bluuebunny/crossref_metadata_2025 huggingface dataset:
2412. Whole-body PET scans for infective endocarditis: differences in patient characteristics and outcomes
Authors: Simpson Kaitlyn , Park Jason , Riddell Jamie
Published: November 2023

Background

Whole-body 18F-FDG PET/CT (WBP) has the potential to impact management of infective endocarditis (IE) through identification of areas of occult primary or metastatic infection. This study compares the characteristics and outcomes in groups of patients with IE who did and did not have WBP as part of their evaluation to help guide how this imaging may be optimally utilized.

Methods

We performed a retrospective cohort study of hospitalized patients discussed at the multidisciplinary endocarditis meeting at a tertiary care center in Michigan, USA between June 2018 and January 2022. Protocolized chart review was performed by three study team members.

Results

There were 114 (26.7%) patients with suspected IE who had WBP and 313 (73.3%) who did not. The two groups were similar in age, gender, and race. Patients with ESRD on dialysis (p=0.01), cardiac and/or ascending aortic prosthetic material (p< 0.001) or endocardial devices (p=0.01), and those who had cardiac PET (P< 0.001) were more likely to have undergone WBP. Complications such as paravalvular abscess (p=0.004) and flail leaflet (p=0.01) were more common in the non-WBP group. There was no difference in surgical indication between groups, though the WBP group had a non-significant trend of not receiving cardiac surgery (p = 0.05). WBP was associated with a longer-course of antibiotics (6.36 vs 5.32; p< 0.001) and suppressive antibiotics (30.70% versus 13.42%; p< 0.001). Within the WBP group, 45.61% had a change in management after imaging with the most common changes being further infectious (20.18%) or non-infectious (9.65%) workup, source control procedure performed (10.52%), and antibiotic regimen change (9.64%). No other outcomes between groups were significantly different between groups including length of stay, 6-month readmission, 6-month infection relapse, 6-month mortality or in-hospital mortality.

Conclusion

Although a mortality benefit was not observed, WBP played an important role in the management of patients with IE with identification of areas of metastatic infection that required longer antimicrobial treatment or addition of suppressive antimicrobials. Further analyses are planned to understand which patients with IE may benefit most from WBP.

Disclosures

All Authors: No reported disclosures
2427. Characterization of Early Healthcare-Associated Infections (HAI) After Implantation of Left Ventricular Assist Devices (LVAD)
Authors: Kling Kendall , Moore William J , Zembower Teresa , Jirak Alison , Nonog Gretchen , Magliola Grace , Harap Rebecca , Wilcox Jane , Pham Duc , Wu Tingqing , Byrd Heather , Stosor Valentina
Published: November 2023

Background

LVADs are established for therapy for heart failure and are implanted in > 2,500 patients in the US annually, but are complicated by infection in up to 60% of patients. Our aim was to characterize the spectrum and epidemiology of post-LVAD infections.

Methods

We performed a single-center prospective observational study of 17 patients post-LVAD implantation from 7/2022 to 3/2023. Demographics, clinical, and microbiological data were collected as part of a study examining these changes in the cutaneous microbiome of the LVAD driveline (DL) site over the duration of LVAD support. Summary and descriptive statistics were performed.

Results

Of the 17 patients, the mean age was 56.7, the majority were male, non-Hispanic White, and had chronic kidney disease (Table 1). Mean follow up was 136 days (range 17-265). VAD-related infections included 3 blood stream infections (mean post-LVAD date 42.3) (Table 2). There was a total of 8 episodes of hospital acquired pneumonia (HAP) in 4 unique participants. Urinary tract infections occurred in 35.3% (n=6), intra-abdominal infection in 17.6% (n=3), and skin and soft tissue infection in 5.9% (n=1). Multi-drug resistant organisms (MDRO) were detected in 8 participants, including vancomycin-resistant Enterococcus (n=1 for UTI and n=8 for rectal colonization), carbapenem-resistant Enterobacteriaceae (n=1), and C. difficile (n=3). Two participants expired due to heart failure (n=2) and infection (n=1).

Conclusion

We observed a high rate of early HAI post-LVAD implantation, including MDRO infections, and a strikingly high rate of VRE acquisition (47%). C. difficile infection rates were also high at 18%. Further study is needed to determine risks for MDRO infection and whether early HAI impact the LVAD DL microbiome and development of LVAD infection.

Disclosures

Valentina Stosor, MD, DiaSorin S.p.A.: Advisor/Consultant|Eli Lilly & Company: Grant/Research Support
2434. Healthcare-associated Infections in the Era of COVID-19 Pandemic: An Experience from a Tertiary Care Hospital in Long Island, New York
Authors: Sajib Monirul I , Adams Tamasin , Donelan Susan V , Go Roderick , Saldivar Miguel A
Published: November 2023

Background

Healthcare-associated infections (HAIs) such as central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI) and ventilator-associated events (VAE) are associated with increased patient morbidity, mortality, and healthcare related cost. One could expect a decrease in the incidence of HAIs during the COVID-19 pandemic due to the enhanced infection control measures and increased awareness among the healthcare workers. The aim of our study is to assess the prevalence of HAIs during the 2 years of COVID-19 pandemic compared to 2 years prior to the pandemic at Stony Brook University Hospital, located in Long Island, NY.

