bluuebunny/crossref_metadata_2025 huggingface dataset:
P-1711. Evaluation of Microbiology and Antibiotic Prescribing Behavior of Foot Puncture Wound Infection: An Opportunity for Antimicrobial Stewardship
Authors: Kim Brian , Arab Niki , Jeng Arthur
Published: January 2025

Background

The primary pathogen(s) of soft tissue infections, including those of the foot, are β-hemolytic Streptococci and Staphylococcus aureus (SA). Pseudomonas aeruginosa (PsA) has been implicated as a cause of foot infections after sustaining a nail puncture wound through a sneaker, historically leading to recommendations for prescribing empiric anti-PsA antibiotics (abx). At Olive View-UCLA Medical Center (Sylmar, CA), we evaluated the microbiology and empiric abx prescribing behavior of foot puncture wound infections.

Methods

Retrospective chart review on adults (≥ 18 years) admitted with an ICD-10 code for puncture wound from January 1, 2017 to December 31, 2023. Inclusion criteria included foot infection after sustaining nail, screw, staple, thumbtack, or razorblade puncture. Non-foot puncture wound and puncture from an object other than those listed in the inclusion criteria were excluded. Anti-PsA abx was defined as either piperacillin-tazobactam, cefepime, ceftazidime, or ciprofloxacin.

Results

58 cases were reviewed and 45 met inclusion criteria. The majority of puncture wound was due to nail (n=34, 76%) followed by screw (n=6, 13%) [Table 1]. Empiric anti-PsA abx was prescribed in the emergency department in 41/45 (91%); empiric anti-PsA abx was prescribed or continued by the admitting physician in 19/45 (42%). Anti-PsA abx average days of therapy (DOT) was 2 days [IQR 2-3]. Wound culture was obtained in 44 cases, with no isolation of PsA. The majority of pathogens consisted of methicillin-susceptible SA (26/44 cases, 59%) and Streptococcus agalactiae (19/44, 43%) [Figure 1]. Infection involving both SA and Streptococcus spp. was seen in 15 cases (34%). Subsequent foot infection with PsA within 30 days of puncture wound infection did not occur in any cases.

Conclusion

PsA was not isolated in any cases of foot puncture wound infections, although the majority were started on an empiric anti-PsA abx, per historical recommendations. The primary pathogen(s) were SA and/or Streptococcus spp. Therefore, current evidence shows that PsA is not a significant pathogen of foot puncture wound infections, and this represents an opportunity for antimicrobial stewardship services to prioritize empiric abx against SA and Streptococcus spp., and not against PsA, for this infection type.

Disclosures

All Authors: No reported disclosures
P-1712. Comparison of Vancomycin vs Linezolid for Treating Adult Patients with sCAP Admitted to the ICU
Authors: Viñán Garcés André Emilio , Sanabria-Herrera Natalia , Duque-Vallejo Sara , Garcia-Gallo Esteban , Reyes Luis Felipe F
Published: January 2025

Background

Community-acquired pneumonia (CAP) remains the leading cause of infectious mortality worldwide. Regarding its etiology, Staphylococcus aureus has been associated with its development and a higher mortality risk than other microbiological etiologies. Current recommendations allow empiric use with either vancomycin or linezolid in patients with risk factors for MRSA, although no consensus exists on which therapy is more beneficial. This study aims to determine if there is a difference in mortality and survival between patients treated with these antibiotics.

Comparison between general characteristics of patients receiving vancomycin and linezolid.

Methods

Data from adult patients with CAP and ICU admission with either linezolid or vancomycin administration for at least 72 hours were extracted from the prospective MIMIC-IV database. A univariate analysis was employed to determine the differences between the patients who received each treatment. Subsequently, a survival analysis adjusted by infection severity using a Cox proportional hazards model was conducted.

Survival analysis for both in-hospital and one-year mortality. A. Kaplan-Meier for One-year Survival Probability; B. Kaplan-Meier for In-hospital 28-day mortality

Results

A total of 2457 adult patients were included, with 98% (2412/2457) receiving vancomycin and 2% (45/2457) Linezolid. The mean age was 68 (56-79), and 56.5% (1389/2457) were male. The most frequent comorbidities in both treatment groups included chronic pulmonary disease (40.9% vs 51.1%; p= 0.169) and congestive heart failure (37.9% vs 42.2%; p=0.55). Both groups presented similar severity of infection, physiological values at admission, and outcomes (Table 1). Survival analysis demonstrated a higher one-year survival probability in the patients receiving Linezolid group. Cox regression analysis revealed a significant association between SAPS II score and mortality (HR = 1.024, 95% CI: 1.02 - 1.028, p < 0.001) (Figure 1). However, when adjusting the survival analysis by disease severity, we did not find ny statistical differences.

Conclusion

While there is no definitive consensus regarding the superiority of empirical anti-MRSA treatments, these results support the idea that linezolid is associated with better outcomes in terms of mortality in patients with sCAP. However, this protective effect was not observed after adjusting by disease severity. Further prospective studies are needed to support these conclusions.

Disclosures

All Authors: No reported disclosures
P-1729. Implementation of a Vancomycin AUC and Trough-based Dosing Policy Across a Large Health-system Reduced Trough Levels, Acute Kidney Injury Events, and Hospital Length of Stay
Authors: Christensen Alyssa , Nelson Zachary , Peglow Rebecca
Published: January 2025

Background

Vancomycin dosing guidelines recommend area-under-the-cure (AUC) over trough-based dosing for severe MRSA infections. Optimal dosing of non-severe or non-MRSA is unknown. Conflicting data exists on the real-world benefits of implementing AUC-based dosing methods.

