bluuebunny/crossref_metadata_2025 huggingface dataset:
627 INTRACAVITARY CORONARY ARTERIES: IS IT REALLY A RARE FINDING? A CORONARY CT STUDY
Authors: La Mura Lucia , Fassano Nicolas Jose
Published: December 2022

Background

The prevalence and clinical relevance of intracavitary coronary arteries coursing within the right ventricle (RV) or right atrial appendix are largely unknown. Only one study has described a prevalence of 17 cases on 31,748 patients (0,054%) by coronary CT angiography.

Purpose

The aim of the study was to assess in a population that underwent coronary CT (CCT) study, how many intra-chamber courses of coronary artery were observed.

Methods

All patients underwent a CCT study from April 2021 to August 2022 in a single center were enrolled. The CCT was performed by a 128-slices system and analyzed by a single operator with over 3 years of experience.

Results

out of 807 patients (41% female, 61.4±10.2 years) who underwent a CCT study, 14 patients with an intra-chamber coronary course were observed, with a prevalence of 1,73%. In particular, 11 had an intra-right ventricle course of the left anterior descending artery and 3 patients had the right coronary artery coursing within the right atrial appendix.

Conclusions

the intra-chamber course of coronary artery seems to be much more frequent than described in the scientific literature. The intra-right ventricle course of the left anterior descending artery may be the most frequently encountered anomaly.
104 EFFECTIVENESS OF 2014 ESC HCM RISK-SCD SCORE IN PREDICTION OF APPROPRIATE ICD SHOCK
Authors: Buongiorno Antonia Luisa , Blandino Alessandro , Bianchi Francesca , Masi Andrea Sibona , Mabritto Barbara , Luceri Stefania , Bongioanni Sergio , De Rosa Catia , Parrini Iris , Tommasello Antonino , Grossi Stefano , Musumeci Giuseppe
Published: December 2022

Background

Since 2014, European Guidelines have recommended using a novel clinical risk prediction model, called the HCM Risk-SCD, to identify which patients with hypertrophic cardiomyopathy (HCM) who are at higher risk for sudden cardiac death (SCD) and would benefit most from having a prophylactic cardioverter defibrillator (ICD) implantable. In recent years, evidence has called into question the effectiveness of this model in patient selection.

Material and Methods

Data from consecutive patients with HCM and ICD who were followed at our Cardiology Department from January 2000 to January 2022 were retrospectively collected.

Results

Among 702 HCM patients, 52 (7%) received an ICD (female, 31%; mean age at implantation, 49 ± 20; S-ICD, 13%; single-chamber ICD, 50%). Of them, 7 (13%) patients were implanted for secondary prevention while 45 (87%) for primary prevention. Out of the 45 primary prevention patients, 7 (16%) experienced 8 appropriate shocks (AS) while 10 (22%) had 15 inappropriate shocks (IS), during a mean follow up of 8 ± 5 years. Overall, mean HCM Risk-SCD score was 6.8 ± 4.7. Patients with AS showed a non-significant higher risk score when compared to non-AS subjects (7.1 ± 5.4 vs 4.8 ± 5.1, p=0.27). By stratifying study population according to pre-established and clinically adopted HCM Risk-SCD score cut-off (such as < 4 vs. > or = 4), we failed to highlight any significant difference in term of AS between groups. Indeed, out of 10 (22%) patients with HCM Risk-SCD score < 4, 3 (7%) experienced AS, while among 35 (78%) patients with HCM Risk-SCD score > or = 4, 4 (9%) had AS (30% vs. 11%, p=0.17).

Conclusions

The HCM Risk-SCD score does not seem to be able to predict the occurrence of life-threatening ventricular arrhythmias and AS in HCM patients. Our data highlight the need to elaborate a new score in order to improve SCD risk stratification and better select patients for ICD implantation.
4 METABOLIC SYNDROME, HYPERTENSION AND DEPRESSION: A DANGEROUS ASSOCIATION FOR POSTMENOPAUSAL WOMEN
Authors: Maiello Maria , Cecere Annagrazia , Ciccone Marco Matteo , Palmiero Pasquale
Published: December 2022

Background

Depression(D) is a common condition in postmenopausal women, related to an increased risk of cardiovascular disease(CVD), however, the relationship between metabolic syndrome(MetS) and D needs to be better clarified, the same for the association between hypertension(H) and D. The diagnosis of D is yet a challenging problem in clinical practice, there is a wide underdiagnosis of this condition, so the evidence that a Dwell-identified population of postmenopausal women, affected by MetS, presents a high risk, of D occurrence, is useful for CVD prevention. Our study aims to assess the prevalence of metabolic syndrome or hypertension diagnosed according to current guidelines, in postmenopausal women with D, and its role as an independent risk factor.

Results

D rate was significantly higher among women affected by MetS:0.17%, 18 women, than CG:0.08%, 45 women, Chi-squared 9.8, Odds ratio 2.3, c.i.95%, p<0.0017. D rate was significantly higher among women affected by H:0.17%, 107 women, than CG:0.08%, 45 women, Chi-squared 25.9, Odds ratio 2.4, c.i.95%, p<0.0000.

D rate was significantly higher among women affected by metabolic cardiopathy:0.18%, 10 women, than CG:0.08%, 45 women, Chi-squared 5.9, Odds ratio 2.3, c.i.95%, p<0.0014. D rate was significantly higher among women affected by hypertensive cardiopathy:0.12%, 43 women than CG:0.08%, 45 women, Chi-squared 25.9, Odds ratio 2.4, c.i.95%, p<0.05.

Conclusion

There was a wide lack of diagnosis of D in our population because in controlled trials the prevalence of depression is 10-15%. However, we observed an interesting relationship between MetS and D, which is even tighter when restricted to women affected by H; otherwise, the relationship doesn't change when restricted to women affected by metabolic or hypertensive cardiomyopathy. An intervention is needed to improve the diagnosis of D in postmenopausal women, even more, when affected by MetS or D.

