bluuebunny/crossref_metadata_2025 huggingface dataset:
148. Antibiotic duration for lower respiratory tract infections with and without procalcitonin monitoring: a propensity score matched cohort across an integrated healthcare network
Authors: Livorsi Daniel J , Heren Jamie , Alexander Bruce , Lund Brian
Published: November 2023

Background

Clinical trials have shown that procalcitonin (PCT) testing is efficacious in reducing antibiotic duration, but it is not known whether the test is also effective in routine clinical practice. The goal of this study was to evaluate whether PCT use in patients with lower respiratory tract infections (LRTI) was associated with shorter antibiotic duration.

Methods

We performed a retrospective cohort study across Veterans Affairs acute care hospitals that were ordering PCT with some degree of frequency between January 2018 and December 2021 and included patients with LRTI (acute exacerbations of COPD and pneumonia) that lacked complicating factors (Figure 1). The primary outcome was length of antibiotic therapy. We used 1:1 nearest neighbor propensity score matching to estimate the difference in the primary outcome between PCT-tested and non-tested patients. Patients were fixed matched on hospital site and admission date, and propensity scores were calculated using a logistic regression model that included demographics, ward location, infection type, comorbidities, severity of illness, and antibiotic class.

Figure 1. Flow diagram of patient selection based on inclusion and exclusion criteria

Results

Eighty-one (65%) VA hospitals had on-site PCT testing; all 81 sites had a pharmacist devoting at least some time to antibiotic stewardship activities. Of the 35,610 admissions that met inclusion criteria, 6,015 (17%) had ≥ 1 PCT test at least 48 hours into their antibiotic course (Table 1); in these patients, the median number of PCT tests checked was 2 (interquartile range, 1-3). Using propensity scores, 3,903 patients in the PCT group were matched to 3,903 patients in the no PCT group: the length of therapy was higher in the PCT group compared to the no PCT group with median of 8 days (IQR 6-11) compared to 7 days (IQR 5-10) and mean difference of 0.4 days (p< 0.01, Table 2).

Conclusion

In this retrospective propensity-matched cohort of patients with LRTI across 81 hospitals, we failed to demonstrate shorter antibiotic duration for patients who underwent PCT testing compared to those who did not. While our findings suggest that PCT use may not be effective for reducing antibiotic duration for LRTI under real-life circumstances, it is unclear if the PCT test was optimally implemented at these sites and whether other stewardship activities may have minimized the test's overall impact.

Disclosures

Daniel J. Livorsi, MD, Merck: Grant/Research Support
2597. Postoperative Pneumonia Characteristics following Pulmonary Thromboendarterectomy (PTE)
Authors: Rathod Shardul N , Ropski Pamela , Glowala Jakub , Quinn Charles M , Stamper Alyssa , Bolon Maureen K , Schimmel Daniel , Malaisrie S Chris C , Mylvaganam Ruben , Cuttica Mike J
Published: November 2023

Background

Pulmonary thromboendarterectomy (PTE) surgery, the gold standard for treatment of chronic thromboembolic pulmonary hypertension (CTEPH), is complicated by reperfusion lung injury (RPLI) in anywhere from 10-40% of cases. Postoperative pneumonia (PNA) following PTE is not well described, but its rates of 17-35% may be higher than expected compared to other cardiothoracic surgeries (5-6%, STS ACSD). Unique features of this highly specialized surgery may predispose patients to increased risk of postoperative PNA. This study aims to describe the incidence of suspected/confirmed post-PTE PNA and assess diagnostic/clinical characteristics and outcomes.

Methods

All patients (n=75) were treated at a single-center CTEPH referral center and underwent PTE between 2016 and 2022. A retrospective chart review was conducted to assess clinical symptoms and signs of RPLI and/or PNA within 7 days of PTE. Microbiologic data was collected via bronchoalveolar lavage (BAL) within 7 days of PTE. Cohorts with microbiologic evidence of PNA and those with RPLI were compared.

