bluuebunny/crossref_metadata_2025 huggingface dataset:
P-1755. Impact of A Pharmacist Vancomycin Dosing and Monitoring Consult Service in The Medical Intensive Care Unit
Authors: McNaught Krysten , Hedvat Jason , Lee Young , Perlman David C , Koshy Sanjana , Sharma Aniket , Devlin Amanda
Published: January 2025

Background

Pharmacist-led vancomycin dosing and monitoring is associated with significant decreases in acute kidney injury (AKI), improvement in treatment efficacy, and reduced mortality. Critically ill patients experience variability of vancomycin pharmacokinetics and pharmacodynamics and require increased monitoring. This study aimed to compare patient outcomes before and following the implementation of a pharmacist consult vancomycin dosing and monitoring service in critically ill patients.

Methods

This was a pre- and post-study conducted in a 16-bed medical intensive care unit (MICU) at Mount Sinai Beth Israel. All adult patients who received vancomycin from January 1, 2022, to June 30, 2022, in the pre-group and from February 21, 2023, to May 23, 2023, in the post-group were included. The primary outcome was the proportion of patients within therapeutic trough range at 72 hours. Secondary outcomes included the proportion of patients with AKI, supra-therapeutic levels, sub-therapeutic levels, appropriate initial level time, dose, and frequency. A therapeutic level was defined as 10-15 mg/L for urinary tract and skin and soft tissue infections or 15-20 mg/L for bacteremia, pneumonia, meningitis, endocarditis, and osteomyelitis. Comparisons were performed using Chi-squared test. P < .05 was considered statistically significant.

Results

Ninety-six patients were included in the final analysis; 53 patients in the pre-group and 43 patients in the post-group. The most common indication for vancomycin was pneumonia (64%). No statistically significant difference was found for the primary outcome between the two groups (43% vs. 41%, P = .8). The proportion of patients with supra-therapeutic levels or with AKI at 72 hours was significantly higher in the pre- group vs. the post-group (52% vs. 12%; P = .0007) and (57% vs. 30%; P = .001) respectively. Patients in the pre-group vs. the post-group were significantly less likely to have an appropriate initial level time (57% vs. 79%; P = .03) and initial vancomycin frequency (51% vs. 86%; P = .0003). No significant differences were found in any of the other secondary endpoints.

Conclusion

A pharmacist consult vancomycin dosing and monitoring service significantly reduced the incidence of AKI and supra-therapeutic vancomycin levels in MICU patients.

Disclosures

All Authors: No reported disclosures
P-1760. Pre- and Post-Guideline Implementation Comparison of Skin and Soft Tissue Infection Empiric Antibiotic Prescribing and Antimicrobial Stewardship Interventions
Authors: Ryan Mitchel , Caverzagie Brady A , Ross Jennifer , Chandorkar Aditya
Published: January 2025

Background

Skin and soft tissue infections (SSTIs) are common in the acute care setting, ranging from uncomplicated cellulitis to necrotizing fasciitis. In 2021, a retrospective review was completed in patients admitted from the Emergency Department (ED) with an SSTI to Lakes Medical Center, a small community hospital, to assess prescribing habits and antimicrobial stewardship (AMS) interventions. An evidence-based guideline for empiric treatment of SSTIs in adults was introduced in 2022 to establish a best practice framework. The purpose of this study is to assess changes in empiric antibiotic use with SSTIs and evaluate guideline adherence following implementation.

Antibiotic Breakdown

Methods

Adult patients started on antibiotics in the ED for an SSTI and subsequently admitted between 1/2023 and 12/2023 were included in this retrospective pre/post implementation study. Patients diagnosed with an SSTI after admission or not started on empiric antibiotics in the ED were excluded. The type of SSTI was determined by ED provider description and pictures uploaded to the electronic health record. Allergies to antibiotics, previous therapies, MRSA history and SIRS criteria were assessed upon presentation. A Fisher Exact test was used to determine significance between categorical values.

Results

Eighty-four patients were included in the post-intervention group compared to 113 patients in the pre-implementation cohort. The proportion of patients by indication were similar between pre/post implementation patients (Table 1). There was no significant difference in the number of patients diagnosed with a non-purulent cellulitis (p= .57). A significant difference was seen in antipseudomonal antimicrobials (p=.029) (Figure 1). Combination therapy was initiated in a similar proportion of patients (p= 1) (Table 2). Pharmacist driven AMS interventions decreased following guideline implementation from 11 to 6 among non-purulent cellulitis cases (p= .43) (Table 3).

Conclusion

Following the implementation of an SSTI guideline, there were significantly fewer patients started on empiric anti-pseudomonal antimicrobials for SSTIs. There was a trend towards decreased antimicrobial stewardship interventions post-implementation.

Disclosures

Jennifer Ross, PharmD, BCIDP, Shionogi Inc.: Advisor/Consultant
P-1779. Effect of a Transitions of Care Pharmacist Intervention on Discharge Oral Antibiotic Prescribing
Authors: Argiro Stephen , Hedvat Jason , Myerson Michaela L
Published: January 2025

Background

An emerging area of focus in antibiotic stewardship programs (ASP) is appropriate antibiotic selection at hospital discharge. The purpose of this study was to assess the effect of a transitions of care (ToC) pharmacist-led review of discharge oral antibiotic therapy on antibiotic appropriateness.

