Antimicrobial Prescribing Research Articles

P-1684. Characterization of Bacteremia and de-escalation practices among 13 public hospitals in Chile: Results from the 2022-2023 Chilean PPS

Abstract Background Antimicrobial resistance (AMR) is a global concern. Collecting data and implementing interventions to optimize antimicrobial (AM) use has significant potential to lower AMR.There is no information in Latin American Region on how prescribers are using data from positive blood culture results to de-escalate AM. We present a sub-analysis of the 2022-2023 Latin-PPS performed in Chile including the characterization of bacteriemia and de-escalation practices. Antimicrobial distribution to treat bacteremia Methods 13 public hospitals joined the Latin-PPS group. This PPS is based on the WHOPPS methodology. Each hospital conducted a survey in which everyday data from AM prescriptions was collected by ward. We include only patients that received AM related to documented bacteremia. The purpose of this study is to describe the etiological agents that caused bacteremia, AM use and compare the blood culture result with appropriate AM prescription. Most common etiological agents and antimicrobials used. Results Chilean PPS included 3,342 beds, where 1302 AM treatments were given and 1,928 AM were administered to a national prevalence of 38.84%. Bacteremia is the 6th most common diagnosis related to AM use and corresponds to 3,76% . We found 49 bacteremia episodes, 9 occurred in ICU. The most common etiological agent was Staphylococcus aureus (16/49). Table 1 describes: most common etiological agents and AM used. The AM distribution to treat bacteremia is shown in graphic 1. 37/49 (75.5%) bacteremia had an organism that matched an appropriate AM. 10 of those missed an opportunity of de-escalation and 7 possibly represented contaminations in which AM could be stopped. Conclusion The AM prescription in hospitalized patients in Chile is lower compared to other LMIC. We found opportunities for AM optimization by de-escalating or stopping AM when blood culture results are available in bacteremia. We plan to recommend evidence-based strategies implementation aiming to de-escalate AM to a narrow more tailored regimen by audit and feedback supported with guidelines. Also to raise awareness about the possibility of contamination when blood cultures isolate coagulase negative staphylococcus as an opportunity to stop antimicrobials. PPS is an effective method to detect antimicrobial prescription habits and prioritize Antimicrobial Stewardship activities with local data. Disclosures Dona Benadof, MD, Biomerieux: Grant/Research Support Mirta Acuña, MD, Pfizer: Grant/Research Support P. , PharmD, Eli Lilly: Stocks/Bonds (Private Company)|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant Ruth A. Rosales, n/a, BECTON DICKINSON DE CHILE: Advisor/Consultant|BECTON DICKINSON DE CHILE: Speaker|Pfizer SA: Speaker

P-1752. Antimicrobial Stewardship Initiative on Prescribing at Discharge from a Community Medical Center

Abstract Background Inappropriate antimicrobial prescribing and overuse propagates multi-drug resistant organisms and increases risk of adverse drug events. Antimicrobial stewardship programs (ASP) focus a majority of interventions on hospital inpatients, but efforts at discharge remain limited. A recent gap analysis at our institution found that 53% of antimicrobial regimens prescribed at discharge were inappropriate in drug choice, dosing, and/or duration. Therefore, a multifaceted ASP initiative focusing on discharge antimicrobial regimens was implemented at our institution. The study objective was to assess program impact on prescription appropriateness. Overall Appropriateness of Antimicrobial Prescriptions Methods Components of the stewardship initiative included development of an institution-specific prescribing guideline, clinician education, and pharmacist prospective audit and feedback at discharge. This IRB-approved study evaluated oral antimicrobial regimens prescribed to adults patients upon discharge from a community medical center. Patients were randomized irrespective of encounter type or discharge destination. Pregnant and post-partum patients were excluded. The validated National Antimicrobial Prescribing Survey (NAPS) tool was used to categorize antimicrobial appropriateness as appropriate (optimal or adequate), inappropriate (suboptimal or inadequate), or not assessable. Hospital-specific treatment guidelines, literature references, and patient-specific factors were used to determine appropriateness. The primary outcome was the proportion of appropriate discharge antimicrobial regimens before versus after initiative implementation. Proportion of Each NAPS Category Results One hundred antimicrobial regimens were analyzed in each cohort. The proportion of appropriate antimicrobial regimens increased by 15% after program implementation (47% vs. 62%, p = 0.03). Exploratory outcome analyses indicated an increase in optimal regimens (26% vs. 44%) and a decrease in suboptimal (33% vs. 26%) and inadequate (20% vs 12%) therapy as categorized by the NAPS tool. Conclusion ASP initiative implementation increased the proportion of appropriate discharge antimicrobial regimens. Study results highlight the positive impact of a multidisciplinary approach in improving discharge antimicrobial prescribing. Disclosures All Authors: No reported disclosures

P-1739. Impact of a Urinary Tract Infection Treatment Algorithm on Antimicrobial Prescribing at a Small Rural Hospital without Formally Trained Infectious Disease Team Members