Key words: postmenopausal women, metabolic syndrome, hypertension, depression, cardiomyopathy
Long-term risk of new-onset arrhythmia in ST-segment elevation myocardial infarction according to revascularization status
Authors: Thomsen Anna F , Jøns Christian , Jabbari Reza , Jacobsen Mia R , Stampe Niels Kjær , Butt Jawad H , Olsen Niels Thue , Kelbæk Henning , Torp-Pedersen Christian , Fosbøl Emil L , Pedersen Frants , Køber Lars , Engstrøm Thomas , Jacobsen Peter Karl
Published: December 2022

Aims

Emerging data show that complete revascularization (CR) reduces cardiovascular death and recurrent myocardial infarction in ST-segment elevation myocardial infarction (STEMI). However, the influence of revascularization status on development of arrhythmia in the long-term post-STEMI phase is poorly described. We hypothesized that incomplete revascularization (ICR) compared with CR in STEMI is associated with an increased long-term risk of new-onset arrhythmia.

Methods and results

Patients with STEMI treated with primary percutaneous coronary intervention (PPCI) at Copenhagen University Hospital, Rigshospitalet, Denmark, with CR or ICR were identified via the Eastern Danish Heart registry from 2009 to 2016. Using unique Danish administrative registries, the outcomes were assessed. The primary outcome was new-onset arrhythmia defined as a composite of atrial fibrillation/flutter (AF), sinoatrial block, advanced second- or third-degree atrioventricular block, ventricular tachycardia/fibrillation (VT), or cardiac arrest (CA), with presentation >7 days post-PPCI. Secondary outcomes were the components of the primary outcome and all-cause mortality. A total of 5103 patients (median age: 62.0 years; 76% men) were included, of whom 4009 (79%) and 1094 (21%) patients underwent CR and ICR, respectively. Compared with CR, ICR was associated with a higher risk of new-onset arrhythmia [hazard ratio (HR), 1.33; 95% confidence interval (CI), 1.07–1.66; P = 0.01], AF (HR, 1.29; 95% CI, 1.00–1.66; P = 0.05), a combined outcome of VT and CA (HR, 1.77; 95% CI, 1.10–2.84; P = 0.02) and all-cause mortality (HR, 1.27; 95% CI, 1.05–1.53; P = 0.01). All HRs adjusted.

Conclusion

Among patients with STEMI, ICR was associated with an increased long-term risk of new-onset arrhythmia and all-cause mortality compared with CR.
Similar mutation rates but different mutation spectra in moderate and extremely halophilic archaea
Authors: Kucukyildirim Sibel , Ozdemirel Huseyin Ozgur , Lynch Michael
Published: December 2022

Archaea are a major part of Earth’s microbiota and extremely diverse. Yet, we know very little about the process of mutation that drives such diversification. To expand beyond previous work with the moderate halophilic archaeal species Haloferax volcanii, we performed a mutation-accumulation experiment followed by whole-genome sequencing in the extremely halophilic archaeon Halobacterium salinarum. Although Hfx. volcanii and Hbt. salinarum have different salt requirements, both species have highly polyploid genomes and similar GC content. We accumulated mutations for an average of 1250 generations in 67 mutation accumulation lines of Hbt. salinarum, and revealed 84 single-base substitutions and 10 insertion-deletion mutations. The estimated base-substitution mutation rate of 3.99 × 10−10 per site per generation or 1.0 × 10−3 per genome per generation in Hbt. salinarum is similar to that reported for Hfx. volcanii (1.2 × 10−3 per genome per generation), but the genome-wide insertion-deletion rate and spectrum of mutations are somewhat dissimilar in these archaeal species. The spectra of spontaneous mutations were AT biased in both archaea, but they differed in significant ways that may be related to differences in the fidelity of DNA replication/repair mechanisms or a simple result of the different salt concentrations.
Risk factors and clinical outcomes of incomplete endoscopic resection of small rectal neuroendocrine tumors in southern China: a 9-year data analysis
Authors: Zhuang Xiaoduan , Zhang Shaoheng , Chen Guiquan , Luo Zongqi , Hu Huiqin , Huang Wenfeng , Guo Yu , Ouyang Yongwen , Peng Liang , Qing Qing , Chen Huiting , Li Bingsheng , Chen Jie , Wang Xinying
Published: December 2022

Background

The histologically complete resection (CR) rate of small rectal neuroendocrine tumors (RNETs) is unsatisfactory at the first endoscopy. Risk factors and clinical outcomes associated with incomplete resection (IR) have not been explicitly elucidated. This study aims to explore the relevant factors of IR.

Methods

This retrospective study reviewed patients with small RNETs (≤10 mm) in eight centers from January 2013 to December 2021. Clinicopathological characteristics and clinical outcomes were compared between the CR and IR groups, and the polypectomy and advanced treatment groups.

Results

Of the 326 patients included, 83 (25.5%) were diagnosed with IR. Polypectomy (odds ratio [OR] = 16.86), a central depression (OR = 7.50), and treatment in the early period (OR = 2.60) were closely associated with IR. Further analysis revealed that an atypical hyperemic appearance (OR = 7.49) and treatment in the early period (OR = 2.54) were significantly associated with the inappropriate use of polypectomy (both P < 0.05). In addition, a total of 265 (81.3%) were followed up with a median follow-up period of 30.9 months. No death, metastasis, or recurrence was found during the follow-up period.