Methods

A standardized vancomycin dosing policy was implemented across an 8-hospital healthsystem in MN and WI. Prior to implementation, most hospitals targeted troughs between 15-20 for severe MRSA infections. The new policy recommended AUC-based dosing for patients with known or suspected severe MRSA infections and lower trough goals (10-15) for all other patients. DoseMeRx was used to calculate AUC and adjust doses. Vancomycin levels, AKI-coded diagnoses, and length of hospital stay (LOS) were compared 6 months pre and post intervention. An approximate and conservative $7,000 cost avoidance was assigned per AKI event based on a literature review.

Results

8,458 patient encounters were included over the 12 month study period (4084 pre, 4,374 post) representing 7,142 patients (3,517 pre, 3,825 post). Average cumulative vancomycin doses were lower in the post group by 401 mg (4,838mg vs 4,435mg). The number of trough levels greater than 15 was significantly reduced post-intervention (56.9% vs 40.6%, p < 0.001). There was a 25% relative reduction in AKI-coded encounters (13.0% vs 9.6%, p < 0.001) and reduction in average LOS (7.8 vs 7.2 days; p < 0.001 ). The number of encounters with S.aureus positive blood cultures was the same between groups (13.0%). The number of patients who received at least one dose of piperacillin/tazobactam was higher in the post-group (36.0% vs 39.7%). The reduction in AKI events was associated with a $1,029,000 cost avoidance.

Conclusion

A system vancomycin dosing policy that incorporated both AUC and trough-based dosing methods was associated with a significant reduction in trough levels > 15, AKI events, and LOS. This represented a significant cost-avoidance of approximately $1,029,000 over a 6-month implementation period.

Disclosures

All Authors: No reported disclosures
P-1774. Order sets paired with facilitation training to effectively reduce postoperative surgical prophylaxis
Authors: McKay Virginia , McGovern Collin , Saito Jacqueline M , Rangel Shawn , Bono Kelly , Newland Jason G , Malone Sara
Published: January 2025

Background

Inappropriate surgical antibiotic prophylaxis occurs in up to 40% of cases, primarily reflecting unnecessary postoperative doses ( >24hrs) in clean or clean-contaminated cases. It accounts for approximately 20% of all inappropriate use in children’s hospitals. We described order set outcomes from the Operatic Trial to compare two strategies, order set changes versus order set change with facilitation, to reducing excessive postoperative prophylaxis.Figure 1.Stepped-wedge trial design comparing order set change only (control) versus order set change plus a facilitation workshop (intervention) attended by the ASP team at the beginning of each step. Nine children’s hospitals were randomized to 1 of 3 cluster. Each cluster included 3 hospitals and each step was 6 months in duration.

Methods

The operatic trial was a stepped-wedge cluster randomized control trial with nine US children’s hospitals (11/1/2020-10/31/2023), with 6 steps lasting 6 months each (Figure 1). Antimicrobial stewardship teams were recruited and enrolled. After 6 months of all hospitals starting in control (step 0) of changing order sets, 3 hospital ASP teams in steps 1-3 participated in a virtual facilitation workshop (int). Facilitation is a strategy that supports people in health services organizations develop the means to change the structure and processes within settings, and clinicians can be educated on the skills and expertise to become an effective facilitator. Hospital ASP teams were surveyed every 2 months to evaluate order set changes.

Results

Approximately 75% of order set changes attempted were completed (65/85). Table 1 describes completed order set changes demonstrating a variety of specialties targeted and a focus on reducing prophylaxis duration. Importantly, only 4 were initiated and completed in the pre-intervention period, while the remaining were either initiated pre-intervention and completed post-intervention or initiated and completed post-intervention suggesting that facilitation training supported order set change completion. The median time to complete an order set change was 5 months. Individuals also reported other activities to support change, for example data dashboards and paper-based guidance.

Conclusion

Changing order sets is an effective approach to reduce excess antibiotic use in children’s hospitals. Facilitation played a role in the successful completion of order sets, including potentially assisting teams to complete order set changes that were initiated prior to facilitation training.

Disclosures

Jason G. Newland, MD, MEd, Moderna: Grant/Research Support|Pfizer: Grant/Research Support
P-1822. Management of Patients with a History of Penicillin Allergy: A Retrospective Observational Study from Saudi Arabia
Authors: Alhifany Abdullah A
Published: January 2025

Background

It has been estimated that 8 to 25% of populations studied globally are labeled penicillin-allergic. However, almost 90% of these patients may not have a true allergy upon work-up, which led prescribers to substitute β-lactams unnecessarily with other broadspectrum antibiotics. Therefore, the aim of this study was to describe how patients with a history of penicillin allergy are treated for infectious diseases, and determine the cost associated with alternative antibiotics.Table I.Baseline characteristics of patients with a documented history of penicillin allergy.

Methods

A retrospective observational study conducted in a tertiary-care teaching hospital in Riyadh, Saudi Arabia. Approval was obtained from the Institutional Review Board, and electronic health records (EHRs) of patients were included if they were 18 years old and older, labeled to have penicillin allergy, and were admitted in medical wards or treated as outpatients.