Methods

This was a prospective single center case-control study at Mount Sinai Beth Israel that included adult patients (≥18 years old) discharged on oral antibiotics for the treatment of common infectious diseases syndromes between February 13, 2023 and May 13, 2023. Appropriateness of antibiotic regimen was based on standardized guidance developed by the ASP team. The primary outcome was the difference in percentage of inappropriate antibiotic prescriptions between the provider-only and ToC pharmacist-reviewed groups. Secondary outcomes included mean duration of therapy between the two groups, percentage of pharmacist interventions accepted, and number of fluoroquinolone prescriptions avoided. Comparisons were performed using Chi-squared or Fischer’s exact test for categorical variables and Student’s t test or the Mann-Whitney U test for continuous variables, as appropriate. P < .05 was considered statistically significant.

Results

A total of 182 patients were included in the analysis, 81 patients in the provider-only group and 101 patients in the ToC pharmacist-reviewed group. The most common diagnoses were intra-abdominal infection (37.9%), urinary tract infection (23.1%), skin and soft tissue infection (21.4%), and community acquired pneumonia (17.6%). Patients in the ToC pharmacist-reviewed group were significantly less likely to have an inappropriate antibiotic prescription at discharge when compared to the provider-only group (25.7% vs. 87.7%; p < .001). The mean duration of therapy was significantly lower in the ToC pharmacist-reviewed group when compared to the provider-only group (7.7 vs. 9.1 days; p =.007). In the ToC pharmacist-reviewed group, 56.9% (33/58) of pharmacist interventions were accepted and 19.3% (11/57) of fluoroquinolone prescriptions were avoided.

Conclusion

A ToC pharmacist’s review of oral antibiotics at discharge significantly reduced inappropriate antibiotic selection and duration of therapy.

Disclosures

All Authors: No reported disclosures
P-1787. Tailor Swiftly: Lessons Learned from a Nationwide Implementation of an Antimicrobial Stewardship Program for Asymptomatic Bacteriuria
Authors: Amenta Eva , Haltom Trenton M , Donnelly John P , Braund Sophia , Hernandez Rogelio , Chou Andrew , Brehm Tyler , Stevens Vanessa W , Trautner Barbara
Published: January 2025

Background

Overtreatment of asymptomatic bacteriuria (ASB) is a major cause of antibiotic overuse. We are facilitating an implementation of ASB Antimicrobial Stewardship (AS) intervention in 40 Veterans Affairs facilities, with 20 of these sites participating in a Virtual Learning Collaborative (VLC). The VLC meets twice monthly for webinars to hear from content experts and share stewardship strategies.

Figure 1.

Thematic Categories of Stewardship Strategies for Implementation of Antimicrobial Stewardship Program

Methods

Data come from descriptive field notes taken during each webinar. Notes focused on stewardship strategies shared by guest presenters or participating local site participants. Webinar sessions were recorded and transcribed using MS Teams. Transcripts were iteratively reviewed first by individual webinar, then across all webinars. Stewardship strategies were then organized thematically. We use exemplar quotes to illustrate and support thematic categories.

Results

Across 19 webinars conducted between May 2023-February 2024, it became clear that each implementation site had different resources, team membership, and organizational structures. Thus, sites had to “tailor [the AS intervention] swiftly” for effective reach and implementation. Tailoring meant adapting the delivery of AS educational materials for timing, length, audience, and location of outreach. Sites used five strategies to implement the AS program: Organization and Structural Strategies, Interpersonal and Recruitment Strategies, Data- and Information-Based Strategies, Interpersonal Strategies, and Resources (Figure 1).

Conclusion

VLC webinars encouraged sites to share tips and strategies about implementation of a nationwide AS program wherein rapid tailoring and focused strategies were effective. "Tailoring swiftly” acknowledges differing resources and organizational contexts to allow implementation sites to adapt AS materials to their needs.

Disclosures

Andrew Chou, MD, MSc, Prolacta Bioscience: Advisor/Consultant Barbara Trautner, MD, PhD, Abbott Laboratories: Stocks/Bonds (Public Company)|AbbVie: Stocks/Bonds (Public Company)|Bristol Myers Squibb: Stocks/Bonds (Public Company)|Pfizer: Stocks/Bonds (Public Company)|Phiogen Pharma: Advisor/Consultant
P-1805. Identifying Hospital Antimicrobial Usage Trends Using Wastewater Based Surveillance
Authors: Penney Matthew , Kuzma Darina , Kormendi Aleshia , Moffett Kayla , O’Grady Christine , Clark Rhonda , Nobrega Diego , Kimura-Hara Susana , McCalder Janine , Vivas Laura , Papparis Chloe , Acosta Nicole , Waddell Barbara Jean M , Hubert Casey R J , Dalton Bruce , Conly John , Parkins Michael , Weyant Benson , Rennert-May Elissa
Published: January 2025

Background

Hospitals represent ideal locations for developing wastewater (WW) surveillance for antibiotics (Abx), owing to the high frequency of Abx use and robust record-keeping. To investigate this technology as a potentially useful stewardship tool, we compared the concentration of several Abx in WW from tertiary care hospitals to their corresponding levels in the surrounding municipality.

Concentration of 4 common antimicrobials found in hospital wastewater effluent over a 4-month period

Concentrations of 4 antimicrobials measured in WW from 3 tertiary care hospitals and the corresponding wastewater treatment plant (WWTP) in the same city. Displayed statistics represent the results of a Wilcoxon test, antimicrobials labelled “*” are commonly administered intravenously.