Conclusions

Polypectomy, a central depression, and treatment in the early period were risk factors for IR. Further, an atypical hyperemic appearance and treatment in the early period were significant predisposing factors for inappropriate choice of polypectomy. For histologically incompletely resected small RNETs, follow-up may be a safe and feasible alternative to rigorous salvage therapy.
Semigroup *-Algebras Arising from Graphs of Monoids
Authors: Chen Cheng , Li Xin
Published: December 2022

We study groupoids and semigroup $C^{\ast }$-algebras arising from graphs of monoids, in the setting of right LCM monoids. First, we establish a general criterion when a graph of monoids gives rise to a submonoid of the fundamental group that is right LCM. Moreover, we carry out a detailed analysis of structural properties of semigroup $C^{\ast }$-algebras arising from graphs of monoids, including closed invariant subspaces and topological freeness of the groupoids, as well as ideal structure, nuclearity, and K-theory of the semigroup $C^{\ast }$-algebras. As an application, we construct families of pairwise nonconjugate Cartan subalgebras in every UCT Kirchberg algebra.
Presenting Lusztig Algebras
Authors: Fu Qiang , Liu Mingqiang
Published: December 2022

Let ${\textbf {U}}_{\!\vartriangle }(n)$ be the quantized enveloping algebra of $\widehat {\mathfrak {g}\mathfrak {l}}_n^{\prime}$ over ${\mathbb {Q}}(v)$, where $\widehat {\mathfrak {g}\mathfrak {l}}_n^{\prime}=\mathfrak {g}\mathfrak {l}_n\oplus \bigoplus _{l\in {\mathbb {Z}},\,l\not =0}{\scriptsize{\rm t}}^l\mathfrak {s}\mathfrak {l}_n$. There is a natural algebra homomorphism $\zeta _r$ from ${\textbf {U}}_{\!\vartriangle }(n)$ to the affine quantum Schur algebra ${\boldsymbol {{\mathcal {S}}}}_{\!\vartriangle }(n,r)$. Let $ U_{\!\vartriangle }(n)_{{{\mathcal {Z}}}}$ be the Lusztig ${{\mathcal {Z}}}$-form of ${\textbf {U}}_{\!\vartriangle }(n)$, where ${{\mathcal {Z}}}={\mathbb {Z}}[v,v^{-1}]$. The algebras ${\textbf {U}}_{\!\vartriangle }(n,r):=\zeta _r({\textbf {U}}_{\!\vartriangle }(n))$ and $U_{\!\vartriangle }(n,r)_{{\mathcal {Z}}}:=\zeta _r( U_{\!\vartriangle }(n)_{{{\mathcal {Z}}}})$ are called Lusztig algebras. Let $\mathcal {K}$ be a commutative ring containing an invertible element $\epsilon $. Let $U_{\!\vartriangle }(n,r)_{\mathcal {K}}=U_{\!\vartriangle }(n,r)_{{\mathcal {Z}}}\otimes _{{\mathcal {Z}}}\mathcal {K}$, where $\mathcal {K}$ is regarded as a ${{\mathcal {Z}}}$-module by specializing $v$ to $\epsilon $. In this paper, we give a presentation for the Lusztig algebra $U_{\!\vartriangle }(n,r)_{\mathcal {K}}$ for any commutative ring $\mathcal {K}$.
Critically Appraising Pragmatist Critiques of Evidence-Based Medicine: Is EBM Defensible on Pragmatist Grounds?
Authors: Thomas S Joshua
Published: December 2022

Significant contributions to debates in the philosophy of evidence-based medicine (EBM) have come from a variety of different philosophical quarters, yet mainstream discourse in the field has been largely devoid of contributions from scholars working in the pragmatist tradition. This is a particularly conspicuous omission, given pragmatism’s commitment to the melioristic view that philosophy both can, and should, be about the business of concretely bettering the human estate. Two exceptions to this oversight come from Brian Walsh and Maya Goldenberg. Unfortunately, in both cases, the misapplication of pragmatist thinking leads to the mistaken view that EBM is committed to some form of pernicious objectivism. This article aims to revise these pragmatist critiques in order to bring them more consistently in line with pragmatist values and commitments. Doing so shows that EBM is defensible on pragmatist grounds against objectivist attacks.
Enrolling Older Adults Onto National Cancer Institute–Funded Clinical Trials in Community Oncology Clinics: Barriers and Solutions
Authors: Hopkins Judith O , Braun-Inglis Christa , Guidice Sofia , Wells Meg , Moorthi Kiran , Berenberg Jeffrey , St. Germain Diane , Mohile Supriya , Hudson Matthew F
Published: December 2022

In April 2021, the National Cancer Institute (NCI) Division of Cancer Prevention collaborated with the NCI Division of Cancer Treatment and Diagnosis to produce a virtual workshop that developed recommendations for enhancing NCI-sponsored clinical trial accrual of older adults. Prior to the workshop, a multidisciplinary group of stakeholders (eg, community oncologists, advanced practice practitioners, clinic and research staff, and patient advocates) gathered information related to accrual of older adults to clinical trials from the literature. Subsequently, a survey was conducted to detail NCI Community Oncology Research Program members’ perspective on accrual barriers for this population; 305 individuals responded to the survey. Barriers to clinical trial accruals included comorbidity-attributed trial ineligibility, transportation and time issues, concern that the proposed regimen is too toxic for older adults, patient or family caregiver declined participation, and lack of trials relevant to older patients. Identified solutions included broadening clinical trial inclusion criteria, increasing the number of clinical trials specifically designed for older adults, simplifying consent forms, improving recruitment materials for older adults and their families, and facilitating transportation vouchers. At the workshop, participants, including stakeholders, used prior literature and survey results to develop recommendations, including interventions to address clinician bias, implement geriatric assessment, and promote clinician and staff engagement as mechanisms to improve accrual of older adults to clinical trials.
Through the Lens of Patient Partners: Challenges in Accrual of Older Adults to NCI Clinical Trials
Authors: BrintzenhofeSzoc Karlynn , Canin Beverly , Casas-Silva Esmeralda , Denicoff Andrea , Braun-Inglis Christa , Okado Izumi , Bakos Alexis
Published: December 2022

