bluuebunny/crossref_metadata_2025 huggingface dataset:
82. Post-Prescription Review with Threat of Infectious Disease Consultation and Sustained Reduction in Meropenem Use Over Four Years
Authors: Mani Nandita S , Lan Kristine F , Jain Rupali , Kim H Nina , Lynch John B , Krantz Elizabeth M , Bryson-Cahn Chloe , Bryan Andrew , Pottinger Paul , Liu Catherine , Chan Jeannie D
Published: January 2021

Background

Following a meropenem shortage, we implemented a post-prescription review with feedback (PPRF) in November 2015 with mandatory infectious disease (ID) consultation for all meropenem and imipenem courses > 72 hours. Providers were made aware of the policy via an electronic alert at the time of ordering.

Methods

A retrospective study was conducted at the University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC) to evaluate the impact of the policy on antimicrobial consumption and clinical outcomes pre- and post-intervention during a 6-year period. Antimicrobial use was tracked using days of therapy (DOT) per 1,000 patient-days, and data were analyzed by an interrupted time series.

Results

There were 4,066 and 2,552 patients in the pre- and post-intervention periods, respectively. Meropenem and imipenem use remained steady until the intervention, when a marked reduction in DOT/1,000 patient-days occurred at both hospitals (UWMC: percentage change -72.1%, (95% CI -76.6, -66.9), P < 0.001; HMC: percentage change -43.6%, (95% CI -59.9, -20.7), P = 0.001). Notably, although the intervention did not address antibiotic use until 72 hours after initiation, there was a significant decline in meropenem and imipenem initiation (“first starts”) in the post-intervention period, with a 64.9% reduction (95% CI 58.7, 70.2; P < 0.001) at UWMC and 44.7% reduction (95% CI 28.1, 57.4; P < 0.001) at HMC.

Meropenem and Imipenem DOT (January 2013 – November 2019)

Conclusion

Mandatory ID consultation and PPRF for meropenem and imipenem beyond 72 hours resulted in a significant and sustained reduction in the use of these antibiotics and notably impacted their up-front usage.

Disclosures

All Authors: No reported disclosures
1086. Epidemiology, Risk Factors, and Effect of Antifungal Prophylaxis on Early Invasive Fungal Infection in Heart Transplant Recipients
Authors: Yetmar Zachary A , Lahr Brian , Brumble Lisa , Banacloche Juan Gea , Steidley D Eric , Kushwaha Sudhir , Beam Elena
Published: January 2021

Background

Invasive fungal infection (IFI) in heart transplant recipients is associated with increased mortality and poor outcome. Reports have estimated the risk of 1-year IFI to be 3.4-8.6% with renal replacement therapy, delayed chest closure, and reoperation suggested as risk factors. However, the role of antifungal prophylaxis is unclear, though previous studies have suggested a reduced incidence of invasive Aspergillosis. The transplant program in Mayo Arizona provides 6 months of universal azole prophylaxis for Coccidioides, while Rochester and Florida only provide prophylaxis to high risk patients. We sought to define epidemiology and risk factors for 1-year IFI and determine the effect of antifungal prophylaxis.

Methods

We conducted a retrospective cohort study of patients undergoing single-organ heart transplantation at Mayo Rochester, Florida, or Arizona from January 2000 to March 2019. We identified baseline characteristics, details of transplant hospitalization such as need for renal replacement therapy, open chest, reoperation, and operative time, receipt of antifungal prophylaxis, and diagnosis of IFI. Multivariable Cox analysis was performed to identify risk factors of time to 1-year IFI.

Results

A total of 966 heart transplant recipients were identified with a median age of 56 years (IQR 47, 62) and 72% male. 444 patients received antifungal prophylaxis which included 32% fluconazole, 34% itraconazole, 18% voriconazole, 15% echinocandin, and < 1% amphotericin or posaconazole. Over 1-year follow-up, 62 patients developed IFI with a cumulative prevalence of 6.4%. The most common organisms were Aspergillus (50%) and Candida (27%). In a multivariable model, factors associated with 1-year IFI were post-transplant renal replacement therapy (HR 3.34, 95% CI 1.69-6.60; P < 0.001) and antifungal prophylaxis (HR 0.32, 95% CI 0.11-0.96; P=0.042). Operative time, recent hospitalization, open chest, and post-transplant mechanical circulatory support were not associated with 1-year IFI.

Conclusion

Renal replacement therapy after transplantation is associated with 1-year IFI. Antifungal prophylaxis appears to be protective and further prospective study is warranted to verify this finding.

Disclosures

All Authors: No reported disclosures
1087. Evaluation of Risk Factors for Infection among Patients Receiving Ibrutinib
Authors: Tham Kenneth , Prelewicz Stacy , deHoll Sara , Stephens Deborah , Gomez Carlos A
Published: January 2021

Background

Ibrutinib is a small-molecule inhibitor of Bruton tyrosine kinase (BTK) approved for various B-cell malignancies and cGVHD. Rates of serious infection—defined as requiring hospitalization or parenteral antimicrobials— and invasive fungal infection (IFI) in patients on ibrutinib are as high as 11.4% and 4.2% respectively (Varughese T, et al. Clin Infect Dis 2018;67(5):687-92), which may be related to off-target inhibition of interleukin-2-inducible T-cell kinase or macrophage function.

Methods

We retrospectively reviewed infection complications in patients receiving ibrutinib at our institution between 06/01/2014 and 08/31/2019, including patients who received single-agent or combination ibrutinib. In this study, serious infection was defined as above, or a diagnosis of pneumonia regardless of hospitalization or parenteral antimicrobial therapy. Logistic regression was used to identify risk factors.

