Perception, Attitude, and Confidence of Physicians About Antimicrobial Resistance and Antimicrobial Prescribing Among COVID-19 Patients: A Cross-Sectional Study From Punjab, Pakistan

Background: Patients with coronavirus disease 2019 (COVID-19) could experience multiple coinfections, and judicial antimicrobials, including antibiotics, is paramount to treat these coinfections. This study evaluated physicians’ perception, attitude, and confidence about antimicrobial resistance (AMR) and antimicrobial prescribing in patients with COVID-19.Methods: A self-administered and validated online questionnaire comprised of six sections was disseminated among physicians working in public sector hospitals in Punjab, Pakistan, using the convenience sampling method from April to May 2021. The study also assessed the validity and reliability of the study questionnaire using exploratory factor analysis and Cronbach’s alpha. In addition, the descriptive and inferential statistics present survey results.Results: A total of 387 physicians participated in this study. The study showed that the questionnaire demonstrated good internal consistency (Cronbach’s alpha = 0.77). Most physicians (n = 221, 57.1%) believed that AMR is a considerable problem in Pakistan. Less than a quarter of respondents (n = 91, 23.5%) consulted with local antibiotic resistance data to prescribe antibiotics in COVID-19 patients. However, the respondents were confident to select a suitable antibiotic (n = 229, 59.2%). More than three-quarters of the respondents believed that advice from a senior colleague (n = 336, 86.8%), infectious disease (ID) physician (n = 315, 81.4%), and implementing antimicrobial stewardship programs (ASPs) could facilitate appropriate prescribing of antibiotics in COVID-19 patients. Multivariate logistic regression revealed that physicians with more than 10 years of experience had higher odds of consulting local guidelines for antibiotic therapy (OR, 4.71 95% CI: 1.62–13.73, p = 0.004) than physicians with less than 5 years of experience. Similar trends were found for consulting national guidelines and local resistance data to select an empiric antibiotic therapy.Conclusion: AMR-related awareness was optimal among physicians. Only a few physicians looked up local antibiotic resistance data before prescribing antibiotics to COVID-19 patients empirically. The significant approaches advised by physicians to reduce AMR risk among COVID-19 patients were the implementation of ASPs combined with advice from ID physicians.

Antimicrobial stewardship among Nigerian children: A pilot study of the knowledge, attitude, and practices of prescribers at two tertiary healthcare facilities in Bayelsa State

Antimicrobial stewardship (AMS), the evidence-based use of antimicrobials, is an effective strategy in controlling antimicrobial resistance (AMR) in humans by reducing the irrational use of antimicrobials. Stewardship in children is less studied. This study assessed the knowledge, attitude, and practice of physicians prescribing antibiotics to children in Bayelsa State, Nigeria to identify gaps in AMS and possible solutions. Following ethical approval, a semi-structured questionnaire was distributed among 40 paediatricians and gynaecologists at the two public tertiary healthcare facilities in Bayelsa State – the Niger Delta University Teaching Hospital and the Federal Medical Centre – for self-completion. Responses were expressed as percentages and analyzed using Bloom’s cutoffs. The Capability, Opportunity, Motivation, and Behaviour (COM-B) model was employed to identify gaps for intervention in prescribing behavior with gaps in each component identified by aggregate scores <80%. Perceived approaches to improve prescribing among 14 selected options were assessed using 5-point Likert scales and options with scores >90% rated the most acceptable. Questionnaires were administered from August to September 2021. The response rate was 68% (27/40). Participants were paediatricians (81%, 22/27) and gynaecologists (19%, 5/27). Antimicrobial Susceptibility Testing (AST) was not performed before antibiotic selection nine times out of 10 (89%, 24/27). In a third (37%, 10/27) of cases, 2-3 antibiotics were prescribed. The top three antibiotics, in rank order, were: cefuroxime or amoxicillin 41% (11/27); ciprofloxacin or amoxicillin 30% (8/27), and azithromycin (33%, 9/27). Aggregate COM-B scores were: capability, 74%; opportunity, 78%; and motivation, 87%. The most acceptable (100%, 27/27) options to improving antibiotic prescribing were: availability of resistance data, availability of guidelines, readily accessible microbiological data, and easy access to infectious disease physicians. There are gaps in knowledge of AMR and opportunity for rational prescribing. There is need for antimicrobial resistance data to promote pediatric AMS at the surveyed healthcare facilities.

Statistical analysis of resistance variability of pepper accessions to Xanthomonas euvesicatoria and Xanthomonas vesicatoria

The limit values of resistance groups were established to Xanthomonas euvesicatoria and Xanthomonas vesicatoria by mean score – ms based on conducted statistical analysis of 155 selection lines of Bulgarian, introduced hybrids and pepper varieties: I- immune; R- resistant; MS- medium sensitive; S- sensitive; SS- strongly sensitive. The genetic diversity between the two bacteria suggest the use of separate resistant groups to determine the resistance. Data on the mean score of infestation on 116 pepper accessions to X. euvesicatoria and 155 (the previous 116 included) to X. vesicatoria were processed and the resistance groups were defined. Breeding pepper accessions with complex resistance requires the application of the established resistance groups to both pathogens. The limit values of the groups by ms based on the statistical analysis of the data on the resistance of pepper accessions to X. euvesicatoria and X. vesicatoria were specified.