Results

Demographics are listed in Table 1. Of the 75 patients who underwent PTE, 28% were documented to have RPLI (mean of 2 days post-PTE) and 21% with PNA (mean of 4 days post-PTE). Of those with RPLI, 43% underwent bronchoscopy with 56% positivity 4 days post-PTE on average (Table 2). Patients with post-PTE PNA were treated with antibiotics for a mean of 6.2 days with Staphylococcus aureus (40%) and Pseudomonas aeruginosa (40%) being the most commonly isolated causative organisms. Patients with post-PTE PNA had longer intensive care unit (ICU) length of stay (LOS) (16.4 vs. 5.6 days, p=0.044) and duration of mechanical ventilation (MV) (7.4 days vs. 1.5 days, p=0.033) along with higher white blood cell counts on postoperative day one (18.3 vs. 14.8 x103µL, p=0.035) (Figure 1).

Conclusion

The cohort demonstrated 28% of patients with RPLI and 21% of patients with PNA. Of those with RPLI who underwent bronchoscopy, over half the patients had positive cultures. Given that PNA is correlated with prolonged ICU LOS and duration of MV, clinicians may consider more systemic evaluation for PNA when considering RPLI, possibly warranting a change in management in these critically ill patients.

Disclosures

Daniel Schimmel, MD, Inari: Advisor/Consultant|Inari: Grant/Research Support|Inari: Honoraria|Penumbra: Advisor/Consultant|Penumbra: Honoraria Mike J. Cuttica, MD, MS, Bayer: Advisor/Consultant|Bayer: Grant/Research Support|Bayer: Honoraria
2600. Incidence of Non-COVID Pneumonia Before and After Mask Mandate at a Midwestern Hospital: An Analytical Cross-Sectional Study
Authors: Szabadi Stephen B , Koenig Katelyn , Gauss Chester , Sila Zachary , Reddy Adithya , Huffman Cuyler , Dewey John , Liu Gordon , Olken Melissa H
Published: November 2023

Background

The introduction of universal masking policies at many American healthcare institutions during the COVID-19 pandemic represented a major shift in infection prevention protocol. However, despite their widespread use, previous data on face masks as a tool for preventing respiratory infections before COVID have been mixed, frequently showing no benefit. This study examines the impact of a universal face mask policy on rates of hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), community-acquired pneumonia (CAP), and other non-COVID pneumonias of indeterminate etiology at Ascension Borgess Hospital in Kalamazoo, Michigan.

Methods

An analytical cross-sectional study was performed comparing patient data from March through September 2019 with the same period in 2020 for any patient admitted with any ICD-10 code for pneumonia. Chi-square analysis was employed to determine pneumonia frequency by subtype, pre and post-mandate. A significance level of p < 0.05 was used for all tests.

Results

1187 patient records were collected, 28 were excluded for incompleteness, and 1159 were included in our analysis. The study population was 81.80% White and 53.66% male. 670 patients (57.81%) were pre-mask mandate and 487 (42.19%) were post-mandate. Pre-mandate, 107 patients had HAP, 575 had all-cause pneumonia (non-COVID pneumonia of any etiology), and 0 had VAP. Post-mandate, 84 patients had HAP, 2 had VAP, and 376 had all-cause pneumonia. A significant difference was observed in the number of all-cause pneumonia cases between pre and post-mandate (χ2 = 13.3058, p < 0.0001), but not in HAP cases (χ2 = 0.2996, p = 0.5841). There were only two instances of VAP; therefore, inferential statistics were not obtained.A significant difference was observed in all-cause pneumonia cases between pre and post-mask mandate implementation (χ2 = 13.3058, p <0.0001), but not in HAP cases (χ2 = 0.2996, p = 0.5841).

Conclusion

Among hospitalized patients, a significant difference in HAP pre and post-mandate was not observed. However, the incidence of non-COVID pneumonia of any etiology was significantly lower during the mask mandate (p < 0.0001). Wether this difference is attributable to universal masking or other mandated or non-mandated precautionary behaviors in the hospital or community cannot be determined. These results suggest that mask mandates as currently implemented do not prevent HAP, but may play a role in decreasing total pneumonia prevalence in the community.