Methods

WW was collected bi-weekly from three tertiary care hospitals (two adult and one pediatric, with 600, 650 and 135 inpatient beds, respectively) and the associated municipal WW treatment plant (serving a population of ∼1,000,000) between February and May of 2024. Aliquots of WW were filtered and run directly on a liquid-chromatography paired triple quadrupole mass spectrometer (LC-QQQ) to quantify specific Abx (azithromycin, doxycycline, ciprofloxacin, levofloxacin, metronidazole, cefazolin, ceftriaxone, piperacillin, tazobactam, meropenem, vancomycin, and sulfamethoxazole). Spiked and replicate samples were randomly included to validate analyte recovery and reproducibility. Agilent MassHunter software (Version 10.1, 2019) was utilized to process and export raw data to R. Box plots and Wilcoxon tests were utilized to compare the concentration of each Abx.

Results

Validation experiments confirmed that filtering WW samples and directly running them on LC-QQQ yields reproducible and reliable results. Serial monitoring revealed that WW from hospitals generally exhibited a broader range of Abx concentrations than was observed city-wide (Figure 1). This variability was particularly evident among the most used Abx, consistent with the changing treatment needs of highly dynamic hospital populations. In addition to this, ceftriaxone, an IV-administered antimicrobial was found at significantly higher concentrations in all hospital sites when compared to the municipal WW treatment plant.

Conclusion

Validating Abx monitoring in WW from a range of scales will enable this approach to be applied across diverse environments as a tool to mitigate Abx resistance. This approach will be strengthened as it is integrated with clinical metadata and metagenomic assessment of antimicrobial resistance genes from the same samples.

Disclosures

All Authors: No reported disclosures
P-1840. Differential Memory CD4 T Cell Responses to SARS-CoV-2 in Children and Adults Pre- and Post-Pandemic
Authors: Rowe Regina K , Huertas Nelson , Matthews Bailey , Nayak Jennifer L
Published: January 2025

Background

Coronaviruses are endemic in the human population and include both seasonal viruses as well as the SARS-CoV-2 virus responsible for the COVID-19 pandemic. As a betacoronavirus, SARS-CoV-2 is closely related to two endemic coronaviruses (OC43 and HKU1), with exposure history differing between children and adults. We sought to identify age-specific differences in memory CD4 T cells specific for the SARS-CoV-2 Spike protein (S), as quantitative and qualitative differences in immune function may be responsible for age-related variation in disease presentation.

Methods

Peripheral blood mononuclear cells were obtained from cohorts of children and adults enrolled pre-2019 and following the SARS-CoV-2 pandemic. Subjects enrolled post-pandemic had a history of COVID-19 vaccination. Cells were stimulated with peptide pools representing the unique and more cross-reactive portions of the S protein for 24 hours, with cytokine release blocked for the last 4 hours of coculture. Subsets of S-specific CD4 T cells were identified using a 31-plex spectral flow cytometry panel.

Results

Pre-pandemic, adults had a higher frequency of activated IFNγ+ CD4 T cells specific for the S protein compared to children, with boosting of responses in both adults and children following SARS-CoV-2 exposure. Overall, the CD4 T cell response to the S protein was Th1 biased, with adults having a greater proportion of cells expressing IFNγ, IL2 and TNFα. When cytokine-expressing, antigen-specific CD4 T cells were subsetted by CD45RA and CCR7 expression, there was a more naïve phenotype pre-pandemic, with transition to an effector memory phenotype post-2019.

Conclusion

A greater magnitude of CD4 T cells specific for the S protein was detected in adults pre-pandemic, with this reactivity boosted in both children and adults following SARS-CoV-2 exposure. Boosting of reactivity to both unique and conserved S protein epitopes in children and adults suggested that exposure to SARS-CoV-2 via vaccination did not preferentially boost memory CD4 T cells specific for conserved epitopes. Post-pandemic, there was a shift to a more Th1 phenotype together with a gain in cytokine-producing CD4 T cells with a phenotype consistent with effector memory.

Disclosures

Jennifer L. Nayak, MD, Merck, Inc.: Grant/Research Support|Moderna, Inc.: Grant/Research Support|Pfizer, Inc.: Grant/Research Support
P-1843. Genomic surveillance of invasive Streptococcus pyogenes in Metropolitan Detroit
Authors: Kaur Jagjeet , Jagannathan Megha , Jordan Tamara , Kinsey Daniel , Truppiano Maryssa , Shallal Anita , Suleyman Geehan
Published: January 2025

Background

Group A streptococcal (GAS) disease is a major problem worldwide and can cause both noninvasive and invasive disease, including necrotizing fasciitis, with significant morbidity and mortality. Overall, the number of invasive GAS infections has been increasing in the United States over the past decade, primarily in adults. We aim to characterize the genomic features of circulating GAS strains causing invasive disease.Table.Patient demographics and genomic characteristics

Methods

We performed whole-genome sequencing (WGS) on clinically obtained GAS blood isolates at Henry Ford Health, a comprehensive, integrated, health care organization in Southeast Michigan from Jan 2017-Dec 2023. Sequencing libraries were created using the QIAseq FX DNA Library Kit (Qiagen,USA) according to manufacturer’s instructions and sequenced on NextSeq 2000 (Illumina Sandiego, USA). Fastq files were used to determine the distribution of traits, virulence factors, and resistance genes using the 1928 Platform.