Neutrosophic statistical analysis of resistance depending on the temperature variance of conducting material

In this work, we have proposed a neutrosophic statistical approach for the analysis of resistance of conducting material depending on the temperature variance. We have developed a neutrosophic formula and applied it to the resistance data. We also use the classical statistical approach for making a comparison between both approaches. As a result, it is observed that the neutrosophic statistical approach is more flexible and informative. Also, this work suggests that the neutrosophic statistical approach analyzes the resistance of conducting material for big data.

177. User Preferences for Visualization of Antibiogram Data in Clinical Practice for Empiric Prescription of Antibiotics

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. 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. Figure 2. Presented antibiograms for focus group discussions using Quest Data. (A) Standard antibiogram for displaying % susceptibility. (B) Antibiogram color-coded for % susceptibility. (C) Antibiogram color-coded for change in % susceptibility, comparing 2013 data to 2016 data. Results Focus groups were held between October 2020 and March 2021. Participants were 44 years of age on average, with 6-23 years of experience in primary care and/or infectious disease practice. Eight of nine participants took the preliminary survey. The survey revealed that 5 (63%) participants used antibiograms in their practice. Most participants (7; 88%) preferred an online format to print out antibiogram tables. Discourse analysis from focus groups (n=3) revealed common themes regarding Figures 2A-C as examples of antibiograms. Key ideas included discussion of the data source and content, arrangement of the table, usability during clinical days, and efforts for antibiotic stewardship related to antibiogram use. All focus group participants (n=9) favored the feature of color-coding cells and found the data in the Fig. 2B user friendly. Consensus across all groups was that antibiogram tables would not be useful for daily practice. Clinicians would rather receive simplified therapy suggestions either in the patient laboratory report or in the electronic health system. Conclusion Antibiograms can be useful for visualization of empirical data but can become a more useful tool if they can be interpreted and simplified for guiding empiric prescribing in daily out-patient practice. Disclosures Hema Kapoor, MD; D(ABMM), Quest Diagnostics (Employee, I am an employee of Quest Diagnostics and receive its stock as part of my employment.) Ann Salm, M (ASCP), MSc, PhD, Quest Diagnostics (Employee, I am an employee of Quest Diagnostics and receive its stock as part of my employment.)

699. Case-Case Comparison of Exposures among Fluoroquinolone-Resistant and Pan-Susceptible Campylobacter Cases, Tennessee, 2016-2018

Background Campylobacter causes an estimated 1.5 million infections each year in the United States. Of those, approximately 448,400 infections are caused by antimicrobial resistant strains, including strains resistant to fluoroquinolones (e.g., nalidixic acid and ciprofloxacin), which are commonly used to treat campylobacteriosis. Campylobacter infection is commonly attributed to consuming poultry products. We compared exposure data between fluoroquinolone-resistant and pan-susceptible Campylobacter cases reported in 2016-2018 to assess attribution. Methods Broth microdilution was performed on Campylobacter isolates at CDC to determine the minimum inhibitory concentration for nine antimicrobial drugs. Whole genome sequencing (WGS) was performed at the Tennessee (TN) State Public Health Laboratory and the sequence data were analyzed at CDC to determine the genetic resistance determinants. Exposure data was collected through routine case interviews. Exposures among cases with fluoroquinolone-resistant infection and cases with no resistance to antimicrobials were compared. Results A total of 606 Campylobacter isolates from TN were submitted to CDC NARMS. Of those, 123 (20%) isolates were resistant to fluoroquinolones and 304 (50%) isolates were pan-susceptible. The gyr A (86) resistance gene was detected in 46/54 (85%) of resistant isolates. Exposure data were available for 59 (48%) fluoroquinolone-resistant cases and 186 (61%) pan-susceptible cases. Consumption of chicken (OR 2.1, p-value 0.03) and handling raw seafood (OR 3.1, p-value 0.03) were significantly associated with fluoroquinolone-resistance. More fluoroquinolone-resistant cases reported international travel compared to pan-susceptible cases (15% versus 4%) with OR 4.6, and p-value 0.004. Conclusion Fluoroquinolone-resistant Campylobacter infections were acquired domestically and internationally. Exposure to chicken products and handling raw seafood were reported more often among fluoroquinolone-resistant cases. Whole genome sequencing of Campylobacter isolates provides predicted resistance data. Coupling predicted resistance data with exposure data facilitates better understanding of source attribution of different strains. Disclosures All Authors: No reported disclosures