Methods

Standardized infection ratio (SIR) and percentile data for CLABSI, CAUTI, SSI and VAE were collected from the National Healthcare Safety Network website for hospitalized patients between January 2018 to December 2019 and between July 2020 and June 2022. Data between January 2020 to June 2020 was not available due to voluntary reporting at the beginning of pandemic. Superficial SSI cases were excluded. Data on organisms involved in CLABSI during this period were also collected.

Results

During January 2018 to December 2019, SIR (percentile) for CLABSI, CAUTI, SSI and VAE are 0.623 (38), 0.455 (31), 1.129 (72) and 0.941 (44) respectively, whereas during July 2020 to June 2022, SIR (percentile) are 0.558 (34), 0.854 (63), 0.870 (56) and 1.316 (53) respectively, with p-value of 0.6149, 0.0007, 0.2471, and 0.0035 and relative risk of 0.896, 1.877, 0.771, and 1.399 respectively. In addition, during January 2018 to December 2019, S. aureus (8), coagulase-negative Staphylococcus (10), Streptococcus (2), Enterococcus (12), gram-negative rods (21) and Candida spp (11) were associated with CLABSI, versus S. aureus (5), coagulase-negative Staphylococcus (2), Streptococcus (2), Enterococcus (14), gram-negative rods (19), and Candida spp (13) during July 2020 to June 2022.

Comparison of HAIs during 2 years prior to the COVID-19 pandemic to 2 years of pandemic.

Organisms associated with CLABSI during 2 years prior to the COVID-19 pandemic compared to 2 years of pandemic

Conclusion

We did not observe a significant reduction in CLABSI and SSI cases during the 2 years of COVID-19 pandemic compared to pre-pandemic phase; however, a significant rise in CAUTI and VAE cases were seen which we suspect is due to the increased urinary catheter and ventilator utilization during the COVID-19 pandemic.

Disclosures

Roderick Go, DO, Aptose Biosciences: Stocks/Bonds|Bristol Meyers Squibb: Stocks/Bonds|Cytodyn Inc.: Stocks/Bonds|Scynexis: Grant/Research Support
2435. Stewardship – It’s Not Just Antibiotics and Testing
Authors: Sampson Mindy , Passaretti Catherine , Eichenblat Siobhan , Kester Shelley , Layell Jessica , Noonan Laura , Billings Corrianne , Bischoff Werner
Published: November 2023

Background

Longer central line (CL) dwell times are associated with increased risk of central line associated blood stream infections (CLABSIs). Removal of invasive devices when they are no longer clinically indicated is key to CLABSI prevention.

Table 1

Comparison of the Device Review Programs Impact on Central Line Utilization Rates and CLABSI Rates

Methods

Our health system designed two quality improvement initiatives intended to serve as external review and feedback processes on the necessity of invasive devices. Line Stewardship (LS) was initiated March 2022 in Hospital A and later implemented in 6 acute care facilities. A team consisting of infection preventionists (IP), vascular access nurses and nurse leaders performed chart reviews to determine if CLs met institutional criteria for necessity. If no indication for the device was found, the clinical team was contacted to recommend removal. The second program was called Infection Prevention Integration Program (IPIP), which had a stepwise rollout throughout 2022 in 5 acute care facilities. This program involved IPs joining multi-disciplinary rounds to make recommendations on device removals.

Results

Hospital A piloted the LS program in 8 units and during the first year, removed 398 CLs, and saw a reduction in the CLABSI rate compared to the year prior (Table 1). Similarly, implementation of IPIP led to a reduction in the CLABSI rate. Both non-LS and non-IPIP units reported an increase in CLABSI rates during the intervention period compared to baseline (Table 1).

Conclusion

Both programs saw improvements in CLABSI rates, achieving the goal of reducing infections. IPIP units saw a larger decrease in the utilization rate compared to LS units. This may be due to differences in the criteria used to determine eligibility for line review. Also, there were differences in unit selection; general wards were selected in LS facilities and intensive care units in IPIP facilities. Both LS and IPIP teams noted benefits of the program beyond line removal in improved attention of staff to overall infection prevention practices. Given the increases seen on non-LS and non-IPIP units, it is important to ensure resources aren’t being diverted away from non-intervention units. While both interventions are time and resource intensive, they led to a reduction in CLABSI burden justifying the necessary institutional support.

Disclosures

All Authors: No reported disclosures
2436. Infections In Patients Undergoing Extracorporeal Membrane Oxygenation (ECMO) At A Tertiary Centre In India
Authors: Santosh Gattu , Narreddy Suneetha , Polati Vishnu Rao , Barigala Ravikiran , ramesh venkat , panigrahi niranjan , sharma ratnamani
Published: November 2023

Background

Infections are a major cause of mortality among patients receiving ECMO treatment. However, little is known about the prevalence and spectrum of infections affecting ECMO patients in India and the factors that contribute to increased risk of infections and mortality in these cases.

Methods

This study presents a retrospective analysis of ECMO patients admitted between 2018-2022. The study recorded demographic information, ECMO indication, duration, type of infection, and outcomes. The primary objective of the study was to determine the prevalence of microbiologically-proven nosocomial infections. The study also aimed to identify secondary factors associated with an increase in the number of infections and mortality.

