bluuebunny/crossref_metadata_2025 huggingface dataset:
1639. Lung Transplant Outcomes in Patients with Chronic Respiratory Disease and Pre-Operative Nontuberculous Mycobacterial Disease
Authors: McGuffin Sarah , Lease Erika D , Bartlett Lauren E , Goss Chris , Johnson Luke M , Jamali Haya
Published: January 2021

Background

Pulmonary infection secondary to nontuberculous mycobacteria (NTM) is associated with significant morbidity and mortality, especially in individuals with underlying structural lung disease. Such infections are challenging to treat due to high virulence, antibiotic resistance, and the lack of effective and tolerable therapies. At many transplant centers, the isolation of NTM may be considered a contraindication for lung transplantation.

Methods

Institutional and referral medical records, microbiology, radiology and pathology databases were reviewed for patients who underwent lung transplantation at the University of Washington between 2006-2020. 8 patients with NTM disease were identified according to the American Thoracic Society (ATS) guidelines. 9 patients with sputum cultures positive for NTM, but not diagnosed with NTM disease were also evaluated.

Results

Patients with NTM disease continued antimycobacterial therapy pre- and post-operatively. NTM organisms isolated included M avium complex, M fortuitum, M abscessus, M kansasii, and M fortiutum.

In the cohort with NTM-disease, one patient died within a year of transplantation (14%), three died within 1-5 years (43%), and four (51%) are still alive 1-9 years post-transplantation. Only one patient clearly died as a direct cause of the NTM infection, and this occurred early post-transplantation due to disseminated M abscessus infection. Of the other deceased patients with pre-existing NTM disease, one died due to graft rejection at 3 years, one died due to graft rejection with concomitant non-NTM pneumonia at 2 years, and one died due to cardiac arrest at 4 years. In the cohort without NTM disease, none died within 1 year of transplantation, 22% died within 1-5 years, 11% died more than 5 years post-transplant, and 66% are still alive 1-14 years post-transplant.

The probability of survival more than 1 year and more than 5 years post-transplant and 38% in patients with NTM-disease, and 100% and 56% in patients without NTM disease.

Conclusion

NTM infection in the lung transplant candidate is uncommon and challenging, however successful treatment can occur, perhaps in the setting of certain subspecies and with prolonged combination antimicrobial therapy.

Disclosures

All Authors: No reported disclosures
137. Evaluating a Novel Antibiogram Format for use in Wisconsin Nursing Homes
Authors: Taylor Lindsay N , Howe Michael , Crnich Christopher J
Published: January 2021

Background

Nursing homes (NHs) increasingly use antibiograms to track antibiotic-related outcomes and guide antibiotic choice. Creation of a facility-specific antibiogram is hampered by low number of cultures collected in NHs. A weighted-incidence syndromic combination antibiogram (WISCA) is an alternative approach that may provide more stable estimates of antibiotic activity. In this study, we compare traditional antibiograms and WISCAs in a sample of Wisconsin NHs.

Methods

We created urine-specific antibiograms using traditional and WISCA approaches at facility and regional levels using culture data collected in study NHs from 01/01/2018 – 12/31/2018. Susceptibility results were standardized across laboratories using CLSI breakpoints. Traditional antibiograms were deemed reliable when ≥ 20 isolates were recovered for at least one species and species exceeding this threshold comprised 75% of all isolates. WISCAs were deemed reliable if ≥ 20 urinary isolates were recovered. Bootstrapped regional mean susceptibilities and confidence intervals for traditional antibiograms and WISCAs were calculated. Susceptibilities calculated at the facility-level were compared to regional estimates. Facility-level susceptibility estimates were deemed concordant if within 1 SD, moderately discordant if between 1 and 2 SDs, and severely discordant if greater than 2 SDs of the regional estimate.

Results

462 urine isolates were obtained from 23 NHs in 2 regions. None of the facility-specific traditional antibiograms met reliability criteria. 10 of 23 facility-specific WISCAs were reliable and increased to 19 of 23 when 2-years of microbiology data were utilized (table). Severe discordance between facility-specific and regional estimates was identified with 62/107 NH species-antibiotic means and 98/119 NH urine isolate-antibiotic means falling outside of 2 SD of corresponding bootstrap regional susceptibility means (figure).

Table. Reliability analysis of facility-specific urinary WISCAs and traditional antibiograms. 2-year projection was created using the assumption of similar culture results over 2-years.

Figure. Proportion of concordant, moderately discordant, and severely discordant NH mean susceptibilities in comparison to bootstrap regional mean susceptibilities for traditional antibiograms and WISCAs. NH mean susceptibilities from 5 isolates of more were included.

Conclusion

WISCAs are more reliable than traditional antibiograms for estimating antibiotic susceptibilities using facility-specific data. The high degree of discordance observed between facility-specific and regional antibiograms raises concerns about pooling culture data from multiple facilities.

Disclosures

All Authors: No reported disclosures
1640. A Clinical Audit and Cost Analysis of Tuberculosis Management at a Tertiary Referral Centre in the Republic of Ireland
Authors: O’Connell James A , de barra Eoghan , McConkey Samuel
Published: January 2021

Background

Ireland is a low tuberculosis (TB) incidence country. Effective TB services are important in the efforts to meet WHO End TB Targets. A dedicated TB clinic was established in our tertiary referral centre in 2018. Our aim is to describe the patients with TB attending our service and evaluate the care provided to them in terms of cost and clinical effectiveness.

