151. Association Between Outpatient Antibiotic Prescribing, Antimicrobial Resistance, and Initial Presentation to Inpatient Setting for Urinary Tract Infections Among Older Adults in New York State

Abstract Background Antibiotic prescribing (AP) and resistance (AR) may influence severity of illness in urinary tract infection (UTI). Limited data exist assessing the relationship between county-level AP and AR on initial presentation to hospital for UTI. This study evaluated the association between county-level AP and AR on UTI severity of illness among hospitalized patients in New York State. Methods Retrospective, cross-sectional analysis, combining data from New York State Statewide Planning and Research Cooperative System (SPARCS) and previously published data on countywide antimicrobial resistance and antimicrobial prescribing. Inclusion criteria: female patients admitted to a New York inpatient setting in 2017, UTI (CCS 159), Medicare insurance. Exclusion criteria: missing countywide prescribing or resistance. All-patient refined (APR) clinical severity ≥ 3 was the primary outcome. Counties were classified as prescribing above or below the median prescribing proportion, and above or below the median prevalence of E. coli resistance for TMP-SMX and NTF. Countywide prescribing practices, antimicrobial resistance, patient factors, and location factors were evaluated for association with APR clinical severity ≥ 3 using chi-squared and logistic regression. Results 8,024 patients met study criteria. Baseline characteristics are presented in Table 1. 3,597 (44.8%) had an APR severity of ≥ 3. Factors associated with APR severity ≥ 3 include age group (P < 0.001), ethnicity (P = 0.013), hospital county (P < 0.001), first line prescribing ≥ 45.4% (P = 0.049), E. coli TMP-SMX resistance ≥ 29.0% (P < 0.001) via chi-squared test. In the logistic regression analysis counties with higher first line prescribing was associated with decreased odds for severe infection (aOR: 0.83 [0.72 – 0.97]). Additional factors associated with severe infection are presented in Table 2. Conclusion Prescribing patterns may have a significant influence on initial presentation to the hospital for urinary tract infections. Outpatient antimicrobial stewardship should endeavor to promote guideline driven prescribing. Further research is needed to corroborate the findings from this cross-sectional study. Disclosures All Authors: No reported disclosures