The workshop “Engaging Older Adults in Cancer Clinical Trials Conducted in the NCI Clinical Trials Network: Challenges and Opportunities” included a Patient Stakeholder Workgroup that explored the needs and concerns of older adults with cancer regarding clinical trials. To accomplish this, the workgroup conducted patient focus groups in which participants were interviewed, recorded conversations were analyzed and coded, and salient themes were identified. The focus groups identified general barriers to accrual such as complex consent forms, general communication, restrictive eligibility, nonreferrals, patient costs, cultural insensitivity, limited accessibility in community settings, and transportation issues. They also identified the influence of knowledgeable information presenters, improved care, family or caregiver support, and the desire to help others as drivers or reasons to participate in clinical trials. The workshop concluded that multi-level interventions could be used to increase the accrual of older adults to National Cancer Institute clinical trials as well as others.
Infrastructure to Support Accrual of Older Adults to National Cancer Institute Clinical Trials
Authors: Kimmick Gretchen , Sedrak Mina S , Williams Grant , McCleary Nadine J , Rosko Ashley E , Berenberg Jeffrey L , Freedman Rachel A , Smith Mary Lou , Ahmed Amina , Muss Hyman B , Chow Selina , Dale William
Published: December 2022

As part of ongoing efforts to meaningfully improve recruitment, enrollment, and accrual of older adults into cancer clinical trials, the National Cancer Institute (NCI) sponsored a workshop with experts across the country entitled Engaging Older Adults in the NCI Clinical Trials Network: Challenges and Opportunities. Three working groups, including Study Design, Infrastructure, and Stakeholders, were formed, who worked together to offer synergistic improvements in the system. Here, we summarize the workshop discussions of the Infrastructure Working Group, whose goal was to address infrastructural challenges, identify underlying resources, and offer solutions to facilitate accrual of older adults into cancer clinical trials. Based on preconference work and workshop discussions, four key recommendations to strengthen NCI infrastructure were proposed: 1) further centralize resources and expertise; 2) provide training for clinical research staff; (3) develop common data elements; and 4) evaluate what works and does not work. These recommendations provide a strategy to improve the infrastructure to enroll more older adults in cancer clinical trials.
736. Impact of COVID-19 on Mortality Associated with Pseudomonas aeruginosa Bloodstream Infection in the Veterans Health Administration System
Authors: Hojat Leila S , Wilson Brigid , Perez Federico , Bonomo Robert A
Published: December 2022

Background

Pseudomonas aeruginosa bloodstream infection (PA-BSI) is associated with high mortality. The extent to which the COVID-19 pandemic has introduced challenges to diagnosis and treatment of this infection is unknown. In this study, we examined the direct and indirect effects of COVID-19 on PA-BSI associated mortality in the Veterans Health Administration (VHA) population.

Methods

We identified patients within the VHA database with PA-BSI identified between January 1, 2009 and December 31, 2019 (pre-COVID) and January 1, 2020 to December 31, 2021 (COVID). Extracted data included age, race, ethnicity, Charlson Comorbidity Index (CCI), susceptibility testing, treatment, and COVID-19 infection. Antimicrobial resistance was characterized as pan-susceptible, any unclassified resistance, multi-drug resistant (MDR), difficult to treat resistant (DTR), and extremely or pan-drug resistant (XDR/PDR). Active therapy was defined as an effective antibiotic initiated within 48 hours of blood culture collection. We used logistic regression to assess the impact of each factor on 30-day mortality.

Results

We identified 7,578 patients with PA-BSI and known 30-day mortality status, which was 24% overall (Table 1). Age and CCI were higher during COVID, while effective treatment and resistance improved (Table 2). In the multivariate analysis, concomitant COVID infection tripled the odds of mortality (odds ratio [OR] 3.00, 95% confidence interval [CI] 1.40–6.37) (Figure 1). However, the COVID period itself was not associated with higher mortality. Effective treatment was associated with 19% lower odds of mortality (OR 0.81, 95% CI 0.66–1.01), while DTR and XDR/PDR nearly doubled mortality (OR 1.75, 95% CI 1.23–2.47 and OR 2.06, 95% CI 1.25–3.34, respectively).

Conclusion

We observed higher odds of mortality in patients with PA-BSI and COVID-19 coinfection, supporting the hypothesis that COVID-19 directly impacts PA-BSI outcomes. Annual PA-BSI incidence and associated 30-day mortality, however, were similar during the COVID period. Favorable resistance trends, effective treatment, and a low rate of PA-BSI and COVID-19 coinfection may explain these findings, despite increased age and comorbidities in this vulnerable population.

Disclosures

Federico Perez, MD, MS, Accelerate: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Grant/Research Support Robert A. Bonomo, MD, Merck: Grant/Research Support|Pfizer: Honoraria|VenatoRx: Grant/Research Support|Wockhardt: Grant/Research Support.
741. Evaluation of Serotonin Syndrome with Linezolid and Serotonergic Agents at an Academic Medical Center
Authors: Kufel Wesley D , Blaine Bruce , Sepiol Riquel , Rubiconti Elizabeth , Khatsko Anna , McKnight Melissa , Parsels Katie A
Published: December 2022

Background

The risk of linezolid-associated serotonin syndrome based on the potency and number of serotonergic agents is unclear. Thus, the primary outcome was to evaluate the incidence of serotonin syndrome among hospitalized patients who are concurrently receiving linezolid with or without serotonergic agents. Secondary outcomes were to assess the potency, agent selection, and number of serotonergic agents.