Results

Among the 235 included patients, the type and severity of allergy reactions were not reported in the majority of patients 200 (85%) and were described in only 35 (15%) patients, which 27 (12%) of them had IgE-mediated allergic reactions (angioedema, anaphylaxis, bronchospasm, and urticaria). None of the cases were referred to an immunologist. Most common antibiotic indications included surgical prophylaxis 81 (33%), followed by respiratory 64 (27%) and gastrointestinal infections 40 (17%). For patients with documented penicillin allergy, macrolides were the most used alternative antibiotics followed by clindamycin, cephalosporins, and fluroquinolones in 63 (26%), 56 (24%), 50 (21%), and 30 (12%) patients, respectively.

Conclusion

This study reveals that mislabeling penicillin allergies in Riyadh's tertiary hospital leads to using less effective antibiotics, increasing adverse reactions, infections, and healthcare costs. It emphasizes improving allergy verification to enhance antibiotic use and reduce expenditures.

Disclosures

All Authors: No reported disclosures
P-1853. Peripheral blood monocytes pro-inflammatory and anti-inflammatory cytokine release in elderly patients with heart failure with reduced ejection fraction
Authors: Mitsuke Yasuiko , Itoh Kazuhiro , Iwasaki Hiromichi
Published: January 2025

Background

Heart failure with reduced ejection fraction (HFrEF) has benn reported to characterize by sub-clinical inflammation status. There are few reports about changes in selected biomarkers of inflammation concomitant with the release of pro-inflammatory and anti-inflammatory cytokines by monocyte in elderly patients with HFrEF.

Methods

We measured plasma levels of the cytokines in 62 elderly Japanese HFrEF patients (aged 85.8 ± 2.7 years, left ventricular ejection fraction 33.7 ± 3.5%) and 20 healthy controls. Peripheral blood monocytes (PBM) obtained from HFrEF patients were stimulated by LPS (10 μg/ml) in the absence or the presence of adenosine (10 μmol/l). After 6hr incubation, the cytokines levels in the culture supernatants were measured by ELISA.

Results

Plasma levels of TNF-alpha, IL-6, IL-10, and IL-12p40 were significantly greater in HFrEF patients than in controls. Plasma IL-12p40 levels of HFrEF patients showed significant correlations with IL-6 and IL-10. In vitro study, adenosine inhibited the generation of pro-inflammatory cytokines from LPS-stimulated PBM (TNF-alpha: 764.2±32.3 to 242.5±55.3pg/ml, IL-6: 82.3±13.5 to 21.4±4.2 pg/ml, IL-12p40: 164.8±23.5 to 18.2±5.1, all p< 0.01), while it augmented IL-10 generation (29.2±6.1 to 54.9±7.8pg/ml, p< 0.01) significantly.

Conclusion

Our data indicated plasma levels of pro-inflammatory and anti-inflammatory cytokine were elevated in eldely patients with HFrEF relating. Adenosine may represent a new pharmacological intervention in such HFrEF patients,the clinical significance of these findings deserves further investigation

Disclosures

All Authors: No reported disclosures
P-1867. Under-Recognized Medication Loss with the Administration of Small-Volume Intermittent Infusions
Authors: Dave Aamir S , Saunders-Hao Patricia , Jain Sumeet , Graci Michele , Luo Evelyn
Published: January 2025

Background

Most antimicrobials administered via intermittent intravenous (IV) infusion are diluted in 50 to 100 mL of diluent. The primary infusion set for a smart pump can hold 25 mL of volume in its tubing, which can contribute up to a 50% drug loss if residual volume is present after administration is complete. For antimicrobials, this may lead to significant underdosing, contributing to poor treatment outcomes and antimicrobial resistance. Many organizations lack departmental policies and procedures (P&P) to ensure complete administration of small-volume intermittent infusions (SVIIs). Previous studies propose several recommendations, such as adding carrier fluids and flushing the line, but there is no easy fix to this common issue.

Methods

Our aim was to implement new guidance in 2 pilot patient units (an ICU and non-ICU) to address the administration of SVIIs and evaluate its effect on medication administration. This was an observational quality improvement initiative assessing the new guidance established for the administration of SVIIs to the current practices at North Shore University Hospital. The new guidance consisted of nursing education to reinforce proper administration techniques and to adjust infusion volumes for overfill. This study was IRB exempt. The primary outcome of this study was the incidence of residual drug volume in IV line before the air-detector, IV bag, or IV vial. This was done through direct observation and data was collected through a survey. Chi-square tests were used to analyze the primary outcomes.

Results

In total, 203 IV administrations were observed, 86% were antimicrobials. There were 124 IV administrations observed before policy guidance initiation, and 79 after initiation. There was a significant reduction in the incidence of fluid remaining in the IV line before the air-detector (85% vs 27%; p-value < 0.001), the IV bag (59% vs. 7.6%; p-value < 0.001), and in the IV vial (47% vs. 24%; p-value < 0.001).

Conclusion

The interventions significantly decreased the incidence of fluid remaining in the IV line, presumably decreasing medication loss. Since most medications were antimicrobials, this may improve clinical outcomes. This will be used to update P&P to standardize IV administration practices and improve patient care.