Abstract Background Small, rural community hospitals lack certified infectious disease (ID) staff, which can make antimicrobial stewardship (AMS) interventions challenging. At our Critical Access Hospital, we developed a treatment algorithm for urinary tract infections (UTIs) and assessed appropriate duration of therapy (DOT), and appropriate antimicrobial selection in cases before and after implementation of our algorithm. Figure 1. Methods In this retrospective observational study, the AMS team published a treatment algorithm for UTIs (Figure 1) in Q1 2023. Implementation of the algorithm focused on physician exposure, buy-in, and follow-up. A webpage was created to house the algorithm. Buy-in was obtained from key physicians. Antimicrobial prescribing was reviewed at quarterly AMS meetings and physician leaders took this information back to their teams for review. A retrospective review was performed after 2 quarters of interventions. We obtained prescribing data via electronic health records. Baseline characteristics are in Table 1. Each UTI case was manually reviewed for DOT and appropriateness of antibiotic choice as defined by agreement with our algorithm. Results The study included in-patients who were treated for UTI between 10/1/21 through 3/31/22, and 10/1/23 through 3/31/24. Exclusion criteria included concomitant infections, inability to follow-up, and expiration. A t-test was performed to compare antibiotic DOT for UTI treatment. The distribution of DOT is presented in Figure 2. There was a decrease in DOT after our intervention (M=3.84, SD 1.95) compared to baseline (M=4.95, SD=2.64); t(2.2491), P=0.0271. Appropriateness of therapy was assessed (Figure 3). A Chi-square test showed association between the intervention and appropriate choice of therapy, χ2 (1, N= 88)= 12.90, p=0.0003. Figure 2. Antibiotic days for the treatment of UTI. Antibiotic days calculated to include discharge medications. Conclusion The development of a treatment algorithm for UTI, paired with stakeholder buy-in, exposure, and follow-up, led to shifts in prescribing habits. We found a reduction in DOT, as well as better adherence to guideline driven antibiotic selection. This study, which included discharge prescribing, is unique in that it follows our cases through the continuum of care. We show that rural hospitals without certified ID staff can effectively implement AMS best practices and affect meaningful change. Figure 3. Retrospective contingency table summarizing number of appropriate and inappropriately treated UTIs. Appropriateness determined by AMS team by comparing antibiotic selection to our UTI algorithm. Disclosures All Authors: No reported disclosures

P-1713. Impact of an Evidence-Based Order Panel on Antimicrobial Prescribing in Ambulatory Patients with Complicated and Uncomplicated Cystitis

Abstract Background Optimizing antimicrobial prescribing for urinary tract infections (UTI) represents an area of opportunity for ambulatory antimicrobial stewardship programs. A pre-populated, ambulatory antibiotic order panel for UTI was implemented in the Mayo Clinic Enterprise on 5/16/2022. The order panel provides antimicrobial regimens which align with both institutional and national treatment guidelines based on patient comorbidities, complicating factors, and beta-lactam allergy status. We aimed to assess the impact of panel use on antibiotic prescribing for complicated and uncomplicated cystitis in the ambulatory setting. Methods This retrospective review included ambulatory encounters from the Mayo Clinic Enterprise in 2022 and 2023. Eligible encounters were randomly selected and included those with a primary ICD-10 code of cystitis performed by primary care or urgent care clinicians. Encounters were excluded if patients had symptoms indicative of pyelonephritis, underwent urinary instrumentation within 30 days, or had a urinary pathogen isolated within 90 days. The primary outcome was concordance with institutional guidelines. Secondary outcomes included repeat healthcare contact and therapy duration. Outcomes were analyzed with Pearson's chi-squared and Wilcoxon rank sum tests (α level = 0.05). Results 793 encounters (397 panel vs. 396 non-panel) were included. Prescribing was guideline concordant in 79.3% and 64.9% (p< 0.001) of panel and non-panel encounters, respectively. Inappropriate duration was the most common reason for non-concordance in the panel use cohort. There was no difference between groups for repeat healthcare contact incidence. Antimicrobials prescribed differed between panel and no-panel groups (Table 1), with higher use of sulfamethoxazole/trimethoprim and lower use of cefdinir in the panel cohort. Numerically shorter durations were seen in the panel group, with more 3- and 5-day regimens than the no-panel group. Conclusion Use of a pre-populated antimicrobial order panel for outpatient cystitis encounters resulted in greater adherence to institutional guideline recommendations, particularly in terms of antimicrobial selection, without adversely impacting repeat healthcare contact. Disclosures Paschalis Vergidis, MD, MSc, AbbVie: Advisor/Consultant|Ansun Biopharma: Grant/Research Support|Cidara Therapeutics: Grant/Research Support|F2G: Grant/Research Support|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support

P-1634. Prescribing Patterns of Antibiotics in an Academic Medical Center Internal Medicine Clinic

Abstract Background Antimicrobial stewardship is critical in the prevention of antibiotic resistance. The CDC estimates nearly 90% of antibiotic use occurs in outpatient settings, with up to half of the prescriptions not carrying appropriate indications. Public health efforts like the National Action Plan for Combating Antibiotic Resistant Bacteria aim to reduce/improve outpatient antibiotic use following the Department of Health and Human Services guidance. Inclusion/Exclusion 350 prescriptions were assessed for inclusion within the study. Prescriptions were excluded if antibiotics were prescribed for prophylaxis, indications outside of preferred list (notably: COPD Exacerbations, prostatitis, pyelonephritis, clearly documented “asymptomatic bacteriuria”), prescriptions continued from inpatient admission, pregnancy, under the age of 18, and infectious disease consults Methods A retrospective descriptive assessment of antimicrobial prescribing practice within one internal medicine clinic was conducted through chart review. Outpatient antibiotic prescriptions from a prespecified list of agents written between March to June of 2023 for cystitis, community-acquired pneumonia, and acute sinusitis were compared to current Infectious Disease Society of America recommendations for treatment. The primary outcome was appropriateness based on indication, drug choice, dose, and duration of therapy. A key secondary outcome assessed was ED or clinic return visits for the same primary problem within 30 days. Prescription Appropriateness Each prescription was assessed for correct indication, drug, dose, and duration based on current IDSA guidelines. Results This study included 166 antibiotic prescriptions written for 147 patients. Of these prescriptions, 67% were inappropriately prescribed. Duration and indication were inappropriate most frequently on prescriptions while drug and dose were appropriately selected by providers. Of the patients with prescription errors, 23.1% (25/108) led to a return visit versus 17.2% (10/58) for patients with antibiotics prescribed correctly (p =0.429). Prescription Inappropriateness by Type of Error This study included 166 antibiotic prescriptions written for 147 patients. Of these prescriptions, 67% were inappropriately prescribed. Duration (33%) and indication (34%) were inappropriate most frequently on prescriptions while drug (16%) and dose (7%) were appropriately selected by providers. Conclusion In conclusion, antibiotics are inappropriately prescribed in the outpatient setting which necessitates the need for increased stewardship efforts. A trend towards increased return visits was observed for patients who received an inappropriate antibiotic prescription. As a secondary outcome, this study was unable to meet statistical significance, but further evaluation should be done to explore this trend. Implementation of institutional prescribing guidelines for common infections such as acute sinusitis or cystitis paired with targeted education for outpatient clinics could help improve antimicrobial prescribing habits. Antibiotic Prescription by Appropriateness The most common antibiotics prescribed included amoxicillin-clavulanate, cephalexin, and nitrofurantoin accounting for 70% of the prescriptions reviewed. Fluroquinolones when prescribed were inappropriate in this study based on indication, dose, duration, or drug. Amoxicillin-clavulanate when prescribed was correct in all four categories for only 50% of prescriptions while nitrofurantoin was appropriate only 29% of the time. Disclosures All Authors: No reported disclosures