Disclosures

All Authors: No reported disclosures
149. Stewardship Efforts during the COVID-19 Pandemic: Impact on Antibiotic Prescribing Practices of Ambulatory Care Providers for Common (non-COVID-19) Viral Respiratory Syndromes
Authors: Mackey Melinda , Cosimi Reese , Daragjati Florian , Rice Erin , Miller Collin , Shoemaker Aaron , Fakih Mohamad G
Published: November 2023

Background

An estimated one third of antibiotics prescribed in the outpatient setting is considered unnecessary. We evaluated ambulatory antimicrobial use for a single system before and during the COVID-19 pandemic and assessed the impact of a system-based stewardship intervention on overall antibiotic selection and prescribing rates for indications with typically viral etiologies.

Comparison of Antibiotic Use for Common Viral Respiratory Syndromes Prepandemic and Pandemic Periods

Change in Antibiotic Use and Spectrum for Prepandemic and Pandemic Periods

Methods

This retrospective, quasi-experimental pre-post design evaluated rates of antibiotic prescribing for ambulatory setting in all ages across a large, multi-state healthcare system with encounters coded for common viral respiratory syndromes. Stewardship interventions were implemented starting July 2021 and included mandatory training on common upper respiratory infections for all Primary Care and Urgent Care clinicians, coupled with feedback on prescribing practices for targeted viral syndromes at quarterly intervals. Encounter volumes for ambulatory care clinicians were stratified by time period and common viral respiratory syndrome diagnosis (excluding COVID-19). Data on systemic antibiotic prescriptions collected from outpatient electronic health records (EHRs) was obtained during a prepandemic year (January 2019 - December 2019) and a pandemic year (January 2022 - December 2022). We compared the use of antibiotics for common viral respiratory syndromes between the two periods in the ambulatory setting and further evaluated for any changes in antibiotic selection.

Results

Ambulatory antibiotic utilization for common viral respiratory syndromes decreased from 54.3% (prepandemic) to 47.1% (pandemic), resulting in an absolute 7.2% reduction (p< 0.001). After adjusting for the decreased volume of common viral syndromes diagnosed during 2022, approximately 28,578 fewer antibiotics were prescribed during the COVID period.

Conclusion

Associated with an intervention to optimize antimicrobial use, we witnessed an improvement in overall use and choice of antimicrobials during the pandemic in a single system.

Disclosures

Melinda Mackey, MSN, RN, CPHQ, CCM, Pfizer, Inc: Advisor/Consultant Reese Cosimi, PharmD, Allergen: Advisor/Consultant
2607. The impact of portable high efficiency Hepa Filters on the incidence of invasive fungal infection in Covid 19 inpatients in a tertiary care hospital: a retrospective analysis from Pakistan
Authors: AHMED A N E E R A , JAMIL B U S H R A , SULTAN A I M A N , LUXMI S H O B A
Published: November 2023

Background

Objective: To identify impact of air filtration on incidence of Invasive fungal infections in COVID-19 patients after restructuring of COVID-19 wards.

Introduction

Most COVID-19 patients present with mild or moderate disease; but patients with comorbidities may be predisposed to secondary and opportunistic infections. Aspergillus infections resulting from failure in air filtration systems have been reported. Our study aims to determine the impact of installation of such preventative measures in covid units on the frequency of invasive fungal disease as a complication of covid 19 illness

Methods

All COVID-19 patients >18 years (non-severe, severe and/or critical) admitted at the tertiary care center were included. Even COVID-19 patients with suspected IPA, based on isolation of fungal species from one or more respiratory samples were included. Two time frames were used for inclusion of patients, one three months prior to and second three months after installation of HEPA filters in COVID wards. Patients with underlying respiratory disease, previous history of invasive pulmonary aspergillosis, on chronic steroid use ( >3 months), on broad-spectrum antibiotics and with hematological malignancies were excluded. SPSS version 23.0 was used for data analysis.

