175. Assessment of Institutional Uptake of Vancomycin AUC Monitoring One-Year Post Guideline Publication in Hospitals Across the United States

Abstract Background A new therapeutic monitoring of vancomycin for serious methicillin resistant Staphylococcus aureus infections guideline was published in March 2020. The guideline recommends a change in monitoring from trough to AUC/MIC based to improve patient outcomes. The purpose of this study was to determine institutional uptake of vancomycin AUC monitoring 1-year post guideline publication in hospitals across the U.S. Methods An electronic survey was created to assess vancomycin AUC monitoring practices and distributed to the American College of Clinical Pharmacy Infections Diseases Practice and Research Network (ACCP IDprn) and American Society of Health System Pharmacists (ASHP). Initial survey distribution (phase 1) occurred May-June 2020 and aimed to serve as baseline data. The survey was re-distributed (phase 2) to the ACCP IDprn and ASHP one year later, May-June 2021. Prior to re-distribution the survey was updated to assess the impact of COVID-19 on uptake. Results were analyzed and reported using descriptive statistics. Chi-Square tests were used to compare categorical data. Results A total of 202 responses to phase 1 and 138 responses to phase 2 were recorded. Significantly more respondents implemented AUC monitoring 1-year post guideline than at baseline (42.8% vs 29.8%, p= 0.013). In both phases, 57% of those who had not implemented AUC monitoring had plans to do so over the next year. Additionally, 46.2% phase 2 respondents reported COVID-19 impacted their ability to transition to AUC monitoring citing issues such as lack of time and inadequate resources. The most common AUC monitoring programs utilized at baseline and 1-year post guideline were purchased Bayesian software (38.3% vs. 35.6%) and homemade software (26.1% vs 23.7%). Perceived challenges to implementing AUC monitoring included cost, difficult use and integration. Conclusion Increased uptake of vancomycin AUC monitoring occurred from baseline to 1-year post guideline publication. However, less than half of hospitals implemented this recommendation. Although COVID-19 impacted a large portion respondents’ ability to implement AUC monitoring, majority plan to transition to vancomycin AUC monitoring over the next year. AUC monitoring should be adapted by all hospitals to optimize vancomycin efficacy and safety. Disclosures All Authors: No reported disclosures


Figure 1. Antimicrobial Stewardship Education and Poster Distribution
Results. A total of 260 cases met study eligibility. In the pre-AAW group, 56 of 131 cases presented with ASB, of which 16 were treated with antibiotics (28.6%). In the post-AAW group, 55 of 129 cases presented with ASB, and 5 were treated with antibiotics (9.1%). Antibiotics were prescribed more often for patients with ASB in the pre-AAW group compared to those in the post-AAW group (p=0.014). Forty providers completed the survey, of which 97.5% had seen the visual aids, 70% had found the education "very" or "extremely" useful, and 43.6% reported they "always or sometimes" treated ASB pre-AAW vs 15% post-AAW (p< 0.01).
Conclusion. AS posters and education defining ASB significantly decreased the treatment of ASB. AAW education on ASB antimicrobial stewardship demonstrated a high value and shifted prescribing behavior to avoid antibiotic treatment of ASB. A similar approach to deliver provider education could serve as a valuable model to change provider AS practices for ASB.
Disclosures. Background. Increasing antimicrobial resistance and the emergence of superbugs are problems globally. Inappropriate empiric antibiotic use would be a reason to cause antibiotic resistance. However, it has been a challenge to prescribe empiric antibiotics as it is difficult to identify the causative organism beforehand. In this study, we aimed to develop a prediction model to estimate the risk of antibiotics resistance using urine culture tests.
Methods. The study population included adult patients who had at least one of the results from a urine culture test and antibiotic susceptibility tests (from ampicillin, ceftriaxone, ciprofloxacin, gentamicin, levofloxacin, nitrofurantoin, tetracycline, trimethoprim/sulfamethoxazole) on admission to Ajou University Medical Center. Outcomes were defined as a resistant or intermediate susceptibility. Candidate predictors were diagnosis, prescription, visit, laboratory, procedures of the study population. We split data to 75:25 for training and test. Lasso logistic regression (LLR), extreme gradient boosting machine (XGB), Random Forest (RF) were used as model algorithms. The models were evaluated by an area under the curve of receiver operator characteristics curve (AUROC), precision-recall curve (AUPRC), and its calibration. All codes are available in https://github.com/ABMI/AbxBetterChoice Results. Total 33 covariates were selected for final prediction models. The RF showed the highest AUROC in the ceftriaxone and tetracycline models (0.823, 0.626, respectively). The XGB presented the highest AUROC for ciprofloxacin and nitrofurantoin (0.731, 0.706, respectively). The AUROC of RF and the XGB were the same in an ampicillin model (0.633). For gentamicin, levofloxacin, and trimethoprim/sulfamethoxazole, the AUROC of LLR was the highest (0.838, 0.831, 0.615, respectively). Among the models, the AUROC was the highest in the gentamicin model regardless of algorithms. All calibrations of the models were acceptable.

Conclusion.
We developed prediction models with competing performances of discrimination and calibration. It would contribute to the proper selection of empiric antibiotics susceptible to those causative pathogens in hospitalized patients with a clinically suspected urinary tract infection. Disclosures.