Results

Baseline characteristics of 134 included patients are in Table 1. Infection and serious infection occurred in 96 (72%) and 48 (36%) patients, respectively. When pneumonia was not included as a criterion for serious infection, the serious infection rate was 22%. Prior allogeneic stem cell transplant (allo-HSCT) (OR 4.50; 95% CI 1.19 – 17.00) and corticosteroid use (OR 5.42; 95% CI 1.49 – 19.82) were significant risk factors for serious infection without pneumonia (Table 2).

Of 37 patients (28%) who received primary HSV/VZV prophylaxis with acyclovir, there was one case of suspected herpes zoster infection (3%). IFI developed in 7 patients (5%): 5 with Pneumocystis jirovecii pneumonia (PJP), 1 with invasive aspergillosis, and 1 with a filamentous fungus, species unknown. Other identified organisms are detailed in Figure 1. Classical risk factors for IFI, including diabetes, allo-HSCT, and concurrent corticosteroid use, were not significant predictors in this group.

Table 1. Baseline Characteristics

Table 2. Risk Factor Analysis

Figure 1. Identified Organisms in Serious Infection

Conclusion

Serious infections developed at a higher rate than previously reported in the literature, with IFI rates similar to those previously described. Prior allo-HSCT and steroid use were found to be risk factors for serious infection without pneumonia. Treating physicians should have a high index of suspicion for pneumonia, IFI, and PJP in this population.

Disclosures

All Authors: No reported disclosures
1090. HHV-6 Encephalitis following Chimeric Antigen Receptor T-cell Therapy: Report of 2 Cases
Authors: Rebechi Melanie T , Bork Jacqueline , Riedel David J
Published: January 2021

Background

Human herpesvirus 6 (HHV-6) is the most common cause of infectious encephalitis following hematopoietic stem cell transplant. Chimeric antigen receptor T-cell (CAR-T) therapy is a novel cancer-directed immunotherapy; chemotherapy conditioning for CAR-T results in prolonged, severe immunosuppression. HHV-6 encephalitis has not been reported in patients after CAR-T therapy.

Methods

We report 2 cases of HHV-6 encephalitis after CAR-T therapy.

Results

Case 1: A 69 year old man underwent CAR-T therapy after fludarabine/cyclophosphamide (Flu/Cy) conditioning for relapsed diffuse large B cell lymphoma (DLBCL). His course was complicated by cytokine release syndrome (CRS) requiring tocilizumab and neurotoxicity requiring high dose dexamethasone. On day 29 he was febrile to 39.3℃, confused, and had difficulty speaking. Mental status (MS) worsened, so LP and MRI of the brain were performed. HHV-6 CSF PCR was positive, and ganciclovir (GCV) was started. He improved gradually over 10 days. At follow up, he reported mild short term memory difficulty but no focal deficits.

Case 2: A 57 year old man underwent CAR-T therapy after Flu/Cy conditioning for refractory DLBCL. His course was complicated by CRS requiring tocilizumab. On day 6, he had difficulty concentrating, slowed thinking, stuttering and repetitive speech. MS continued to worsen, and dexamethasone and siltuximab were given for CAR-T neurotoxicity. After 1 week he was following commands. By week 3 he remained intermittently confused and agitated, so MRI and LP were performed. HHV-6 PCR was positive in the CSF. He was started on GCV and improved gradually over the next 2 weeks but remained dysarthric with slowed speech. On day 55, HHV-6 remained detectable in CSF but not quantifiable and GCV was discontinued despite persistent cognitive deficits.

Table 1: Demographics and clinical characteristics of 2 patients with HHV-6 encephalitis following CAR-T therapy

Conclusion

Diagnosing HHV-6 encephalitis can be challenging after CAR-T therapy because altered MS is often attributed to CAR-T associated neurotoxicity. It is important to maintain a high index of suspicion for infectious causes of altered MS after CAR-T therapy, including HHV-6 encephalitis, especially in patients treated with further immunosuppression for CRS and CAR-T related neurotoxicity.

Disclosures

All Authors: No reported disclosures
1091. Incidence of Post-Transplant Lymphoproliferative Disorders among Epstein-Barr Virus Donor Positive, Recipient Negative Adult Solid Organ Transplant Recipients
Authors: Limaye Abhijit P , Heldman Madeleine R , Edlefsen Kerstin L , Kapnadak Siddhartha G , Rakita Robert M , Fisher Cynthia E
Published: January 2021

Background

Epstein-Barr virus (EBV) donor positive (D+), recipient negative (R-) serostatus is a major risk factor for post-transplant lymphoproliferative disorder (PTLD) in adult solid organ transplant recipients (SOTR). Few studies have systematically characterized absolute organ transplant type-specific incidence, timing, and outcomes of PTLD in adult EBV D+R- SOTR.

Methods

We retrospectively assessed the incidence, timing, and associated morbidity and mortality of biopsy-confirmed PTLD (WHO classification) among consecutive adult SOTR between Jan 1, 2000 and Apr 30, 2018 at a single university center, and who had a minimum 2 years of follow-up. Antibodies to EBV (viral capsid antigen and nuclear antigen) were assessed in candidates and donors by FDA-cleared ELISA assay. Donors with unknown serology were considered seropositive based on the known prevalence of >93% seropositivity in this donor population.