Methods

We performed a retrospective review of patients attending our service from 01/07/2018-31/12/2019. We included patients who were referred for assessment of symptoms of active tuberculosis. We collected data on patients risk factors for TB, time from illness onset to diagnosis and resources utilized (including hospital admissions, outpatient appointments, investigations and drug treatment). We estimated the productivity losses due to TB in our cohort following the Hanover Consensus. Using national TB notifications data we used our estimate treatment cost and productivity losses to estimate the total national cost of TB in Ireland in 2019.

Results

Fifty-four patients were assessed for TB in our clinic. Most patients (68.5%) referred had a diagnosis of TB made, 5.6% had a non-tuberculosis mycobacterial infection and the remainder had no mycobacterial infection diagnosed. Over half (51.4%) of patients with TB had respiratory TB. The most prevalent risk factor was being from a country of high TB incidence (59.5% of TB patients). Five patients (13.5%) had drug resistance. Patients were referred most frequently from the emergency department (54.1%). The median time from symptom onset to diagnosis was 14.1 weeks (IQR 5.3-30) in patients with respiratory TB compared to 25.9 weeks (IQR 6.3-55.9) in patients with non-respiratory TB. Out of 35 patients who remained within our service 97.1% (34/35) completed treatment and 2.9% (1/35) are still on treatment.

We estimate that the median cost of managing a case of TB in our centre was €6088 (€1,003-17,588). The estimated cost of managing all 267 cases of TB in Ireland in 2019 was €9,048,380 which incurred productivity losses of €791,421. The total cost of TB to Ireland in 2019 was €9,839,801.

Conclusion

Our clinic had a high rate of treatment success. Interventions to reduce diagnostic delay and cost are needed.

Disclosures

All Authors: No reported disclosures
1652. Diagnoses of Non- Tuberculosis Mycobacterium (NTM) in patients with granuloma on lung biopsy
Authors: Singh Vansha , Kim Angela , Hayes Lisa , Rasul Rehana , Schwartz Rebecca , Epstein Marcia , Epstein Marcia
Published: January 2021

Background

The prevalence of non-Tuberculous mycobacteria (NTM) lung disease has increased from 8.7 to 13.9/100,000 from 2008-2013 making NTM lung disease a rising public health problem. Patterns of infection include fibrocavitary, bronchiectatic or nodular. Diagnosis of NTM may be incidental after surgical resection performed during malignancy work up. We aimed to identify the proportion of NTM in resected lung lesions (both nodules and masses) with granulomas (GL) both necrotizing (NGL) and non-necrotizing (n-NGL) on pathology and to compare differences in characteristics of patients with NTM versus those without NTM.

Methods

This was a retrospective chart review of patients who underwent resection of lung nodules and/or a lung mass during malignancy work up from January 2013 through March 2019 including only those with granulomatous inflammation on pathology. 497 patients met these criteria and their electronic medical records were reviewed. Findings of culture-confirmed NTM on tissue, bronchoalveolar lavage or sputum (at time of resection) were classified as “NTM” group; and those with no NTM diagnoses were classified as “Non-NTM” group. Patients with NTM and another diagnoses were classified within the NTM group. Study variables were compared by the dichotomous NTM group using Chi-square test for categorical variables and T-test for continuous variables.

Results

Among all patients, the most common diagnosis was lung cancer (21.93%). There were 81 (16.3%) patients with NTM (Table 1). Within the NTM group, percentage of Asians, presence of NGL, placement on airborne precautions and prior history of tuberculosis were significantly higher. The NTM group also had a higher proportion of both COPD and lung cancer as their underlying condition (Table 2). 161 patients had non-diagnostic biopsies.

Table 1

Table 2

Table 2

Conclusion

Mycobacterial infections made up a significant percentage of resected lung nodules and/or lung masses for malignancy evaluation. NTM were isolated with greater frequency than M. Tuberculosis even with NGL on lung pathology. This reflects the changing epidemiology of NTM. The significant proportion of Asians with NTM compared with GL found during a malignancy work up without NTM is interesting and deserves further investigation.

Disclosures

All Authors: No reported disclosures
1665. Using Electronic Health Records to Describe TB in Community Health Settings: a Cohort Analysis in a Large Safety-Net Population
Authors: Todd Jonathan , Puro Jon , Jones Matthew , Oakley Jee , Vonnahme Laura A , Ayers Tracy
Published: January 2021

Background

Over 80% of tuberculosis (TB) cases in the United States are attributed to reactivation of latent TB infection (LTBI). Eliminating TB in the United States requires expanding identification and treatment of LTBI. Centralized electronic health records (EHRs) are an unexplored data source to identify persons with LTBI. We explored EHR data to evaluate TB and LTBI screening and diagnoses within OCHIN, Inc., a U.S. practice-based research network with a high proportion of Federally Qualified Health Centers.

Methods

From the EHRs of patients who had an encounter at an OCHIN member clinic between January 1, 2012 and December 31, 2016, we extracted demographic variables, TB risk factors, TB screening tests, International Classification of Diseases (ICD) 9 and 10 codes, and treatment regimens. Based on test results, ICD codes, and treatment regimens, we developed a novel algorithm to classify patient records into LTBI categories: definite, probable or possible. We used multivariable logistic regression, with a referent group of all cohort patients not classified as having LTBI or TB, to identify associations between TB risk factors and LTBI.

