Usage Of Broad-spectrum Antibiotics Research Articles

Empiric gram-negative antibiotics usage among critically ill patients across 13 ICUs of Nepal: A retrospective cohort study

Background This study aims to investigate the associations between patient characteristics and the receipt of empiric broad-spectrum gram-negative antimicrobials among adult patients admitted to ICUs in Nepal. Methods A retrospective cohort study was conducted in 13 ICUs in Nepal between January 1st, 2020, and December 31st, 2022. Empiric antibiotic use was defined as receiving gram-negative antibiotics within the first two days of ICU admission without evidence of infection from culture. Patient characteristics between patients receiving narrow-spectrum antibiotics and broad-spectrum gram-negative antibiotics were compared. Continuous variables were compared using mean and standard deviation, with mean differences and 95% confidence intervals calculated. Categorical variables were compared using the chi-square test. A multi-level multivariable regression model assessed the relationship between selected variables and broad-spectrum antibiotic usage, treating admitting ICU as a random factor. Results Among 12,349 eligible patients, 8720 (70.6%) received Empiric gram-negative antibiotics. Of those, 3240 (37.15%) received empiric narrow-spectrum gram-negative antibiotics, and 5480 (62.8%) received Empiric broad-spectrum gram-negative antibiotics. Patients receiving broad-spectrum gram-negative antibiotics were older (57.4 vs 53.8 yrs); had higher mean heart rates (97.3 vs 89.5 bpm), respiratory rates (24 vs 21.9), a fraction of inspired oxygen ( 50% vs 40%), blood sugar levels (163.4 vs 153.9 mg/dl), total leucocyte counts (12,685 vs 10,647 cells/cu mm) and serum creatinine (2.06 vs 1.03 umol/l) compared to narrow spectrum antibiotics. Similarly, patients receiving broad-spectrum gram-negative antibiotics had lower systolic blood pressure (122.6 vs 126.5 mm Hg), partial pressure of oxygen (96.7 vs 105.3), and pH ( 7.33 vs 7.36) compared to narrow-spectrum antibiotics. On multivariable regression; patients with readmission, cardiac support, and mechanical ventilation were more likely to receive broad-spectrum antibiotics. Conclusion The rate of empiric broad-spectrum gram-negative antibiotics usage in intensive care units is significantly high and associated with features of increased severity of illness.

A-257 Revolutionizing Fungal Infection Diagnosis: A Sensitive, Cost-Effective, and Time-Efficient Solution

Abstract Background Fungal infection detection is essential for optimizing therapeutic strategies, preventing complications, enhancing overall health, and alleviating the financial burden, and preventing transmission. According to the CDC, fungal illness resulted in 75,000 hospital admissions and 9 million outpatient visits annually, with 7,199 deaths predicted in the United States in 2021. The rising prevalence of fungal infections, influenced by factors such as population expansion and evolving treatment strategies poses a growing challenge to achieving an early and accurate diagnosis. There is the crucial need for improved detection methods to promptly identify various fungal infections, including Candida species, spanning from skin issues to potentially fatal systemic diseases, ultimately reducing associated morbidity and mortality. Severe and profound infections with life-threatening potential are common in individuals with compromised immune systems and those who are hospitalized. This risk is notably elevated among patients with organ transplants, immunosuppressive treatments, diabetes, recent broad-spectrum antibiotic usage, catheter utilization, and extended hospitalization periods. Our advancement seeks to introduce innovative methods leveraging carbon-based nanomaterials for the detection of fungal infections, offering distinct advantages including cost-effectiveness, ease of operation, and time efficiency compared to conventional techniques. Methods Our technology utilizes carbon-based nano materials, a promising advancement in nanotechnology to detect fungal infections, especially Candida manifestations. The samples are brought into contact with pre-probed carbon-based nano materials sensors maintained at a specific annealing temperature, facilitating nucleic acid hybridization. Subsequently, alterations in the carbon nanotube's electrical signal are observed, indicating a change in conductivity. This change can allow for the measurement of a voltage difference across a continuous flow of electricity, correlating with the concentration of targets present in the sample, thereby enabling the detection of specific microorganisms. No change was noticed in electrical properties of carbon-based nano material when negative experiments were conducted. Results The initial findings showed the presence of specific microorganisms within the sample in less than 15 minutes with carbon-based nano materials sensors. Comparative analysis of the electrical signal magnitude values obtained from carbon nanotube measurements against the corresponding CT values from quantitative PCR (qPCR) provides insights into the correlation between the electrical readouts and molecular quantification, offering a comprehensive evaluation of the nanotube-based detection system's performance in diagnostics procedure. Conclusions Unlike conventional blood culture and qPCR, our technology, delivers outcomes with heightened sensitivity, cost-effectiveness, and time efficiency. Our team's uncomplicated sample collection method notably reduces the intricacies of sample preparation, enabling the proper disposal of both the sample container and sensor part without requiring disassembly. Enhanced sensitivity, coupled with the economical and rapid detection capabilities of advanced technologies like carbon-based nano materials, is a promising alternative for the accurate and efficient diagnosis of fungal infections. Consequently, the implementation of such technology not only enhances diagnostic efficiency but also contributes to better patient outcomes through prompt and targeted therapeutic interventions.