P-1695. Antimicrobial prescribing differences for urinary tract infections between advanced practice practitioners and physicians at a safety-net community hospital

Abstract Background Advanced practice practitioners (APPs) are increasingly working in inptient settings as hospitalists. Despite these trends, there's a paucity of data on APP antimicrobial prescribing practices. Antimicrobial stewardship programs (ASPs) can reduce antimicrobial overuse and misuse. One of the most common infections in the inpatient setting is urinary tract infections (UTIs). We examine antibiotic prescribing practices of APPs and physicians for treatment ofUTIs. Understanding prescribing practices can highlihgt stewardship gaps and help guide ASP efforts. Figure 1 UTI severity and empiric antimicrobial selection by physicians and APPs Methods A retrospective analysis of antimicrobial prescriptions was conducted at a 151-bed community hospital. ASP prospective audit and feedback (PAF) data for UTIs from July 2022 to June 2023 was reviewed, including initial antimicrobial selection, duration, and guideline concordance for APPs and physicians. Guideline adherence, antimicrobial effectiveness based on local antibiogram, and days of therapy (DOT) per 1000 patient days was compared between APPs and physicians. Figure 2 Empiric antimicrobial selection by physicians and APPs Results A total of 209 initial PAF events for UTIs were reviewed, of which, 161 were physicians and 48were APPs. Physicians’ initial empiric choice was 9% (15) guideline discordant and ineffective. APP initial choice was 17% (8) guideline discordant and ineffective. TMP-SMX was more commonly used by APPs (Figure 1). Total DOT/1000 was 145. DOT/1000 was 44 for physicians, of which 11% were anti-pseudomonal beta lactams (APBLs) and 34% non-APBLs. DOT/1000 was 21 for APPs, of which 19% were APBLs and 27% non-APBLs (Figure 2). DOT/1000 was 44 for physicians, of which 11% were anti-pseudomonal beta lactams (APBLs) and 34% non-APBLs. DOT/1000 was 21 for APPs, of which 19% were anti-pseudomonal beta lactams (APBLs) and 27% non-APBLs (Figure 2). Conclusion APPs more commonly chose guideline discordant or ineffective initial empiric choices for UTIs compared to physicians. Empiric selection of ineffective agents according to local antibiogramswas higher for APPs. This underscores the importance of targeted ASP education on UTI guidelines and local antibiogram interpretation to improve antibiotic prescribing practices among APPs. Disclosures All Authors: No reported disclosures

P-1142. Evaluating Ambulatory Antibiotic Prescribing for Respiratory Infections at a Pediatric Institution

Abstract Background Over 85% of antibiotic prescribing occurs in outpatient settings such as emergency departments (ED), urgent care centers (UCC), and primary care clinics (PCC); almost half of antibiotics are prescribed for respiratory infections (RI). Given the rise of telehealth visits (TH) in both UCC and PCC settings in the past several years, this study examines the effect of location sites on antibiotic prescribing for RI at our institution. Methods Single-center, retrospective cohort study in Portland, Oregon, USA. Patients < = 20 years of age seen in the ED, UCC, and PC settings between 1/1/2019-12/31/2024, were included. Electronic data included age, race, ethnicity, location and encounter type, payor status, visit ICD-10 codes, and antibiotic prescription details. Multivariate logistical regression determined the effect of patient factors on antimicrobial prescribing. Results A total of 157,499 ambulatory encounters were included of which 24,236 were respiratory ICD10 code-related visits. Respiratory visit rates were not significantly different between non-Hispanic White and Hispanic/non-White children or by age group. RI were categorized as viral (57.7%), possible bacterial (37.6%), or co-infection (4.7%); antibiotics were prescribed 5.3%, 60.4%, and 62.8% of visits respectively. The rate of antibiotic prescribing for viral and possible bacterial RI was not different between non-Hispanic White and Hispanic/non-White children or between payor status. For viral RI, PCC and UCC settings were more likely to prescribe antibiotics compared to the ED (OR 1.4 and OR 2.36, respectively). Furthermore, PCC and UCC were less likely to prescribe narrow-spectrum antibiotics for possible bacterial RI compared to the ED (OR 0.84 and OR 0.79, respectively), including TH PCC and TH UCC visits (OR 0.29 and OR 0.56, respectively). Conclusion Pediatric patients with RI can receive ambulatory care through multiple settings. PCC TH (although a small percentage of all RI visits) shows the highest use of antibiotics for viral RI and the least narrow spectrum antibiotic prescribing for presumed bacterial RI. Efforts to reduce antibiotic use in viral RI should focus on non-ED settings, including TH. Strategies to encourage use of narrow-spectrum activity agents for RI should be shared with all departments. Disclosures All Authors: No reported disclosures

