prescribing and monitoring. Further research and implementation of improved prescribing practices could contribute to the preservation of vancomycin as an effective antibiotic.

Antibiotic prescribing guideline recommendations in COVID-19: a systematic survey

COVID-19 and antimicrobial resistance (AMR) are two intersecting public health crises. Antimicrobial overuse in patients with COVID-19 threatens to worsen AMR. Guidelines are fundamental in encouraging antimicrobial stewardship. We sought to assess the quality of antibiotic prescribing guidelines and recommendations in the context of COVID-19, and whether they incorporate principles of antimicrobial stewardship. We performed a systematic survey which included a search using the concepts "antibiotic/antimicrobial" up to November 15, 2022 of the eCOVID-19 living map of recommendations (RecMap) which aggregates guidelines across a range of international sources and all languages. Guidelines providing explicit recommendations regarding antibacterial use in COVID-19 were eligible for inclusion. Guideline and recommendation quality were assessed using the AGREE II and AGREE-REX instruments, respectively. We extracted guideline characteristics including panel representation and the presence or absence of explicit statements related to antimicrobial stewardship (i.e., judicious antibiotic use, antimicrobial resistance or adverse effects as a consequence of antibiotic use). We used logistic regression to evaluate the relationship between guideline characteristics including quality and incorporation of antimicrobial stewardship principles. Protocol registration (OSF): https://osf.io/4pgtc. Twenty-eight guidelines with 63 antibiotic prescribing recommendations were included. Recommendations focused on antibiotic initiation (n=52, 83%) and less commonly antibiotic selection (n=13, 21%), and duration of therapy (n=15, 24%). Guideline and recommendation quality varied widely. Twenty (71%) guidelines incorporated at least one concept relating to antimicrobial stewardship. Including infectious diseases expertise on the guideline panel (OR 9.44, 97.5% CI: 1.09-81.59) and AGREE-REX score (OR 3.26, 97.5% CI: 1.14-9.31 per 10% increase in overall score) were associated with a higher odds of guidelines addressing antimicrobial stewardship. There is an opportunity to improve antibiotic prescribing guidelines in terms of both quality and incorporation of antimicrobial stewardship principles. These findings can help guideline developers better address antibiotic stewardship in future recommendations beyond COVID-19. This project was funded by Michael G. DeGroote Cochrane Canada and McMaster GRADE centres.

The Challenge of Overcoming Antibiotic Resistance in Carbapenem-Resistant Gram-Negative Bacteria: "Attack on Titan".

The global burden of bacterial resistance remains one of the most serious public health concerns. Infections caused by multidrug-resistant (MDR) bacteria in critically ill patients require immediate empirical treatment, which may not only be ineffective due to the resistance of MDR bacteria to multiple classes of antibiotics, but may also contribute to the selection and spread of antimicrobial resistance. Both the WHO and the ECDC consider carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Acinetobacter baumannii (CRAB) to be the highest priority. The ability to form biofilm and the acquisition of multiple drug resistance genes, in particular to carbapenems, have made these pathogens particularly difficult to treat. They are a growing cause of healthcare-associated infections and a significant threat to public health, associated with a high mortality rate. Moreover, co-colonization with these pathogens in critically ill patients was found to be a significant predictor for in-hospital mortality. Importantly, they have the potential to spread resistance using mobile genetic elements. Given the current situation, it is clear that finding new ways to combat antimicrobial resistance can no longer be delayed. The aim of this review was to evaluate the literature on how these pathogens contribute to the global burden of AMR. The review also highlights the importance of the rational use of antibiotics and the need to implement antimicrobial stewardship principles to prevent the transmission of drug-resistant organisms in healthcare settings. Finally, the review discusses the advantages and limitations of alternative therapies for the treatment of infections caused by these "titans" of antibiotic resistance.

The Dark Side of Nosocomial Infections in Critically Ill COVID-19 Patients.

Coronavirus disease 2019 (COVID-19) is a potentially serious acute respiratory infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Since the World Health Organization (WHO) declared COVID-19 a global pandemic, the virus has spread to more than 200 countries with more than 500 million cases and more than 6 million deaths reported globally. It has long been known that viral respiratory tract infections predispose patients to bacterial infections and that these co-infections often have an unfavourable clinical outcome. Moreover, nosocomial infections, also known as healthcare-associated infections (HAIs), are those infections that are absent at the time of admission and acquired after hospitalization. However, the impact of coinfections or secondary infections on the progression of COVID-19 disease and its lethal outcome is still debated. The aim of this review was to assess the literature on the incidence of bacterial co-infections and superinfections in patients with COVID-19. The review also highlights the importance of the rational use of antibiotics in patients with COVID-19 and the need to implement antimicrobial stewardship principles to prevent the transmission of drug-resistant organisms in healthcare settings. Finally, alternative antimicrobial agents to counter the emergence of multidrug-resistant bacteria causing healthcare-associated infections in COVID-19 patients will also be discussed.