The clinical characteristics and risk factors analysis within one week before the onset of necrotizing enterocolitis

There are considerable researches on risk factors for necrotizing enterocolitis (NEC), focusing primarily on the entire course before onset. However, fewer studies address risk factors within the brief period before NEC occurrence. The current study aims to retrospectively analyze the clinical data of NEC patients while focusing on relevant risk factors in the preceding week of NEC onset. Infants born between January 2019 and December 2021 at Suzhou Municipal Hospital and Suzhou University Children’s Hospital with a birth weight < 1500 g or a gestational age < 32 weeks were included. Around 54 NEC patients and 180 controls were recruited in the study. NEC patients satisfying the inclusion criteria formed the case group, while a 1:4 matching principle helped select the control group based on gestational age and birth weight. A statistically significant difference was observed between groups when red blood cell transfusions were compared the week before NEC onset (adjusted OR and 95% CI 2.16 (1.10, 4.24)). Broad-spectrum antibiotic usage before NEC occurrence was significantly lower in the NEC group than in the control group (adjusted OR and 95% CI 0.95 (0.91, 0.99)). A statistically significant difference was observed between groups while comparing patent ductus arteriosus (PDA) (adjusted OR and 95% CI 2.45 (1.23, 4.91)). The indication for packed red blood cell transfusion should be strictly controlled. Moreover, close monitoring of the patient’s condition for NEC occurrence should be conducted within one-week post-transfusion. Accurately identifying infections and using broad-spectrum antibiotics can reduce the incidence of NEC.

Validation of Lyophilized Human Fecal Microbiota for the Treatment of Clostridioides difficile Infection: A Pilot Study with Pharmacoeconomic Analysis of a Middle-Income Country-Promicrobioma Project.

Clostridioides difficile infection (CDI) represents a prevalent and potentially severe health concern linked to the usage of broad-spectrum antibiotics. The aim of this study was to evaluate a new lyophilized product based on human fecal microbiota for transplant, including cost-benefit analysis in the treatment of recurrent or refractory CDI. The product for fecal microbiota transplant was obtained from two donors. Microbiological, viability, and genomic analysis were evaluated. After validation, a clinical pilot study including recurrent or refractory CDI with 24 patients was performed. Clinical response and 4-week recurrence were the outcome. Cost-benefit analysis compared the fecal microbiota transplant with conventional retreatment with vancomycin or metronidazole. The microbiota for transplant presented significant bacterial viability, with and adequate balance of Firmicutes and Bacteroidetes. The clinical response with the microbiota transplant was 92%. In financial terms, estimated expenditure for CDI solely related to recurrence, based on stochastic modeling, totals USD 222.8 million per year in Brazil. The lyophilized human fecal microbiota for transplant is safe and can be an important step for a new product with low cost, even with genomic sequencing. Fecal microbiota transplantation emerges as a more cost-effective alternative compared to antimicrobials in the retreatment of CDI.

A retrospective study of non-ventilator hospital-acquired pneumonia in a Norwegian hospital: a serious medical condition in need of better and timelier microbiological diagnostics