Results

We sequenced unique isolates from 64 patients, of whom 38 (59%) were males with median age 57 years [Table]. Most isolates were from 2022 (25%) and 2023 (53%). Fifteen M protein (emm) serotypes and 19 sequence type (ST) were obtained from 64 characterized isolates. The most frequent emm lineages were emm1 (n=16) and emm12 (n=12), where most patients had skin and soft tissue infection. The predominant emm1 lineage belonged to ST28. None of the emm1 and emm12 isolates carried aminoglycoside, macrolides/lincosamides/streptogramines (MLS), or tetracycline resistance genes. All the emm11 and emm49 isolates exhibited erm(A) and tetracycline resistance genes. Streptococcal superantigen (SAgs) genes were frequently detected; streptococcal pyrogenic exotoxin (SPE)-G was the most detected SAgs (97%), followed by streptococcal mitogenic exotoxin (SME)-Z (75%). SPE-H and SPE-I were each found in 48% of the isolates.

Conclusion

In our cohort of patients with invasive GAS, several SAgs were detected. SPE-A, SPE-G, SME-Z and SPE-J were most frequently found in emm1 lineages. However, there was no correlation between various clinical syndromes and the virulence genes identified. Continued genomic surveillance can help characterize features associated with emerging invasive strains to inform management and infection prevention strategies.

Disclosures

All Authors: No reported disclosures
P-1869. Utilizing Large Language Models for Enhanced Decision Support in Travel Medicine Clinic: our experience at Mayo Clinic
Authors: O’Horo John C , Akhtar Haris , Anantraman Vish , Ammar Muhammad , Gottweis Juro , Challener Douglas
Published: January 2025

Background

The integration of Generative AI (GAI) into healthcare systems is increasingly recognized for its potential to transform patient management. The primary aim of this research was to evaluate and quantify the performance of large language models (LLMs) in generating actionable travel medicine advice.

Architectural design of the Travel Clinic LLM project.

Four phases of Discovery, Design, Evaluation, and Implementation/Deployment.

Methods

This study utilized two iterative phases of evaluation. In the initial phase, LLMs were prompted with detailed clinical scenarios including demographic data, medical and immunization histories, and specific travel plans. These prompts were designed to mimic typical inquiries encountered in travel consultations. The LLMs' initial responses were generated using the CDC’s Yellow Book as a foundational knowledge base. In the subsequent phase, the prompts were refined for greater specificity and clarity, and the knowledge base was enhanced by transitioning to Travax’s Travelers’ Health database. Additional structured data inputs included an exhaustive list of vaccines from our pharmacy formulary and a detailed table of vaccine contraindications. The responses were evaluated and scored by ID clinicians from the Mayo Clinic.

Results

Initial findings after first iteration revealed limited efficacy with recall at 23.9%, an F1 score of 38.6%, accuracy also at 23.9%, and precision maintained at 100%, utilizing the CDC's Yellow Book. With the implementation of Travax and refined prompting techniques, preliminary results suggest a notable improvement in the quality of responses, though detailed scoring is presently underway.

Improvements in the LLM’s performance can be attributed to several key adjustments: the adoption of a more comprehensive knowledge base, refined prompt engineering, and the incorporation of structured data to support more accurate and detailed recommendations. The collaborative engagement of Mayo Clinic with Google and Travax facilitated a synergistic approach to optimizing the AI model's utility and integration. Future plans include embedding the LLM into our EMR system.

Conclusion

The findings from this study highlight the significance of strategic collaborations between large healthcare centers, IT industry, and specialized knowledge database firms in effectively harnessing GAI for clinical use.

Disclosures

All Authors: No reported disclosures
P-1870. Clinical Outcomes of Self-Administered Outpatient Parenteral Antimicrobial Therapy over 12 Years in a Safety Net Hospital
Authors: Jacobs Anna , Smartt Jillian , Harms Michael , Castellino Laila M , Alvarez Kristin , Bhavan Kavita
Published: January 2025

Background

Outpatient Parenteral Antimicrobial Therapy (OPAT) is safe and effective for medically stable patients requiring intravenous (IV) antibiotics.1 OPAT is most commonly administered in a healthcare setting (H-OPAT), utilizing home health services, infusion centers, nursing homes, or hemodialysis centers. However, patients without health insurance are often unable to afford H-OPAT services, leading to lengthy hospital stays and potentially avoidable healthcare costs. Self-administered OPAT (S-OPAT) is relatively uncommon. At our safety net hospital, we established a S-OPAT clinic for uninsured patients in 2009. Data published from the first four years of our S-OPAT program in 2015 demonstrated a decreased risk of 30-day readmission among S-OPAT compared to H-OPAT with no significant difference in 1-year mortality.1. A registry of all patients discharged on OPAT has since been developed.Table 1:Patient Demographics

Methods

Data from 7335 OPAT discharges between October 2012 and December 2023 were analyzed. We assessed both H-OPAT and S-OPAT groups for blood stream infections secondary to vascular access sites in the ambulatory setting, 30-day readmission rates, and total number of S-OPAT days as an estimate for prevented inpatient days.Table 2.Clinical Outcomes for S-OPAT versus H-OPAT

Results

Of the 7,335 OPAT discharges from 2012 to 2023, 49.9% were discharged to H-OPAT and 50.1% to S-OPAT (Table 1). There was no difference between 30-day readmissions (OR 1.01 [CI 1.000 - 1.029) for S-OPAT as compared to H-OPAT (Table 2). There were a total of 47 blood stream infections over this 12-year period. 35 occurred in H-OPAT patients and 12 in S-OPAT patients (p < .01). A total of 54,733 days of S-OPAT were prescribed, preventing an estimated same number of inpatient days.