Results

During the study period, 37 patients received ECMO support, with a mean age of 44.97±14.19 years. The most common indication for ECMO was respiratory failure secondary to ARDS. 26 (70.3%) patients were placed on VV-ECMO, while 11 (29.7%) patients received VA-ECMO. 29 patients (83.4%) developed infections, with an incidence of 147.1 infections per 1000 ECMO days. Ventilator-associated pneumonia (48.04%) was the most frequently reported type of infection, followed by bloodstream infection (47.1%). The most commonly isolated organisms were Klebsiella pneumoniae (27%), Acinetobacter baumanii (15%) and B. Cepacia (13%) with Staphylococcus and Enterococci accounted for only 10% of infections. Additionally, carbapenem resistance was found in 80% and 100% of Klebsiella and Acinetobacter isolates respectively. Candidemia accounted for 10% of infections, with one patient developing candidemia as early as 4 days after ECMO initiation. Our study revealed a mortality rate of 62% among those who developed infections versus 51% in those who did not develop infections. Patients who developed infections more frequently required CRRT (62% vs. 12.5%, p =0.013). Longer the duration of ECMO, greater the number of infections were observed ( < 7d- 24%; 7-14d- 33.65% & >14d- 42.3%) (Table-4).

Figure-1

Distribution (%) of Nosocomial infections

Figure-2

Distribution (%) of Pathogens

Table-2

Requirement of CRRT among ECMO patients

Conclusion

There was a high incidence of infections (particularly due to carbapenem resistant organisms) in ECMO patients in our study. Infection risk correlated with duration of ECMO and need for CRRT.

Table-3

Correlation between CRRT & Mortality

Table-4

Correlation of number of infections with ECMO Duration

Disclosures

All Authors: No reported disclosures
2446. Effect of the Implementation of a Fluconazole Prophylaxis Protocol on the Incidence of Invasive Fungal Infection in High-Risk Neonates
Authors: Isada Patricia Marie D , Pagcatipunan Marimel
Published: November 2023

Background

Invasive fungal infection (IFI) is one of the most important causes of morbidity and mortality in the neonatal intensive care unit. International societies have supported the use of fluconazole prophylaxis for neonates weighing < 1000 grams, but administration to other high-risk patients remains controversial. An institutional fluconazole prophylaxis guideline was implemented in December 2020 to include two other groups of neonates.

Methods

One hundred thirty infants who were admitted at the NICU from January 2020 to January 2022 and fulfilled one of the following criteria: weight of < 1000 grams (Group A), weight of ≤1500 grams and on broad-spectrum antibiotics (Group B), or weight of >1500 grams and on prolonged nil per os (NPO) (Group C) were included in the study. They were divided into two groups: those who were born prior to the implementation of the protocol (January to December 2020) and not given fluconazole prophylaxis, and those born after (January 2021 to January 2022) and given prophylaxis. The primary outcome was the development of IFI.

Results

A total of 130 infants were included in this study with 21 (5 control, 16 prophylaxis), 69 (28 control, 41 prophylaxis), and 40 (16 control, 24 prophylaxis) patients in Groups A, B, and C, respectively. There were no significant differences in the development of IFI among the groups (Group A: control - 40%, prophylaxis - 62%; Group B: control - 21.4%, prophylaxis - 22%; Group C: control - 29.2%, prophylaxis 31.5%) with a p-value of > 0.05. The presence of a central vascular access line, endotracheal tube, placement on NPO, histamine H2-blockers, and necrotizing enterocolitis were associated with the development of IFI. Candida parapsilosis comprised 60% of isolates. All isolates had 100% susceptibility to fluconazole. Jaundice developed in 3.7% of patients given fluconazole, with elevations in AST, ALT, and TB.

Incidence of fungal infection in high-risk neonates

There were no significant differences in the development of IFI among the three high-risk groups, with p-value of > 0.05.

Conclusion

Invasive fungal infection remains a heavy burden to high-risk neonates. The protocol at present does not significantly prevent the occurrence of IFI. There is a need to revise the protocol to include the presence of a combination of multiple risk factors (central line, endotracheal tube, prolonged NPO, H2-blockers, and necrotizing enterocolitis) before initiating fluconazole prophylaxis.

Disclosures

All Authors: No reported disclosures
2448. Emergence of Candida auris in a Delaware Healthcare System
Authors: Pheiffer Rebecca , Briody Carol , Anderson Ken , Cyril Elicious , Harris Lajune , Heckman Timothy , Kelly Stephanie , Luckner Kathleen , Moeller Julia , Pal Carmen , Penn Ryan , Power Michelle , Ritter Carol , Stanton Ann-Catherine , Drees Marci
Published: November 2023

Background

In Aug 2022, a patient was admitted to our facility after blood cultures revealed C. auris; this was the first case identified in Delaware. The patient had been cared for in our system 2 mo previously and was admitted from a long-term acute care hospital. In Sep 2022, two additional cases were identified who had been recently or were currently admitted to our transitional medical (stepdown) unit (TMU).

Methods

We worked with the Delaware Division of Public Health (DPH) to establish protocols to identify colonized cases via biweekly point prevalence (PP) surveys of all patients currently admitted on TMU using the public health laboratory; later we transitioned to weekly PP via a commercial lab to improve frequency and turnaround time. Patients were screened using axillary/groin swabs. We provided ongoing staff education; improved adherence to hand hygiene and contact isolation precautions; created auto-isolation orders for newly identified and readmitted patients; and reviewed disinfectants. Environmental Services (EVS) performed enhanced cleaning of all patient rooms and auxiliary areas on the unit, and added ultraviolet light and curtain changes for all terminal cleans. DPH performed an Infection Control Risk Assessment (ICAR) to identify further opportunities. We expanded these interventions to our medical ICU (MICU) when cases were identified there, and added admission surveillance screening of high-risk patients to TMU or MICU.