Background Hospital-acquired pneumonia (HAP) is the most common hospital-acquired infection (HAI). HAP is associated with a high burden of morbidity and mortality, but the diagnosis is difficult to establish and the incidence uncertain. Methods Patients aged ≥ 18 years hospitalised with radiologically verified non-ventilator hospital acquired pneumonia (NV-HAP) during 2018 were retrospectively identified at Drammen Hospital, a Norwegian general hospital. Infectious Diseases Society of America and the American Thoracic Society’s definition of HAP was used. Results In total 119 cases of NV-HAP were identified among 27,701 admissions. The incidence was 4.3 per 1000 admissions and 1.2 per 1000 patient-days. The median age was 74 years, 63% were male and median Charlson comorbidity index was 5. Coronary heart disease (42%) was the most common comorbidity. Median length of stay was 17.2 days. A blood culture was obtained in 53.8% of patients, while samples from lower airways were seldom obtained (10.9%). In-hospital mortality was 21%, accumulated 30-day mortality was 27.7% and accumulated 1-year mortality was 39.5%. Thirty-day readmission rate among survivors was 39.4%. Conclusion NV-HAP was present in approximately 1 in 250 hospitalisations, most had multiple comorbidities, and 1 in 5 died in hospital. Although thorough microbiological sampling is recommended when NV-HAP is suspected, our data indicate that airway sampling is infrequent in clinical practice. Our findings underscore the need to develop microbiological diagnostic strategies to achieve targeted antimicrobial treatment that may improve patient outcomes and reduce broad-spectrum antibiotic usage.

Evaluation of Stenotrophomonas Maltophilia Bloodstream Infections in a Tertiary Pediatric Cardiovascular Surgery Intensive Care Unit in Turkey

Background: Stenotrophomonas maltophilia poses a significant challenge as a drug-resistant opportunistic bacterium, particularly in ICU settings. However, its impact on pediatric ICU patients, especially those undergoing cardiovascular surgery, are scarce. Therefore, we aimed to analyze the factors behind S. maltophilia bloodstream infections (BSI) in our tertiary pediatric cardiovascular surgery ICU by evaluating the 2-year data. Methods: In this retrospective study, we analyzed data of 11 (mean age 20.3±17.6 months) and 18 cases (mean age 22.4±18.5 months) diagnosed with S. maltophilia BSI out of 635 and 685 children who underwent cardiovascular surgery from March 2021 to February 2022, and March 2022 to February 2023, respectively. Factors including age, gender, cardiac pathologies, surgical risk scores, duration of extracorporeal membrane oxygenation (ECMO) and mechanical ventilation, length of ICU stay, and use of broad-spectrum antibiotics were compared. Results: The incidence of S. maltophilia BSI increased by 50.5% in 2022-2023 compared to the previous year. While no significant differences were noted in age, gender, or surgical frequency, notable distinctions emerged in ECMO and mechanical ventilation durations, ICU length of stay, and broad-spectrum antibiotic usage (p values&lt;0.05). Conclusion: Prolonged ECMO and mechanical ventilation, along with extended ICU stays and broad-spectrum antibiotic administration following highrisk cardiac surgeries, emerged as significant contributors to S. maltophilia BSI in our ICU. This underscores the necessity for a comprehensive approach encompassing infection control protocols, prudent antimicrobial utilization, and strategies to minimize invasive procedures. Such a multifaceted approach is paramount in mitigating the prevalence of S. maltophilia BSI, especially in high-risk ICU environments.

Anti-candidiasis functional material for women’s cotton undergarments

The escalating incidence of Candida spp. infections among individuals with compromised immune systems is attributed to various factors, including broad-spectrum antibiotic usage, common health issues, and inadequate undergarments, requiring novel preventive measures. While the pathogenic mechanisms of Candida spp. infections remain incompletely understood, their virulence attributes and opportunistic nature challenge host defenses. In response, this research study introduces an innovative nanobiotechnological approach employing L-cysteine to develop nontoxic anti- Candida spp. textile materials. Cotton, an ideal material for women’s underwear, was functionalized with L-cysteine through an exhaustion procedure following activation with 2,2,6,6-tetramethylpiperidinyl-1-oxy free radical. The results demonstrated increased energy dispersive X-ray peaks corresponding to sulfur atoms in the functionalized cotton fabric, confirming that L-cysteine remained attached to the cotton surface even after washing cycles. Moreover, the cotton containing L-cysteine displayed morphology and mechanical properties similar to the nonfunctionalized cotton, indicating that the incorporation of L-cysteine did not impact the cotton properties. In addition, cotton functionalized with L-cysteine exhibited a significant reduction in yeast growth – 87.04 ± 1.90% for Candida albicans and 65.28 ± 3.03% for Candida parapsilosis – highlighting its potential as a class I medical device, particularly for preventing candidiasis in women’s medical underwear.

