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Background Antibiotics are frequently prescribed unnecessarily in outpatients with coronavirus disease 2019 (COVID-19). We sought to evaluate factors associated with antibiotic prescribing in outpatients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods We performed a population-wide cohort study of outpatients aged ≥66 years with polymerase chain reaction–confirmed SARS-CoV-2 from 1 January 2020 to 31 December 2021 in Ontario, Canada. We determined rates of antibiotic prescribing within 1 week before (prediagnosis) and 1 week after (postdiagnosis) reporting of the positive SARS-CoV-2 result, compared to a self-controlled period (baseline). We evaluated predictors of prescribing, including a primary-series COVID-19 vaccination, in univariate and multivariable analyses. Results We identified 13 529 eligible nursing home residents and 50 885 eligible community-dwelling adults with SARS-CoV-2 infection. Of the nursing home and community residents, 3020 (22%) and 6372 (13%), respectively, received at least 1 antibiotic prescription within 1 week of a SARS-CoV-2 positive result. Antibiotic prescribing in nursing home and community residents occurred, respectively, at 15.0 and 10.5 prescriptions per 1000 person-days prediagnosis and 20.9 and 9.8 per 1000 person-days postdiagnosis, higher than the baseline rates of 4.3 and 2.5 prescriptions per 1000 person-days. COVID-19 vaccination was associated with reduced prescribing in nursing home and community residents, with adjusted postdiagnosis incidence rate ratios (95% confidence interval) of 0.7 (0.4–1) and 0.3 (0.3–0.4), respectively. Conclusions Antibiotic prescribing was high and with little or no decline following SARS-CoV-2 diagnosis but was reduced in COVID-19–vaccinated individuals, highlighting the importance of vaccination and antibiotic stewardship in older adults with COVID-19. [ABSTRACT FROM AUTHOR]

Background The coronavirus disease 2019 (COVID-19) pandemic has potentially impacted outpatient antibiotic prescribing. Investigating this impact may identify stewardship opportunities in the ongoing COVID-19 period and beyond. Methods We conducted an interrupted time series analysis on outpatient antibiotic prescriptions and antibiotic prescriptions/patient visits in Ontario, Canada, between January 2017 and December 2020 to evaluate the impact of the COVID-19 pandemic on population-level antibiotic prescribing by prescriber specialty, patient demographics, and conditions. Results In the evaluated COVID-19 period (March–December 2020), there was a 31.2% (95% CI, 27.0% to 35.1%) relative reduction in total antibiotic prescriptions. Total outpatient antibiotic prescriptions decreased during the COVID-19 period by 37.1% (95% CI, 32.5% to 41.3%) among family physicians, 30.7% (95% CI, 25.8% to 35.2%) among subspecialist physicians, 12.1% (95% CI, 4.4% to 19.2%) among dentists, and 25.7% (95% CI, 21.4% to 29.8%) among other prescribers. Antibiotics indicated for respiratory infections decreased by 43.7% (95% CI, 38.4% to 48.6%). Total patient visits and visits for respiratory infections decreased by 10.7% (95% CI, 5.4% to 15.6%) and 49.9% (95% CI, 43.1% to 55.9%). Total antibiotic prescriptions/1000 visits decreased by 27.5% (95% CI, 21.5% to 33.0%), while antibiotics indicated for respiratory infections/1000 visits with respiratory infections only decreased by 6.8% (95% CI, 2.7% to 10.8%). Conclusions The reduction in outpatient antibiotic prescribing during the COVID-19 pandemic was driven by less antibiotic prescribing for respiratory indications and largely explained by decreased visits for respiratory infections. [ABSTRACT FROM AUTHOR]

Purpose. The physical compatibility of vancomycin and piperacillin sodium-tazobactam at dosing concentrations commonly administered during prolonged infusions was studied. Methods. Concentrations of vancomycin and piperacillin sodium-tazobactam typically used in prolonged infusions were evaluated. Vancomycin hydrochloride and piperacillin sodium-tazobactam were reconstituted with 0.9% sodium chloride injection and diluted to the following concentrations: vancomycin, 4 mg/mL; piperacillin sodium 30 mg/mL plus tazobactam 3.75 mg/mL; and piperacillin sodium 40 mg/mL plus tazobactam 5 mg/mL. Combinations of vancomycin and piperacillin sodium-tazobactam were tested using simulated Y-site administration; phenytoin served as a positive control for precipitation with vancomycin. Each combination was prepared in triplicate, alternating the order of drug addition, and stored without light protection at room temperature. The resultant admixtures were microscopically observed and subjected to particle-size and turbidity analyses for five days. Statistical analyses were performed using two-way repeated measures analysis of variance with conservative Bonferroni corrections for multiple comparisons. Results. Vancomycin was compatible with piperacillin sodium-tazobactam in the concentrations tested. No particulate matter was observed by the unaided eye. Similarly, the antibiotic admixtures displayed no differences microscopically, by particle-size analysis, or by turbidity analysis when compared with negative controls at five days. Conclusion. Vancomycin 4 mg/mL and piperacillin sodium 30 mg/mL plus tazobactam 3.75 mg/mL or piperacillin sodium 40 mg/mL plus tazobactam 5 mg/mL were physically compatible during simulated Y-site injection at room temperature without light protection for five days. [ABSTRACT FROM AUTHOR]