Methods

This was a single-center, retrospective cohort study of hospitalized patients >18 years of age who received >1 dose of linezolid with or without a concurrent serotonergic agent between 1/1/14–6/30/2021. Patients were excluded if < 18 years of age, had linezolid ordered but not administered, were pregnant, or incarcerated. Up to five concurrent serotonergic agents were recorded and potency was divided into low, moderate, and high potency based on if the drug strength was < 33%, 33–66%, and >66% of the maximum daily dose, respectively. Serotonin syndrome was identified by searching patients’ electronic medical record for ‘serotonin syndrome’ or ‘serotonin toxicity’. If either term was identified, Hunter and Sternbach criteria were applied. Descriptive statistics including number (percentages) and mean (standard deviation) were used.

Results

Of 2022 patients screened, 1743 were included. Mean age, weight, and linezolid duration were 58.5 years, 90.7 kg, and 4.1 days, respectively. Of patients included who received linezolid, 43.2%, 16.2%, 5.7%, 1.4%, and 0.5% received at least one, two, three, four, and five concurrent serotonergic agents, respectively. Most patients received either a moderate and/or high potency (53.8%) compared to a low potency serotonergic agent (46.2%). Only 2 patients (0.11%) were identified with ‘serotonin syndrome’ or ‘serotonin toxicity’. Patient 1 received escitalopram moderate potency and trazodone low potency but did not meet either Hunter or Sternbach criteria. Patient 2 received duloxetine moderate potency, vilazodone moderate potency, and metoclopramide low potency but only met Sternbach criteria.

Conclusion

Serotonin syndrome among hospitalized patients receiving linezolid with other serotonergic agents was exceedingly rare, even among those who received multiple and more potent serotonergic agents.

Disclosures

Wesley D. Kufel, Pharm.D., BCPS, BCIDP, AAHIVP, Melinta: Grant/Research Support|Merck: Grant/Research Support|Theratechnologies, Inc.: Advisor/Consultant.
1541. Impact on Reduction of Blood Culture Incubation Period from Five to Four Days from Large Tertitary Care Center
Authors: Patel Premalkumar M , Pagacz Michael , Tumarinson Taisiya , Yousefzadeh Michelle , Rivera Cynthia , Recine Monica
Published: December 2022

Background

Hospitals have been experiencing an increasing number of acutely ill patients as well as those requiring prolonged hospitalizations, further worsened by the COVID-19 pandemic. This has resulted in increased orders for blood cultures. Once collected, the culture bottles require an incubation period, typically 5 days. The BD BACTEC Fx, a blood culture incubation automated system, holds blood culture bottles until growth is demonstrated or for 5 days, whichever occurs first. New bottles are placed in the apparatus along with older bottles awaiting growth. Capacity is reached when the machine cannot accommodate new bottles due to limited space. When this occurs, manual plating of blood cultures on agar plates is required. Manual plating adds additional responsibility to already overwhelmed microbiology labs.

Methods

Following the institutional review board (IRB) approval, data were collected retrospectively at a 765-bed tertiary care center. Data was obtained from positive blood cultures from July 2017 to June 2020. We stratified positive blood cultures based on the day of positivity, from day one to day five. The charts were reviewed for positive blood culture results on day four and day five to evaluate for clinical significance. Clinical significance was determined by an Infectious Disease subspecialty team. Blood culture bottles that were positive on day 4 and day 5 in 1 bottle out of 2 bottles with coagulase-negative species of Staphylococcus, Corynebacterium spp, or Propionibacterium acnes were considered a contaminant and did not warrant further chart review.

Results

On a retrospective review of data from July 2017 to June 2020, the total number of blood cultures obtained was 120,320. Among them, 7,558 blood cultures were positive. 94% were positive on day 1, 4% positive on day 2, 2% positive on day 3, 1% positive on day 4 and < 1% positive on day 5. Positive blood cultures on day 5 did not have any clinical significance, according to the chart review.

Conclusion

Our study demonstrated that four days of incubation is sufficient for the BD BACTEC Fx automated blood culture incubation system without compromising clinical significance. Implementation of a 4-day incubation period will help with reducing saturation of slots and will improve readiness to accommodate more blood culture bottles.

Disclosures

All Authors: No reported disclosures.
1243. Hepatitis D Virus and Hepatitis B Virus Epidemiology in Utah
Authors: Hesterman Matthew , Fallon Braden , Wilson Paul , Weller Melodie L
Published: December 2022

Background

Hepatitis Delta Virus (HDV) is a rare infectious disease that requires a helper virus (ex. Hepatitis B Virus (HBV)) for transmission. Worldwide, it is estimated that 12-72 million individuals are infected with HDV. Within the United States, an accurate measure of HDV prevalence is attenuated by limited testing and variable notifiable disease status. Recent reports have noted a significant shift in the international HDV epidemiology. This retrospective study was designed to further evaluate the prevalence and clinical features of HDV and HBV within the Utahn patient population.

Methods

Within University of Utah Health, patient demographics, diagnostic codes (ICD9, ICD10) for HBV and HDV, CPT test codes and lab results were evaluated from 2000-2020. Univariate and multivariate analyses were performed. Timeseries analyses, including Mann-Kendall (MK) trend test, Bayesian Information Criterion (BIC) and Autoregressive Integrated Moving Average (ARIMA) were performed to characterize trends in HDV and HBV prevalence.

Results

Between 2000-2020, 2878 HBV and 180 HDV patients were identified within the University of Utah Health system. The median age of the HBV and HDV patients was 45 years with 56% males and 42 years with 60% males, respectively. 10% of all HBV-tested patients were tested for HDV. The positivity rate of patients tested for HDV was 7%. Statistical analysis of race and ethnicity showed a significant difference in incidence and testing rates among the Utahn Asian population when compared against non-Asian populations. A significant increasing trend in the incidence of both HBV (MK=156, p=2.8e-6) and HDV (MK=83, p=0.01) was observed between 2000-2020. Within the timeframe analyzed, two structural breaks were observed for HDV/HBV incidence ratio.