Results

Among 2,190,686 patients, 6.9% (n=151,195) had a TB screening test; among those, 8% tested positive. Non-U.S. –born or non-English–speaking persons comprised 24% of our cohort; 11% were tested for TB infection, and 14% had a positive test. Risk factors in the multivariable model significantly associated with being classified as having LTBI included preferring non-English language (adjusted odds ratio [aOR] 4.20, 95% confidence interval [CI] 4.09–4.32); non-Hispanic Asian (aOR 5.17, 95% CI 4.94–5.40), non-Hispanic black (aOR 3.02, 95% CI 2.91–3.13), or Native Hawaiian/other Pacific Islander (aOR 3.35, 95% CI 2.92–3.84) race; and HIV infection (aOR 3.09, 95% CI 2.84–3.35).

Conclusion

This study demonstrates the utility of EHR data for understanding TB screening practices and as an important data source that can be used to enhance public health surveillance of LTBI prevalence. Increasing screening among high-risk populations remains an important step toward eliminating TB in the United States. These results underscore the importance of offering TB screening in non-U.S.–born populations.

Disclosures

All Authors: No reported disclosures
1667. Change in characteristics of community-onset ciprofloxacin-resistant E. coli isolates causing community-acquired acute pyelonephritis in South Korea
Authors: Kim Bongyoung , Kwon Ki Tae , Ryu Seong-yeol , Wie Seong-Heon , Jo Hyun-uk , Kim Jieun , Park Se Yoon , Hong Kyung-Wook , Kim Hye In , Kim Hyun ah , Kim Mi-Hee , Bae Mi-Hyun , Sohn Yong-Hak , Kim Jieun , Lee Yangsoon , Pai Hyunjoo
Published: January 2021

Background

The aim of this study was to examine the change in characteristics of community-onset ciprofloxacin-resistant (CIP-R) E. coli isolates causing community-acquired acute pyelonephritis (CA-APN) in South Korea between 2010-2011 and 2017-2018.

Methods

E. coli samples isolated from the blood or urine were collected from patients with CA-APN aged 19 years and more who were admitted to 8 Korean hospitals from September 2017 to August 2018, prospectively. One isolate was collected from each patient. Phylogenetic typing, multilocus sequence typing (MLST), and molecular characterization of β-lactamase resistance and plasmid-mediated quinolone resistance (PMQR) determinants were performed. The data were compared with those from the previous study with same design in 2010-2011.

Results

A total of 346 and 300 isolates were collected during 2017-2018 and 2010-2011, respectively. Among them, 76 (22.0%) and 77 (25.7%) were CIP-R isolates. Significantly higher antimicrobial resistance against ampicillin (75.7% vs. 100%, P < 0.001) and cefotaxime (23.9% vs. 77.9%, P < 0.001) were observed for isolates in 2017-2018 compared to those in 2010-2011. The proportion of phylogenic group B2 had increased significantly (44.7% vs. 79.2%, P < 0.001). As for MLST, the proportion of ST131 (27.6% vs. 66.2%, P < 0.001) had increased while that of ST393 (18.4% vs. 3.9%, P =0.004) had decreased significantly. Higher proportion of CIP-R E. coli isolates in 2017-2018 had extended-spectrum β-lactamase (ESBL)/plasmid-mediated AmpC β-lactamase (PABL) (23.7% vs. 79.2%, P < 0.001) and PMQR determinant (11.8% vs. 40.8%, P < 0.001) compared to those in 2010-2011.

Phlogenetic tree

Analyzed by SplitsTree

Conclusion

Among uropathogenic CIP-R E. coli isolates in South Korea, ST131 predominance had become more prominent and the proportion of containing ESBL/PABL and/or PMQR determinants had increased.

Disclosures

All Authors: No reported disclosures
1668. Clinical Risk Score Model for Predicting Extended Spectrum Beta Lactamase (ESBL)-Positive Urinary Tract Infection among Hospitalized Filipino Patients: a Retrospective Single-Center Study
Authors: Edding Sherida , Cadeliña Jekrylei , Leaño Danice Romagne , Panaligan Mario , Hufano Ma Charmian
Published: January 2021

Background

Infections caused by Extended-Spectrum B-lactamases (ESBL) organisms are an emerging health concern worldwide. In the background of progressive rise of antibiotic resistant organisms, efforts should be started to minimize antibiotic resistance. The development of clinical risk score models to predict the possibility of infection with these drug resistant organisms will bridge the gap between treating too late and treating too early and too much.

Methods

This is a single-center cross-sectional study of ESBL positive urinary tract infection (UTI) among patients admitted at St Luke’s Medical Center - Global City from January 2018 to December 2018. A total of 93 patients positive for ESBL-positive UTI and 186 patients with ESBL-negative UTI were included in the study. Clinical characteristics, medical and medication histories were obtained from the computerized medical database. To develop the risk score, clinical risk indicators measured at the time of recruitment were built by logistic regression. Regression coefficients were transformed into item scores and added up to a total score. A risk-scoring scheme was developed from clinical predictors.