Functional antagonism and insights into the biosynthetic potential of human gut-derived microbes

The specialised small molecules encoded by commensal microbes mediate distinct functional interactions. However, there is a landscape of antagonistic interactions mediated by specialised strains and their small molecules. Herein, the antagonistic landscape within a collection of 330 human gut-derived commensal microbial strains was elucidated to evaluate antimicrobial interactions as a defensive contributor, and gain new insights into structure-related functions. The potential antagonistic gut-derived strains displayed strain-specific selective inhibition. This is in contrast to common antimicrobial drugs, which typically wipe out a broad range of species and are usually found in environmental microbes. Genome sequencing of representative gut strains revealed the presence of significant biosynthetic gene clusters (BGCs) encoding compound families that contribute to antagonistic activities, and are important in host defence and maintaining gut homeostasis. Subsets of these BGCs were abundant in metagenomic sequencing data from healthy individuals. Furthermore, the cell culture secretome of these strains revealed potential biomarkers linked to hallmark pathways. These microorganisms have biosynthetic novelty and are a source of biologically significant natural products. Such natural products are essential in the development of new antimicrobial agents to reduce the usage of broad-spectrum antibiotics and combat antimicrobial resistance.

Mucormycosis related knowledge among a sample of the general population in Egypt

In the fight against COVID-19, the mass usage of broad-spectrum antibiotics and steroids may result in the development or worsening of a pre-existing fungal disease. The researchers conducted the current study among a sample of the general population in Egypt to assess their mucormycosis-related knowledge. The current work was an exploratory cross-sectional study performed via an online survey. The investigators conducted a convenience sampling by looking for large-networked groups on Facebook; 473 completed the questionnaire. It included: socio-demographics, 28 knowledge questions addressing definition, risk factors, modes of transmission, symptoms, and prevention of mucormycosis, and sources of knowledge. The median total knowledge percent score was 58 (9-38). The least median percent score was 25 (0-83) for prevention knowledge. The comparison between knowledge percent score and participants' demographics showed no statistically significant difference. However, the participants working in the medical field had a higher median knowledge percent score, with a p-value &amp;lt;0.05. The major sources of information were cited as being the internet and social media. Despite being educated, and most of the enrolled individuals were university graduates, most participants had insufficient mucormycotic knowledge. This emphasizes the importance of conducting mucormycosis awareness campaigns for the public.

1706. Risk factors for infections caused by extended spectrum beta lactamase (ESBL) producing and Carbapenem-resistant Enterobacterales (CRE) in pediatric critical care settings: A case control study

Abstract Background Infections due to Gram negative resistant bacterial pathogens are a major concern in intensive care units. The purpose of this study is to determine the risk factors for developing ESBL-producing and CRE infections in pediatric patients in critical care settings (PICU and NICU). Methods A retrospective case control study of infections due to ESBL-producing and CRE during a 5-year period (2016-2021) at Children’s Hospital of Michigan, Detroit. All patients had positive cultures during their PICU/NICU stay. Control cases were matched for age, infection site and year of infection but their cultures grew Enterobacterales that were non-ESBL or carbapenemase producers. Results A total of 58 patients with ESBL/Carbapenemase-producing Enterobacterales (cases) and 59 control patients were included. Majority of organisms were E. coli and Klebsiella species recovered from respiratory tract. There was no difference in both groups in regards to age, gender, race or length of hospital stay (p &amp;gt;0.3). There was no difference in prior hospital admission, PICU or NICU stay during the previous 6 months, indwelling devices, comorbid conditions, or surgery in the last 6 months (p &amp;gt;0.3). However, the presence of gastrostomy tube was more frequent in the cases group (29.3%) than the control group (15.3%) (p=0.078). Risk factors by univariate analysis included history of antibiotic use in last 6 months (93% in cases vs 73% in controls; p=0.006), cephalosporins use &amp;gt; 14 days (67% vs 31.2%; p=0.006),Trimethoprim/Sulfamethoxazole treatment duration &amp;gt; 14 days (11.1% vs 0%; p=0.012), carbapenem treatment duration &amp;gt; 14 days (14% vs 1.9%; p=0.027), and vancomycin use &amp;gt; 14 days (43.6% vs 21.6%; p=0.053). However, multivariate logistic regression analysis showed that antibiotic usage in the last 6 months was the single best predictor for cases with odds ratio of 5.02-fold (95% CI 1.56-16.13) (p=0.007). Conclusion Prior broad spectrum antibiotic usage was significantly associated with acquisition of ESBL and carbapenemase producing Enterobacterales. The study further underscores the need for optimizing antimicrobial stewardship practices to limit unnecessary and prolonged use of antibiotics to prevent the emergence of resistant pathogens. Disclosures All Authors: No reported disclosures