P-1756. Impact of order set implementation on appropriate treatment of community acquired pneumonia (CAP)

Abstract Background The overuse and misuse of antibiotics can lead to adverse events, antibiotic resistance, and increased healthcare costs. In 2022, Ascension Borgess Hospital implemented a community acquired pneumonia (CAP) order set to help guide appropriate antimicrobial prescribing.The orderset included guideline-concordant agents and durations of therapy for CAP as well as comments empowering pharmacists to adjust total duration of therapy to account for antimicrobial doses received in the emergency department. The purpose of this study is to evaluate appropriate antimicrobial prescribing after implementing a pneumonia order set. Methods This retrospective cohort study was conducted at a 450-bed community teaching hospital. The primary objective of this study was a composite outcome of appropriate empiric antimicrobial selection, dosing, and duration in accordance with the national guidelines. Secondary outcomes include length of hospital stay (LOS), readmission rates, mortality rates and Clostridium difficile infection rates. An exploratory outcome was pre-determined to evaluate pharmacists' intervention on duration of therapy, and utilization of the order-set to prescribe antibiotics. Patients were eligible for inclusion if they were 18 years or older and treated for CAP between 10/1/2021 and 8/1/2023 Results A total of 236 patients were included (118 patients per group). Significantly more patients in the post-implementation group received guideline-concordant therapy for CAP (5.9% vs 35.6%, p< 0.001). Results were heavily influenced by improvements in appropriate durations of therapy (pre- 6.8% vs post 39.9%, p< 0.001). There were no significant differences observed for LOS, 30 day readmission rates, C. difficile infections within 30 days, or mortality rates between groups. For exploratory endpoints, the orderset was utilized in 66.1% of patients included in the post-implementation group. Additionally, pharmacists were more likely to intervene following implementation of the orderset (22.9% v 43.2%, p < 0.001), as a result of order comments and increased awareness. Conclusion Implementing a guideline concordant orderset significantly improved inpatient antibiotic prescribing for CAP with no difference in clinical or safety outcomes. Disclosures All Authors: No reported disclosures

P-1677. Assessing An Institution’s Approach to Management of Gram-Negative Bacteremia in High-Risk Populations

Abstract Background Immunocompromised populations present unique antimicrobial management and stewardship challenges. These challenges can persist despite existing stewardship policies. This study examined management of gram-negative bacteremia (GN-BSI) in a diverse immunocompromised population at the National Institutes of Health Clinical Center (NIH CC). Methods Episodes of GN-BSI admitted to the NIHCC from January 1 to December 31, 2023 were identified through positive blood culture results. Charts were abstracted for baseline demographics, episode-specific data, antimicrobial prescribing, and clinical outcomes. Results Seventy-five episodes of GN-BSI were identified. Thirty-six (48%) were undergoing cellular therapy and 54 (58.7%) were neutropenic. About 50.7% identified translocation as etiology of infection. Eleven (14.7%) were ESBL-positive by BCID2 panel. Seventy-two (96%) involved infectious disease (ID) consultation. Empiric choice of gram-negative antibiotics included ceftazidime/avibactam in 9 (12%) episodes, meropenem in 38 (50.7%) episodes, piperacillin/tazobactam in 15 (20%) episodes, and an anti-pseudomonal cephalosporin in 32 (42.7%). Twenty (26.7%) received 2+ empiric anti-pseudomonal antibiotics. After 72 hours, 37 (49.3%) still received meropenem with most isolates susceptible to narrower spectrum (Table 1). Similar results were seen with final ID recommendations (Table 2). Seven (10%) had transitioned to an oral agent by the seventh day. Comparing 72-hour antibiotic (Meropenem vs anti-pseudomonal cephalosporin), ICU admission (32.4% v 25%, p=0.62) and 30-day mortality (5.4% v 6.3%, p=0.87) were similar. Median therapy duration was 14 days (IQR 14-18.5). Of the 65 episodes with indwelling central venous access (CVAD), only 16 had removal of all CVADs. Those with CVAD removal had lower 30-d mortality (0% v 11.9%, p=0.22) though not statistically significant. Conclusion In a high-risk immunocompromised population, there is a low rate of narrowing gram-negative coverage at 72 hours although options for narrowing exist. Choice of empiric antimicrobial and targeted therapy for these GN-BSI episodes are the two major areas of improvement in our population. Primary teams and ID consultants should be involved in ongoing stewardship interventions. Disclosures All Authors: No reported disclosures

P-2080. Impact of the Implementation of Multiplex Gastrointestinal PCR Panel on Antimicrobial Use for Infectious Diarrhea

Abstract Background Rapid molecular methods, such as BioFire FilmArray™ Gastrointestinal (GI) Panel, have become common in clinical practice. The GI Panel identifies 22 GI pathogens in approximately 1 hour. We evaluated antimicrobial prescribing before and after the implementation of the GI Panel to see the impact on appropriate prescribing for infectious diarrhea and to identify quality improvement areas for antimicrobial stewardship moving forward.Figure 2:Percent Type of Antibiotic Change After Result of Diagnostic Testing Methods This retrospective cohort analysis compared antimicrobial prescribing practices for infectious diarrhea one year before and after the implementation of the BioFire GI Panel at the University of Maryland Medical Center (UMMC) in August 2021. Prior to GI Panel implementation at UMMC, the major diagnostic tests for infectious diarrhea were stool culture, ova and parasite smear, and a parasite PCR. Cases were randomly selected with an even distribution from each month from August 2019 to August 2022. Appropriateness of empiric and definitive management was assessed based on diarrhea type (bloody, acute, or prolonged), the patient's immune status, travel history, clinical presentation, and antibiotic selection. Results 353 patients were included: 179 pre-GI panel implementation and 174 post-implementation. Empiric antibiotic therapy for infectious diarrhea was started in 47/179 (26.3%) of the pre-panel group and 50/174 (28.7%) of the post-panel (P = 0.601). The diagnostic tests resulted in positive organism identification in 10% of patients in the pre-group, while positive identification increased to 19.4% post-group (P = 0.012). When an organism was identified, 12/33 (66.7%) of the post-panel group received antibiotic therapy, while only 6/18 (33.3%) of the pre-panel group received antibiotics (P = 0.83) Conclusion Our analysis showed that many patients did not have antimicrobial therapy for infectious diarrhea, which was impacted by the diagnostic test. The increased sensitivity to detect organisms in the GI Panel may account for the increased utilization of definitive antimicrobials in the post-implementation cohort. Disclosures J Kristie Johnson, PhD, D (ABMM), biomerieux: has given presentations/speeches for the company listed above Kimberly C. Claeys, PharmD, PhD, bioMérieux: Advisor/Consultant|bioMérieux: Honoraria