Disclosures

All Authors: No reported disclosures
P-1872. Dalbavancin workflow for inpatient discharges: a multidisciplinary model
Authors: Baldino Maria , Hanretty Alexandra , Kludjian Geena , Pedroza Lisa , Nahra Raquel
Published: January 2025

Background

The role of dalbavancin (DAL) for the treatment of deep-seated infections is of growing interest. The long half-life, extensive tissue distribution, and ease of administration makes it ideal for use in populations that have physical or social barriers to treatment with standard antibiotics for infections such as endocarditis, septic arthritis, and osteomyelitis. A workflow for DAL in high-risk populations has previously not been well described. Our aim is to describe the multidisciplinary approach to DAL on discharge and describe impact on readmissions, length of stay and adherence.Figure 1:Dalbavancin inpatient to discharge workflow

Methods

A multidisciplinary approach at a tertiary academic healthcare system included nursing, antimicrobial stewardship (ASP), infectious diseases (ID) and addiction medicine (AM) to develop a workflow to identify DAL patients and improve adherence (figure 1). Patients had to be clinically stable with evidence of deep-seated infection from confirmed or strongly suspected Gram-positive organisms with plausible susceptibility to DAL and lack of any reliable oral antibiotic options (feasibility, drug toxicity, drug-drug interactions, resistance, or inability to comply with oral medication due to socioeconomic barriers). DAL had to be recommended by ID or ASP. Patients on buprenorphine (BUP) had their second dose aligned with an AM appointment. Patients were excluded if they left against medical advice prior to DAL, had lack of source control, persistent bacteremia, severe vancomycin allergy, or were discharged to a rehab or skilled nursing facility.Table 1:Patient Demographics

Results

Seventy patients were treated with DAL; six patients via the AM pathway and 64 via the standard pathway. In total, 57 patients (81.4%) completed the recommended treatment. In patients who had two doses prescribed, there was 67% completion. In total, 1691 hospital days were avoided. There were 14 readmissions, none were due to DAL failure. Two patients experienced anaphylaxis with their 2nd dose.

Table 2: Patient Outcomes

Conclusion

This approach demonstrates that in high-risk populations, DAL can be an effective treatment strategy for invasive infections resulting in high rates of treatment completion. Our data is limited as it does not evaluate outcomes in comparison to standard of care.

Disclosures

Alexandra Hanretty, PharmD, Abbvie: Advisor/Consultant
P-1874. Impact of Compromised Host AntimicRobial Management Service (CHARMS) on All Cause Readmission in Solid Organ Transplant Patients Discharged on Intravenous Antimicrobials
Authors: Footer Brent W , Bartelt Luther A , Friedland Anne , Lachiewicz Anne , Seña Arlene C , Andermann Tessa , Arant Elizabeth C , Bowman Mary Catherine , Deyo Zack , van Duin David
Published: January 2025

Background

The Compromised Host AntimicRobial Monitoring Service (CHARMS) was created to support safe, efficient, streamlined care for immunocompromised patients discharged on outpatient parenteral antimicrobial therapy (OPAT). However, outcome data for OPAT programs in solid organ transplant (SOT) is lacking and to our knowledge no published literature specific to this patient population exists. The purpose of this study is to evaluate the effect of CHARMS on hospital readmission in SOT patients discharged on OPAT.Table 1.Baseline Characteristics at Start of OPAT Course*Includes patients with multiple organs and/or multiple transplants of the same organ

Methods

This study utilized a quasi-experimental study design with pre- and post-CHARMS implementation periods of 1/1/23-6/30/2023 and 9/1/23-4/30/24, respectively. No patients were enrolled during the two-month period of CHARMS implementation. All adult SOT patients seen in consultation by infectious diseases and discharged from UNC Medical Center on IV antimicrobials were included. The primary endpoint was 30-day all cause hospital readmission. Secondary endpoints were all cause hospital readmission over the entirety of the OPAT course and central venous catheter (CVC) complications.Table 2.Baseline Infection Related Characteristics

Results

30 and 43 OPAT courses were included in the pre- and post-CHARMS cohorts, respectively. There were minimal differences in baseline characteristics with no difference in the median duration of IV antimicrobials (Table 1). Approximately 25% of patients in each group were treated for bacteremia and more patients in the pre-intervention group were treated for cytomegalovirus (13.3% vs. 2.3%, p=0.067) (Table 2). More patients in the post-intervention group received >1 IV antimicrobial (39.5% vs. 20%, p=0.036) (Table 3). In terms of outcomes, 30-day all cause hospital readmission was decreased in the post-intervention group (pre: 36.7% vs. post: 25.6%, p=0.310). Similarly, a decrease in all cause hospital readmission over the entirety of the OPAT course was observed in the post-intervention group (pre: 43.3% vs. post: 25.6%, p=0.112). CVC complications did not differ between the groups (pre: 10% vs. post: 11.6%, p=0.827).Table 3.Antimicrobials Received During OPAT

Conclusion

There was trend towards decreased 30-day all cause readmission in SOT patients managed by a dedicated compromised host OPAT service. Additional patients are needed to evaluate the full impact of the program.

Disclosures

David van Duin, MD, PhD, Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Qpex: Advisor/Consultant|Roche: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support
P-1875. A Quality Initiative to Understand Risk Factors for Pneumonia Readmissions at a Regional Medical Center
Authors: Morgan Chloe A , Jaronko Jaime , Schembri Frank , Manzoor Kamran
Published: January 2025

Background

Pneumonia is a significant cause of hospitalizations in the United States, with 1 million pneumonia-related hospital admissions in 2014. Additionally, patients discharged after pneumonia treatment have a high all-cause 30-day readmission rate between 17%-25%. In order to create a quality improvement initiative to decrease pneumonia readmissions, we sought to identify risk factors, rates, and causes of readmission in patients with index admissions due to pneumonia.

Most Common Readmission Comorbidities

Methods

We performed a manual review of deidentified electronic medical record (EMR) data to select adult patients hospitalized for pneumonia for four consecutive months over two years (August to November 2022 and 2023) at a regional medical center. We assessed the primary cause of readmission for patients readmitted within 30 days of discharge to understand the risk factors, associated comorbidities, and care received.