Results

The following factors were observed to be predictive of ESBL UTI: hospital-acquired or healthcare-associated infection, prior ESBL infection, cardiac comorbidity and history of carbapenem intake. Scoring for the predictive model is as follows: having age at least 50 years old=1.5, hospital-acquired or healthcare-associated infection=1, having prior ESBL infection=2, having cardiac comorbidity (NYHA I-II)=1, having cardiac comorbidity (NYHA III-IV)=2.5, and history of carbapenem intake=3. ROC analysis showed that the optimum cut point in the model predictive of ESBL is 3.5/10. The risk prediction model for ESBL had high sensitivity of 87%, medium specificity of 68%, and good predictive accuracy of 0.78.

Conclusion

A simple and non-invasive scoring scheme of three predictors provides good prediction indices for presence of ESBL organisms in patients diagnosed with UTI. However, a large sample study is needed to improve the power of the study. Validation studies are also needed.

Disclosures

All Authors: No reported disclosures
1678. Evaluation of Sodium-Glucose Co-Transporter 2 Inhibitor Therapy and Other Potential Risk Factors for the Development of Bacteremia in Patients with Urosepsis
Authors: Slaten Kelly , Harnden Adam , Britton Johnathyn , Covington Elizabeth W , Johnson William
Published: January 2021

Background

Though sodium-glucose co-transporter 2 (SGLT2) inhibitors have been associated with an increased risk of urinary tract infection, it is unknown whether SGLT2 inhibitors increase the risk of urinary-source bacteremia. Early recognition of bacteremia risk factors in patients with urosepsis could allow rapid management to improve patient outcomes. The purpose of this study is to assess patients presenting with urosepsis and a positive urine culture to evaluate the impact of sodium-glucose co-transporter 2 (SGLT2) inhibitor receipt and other potential risk factors for developing bacteremia.

Methods

This was a single-center, retrospective, case-control study performed at a community hospital. Patients were included if they presented with a positive urine culture and met pre-specified criteria for urosepsis. Patients were categorized in one of two groups: bacteremia and non-bacteremia. The following patients were excluded: confirmed pregnancy, age less than 18 years, and/or a proven source of bacteremia outside the urogenital tract. The primary endpoint assessed the percentage of patients taking a SGLT2 inhibitor in the bacteremia versus non-bacteremia groups. Independent risk factors for bacteremia were assessed via binary logistic regression. Additional statistical analysis included chi-square for categorical data and Student’s t-test for continuous data.

Results

A total of 162 patients were analyzed in the study (n=81 in bacteremia and non-bacteremia groups). There was no difference in percentage of patients with or without bacteremia who received SGLT2 inhibitor therapy (p = 0.499). The following were identified as independent risk factors for bacteremia in the binary logistic regression analysis: temperature ≥ 100.4 degrees Fahrenheit (OR 4.1; 95% CI 1.5 – 11.4), bicarbonate level < 20 mmol/L (OR 11.4; 95% CI 3.1 – 41.5), and blood glucose level > 180 mg/dL (OR 3.9; 95% CI 1.3 – 11.6).

Conclusion

In this study of patients in a community hospital, SGLT2 inhibitors in the setting of patients with urosepsis and positive urine cultures did not increase the risk for bacteremia. Independent risk factors associated with an increased risk of bacteremia included temperature ≥ 100.4 degrees Fahrenheit, bicarbonate level < 20 mmol/L, and blood glucose level > 180 mg/dL.

Disclosures

All Authors: No reported disclosures
1680. Evaluation of the Urinalysis Reflex to Culture Sensitivity and Impact on Antibiotic Utilization
Authors: Wellen Jacob , Harrington Nicole , Leri Jessica
Published: January 2021

Background

In June of 2016 at ChristianaCare a urinalysis with reflex to culture (UARC) order set was made available, which allows for urine cultures to be performed automatically if pre-defined criteria for a positive urinalysis are met. The objective of this study was to evaluate the utility of the UARC as it relates to identifying a symptomatic urinary tract infection (UTI), as well as to describe the impact of UARC on antibiotic utilization.

Methods

A retrospective cohort study was performed including patients aged 18 to 89 ordered a UARC. Patients were excluded if they were currently pregnant, had an absolute neutrophil count of < 100 cells/mm3, were undergoing a urological procedure, or receiving antibiotics for another indication. The primary outcome of this study was to determine the utility of the UARC in identifying a symptomatic UTI, as determined by the Youden index. Secondary outcomes evaluated included mean days antibiotics and length of stay, adherence to duration of treatment guidelines, 30 day post discharge readmissions, 30 day post discharge mortality, and new Clostridioides difficile infection within 30 days.

Results

A total of 123 patients were included in this study. A Youden index of 7.2% was calculated for the primary outcome. Patients with a positive UARC and UTI symptoms received an average of 7.54 days of antibiotics. Asymptomatic patients with a positive UARC received significantly more antibiotics than those with a negative UARC (3.05 vs 0 days, respectively,p=0.02). Adherence to duration of treatment guidelines was found to be 77.8%, 66.7%, and 50% for uncomplicated cystitis, complicated cystitis and pyelonephritis respectively. No difference was observed between groups for length of stay, 30 day post discharge readmissions, and 30 day post discharge mortality. No cases of new C. difficile infection were identified.