Determination of Antibiotic Prescription Pattern in Private Healthcare Facilities in Port Harcourt Metropolis, Rivers State, Nigeria

Background: The consequences of antimicrobial resistance are severe, as mortality and morbidity rates continue to increase. The extensive use of antibiotics contributes significantly to the development and spread of antimicrobial resistance. It is crucial to have knowledge supported by data to improve antimicrobial stewardship and address the growing problem of antimicrobial resistance globally and locally. Thus, an evaluation was conducted to assess the prescription practices of doctors working in private medical facilities in Port Harcourt, Rivers state, Nigeria.
 Methods: A cross-sectional survey was carried out using a structured questionnaire to collect information on medical training and antibiotic prescription practices among 102 medical doctors. Data was analyzed at a 95% confidence interval using the SPSS v25 software and a p-value less than 0.05 was considered significant.
 Results: The respondents' demographics indicated that 67.6% were male, while 32.4% were female practitioners. The majority, about 60.8%, had MBBS only, while 21.6% had a postgraduate medical fellowship and 17.6% had postgraduate degrees (PGD/MSc/PhD). The data revealed that 35.3% of the respondents had practiced for at least 15 years, while 33.3% had practiced for 1-5 years and 23.5% for 6-10 years. Cephalosporins were commonly prescribed by 43.1% of the respondents, with cefuroxime being the most frequently prescribed. Amoxicillin was prescribed by 20.6% of the respondents, while only 2.9% of them indicated prescribing Penicillins V or G. Laboratory investigations were the basis for prescribing antibiotics in 30.4%, while 69.6% prescribed on an empirical basis. The cross-tabulation of basis of prescriptions with qualifications showed that persons with postgraduate medical fellowship (86.4%) mostly prescribed based on clinical judgment, while individuals with MBBS only least commonly prescribed by clinical judgment. The prescription by empirical assessment was also mostly common among individuals with 6-10 years of practice experience (75%). However, no statistically significant association was found between the basis of prescriptions and academic qualifications or years of practice.
 Conclusion: The study's results revealed that doctors in private medical facilities in Port Harcourt have a strong inclination towards prescribing cephalosporins, particularly on empirical grounds rather than laboratory investigations. It is highly recommended to take immediate measures to promote the implementation of antimicrobial stewardship principles to address the local rise in antimicrobial resistance.

Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a multidisciplinary statement

BackgroundAntimicrobial resistance represents a major critical issue for the management of the critically ill patients hospitalized in the intensive care unit (ICU), since infections by multidrug-resistant bacteria are characterized by high morbidity and mortality, high rates of treatment failure, and increased healthcare costs worldwide. It is also well known that antimicrobial resistance can emerge as a result of inadequate antimicrobial therapy, in terms of drug selection and/or treatment duration. The application of antimicrobial stewardship principles in ICUs improves the quality of antimicrobial therapy management. However, it needs specific considerations related to the critical setting.MethodsThe aim of this consensus document gathering a multidisciplinary panel of experts was to discuss principles of antimicrobial stewardship in ICU and to produce statements that facilitate their clinical application and optimize their effectiveness. The methodology used was a modified nominal group discussion.ConclusionThe final set of statements underlined the importance of the specific interpretation of antimicrobial stewardship’s principles in critically ill patient management, quasi-targeted therapy, the use of rapid diagnostic methods, the personalization of antimicrobial therapies’ duration, obtaining microbiological surveillance data, the use of PK/PD targets, and the use of specific indicators in antimicrobial stewardship programs.

Impact of a Pro-Active Infectious Disease Consultation on the Management of a Multidrug-Resistant Organisms Outbreak in a COVID-19 Hospital: A Three-Months Quasi-Experimental Study.