Results

EMR review identified 161 hospitalizations due to pneumonia in 8 months. Of these, 24 patients (15%) were readmitted within 30 days of hospital discharge, and most (15) of these readmissions were within 15 days. Notably, only 2 readmissions (8.3%) were due to pneumonia-related causes. The two most common causes for readmission were infections other than pneumonia (25%) and renal failure (21%). Most readmissions (14 readmissions [58%]) were classified as at risk for aspiration, and 4 (17%) were associated with opioid use. The most frequently seen comorbidities in readmission were aspiration risk/dysphagia, chronic kidney disease, chronic obstructive pulmonary disease, and atrial fibrillation (Figure 1). 15 out of 24 patients (63%) did not have a 30-day follow-up with their primary care provider.

Conclusion

Our data suggest that most readmissions were not directly related to pneumonia, further suggesting that patient comorbidities and risk factors play a more significant role. Quality improvement programs should focus on a broad, multidisciplinary approach to identify the most vulnerable patient populations and associated risk factors and prioritize prompt outpatient follow-up with a primary care physician.

Disclosures

All Authors: No reported disclosures
P-1895. Outpatient Parenteral Antimicrobial Therapy Multidisciplinary Partnership Reduces Readmissions and Emergency Center Visits in a Comprehensive Cancer Center
Authors: Dailey Garnes Natalie J , Rowan Meagan , Pena Jaime , Kamath Meghan , Florack Ashlyn Anastasia , Finder Janice , Baulis Jessica E , Amistad Wesley , Jiang Ying , Adachi Javier
Published: January 2025

Background

Outpatient parenteral antimicrobial therapy (OPAT) programs have reduced readmissions without impacting emergency center (EC) visits. Our initial pilot OPAT program improved laboratory monitoring without decreasing readmissions or EC visits. We expanded the program and made additive quality improvement interventions.

Outcomes Associated with Outpatient Parenteral Antimicrobial Therapy Interventions in Patients Receiving Care at a Comprehensive Cancer Center

*Previously published initial pilot program. **Compared with baseline among patients with >/= 1 EC visit.

OPAT, Outpatient parenteral antimicrobial therapy; APP, advanced practice provider; EMS, electronic medical system; EC, emergency center; ID, infectious diseases

Methods

We obtained demographic data and baseline frequencies of 30-day unplanned readmissions and EC visits from our electronic medical system (EMS) for 48 patients over 6 weeks prior to pilot implementation. Using the Model for Improvement, we made iterative additions, including pharmacist regimen review, monitoring within the EMS, online commercial laboratory result access, weekly nursing phone calls after discharge, and expansion to infectious disease outpatient starts. After interventions, we compared categorical variables to baseline by using Chi-square or Fisher’s exact test, as appropriate, and compared continuous variables by using nonparametric Wilcoxon rank sum test. We performed multivariable logistic regression to identify risk factors independently associated with readmission.

Results

During June 2018–November 2023, our OPAT program provided care for 1,274 patients. Readmissions decreased from 30% to 15% (p = 0.02) (Figure). Mean number of EC visits per patient decreased (1.3 vs. 1.0, p = 0.002). In multivariable analysis, EMS monitoring and online access to laboratory results were independently associated with decreased readmission risk (aOR 0.22 [95% CI: 0.09-0.56]). Nursing calls after discharge independently protected against readmission (aOR 0.18 [95% CI: 0.07-0.47]). Patients with Eastern Cooperative Oncology Group-Performance Status ≥2 were readmitted more often than those with < 2 (aOR 1.63 [95% CI: 1.05-2.52]).

Conclusion

Improving efficiency and access to laboratory data and weekly nursing phone follow up were associated with fewer readmissions among OPAT patients with cancer. This study is the first, to our knowledge, to show an impact of OPAT on EC visits in any population. OPAT patients with poor functional status have an increased risk for readmission and may benefit from closer monitoring. OPAT programs can improve safety for adult patients with cancer despite competing risks inherent to this population.

Disclosures

Natalie J Dailey Garnes, MD, MPH, MS, AlloVir: Grant/Research Support
641. Real-Time Whole Genome Sequencing Surveillance of Healthcare Associated SARS-CoV-2, Respiratory Syncytial Virus (RSV) and Influenza
Authors: Rangachar Srinivasa Vatsala , Griffifth Marrisa P , Patrick Rose , Waggle Kady D , Okonkwo Dumebi , Van Tyne Daria , Snyder Graham M , Sundermann Alexander , Pless Lora , Harrison Lee
Published: January 2025

Background

Seasonal respiratory viruses contribute to substantial healthcare burden, marked by elevated rates of hospitalizations, morbidity and mortality. The transmission dynamics of respiratory viruses in adult acute care hospitals are not well described. To address this, we performed whole genome sequencing (WGS) surveillance to investigate transmission of SARS-CoV-2, RSV, and influenza among hospitalized patients in a single health system.

Methods

From August 30, 2023 to March 31, 2024, nasal swab specimens positive for SARS-CoV-2, influenza, or RSV were collected weekly from inpatients hospitalized for ≥ 3 days from two hospitals. Additional specimens collected from the same patient within a 14-day period were excluded. Specimens with qPCR cycle threshold (Ct) values ≥ 34, ≥ 39, and ≥ 31 for SARS-CoV-2, RSV and influenza, respectively, were excluded from WGS. WGS was performed using tiled PCR amplicons or Twist Bioscience hybridization method, followed by bioinformatic analyses to assess genetic relatedness [≤ 2 single nucleotide polymorphisms (SNPs) except for influenza (≤ 3 SNPs)]. Clusters were further investigated for epidemiological connections (shared locations or staff).