Conclusion

This study demonstrates that the UARC does not have utility as a diagnostic test for predicting a symptomatic UTI. The presence of a positive UARC in the absence of symptoms attributable to a UTI resulted in inappropriate prescribing of antibiotics. Further evaluation of how a UARC is ordered, perhaps requiring prescribers to document urinary symptoms, in addition to caregiver education is warranted

Disclosures

All Authors: No reported disclosures
1682. Health Resource Utilization in Patients with Complicated Urinary Tract Infections (cUTI) and Antibiotic Resistance or Treatment Failure: A Retrospective Database Analysis
Authors: Sulham Katherine , Reese Jennifer
Published: January 2021

Background

In the United States, urinary tract infections (UTIs) are predominately treated in the outpatient setting. Resistance to gram-negative bacteria has substantially increased in recent years, however, and many common oral treatment options continue to lose efficacy. As a result, patients may receive multiple courses of antibiotics at various outpatient settings and may ultimately require hospitalization. Here, we quantify health resource utilization and rate of hospitalization in patients with complicated UTI (cUTI).

Methods

A retrospective study was performed in partnership with Komodo Health, Inc., using aggregate data from the Komodo Healthcare Map™ for cUTI-related events. Inclusion criteria: (1) 2+ UTI-related encounters within 35 days, beginning in 2017-2018, (2) clinical/coding features indicative of treatment failure or antibiotic resistance, or treatment with carbapenem or piperacillin/tazobactam.. Location of service, number of cUTI-related healthcare encounters, and rate of hospitalization following service location were quantified.

Results

1,889,216 cUTI patients with antibiotic resistance or treatment failure were identified; 1,545,559 were included in the site of care analysis. These patients incurred 8,694,236 cUTI-related healthcare encounters in 2017-2018. In 2017, among 1,105,459 patients, there were 385,981 cUTI-related inpatient hospitalizations, 798,574 emergency department (ED) visits, 285,985 long-term care (LTC) stays, 147,291 home health (HH) visits, and 2,534,083 other outpatient (OP) encounters. For patients with an ED visit, the mean number of visits was 1.67/patient; mean number of LTC, HH, and OP visits were 1.67, 3.07, and 2.97/patient, respectively. Of those who were hospitalized, 38% of patients were hospitalized following an ED encounter; hospitalization rates following LTC, HH, and OP visits were 30%, 43%, and 24%, respectively. The 30-day cUTI-related rehospitalization rate for inpatients was 12%. 2018 data was similar.

Conclusion

cUTI is associated with substantial health resource utilization, the majority of which occurs in the outpatient setting.

Disclosures

Katherine Sulham, MPH, Spero Therapeutics (Independent Contractor) Jennifer Reese, PharmD, Spero Therapeutics (Employee)
1710. Comparison of herpes simplex prevalence in serum and semen-cervical sample of infertility patients: A systematic review and meta-analysis
Authors: Chiu Chia-Yu , Sarwal Amara , Yangga Peter , Feinstein Addi , Hennessey Karen
Published: January 2021

Background

Herpes simplex virus (HSV) is a common pathogen of sexually transmitted infections, however the role it plays in the development of infertility is unknown. In animal studies, inoculating murine rete testis with HSV-1 revealed irreversible atrophy of the germinal epithelium. Another study found that human herpesvirus 1 thymidine kinase (HHV-1 TK) protein disrupts spermatogenesis by creating immature sperm and accelerating apoptotic cell death in rodent. Although it is well established that herpes virus affects fertility in male animal models, the question remains as to the effect of HSV in human infertility.

Routine testing of serum HSV IgG/IgM/DNA or HSV PCR in semen-cervical sample is not commonly done in clinical practice, and there are no set guidelines as when to screen. We aim to review the available literature and compare the prevalence of HSV in serum versus semen-cervical samples, focusing on the infertile patient population.

Methods

We searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov from inception to December 2019. Our search terminology included: “Herpes, Human herpesvirus, infertility.” Inclusion criteria required testing to be done on either serum, sperm, menstrual fluid, or endocervical sample in infertile patients.

PRISMA Flow Diagram for study selection.

Results

17 retrospective studies were included in this review. In the male-infertility cohort, a total of 11 studies were compared. The random-effects pooled prevalence was 12.7% in semen sample, and 16.8% in serum sample. In the female-infertility cohort, a total of 6 studies were compared. The random-effects pooled prevalence was 12.1% in menstrual fluid /endocervical sample, and 17.8% in serum sample.

Figure 1. Studies enroll in this meta-analysis, Male

Figure 2. Studies enroll in this meta-analysis, Female

Conclusion

The prevalence of HSV in semen-cervical sample was about 12%, compared to HSV in serum sample is about 17%. Therefore, HSV contribution to infertility will be overestimated when we use serum sample for diagnosis. It is noteworthy to mention that the seroprevalence of HSV IgG is much higher in general population, previously reported at 35% to 50%. In addition, given that current antiviral treatment for HSV has side effects that could cause infertility on its own, as seen in animal studies. More studies are needed to evaluate the role HSV plays in causation of infertility.

Disclosures

All Authors: No reported disclosures
1711. Comparison of the clinical course and prognosis of dengue cases with and without Diabetes Mellitus
Authors: Rivera-Ortiz Lorreine , Torres-Borrero Natasha , Rodriguez-Gonzalez Robert , Alvarado-Domenech Luisa I , Rivera-Amill Vanessa
Published: January 2021

Background

Dengue, the most prevalent arboviral infection disease worldwide affects more than 2.5 billion people. Puerto Rico has endemic transmission of dengue virus (DENV). Chronic diseases like diabetes mellitus (DM) tend to increase susceptibility to infectious diseases. Diabetes mellitus (DM) is also one of the chronic diseases with higher prevalence in the United States (9.1%) and Puerto Rico (12.8%), and its effect on arboviral infections is understudied.