Antimicrobial and diagnostic stewardship (AS/DS) principles are crucial for the management of multidrug-resistant organisms (MDROs) infections. We evaluated the impact of a pro-active Infectious Disease (ID) consultation on the mortality risk of patients during an MDROs outbreak in a COVID-19 hospital. A quasi-experimental study was performed in a dedicated COVID-19 hospital, including patients with suspected/confirmed infection and/or colonization by MDROs, which were managed as follows: (i) according to the standard of care during the pre-phase and (ii) in collaboration with a dedicated ID team performing a pro-active bedside evaluation every 48-72 h in the post-phase. Overall, 112 patients were included (pre-phase = 89 and post-phase = 45). The AS interventions included the following: therapy optimization (33%), de-escalation to narrow the spectrum (24%) or to lessen toxic drugs (20%), and discontinuation of antimicrobials (64%). DS included the request of additional microbiologic tests (82%) and instrumental exams (16%). With the Cox model, after adjusting for age, sex, COVID-19 severity, infection source, etiological agents, and post-phase attendance, only age predicted an increased risk of mortality, while attendance in the post-phase resulted in a decreased risk of mortality. Implementation of AS and DS intervention through a pro-active ID consultation may reduce the risk of 28-day mortality of COVID-19 patients with MDROs infections.

PHARMACOKINETICS OF RECTALLY AND ORALLY ADMINISTERED LEVOFLOXACIN IN ASIAN ELEPHANTS (ELEPHAS MAXIMUS).

Appropriate and effective antibiotic use is a critical component of veterinary medicine, but there are variations across species regarding dosage and administration of these drugs. Oral or rectal routes of administration are typically used in elephants, but not all medications can achieve adequate concentrations rectally. The fluoroquinolone antimicrobials are used in elephants because of their favorable antimicrobial spectrum and pharmacokinetics compared with other oral agents. They are commonly used as part of multiple antibiotic regimens for the treatment of tuberculosis (Mycobacterium tuberculosis). The objective of this study was to determine the pharmacokinetic profile of levofloxacin after oral and rectal administration in Asian elephants (Elephas maximus). Dosages of 5 mg/kg orally and 15 mg/kg rectally were evaluated in 13 Asian elephants. Blood was collected at various time points from 0 to 72 h for pharmacokinetic analysis. Pharmacokinetic parameters were determined and reached concentrations above minimum inhibitory concentrations of various bacterial organisms via both routes. A pharmacokinetic-pharmacodynamic assessment was used to estimate appropriate minimal inhibitory concentrations for bacteria that could be potentially treated with this antimicrobial. Based on these findings, levofloxacin may be a consideration for administration orally (5 mg/kg) and rectally (15 mg/kg) in Asian elephants. Antimicrobial stewardship principles, culture and susceptibility of suspected pathogens, and blood level monitoring should be used to tailor administration of levofloxacin in this species.

An app a day: Results of pre- and post-surveys of knowledge, attitudes, and practices (KAP) regarding antimicrobial stewardship principles among nurses who utilized a novel learning platform.

Nurses perform several functions that are integral for antimicrobial stewardship (AMS). However, nurses are underrepresented in research and underutilized in implementation of AMS interventions. The objective of this pilot study was to assess the effect of asynchronous microlearning on inpatient nursing staff knowledge, attitudes, and practices (KAP) regarding AMS principles. A team of pharmacists, physicians, and nurses developed 9 case-based, multiple-choice questions with accompanying educational explanations on associated AMS principles. One case was delivered to participants daily via an institutional web-based application (QuizTime). A KAP survey with 20 questions on a 5-point Likert scale was administered before and after the intervention. Survey results were compared using a Wilcoxon signed-rank test. Participants' mean survey score after the intervention demonstrated statistically significant improvement for 18 (90%) of 20 items compared to before the intervention. Participants' confidence improved in key AMS activities: (1) differentiating between colonization and infection (mean difference, 0.63; P < .001), (2) identifying unnecessary urine cultures and inappropriate treatment of urinary tract infections (mean difference, 0.94; P < .001), (3) recognizing opportunities for intravenous to oral therapy conversion (mean difference, 1.07; P < .001), and (4) assessing for antibiotic-associated adverse effects (mean difference, 0.54; P < .001). Nursing education provided through an asynchronous, microlearning format via a mobile platform resulted in statistically significant improvement in most KAP topics. Nurses are integral members of a multidisciplinary AMS team, and novel education methods can help equip them with the necessary AMS tools. This pilot study forms the basis for expanded AMS educational efforts in all healthcare professionals.

Antimicrobial stewardship for nurse practitioners and physician assistants: enhancing patient safety through education.