P-1658. Healthcare Provider Perspectives on Antibiotic Use in Immigrants and Refugees in the United States: A Qualitative Study

Abstract Background Antimicrobial resistance (AMR) is a global health threat with greater prevalence in refugee populations. Prior work demonstrated that compared to native-born Americans, immigrants/refugees from low- and middle-income countries have lower health literacy about AMR, increasing risk for inappropriate antibiotic use. Healthcare provider (HCP) perceptions of prescribing practices regarding immigrant/refugee populations in the United States (US) is lacking. We aimed to understand US HCP views on antibiotic prescribing practices and barriers that may lead to disparities affecting immigrants/refugees. Methods From September 1, 2023 through April 27, 2024, as a follow up to patient-centered work on antibiotic knowledge in the immigrant/refugee population, we conducted semi-structured qualitative interviews of 14 HCPs, both prescribers (e.g. physicians, advanced practice providers) and non-prescribers (e.g. nurses, medical assistants), from primary care clinics in SE Michigan that care for immigrants/refugees. We also collected participant demographic information. We generated a codebook through an iterative, inductive process using Dedoose software to code interviews and facilitate thematic analysis. Results Self-reported proportions of participants’ patient panels comprised of immigrants, refugees, and non-English speakers were 31.0%, 30.1%, and 48.2% , respectively. Most participants were prescribers and graduate-degree holders (Table 1). Eight major themes emerged: Clinical Decision-Making, Discussing Antimicrobial Consequences, Patient Life Challenges, Patient Medical Background, Antibiotic Use Differences, Patient Perspectives, Clinic Dynamics, and Patient-Provider Communication. There was consensus that distinctive challenges exist for appropriate antimicrobial prescribing among immigrant/refugee populations (Table 2). Conclusion Findings suggest that immigrant/refugee populations face multiple barriers to care. This population may benefit from an interdisciplinary outpatient team to navigate cultural differences and trauma-informed care. Our findings can inform ambulatory antibiotic stewardship interventions in immigrant/refugee populations. Disclosures All Authors: No reported disclosures

P-1700. Benchmarking Clinical Outcomes by Antimicrobial Spectrum in Patients with Community-Acquired Pneumonia

Abstract Background Antimicrobial benchmarking provides insight into practice variation relative to peers and outcomes relative to projections. Incorporation of patient-level risk-adjustment amplifies the validity and utility of data generated. The Vizient Clinical Data Base (CDB) is a healthcare analytics platform incorporating granular patient-level data from over 1,100 US hospitals and can be used to benchmark patient outcomes. The CDB’s multi-variate 2023 Academic Medical Center Risk Model is validated to produce reliable estimates for patient outcomes. Methods The CDB evaluated length of stay (LOS) and mortality for hospital admissions for community-acquired pneumonia (CAP). Admissions in CY2023 were included when labeled with a principal ICD-10 code for bacterial pneumonia, adjudicated as present on admission, and when the admission source was an outpatient location. Compared to the observed LOS, the risk model computed expected LOS (eLOS) and produced an observed to expected (O:E) index; a similar O:E index was created for mortality. Those who received narrow-spectrum (NS) antimicrobials, defined as ceftriaxone plus either azithromycin (CA) or doxycycline (CD), or levofloxacin or moxifloxacin (FLQ) monotherapy, were compared to patients who received broad-spectrum (BS) therapy, defined as vancomycin plus either piperacillin/tazobactam (VPT) or cefepime (VCP). Admissions attributed to the NS cohort did not receive any doses of a BS (VPT/VCP) antimicrobial and vice versa. Admissions were limited to those with eLOS of 3-7 days to balance medical complexity between NS and BS cohorts and limit confounding amongst eLOS, morality estimates, and antimicrobial prescribing. Results A principal diagnosis of CAP was assigned to 46,585 admissions. The LOS index was < 1 for NS regimens, but > 1 for those receiving BS therapy (Table 1). All deviations were statistically significant. The mortality index was < 1 for all antimicrobial combinations; however, it was significantly lower than expected (p < 0.01) for NS regimens (CA 0.36; CD 0.27; FLQ 0.52), but not for VPT 0.81 or VCP 0.95 (p > 0.05). Conclusion After risk-adjusting for patient-level confounders impacting LOS and mortality, the use of NS antimicrobials for the treatment of CAP was associated with better outcomes than BS antimicrobials. Disclosures Kirthana Beaulac, PharmD, Abbvie: Honoraria Pratish C. Patel, PharmD, BCIDP, AAHIVP, VBI Vaccines: Stocks/Bonds (Public Company)

P-1764. Point Prevalence Study of Antibiotic Appropriateness and Economical Cost in a Tertiary Care Trauma Hospital of Northern India to Tailor Antibiotic Stewardship Interventions