Conclusion

S-OPAT was designed to provide an alternative to prolonged hospital stays for uninsured patients requiring prolonged IV antibiotics. There is always a concern about the safety of discharging patients with vascular access, especially in patients with limited access to healthcare. Our data demonstrates that the safety of S-OPAT is as good, if not better, than the standard of care, H-OPAT, while allowing for more effective utilization of and improving health equity for our uninsured patients in our safety net hospital.

Disclosures

All Authors: No reported disclosures
P-1903. Beyond the Hospital Walls: Unveiling the Post-COVID-19 Path to Institutionalization
Authors: Bandera Alessandra , Colaneri Marta , Canuti Marta , Galbussera Alessia , Dall’Olio Lucia , Bobbio Chiara , Baldi Sante Leandro , Nobili Alessandro , Puoti Massimo , Marchetti Giulia , Latronico Nicola , Plebani Pierluigi , Raviglione Mario , Gori Andrea , Ojeda Fernandez Maria Luisa , Baviera Marta , Leoni Olivia , Fortino Ida , Tettamanti Mauro
Published: January 2025

Background

Functional decline (decrement in physical/cognitive functioning that causes inability to engage in daily activities) is common following acute hospitalization in elderly patients and is associated with hospital readmission, institutionalization, and mortality. We sought to determine rate of institutionalization after COVID-19 hospitalization and to characterize functional decline of patients institutionalized after COVID-19.

Characteristics of COVID-19 and pre-COVID-19 hospitalized patients

Methods

We conducted a retrospective cohort study using health administrative database from Lombardy Welfare Directorate. We included patients 44 years-old and older who were discharged from a Lombardy hospital with a diagnosis of COVID-19 between Feb 1st, 2020 and Jun, 30th, 2022 (COVID cohort) compared with patients discharged from the same sites with any diagnosis from Jan, 1st 2018 until Dec 31st, 2018 (pre-COVID cohort). Our primary outcome was institutionalization during the 6-month period following hospital discharge. We also compared functional decline parameters at institutionalization in the two cohorts.

Trend of institutionalization during the COVID-19 pandemic waves

Results

Our study included 141651 patients hospitalized for COVID-19 and 251459 individuals acutely hospitalized before COVID-19 pandemic (pre-COVID-cohort) for any diagnosis (Table 1). Among them, 3835 (2.7%) and 7976 (3.2%) were institutionalized during the following 6-months, respectively. Rates of institutionalization in the COVID-cohort increased over time during the observation period (Table 2). At institutionalization, patients hospitalized for COVID-19 were younger (median 83.6 years vs 84.9 years, p >0.0001), and more frequently female (37.8% vs 32.3%, p< 0.0001). Moreover, they had more frequently pressure sores (20.5% vs 16.3%, p< 0.0001) and urinary catheter (27% vs 19.8%, p< 0.0001) and fewer assistive devices (p< 0.0001) as compared to the pre-COVID cohort (Table 3).

Characteristics of institutionalized patients following acute COVID-19-realated hospitalizations vs non-COVID-19 acute hospitalization

Conclusion

Hospitalization for COVID-19 was followed by institutionalization at the same rate as acute hospitalization for all-cause in the pre-COVID period. However, functional decline, pressure sores, urinary catheter, incontinence, and use of assistive devices following COVID-19 hospitalization in the elderly population should be closely monitored.

Disclosures

All Authors: No reported disclosures
642. The Role of Electronic Medical Record Automation in Latent Tuberculosis Screening and Treatment in a Large Health System
Authors: Li Hannah T , Sahni Harleen , Cervenka Andrea
Published: January 2025

Background

Valley Medical Center is a tertiary county hospital in San Jose, California that also staffs 12 clinics. Our institution’s Mycobacterial and Refugee Health Clinic is the main referral center for latent tuberculosis (LTBI) and active TB cases in the county.

The USPFTF recommends screening for LTBI in asymptomatic adults who are at higher risk. This is challenging in primary care settings where physicians often see a high number of patients within limited time frames. There are many points on the LTBI care cascade (Figure 1) where patients can fall off. In the age of automation, technological tools can be designed to help reduce clinician burden.Figure 1:Latent Tuberculosis Care CascadeSource: California Department of Public Health Tuberculosis Control Branch

Methods

An EMR tool was engineered to prompt physicians to order a QuantiFERON (QFN) if a patient meets certain criteria: 18 years or older, no prior QFN or TB skin test, and any of the following risk factors: HIV positive, in custody, drug use, homelessness, or non-English primary language (proxy for foreign birth). This EMR tool went live on 8/9/22.