Session: P-09. Antimicrobial Stewardship: Trends in Antimicrobial Prescribing
Background. Background: Pseudomonas aeruginosa continues to be an important cause of nosocomial infections associated with a high morbidity and mortality. Despite the availability of ceftazidime-avibactam (CAZ-AVI) and ceftolozone-tazobactam (CFT-TAZO), CEF continues to be an empiric agent of choice in several institutions. Aim: To evaluate the prevalence and trend in susceptibilities of P. aeruginosa to CEF over a 7-year period, identify possible correlation with the use of CAZ, AZT, PTZ, CIP, and CAR, (DOT/1000 patient days), as a quality improvement (QI) measure for optimizing CEF use, introduce antibiotic cycling as a tool to avoid emergence of drug-resistance in P. aeuriginosa.
Methods. A retrospective review of antimicrobial susceptibility data of all isolates of P. aeruginosa, (inpatient and outpatient) at the Detroit VAMC pre and post implementation of antibiotic cycling, over a 7-year period (2011-2017) was performed. Susceptibility testing was performed by reference broth micro-dilution methods in a central laboratory. Data analysis was performed using Pearson correlation coefficient score. Being a QI project, clinical data were not reviewed.
Results. A total of 977 isolates were identified during the study period. (drug usage are in DOT/1000 PD); CAZ and AZT use surged during 2013-14 from 5 to 8 dropping in 2015-17 to < 3; PTZ usage increased to 100 during 2011-14 but dropped to 38 in 2015-17 (drug shortage); CAR use averaged at 10 until 2016 and dropped to 8 in 2017; CIP use dropped by 50% from 30 in 2012 to 15 in 2017; P. aeruginosa susceptible to CEF decreased from 88% in 2012 to 81% in 2014 mirroring the increased use of CEF, AZT, CAZ, and CIP; AG use was very low at < 5. With restrictions on the use of AZT, CAZ, and CIP, from 2014-15, CEF susceptibility increased significantly to 95.5% in 2015. Drug shortage of PTZ in 2015 and increased use of CEF from 2015-17 led to a drop in susceptibility to (82%); P. aeruginosa susceptible to CAR and AG averaged at 88% and 97% respectively (2011-17). However, reintroduction PTZ, resulted in improved susceptibility of P. aeuruginosa to CEF by 40% within a year.
Conclusion. Judicious antimicrobial use and antibiotic rotation play a significant role in reversing drug resistance in P. aeuruginosa.
Disclosures. Background. Antibiotic prescribing (AP) and resistance (AR) may influence severity of illness in urinary tract infection (UTI). Limited data exist assessing the relationship between county-level AP and AR on initial presentation to hospital for UTI. This study evaluated the association between county-level AP and AR on UTI severity of illness among hospitalized patients in New York State.
Methods. Retrospective, cross-sectional analysis, combining data from New York State Statewide Planning and Research Cooperative System (SPARCS) and previously published data on countywide antimicrobial resistance and antimicrobial prescribing. Inclusion criteria: female patients admitted to a New York inpatient setting in 2017, UTI (CCS 159), Medicare insurance. Exclusion criteria: missing countywide prescribing or resistance. All-patient refined (APR) clinical severity ≥ 3 was the primary outcome. Counties were classified as prescribing above or below the median prescribing proportion, and above or below the median prevalence of E. coli resistance for TMP-SMX and NTF. Countywide prescribing practices, antimicrobial resistance, patient factors, and location factors were evaluated for association with APR clinical severity ≥ 3 using chi-squared and logistic regression.
Results. 8,024 patients met study criteria. Baseline characteristics are presented in Table 1. 3,597 (44.8%) had an APR severity of ≥ 3. Factors associated with APR severity ≥ 3 include age group (P < 0.001), ethnicity (P = 0.013), hospital county (P < 0.001), first line prescribing ≥ 45.4% (P = 0.049), E. coli TMP-SMX resistance ≥ 29.0% (P < 0.001) via chi-squared test. In the logistic regression analysis counties with higher first line prescribing was associated with decreased odds for severe infection ). Additional factors associated with severe infection are presented in Table 2.

Conclusion.
Prescribing patterns may have a significant influence on initial presentation to the hospital for urinary tract infections. Outpatient antimicrobial stewardship should endeavor to promote guideline driven prescribing. Further research is needed to corroborate the findings from this cross-sectional study.
Disclosures. Background. Antimicrobials are empirically used in COVID-19 patients resulting in inappropriate stewardship and increased antimicrobial resistance. Our objective was to assess antimicrobial use among suspected COVID-19 in-patients while waiting for the COVID-19 test report.
Methods. From March to August 2020, we collected data from in-patients of 12 tertiary-level hospitals across Bangladesh. We identified suspected COVID-19 patients; collected information on antimicrobial received within 24 h before and on hospitalization; and tested nasopharyngeal swab for SARS-CoV-2 using rRT-PCR. We used descriptive statistics and a regression model for data analysis.
Results. Among 1188 suspected COVID-19 patients, the median age was 34 years (IQR:2-56), 69% were male, 40% had comorbidities, 53% required oxygen, and 1% required ICU or ventilation support after admission. Antibiotics were used in 92% of patients, 47% within 24 h before, and 89% on admission. Patients also received antiviral, mostly favipiravir (1%) and antiparasitic drugs particularly ivermectin (3%). Third-generation cephalosporin use was the highest (708;60%), followed by macrolide (481;40%), and the majority (853;78%) who took antibiotics were SARS-CoV-2 negative. On admission, 77% mild and 94% moderately ill patients received antibiotics. Before admission, 3% patients had two antibiotics, and on admission, 27% received two to four classes of antibiotics at the same time. According to WHO AWaRe classification, the Watch group antibiotics were mostly used before (43%) as well as on admission (80%). Reserve group antibiotic particularly linezolid was used in 1% patients includes mild cases on admission. Antibiotic use on admission was higher among