Results

Between Aug 2022 – Mar 2023, 64 patients with C. auris were identified (55 [86%] via PP surveys) (Table). Greater than 94% of eligible patients were successfully screened each week; PP positivity rate ranged from 0-30% (Fig). Admission screening continued to identify new cases admitted to these units. Four (6.5%) patients initially identified with C. auris colonization developed clinical infections.

Characteristics of Patients Identified with Candida auris Colonization or Infection

Conclusion

Despite expending significant lab, EVS and other personnel resources to improve patient identification and infection control practices, once C. auris was established in the units it was unable to be eradicated. These resources were not sustainable; we are shifting from PP to expanded admission screening while maintaining environmental cleaning and infection prevention practices.

Disclosures

All Authors: No reported disclosures
2457. Improved Identification of Primary Infection Sites in Suspect Central Line Bloodstream Infections (CLABSI) through Preliminary Blood Culture Notifications
Authors: Bischoff Werner , Kieta Cheryl , LaFontaine Tiffany , Billings Corrianne
Published: November 2023

Background

Central Line Bloodstream Infections (CLABSI) pose a significant risk for patients with high burden of morbidity and mortality. Accurate and timely identification of these events is paramount for the development of effective interventions.

Methods

A quasi-experimental (before/after) study included all inpatients with central venous catheters (CVC) admitted to five acute care hospitals in North Carolina. Starting in 03/2022 all preliminary blood culture results were evaluated within 24 hours by surveillance infection preventionists (SIP) and results indicative of potential CVC infection were escalated to medical teams. Escalation included identification of potential primary site infections, and discussion of the need for further testing and documentation. Mid-P exact tests were used to compare CLABSI burden before and after the intervention.

Results

From 03/22 through 03/23 preliminary blood culture results in a total of 498 cases were reviewed by SIP. Of those, 201 (40%) were escalated to the IP team with 94 determined to be CLABSI, and 107 (53%) referred to further assessment by IP and medical teams. A primary infection site other than CVC was established based on escalation conversations in 23 events leading to a reduction in potential CLABSI cases by 11.4%. Standardized Infection Ratios for all and publicly reportable locations were reduced by 13% and 27% (table 1).

Of the 23 events interventions led to the establishment of a primary site of infection or documentation for exclusion criteria: pneumonia (9, 39%), burn (6, 26%), endocarditis (2, 9%), patient line injection (2, 9%), central line documentation clarification (1, 4%), intraabdominal infection (1, 4%), necrotizing enterocolitis (1, 4%), and skin infection (1, 4%). Interventions included imaging studies, culture collection of purulent sites, and documentation clarification including: abnormal/changes in wound characteristics, patient line injection, central line documentation.

Conclusion

Moving the process of CLABSI identification from finalized blood cultures to preliminary blood culture results improved the accuracy of CLABSI detection. Early inclusion of medical teams in the discussion of potential CLABSI increased awareness of the source of infection.

Disclosures

All Authors: No reported disclosures
2470. A Survey of the Collection of Denominator Data in the Korean National Healthcare-associated Infections Surveillance System (KONIS), Intensive Care Unit Module
Authors: Kwak Yee Gyung , Lee Mi Suk
Published: November 2023

Background

National surveillance data should be validated to identify data quality issues. While denominator data can have a significant effect on the healthcare-associated infection (HAI) rate, they are relatively overlooked compared to numerator data. The Korean National Healthcare-associated Infections Surveillance System (KONIS) has been conducting data validation, and this study analyzed the current status of, and problems with, collecting denominator data for the first time.

Methods

The web-based cross-sectional survey was conducted on January 6, 2023 on 183 infection control nurses from 127 hospitals, among a total of 275 participating hospitals in the KONIS ICU module. The questionnaire was delivered using the QR code method and answered online by participants via SurveyMonkey®. The survey examined denominator data collection methods, such as patient days and device days of central lines and urinary catheters. The knowledge of the types of central lines and urinary catheters for KONIS reporting and the responses to case questions about specific situations related to the calculation of device days, were also evaluated.

Results

The respective proportions of manual vs. electronic methods for counting denominator data were 10.4% vs. 81.4% for patient days, 22.4% vs. 67.8% for central line days, and 23.5% vs. 69.4% for urinary catheter days. About 27.3%, 29.5%, and 31.1% of respondents reported periodically checking the accuracy of patient days, central line days, and urinary catheter days data, respectively. Infection control nurses were responsible for collecting the majority (66.1%) of the denominator data and entering them into the Web-based Report and Analysis Program (88.0%). The survey results indicated that the rate of accurately understanding and responding to the case questions on device days for central lines ranged from 24.6% to 78.7%, while for urinary catheters, it ranged from 27.3% to 92.3%.

Conclusion

To maintain the reliability of the national HAI surveillance data, it is important to collect accurate denominator data, in addition to numerator data. This study has identified several areas where improvements in denominator data collection methods are needed. Continuing education on the definition of denominator data and accurate data collection methods is crucial.