Results

Among 4,923 SOTR, prior to transplant, 4,770 (96.9%) were R+ (regardless of donor status), 144 (2.9%) were D+R-, and 9 (0.2%) were D-R-. PTLD incidence by last follow-up was higher among D+R- (15/144 [10.4%]) than R+ (61/4,770 [1.2 %]), P < 0.0001, and occurred earlier after transplant (median 9.6 months [IQR 6.1-34.2] versus 35.1 months [IQR 7.1-73.1]), P= 0.003, respectively. Among D+R-, incidence was higher among recipients of non-kidney versus kidney organs (13/89 [14.6%] vs. 2/55 [3.6%], P = 0.05, respectively). Incidence in rank order was: pancreas (2/9 [22.2%]), lung (6/29 [20.7 %]), heart (2/21 [9.5%]), and liver (3/30 [6.7%]). PTLD histopathology was monomorphic in 9/15 [60%] and EBV-encoded RNA-1 (EBER-1) positive in 12/12 evaluable cases. Outcomes among the 15 PTLD cases included: graft failure without transplant in 3 (20%), graft failure with re-transplant in 2 (13.3%), and death within 6 months in 3 (20%).

Table 1: Characteristics of the EBV Donor seropositive, Recipient seronegative (D+R-) cohort

Figure 1: Cumulative Incidence of PTLD among the EBV D+R- cohort (all organs)

Figure 2: Incidence of PTLD among the D+R- cohort, stratified by organ transplant type

Conclusion

Although rare overall, we identified a specific subgroup of adult SOT patients (EBV D+R- non-kidney recipients) whose absolute PTLD incidence and associated morbidity and mortality are high, and who should be targeted for future mechanistic or therapeutic studies.

Disclosures

All Authors: No reported disclosures
1092. Increased Risk of Serious Infections in Mantle Cell Lymphoma Versus Other Hematologic Malignancies in Patients on Ibrutinib
Authors: Holowka Thomas , Cheung Harry , Malinis Maricar F , Perreault Sarah , Isufi Iris , Azar Marwan M
Published: January 2021

Background

Ibrutinib, a tyrosine kinase inhibitor used for treatment of hematologic malignancies, is associated with an increased risk of infection including invasive fungal infections (IFI). However, the risk of infection may vary across different types of malignancies. The primary aims of our study were to determine the incidence of serious infection and associated risk factors in different hematologic malignancies while on ibrutinib.

Methods

We performed a retrospective analysis of patients prescribed ibrutinib for ≥ 1 week at Yale New Haven Hospital between January 2014 and July 2019 by chart review. We collected demographic, and clinical data along with oncologic history, and identified serious infections defined as those requiring inpatient management. Chi-squared tests were used to determine characteristics associated with an increased risk of infection.

Results

A total of 254 patients on ibrutinib were identified including 156 with CLL, 89 with NHL including 20 with Mantle Cell Lymphoma (MCL) and 9 with other leukemias. Among these, 21 underwent HSCT, 9 complicated by GVHD. Of 51 patients with serious infections, 10 (20%) had MCL, 11 (20.3%) had other NHLs, 28 (54.9%) had CLL and 2 (3.9%) had other malignancies. The relative frequency of serious infections was higher in MCL than non-MCL (50% vs. 17.1%). More MCL patients experienced IFI (1 pulmonary cryptococcosis, 2 pulmonary aspergillosis), compared to non-MCL patients (2 pulmonary aspergillosis; 15% vs. 0.9%). Risk factors associated with serious infection in MCL included maximum ibrutinib dose of 560 mg (OR 16.4, p < 0.001), other concurrent chemotherapy (OR 8.2, p < 0.001), prior HSCT (OR 5.9, p < 0.001), concurrent steroid use (≥ 10 mg prednisone for ≥ 2 weeks; OR 2.4, p < 0.05), lymphopenia (OR 2.4, p < 0.05) a history of prior chemotherapy (OR 0.2, p < 0.05) and ECOG score ≥ 2 (OR 3.2, p < 0.01).

Conclusion

In this study of hematologic malignancy on ibrutinib, MCL patients had a greater risk of serious infection. This increased risk in MCL could be associated with more prolonged and intense immunosuppression rather than underlying disease pathogenesis. Antimicrobial prophylaxis should be considered in MCL patients on ibrutinib to mitigate risk of infection.

Disclosures

All Authors: No reported disclosures
83. Staff Pharmacist-driven Prospective Audit and Feedback at a Community Hospital: Assessing an all Hands on Deck Approach to Antimicrobial Stewardship
Authors: Dempsey Casey J , Weiner Natasha , Riccardi Michele , Linder Kristin
Published: January 2021

Background

Facilities with robust antimicrobial stewardship programs often have infectious disease (ID) pharmacists with devoted time to complete antimicrobial stewardship initiatives. Smaller facilities with limited resources or lacking ID pharmacists, may encounter challenges meeting antimicrobial stewardship regulatory requirements. The goal of this study is to assess the impact of a staff pharmacist-driven prospective audit and feedback program in a small community hospital.

Methods

A pre- and post-intervention study was performed to assess the primary outcome of days of therapy per 1,000 patient days (DOT) for targeted antimicrobials (ciprofloxacin, levofloxacin, piperacillin/tazobactam, cefepime, ceftazidime). Secondary outcomes were antibiotic expenditures and rates of Clostridioides difficile infection (CDI).