Abstract Background Conducting Point prevalence surveys (PPSs) is challenging, especially in developing countries, in the absence of electronic records, lack of dedicated resources and high patient load. This survey was conducted to provide background data for strengthening antimicrobial stewardship(AMS) practices and estimate the economic cost of antimicrobial resistance per antibiotic consumed in a tertiary care trauma hospital in India. Summary of Quality indicators of antibiotic prescribing (in %) Methods The survey included all inpatients admitted in wards and intensive care units of the hospital (300 beds) during World Antibiotic Awareness Week 2023. Standardised modules were adopted from the Global PPS for collecting data on patient demographics, prescribed antimicrobial agents with dosage, indication(s) and duration of treatment, and microbiolgical results. Further, the cost minimization analysis was carried out to assess the treatment cost and variations in costs arising due to generic or branded prescribing. Results Among the 254 patients admitted, the patients treated with at least one antimicrobial was 88.6% (N=225). The median (IQR) day of hospitalization was 7 (3.75) days. The highest prevalence of antimicrobial use was in the ICU (100%), followed by Emergency medicine (97.5%). The majority of patients received empiric than targeted antimicrobial therapy. Antimicrobial prescription was mostly for surgical prophylaxis (49.04%). Among patients for >7 days on treatment, microbiological culture were sent in 16.7% (5/30) patients. Antibiotic quality indicators such as reason in notes and documentation of review date were comparatively lower (Figure-1). Treatment costs varied significantly with prescriptions of maximum and minimum-priced brands, ranging from 69.81%-1490%. Branded therapy were three times costlier than generic therapy in 36 (52.9%) regimens. Conclusion Poor transition from empiricism to rationalism, continuation of surgical prophylaxis for more than one day and underutilization of microbiological tests were noted. There was large variations in treatment cost of infections depending on regimen chosen. Adherence to local antibiotic policy, optimal dosing and regular audit with positive feedback of antibiotic use to treating physician can be useful approaches to implement the AMS Program in the study centre. Disclosures All Authors: No reported disclosures

P-1696. Antibiotic consumption and resistance among admitted patients with urinary tract infection in the Philippines: Results from a longitudinal Global Point Prevalence Survey

Abstract Background Urinary Tract Infection (UTI) is a common diagnosis among hospitalized patients for which Escherichia coli (E.coli) is the most common etiologic agent. Recently, increasing antimicrobial resistance of E. coli to common antibiotics has been reported in the Philippines. We describe the prevalence of antimicrobial use for UTI in Philippine hospitals from 2017-2022 and compare this with the antimicrobial resistance pattern of urinary E. coli generated by the Department of Health, Antimicrobial Resistance Surveillance Program. Methods Since 2017, the Philippines has been conducting point prevalence surveys (PPS) on antimicrobial consumption using the standardized and validated methodology of the Global-PPS. All admitted patients on antimicrobials at 8 AM on the day of the survey were included. Type of infections and their corresponding antimicrobial prescriptions were recorded. Results Data were collected in 62 hospitals in the Philippines. Overall, three percent (N= 2242; 3.3%) of patients admitted in Philippine hospitals on the day of the PPS were treated with antimicrobials for UTI (lower UTI: 1,8%, upper UTI:1.5%). Ceftriaxone, cefuroxime, piperacillin-tazobactam, ciprofloxacin and meropenem were the top five antibiotics used (table 1), all of which are classified under the WATCH list of the WHO AWaRe classification. Seventy-seven percent of all antibiotics were prescribed empirically. Based on the antimicrobial surveillance data of the Department of Health, the resistance rates of E. coli to these antibiotics were high with on average more than 40% resistance to cefuroxime, ceftriaxone and ciprofloxacin (figure 1). Conclusion There is an opportunity to strengthen hospital antimicrobial stewardship programs, with particular emphasis on pre-authorization and audit and feedback strategies. Consideration may be given to placing ceftriaxone, cefuroxime, and ciprofloxacin under restricted categories requiring approval by the AMS clinician prior to empiric use. Importantly, local antibiograms should be reviewed on a regular basis and should be used as a basis for empiric antimicrobial recommendations in hospitals. Repeated point prevalence surveys are needed to measure the impact of interventions implemented by hospital AMS committees. Disclosures All Authors: No reported disclosures

P-1790. Multifaceted Stewardship for Oral Antimicrobial Agents in the Outpatient Setting of a Japanese Tertiary Care Center

Abstract Background Oral antimicrobials accounted for approximately 90% of all antimicrobial prescriptions. The 2023-2027 Japanese National Action Plan on Antimicrobial Resistance encourages reducing prescriptions for oral broad-spectrum antimicrobials, especially third-generation cephalosporins (3GC), fluoroquinolone (FQ), and macrolide (MC). However, only a few studies have examined antimicrobial stewardship programs (ASP) in the outpatient setting in Japan. In this study we aim to evaluate the effectiveness of multifaceted ASP for oral antimicrobials in the outpatient setting of a Japanese tertiary care center. Methods The present, before-after trial was conducted in the outpatient setting of a Japanese tertiary care center. The pre-intervention period was from October 2021 to September 2023, and the implementation period was from October 2023 to March 2024. The intervention consisted of 1) an infectious disease (ID) physician’s focused, educational lectures for prescribers; 2) local treatment guidelines for common infectious diseases; 3) monthly reports to all physicians on changes in days of therapy (DOT) with 3GC, FQ, and MC per 100 visits; and 4) post-prescription review and feedback from a designated ID physician. Interrupted time-series analysis (ITSA) was used to assess changes in the monthly DOT per 100 visits. Results In total, 344,330 and 89,898 patients visited, and 15,324 (4.45%) and 3,845 (4.28%) prescriptions were issued during the pre-intervention and intervention periods, respectively. ITSA revealed an immediate decrease in DOT per 100 visits for 3GC (-1.03; 95% confidence interval [CI]: -1.31 to -0.74; P< 0.001 for intercept) and a decreasing trend in FQ and MC during the intervention period (-0.71 and -0.41; 95% CI: -0.54 to -0.27 and -1.18 to -0.25; P< 0.001 and 0.004, respectively). ITSA also found a decreasing trend in the DOT per 100 visits for all oral antimicrobials (-2.04; 95% CI: -2.88 to -1.20; P< 0.001). Conclusion Multifaced ASP was able to reduce the prescription rate of three antimicrobials targeted by the Japanese National Action Plan on Antimicrobial Resistance in the outpatient setting of a community hospital. Disclosures Yoshiaki Gu, MD, PhD, MPH, MSD K.K.: Grant/Research Support