Methods

A Sentinel Enhanced Dengue Surveillance System was established in a tertiary hospital in the southern region of Puerto Rico. Study aims are to describe and compare the clinical course and prognosis of dengue in patients with and without the DM co-morbidity. A retrospective case-control study (2012-2015) was performed, where 1,005 participants with confirmed dengue were identified.

Results

In those with dengue, we examined 57 cases with DM and 171 controls without DM on presentation. Mean age of participants was 40 years old, 31 (54.4%) were males. Relevant clinical features of cases were high blood pressure (HBP) in 51%, muscle pain (70.2%) and joint pain (63.2%). Laboratory results were thrombocytopenia (40%), high creatinine >1.2mg/dl (18.5%), high BUN >20mg/dl (16.6%) and low albumin < 3.4 g/dl (28.7%). For controls, clinical and laboratory results were HBP in 26.9%, muscle pain (64.3%) and joint pain (56.7%); thrombocytopenia (38.6%), high creatinine (4.7%), high BUN (1.8%) and low albumin (21.6%). ANOVA test compared the means of clinical features and laboratory parameters between the case and control groups. The results indicate that high blood pressure, high creatinine and high BUN were significantly more common in cases than in controls (P < 0.01). Cases that had high creatinine (OR = 2.03 [CI: 0.01 – 6.08]), high BUN (OR = 1.30 [CI: 0.93 – 1.81]) and high blood pressure (OR = 1.02 [CI: 0.93 – 1.11]) were more likely to present bleeding, a warning sign for severe dengue. Also, diabetic cases that presented thrombocytopenia were more likely to be admitted to the hospital (OR = 2.64 [CI: 0.36 – 19.37]).

Conclusion

Understanding the clinical manifestation of dengue in patients with DM can increase clinician awareness of the importance of this co-morbidity in order to implement preventive measures and improve clinical outcomes.

Disclosures

All Authors: No reported disclosures
1712. Epidemiology, Clinical Characteristics, and Outcomes of Influenza-Associated Hospitalizations in Children in the post-2009 Pandemic Era
Authors: Kamidani Satoshi , Garg Shikha , Campbell Angela P , Cummings Charisse N , Openo Kyle P , McMullen Chelsea L , Chai Shua , Herlihy Rachel , Yousey-Hindes Kim , Monroe Maya , Kim Sue , Lynfield Ruth , Dufort Elizabeth , Billing Laurie M , Sutton Melissa , Talbot Helen , McCaffrey Keegan , Anderson Evan J
Published: January 2021

Background

Significant changes in influenza vaccination coverage and antiviral treatment guidance occurred following the 2009 influenza pandemic in children. However, data are limited describing recent epidemiology, clinical characteristics, antiviral use, vaccine coverage, and outcomes of influenza-related hospitalizations in children.

Methods

Children < 18 years hospitalized with influenza during seasons 2010–2011 through 2018–2019 were included through the US Influenza Hospitalization Surveillance Network (FluSurv-NET). Age-stratified hospitalization rates were calculated using the number of catchment-area residents with laboratory-confirmed influenza within 14 days prior to or ≤3 days after hospital admission during October 1-April 30 of each influenza season. Data on underlying medical history, influenza vaccination, antiviral use, and outcomes were abstracted from medical records using standard case report forms by trained surveillance officers.

Results

Over 9 seasons, 13,235 children were identified. Stepwise decreases in unadjusted hospitalization rates with age occurred, with the highest rates in infants < 6 months (ranging 56–184 per 100,000 persons) (Fig.1). Among these children, 56% were male, 34% were non-Hispanic White, 55% had a preexisting medical condition, and 8% were immunocompromised (Table 1). Use of antiviral treatment substantially increased from 56% to 85%, and influenza vaccination rates among hospitalized children increased from 34% to 43% over time. Regarding severe outcomes, 2,676 (20%) were admitted to ICU, 2,262 (17%) had pneumonia, 690 (5%) required mechanical ventilation, and 72 (0.5%) died. In univariable analysis, compared to hospitalized infants < 6 months, children >13 years had higher odds of ICU admission (odds ratio (OR), 2.0; 95% CI, 1.7–2.4), mechanical ventilation (OR, 1.7; 95% CI, 1.2–2.3), and pneumonia (OR, 2.6; 95% CI, 2.1–3.3) (Table 2).

Figure 1

Table 1

Table 2

Conclusion

Although influenza-related hospitalization rates decreased with increasing age, severe outcomes were more common among hospitalized older children. Room for improvement exists in influenza vaccination coverage and antiviral use. While 20% of children were admitted to ICU, death was uncommon.

Disclosures

Sue Kim, MPH, Council of State and Territorial Epidemiologists (CSTE) (Grant/Research Support) Melissa Sutton, MD, MPH, CDC funding (Emerging Infections Program) (Grant/Research Support) Evan J. Anderson, MD, Sanofi Pasteur (Scientific Research Study Investigator)
146. Outpatient Antibiotic Stewardship in the COVID Era: Trends in antibiotic prescription in a statewide Veteran’s Affairs health care system
Authors: Werzen Alissa , Dave Rohini , Talwani Rohit , Bork Jacqueline
Published: January 2021

Background

Outpatient antibiotic stewardship is an emerging area of interest. The COVID-19 pandemic has led to unique restrictions such as social distancing and an increase in telemedicine visits. The effects on outpatient antimicrobial prescription needs further exploration.