Results

Significant decreases in DOT were observed for piperacillin/tazobactam (29.88 vs. 9.25; p < 0.001), ciprofloxacin (23.22 vs. 9.97; p < 0.001), levofloxacin (11.2 vs. 5.07; p < 0.001) and overall antipseudomonal DOT (62.91 vs. 51.67; p < 0.001). There was no difference in ceftazidime DOT (8.75 vs. 6.47; p= 0.083) and an increase in cefepime DOT (20.47 vs. 34.35; p < 0.001). A trend towards decreased rates of CDI was seen (4.9/10,000 patient days vs. 2.64/10,000 patient days; p= 0.931). There were significant decreases in antibiotic expenditures for piperacillin/tazobactam ($52,498 vs. $10,937; p < 0.001), levofloxacin ($2,168 vs. $672; p < 0.001), ciprofloxacin ($6,700 vs. $1,954; p < 0.001). Lower expenditures for ceftazidime were seen ($9,952 vs. $7,457; p= 0.29). Cefepime expenditures increased ($25,638 vs. $40,097; p= 0.001). An overall decrease in the expenditure for the targeted antibiotics was seen ($95,715 vs. $62,837; p < 0.001).

Conclusion

Implementation of a staff pharmacist-driven prospective authorization and feedback program led to a significant decrease in DOT and antibiotic expenditures for several targeted antibiotics and a trend towards decreased rates of CDI. Despite increased DOT and expenditures for cefepime, there was an overall decrease amongst the targeted antibiotics. With proper implementation, staff pharmacists can significantly benefit antimicrobial stewardship initiatives.

Disclosures

All Authors: No reported disclosures
1096. Linezolid versus Tedizolid for the Treatment of Nontuberculous Mycobacteria in Solid Organ Transplant Recipients: An Assessment of Safety
Authors: Poon Yi Kee , Hoz Ricardo M La , Sanders James , Hynan Linda S , Monogue Marguerite
Published: January 2021

Background

Treatment options for nontuberculous mycobacteria (NTM) infections are limited by the long-term tolerability of antimicrobials. The oxazolidinones, linezolid and tedizolid, display in vitro activity against many NTM species and demonstrate excellent oral bioavailability. This study compares the hematologic safety profile of linezolid versus tedizolid for the treatment of NTM in solid organ transplant (SOT) recipients.

Methods

This retrospective cohort study included adult SOT recipients who received linezolid or tedizolid as part of a multi-drug regimen to treat NTM between January 1, 2010 to August 31, 2019. The primary endpoint was the hematologic effects of linezolid versus tedizolid from therapy initiation to week seven. This time frame was chosen based on the median duration of therapy. A mixed-effects ANOVA model was used to assess the effects of linezolid and tedizolid on platelet counts (PLT), absolute neutrophil counts (ANC), and hemoglobin (Hgb) across time. Subjects were treated as a random effect. The secondary analysis described the proportion of adverse effects and discontinuation.

Results

Twenty-four patients were included in the analysis (9 linezolid, 15 tedizolid). Mycobacterium abscessus abscessus was the most common isolate, and pulmonary was the most common site of infection (Table 1). The median duration of therapy was 24 days (range 3 to 164 days) and 48 days (range 11 to 571 days) for linezolid and tedizolid, respectively. All patients in the linezolid group received 600 mg daily or less for the majority of treatment duration. In the mixed-effects ANOVA, the ANC decreased in both groups after seven weeks of therapy (p=0.04). Otherwise, no significant effects for week, treatment group, or interaction between week and treatment group were found (Figure 1). Thrombocytopenia and neutropenia were common in both groups, and around one-fifth of patients in each group discontinued the medication due to adverse effects (Table 2).

Table 1. Baseline characteristics of solid organ transplant recipients who received linezolid or tedizolid as part of a multi-drug regimen to treat nontuberculous mycobacteria infections between January 1, 2010 to August 31, 2019 at UT Southwestern Medical Center.

Table 2. Adverse drug events and discontinuation of therapy over seven weeks of therapy.

Figure 1. Effects of linezolid versus tedizolid during the initial seven weeks of therapy using a mixed-effects ANOVA model, (a) platelet counts, (b) absolute neutrophil counts, and (c) hemoglobin.

Conclusion

Non-significant statistical differences were found comparing the effects of linezolid versus tedizolid for PLT, ANC, and Hgb using mixed-effects ANOVA models. Larger cohort studies are required to compare the hematologic adverse effect profile of the oxazolidinones for the treatment of NTM infections in SOT recipients.

Disclosures

All Authors: No reported disclosures
1099. Opportunistic Infections Among Long Term Survivors of Kidney Transplantation: Defining Risk Factors
Authors: Cheung Harry , Azar Marwan M , Gan Geliang , Deng Yanhong , Cohen Elizabeth A , Kulkarni Sanjay , Malinis Maricar F
Published: January 2021

Background

Opportunistic infections (OIs) in kidney transplant recipients (KTR) most commonly occur in the early post-transplant period or with increased immunosuppression, largely as a result of impaired T-cell function. Additionally, age confers susceptibility to infection independent of time post-transplant. The combined impact of cumulative immunosuppression and immunosenescence on infection risk of long-term KT survivors has not been well described.

Methods

We performed a retrospective chart review of patients age ≥ 18 years who underwent KT between 2003 to 2009 and who survived ≥ 10 years post-KT, in order to evaluate the risk factors for OIs. Demographics, comorbidities, immunosuppression, and clinical data for OIs occurring ≥ 10 years of KT were collected. AST ID Working Group on Infectious Disease Monitoring definitions for OIs was used. Risk factors for OIs were assessed by simple logistic regression.