Disclosures

All Authors: No reported disclosures
2491. The Association of Parkinson’s Disease with Hepatitis C Virus Infection and Its Treatment
Authors: Aslam Samia , Yan Peng , Butt Adeel A
Published: November 2023

Background

There are contradicting reports regarding the relationship between hepatitis C virus (HCV) infection and its treatment with idiopathic Parkinson’s Disease (PD). We sought to determine the association of HCV infection and its treatment with idiopathic PD.

Methods

We used the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES), as well characterized national cohort of HCV infected Veterans and uninfected controls to create a dataset of HCV infected individuals and propensity-score matched (PSM) uninfected controls, matched on age, race, sex, body mass index, using nearest neighbor matching with a caliper of 0.2 SD. We excluded individuals with prevalent PD diagnosis (any PD diagnosis before the first HCV positive test date and the match date for corresponding controls), HIV or hepatitis B virus coinfection from both groups, and those with missing or undetectable baseline HCV RNA values among the HCV infected group. PD was defined as presence of > 1 inpatient or > 2 outpatient ICD-10 CM codes. HCV treatment was defined as receipt of any FDA-approved treatment with combination directly acting antiviral agents for > 30 consecutive days. Cox regression analysis was used to determine the probability of disease-free survival for HCV infected and uninfected, and among the HCV infected for those treated and untreated for HCV.

Results

We identified a total of 25,579 matched pairs. Incident idiopathic PD was diagnosed in 344 (1.34%) of HCV+ and 252 (0.99%) of HCV- individuals. Among the HCV+, 9,445 (36.9%) were treated and 91 (0.96%) were diagnosed with PD; while 16,134 were untreated and 161 (1.00%) were diagnosed with PD. Kaplan-Meier curves showed no difference in the probability of remaining PD-free between HCV+ and HCV- (log-rank p=0.5; see figure), while among the HCV+, those who were treated had a higher probability of remaining PD-free over median of 10.5 years (IQR 5.3-15.6; maximum 23.6 years) of follow-up (log-rank p < 0.001; see figure).

Conclusion

While we did not find a difference incidence of idiopathic PD among HCV+ vs. HCV- individuals, HCV+ individuals who received anti-HCV treatment were less likely to develop incident idiopathic PD over a median of 10.5 years of follow up.

Disclosures

Adeel A. Butt, MBBS, MS, Gilead Sciences: Grant/Research Support|Merck and Company: Grant/Research Support
2499. What Are We Waiting for? Chronic Hepatitis C Treatment Initiation During Inpatient Admission
Authors: Ham YoungYoon , Ryu HaYoung , Williams Carissa , Babiarz Jane , Varley Cara D , Streifel Amber C , Maier Marissa , Conte Michael , Govindan Sujeet
Published: November 2023

Background

Chronic hepatitis C virus (HCV) infection is highly prevalent among people who inject drugs. This vulnerable population experiences many barriers to engaging with the healthcare system. Evaluating and treating HCV during a hospital stay can be an opportunity to cure and prevent adverse HCV complications in a population that can be difficult to reach in an outpatient setting.

Methods

This was a retrospective review of treatment outcomes of patients who started on treatment for HCV infection with direct acting antivirals (DAAs) while hospitalized at an academic medical center between January 2022 and January 2023. DAAs were dispensed by outpatient pharmacies and brought into the hospital for patient use. Various teams were involved in the treatment of these patients and level of support varied between groups, ranging from full social services and pharmacy support to follow-up clinic visits only. Data collected included demographics, insurance type, injection drug use, housing status, DAA agents used, treatment duration and completion status, and sustained virological response (SVR) 12 or more weeks post-treatment.

Results

A total of 17 patients began treatment with DAAs while hospitalized. Sixteen (94%) were treated with glecaprevir-pibrentasvir for 8 weeks, while 1 (6%) received sofosbuvir-velpatasvir for 12 weeks. Sixteen (94%) reported using injection drugs and 12 (71%) reported unstable housing. All patients had government-managed health insurance, with 16 having Medicaid. Twelve (71%) patients completed treatment: 9 of 12 patients who completed treatment attained SVR12 and 3 were lost to follow up after treatment completion. Of the 5 patients who did not finish treatment, 2 attained SVR12 despite incomplete therapy, 1 is not yet due for SVR12, and 2 were lost to follow up.

Conclusion

In a vulnerable population with barriers to outpatient care, in-hospital evaluation and DAA initiation is a valuable opportunity to cure. Further evaluation is needed to optimize and implement strategies for inpatient HCV treatment initiation.

Disclosures

All Authors: No reported disclosures
2510. Adapting the CDC HCV viral clearance cascade methodology for persons with HIV (PWH) and HCV co-infection in 5 Health Department Jurisdictions in the US
Authors: Wegener Maximilian D , Brooks Ralph P , Nichols Lisa G , Villanueva Merceditas
Published: November 2023

Background

Cascades of care have been used by health departments to evaluate outcomes and gaps in HIV care and until recently, no standard existed for HCV cascades. The CDC guidance for HCV viral clearance cascades allows standardized use of HCV surveillance data. We adapted this approach for persons with HIV/HCV coinfection for 5 health jurisdictions in the US.