As nurse practitioners and physician assistants (APPs) become more prevalent in delivering pediatric care, their involvement in antimicrobial stewardship efforts increases in importance. This project aimed to create and assess the efficacy of a problem-based learning (PBL) approach to teaching APPs antimicrobial stewardship principles. A PBL education initiative was developed after communication with local APP leadership and focus group feedback. It was offered to all APPs associated with Lurie Children's Hospital of Chicago. Participants completed a survey which assessed opinions on antimicrobial stewardship and included knowledge-based questions focused on antimicrobial stewardship. Prescriptions for skin and soft tissue infections associated with APPs were recorded via chart review before and after the education campaign. Eighty APPs participated in the initial survey and teaching initiative with 44 filling out the 2-week follow-up and 29 filling out the 6-month follow-up. Subjective opinions of antimicrobial stewardship and comfort with basic principles of AS increased from pre-intervention. Correct responses to knowledge-based assessments increased from baseline after 2-week follow-up (p < 0.01) and were maintained at the 6-month follow-up (p = 0.03). Simple skin and soft tissue infection prescriptions for clindamycin went from 44.4% pre-intervention to 26.5% (p = 0.2) post-intervention. A PBL approach for APP education on antimicrobial stewardship can be effective in increasing knowledge and comfort with principles of antimicrobial stewardship. These changes are maintained in long-term follow-up. Changes in prescribing habits showed a strong trend towards recommended empiric therapy choice. Institutions should develop similar education campaigns for APPs.

921. Leveraging the Electronic Health Record for Antimicrobial Stewardship: Assessing the Impact of Antimicrobial Ordering Clinical Decision Support Tools on Duration of Therapy

Abstract Background In an ideal state, the stewardship of antimicrobial agents would happen at the point of order entry. In June 2018, Eskenazi Health implemented a series of clinical decision support tools in the electronic health record (EHR), including required fields on all inpatient antimicrobial orders for indication, type of therapy (empiric or definitive), and duration. When empiric therapy is selected, providers receive a Best Practice Advisory (BPA) at 48 hours to re-evaluate therapy. Additionally, a side bar table was added to all antimicrobials orders that included drug-specific duration of therapy recommendations for common indications. Methods This is a single-center, retrospective, observational chart review that includes adult inpatients prescribed antibiotics for the treatment of CAP or UTI from July 2017 to December 2018. The primary outcome is the overall length of therapy between pre- and post-intervention groups for CAP and UTI. Secondary outcomes include duration of empiric/broad-spectrum therapy, duration of definitive therapy, time to de-escalation, length of hospital stay, C. difficile infections, 30-day readmission, and cost of antimicrobial therapy. Results A total of 541 orders were included for analysis. The composite overall duration of therapy decreased from 7 days to 5 days in the post-intervention group (p&amp;lt; 0.001). For CAP, the duration of therapy (5 days) was not different between groups. For UTI, the duration of therapy decreased from 11 days to 7 days in the post-intervention group (p&amp;lt; 0.001). The duration of empiric therapy decreased from 3 days to 2 days (p&amp;lt; 0.001) and the duration of definitive therapy decreased from 4 days to 3 days (p&amp;lt; 0.001). There was a 1 day longer length of stay for patients in the post-intervention group (p=0.038); however, there was a lower 30-day readmission rate in the post-intervention group (p=0.003). The rate of hospital-acquired C. difficile infections did not differ between groups (p=1.000). It was found that action was taken from the BPA 55.4% of the time after implementation. Conclusion The duration of therapy overall was shortened by 2 days, which was driven by the difference in duration for UTI. Incorporating antimicrobial stewardship principles at the point of order entry can result in fewer days of unnecessary therapy. Disclosures All Authors: No reported disclosures.

1761. A Pre-Post Interventional Study on the Impact of Asynchronous Microlearning of Antimicrobial Stewardship Principles among Nursing Staff at a Large Academic Medical Center

Abstract Background Nurses perform several functions that are integral for antimicrobial stewardship (AS). However, nurses are underrepresented in research and underutilized in AS interventions and implementation. Additionally, lack of education and training is consistently cited as a barrier to full nurse participation in AS activities. We used a novel approach for nursing AS education by utilizing an asynchronous mobile learning platform which delivered small amounts of information to participants daily via e-mail or text message. The objective of this study was to determine the effect of this innovated AS microlearning pedagogical approach on nursing staff knowledge, attitudes, and practices (KAP) regarding AS principles. Methods A course consisting of 9 case-based multiple-choice questions was developed. One question per day was delivered to participants via an institutional web-based application and followed by a brief educational explanation on associated AS principles. A KAP survey with 20 Likert scale questions on a 5-point scale was administered to participants pre-and post-intervention. Survey results were compared using a Wilcoxon signed-rank test. Results Of the 46 participants, most (86%) reported they administer antibiotics to &amp;gt;50% of their patients. Of the 20 KAP questions, participant’s mean score post-intervention demonstrated statistically significant improvement for 90% (18/20) of the items. Participant’s confidence improved in key AS activities including differentiating between colonization and infection (P&amp;lt; 0.001), identifying unnecessary urine cultures and inappropriate treatment of urinary tract infections (P&amp;lt; 0.001), recognizing opportunities for intravenous to oral therapy conversion (P&amp;lt; 0.001), and assessing for antibiotic-associated adverse effects (P&amp;lt; 0.001). Conclusion Inclusion of nurses in AS is critical. AS nursing education through an asynchronous, brief educational format via a mobile platform resulted in statistically significant improvement in most topics covered. After course completion, participants felt more confident in their ability to participate in key AS activities. This study forms the basis for expanded AS educational efforts for all healthcare professionals. Disclosures All Authors: No reported disclosures.