Results

We collected 179 SARS-CoV-2, 37 influenza and 16 RSV specimens, of which 93 specimens did not meet the inclusion and the qPCR QC criteria. We sequenced 84% (87/104) of SARS-CoV-2, 86% (19/22) of influenza, and 92% (12/13) of RSV specimens. Of these, 45% (39/87) of SARS-CoV-2 and 32% (6/19) of influenza genomes formed genetically related clusters, each with 2-4 patients. We identified an epidemiological link for 73% (11/15) of SARS-CoV-2 and 100% (2/2) of influenza clusters (Fig. 1 & Fig. 2). For RSV genomes, we identified one cluster with two epidemiologically linked patients (Table1). On average, the transmission clusters spanned a duration of 15 days (range: 1−35 days, Table1).

Conclusion

Respiratory viral transmission is frequent in hospitals, with around 40% of sequenced specimens genetically related to each other. While this study serves as an initial step towards possible implementation of real-time WGS surveillance, further investigation is needed to address broader implications, including implementation of infection prevention strategies to address transmission clusters.

Disclosures

Graham M. Snyder, MD, SM, Infectious Diseases Connect: Advisor/Consultant Alexander Sundermann, DrPH, CIC, FAPIC, OpGen: Honoraria Lee Harrison, MD, GSK: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Sanofi: Advisor/Consultant
P-1917. Hospital-Acquired Infections and Their Impact on Length of Stay for Veterans with COVID-19: A Nationwide Cohort Study
Authors: Li Haojia , Khader Karim , Jones Barbara E , Rubin Michael , Zhang Yue
Published: January 2025

Background

The COVID-19 pandemic has intensified concerns about hospital-acquired infections (HAI) due to multidrug-resistant organisms (MDRO) in hospitalized patients. This study assesses the excess length of stay (LOS) attributed to MDRO HAI across all acute Veterans Affairs (VA) hospitals.

Methods

A retrospective cohort study was conducted within the VA healthcare system, including 115,000 hospital admissions from March 1, 2020, to August 31, 2022. We included 71,432 COVID-19 patients admitted within 14 days of a lab-confirmed diagnosis, excluding cases with community-acquired infections, non-MDRO HAIs, and readmissions. We utilized balanced risk-set matching (RSM) and mixed integer programming (MIP) to optimize covariate balance via Mahalanobis distance among key variables including demographic data, comorbidities, and both time-independent and -dependent treatments. Standardized mean differences (SMD) were used to ensure covariate balance, with an absolute value of less than 0.1 considered balanced.

Results

We matched 1,088 patients who experienced HAI with MDRO. Covariate balance was achieved, with only minor deviations (SMD slightly over 0.1). The mixed-effect Poisson regression model adjusted for temporal and facility-level factors revealed that HAIs associated with MDRO resulted in a 32% longer LOS compared to the non-HAI group (95% CI: 30% - 35%; mean LOS: 26.8 days vs. 20.5 days; median LOS: 22 days vs. 16 days).

Conclusion

This study highlights the significant impact of HAIs due to MDROs on the length of hospital stays among veterans with COVID-19. The findings underscore the need for enhanced infection control practices and targeted strategies to mitigate the burden of HAIs in this vulnerable population. Further research should explore the specific mechanisms by which HAIs extend hospitalization and the potential for intervention at various levels of healthcare delivery.

Disclosures

All Authors: No reported disclosures
P-1923. Outcomes of COVID-19 in Patients with Liver Cirrhosis
Authors: Monteiro Menezes Luanna Silva , Sales da Cunha Pedro Ferrari , Pires Magda Carvalho , Valle Lucas Rocha , Rodrigues Carvalho Rafael Lima , Marcolino Milena S
Published: January 2025

Background

There is scarce data related to chronic liver disease in some developing countries, including prognosis and behavior in face of SARS-Cov-2 infection. In this context, robust studies from Latin America investigating the clinical outcomes of COVID-19 in patients with cirrhosis are lacking. Therefore, this study aimed to compare the clinical features and outcomes between COVID-infected inpatients with and without cirrhosis in Brazil.

Methods

This study is a substudy of a multicenter retrospective cohort of patients from 41 Brazilian hospitals diagnosed with COVID-19 from March to September 2020 and from March 2021 to August 2022. Demographic data, clinical characteristics and outcomes were collected from the medical records. To adjust for potential confounding variables, patients with cirrhosis were matched with patients who did not have cirrhosis (controls) based on propensity score. The propensity score model was estimated by logistic regression and included sex, age, number of comorbidities and hospital of admission. Chi-square and Fisher’s exact tests were used to compare categorical variables and the Wilcoxon–Mann–Whitney test for continuous variables. Results were considered statistically significant if p-value was < 0.05.

Results

This study included 749 patients (median 61 years old [interquartile range: 50-70], 63,4% were men). Among those, 117 were patients with cirrhosis and 632 matched controls. There were no significant differences in the self-reported symptoms between cases and matched controls. Compared to matched controls, cirrhotic patients presented higher in-hospital mortality (51.3% vs. 21.7%, p < 0.001), frequency of admission in intensive care unit (ICU) (51.3% vs. 38.0%, p = 0.007), invasive mechanical ventilation (IMV) (26.6% vs. 43.9%, p < 0.001), dialysis (17.9% vs. 11.1%, p = 0.038), septic shock (23.9% vs. 14.9%; p = 0.015) and institution of palliative care (19.7% vs. 7.4%; p < 0.001).