Using EMR data-collection tools, a retrospective analysis was done among patients who had a clinical encounter (office visit or telemedicine) between 8/9/21-8/9/22 and 8/9/22-8/9/23 (one year before and after implementation of the tool). We determined the number of patients who were eligible for screening, obtained a QFN, had a positive QFN, initiated, and completed treatment. A 2-sample Z-test was used to assess temporal trends.Table 1:LTBI Care Cascade for Patients Seen by a Primary Care Physician in 8/9/21-8/9/22 and 8/9/22-8/9/23

Results

From 8/9/22-8/9/23, 34251 patients were marked eligible for LTBI screening based on the EMR tool (Table 1, Figure 2). The proportion of patients tested for LTBI increased from 45.3% to 81.2% (p-value < 2.2e-16). The proportion of positive LTBI results increased from 8.6% to 12.4% (p-value < 2.2e-16). The number of patients who initiated treatment increased from 545 (40.8%) to 1038 (30%). The number of patients who completed treatment increased from 417 (76.5%) to 770 (74.2%).Figure 2:LTBI Care Cascade for Patients Seen by a Primary Care Physician in 8/9/21-8/9/22 and 8/9/22-8/9/23

Conclusion

This study highlights that a low-cost EMR intervention can lead to substantial increases in LTBI screening, and as a result higher treatment completion. EMR automation can also improve accuracy in screening, reflected by the increased proportion of positive QFN results. Future tools involving digital technology can be designed to reduce drop-offs at other points along the LTBI cascade as well.

Disclosures

All Authors: No reported disclosures
P-1916. The impact of SARS-CoV-2 VOCs on clinical outcomes: an Umbrella Review
Authors: Fama Federico , Fattore Rebecca , Raimondo Paolo , Brivio Fabio , Holmes Darcy , Muheberimana Toussaint , Nayfeh Tarek , Gori Andrea , Passerini Matteo , Colaneri Marta
Published: January 2025

Background

Studies aiming to synthetize data from literature are helpful to valid the robustness of associations, to assess the quality of the data, and, eventually, to propose recommendations. This is particularly evident for the huge amount of data reported for SARS-CoV-2.

The aim of this study was to perform an umbrella review to identify the strength and validity of associations between variants of concern (VOCs) and pre-specified clinical outcomes in COVID-19 patients.

Table 1

Effect size measures reported in the studies included in the review, divided by outcome.

Acronyms: CI, confidence interval; OR: odds ratio; RR, risk ratio; cCFR, confirmed case-fatality risk; HFR, hospitalization-fatality risk; N/A, not available

Methods

An umbrella review according to the principles to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed searching multiple databases in January 2024. Peer reviewed systematic reviews considering ≥ 2 VOCs with a clinical outcome among death, hospitalization, severe disease, admission to intensive care unit (ICU), and mechanical ventilation were included. Data on study population and measures of association between clinical outcome and VOCs were considered. The quality of the studies was assessed through the AMSTAR-2 tool. The effect size measures with the confidence interval for each association between VOCs and clinical outcomes were reported. Subgroup analyses were performed, if possible. A citation matrix was used to assess the overlap between the systematic reviews included.

Table 2

Risk of bias assessment of the included systematic reviews using the AMSTAR-2 score. In bold the key domains.

Results

A total of 11 studies were included in our review. 24 total comparison were considered, most regarding Omicron versus Delta (19/24), where Omicron was always associated with better clinical outcomes than Delta. The overall quality of the studies was low. None of the reviewed studies incorporated consideration of risk factors other than VOCs in evaluating clinical outcomes.

The overlap between the included reviews is low, only 10% of them having a significant overlap ( > 15%).

Conclusion

Our umbrella review shows the lower hazard on human health of the Omicron compared to Delta variant. However, the quality of the reviews included were generally low and there is a lack of correction with other risk factors such as comorbidities and vaccination status.

While our review provides valuable insights into the association between VOCs and clinical outcomes of SARS-CoV-2 infection, further research incorporating risk factor analysis and ensuring methodological rigor is warranted.

Disclosures

All Authors: No reported disclosures
P-1918. Incidence of viral rebound in hospitalized COVID-19 patients
Authors: Weng Tzu-Ping , Syue Lingshan , Li Mingchi , Lee Nan-Yao
Published: January 2025

Background

Viral rebound, characterized by a resurgence of viral activity after initial suppression, presents a potential threat to infection control within healthcare settings. We aimed to investigate the incidence of viral rebound in patients hospitalized for COVID-19.

Methods

The retrospective study included symptomatic adults admitted for COVID-19 to a tertiary hospital in Taiwan during 1 January 2022 to 31 December 2022. Viral rebound was defined as an increase of △Ct ≥ 5 units or a new positive test after having tested negative during 10-30 days after COVID-19 diagnosis. The indication of antiviral agent was evaluated by physician according to initial severity and risks to develop severe COVID-19. The patients with prior COVID-19 infections, receipt of ≥ 2 antiviral agents, incomplete treatment course of antiviral agent, or active problem for hospitalization other than COVID-19 were excluded.

Results

Of the included 354 participants, 26 received Paxlovid, 98 received molnupiravir, 54 received 3-day remdesivir, 101 received 5-day remdesivir, and 84 didn’t receive any antiviral agent. The incidence of viral rebound was higher in patients not receiving antiviral agent (n=75) compared to those who received either antiviral therapy (n=279) (17.3% vs. 11.5%, p=0.18). Additionally, the duration from COVID-19 diagnosis to onset of viral rebound was similar between the two groups (16.2 days vs. 14.3 days, p=0.20). Among the 148 with severe COVID-19, viral rebound was higher in patients without antiviral agent exposure (n=47) compared to those who received 5-day remdesivir (n=101) (21.3% vs. 15.8%, p=0.18). In 206 with non-severe disease, no significant differences were found in the incidence of viral rebound between patients who received Paxlovid (n=26) and molnupiravir (n=98) (11.5% vs. 7.1%, p=0.44).