Results

Of 332 KTR, 16 (4.8%) had an OI with 18 total episodes. Of 16 KTR, half were white, 10 (62.5%) were male, median age at time of transplant was 43 (range 25-72) and the median post-transplant follow-up was 14.2 years (range 10.3-37.6). The mean Charlson Comorbidity Index (CCI) at diagnosis was 5.6 (S.D. 3.6). Ten patients (62.5%) were on mycophenolate-based regimens. The mean absolute lymphocyte count (ALC) at the time of OI was 0.78 x 103/µL (S.D. 0.43). Two (12.5%) had acute rejection within 1 year of OI. Of 18 OI episodes, there were 6 PJP, 2 candida esophagitis, 3 CMV (2 viremia, 1 colitis), 2 cryptococcal infections (1 meningitis, 1 myositis/disseminated), 2 adenovirus (pneumonia, colitis), 2 VZV (herpes zoster) and 1 HSV (esophagitis). Two patients had 2 concurrent OIs (1 had PJP and cryptococcus and 1 had HSV and candida esophagitis). Three died within 30-days of OI diagnosis. OI incidence was associated with years from date of transplant [OR 1.3, p=0.002], cerebrovascular disease [OR 4.45, p=0.02], and lower ALC [OR 5.9, p < 0.05]. CCI also trended towards association [OR 1.24, p=0.09].

Table 1: Demographics, comorbidities, immunosuppression, and clinical data for patients with OIs

Table 2: Detailed characteristics of each patient with opportunistic infections

Conclusion

OIs were infrequently observed beyond 10 years of transplant among long-term survivors of KT. However, OI incidence was associated with poor outcome. Low ALC and a higher burden of comorbidities were risk factors for very late occurrence of OIs in this population.

Disclosures

All Authors: No reported disclosures
1100. Outcomes of HIV-Associated Lymphoma Treatments: A Contemporary Single Center Cohort Study
Authors: Mousa Rinda , Song Xing , Clough Lisa A , Dias Ajoy , Merino Fernando , El Atrouni Wissam
Published: January 2021

Background

There is a paucity of outcome studies on HIV-associated lymphoma treated with chemotherapy with or without autologous hematopoietic stem cell transplantation (autoHSCT) in comparison to HIV-uninfected individuals with similar histology.

Methods

In our retrospective matched cohort study, we enrolled adult HIV-positive patients with lymphoma treated with chemotherapy with (group 2) or without autoHSCT (group 1) between January 1, 2007 to December 31, 2018 at the University of Kansas Medical Center and followed until May 1, 2020. Group 1 were matched 1:1 to HIV-negative patients based on age, gender, lymphoma histology, stage at diagnosis, year of lymphoma diagnosis, and Group 2 were matched 1:2 to HIV-negative patients based on age at autoHSCT, gender, lymphoma histology, stage at diagnosis and year of transplantation. Overall survival (OS) and progression-free survival (PFS) at 2 years were calculated using Kaplan-Meier (KM) analysis, and adjustment for ECOG and IPI/IPS scores was done using multivariate Cox model.

Results

We had 37 HIV+ patients with lymphoma in our cohort: 9 Hodgkin’s disease (HD), 28 Non Hodgkin’s Lymphoma (NHL). Eleven underwent autoHSCT (3 HD, 8 NHL). The majority were white (76.2%), non-hispanic (92.9%), males (90.5%) and mean age was 46 years. Median CD4 was 172.5, HIV viral load was < 50 copies/mL in 43..2%, and 76.2% were on antiretroviral therapy (ART) at diagnosis. ART was interrupted in 14.6% and adjusted in 40.5% of patients. After excluding rare histological types, 22 in group 1 and 9 in group 2 were included in the matched analysis. On KM survival at 2-years, group 1 had worse OS (75% vs 95%, p=0.02), and a trend for worse PFS (75% vs 90%, p=0.07) than the matched referent group, while group 2 had similar OS (100% vs 94%, p= 0.47) and better PFS (100% vs 70%, p=0.02) than the matched referent group. On Cox models adjusting for ECOG and IPI/IPS, HIV status was no longer independently associated with OS in group 1 or PFS in group 2.

Group 1 HIV lymphoma cases and controls characteristics

Group 2 HIV lymphoma with HSCT cases and controls characteristics

Conclusion

In patients with HIV and lymphoma treated with chemotherapy with or without autoHSCT, the outcomes are comparable to those without HIV in our single center contempory cohort.

Disclosures

Wissam El Atrouni, MD, ViiV (Advisor or Review Panel member)
1103. Respiratory Virus Infections In Solid Organ Transplant Recipients: A Single Center Experience
Authors: Mendoza Maria A , Raja Mohammed A , Rosello Gemma , Anjan Shweta , Simkins Jacques , Camargo Jose F , Morris Michele I , Sinha Neeraj , Guerra Giselle , Abbo Lilian M , Abbo Lilian M , Natori Yoichiro
Published: January 2021

Background

Community acquired respiratory virus infections (RVI) are a major concern in solid organ transplant (SOT) recipients due to severe complications such as lower respiratory tract infection (LRTI), superimposed fungal and bacterial pneumonia, intensive care admission and mortality. Besides influenza and respiratory syncytial virus (RSV), there is paucity of data of RVI in SOT recipients.