Background.
A new therapeutic monitoring of vancomycin for serious methicillin resistant Staphylococcus aureus infections guideline was published in March 2020. The guideline recommends a change in monitoring from trough to AUC/MIC based to improve patient outcomes. The purpose of this study was to determine institutional uptake of vancomycin AUC monitoring 1-year post guideline publication in hospitals across the U.S.
Methods. An electronic survey was created to assess vancomycin AUC monitoring practices and distributed to the American College of Clinical Pharmacy Infections Diseases Practice and Research Network (ACCP IDprn) and American Society of Health System Pharmacists (ASHP). Initial survey distribution (phase 1) occurred May-June 2020 and aimed to serve as baseline data. The survey was re-distributed (phase 2) to the ACCP IDprn and ASHP one year later, May-June 2021. Prior to re-distribution the survey was updated to assess the impact of COVID-19 on uptake. Results were analyzed and reported using descriptive statistics. Chi-Square tests were used to compare categorical data.
Results. A total of 202 responses to phase 1 and 138 responses to phase 2 were recorded. Significantly more respondents implemented AUC monitoring 1-year post guideline than at baseline (42.8% vs 29.8%, p= 0.013). In both phases, 57% of those who had not implemented AUC monitoring had plans to do so over the next year. Additionally, 46.2% phase 2 respondents reported COVID-19 impacted their ability to transition to AUC monitoring citing issues such as lack of time and inadequate resources. The most common AUC monitoring programs utilized at baseline and 1-year post guideline were purchased Bayesian software (38.3% vs. 35.6%) and homemade software (26.1% vs 23.7%). Perceived challenges to implementing AUC monitoring included cost, difficult use and integration.
Conclusion. Increased uptake of vancomycin AUC monitoring occurred from baseline to 1-year post guideline publication. However, less than half of hospitals implemented this recommendation. Although COVID-19 impacted a large portion respondents' ability to implement AUC monitoring, majority plan to transition to vancomycin AUC monitoring over the next year. AUC monitoring should be adapted by all hospitals to optimize vancomycin efficacy and safety.
Disclosures. Background. Data suggest that topical antibiotic and antiseptic use in the operating room is common but not commonly monitored by antimicrobial stewardship programs. Although some data suggest a benefit in certain surgical procedures, the CDC and WHO advise against the routine use of topical antibiotics in surgery due to uncertainty and heterogeneity in the overall data.
Methods. We conducted a retrospective 28-day period prevalence study of topical antibiotic and antiseptic use during surgical procedures performed in the operating room by 6 surgical specialties at a tertiary care medical center. For the subset of patients undergoing orthopedic surgeries, we evaluated the types of topical antibiotics received and the rates of surgical site infections (SSI) and adverse drug events within 28 days of the procedure.
Results. Of 744 surgical procedures reviewed, topical antibiotics were used in 127 (17.1%), topical antiseptics in 71 (9.5%), and both in 18 (2.4%) ( Table 1). Antiseptic use was higher in orthopedics relative to all other surgical specialties while topical antibiotic use was higher in neurosurgery. Hand, vascular and plastics had distinguishably lower use. In the orthopedic subgroup, after exclusions, 218 procedures were evaluated. Topical antibiotics were used in 42 (19.2%). Topical antibiotic therapy was more likely to be administered if prosthetic material was implanted, the procedure was emergent, or if a Staphylococcus aureus infection was present. Vancomycin was the most commonly used topical antibiotic and powder was the most commonly used type of application. As shown in table 2, SSI occurred more often when both topical antibiotics and antiseptics were applied; however, SSI events were relatively uncommon, and these were more likely to have infection present at the time of surgery. Adverse events were rare.

Conclusion.
In our institution we noted significant variability in use of topical antibiotic and antiseptic therapy among surgical specialties as well as within the orthopedic surgical specialty. Although opportunities to standardize use/nonuse of these therapies exist, this may be challenging due to the uncertainty and heterogeneity of currently available data.
Disclosures. All Authors: No reported disclosures Background. Antibiograms are widely used to present antibiotic susceptibility data, but user preferences for data visualization have received little attention. We report on a qualitative research study designed to gauge preferences for presenting antibiotic resistance data, with the goals of improving speed and effectiveness of prescribing empiric antibiotics in out-patient practices to meaningfully influence antibiotic stewardship programs.

User Preferences for Visualization of Antibiogram Data in Clinical Practice for Empiric Prescription of Antibiotics
Methods. Criteria for online focus groups included having the ability to prescribe antibiotics, practice in Washington state, and familiarity with antibiogram usage. A preliminary survey ( Fig. 1) was sent to selected participants to understand their role in healthcare and their current attitudes towards antibiograms. During focus groups, we presented examples of 3 antibiograms: standard ( Fig. 2A), color-coded for % susceptible (Fig. 2B), and color-coded for change in % susceptible from 2013 to 2016 (Fig. 2C).

Figure 1. Preliminary Survey via RedCap
A preliminary survey via RedCap was sent all focus group participants to capture current attitudes towards antibiograms and antibiotic resistance data.