Changes in burn wound microbiology profile over 14 years of an adult tertiary burn center

Burn wound colonization can progress to invasive infection. During 14 years of this study, the burn center was relocated to a center with improved infrastructure. This study investigates the association that infrastructure, geography and time may have on colonization. Data were collected Oct-2004 to Aug-2018, relocation took place June-2010, defining the two study periods. Admission swabs were within 48 hours. Unique isolates and resistance data were analyzed and compared statistically between two study periods. 2,001 patients with 24,226 wound swabs were included. Median age 45.4 [IQR30.2-61.6], length of stay 11 days [IQR6-21] and %TBSA 5.5 [IQR2.5-11]. Staph. aureus (33.7/100 patients) and Pseudomonas spp. (13.1/100 patients) were the most prevalent bacterial growths. After admission, prevalence of MRSA, coliform spp. and Aci. baumanni were greater in first site, candida spp. colonization was higher in the second study period site. Prevalence of patients affected by multi-drug resistant organisms was lower in the second study site, 13.5/100 patients vs 16.6/100 patients, p&lt;0.05. There are differences in burn wound colonization across time, within the same region. Candidal spp. growth has been shown to be increased over time and represents an added challenge. Awareness facilitates effective empirical antimicrobial therapies and protocols locally.

Unravelling Resistance: Data Activism Configurations in Latin American Civil Society

This work examines the evolution of Latin American Civil Society Organizations’ (CSOs) resistance practices in the context of datafication and how these relate with the overall notions of symbolic domination denounced by the Latin American School of Communication. Although CSOs in Latin America are still exploring the problems surrounding datafication, signs of vitality are already showing in broader debates around human rights, community development, and media policies. The study identifies the main themes underlying datafication work by Latin American CSOs and assesses how they shape resistance practices and CSOs’ perceptions of asymmetrical power relations. While some patterns can fall into existing conceptualisations surrounding resistance practices and data activism, this paper identifies new conceptual and empirical approaches to face the challenges posed by a datafied society.

Interplay between Phenotypic Resistance to Relevant Antibiotics in Gram-Negative Urinary Pathogens: A Data-Driven Analysis of 10 Years’ Worth of Antibiogram Data

The global emergence of antimicrobial resistance (AMR) has become a critical issue for clinicians, as it puts the decades of developments in the medical field in jeopardy, by severely limiting the useful therapeutic arsenal of drugs, both in nosocomial and community-acquired infections. In the present study, a secondary analysis of taxonomic and resistance data was performed, corresponding to urinary tract infections (UTIs) caused by Gram-negative bacteria, detected between 1 January 2008 to 31 December 2017 at the Albert Szent-Györgyi Health Center, University of Szeged. The following were identifiable from the data collected: year of isolation; outpatient (OP)/inpatient (IP) origin of the isolate; taxonomy; and susceptibility/resistance to selected indicator antibiotics. Principal component analysis (PCA) and a correlation matrix were used to determine the association between the presences of resistance against indicator antibiotics in each taxonomic group. Overall, data from n = 16,240 outpatient and n = 13,964 inpatient Gram-negative UTI isolates were included in the data analyses. In E. coli, strong positive correlations were seen between resistance to ciprofloxacin (CIP) and gentamicin (GEN) resistance (OP: r = 0.6342, p = 0.049; IP: r = 0.9602, p < 0.001), whereas strong negative correlations were shown for fosfomycin (FOS) and nitrofurantoin (NIT) resistance (OP: r= −0.7183, p = 0.019; IP: r= −0.7437; p = 0.014). For Klebsiella spp. isolates, CIP resistance showed strong positive correlation with resistance to third-generation cephalosporins (3GC) and GEN (r = 0.7976, p = 0.006 and r = 0.7428, p = 0.014, respectively) in OP isolates, and with resistance to trimethoprim-sulfamethoxazole (SXT) and FOS (r = 0.8144, p = 0.004 and r = 0.7758, p < 0.001, respectively) in IP isolates. For members of the Citrobacter-Enterobacter-Serratia group, the resistance among indicator antibiotics showed a strong positive correlation, with the exception of FOS resistance. In the Proteus-Providencia-Morganella group, the strongest association was noted between CIP and SXT resistance (OP: r = 0.9251, p < 0.001; IP: r = 0.8007; p = 0.005). In the case of OP Acinetobacter spp., CIP showed strong and significant positive correlations with most indicator antibiotics, whereas for IP isolates, strong negative correlations arose among imipenem (IMI) resistance and resistance to other drugs. For Pseudomonas spp., strong and positive correlations were noted among resistance to β-lactam antibiotics and aminoglycosides, with the exception of ceftazidime (CEFT), showing strong, but negative correlations. Though molecular tests and sequencing-based platforms are now considered as the gold-standard for AMR surveillance, standardized collection of phenotypic resistance data and the introduction of Big Data analytic methods may be a viable alternative for molecular surveillance, especially in low-resource settings.