Conclusion

Our study highlights the risk of viral rebound in hospitalized COVID-19 patients. Patients without antiviral treatment had a higher rebound incidence. Among severe cases, antiviral therapy reduced rebound rates, underscoring its importance. Interestingly, antiviral choice did not significantly affect rebound incidences in non-severe cases. These findings stress the crucial role of antiviral therapy in infection control strategies.

Disclosures

All Authors: No reported disclosures
P-1921. Risk Factors for Hospitalization due to COVID-19 in the Current Era of the Pandemic
Authors: Ancha Bhavya , Hamilton Keith W , Dutcher Lauren , Degnan Kathleen , Palumbo Kurt , Binkley Amanda , Ilyas Sahrish
Published: January 2025

Background

Certain risk factors place SARS-COV-2 infected individuals at a higher risk of hospitalization and death. While increased vaccination rates and herd immunity have decreased the overall risk of hospitalization and death from COVID-19, some groups of patients may still be at significant risk of morbidity and mortality from COVID-19. However, this population has not been well-described. This study sought to understand the current landscape of patients hospitalized due to COVID-19 to gauge who would most benefit from pre-exposure prophylaxis and other therapies for COVID-19.Table 1:Demographics.Demographics of patients admitted to hospital due to COVID-19.*Immunosuppression defined as having at least one of the following: hematologic malignancy, solid organ transplant, bone marrow transplant, metastatic cancer, asplenia, HIV with CD4 count < 200, other immunosuppressive disease with impaired humoral or cell-mediated immunity, or immunosuppressive medication including corticosteroids (prednisone ≥ 2mg/kg/day or ≥ 20 mg/day or equivalent dose of other corticosteroid) for > 14 days, chemotherapy within past 3 months, calcineurin inhibitor, anti-proliferative agent, mTOR inhibitor, B-cell or T-cell depleting medication, or TNF-alpha inhibitor.

Methods

This was a retrospective study of adults admitted to a single center for a COVID-19-related reason from August 4, 2023, through February 5, 2024. All admitted patients with a positive SARS-CoV-2 test were identified; patients who were admitted for a non-COVID-19 related reason were excluded from manual chart review. Patient demographic information, vaccination status, risk factors, symptoms, hospital course, and treatment interventions were collected. These data were then analyzed and descriptively characterized.Table 2:OutcomesClinical outcomes of patients admitted to hospital due to COVID-19.

Results

Of the 408 patients identified who were hospitalized for a COVID-19-related reason during the study period, the median age was 70 years (IQR 60 – 81) with a median length of stay of 5 days (IQR 3-8). Only 13% of patients were up to date on their COVID-19 vaccination at their time of admission (Table 1). Admitted patients had a median of 3 (IQR 2 – 4) risk factors for severe infection, and 26.5% of patients were noted to be immunosuppressed (Table 1). Nearly half of all patients did not require supplemental oxygen during their stay (47%); 38% required only low flow nasal cannula (Table 2). There was a 7.8% 90-day mortality rate.

Conclusion

These data suggest that most admitted patients in the current COVID-19 era have multiple risk factors and are under-vaccinated. This high-risk population may benefit from updated vaccination, pre-exposure prophylaxis, and/or other therapies to reduce the morbidity from COVID-19.

Disclosures

Kathleen Degnan, MD, Gilead: Grant/Research Support Amanda Binkley, PharmD, BCIDP, AAHIVP, Viiv: Advisor/Consultant
P-1940. Low Visceral Fat Volume and Hypoalbuminemia as Prognostic Markers in Hospitalized Patients with COVID-19 During the Omicron Variant Epidemic
Authors: Nakayama Shin , Wakabayashi Yoshitaka , Kawase Kyotaro , Yamamoto Ai , Kitazawa Takatoshi
Published: January 2025

Background

The rate of severe cases of coronavirus disease 2019 (COVID-19) has decreased since the Omicron variant became epidemic. Visceral fat volume was a risk factor for COVID-19 severity with prior prevalent variants, but whether visceral fat volume remains a risk factor for the Omicron variant is unclear. We investigated the associations of clinical factors including visceral fat volume with severity and mortality among hospitalized patients with COVID-19 during the Omicron variant epidemic.Table 1.Multivariable analysis of clinical factors associated with COVID-19 severity.

Methods

We included hospitalized patients with COVID-19 during the Omicron variant epidemic who underwent computed tomography of the abdomen. Clinical data were obtained from the medical records and visceral fat area (VFA) was measured using a 3-dimensional image analysis system volume analyzer. Severity was determined by the presence or absence of oxygen supplementation.Table 2.Multivariable analysis of clinical factors associated with mortality in hospitalized 206 patients with COVID-19.

Results

Among the 226 patients, 66 patients showed moderate severity and 29 patients were non-survivors. Hypoalbuminemia was associated with severity (odds ratio [OR] 3.93, 95% confidence interval [CI] 1.91–8.07; p=0.0002)(Table 1), and hypoalbuminemia (OR 8.38, 95%CI 2.37–29.58; p=0.0010) and low VFA (OR 3.40, 95%CI 1.15–10.06; p=0.027) were associated with mortality (Table 2). Decision tree analysis showed that mortality rate in the hypoalbuminemia and low-VFA group (37.3%) was significantly higher than in other groups (p< 0.01)(Fig.1).Fig 1.Decision tree analysis of patient mortality rates classified by serum albumin level and visceral fat area.Patients were initially classified with a cutoff value of 3.5 g/dL for serum albumin, then classified into four groups using a cutoff value of 100 cm² for visceral fat area.