Table 1: Patients characteristics

Table 2: Concomitant infections

Methods

Retrospective cohort study of a single large transplant center was performed. Data of multiplex qualitative PCR-based respiratory viral panel (RVP) samples collected between January 2017 and December 2019 were included. It is important to mention that our institution generally performs the RSV/influenza rapid detection assay as an initial test; if negative, the multiplex PCR panel is usually done. We did not include results from the RSV/influenza rapid test in this study.

Results

One hundred transplant patients with a single positive RVP were included (table 1). Transplanted organs include kidney (40%), followed by lung (33%) and liver (9%). Most common presenting symptoms were cough (52%), shortness of breath (28%) and rhinorrhea (26%). Of note fever was seen in only 24%. Most common RVI was Rhinovirus/Enterovirus (RHV/ENT) (59%), followed by non-SARS-CoV-2 Coronavirus (19%) and Parainfluenza (PIV) (14%). None of the patients had neutropenia, however, 52% had lymphocytopenia. Lung transplant patients developed LRTI in 70% of cases compared to non-lung transplant 64% (p=0.412). Multivariate analysis showed patients with PIV 3 were less likely to develop LRTI (p= 0.038). Significant Cytomegalovirus DNAemia (>137 IU/mL) was noted in 9.8% of the recipients. No proven or probable pulmonary fungal infection were noted within 3 months after diagnosis of RVI. Five patients were admitted to the Intensive care unit due to septic shock. Three patients died at 4, 5 and 35 days after diagnosis of RHV/ENT, PIV-3 and RHV/ENT respectively.

Conclusion

Most of the cases of RVI were due to RHV/ENT. Patients with PIV 3 were less likely to develop LRTI. Lung transplant recipients developed LRTI with similar incidence to non-lung recipients. Our data shows a very low mortality of 3% after RVI in our SOT cohort, which warrants larger studies.

Disclosures

Michele I. Morris, MD, Viracor Eurofins (Advisor or Review Panel member)
84. T2Candida Panel Use Evaluation: a Quality Improvement Project
Authors: Schwarz Erika Reategui , Rana Meenakshi , Chasan Rachel , Gitman Melissa R
Published: January 2021

Background

Invasive candidiasis is a life-threatening infection with 40% mortality despite antifungal therapy[1] A retrospective chart review of results from our T2Candida Panels from March 2019 to March 2020 was conducted. We compared demographics, co-morbidities, days of antifungal use, length of stay (LOS) and mortality in patients with positive and negative assays.

Results

271 assays were performed, 27 were positive and were compared to 81 negatives. Baseline demographics and co-morbidities were similar in both groups. All patients tested had >1 risk factor for candidemia.

78% were positive for C. albicans/C. tropicalis and 11% positive for C. glabrata/C. krusei and C. parapsilosis respectively. Blood cultures were positive in 8 individuals, of which 5 had a positive assay; among the other 3, one grew C. auris. All species in the T2Candida matched the blood cultures when available.

β-D-glucan was positive in 82% of patients with positive T2 results vs 46% in the T2 negative group (p = 0.016).

Antifungal administration within the time of assay collection was 54% in the negative group vs 74% in the positive group (p = 0.030). Mean duration of antifungal use were significantly lower in the negative group than the positive group (5.98 vs 17.55 days, p = 0.04).

Demographics and Comorbidities

Outcomes

Cultures

Conclusion

T2Candida was an effective diagnostic and antimicrobial stewardship tool, leading to testing in high risk patients and reducing unnecessary antifungal use. Additional education is required for improved ordering of concurrent blood cultures. Negative results should be interpreted with caution in suspected invasive candidiasis with consideration for species not included in the panel.

Disclosures

All Authors: No reported disclosures
85. The Impact of Carbapenem-Sparing Interventions on the Evolution of Resistance in Pseudomonas aeruginosa in the USA
Authors: Townsend Jeffrey , Pandey Abhishek , Tang Amber B , Chen Yiziying , Foster Eric M , Nathwani Dilip , Merchant Sanjay , Sarpong Eric , Fitzpatrick Meagan C , Galvani Alison
Published: January 2021

Background

Carbapenem resistance (CR) among Pseudomonas aeruginosa infections is a pressing public health concern in the United States. Therapeutic alternatives for CR infections are limited. Implementation of a key antimicrobial stewardship intervention such as formulary restriction, which is one of the many stewardship strategies, can minimize selection pressure for resistance. We evaluate the consequent impact of this intervention on bacteremia patients infected with P. aeruginosa in the US.

Methods

We developed a population-genetic model of selection for CR. Increases in CR were modeled as a consequence of inappropriate prescription. Inappropriate empiric therapy, i.e. antibiotic, did not cover the organism or appropriate coverage not started within 2-days, was estimated from a published study and future projections were based on historical resistance frequencies and yearly carbapenem consumption associated with P. aeruginosa bacteremia. We projected peak P. aeruginosa CR frequencies and cumulative CR cases from 2020–2040. We compared scenarios without carbapenem restriction to usage decreased linearly by an amount demonstrated in a previous hospital study (51.7%) over 5 years of implementation starting in 2020 (early implementation) or 2030 (late implementation).

Results

Early and late implementation of carbapenem restriction leads to CR frequencies that ascend as high as 42% and 74% respectively eventually mitigating those frequencies by bringing them down to 23% and 37% respectively. By 2045, early carbapenem restriction could prevent 29,600 CR cases of P. aeruginosa bacteremia, compared to 15,200 prevented by late implementation.

Conclusion

We demonstrate that early restriction of carbapenem consumption could markedly reduce future CR in P. aeruginosa bacteremia patients. Implementing early carbapenem restriction should be expected to result in a lower ultimate frequency of CR and a lower number of cumulative cases of resistant infections, thereby decreasing the overall burden of CR cases that will be encountered in the future.