Initial blood culture collection practices and the associated factors upon continued empiric piperacillin-tazobactam usage

Background: Approaches to the prescription behavior of broad-spectrum antibiotics, including preauthorization and prospective audit and feedback (PAF), are a focus of antimicrobial stewardship (ASP). However, preprescription behavior, such as blood-culture collection before empiric prescription, is understudied and merits more attention given its influence on the usage of broad-spectrum antibiotics. At the University of Tokyo Hospital, carbapenems are subject to PAF, which has resulted in a compensatory increase in piperacillin-tazobactam use. To evaluate the inherent preprescription behavior associated with a broad-spectrum antibiotic, we investigated the initial blood-culture collection practices upon hospitalization in patients who were continued on empiric piperacillin-tazobactam. Methods: A retrospective observational study was conducted at the University of Tokyo Hospital, a tertiary-care hospital in Tokyo, Japan. Patients who were administered piperacillin-tazobactam on the day of hospitalization between April 2016 and December 2017 were included. Patients aged &lt;=18 years and/or patients who discontinued piperacillin-tazobactam within two days were excluded. Only 1 admission per patient was kept for analysis. The medical records of 250 randomly selected patients were reviewed to obtain data on demographics, blood-culture collection, severity, specialties, and risk factors for multidrug-resistant organisms. A multivariable logistic regression analysis was used to identify factors associated with blood-culture collection. Results: In total, 960 discrete patients fulfilled the study criteria. Of the randomly selected 250 patients, blood cultures were collected from 162 patients (64.8%), and microbial growth was observed in 30 cases (18.5%). Enterobacterales and anaerobes accounted for 73.3% of the microbial population. Gastroenterologists (94, 37.6%) and general surgeons (52, 20.8%) were the most common prescribers. Hepatobiliary (83, 33.2%), respiratory (58, 23.2%), and intra-abdominal infections (IAI; 34, 13.6%) were the major suspected diagnoses. Blood-culture collection was associated with the use of immunosuppressive agents (OR, 3.48; 95% CI, 1.49–8.99), intrabdominal infection (OR, 0.28; 95% CI, 0.12–0.67), systemic inflammatory response syndrome criteria ≥ 2 (OR, 4.50; 95% CI, 2.25–9.42), and surgical specialty (OR, 0.33; 95% CI, 0.18–0.60). Conclusions: More than one-third of patients requiring hospitalization and empiric piperacillin-tazobactam did not undergo blood-culture collection. The finding that blood cultures were less likely to be obtained in patients with suspected IAI requiring hospitalization and by surgical specialties raises a concern regarding suboptimal evaluation. Further assessment of the appropriateness of blood-culture collection in the setting of broad-spectrum antibiotic prescription and tailored promotion of blood-culture collection to surgical specialties may be warranted.Disclosures: S.K.: The author (during graduate school (PhD) was involved in antiviral research relevant to a neglected tropical disease and favipiravir. During this graduate school research, favipiravir was provided by FUJIFILM Toyama Chemical Co. Ltd

Mucormycosis in Patients treated for Covid-19: Case Series

Mucormycosis is used to describe diseases caused by many non-septate filamentous fungal species which is caused by sub-phylum Mucormycotina. It is also known as Zygomycosis. It is an acute opportunistic and convulsive infection that is known to occur in immunocompromised patients. Covid 19 infection caused various opportunistic infections, owing to an altered immune response, prolonged steroids and usage of broad spectrum antibiotics. This report includes cases who were treated for COVID-19 and later on presented with necrosis, sloughing and perforation in the oral cavity. Histopathologically structures resembling fungal hyphae are observed. Surgical excision was done and the cases were followed up. Since the mortality associated with invasive mucormycosis is high, early diagnosis and management is necessary. Keywords: COVID-19, Immunosuppression, Mucormycosis, SARS-CoV-2, Zygomycosis

Procalcitonin as a biomarker for predicting bacterial infection in chimeric antigen receptor T-cell therapy recipients.