Promising antimicrobial protein from &lt;em&gt;Klebsiella&lt;/em&gt;

Increasing antibody resistance necessitates the use of new antimicrobial products. Antimicrobial peptides (AMP`s) And Proteins are a promising alternative to antibiotics currently being used due to their high degree of specificity & wide range of action Here we report a novel antimicrobial protein from iron reducing bacteria isolated from the coffee estate soils of Coorg district, Karnataka, India. Iron reducing bacteria are known to be antagonistic to others due to the presence of Pseuderophores. It makes them a good source of antimicrobial active principles. Fifteen isolates were obtained by selectively screening for iron reduction. These isolates were tested for antimicrobial activity against Gram positive [Staphylococcus aureus (MTCC3160), Bacillus cereus (MTCC6620)] & Gram negative [Escherichia coli (MTCC1650), Salmonella typhi (MTCC3224) and Pseudomonas aeruginosa (MTCC2453)] bacteria. Of the 15 isolates, one isolate, CBI-8, which showed good antimicrobial activity, was selected for further studies. The isolate was identified by MALDI-TOF & 16S rDNA sequencing as Klebsiella variicola/quasipneumonae (strain IS93) (genebank - MN814029). To induce and augment the production of antimicrobial molecules, CBI-8 was grown in the presence of Salmonella typhi and the spent medium was subjected to ammonium sulphate precipitation. The fractions which showed promising activity were further subjected to preparatory HPLC. The distinct bands obtained in the SDS-PAGE corresponding to the HPLC peak that showed antimicrobial activity from the induced sample was analyzed by Mass Spectrometry. Antimicrobial Peptide Database (APD3) calculator, Collection of Anti-Microbial Peptides (CAMPR3) software used to predict AMPs in the proteins identified from MS data.

Broad spectrum antibiotic stewardship by quality improvement methods.

With the majority of antibiotics being prescribed in primary care it is of utmost importance that antimicrobial stewardship principles are adhered to in order to slow down the incidence of antimicrobial resistance. Broad spectrum antibiotic prescribing is often seen as a proxy marker of increasing resistance within a population and so it is important that they are used sparingly, to avoid drug-resistant bacteria developing. In Tameside and Glossop a novel approach, using quality improvement methods, was employed to allow the behaviour change to be sustained for a longer period. Practices submitted monthly broad spectrum usage data, and if over a set target they were required to submit a "deep dive". A 10.6% reduction of broad spectrum antibiotic usage was seen over the 2019-20 financial year. Over time the number of practices submitting a deep dive reduced and clinicians saw the deep dive as method to peer review their prescribing. Putting the practice staff in control of their own prescribing, allowed for a better method to sustain the improvement.

Epidemiology and Economic Outcomes Associated with Timely versus Delayed Receipt of Appropriate Antibiotic Therapy among US Patients Hospitalized for Native Septic Arthritis: A Retrospective Cohort Study.

Timely administration of appropriate antibiotic therapy is associated with better patient outcomes and lower costs of care compared to delayed appropriate therapy, yet initial treatment is often empiric since causal pathogens are typically unknown upon presentation. The challenge for clinicians is balancing selection of adequate coverage treatment regimens, adherence to antimicrobial stewardship principles to deter resistance, and financial constraints. This retrospective cohort study aimed to assess the magnitude and impact of delayed appropriate antibiotic therapy among patients hospitalized with septic arthritis (SA) in the U.S. from 2017 to 2019 using healthcare encounter data. Timely appropriate therapy was defined as the receipt of antibiotic(s) with in vitro activity against identified pathogens within two days of admission; all other patients were assumed to have received delayed appropriate therapy. Of the 517 patients admitted to hospital for SA who met all selection criteria, 26 (5.0%) received delayed appropriate therapy. In inverse-probability-treatment-weighting-adjusted analyses, the receipt of delayed appropriate therapy was associated with an additional 1.1 days of antibiotic therapy, 1.4 days in length of stay, and $3531 in hospital costs (all vs. timely appropriate therapy; all p ≤ 0.02). Timely appropriate therapy was associated with a twofold increased likelihood of antibiotic de-escalation during the SA admission.