Disclosures

Jeffrey Townsend, PhD, Merck (Consultant)Merck (Consultant) Sanjay Merchant, PhD, Merck & Co., Inc. (Employee) Alison Galvani, PhD, Merck (Consultant)
1119. Impact of Real-World and Real-Time Interdisciplinary Cases on Infectious Diseases Content Knowledge and Confidence in Pharmacy Students Enrolled in an Infectious Diseases Elective Course
Authors: Rybakov Ilya , Seadler Jessica L , Srivastava Sneha , Tucker Natalie , Cady Beth
Published: January 2021

Background

The Accreditation Council for Pharmacy Education (ACPE) requires students to demonstrate competence in interprofessional education. In 2018, an “interdisciplinary” active learning infectious disease (ID) elective course was created for pharmacy students in the fall semester of the third professional year. Through the use of real-time patient cases and acting healthcare professionals, students are able to have multiple interdisciplinary experiences without leaving the classroom. The objectives of this course are to improve both content knowledge and levels of confidence in making recommendations to healthcare providers. The purpose of this study was to assess those objectives.

Methods

The course meets once weekly for 3 hours. Maximum enrollment is 35 students. All activities are performed in groups of 3-5 students and each group is assigned a case on day 1. Cases are intentionally developed to give each group a nominal amount of information, similar to a real world experience where there is minimal patient data available on day 1 of a hospital admission. Students are given the phone numbers to the microbiology lab and attending physician. The attending physicians are represented by ID pharmacists across the country who have volunteered to serve in the roles. Students are to call the physicians/lab daily for updates and to make pharmacotherapy recommendations as the patient progresses through their hospital stay. The case is complete when a full care plan is accepted by the physician. Student groups then give a formal case presentation to their classmates. Students voluntarily take a pre- and post-survey at the beginning and end of the course to assess ID content knowledge and rate their perceived level of confidence in making recommendations to a physician. This study was IRB approved.

Results

Survey completion rate was 100%. There was a statistically significant increase in students’ confidence levels in making real-time recommendations to providers after completing the course (P< 0.001). A significant increase was also seen in ID content knowledge (P< 0.0001).

Conclusion

After taking an interdisciplinary ID elective course, pharmacy students’ ID content knowledge improved and they felt more confident in making therapy recommendations to physicians.

Disclosures

All Authors: No reported disclosures
1125. Innovative Virtual Learning in the Midst of a Pandemic - Patients, Populations, and Pandemics: Responding to COVID-19
Authors: Kohlenberg Lucille K , Solberg Muriel J , Ali-Mirza Fatima N , Shenoi Sheela , Omer Saad
Published: January 2021

Background

The COVID-19 pandemic has posed a unique challenge to undergraduate medical education. Medical schools postponed student participation in direct patient care in mid-March 2020, creating the need for rapidly-designed, virtual, and innovative learning experiences.

Methods

Utilizing Kern’s six-step approach to curriculum development, faculty and medical student liaisons rapidly designed a six-week online and interactive course for clerkship-year students and above, launched on March 30th, 2020. “Patients, Populations, and Pandemics: Responding to COVID-19” emphasized honing higher level skills of Bloom’s taxonomy, namely evaluating, synthesizing, and creating. Following weekly faculty-led lectures, student groups identified research questions, analyzed literature, presented data, critiqued peer presentations, and created infographics for the public.

Results

We aimed to maintain quality and interactiveness despite challenges posed by our timeframe, the evolving COVID-19 literature, and the virtual setting. We recruited frontline faculty and designed the course to facilitate discussion, thereby promoting real-time exploration of public health and clinical challenges. Encouraging student participation, we incorporated group synthesis sessions and instructed use of video, hand-raising, and chat features. In a survey administered at the end of the first week, 85.7% (18/21) of students strongly agreed or agreed that small group presentations successfully enabled synthesis of new and emerging data. Among the 29 enrolled students, 82.8% (24/29) of students completed final course evaluations, with 87.5% (21/24) agreeing that the learning activities “usually” or “always” helped meet the learning objectives identified at the beginning of the course. The course was rated as “excellent” or “very good” by 83.3% (20/24) of students.

Conclusion

Lessons learned include providing students with increased direction on critically reviewing peer presentations and imparting guidance on best practices for data synthesis. This course model will be disseminated throughout our institution and beyond to address challenges in remote learning and to serve as a paradigm during future health crises.

Disclosures

All Authors: No reported disclosures
1127. Medical School in the Era of COVID-19: Innovations in Direct Near Peer Teaching of Immunology/Microbiology Content During the Pandemic
Authors: Hampshire Karly , Phinney Lauren , McCarthy Elizabeth E , Schwartz Brian , Chin-Hong Peter , Chin-Hong Peter
Published: January 2021

Background

Near-peer teaching (NPT) is increasingly utilized in undergraduate medical education. At our institution’s NPT program, teachers are recruited and trained in the final block of their first year, involving simultaneous learning and teaching of Immunology and Microbiology content to classmates. This year, in-person training and teaching was conducted virtually due to COVID19. This study aims to understand how NPT in a newly virtual curriculum impacted student experiences of learning infectious disease content.

Methods

We conducted one-on-one interviews with student-learners and direct-peer student-teachers at the end of their first year in June 2020. Using constructivist grounded theory, we coded, reconciled, and analyzed interview transcripts to identify themes.