Methods

We investigated the outpatient antimicrobial prescription trend pre (January 5 to March 14 2020) and post (March 15 to May 31 2020) COVID-19 restrictions at the Veteran’s Affairs Maryland Health Care System. We compared prescribing characteristics pre and post restrictions using Chi-squared and Mann Whitney U tests. Segmented regression analysis was used to compare antimicrobial prescriptions per 1000 encounters, with a control group from the same weeks in 2019.

Results

There were 3,881 total antibiotics prescribed for 382501 encounters during the 16 weeks in 2020. Post-restrictions, there was a significant decrease in encounters and antibiotics per week with mean difference of -15241 and -147, for encounters and antibiotics, respectively. The mean antibiotics per 1000 encounters was slightly higher in the post-restriction group, but without statistical significance by this analysis (10.1 vs 10.4, p-value 0.48). Other notable changes post-prescription described in the Table was a decrease in macrolide and an increase in trimethoprim-sulfamethoxazole; urgent care prescriptions decreased, while primary care prescription increased; and refill prescriptions were less common, while mail prescriptions were more common. On regression analysis, we found a significant level change of +2.7 antibiotics per 1000 encounters (p=0.02) immediately after restrictions were placed, without any significant change in trend (Figure). This translates to an additional 243 antibiotics prescribed during the post-restriction weeks. This was in comparison to data from 2019 which had no significant level or trend change during the same weeks.

Table 1. Characteristics of antibiotics prescribed and comparison between pre and post COVID-19 restrictions in 2020, with 2019 control.

Figure 1. Segmented Regression of antibiotic prescription per 1000 encounters pre and post COVID-19 restrictions with 2019 as control group.

Conclusion

We found an immediate increase in antibiotics relative to encounters post COVID-19 restrictions though antibiotics and encounters were all generally decreased with azithromycin showing the most appreciable decrease. Further investigation is needed to understand these findings and the implications on the population.

Disclosures

All Authors: No reported disclosures
160. A Pre- and Post-intervention Study to Implement a Successful Antimicrobial Stewardship Program in Palliative Care
Authors: McCracken James A , Nakeshbandi Mohamed , Sainvil Carline , Porosnicu Eduard , Sharma Roopali
Published: January 2021

Background

In patients receiving palliative care, medical interventions are transitioned away from aggressive and curative attempts to less invasive and more comfort measures. Antimicrobial usage remains a challenging subject in palliative care decisions, where many physicians focus interventions on reduction of patient pain and discomfort, without consideration for adverse effects such as the development of antimicrobial resistance or patient-specific adverse drug events. With limited data on the comfort benefit, we aimed to assess antimicrobial use in patients at the end of life in our institution as well as the success of targeted stewardship interventions in palliative care patients.

Methods

Patients who expired between November 2018 and August 2019 were assessed retrospectively for antimicrobial use during their last 14 days of life. In January 2020, a prospective stewardship initiative began in collaboration with our institution’s palliative care team to focus antimicrobial interventions on patients involved in goals of care discussions.

Results

In our retrospective review of 200 patients, 139 (69.5%) of patients received antimicrobials in their last two weeks of life, with 50% having formal palliative care consultations. The most commonly used antimicrobials were piperacillin-tazobactam (64.7%) and vancomycin (60.4%), with primary indications being pneumonia (34.5%) and empiric coverage/sepsis (24.5%). Of note, 46% of antimicrobial regimens were eligible for optimization through stewardship initiatives.

From January through February 2020, sixteen stewardship interventions were made on thirteen palliative care patients, with an 81.3% acceptance rate. Duration of therapy based on indication and discontinuation of antibiotics following transition to comfort measures only were the most frequent interventions made.

Table 1. Baseline Characteristics

Table 2. Antimicrobial Usage - Pre-intervention

Table 3. Prospective Intervention Data

Conclusion

Close of half of patients receiving antimicrobials at the end of life are eligible for interventions to improve antibiotic regimens. These patients are often overlooked in antimicrobial stewardship, and, despite small sample size, our study shows the benefit of targeted stewardship in palliative care populations with an intervention acceptance rate of over 80%.

Disclosures

All Authors: No reported disclosures
161. Assessing Antimicrobial Stewardship Engagement among Frontline Oncology Nurses and Chartering a Path Forward
Authors: McCort Margaret E , Bartash Rachel , Cowman Kelsie , Sakalian Susan , Sheridan Carol , Wright Karen , Hopkins Una T , Nori Priya , Nori Priya
Published: January 2021

Background

Developing robust, multidisciplinary antimicrobial stewardship programs to combat drug resistance is a priority of healthcare institutions, in accordance with Joint Commission standards and national legislature. However, the involvement of nurses in stewardship programs has trailed behind that of physicians and pharmacists, despite their unique position as frontline providers. In particular, oncology nursing staff can play a key role in extending stewardship to their high acuity patients, who frequently require antimicrobials. We sought to conduct a survey study of oncology nursing providers on their understanding, perceptions, and attitudes about antimicrobial stewardship.

Methods

A voluntary and anonymous survey was emailed to oncology nursing staff on adult and pediatric oncology wards and clinics throughout our hospital system. We used an adapted 28-item Likert scale-based survey to assess understanding of antimicrobial stewardship attitudes and perceived barriers to greater involvement in stewardship programs. A survey reminder was emailed weekly for 8 weeks and completion was encouraged by nursing leadership in unit staff meetings.