P-897. Inconsistent Participant Demographic Reporting in Published Antibiotic Clinical Trials Targeting Multidrug-Resistant Gram-Negative Organisms

Abstract Background NIH policies and reporting requirements relating to the inclusion of women and minoritized individuals in clinical trials have evolved since 2000. Over time, prioritization of gender equity in participant recruiting has been successful. However, many studies have demonstrated underrepresentation of participants from minoritized populations. With growing evidence of racialized disparities in antimicrobial resistance and prescribing, clinical trials for new antimicrobials should prioritize equitable participation. We aimed to assess participant demographic reporting in published clinical trials targeting multi-drug resistant gram-negative organisms (MDRGNOs). Record identification, screening, and inclusion Flow chart for record identification and review leading to the 38 included studies. Methods Four databases were searched to identify randomized controlled clinical trials of antibiotic regimens used to treat infections with MDRGNOs published 2010-2023 (Fig1). Participant demographics were extracted from eligible studies and data summarized with descriptive statistics. Fisher’s exact test evaluated associations between variables and Cochran-Armitage tested for trends. P< 0.05 was considered statistically significant. Study Characteristics Table showing the characteristics of information reporting across the 38 included studies. Results 38 full-text articles were included. All studies reported age and binary sex. 31/38 reported race or ethnicity; all 31 reported White race and 10/31 only reported White or Other race (Table). Adverse events, mortality, and efficacy were stratified by demographics 6 times in 5 unique articles. There was no significant pattern in reporting race or ethnicity in published trials for antibiotics targeting MDRGNOs between 2010 and 2023 (Fig2). Among federally funded studies 50% (3/6) reported race or ethnicity compared to 87% (28/32) of industry funded studies, which was marginally significant (p=0.063, Fig3). Figure 2 shows the number of published studies reporting race or ethnicity per year (gray line) compared with the number of included studies by year (black bar). Conclusion Sex and age reporting occurred across all published clinical trials reviewed focused on treating MDRGNOs. Major study outcomes were rarely stratified by participant demographics. We identified inconsistent reporting of race, ethnicity, and other demographic data. Attribution of demographic data is unstandardized and often not identified. Inconsistent and incomplete reporting limits the ability to accurately study participant demographic representation over time and across studies. Figure 3 shows the comparison of reported funding source (black bar) with studies reporting race or ethnicity (gray bar). 50% of federally funded studies reported race or ethnicity and 87% of industry funded studies included race or ethnicity. Disclosures Jacinda C. Abdul-Mutakabbir, PharmD, MPH, CSL Sequiris: Advisor/Consultant|CSL Sequiris: Honoraria|GSK: Advisor/Consultant|GSK: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria

P-1792. Impact of Integrated Interventions of Prescriber Education and De-escalation Strategies on Implementing WHO Access: Watch Targets: Insights from a South Indian Tertiary Care Setting

Abstract Background The study aims to determine the Access: Watch ratio, as recommended by the WHO AWaRE guide 2022, to regulate antimicrobial prescribing practices, highlighting the importance of educational sessions for successful AMS interventions.Table 1:Quantification of antibiotic use during the study periodBased on Days of therapy (DOT), an AMS metric. Methods The study analyzed antimicrobial usage data from 360 patients from March to July 2023. It quantified DOT by comparing Access and Watch group antibiotics. The first three months focused on auditing antimicrobial prescribing practices, followed by a session on rational prescribing and an educational survey. The second two months focused on feedback on the impact of educational interventions.Figure 1:Trend of Access:Watch ratio of antibiotics during the study period Results The use of Cefoperazone + Sulbactam, a broad-spectrum watch class antibiotic, was high in April and May (48.7 and 50.7, respectively) but decreased to 19.3 and 18.1 in the subsequent months following educational interventions. Optimization of de-escalation practices through audit and feedback strategies, emphasized in the continuing medical education sessions, contributed to this reduction. The Access: Watch Ratio increased from 0.45 to 0.52 over the study period, indicating a reduction in Watch antibiotic use. Pre-survey results showed 88.9% of prescribers considered de-escalation safer, increasing to 100% post-intervention. Various case-scenarios presented to prescribers showed improved understanding and adoption of rational antibiotic prescribing and de-escalation strategies after the educational session. Conclusion Integrated interventions, including prescriber education and de-escalation strategies, were effective in achieving the WHO Access: Watch target in our South Indian tertiary care setting. The reduction in Watch antibiotic use and the increase in the Access: Watch ratio demonstrate the impact of these interventions on antimicrobial prescribing practices. Ongoing education and support for rational antibiotic use are critical in addressing antimicrobial resistance. Disclosures All Authors: No reported disclosures

P-1674. Comparative study of advance practice providers and physician prescribing practices for complicated intra-abdominal infections in patients hospitalized at a safety-net community hospital