Conclusion

Together, our analysis suggests a significant change in the incidence of HDV and, due to the global temporal trend observed, may be suggestive of a change in HDV transmission pattern. Active surveillance of HDV in the United States and worldwide is warranted to further define these observed changes in HDV incidence.

Disclosures

All Authors: No reported disclosures.
1649. Ceftolozane-Tazobactam or Ceftazidime-Avibactam Versus Best Available Therapy in the Treatment of Difficult-to-Treat Pseudomonas aeruginosa Infections: a Retrospective Comparative Effectiveness Analysis of 195 U.S. Hospitals, 2016–2020
Authors: Lawandi Alexander , Mishuk Ahmed Ullah , Yek Christina , Yu Amy , Li Xiaobai , Strich Jeffrey R , Sarzynski Sadia , Warner Sarah , Kadri Sameer S
Published: December 2022

Background

Infections due to Pseudomonas aeruginosa displaying difficult-to-treat resistance (DTR-PA) necessitate the use of sub-efficacious and/or toxic “reserve” antibiotics and are associated with considerable morbidity and mortality. Ceftazidime-avibactam (CAZ-AVY) and ceftolozane-tazobactam (CEF-TAZO) are novel ß-lactam/ß-lactamase inhibitors (BLBLI) that tend to retain in vitro activity against DTR-PA. However, little is known about their in vivo effectiveness compared to reserve agents.

Methods

Inpatients aged ≥ 18 years with ≥1 blood, urine, respiratory, or body fluid culture growing DTR-PA who received targeted therapy with either CAZ-AVY, CEF-TAZO, or Best-Available Therapy (BAT) were identified in the Premier Healthcare Database. Primary outcome was in-hospital mortality or discharge to hospice and secondary outcome was length of hospital stay (LOS) for survivors. The primary outcome was compared for CAZ-AVY vs CEF-TAZO and novel agents (CAZ-AVY or CEF-TAZO) vs BAT using overlap weighting and binomial regression with downstream adjustment controlling for patient and treatment characteristics. The secondary outcomes were compared using overlap weighting and poisson regression with downstream adjustment controlling for patient and treatment characteristics.

Results

Between 2016 and 2020, 1,552 patients with DTR-PA infections were identified at 105 hospitals, of which 202 (13.0%) were treated with CAZ-AVY, 906 (58.4%) with CEF-TAZO, and 444 (28.6%) with BAT. Patient characteristics were similar among treatment groups (Table 1, Table 2). Overall crude mortality was 15.5%. The adjusted risk of mortality was lower in patients treated with CAZ-AVI (12.5%, 95% CI 7.9–17.1) vs CEF-TAZO (18.8%, 95% CI 15.9–21.8) for a risk difference of 6.3% (95% 1.1–11.5, p = 0.02). The novel agents were not associated with a reduced mortality risk when collectively compared to BAT (risk difference -1.1%, 95% CI -5.4; 3.2%). LOS favoured novel agents and were comparable for CAZ-AVY and CEF-TAZO.

Conclusion

In this real-world observational study of patients with DTR-PA infections, the novel ß-lactam/ß-lactamase inhibitors were comparably effective against BAT, though the use of CAZ-AVY was associated with a reduced mortality compared to CEF-TAZO.

Disclosures

All Authors: No reported disclosures.
1364. Providing preventative care during the SARS-CoV-2 pandemic: Street medicine interventions amongst those experiencing unsheltered homelessness in the City of Detroit
Authors: Joshi Seema , Mann Yasmeen , Petersen Anneliese , Small Eliana , Ayyar Iven T , Abadejos Justin R , Venable Stephen , Ilagan Roxanne , Ho Brandon H , Shallal Anita , Chen Anne , Zervos Marcus , Bryce Richard
Published: December 2022

Background

In 2021, there were approximately 1300 people on a given day who have experienced homelessness within the city of Detroit, Michigan. Sheltered beds within the 24 homeless shelters in the city were drastically cut in half during the COVID-19 pandemic due to concerns of overcrowding perpetuating SARS-CoV-2 outbreaks. We aimed to describe the outreach efforts made by Street Medicine Organizations (SMO) of Detroit during the SARS-CoV-2 pandemic, highlighting infection prevention and control strategies, and promotion of COVID-19 vaccinations amongst the unsheltered homeless.

Methods

Health promotion interventions were directed at individuals who were unsheltered (defined as those living on the streets of Detroit, encampment sites and abandoned buildings). Education, which was provided through in-person sessions, as well as targeted COVID-19 informational pamphlets were distributed with every street-based run. Hygiene kits, which included masks, hand sanitizer and gloves were distributed thrice weekly at shelters and encampment sites. Since access to hand hygiene was drastically limited, the SMO constructed 10 hand washing stations throughout the city. COVID-19 vaccination in people experiencing homelessness started in April 2021.

Results

SMO prioritized a 60 square mile range within the city of Detroit, providing care to approximately 500 persons over the months of April 2020 to April 2021. Demographics for this population varied; age ranged from 23 to 76 years old, sex was 70% males, race were 67% Black, 29% White and 4% Hispanic. More than 2000 hygiene kits were distributed throughout this period. Ninety-one individuals experiencing unsheltered homelessness were provided the COVID-19 vaccine in April 2021.

Conclusion

Individuals experiencing unsheltered homelessness face unique challenges to accessing timely medical care, which has been further exacerbated during the pandemic. These individuals have limited or no access to necessary measures needed to prevent the spread and severity of diseases of SARS-CoV-2. We describe a focused and effective approach to preventing infection among these individuals as a model for organizations nationally.