It is unknown whether serum procalcitonin (PCT) concentration monitoring can differentiate between bacterial infection or cytokine release syndrome (CRS) when chimeric antigen receptor T-cell (CAR-T) recipients present with a constellation of signs and symptoms that may represent both complications. The objective of the study was to assess the utility of serum PCT concentrations as a biomarker of bacterial infection in CAR-T recipients. This single-center, retrospective, medical record review evaluated patients prescribed CAR-T therapy until death or 30 days after infusion. Logistic regression modeling determined the association between elevated serum PCT concentrations within 48 h of fever onset and microbiologically confirmed infection. Secondary outcomes included clinically suspected infection, CAR-T toxicity rates, and broad-spectrum antibiotic usage. Predictive performance of PCT was assessed by area under the receiver operating characteristic curve (AUC). The 98 included patients were a median age of 63 (IQR: 55-69) years old, 47 (48%) were male, and 87 (89%) were Caucasian. Baseline demographics and clinical characteristics were similar between patients with and without a bacterial infection. Serum PCT >0.4 ng/mL within 48 h of fever was significantly associated with a microbiologically confirmed bacterial infection (OR: 2.75 [95% CI: 1.02-7.39], p= 0.045). Median PCT values in patients with and without confirmed infections were 0.40 ng/mL (IQR: 0.26, 0.74) and 0.26 ng/mL (IQR: 0.13, 0.47), respectively. The AUC for PCT to predict bacterial infection was 0.62 (95% CI 0.48-0.76). All patients experienced CRS of some grade, with no difference in CRS severity based on elevated PCT. Broad-spectrum antibiotics were used for a median of 45% and 23% of days in those with and without confirmed infection, respectively (p= 0.075). Elevated serum PCT concentrations above 0.4ng/mL at time of first fever after CAR-T infusion was significantly associated with confirmed bacterial infection. Furthermore, rigorous, prospective studies should validate our findings and evaluate serial PCT measurements to optimize antimicrobial use after CAR-T therapy.

Bovine Lactoferrin and Current Antifungal Therapy Against Candida Albicans: A Systematic Review and Meta-Analysis.

Candida albicans is an important causative organism of opportunistic fungal infection, and it is a growing medical concern due to the increasing usage of broad-spectrum antibiotics, immunosuppressant agents, and other immunocompromising conditions. Currently, bLf and antifungal drugs have been known to have synergistic effects, increasing the drug's efficacy. This study aims to investigate the efficacy of the synergistic effect of bLf and antifungal drugs. This review addressed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We conducted literature searches to assess the association of lactoferrin and current antifungal therapy against Candida albicans in ProQuest, PubMed, MEDLINE, EBSCOhost, SAGE, JSTOR, GARUDA, and Open Gray with no date restriction (until March 5th, 2021). We used Jeffry's Amazing Statistical Program (JASP) to measure the overall size effect of MIC (minimum inhibitory concentration) between studies. A total of 7 studies retained were experimental in vitro studies. Based on the available data, 4 out of 7 studies were included in the quantitative analysis. This systematic review showed that bovine lactoferrin could help inhibit the development of azole-susceptible and azole-resistant C. albicans. Furthermore, there was synergistic activity between lactoferrin and various antifungals. Our meta-analysis showed that lactoferrin could significantly inhibit the C. albicans growth than the control group. Bovine lactoferrin and its peptide derivatives isolated from bovine milk can significantly inhibit the growth of C. albicans, both susceptible to azoles and those with azole resistance.

Comparing the appropriateness of antimicrobial prescribing among medical patients in two tertiary hospitals in Malaysia.

Malaysia is an upper-middle-income country with national antimicrobial stewardship programs in place. However, hospitals in this country are faced with a high incidence of multidrug-resistant organisms and high usage of broad-spectrum antibiotics. Therefore, this study aimed to use a standardized audit tool to assess clinical appropriateness, guideline compliance, and prescribing patterns of antimicrobial use among medical patients in two tertiary hospitals in Malaysia to benchmark practice. A prospective hospital-wide point prevalence survey was carried out by a multidisciplinary team in April 2019 at the University Malaya Medical Centre (UMMC) and the Hospital Canselor Tuanku Muhriz (HCTM), Kuala Lumpur, Malaysia. Data was collected from the patient's electronic medical records and recorded using the Hospital National Antimicrobial Prescribing Survey toolkit developed by the National Centre for Antimicrobial Stewardship, Australia. The appropriateness of prescriptions was 60.1% (UMMC) and 67% (HCTM), with no significant difference between the two hospitals. Compliance with guidelines was 60.0% (UMMC) and 61.5% (HCTM). Amoxicillin-clavulanic acid was the most commonly prescribed antimicrobial (UMMC = 16.9%; HCTM = 11.9%). The appropriateness of antimicrobial prescribing in medical wards, compliance with guidelines, and prescribing patterns were similar between the two hospitals in Malaysia. The survey identified several areas of prescribing that would need targeted AMS interventions.