Abstract Background The expansion of advanced practice providers (APPs) in the inpatient setting warrants understanding of their antimicrobial prescribing practices in these settings to help adapt antimicrobial stewardship (ASP) strategies. Variability in APP training programs further complicates the landscape. This study aims to investigate disparities in antibiotic prescription practices for complicated intra-abdominal infections (cIAI) between APPs and physicians. Figure 1 clAl severity and empiric antimicrobial selection by physicians and APPs Methods A retrospective review of antibiotic orders was conducted at a 151-bed community hospital. ASP prospective audit and feedback (PAF) data from July 2022 to June 2023 was reviewed, including initial antibiotic selection, duration, and guideline concordance for APPs and physicians. Guideline adherence, antimicrobial effectiveness, and days of therapy (DOT) per 1000 patient days was compared between APPs and physicians. FIgure 2 Empiric antimicrobial selection by physicians and APPs Results A total of 175 initial empiric PAF entries for cIAI were reviewed, of which 145 were from physicians and 30 from APPs. Guideline non-adherence was 10% (14) for physicians and 20% (6) for APPs. Additionally, 3% (5) of physician and 7% (2) of APP prescriptions were ineffective. Critical illness was higher for physician cases (Figure 1). Physicians prescribed more antipseudomonal beta-lactam (APBLs) than APPs (52% vs 30%). APPs prescribed more quinolones (FQ) than physicians (33% vs 26%). Of the patients treated with FQs by APPs, 37% had allergies to beta-lactams, compared to 22% of patients treated by physicians. Total DOT/1000 during the study period was 145. DOT/1000 was 44 for physicians, of which 11% were anti-pseudomonal beta lactams (APBLs) and 34% non-APBLs. DOT/1000 was 21 for APPs, of which 19% were anti-pseudomonal beta lactams (APBLs) and 27% non-APBLs (Figure 2). Conclusion Empiric antimicrobial selection for cIAI differed between APPs and physicians, with APP showing higher quinolone use, a non-preferred agent, and almost double the level of non-adherence to guidelines. These findings underscore the need for tailored ASP education and interventions that address the unique practices and educational backgrounds of APPs, aiming to standardizing and optimizing antimicrobial use. APPs may require specific education for cIAI and ASP guidance. Disclosures All Authors: No reported disclosures

P-1644. Antimicrobial Stewardship Opportunities for Urine Cultures Resulting After Patient Discharge

Abstract Background Urinary tract infections (UTIs) constitute 3 million emergency department visits (ED) annually and 15% of outpatient antibiotic prescriptions. The outpatient setting is the highest volume of antimicrobial prescribing in the United States, however, is generally a neglected practice area for antimicrobial stewardship (AS) programs. This study sought to evaluate need for AS with an existing ED feedback system for ambulatory patients. Primary Outcome Methods This multi-center, retrospective study included adults > 18 years old and admitted inpatient or visited the emergency department from August 1, 2022 to February 1, 2023. Patients were included if prescribed antibiotics at discharge or within 72 hours of discharge and had a significant update to urine culture results post discharge up to 14 days. Patients were excluded if prescribed non-urinary indication antibiotic, deceased prior to final culture result, or discharged to hospice. A random 10% convenience sample was analyzed. Descriptive statistics were used to summarize patient characteristics and primary and secondary objectives. Secondary Outcomes Results From a cohort of 1,362 patients, 137 encounters were screened and 111 met the inclusion criteria. Over 70% of encounters had at least one AS opportunity. Misdiagnosis attributed to 42% of all opportunities for intervention. Additionally, 20 (18%) patients received longer duration of antibiotics than indicated, and upon culture review, 14 (12.6%) patients received antibiotics post-discharge despite initial diagnosis of asymptomatic bacteriuria. Conclusion The majority of patients prescribed antibiotics with pending urine culture data receive unnecessary exposure in our system. Given the high frequency of misdiagnosis of UTI’s and errors in antibiotic prescribing found in this cohort, it is ripe for AS intervention and is uniquely structured with existing culture review systems as present in many EDs. Provision of decision support and provider education to reduce risks of unnecessary antibiotic therapy is needed. Disclosures Rebekah W. Moehring, MD, MPH, FIDSA, FSHEA, UpToDate, Inc.: Author Royalties

P-1736. Examining the Impact of Eliminating a Transitions of Care Pharmacist Program on Antimicrobial Use

Abstract Background Antimicrobial stewardship interventions during transitions of care (TOC) have increased guideline concordant prescribing at hospital discharge. A TOC pharmacy program targeting discharging patients at the high risk for mortality was established at our community teaching hospital in 2016. A previous program analysis reported 14.4% of all pharmacist interventions made involved antimicrobials. The TOC pharmacy program was eliminated in 2022. The purpose of this study was to assess the impact of program elimination on appropriate and optimal antimicrobial prescribing. Methods This retrospective, single center, pre-post cohort study investigated the impact of the elimination of the TOC program on appropriate and optimal antimicrobial prescribing. Adult inpatients with the highest risk of 30-day mortality receiving an antimicrobial at discharge between September - November 2021 (TOC pharmacist program cohort) and September - November 2022 (post-TOC cohort) were included. Appropriate antimicrobial use was defined as prescribing of indication-based effective and safe therapy. Optimal prescribing was defined as adherence to institutional guideline-based antimicrobial stewardship recommendations. Results Six-hundred twenty-six patients were included with 313 patients in each cohort. Baseline characteristics between cohorts were generally similar with significant differences in the number of patients treated for community-acquired pneumonia (20.4% vs. 28.4%; P = 0.026) and bacteremias (11.5% vs. 5.1%; P = 0.004). There were no differences in appropriate (90.4% vs. 90.1%; P = 0.893), or optimal prescribing (80.8% vs. 78%; P = 0.374) between cohorts. There were no differences in incidence of non-optimal antimicrobial dosing (6.4% vs. 5.8%; P = 0.738), or non-optimal antimicrobial selection (1.3% vs. 2.9%; P = 0.161); however, the incidence of non-optimal duration decreased in the post-TOC cohort (22% vs. 15%; P = 0.024). Conclusion The elimination of the TOC pharmacy program did not impact appropriate or optimal antimicrobial prescribing. Relatively high appropriate and optimal prescribing were noted in both cohorts and additional ongoing stewardship interventions may have confounded results. Disclosures All Authors: No reported disclosures