Disclosures

All Authors: No reported disclosures.
1423. A Rare Case of Mycobacterium chelonae Septic Joint
Authors: Torres Jordan L , Zhao Yang , Gomez Mariana , Grider Douglas J , Griffin Daniel C
Published: December 2022

Background

Nontuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause chronic soft tissue infections and which may affect underlying joints and bone by direct extension. NTM septic joint infections are rare and literature on their management is scarce.

Methods

Here we describe a case of septic ankle due to M. chelonae, a rapid grower NTM, and review treatment of these infections.

Results

An 86-year-old man presented to our hospital with complaints of a painful left ankle. Three months prior he noticed a pimple on his left foot after tripping over a lawnmower. The lesion evolved into erythema and painful swelling of the left ankle. Magnetic resonance imaging (MRI) of the left lower extremity revealed a fracture of the distal tibial metaphysis. Turbid joint fluid was aspirated showing 211,450 white blood cells with 97% neutrophils. Patient underwent partial removal of the left tibia with insertion of a drug implant device. Culture results showed acid fast bacilli at day three and the pathology report confirmed atypical mycobacterial infection (Fig 1, 2). Empiric meropenem, linezolid, and azithromycin were initiated until the identification of M. chelonae was obtained. Based on susceptibilities meropenem was discontinued and ciprofloxacin was added. A repeat MRI showed osteomyelitis and small abscesses about the left ankle leading to repeat debridement. Cultures from debridement were negative. Tobramycin IV three times a week was added and ciprofloxacin was discontinued. Patient soon developed acute renal failure, NSTEMI, and lactic acidosis. After a goals of care discussion with patient’s family, antibiotics were discontinued. He passed away soon thereafter.

The backbone of NTM treatment usually consists of a macrolide plus 2-3 other agents but susceptibilities can be misleading. Data correlating outcomes of in vitro susceptibility and clinical response is mixed. Consequently, management of NTM infections is often derived from case reports and from the tuberculosis literature. As seen in this patient, effective treatment can be elusive.

Neutrophils surround vacuoles filled with acid-fast staining organisms on Fite staining

H&E Stain shows pink stained organisms in vacuoles

Conclusion

NTM infections are often resistant to antimycobacterial therapy and require multi-drug regimens with surgical intervention. Due to this complexity, a multidisciplinary approach is vital to improve outcomes.

Disclosures

All Authors: No reported disclosures.
1816. Bloodstream Infection Following Arterial Aneurysm Repair: A Population-Based Study
Authors: Tabaja Hussam , Chesdachai Supavit , Baddour Larry M , DeMartino Randall , Lahr Brian D , DeSimone Daniel C
Published: December 2022

Background

Bloodstream infection (BSI) following arterial aneurysm repair may signify vascular graft infection (VGI). The incidence of BSI and its implications in patients with arterial grafts have received scant attention with limited contemporary study. Therefore, the aim of the current investigation is to describe the incidence and epidemiology of BSI following arterial aneurysm repair in a population-based cohort.

Methods

Retrospective case-cohort study using the expanded Rochester Epidemiology Project (e-REP) to identify all arterial aneurysm repairs performed in adults (>18 years) residing in eight counties in southern Minnesota between January 1, 2010 and December 31, 2020. All repairs were performed at Mayo Clinic Rochester. Electronic health records were screened for initial BSI episode following aneurysm repair and complicating VGI.

Results

Overall, 643 patients underwent 708 aneurysm repairs: 417 endovascular and 291 open surgical repairs. Forty-two patients developed BSI during 2,992 cumulative person-years of follow-up. The median time from repair to BSI was 3.1 [interquartile range 0.5, 6.4] years. The BSI incidence rate, in cases per 1000 person-years, was 14.0 (95% CI 10.1-19.0) overall, including 18.2 (95% CI 11.9-26.7) following open surgical repair and 10.2 (95% CI 5.8-16.6) following endovascular repair (p=0.148). Thirty-nine (92.9%) of the BSI cases were monomicrobial, with 18 (46.2%) due to Gram-positive organisms and 21 (53.8%) due to Gram-negative organisms. Of the 42 patients with BSI, 10 (23.8%) had VGI. VGI occurred in 8/18 (44.4%) monomicrobial Gram-positive BSI as compared to 2/21 (9.5%) monomicrobial Gram-negative BSI (p=0.013). The 3-year mortality rate following BSI was 52.3%.

Conclusion

There was no statistically significant difference in incidence rates of BSI following open surgical repair and endovascular repair. Higher rates of VGI were seen with Gram-positive BSI as compared to Gram-negative BSI.

Disclosures

Larry M. Baddour, M.D., Boston Scientific: Advisor/Consultant|Botanix Pharmaceuticals: Advisor/Consultant|Roivant Sciences: Advisor/Consultant|UpToDate, Inc.: Royalty payments - authorship duties.
1819. Characterizing Treatment Duration of Viridans Group Streptococci Bacteremia in Neutropenic Cancer Patients: Is 14 Days Necessary?
Authors: Vu Yaling , Wong Jenny , Liu Catherine , Tverdek Frank P
Published: December 2022

Background

Neutropenic oncology patients often have mucosal barrier injury as a consequence of chemotherapy and are at risk of Viridans Group Streptococci (VGS) bacteremia. VGS is a commonly identified pathogen among oncology patients with neutropenic fever, however, limited data exists as to appropriate treatment duration.

Methods

The purpose of this study is to characterize the treatment duration and clinical course among neutropenic oncology patients with VGS bacteremia. A retrospective chart review of patients with VGS bacteremia from June 1, 2020 through January 31, 2022 at the University of Washington Medical Center (UWMC) and Seattle Cancer Care Alliance (SCCA). Eligible patients include adults ≥ 18 years with any cancer diagnosis, absolute neutrophil count ≤ 500 at time of blood culture collection, ≥ 1 positive blood culture for VGS, and treated with antibiotics for ≥ 48 hours. Polymicrobial infections were excluded.