385. Impact of the COVID-19 Pandemic First Wave on Clostridioides difficile Infection

Abstract Background Clostridioides difficile infection (CDI) is the leading cause of nosocomial diarrhea and a costly burden on the healthcare system. The COVID-19 pandemic brought enhanced infection control measures that could hypothetically decrease CDI transmission. Nonetheless, diarrhea secondary to COVID-19 and increased usage of broad-spectrum antibiotics could potentially increase testing for or frequency of CDI. We aimed to assess variations in CDI testing and frequency during the first surge of the COVID-19 pandemic in a tertiary community medical center in the Southern United States. Methods Records from adult patients were retrospectively reviewed at Princeton Baptist Medical Center, Birmingham, AL. Three groups spanning equal time periods were created based on the CDC COVID-19 rate curves for Alabama: PPG (pre-pandemic, 03/01/2020 to 05/31/2020), PG (pandemic, 06/01/2020 to 08/31/2020), and SCG (seasonal control, 06/01/2019 to 08/31/2019). We included patients ≥ 18 years old and excluded readmissions and follow-up visits. We determined the frequency, testing rates, and positivity rates for CDI in each group to assess their differences. Also, we measured the rate of coinfection between C. difficile and SARS-CoV-2. CDI cases were defined as positive toxin enzyme-linked immunosorbent assay (EIA) and glutamate dehydrogenase (GDH), or positivity of either in addition to positive nucleic acid amplification test (NAAT). Differences in frequencies and rates across groups were compared with Fisher exact test. Results Overall, 7,252 hospitalized patients and 29,671 outpatients were included (Figure 1). No outpatient CDI cases were detected. Outpatient testing rates were: PPG 3 (0.05%), PG 4 (0.05%), and SCG 9 (0.06%). Among inpatients, 3,912 (53.9%) were female with a mean ± SD age of 61.2 ± 17.5 years. Overall, CDI frequency, testing rates, and positivity rates did not vary significantly among all groups (Table 1). Among those tested, the only case of C.difficile/SARS-CoV-2 coinfection corresponded to PPG. Figure 1:Patient distributionTable 1:Frequency of CDI and COVID-19 infection in inpatients Conclusion There were no statistically significant differences in CDI frequency, or positivity rate between the pre-pandemic, pandemic, and seasonal control groups for inpatients. No CDI cases were detected in outpatients. This is likely due to a low testing rate in our population. Disclosures All Authors: No reported disclosures.

928. The Cost-effectiveness of the Pediatric Antimicrobial Stewardship Program in a Non-Freestanding Children’s Hospital

Abstract Background Improper utilization of antimicrobials has impacted clinical outcomes in patient care and economical costs. Pediatric antimicrobial stewardship (Ped ASP) lowers healthcare costs by promoting efficient and judicious use of antimicrobials which improves patient outcomes and amends resource utilization. The objective of this study is to evaluate the cost-effectiveness of a Ped ASP in a non-freestanding children’s hospital within an adult-centered tertiary hospital. Methods We conducted a cost-effective analysis of our Ped ASP within a 685-bed, adult-centered medical center. Impacted by the COVID pandemic, the pediatric services reduced from 21 to 14 beds with 10 general pediatrics (PED) and 4 pediatric intensive care (PICU) beds. Our Ped ASP activities include thrice-weekly chart reviews followed by handshake rounds and quarterly reviews of documented interventions. The preset values of antimicrobial-specific interventions in the Electronic Medical Record system were utilized. An average cost savings of $732 (range: $2.5 - $2,640) per patient as determined by previous studies was used to calculate the annual cost savings. Results During years 2020 to 2021, antibiotic days of therapy per 1000 patient days (DOT) decreased from 290.4 to 100.2 in PED but increased from 433 to 569.1 in PICU. The ratio of broad to narrow-spectrum antibiotics decreased from 0.46 to 0.20 in PED and 0.69 to 0.63 in PICU. In 2020, 286 reviews were completed of 155 patients which projected an average cost savings of $113,460 (range: $387.5 - $409,200). In 2021, 256 reviews of 116 patients projected an average cost savings of $84,912 (range $290 - $306,240). An estimated overall annual cost-savings was $99,186. The total number of ASP-specific interventions in 2020 and 2021 were 172 and 146 with projected pharmacy intervention values of $26,354 and $19,170 respectively. Conclusion Our Ped ASP effectively reduces the usage of broad-spectrum antibiotics in both PED and PICU demonstrating cost savings. Implementing antibiotic time-out reports on specific broad-spectrum antibiotics based on local susceptibility data may further enhance the safety and appropriateness of antimicrobial therapy. Disclosures All Authors: No reported disclosures.