Conclusion

COVID-19 inpatients with cirrhosis had significantly worse clinical outcomes when compared to matched controls. Our findings reinforce that those patients require particular attention from the healthcare team and resources.

Disclosures

All Authors: No reported disclosures
P-1999. Predictors of Mortality in Myelodysplastic Syndrome with COVID-19: A 2020-2021 National Study
Authors: Jagannathan Madhumithaa , Sivasubramanian Barath Prashanth , Babu Sonia , Sripathi Shanthi Reddy , Javvaji Avinash , Jain Priyanshu , Joshi Shashvat , Shanmugam Dinesh Kumar , Swami Kannan Bharath Duraisamy , Dalal Rutul , Tirupathi Raghavendra
Published: January 2025

Background

We aimed to evaluate mortality predictors in Myelodysplastic Syndrome who were admitted for COVID-19 (MDSCov) using the Healthcare Cost and Utilization Project.

Sociodemographics in MDSCoV Patients

Methods

A cross-sectional study using the NIS on adults (≥ 18 years) hospitalized in the United States for MDSCov (n=769). We identified 151 nonsurvivors among MDSCov. Analysis was done using t-tests and chi-square tests, and multivariate regression models were constructed with p≤ 0.05 significance.

Factors Associated with Higher Mortality in MDSCoV Patients

Results

The average age of MDSCov was higher than those without COVID-19 (77.3 vs 53.5 years, p=0.0000). MDSCov had a longer average length of stay (7.9 vs 5.1 days, p=0.0000) and higher total hospital charges ($85,059.6 vs $66887.8, p=0.0001) compared to MDS patients without COVID-19. We found that HSCT (allogenic and autogenic) was not associated with increased MDSCov hospitalization (2.2% vs 2.5%, p=0.8286). Males experienced a higher mortality rate (64.9% vs 53.9%, p=0.015; aOR 1.51, p=0.076) as they have higher expression of ACE2 receptors than females, correlating to disease severity. Race did not contribute to mortality (White 72.8% vs 77.3%, p=0.5267). The Non Survivors of MDSCov showed a high association with stroke (2% vs 0.3%, p=0.0227; aOR 4.7, p=0.026), severe sepsis (17.9% vs 0.6%, 0.0000; 9.1, 0.000), acute respiratory failure (66.9% vs 49.5%, 0.0001; 3.93, 0.000), and acute kidney injury (45.7% vs 29.1%, 0.0001; 1.27, 0.326). Due to COVID-19, T-cell exhaustion and secondary infections that contribute to sepsis can occur. Increased microthrombus formation and endothelial dysfunction can lead to thromboembolic episodes. Increased proinflammatory cytokines (IL-1β, IL-6, IL-12, IFN-γ, IP-10, and MCP-1) caused by the virus contribute to pulmonary inflammation and lung injury. The use of vasopressors to maintain MAP (9.3% vs 0.2%, p=0.0000; aOR 6.65, p=0.081) was markedly higher but not significant among nonsurvivors.

Sociodemographic Profile of Patients with MDS

Conclusion

Our study identified several predictors of mortality in MDSCov. However, due to the need for more information on disease severity and laboratory evidence, future studies are needed to develop timely treatment plans. Appropriate chemotherapeutic regimens for MDS and antivirals/biologics for COVID-19 are needed.

Predictors of In-hospital Mortality in Patients with MDS and COVID-19

Disclosures

All Authors: No reported disclosures
P-2000. A Case-Control Study of the Risk of COVID-19 Infection in Underserved Persons with HIV (PWH) in Middle Tennessee
Authors: Rao Mallika , Wilus Derek , Berthaud Vladimir
Published: January 2025

Background

The COVID-19 pandemic had disproportionately affected racial and ethnic minorities. We undertook this study to examine the risk factors for COVID-19 infection and death in African Americans with HIV.

Methods

We conducted a prospective case-control study to assess the risk for COVID-19 infection in a clinic serving predominantly underserved African Americans in Middle Tennessee. Matched cases and controls were tested for COVID-19 by PCR around the same time. COVID-19 information, demographics, clinical and social determinants of health (SDoH) data were collected from electronic health records. Chi-square and Fisher’s exact tests were applied to evaluate the associations between outcome and predictor variables. Binary logistic regression was used to examine the effects of 18 predictors on COVID-19 infection. R/RStudio version 4.3.2 was used. The local IRB approved the study protocol.

Results

From 4/2020 to 11/2023, 91 PWH tested COVID-19-positive and 181 negative. We excluded 11 cases and 29 controls due to missing SDoH data; 81.0% of the patients were African American, 26.3% were female, and 46.1% fell into the 45-64-year-old age group. Among 73 symptomatic cases, the most common symptoms were cough, fever, and chills. 28/91 were admitted to the hospital, 11/28 went to ICU, and 8/28 died. All the deceased had >1 cardiovascular risk factor. 12/91 cases had a CD4 cell count < 200/mm3 and 73/91 had an HIV-1 RNA level < 200 copies/mL. In the bivariate analysis, incarceration (p < 0.001), renal failure (p < 0.001), smoking (p < 0.001), alcoholism (p = 0.003), drug use (p = 0.023), and cardiovascular risk (p = 0.023) were highly associated with COVID-19 infection. In the multivariable model, the most strongly associated risks were incarceration [OR = 18.68; 95% CI: (4.66, 74.87); p < 0.001], renal failure [OR = 40.62; 95% CI: (3.96, 416.83); p = 0.002], hyperlipidemia [OR = 3.94; 95% CI: (1.54, 10.06); p = 0.004], 25-44 years of age [OR = 2.48; 95% CI: (1.10, 5.58); p = 0.028], no insurance [OR = 0.36; 95% CI: (0.14, 0.92); p = 0.033], and smoking [OR = 2.20; 95% CI: (1.01, 4.82); p = 0.048].