Conclusion

Low visceral fat volume and hypoalbuminemia were associated with mortality in hospitalized patients with COVID-19 during the Omicron variant epidemic. Classification by VFA and serum albumin may allow simple prediction of mortality risk among hospitalized patients with COVID-19.

Disclosures

All Authors: No reported disclosures
P-1941. COVID-19 Impact on Acute Pancreatitis Hospitalization and Mortality: A Retrospective United States Cohort Study
Authors: Suenghataiphorn Thanathip , Lohawatcharagul Tuntanut , Wattanachayakul Phuuwadith , Kulthamrongsri Narathorn , Danpanichkul Pojsakorn , Polpichai Natchaya , Thongpiya Jerapas
Published: January 2025

Background

Acute pancreatitis, a prevalent gastrointestinal condition, frequently necessitates hospitalization and is associated with potential adverse in-hospital outcomes. Recent data showed the detrimental effects of COVID-19 infection on acute pancreatitis, particularly in patients with severe COVID-19 infections. However, limited information exists on the specific impacts of COVID-19 infection in patients hospitalized for acute pancreatitis.

Methods

We analyzed the 2020 U.S. National Inpatient Sample (NIS) to investigate the effects of COVID-19 infection on cases primarily admitted due to acute pancreatitis. Participants aged 18 and above were identified using relevant ICD-10 CM codes. Adjusted odds ratios (aORs) for specified outcomes were calculated through multivariable logistic and linear regression analyses. The primary outcome was inpatient mortality, with secondary outcomes including system-based complications. Statistical significance was established at a P value of 0.05.

Results

We identified 252,435 patients with a primary discharge diagnosis of acute pancreatitis. The mean age was 50.1 years; 48.6% were female. Caucasians accounted for 41%, followed by Hispanics. Of these, 1.05% (2,675/252,435) had a concurrent diagnosis of COVID-19 infection.

In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, COVID-19 infection was associated with higher in-hospital mortality (aOR 3.71; 95% CI 2.01, 6.84, P < 0.001), prolonged length of stay (β LOS 1.05; 95% CI 0.46, 1.64, P < 0.001), increased hospitalization charge ( β charge 9,327; 95% CI 820, 17834, P < 0.001), and acute respiratory failure (aOR 2.49; 95% CI 1.75, 3.53, P < 0.001), We observed non-significant, but increased, risks of shock, acute kidney injury (AKI), pancreatic pseudocyst, acute respiratory distress syndrome (ARDS), and mechanical ventilation in COVID-19 positive patients.

Conclusion

In conclusion, our study underscores that COVID-19 infection is associated with higher in-hospital mortality, prolonged hospital stays, and increased incidence of acute respiratory failure in patients diagnosed with acute pancreatitis. Future longitudinal studies are warranted to comprehensively assess the long-term health sequelae in this population.

Disclosures

All Authors: No reported disclosures
P-1. Impacts of a Quality Improvement Initiative to Build Confidence in Human Papillomavirus (HPV) Vaccination Among American Indian Communities
Authors: Humiston Sharon G , Molloy Leah , Simone Laura , Napolitan Chris , Carter Jeffrey D , Meza Jimenez Jenniffer A , Anderson Chadha Chelsie , Douglas Bonnie
Published: January 2025

Background

HPV vaccination is highly effective to prevent HPV-associated cancers, but uptake among adolescents and young adults remains suboptimal. This program aimed to identify barriers and support HPV vaccine confidence in American Indian communities in partnership with a Rural Tribal Clinic in Nevada and an urban Federally Qualified Health Center (FQHC) in North Dakota.

Methods

Clinics led 3 live education sessions virtually or in-person from 3/23 to 8/23, which were attended by 91 patients and family members (patients) and 10 healthcare professionals (HCPs). Surveys were administered before, immediately after, and 3 months after each session.

Results

At baseline, 70% of HCPs reported facing hesitancy from patients about the HPV vaccine, with top challenges including patient refusal to discuss vaccination (43%) and sexual stigma around HPV (29%). When asked to identify their patients’ top reason for not getting the HPV vaccine, HCPs reported low perception of self-risk (40%). Conversely, patients reported their top concerns were long-term (39%) and short-term (32%) side effects. When asked what they thought would increase patient interest in vaccination, HCPs identified a strong recommendation from their doctor (60%) while patients prioritized learning more about HPV and associated cancers (57%). Patient HPV vaccine knowledge and confidence improved after sessions. More patients recognized that the HPV vaccine can prevent certain cancers (92% vs 60%, p < .001) and agreed the vaccine is safe (95% vs 64%, p < .001) after sessions than before. Awareness of vaccine access also improved: more patients recognized that vaccines are available free of charge after sessions than before (95% vs 66%, p < .001). Most patients (90%) reported being likely to share what they learned with family and friends, and 100% of providers were likely to lead another session. At 3-month follow-up, HCPs had helped a total of 75 patients get the HPV vaccine.

Conclusion

This initiative highlights the feasibility and impact of clinic-based education sessions on patient vaccine knowledge and confidence and offers insights into community-level barriers and motivators to vaccination.

Disclosures

Sharon G. Humiston, MD, MPH, Sanofi: Advisor/Consultant|Sanofi: Honoraria