Methods

Lists of coinfected persons were generated by matching HCV surveillance data to prevalent HIV surveillance (eHARS) as of 12/31/2019. Dispositions based on HCV test results were created for viral clearance cascade steps: ever infected, viral testing, initial infection, cleared, and persistent infection. We collected aggregate data from each jurisdiction’s prevalent HIV, HCV, and coinfected populations. Quarterly updated data were submitted and analyzed from 12/31/2019-12/31/2021.

Results

Overall, jurisdictional coinfected populations were White (61%), Male [sex at birth] (75%), over 45 (76%) with IDU as HIV transmission risk factor (44%). As of most recent submission: virally tested was 73% (jurisdictional range 65-88%) of ever-infected; initial infection 83% (81-89%) of virally tested; cleared 44% (21-63%) of initial infection. Those more likely to receive viral testing include persons over 45, IDU, and those with more recent HCV and HIV lab tests; less likely were MSM (HIV transmission) along with Asian and Native American persons. Those more likely to achieve HCV clearance include those over 45, those with more recent HCV and HIV lab tests, and persons with undetectable HIV viral loads; less likely were Transgender persons.

Conclusion

Diverse health jurisdictions successfully developed data strategies including enhancing HCV surveillance databases to implement the CDC HCV viral clearance cascade adapted for persons with HIV/HCV co-infection. Jurisdictions are now able to not only assess HCV cure rates of their co-infected population but testing and treatment gaps as well. The viral clearance cascades can provide key implementation strategy data for HCV microelimination through the development of innovative engagement strategies focused on the identified gaps.

Disclosures

Ralph P. Brooks, MS, Merck: Stocks/Bonds
2528. Cefepime Induced Neurotoxicity in Patients With or Without a History of Seizures
Authors: Baalbaki Nadeem , Hoge Christopher , Dar Aleena , Mohsen Mahinaz , Sackey Joachim , Salim Tanzila
Published: November 2023

Background

Cefepime is a commonly utilized antimicrobial for the treatment of nosocomial infections and serves as a carbapenem sparing agent for the treatment of ampC inducible bacteria. Although generally tolerated, cefepime induced neurotoxicity (CIN) is a well-documented adverse effect that has been observed most significantly in patients with renal dysfunction and elevated serum troughs. Data describing the incidence of CIN in patients with a history of seizures is currently limited.

Methods

This was a retrospective matched cohort study of patients admitted to University Hospital from May 2020 to May 2022 who were treated with cefepime for > 48 hours with or without a baseline history of seizures. Patients with seizures were identified using ICD-10 codes. Patients were matched at a rate of 1:1 by age (+/- 5), sex at birth, and month of admission (+/- 1). The primary outcome was the rate of CIN in patients with a history of seizures versus patients without a history of seizures. The secondary outcome was identification of risk factors associated with CIN.

Results

A total of 102 patients were included in this study (51 in each group). There was no statistically significant difference in the rate of CIN in patients with a history of seizures versus patients without a history of seizures (11.8% vs 5.9%, P = 0.487). In a univariate analysis, patients with acute kidney injury (OR, 13.1 [95% CI, 2.3-74.8]) and an intensive care unit (ICU) stay (OR, 5.3 [95% CI, 1.04-36.4]) were associated with an increased risk of CIN. In a multivariate analysis, duration of cefepime administration was the only risk factor associated with CIN that was statistically significant (OR, 1.94 [95% CI 1-3.8]).

Conclusion

There was no statistically significant difference in the rate of CIN in patients with a history of seizures compared to patients without a history of seizures, although there were twice as many patients with CIN in the seizure group. Patients with acute kidney injury and an ICU stay were more likely to experience CIN in a univariate analysis, however confidence intervals were wide requiring caution with interpretation. There was a 1.94 times increase in the odds of CIN with every additional day of cefepime administration. Further investigations with larger sample sizes are warranted to confirm these findings.

Disclosures

All Authors: No reported disclosures
2543. Multisite Analysis of Vancomycin Predictions in a Bayesian Software in Patients with and without Acute Kidney Injury in Adult and Pediatric Patients
Authors: Hughes Maria-Stephanie , Hughes Jasmine
Published: November 2023

Background

Inpatients that require vancomycin therapy often present with an acute kidney injury (AKI). Due to their unstable renal function, pharmacists hesitate to base dosing decisions on predictions provided by pharmacokinetic (PK) models within a Bayesian software. This study will therefore compare accuracy of predictions by various PK models in patients presenting with and without AKI.

Methods

Adult and pediatric patients receiving vancomycin therapy from 1/1/2022 - 12/31/22 that were dosed using a Bayesian software were retrospectively evaluated. Data on patient age, weight, height, serum creatinine (SCr), sex, and vancomycin doses and levels were recorded. Baseline SCr was defined as the median of SCrs before vancomycin was given. AKIs at start of therapy were defined as a baseline SCr or any SCr collected < 12 hours into therapy that was > 1.5 times higher than any subsequent SCrs. A priori accuracy was calculated by measuring root mean square error (RMSE) of 7 PK models for patients with and without AKIs at start of therapy. Statistical difference between RMSE values was determined by non-overlapping 95% confidence intervals.

Results

A total of 149,100 adult and 4,311 pediatric patient treatment courses were included (see Table 1). Higher RMSE, or lower accuracy, was seen in the AKI groups for all models evaluated, and all except one were statistically different (see Table 2). The RMSE in the group without an AKI at baseline ranged from 4.27 - 6.70 mg/L whereas in the AKI group it ranged from 4.58 - 7.31 mg/L. The absolute difference between groups for each model ranged from 0.03 - 2.05 mg/L and the percent difference ranged from 0.45-39%.