Conclusion

Incarceration, renal failure, and cardiovascular disease were very strong risk factors for COVID-19 infection in this population of PWH in Middle Tennessee.

Disclosures

Vladimir Berthaud, MD MPH, GILEAD SCIENCES: Grant/Research Support|GSKVIIV: Grant/Research Support|MODERNA: Grant/Research Support|NOVAVAX: Grant/Research Support
P-2003. Clinical Outcomes of COVID-19 among Immunocompromised Patients at Siriraj Hospital
Authors: Phoompoung Pakpoom , Dilokruangchai Jirapa
Published: January 2025

Background

The coronavirus disease 2019 (COVID-19) pandemic has caused significant mortality for patients worldwide. The clinical outcomes of COVID-19 among immunosuppressed patients, who are at presumably risk of more severe disease have not been well characterized.

Clinical outcome between immunocompetent and immunocompromised patients hospitalized with COVID-19

Methods

We performed a retrospective cohort study including all adult patients hospitalized with COVID-19 during July to December 2021. Primary outcome was a 3-month death among immunocompetent and immunocompromised patients. Secondary outcomes included superimposed infections and intensive care unit (ICU) admission within a 6-month period, and factors associated with death in immunocompromised patients.

Comparison between immunocompromised patients hospitalized with COVID-19 who were dead and survived during 3 months after COVID-19

Results

303 patients were enrolled (239 immunocompetent and 64 immunocompromised patients, with mean age of 71 (±14) and 63 (±16) years, respectively). Immunocompromised patients showed more superimposed herpes simplex virus infection (3.1% vs. 0%, P 0.006). There was a trend towards higher ICU admission rate (20.3% vs. 11.%, P 0.058) in the immunocompromised group. However, the 3-month death between both groups did not differ significantly (24.7% immunocompromised vs 20.5% immunocompetent, P 0.437). Interestingly, there was a higher death among immunocompromised patients who had co-infections (61.5% vs. 32.4%, P 0.019) and superimposed infections (56.5% vs. 17.9%, P 0.002). On the other hand, there was a lower death rate in immunocompromised patients receiving immunosuppressive drugs prior to COVID-19 diagnosis (12.9% vs. 59.2%, P < 0.001).

Conclusion

Three-month mortality rate did not differ between immunocompromised and immunocompetent patients. Superimposed and co-infections increased mortality in immunocompromised COVID-19 patients. Prior use of immunosuppressive agents was associated with less mortality, which may be explained by less detrimental inflammatory response.

Disclosures

All Authors: No reported disclosures
P-2005. Long-term complications of COVID-19 in pediatric population in Lima, Peru
Authors: Navarro Rafaella , Ochoa Theresa , Carrasco Gabriel , Peña Brian
Published: January 2025

Background

Peru is the eighth country in South America with most COVID-19 cases (134 684 cases per million population) and the first country in the world with most COVID-19 deaths (6 595 deaths per million population). However, is lacking data on the long term complications of COVID-19 in children and adolescents. Peru does not have guidelines for the diagnosis and management of long-term complications of COVID-19. Thus, studies are needed to develop evidence-based management and to propose the necessary infrastructure to provide comprehensive care.

Methods

A multicenter study was carried out in 16 hospitals from Lima to describe the long-term complications of COVID-19 in subjects under 18 years and to compare with subjects without a history of COVID-19 (controls). A history of COVID-19 episode was defined by a positive laboratory test or presence of symptoms with a confirmed household case. The comparison group included subjects with no history of COVID-19 symptoms, no history of COVID-19 epidemiological contact and/or negative laboratory tests. Enrolled patients were screened using a survey from the Long-COVID Clinic of Miami. If the screening was positive the Yorkshire Test was applied during a medical evaluation.

Results

2,954 cases and 1,500 controls were enrolled, from which 2,558 cases and 1,452 controls completed the screening survey. A higher positive screening for long-term symptoms was found in subjects with COVID-19 history (1,389/2,558, 54.3%) in comparison with subjects without COVID-19 history (251/1452, 17.3%). Among subjects with a positive screening, 439 (31.6%) cases and 53 (21.1%) controls completed a medical evaluation; 381 (86.8%) cases had at least one new symptom posterior to COVID-19 that lasted at least 3 months (positive Yorkshire Rehabilitation Scale) and 32 (60.4%) among controls. (Tab 1) The most common symptoms were cough (53% vs 26%), pain (48% vs 21%), gastrointestinal symptoms (48% vs 16%), and anxiety (44% vs 30) among cases and controls, respectively. (Tab 2)

Conclusion

More than half of pediatric patients with COVID-19 have long-term symptoms. Study limitations are: recall bias, not all subjects with a positive screening were evaluated by a physician, and we could be overestimating the frequency of symptoms since we enrolled subjects in hospitals.

Disclosures

Rafaella Navarro, n/a, Pfizer: Grant/Research Support Theresa Ochoa, PhD, Pfizer: Grant/Research Support Gabriel Carrasco, n/a, Pfizer: Grant/Research Support Brian Peña, n/a, Pfizer: Grant/Research Support