1753. Impact of a Pharmacist-Driven Home Hospital Antimicrobial Stewardship Program Pilot within a Large Community Health System

Abstract Background Home Hospital (HH) is a unique and rapidly expanding care model that allows patients to receive medical therapy and monitoring through telehealth communication and nursing visits, and there are currently no published studies evaluating antimicrobial stewardship interventions in the HH setting. The goal of this study is to evaluate the impact of a pharmacist-driven antimicrobial stewardship pilot for the HH program. Methods This was a pre-post quasi-experimental study of adult patients enrolled in HH program between January through March in 2021 (control cohort) and in 2022 (intervention cohort), who received antibiotics (oral/intravenous) during their HH admission. Patients on long-term prophylactic antimicrobials, antifungals, external antimicrobials, or mycobacterial treatment were excluded. The antimicrobial stewardship pharmacist performed prospective audit and feedback and provided recommendations to clinicians through the electronic medical record. The primary endpoint was antibiotic use (days of therapy per 1000 patient-days). Secondary endpoints included broad-spectrum antibiotic usage; appropriateness of antibiotic indication, dosing, and duration; compliance with the institution’s outpatient antibiotic reference guide or outpatient intravenous antibiotic therapy (OPAT) monitoring; treatment failure; antibiotic-associated adverse effects; and cost of antibiotic therapy. Results The study included 73 and 127 patients in the control and intervention group, respectively (Figure 1). On average, the pharmacist reviewed 8 eligible patients/day. Interventions were generally well received by HH providers (Figure 2). There was no significant difference in the primary outcome. More inappropriate antibiotic indication was identified in the intervention group (46 [36%] vs. 15 [19%], p=0.01), associated with post-surgical infection prophylaxis after orthopedic procedures (Figure 3). Other secondary outcomes did not vary significantly between the groups. Figure 1:Study inclusion flowchartFigure 2:Intervention breakdownFigure 3:Infection types Conclusion The pilot allows for better understanding of outpatient and HH antibiotic prescribing practices to provide targeted interventions, and suggests the need for additional antimicrobial stewardship involvement to optimize antibiotic therapy in this novel care setting. Disclosures Elizabeth B. Hirsch, PharmD, FCCP, FIDSA, Melinta: Advisor/Consultant|MeMed: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support.

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.

Association of Multidrug Resistance Bacteria and Clinical Outcomes of Adult Patients with Sepsis in the Intensive Care Unit.

Multi-drug resistance organisms (MDRO) often cause increased morbidity, mortality, and length of stays (LOS). However, there is uncertainty whether the infection of MDRO increase the morbidity, mortality, and ICU-LOS. This study was performed to determine the prevalence of MDRO in the ICU, the site of infection, and the association of MDRO or site of infection with mortality. The secondary outcome was determined by ascertaining the association of MDRO or site of infection with ICU-LOS. A retrospective cohort study was performed with adult sepsis patients in the ICU. Univariate and multivariate (MVA) logistic regression with cox regression modeling were performed to compute the association of MDRO with ICU mortality. MVA modelling was performed for ICU-LOS predictors. Out of 228 patients, the isolated MDRO was 97 (42.5%), of which 78% were Gram-negative bacteria. The mortality rate among those with MDRO was 85 (37.3%). The hospital acquired infection (HAI) was a significant predictor for ICU-LOS in univariate linear regression (R2 = 0.034, p = 0.005). In MVA linear regression, both Enterococcus faecalis infection and Acinetobacter baumannii (AC)-MDRO were predictors for ICU-LOS with (R2 = 0.478, p &lt; 0.05). In the univariate cox regression, only the infection with AC-MDRO was a risk factor for ICU-mortality with [HR = 1.802 (95% CI: 1.2-2.706; p = 0.005)]. Identifying risk factors for MDRO addresses the appropriate administration of empirical antibiotics and allows to effectively control the source of infection, which would reduce mortality and ICU-LOS. The usage of broad-spectrum antibiotics should be limited to those with substantial risk factors for acquiring MDRO.