Results

Qualitative analysis of interviews with students (n=5) and near-peer teachers (n=7) yielded the following themes:

1.Optimized learning environment: Direct peer teaching leads to students feeling more personally invested in their peers’ lessons and wellbeing, creating a safe community and increased engagement despite the virtual format and recordings.

2.Benefits of education technology: Teachers employed creative virtual learning modalities to promote students’ mastery of challenging memorization-based microbiology content.

3.COVID-19 relevance: Learning microbiology and immunology content synchronously with the COVID pandemic conferred more content relevance, but presented academic challenges due to social and personal stressors.

4.Educator development: Despite the difficulty of occupying a dual student-teacher role, teachers derived many benefits from teaching, including improved communication skills, which extended to the clinic, content mastery, and increased confidence.

Conclusion

The COVID-19 pandemic led to unprecedented disruptions in medical education. However, the shift to virtual direct peer teaching presented an opportunity for creative virtual teaching strategies and increased lesson accessibility via recordings. Unexpectedly, virtual lessons were perceived as non-inferior to in-person lessons. Findings from this study support the use of virtual near-peer teaching programs in infectious diseases medical education.

Disclosures

All Authors: No reported disclosures
87. Utilization of Methicillin-Sensitive/Resistant Staphylococcus aureus Nares Screen to Decrease Vancomycin and Linezolid Use in Hospitalized Patients with Respiratory Infections
Authors: Zaidan Noor F , Britt Rachel S , Reynoso David , Ferren R Scott
Published: January 2021

Background

Pharmacist-driven protocols for utilization of methicillin-resistant Staphylococcus aureus (MRSA) nares screenings have shown to decrease duration of empiric gram-positive therapy and rates of acute kidney injury (AKI) in patients with respiratory infections. This study evaluated the impact of a pharmacist-driven MRSA nares screening protocol on duration of vancomycin or linezolid therapy (DT) in respiratory infections.

Methods

Patients aged 18 years and older with a medication order of vancomycin or linezolid for respiratory indication(s) were included. The MRSA nares screening protocol went into effect in October 2019. The protocol allowed pharmacists to order an MRSA nares polymerase chain reaction (PCR) for included patients, while the Antimicrobial Stewardship Program (ASP) made therapeutic recommendations for de-escalation of empiric gram-positive coverage based on negative MRSA nares screenings, if clinically appropriate. Data for the pre-intervention group was collected retrospectively for the months of October 2018 to March 2019. The post-intervention group data was collected prospectively for the months of October 2019 to March 2020.

Results

Ninety-seven patients were evaluated within both the pre-intervention group (n = 50) and post-intervention group (n = 57). Outcomes for DT (38.2 hours vs. 30.9 hours, P = 0.601) and AKI (20% vs. 14%, P = 0.4105) were not different before and after protocol implementation. A subgroup analysis revealed a significant reduction in DT within the pre- and post-MRSA PCR groups (38.2 hours vs. 24.8 hours, P = 0.0065) when pharmacist recommendations for de-escalation were accepted.

Conclusion

A pharmacist-driven MRSA nares screening protocol did not affect the duration of gram-positive therapy for respiratory indications. However, there was a reduction in DT when pharmacist-driven recommendations were accepted.

Disclosures

All Authors: No reported disclosures
1134. Substance Use Disorder Patients’ Perspectives of a Multidisciplinary Antimicrobial Infusion Service
Authors: Juskowich Joy J , Cooper Clinton G , Bhandari Ruchi , Boyd Stephanie S , Reece Neil , Fisher Melanie A
Published: January 2021

Background

Injection drug use is associated with infectious diseases such as endocarditis and osteomyelitis requiring prolonged intravenous (IV) antimicrobial therapy. Few programs offer simultaneous inpatient infectious disease and addiction treatment. WVU Medicine implemented a multidisciplinary Infusion Service (IS) to provide IV antimicrobial therapy while treating substance use disorder. From 2017 through 2019, IS cared for over 840 patients. The aim of this study was to evaluate IS by assessing patients’ perspectives of overall experience, interactions with healthcare providers, and preparation for continued recovery from substance use.

Methods

Adults ≥ 18 and < 90 years-old with substance use disorder on IS between November 2019 and May 2020 were eligible. Demographic, substance use, and infectious diseases data were obtained by chart review. Confidential surveys with questions about overall experience, interactions with healthcare providers, and preparation for continued recovery were administered during the first week after transfer to IS and again the week of discharge.

Results

Forty-two patients completed 39 initial and 12 follow up surveys. All used injection drugs, 85.7% (36/42) used opioids and 66.7% (28/42) used methamphetamine. Endocarditis was most common infection (61.9% (26/42)), with Staphylococcus aureus most often isolated (59.5% (25/42)). IS experience and care for infection were excellent or good in 97.4% (38/39) initial and 100% (12/12) follow up surveys. During IS, patients did not perceive being treated differently due to substance use in 94.9% (37/39) initial and 83.3% (10/12) follow up surveys. Before IS, patients perceived being treated differently in 84.6% (33/39) initial and 100% (12/12) follow up surveys. Patients felt IS would help with continued recovery in 84.6% (33/39) initial and 100% (12/12) follow up surveys.

Conclusion

According to patients’ perspectives, IS is effective in creating a positive overall healthcare experience, reducing stigma associated with substance use, and preparing patients for continued recovery after discharge. This study supports combining inpatient infectious disease and addiction therapy. Infectious diseases providers should be educated about this multidisciplinary approach.

Disclosures

All Authors: No reported disclosures