Results

Among 86 patients identified with VGS bacteremia, 57 patients were included. Baseline characteristics are depicted in TABLE 1. Hematologic malignancy was present in a majority of patients. The mean duration of treatment was 12.4 (± 2.9) days. Mean time to defervescence was 3.7 days. The most common empiric regimen was cefepime + vancomycin (64.9%) with 78.9% of patients receiving ceftriaxone as definitive therapy. All VGS isolates were susceptible to at least one drug in their empiric regimen. Clinical outcomes are depicted in TABLE 2. There was 1 recurrence of VGS bacteremia and three deaths in the cohort. In TABLE 3, results are stratified by treatment duration.

Conclusion

There was significant heterogeneity in the duration of treatment of VGS bacteremia among neutropenic cancer patients utilizing levofloxacin prophylaxis, with > 50% treated in excess of 14 days. Fever persisted for several days despite active antimicrobials consistent with prior reports. The low rate of recurrence and death at any treatment duration suggests that a shorter duration of less than 14 days for VGS bacteremia may be feasible. A prospective evaluation is needed to confirm these findings.

Disclosures

All Authors: No reported disclosures.
1882. Effects of BA.1/BA.2 Subvariant, Vaccination, and Prior Infection on Infectiousness of SARS-CoV-2 Omicron Infections
Authors: Qassim Suelen , Abu-Raddad Laith J , Chemaitelly Hiam , AlMukdad Sawsan
Published: December 2022

Background

Qatar experienced a large SARS-CoV-2 Omicron (B.1.1.529) wave that started on December 19, 2021 and peaked in mid-January, 2022. We investigated effects of Omicron subvariant (BA.1 and BA.2), previous vaccination, and prior infection on infectiousness of Omicron infections, between December 23, 2021 and February 20, 2022. The RT-qPCR cycle threshold (Ct) value of a SARS-CoV-2 infection represents the inverse of viral load and is correlated with culturable virus; thus, it can be used as a proxy for SARS-CoV-2 infectiousness.

Methods

The study population included all individuals with an RT-qPCR-confirmed SARS-CoV-2 infection in Qatar in the study period. All relevant data for this population were extracted from the national, federated SARS-CoV-2 databases. A SARS-CoV-2 infection with BA.1 was proxied as an S-gene “target failure” (SGTF) case, whereas infection with BA.2 was proxied as a non-SGTF case. The average Ct values of the N, ORF1ab, and S (if not an SGTF case) genes was used as the dependent variable. Univariable and multivariable regression analyses were conducted to estimate the association between Ct value and each of the Omicron subvariants, mRNA vaccination, prior infection, reason for RT-qPCR testing, study-period week of RT-qPCR test, and demographic factors.

Results

Compared to BA.1, BA.2 was associated with 3.53 fewer cycles (95% CI: 3.46-3.60), signifying higher infectiousness (Table 1). Ct value decreased with time since second and third dose vaccinations. Ct values were highest for those who received their boosters in the month preceding the RT-qPCR test—0.86 cycles (95% CI: 0.72-1.00) higher than for unvaccinated persons. Ct value was 1.30 (95% CI: 1.20-1.39) cycles higher for those with a prior infection compared to those without prior infection, signifying lower infectiousness.

Conclusion

BA.2 appears to be associated with substantially higher infectiousness than BA.1. This may reflect higher viral load and/or longer duration of infection, thereby explaining the rapid expansion of this subvariant in Qatar. Natural immunity from previous infection and strength of vaccine immunity correlated with less infectious breakthrough infections.

Disclosures

All Authors: No reported disclosures.
2093. Utilizing Implementation Science to Identify Barriers and Facilitators to Implementing Harm Reduction Services in the Veterans Health Administration (VHA)
Authors: Harvey Leah , Sliwinski Samantha K , Flike Kimberlee , Boudreau Jacqueline , Gifford Allen L , Branch-Elliman Westyn , Hyde Justeen
Published: December 2022

Background

Rising rates of substance use, particularly synthetic opioids, have led to increases in fatal overdoses and injection-associated infections. Harm reduction, including infection prevention via provision of supplies and education, is an approach to minimize risk of severe outcomes. Although harm reduction services (HRS) are highly evidence-based, implementation in most healthcare settings is limited. The aim of this study was to identify facilitators and barriers to the implementation of HRS to inform strategies for increasing access and adoption of a comprehensive bundle of harm reduction resources within the VHA.

Methods

Qualitative interviews were conducted using a semi-structured interview guide and explored how harm reduction is currently understood and implemented by VHA providers and was designed to identify perceived gaps and barriers. Data were analyzed using a directed content analysis. After barriers and facilitators were identified, they were mapped to relevant implementation strategies using the Consolidated Framework for Implementation Research - Expert Recommendations for Implementing Change (CFIR – ERIC) tool.

Results

15 interviews with VHA providers (physicians, social workers, pharmacists, and directors of addiction and mental health services) were conducted across 5 sites. Multiple barriers and few facilitators to the provision of HRS were identified (Table 1). Currently, HRS were thought to be fragmented and dependent on the knowledge, time, and comfort level of individual providers. Participants also highlighted stigma around substance use, limited support, and burdensome regulatory requirements. Existing infrastructure, social programming, and local champions were highlighted as facilitators. Given these factors, implementation strategies that may be bundled to promote adoption of HRS include engagement of champions, communications and educational strategies, existing policies, and creation of dashboards and tracking and feedback systems (Table 1).

Conclusion

HRS are effective, evidence-based, and patient-centered tools. Mapping of barriers to evidence-based implementation strategies may help improve integration of HRS into VHA healthcare, however, challenges addressing stigma remain a substantial barrier.

Disclosures

Westyn Branch-Elliman, MD, MMSc, DLA Piper,LLC/Medtronic: Advisor/Consultant|Gilead Pharmaceuticals: Grant/Research Support.