Background Converting intravenous (IV) antibiotics to an oral (PO) route is an important stewardship activity to reduce patient harm, including extravasation, thrombophlebitis, and catheter-related infections. The INFORMER Project aims to develop a "smart" electronic tool to streamline IV to PO conversion in eligible patients using an algorithm derived from patient-level data. In designing the algorithm, we noted significant clinician subjectivity in reviewing PO eligibility criteria. To support algorithm development and frontline clinician buy in for future e-tool use, an initial step of our project explored agreement level for IV to PO switch between general internal medicine (GIM) vs. ID clinicians. Methods A convenience sample of GIM patients (tertiary teaching hospital) were reviewed in a 4-month pilot. Patients were still on the ward and received a target IV antibiotic (fluoroquinolone, sulfamethoxazole/trimethoprim, clindamycin, metronidazole, linezolid, fluconazole, voriconazole, azithromycin). To mimic real-time decision-making, clinicians (MD and PharmDs) retrospectively assessed IV to PO eligibility of the last IV antibiotic dose on admission for (1) GI/absorption, (2) clinical stability and (3) global review (but not given specific thresholds/criteria). Agreement level was compared for ID vs. non-ID reviews. Results Overall, 52 patients' IV to PO eligibility was assessed by multiple clinicians; 5 GIM teams and 6 ID MDs or PharmDs participated. ID vs. GIM respective assessment of Global eligibility was 61% vs. 48% (agreement in 71% of cases). ID vs. GIM assessment of acceptable absorption was 82% vs. 67%; acceptable clinical stability was 64% vs. 62% (Fig 1). Clinician comments were reviewed to identify algorithm improvements and areas for frontline education. Conclusion Our results are consistent with prior data suggesting up to 40–50% of patients may be eligible for IV to PO conversion, even at institutions that have IV to PO protocols. Our data also shows that overall, ID clinicians were more likely to assess a patient as ready for PO antibiotics vs. non-ID clinicians. Our findings are important as understanding cases of non-agreement and obtaining GIM consensus for tool utility are important for our next step, assessing INFORMER implementation on realtime IV to PO conversion rates. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background A goal of Antimicrobial Stewardship Programs (ASP) is to optimize antimicrobial use; many using audit and feedback (AAF). Although AAF decreases unnecessary target antimicrobial use, it is resource-intensive. As a result, temporary suspensions in AAF activity may occur from human resource limitations or other factors. We describe the impact of these temporary suspensions and intensity of care on antimicrobial utilization trends. Methods This retrospective study describes the initiation and temporary suspensions of AAF in the General Internal Medicine (GIM) unit at an urban teaching hospital. Data were collected over 65 months. During active-AAF, a dedicated ID trained clinical pharmacist and ID physician-reviewed antimicrobial use for all GIM patients and provided patient-specific advice to physicians. Antimicrobial use was measured by Defined Daily Doses (DDD) normalized per 1,000 patient-days. To assess the impact of temporary suspensions, data were compared in two ways: 1. All nonactive-AAF time-frames were compared with active AAF 2. Pre-ASP was compared with Post-ASP Initiation which includes suspension periods. To determine whether differences in trends were seen based on acuity level of the patients (identified at admission as benefiting from frequent monitoring), analyses were repeated after stratification of patients admitted to the Step-Up unit (GIM-SU) and the regular ward (GIM-W). Results Comparing nonactive AAF vs. active-AAF, significant changes (P < 0.05) in mean normalized DDD were observed for total antimicrobials (-19%), antipseudomonals (-21%) fluoroquinolones (−41%) and first-generation β lactams (−30%). Pre ASP vs. Post ASP comparisons showed similar but less pronounced trends. Following stratification to GIM-SU and GIM-W, greater variation in significant changes to targeted antimicrobials between comparisons was observed. Different significant antimicrobial changes were seen in SU vs. W. Conclusion Our results show that the temporary suspension of ASP AAF impacts antimicrobial utilization trends. Greater sustained decreases in targeted antimicrobials utilization were associated with active AAF. Stratification by patient acuity lead to increased variation in the impact on target antimicrobials and increased the impact of suspension. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Survival of patients with septic shock is dependent on the timing of effective antibiotic administration. The initial notification by the microbiology lab of a positive blood culture is a key factor in improving patient outcomes. It can take >24 hours to definitively identify bacteria from positive blood cultures. Accordingly, we employed rapid organism identification and studied the impact of this on patient management from a quality improvement perspective. Methods Rapid organism identification was performed for bacteremic patients admitted to an ICU at St. Michael's Hospital in Toronto, ON, by creating a pellet from positive blood culture bottles using a lysis centrifugation technique. MALDI-TOF was then used to obtain an organism identification. The microbiology lab verbally notified the ward clerk of the identification and surveys were conducted with treating physicians within 24–48 hours to evaluate the downstream impact of the rapid identification including changes to antibiotics, diagnostic testing, central line management and requests for specialty consultations. Results Between January 28 and April 28, 2019, 17 rapid blood culture results were included for study. When asked how physicians received the result, in 7 cases the physician did not remember; other responses included microbiology report (2), nurse (2), pharmacist (1), antimicrobial stewardship or lab (1), on-call team (1) and residents (1). Antibiotics were adjusted in 13 patients; 3 of which may have changed antibiotics for reasons other than the organism identification. Reasons for not changing therapy include: appropriate empiric treatment, likely contaminants, or physician not being notified of the result. In 5 cases, all antibiotics were discontinued, in another 2 cases the antibiotics were broadened and a further 5 narrowed to cover the organism; the remaining 5 continued the same empiric therapy. Repeat blood cultures were obtained for 5 cases, follow-up imaging in 5 cases and lines were changed/removed in 5 cases. Consultation was requested for 7 cases. Conclusion Based on preliminary data, rapid organism identification shows promise of improved patient management with line removal and antibiotics adjustments occurring 1 day sooner with rapid results. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]