Conclusion

PK models had reduced accuracy in patients with an AKI at start of therapy compared to those that do not. However, differences were small and statistical differences were likely detected due to large sample sizes. For adults, the Colin and Thomson models showed small (< 10%) reductions in accuracy in patients with an AKI, while for pediatric patients, the Kloprogge model showed equal accuracy in all patients regardless of AKI status. These findings may help pharmacists decide whether to use PK models to inform initial vancomycin dosing.

Disclosures

Maria-Stephanie Hughes, PharmD, InsightRX: Stocks/Bonds Jasmine Hughes, PhD, InsightRX: Employee
2579. Pneumonia Severity Index and CURB-65 scoring for the evaluation of community associated pneumonia in patients with cancer at a major cancer center
Authors: Gali Varshini , Lee Yeon Joo , Jani Krupa , Kaltsas Anna , Seo Susan K , Cintron Melvili
Published: November 2023

Background

Cancer patients with pneumonia (PNA) have 2 to 21 times higher mortality rate compared to the general population. The Pneumonia Severity Index (PSI) and CURB-65 scale have been used to predict mortality for patients with community acquired pneumonia (CAP). While these scales are well studied in the general population, there is a paucity of research on the utility of PSI and CURB-65 for predicting outcomes from CAP in patients with cancer. In this study, we assessed the relationship between PSI and CURB-65 score and 30-day mortality of CAP in cancer patients at Memorial Sloan Kettering Cancer Center (MSKCC).

Methods

A prospective study at MSKCC was conducted between 01/2023 and 06/2023 on patients who presented with clinical symptoms consistent with PNA and had a urine streptococcus antigen test sent for evaluation. PNA was defined as pulmonary infiltrates on chest X-ray or CT < 48 hours of index event and ≥ 1 clinical symptoms (fever, cough, dyspnea, increased sputum production, hypoxemia). Descriptive statistics were performed to report participant outcomes based on PSI and CURB-65 score and to identify the factors associated with CAP in this population. PSI and CURB-65 scores were derived as described in the literature, based on patient comorbidities (including neoplasia), clinical signs and laboratory values. Higher score is associated with worsening 30-day mortality.

Results

For 86 participants with who presented with symptoms of PNA and had a urine antigen test sent, 43 (50%) were diagnosed with CAP (Figure 1). The median age was 70 (range: 29-88), 21 (49%) were male, and 16 (37%) had hematologic malignancies (Table 1). Etiologies of CAP were identified in 8 patients (bacteria in 4 patients, virus in 3 patients, fungus in 1 patient). Of the 28 patients with 30-day outcome data available, 5 (18%) died within 30 days of CAP diagnosis. All 5 deceased participants were categorized as PSI Class IV or V (moderate to high risk); however, these participants only scored 0-2 (low to moderate risk) on the CURB-65 scale (Table 2).

Conclusion

We observed a 30-day overall mortality (n=28) of 18%. For cancer patients who present with CAP, PSI class provides a better means to assess mortality risk than CURB-65 score. Further study is needed to validate our findings.

Disclosures

Yeon Joo Lee, MD, MPH, AiCuris: institutional research support for clinical trials|Karius: institutional research support for clinical trials|Merck: Grant/Research Support|Scynexis: institutional research support for clinical trials Susan K. Seo, MD, Merck: Grant/Research Support
2582. Real-World Analysis of the Outcomes of Patients Treated with Ceftazidime-Avibactam
Authors: Wazzi-Mkahal Rayyan , Mansour Reem , Hamade Mahdi , Ghoussaini Racha , Tashman Adeeb , Doumat George , Abou-Fayad Antoine , Matar Ghassan , Kanj Souha S , Kanafani Zeina
Published: November 2023

Background

Ceftazidime-avibactam (CAZAVI) is a novel β-lactam/β-lactamase inhibitor combination with activity against Pseudomonas aeruginosa and some carbapenem-resistant Enterobacterales. CAZAVI has been particularly useful as a carbapenem-sparing strategy to mitigate the selection pressure observed with carbapenems. We aim to perform a real-world analysis of patients treated with CAZAVI for various clinical indications at a tertiary care center in Lebanon.

Methods

This is a retrospective study conducted at the American University of Beirut Medical Center from 2019-21. We excluded patients who were less than 18 years old, received CAZAVI for less than 48 hours, had severe COVID-19 infection, received more than three courses of CAZAVI, and patients on palliative care before CAZAVI treatment. Data were collected from electronic medical records. The primary endpoint was unfavorable outcome defined as death or incomplete clinical response.

Results

A total of 301 patients were included contributing 373 infection episodes. The median age was 66 years, with 48% of patients being male, and 55% having a high Charlson Comorbidity Index (CCI) of ≥ 5. A large proportion of patients had been admitted to the intensive care unit and had received antibiotics for more than 48 hours during the preceding 30 days. The majority of infection episodes were hospital-acquired (66%). The most common indication for CAZAVI was respiratory infection (44%) followed by bacteremia (9%). Clinical cultures were positive in 44% of episodes distributed as Enterobacterales 64%, P. aeruginosa 10%, and polymicrobial 26%. Clinical success was 66% and microbiological success was 52%. Mortality was 32%, 65% of which was directly attributable to the infection. The primary endpoint was achieved in 38% of episodes. Multivariate analysis of independent predictors of unfavorable outcome is shown in the Table.