Results

The survey was emailed to 281 nurses, of whom 39% (n=109) responded. 54.1% of nurses believed that an antibiotic stewardship program was very important in their healthcare setting. However, 56% of respondents were unfamiliar with the meaning of antibiotic stewardship, and 83.5% were not aware of how to contact the antimicrobial stewardship team with questions. More than 75% felt that nurses could help with antibiotic use, though 76% indicated wanting to know more about which antibiotics treat different infections and 74% wanted to know more about appropriate durations of antibiotics.

Conclusion

Oncology nurses have the potential to play a valuable role in antimicrobial stewardship. Barriers to nursing involvement include knowledge gaps on antibiotics and unfamiliarity with existing stewardship programs and their functions within hospital systems. Nursing education and orientation to available resources are key steps to involving nursing staff in antimicrobial stewardship programs, maximizing benefits for both patients and hospitals.

Disclosures

All Authors: No reported disclosures
178. Implementation of the Core Elements of Antibiotic Stewardship in Nursing Homes – National Healthcare Safety Network (NHSN), 2016–2018
Authors: Gouin Katryna A , Anttila Sarah Kabbani; Angela , Mak Josephine , Mungai Elisabeth , McCray Ti Tanissha , Bell Jeneita , Hicks Lauri , Stone Nimalie D
Published: January 2021

Background

Since 2016, nursing homes (NHs) enrolled in the Centers for Disease Control and Prevention’s NHSN Long-term Care Facility (LTCF) Component have reported on their implementation of the core elements of antibiotic stewardship. In 2016, 42% of NHs reported implementing all seven core elements. Recent regulations require antibiotic stewardship programs in NHs. The objectives of this analysis were to track national progress in implementation of the core elements and evaluate how time dedicated to infection prevention and control (IPC) is associated with the implementation of the core elements.

Methods

We used the NHSN LTCF 2016–2018 Annual Surveys to assess NH characteristics and implementation of the core elements, defined as self-reported implementation of at least one corresponding stewardship activity. We reported absolute differences in percent implementation. We used log-binomial regression models to estimate the association between weekly IPC hours and the implementation of all seven core elements, while controlling for confounding by facility characteristics.

Results

We included 7,506 surveys from 2016–2018. In 2018, 71% of NHs reported implementation of all seven core elements, a 28% increase from 2016 (Fig. 1). The greatest increases in implementation from 2016–2018 were in Education (+19%), Reporting (+18%) and Drug Expertise (+15%) (Fig. 2). Ninety-eight percent of NHs had an individual responsible for antibiotic stewardship activities (Accountability), with 30% indicating that the role was fulfilled by an infection preventionist. Furthermore, 71% of NHs reported pharmacist involvement in improving antibiotic use, an increase of 27% since 2016. NHs that reported at least 20 hours of IPC activity per week were 14% more likely to implement all seven core elements, when controlling for facility ownership and affiliation, 95% CI: (1.07, 1.20).

Conclusion

NHs reported substantial progress in antibiotic stewardship implementation from 2016–2018. Improvements in accessing drug expertise, providing education and reporting antibiotic use may reflect increased stewardship awareness and use of resources among NH providers under new regulatory requirements. NHs with at least 20 hours dedicated to IPC per week may have greater capacity to implement all core elements.

Disclosures

All Authors: No reported disclosures
191. The impact of antibiotic use on clinical outcomes in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis
Authors: Vafea Maria Tsikala , Belani Neel , Vieira Kendra , Farmakiotis Dimitrios
Published: January 2021

Background

Observational studies and experimental models suggest that use of antibiotics close to the administration of immune checkpoint inhibitors (ICI) can negatively affect tumor response and patient survival. This observation may be attributed to microbiome dysbiosis and the resultant suppression of host immune response against neoplastic cells.

Methods

We conducted a systematic search of PUBMED and EMBASE databases and references of articles retrieved. We included studies published between 1/1/17 and 2/1/20, which evaluated the association between antibiotic use and clinical outcomes in cancer patients treated with ICI. Primary endpoints were overall survival (OS), progression free survival (PFS), response rate (RR) and progressive disease (PD) rate. We performed a study-level random-effects meta-analysis with pooling of hazards ratios (HR) for OS, PFS, and odds ratios (OR) for RR and PD (PROSPERO ID: CRD42020166473).

Results

We included 41 studies with a total of 10,857 patients. The most common malignancies were lung cancer (59.7%), melanoma (23.1%), renal cell and urothelial carcinomas (8.1%). OS and PFS were shorter, RR lower, and PD higher in patients receiving antibiotics, both in univariate analyses and after adjustment for other confounders. Heterogeneity was significant for all outcomes, less so for adjusted OS and PFS (Table). To our knowledge, this is the largest meta-analysis on the association between antibiotic use and efficacy of ICI, and the only one to address RR and PD to-date.

Association between antibiotics and clinical outcomes.

Conclusion

We demonstrated a significant association between antibiotic use and unfavorable clinical outcomes in patients with cancer receiving ICI. Such patients may be an important target group for antibiotic stewardship interventions. The high heterogeneity across all outcomes underscores the need for more detailed, patient-level studies with stratification by host, antibacterial and cancer treatment factors.

Disclosures

All Authors: No reported disclosures