Independent Predictors of Unfavorable Outcomes in Patients Receiving CAZAVI

Conclusion

Results from this highly morbid patient population suggest a good overall response to CAZAVI therapy. The presence of multiple infection sites is an important predictor of unfavorable outcome.

Disclosures

Souha S Kanj, MD, Gilead: Advisor/Consultant|Menarini: Advisor/Consultant|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant
2595. Burden of Lower Respiratory Tract Infection in United States of America and its Trend from 1990-2019: A Benchmarking Analysis from the Global Burden of Disease Study
Authors: Raj Deepti , Rao Mallyala Sahithi , Chirumamilla Avinash , Gajjar Jay , Patel Sneh , Dekhne Anushka , Dineshbhai Desai Hardik
Published: November 2023

Background

Lower respiratory infections (LRIs) cause substantial mortality and morbidity in the United states of America (USA) accounting for 2.78% of all causes of deaths. However, there is a large statewide variation within the United States with regard to LRIs burden. Comparable and consistent state-level measures of total LRIs burden have not been produced previously.

Methods

We used Global Burden of Disease Methodology to estimate the burden of LRIs by Age-groups, year, sex, location across the USA.

Results

In 2019, there were 299,564(95% UI 281,732–317,390) prevalent cases of LRIs in the USA, with an age-standardized rate (ASR) of 85.2 (95% UI 78.8-91.9) per 100,000 population. The annual percentage change of total number incidence increased by 14% followed by deaths increased 13% from 1990-2019. Furthermore, Mississippi [20.49 (95% UI 17.4–23.9)] per 100,000 and Tennessee [19.1 (95% UI 16–22.5)]per 100,000 had the highest age-standardized mortality rate (ASMR) in 2019. In 2019, the incidence and DALY were highest in the 60-64 age group,75-79 age group respectively in both females and males.

Age-Standardized Incidence, Mortality and DALYs Lower Respiratory Tract Infection in United States, 2019

Trend of Lower Respiratory Tract Infection in USA from 1990-2019

A) All age-counts, Incidence, Death, DALY B) Age-standardized rate Incidence, Death, DALY

Sex-wise distribution of Lower Respiratory Tract Infection, Deaths, per 100,000 across the United States

Conclusion

LRIs continue to be a significant burden on the healthcare system in the United States, causing a significant economic impact and affecting vulnerable populations disproportionately. Preventive measures and prompt treatment can help reduce this burden and improve the overall health of the population.

Disclosures

All Authors: No reported disclosures
2603. Acceptance of Pharmacist-Led Stewardship Recommendations for Patients with Community-Acquired Pneumonia
Authors: Walker Ramara E , Pallotta Andrea , Schulte Rebecca , Tereshchenko Larisa , Criswell Victoria A , Deshpande Abhishek , Rothberg Michael
Published: November 2023

Background

Community-acquired pneumonia (CAP) is a leading cause of hospitalizations and mortality in the US. Overuse of extended spectrum antibiotics (ESA) for CAP contributes to antimicrobial resistance. The 2019 Infectious Diseases Society of America/American Thoracic Society guidelines emphasize de-escalation of ESA following negative cultures, early switch to oral (PO) antibiotics and limited duration of therapy (DOT). This study describes physician acceptance of pharmacist-led stewardship recommendations in hospitalized CAP patients.

Methods

This intervention is part of an ongoing, large, pragmatic, 2×2 factorial, cluster-randomized, controlled trial across 12 Cleveland Clinic hospitals evaluating the independent and combined effects of pharmacist-led de-escalation and rapid diagnostic testing versus usual care in adults with CAP. The pharmacist developed and delivered the following interventions: ESA de-escalation, DOT, intravenous (IV) to PO transition, and antimicrobial discontinuation. Descriptive statistics were used to describe acceptance rates by prescribers for each pharmacist intervention types.

Results

From November 1, 2022 to March 16, 2023, the pharmacist recommended 317 interventions for 212/1533 CAP patients (14%). Of the recommended interventions, 57.5% were for patients receiving an ESA during their hospitalization, and 16% were for patients classified as having severe CAP. ESA de-escalation, DOT, IV to PO transition, antimicrobial discontinuation, and other interventions made up 22%, 45%, 18%, 11%, and 4% of the total recommended interventions, respectively. Providers accepted 238 recommendations (75%); they were most likely to accept recommendations for ESA de-escalation (60/69, 87%) and IV to PO transition (48/56, 86%), followed by antimicrobial discontinuation (26/35, 74%), and other (10/13, 77%). Recommendations to limit DOT were least likely to be accepted (94/144, 65%). CAP recommendations were made to the following prescribers: physicians (83%) and advanced practice providers (17%) with equal acceptance rate (75%).

Summary of CAP-targeted intervention acceptance rates by intervention category

Conclusion

Approximately 1 in 7 patients garnered a CAP recommendation. While most recommendations were accepted, prescribers were most receptive to de-escalating ESA and least receptive to limiting DOT.

Disclosures

Abhishek Deshpande, MD; PhD, Merck: Advisor/Consultant|Seres Therapeutics: Grant/Research Support Michael Rothberg, MD, MPH, Blue Cross Blue Shield: Advisor/Consultant