Results

From 187 patients, 97 enrolled before installation of HEPA filters while 90 after installation of HEPA filters. Overall the mean age of patients was 62.7 ± 14.6 years. A significant difference of p-0.04 was observed in terms of length of stay in-between before installation of HEPA filter group (13.1 ± 11.2 days) and in after installation of HEPA filter group (10.2 ± 8.2 days). Beta-D-Glucan test with HEPA filter was positive in 17 (17.5%) of patients while in 28 (31.1%) of patients without HEPA filter (p-0.03). Treatment with Azoles was found to have significant difference in-between both groups (p-0.002). Overall, treatment was successful in 16 (16.5%) patients in without HEPA filter group while in 38 (42.2%) of patients with HEPA filter (p< 0.001)

Conclusion

Substantial decrease in incidence of invasive fungal infections among COVID-19 patients was reported in terms of age, length of stay, Beta-D-Glucan, treatment with azoles and overall treatment in favor of HEPA filters.

Disclosures

All Authors: No reported disclosures
2610. Home Administration of Intranasal Live Attenuated Influenza Vaccine: A Review of Current Evidence and Potential for Meeting Vaccination Targets
Authors: Jhaveri Ravi , Zahn Matt , Bandell Allyn R
Published: November 2023

Background

During the 2010–2021 influenza seasons, vaccination coverage was below the 70% target for the United States at 33.4–58.6% among children and 50.2% among adults.[1, 2] The live attenuated influenza vaccine (LAIV) is currently approved for healthcare professional administration (HCPA); however, self- and home-administered LAIVs may provide an additional, effective option for vaccine administration, which could expand seasonal influenza vaccine accessibility. LAIV is a quadrivalent influenza vaccine administered intranasally, with comparable effectiveness to the inactivated influenza vaccine.[3] Broadening vaccine availability to multiple vaccination sites has been shown to increase vaccination rates by up to 22%.[4]

Here we summarize the current evidence on self- and home-administered LAIV efficacy and safety, and potential applications for increasing community influenza vaccination accessibility.

Methods

Publications evaluating the efficacy, safety, and practicality of self- and home-administered LAIV were identified from a literature search with the following search string: (live attenuated influenza vaccine OR LAIV) AND (home administration OR self administration OR self immuni*).

Results

In three studies comparing LAIV self- and home administration to HCPA (Table), home administration was preferred by 64, 74, and 96% of participants. Sample sizes ranged from 41 children to 4561 patients receiving LAIV, with participants aged between 2.6 and 64 years old. A trial of 4561 patients comparing LAIV self- and home administration to HCPA groups found similar effectiveness against influenza-like illness, immunogenicity, and adverse events post-vaccination.

Conclusion

Evidence suggests that self- and home-administered LAIV could be safely and effectively offered, and may be preferable for a subset of the population, which could expand seasonal influenza vaccine accessibility.

References

[1] Centers for Disease Control and Prevention. Flu vaccination coverage, United States, 2020–21 influenza season.

[2] Gates DM et al. Vaccine. 2022;40(44):6337-6343.

[3] Bandell A et al. Open Forum Infect Dis. 2020;7(Suppl 1):S709.

[4] Ipsos. Expanding flu vaccine access.

Disclosures

Ravi Jhaveri, MD, AbbVie: Grant/Research Support|AliOS: Grant/Research Support|AstraZeneca: Advisor/Consultant|Gilead: Grant/Research Support|MedImmune: Advisor/Consultant|Merck: Grant/Research Support|Saol Therapeutics: Advisor/Consultant|Seqirus: Advisor/Consultant Allyn R. Bandell, PharmD, AstraZeneca: employee|AstraZeneca: Stocks/Bonds
2640. Estimated Additional Burden Averted from Use of Cell-Based Influenza Vaccines Compared to Egg-Based Influenza Vaccines Among People 0-64 Years of Age in the United States: 2017-2020 Seasons
Authors: McGovern Ian , Taylor Alexandra , Sardesai Aditya , Toro-Diaz Hector , Haag Mendel
Published: November 2023

Background

Influenza vaccines have traditionally been produced in eggs, which can introduce egg-adaptive mutations. Cell-based influenza vaccines avoid egg-adaptive mutations, potentially improving match to circulating influenza viruses and therefore vaccine effectiveness. This study modeled the public health impact if all vaccinated people 0-64 years of age in the United States received cell-propagated inactivated quadrivalent influenza vaccine (IIV4c) compared to egg-propagated inactivated quadrivalent influenza vaccine (IIV4) across the 2017-2018 through 2019-2020 Influenza Seasons.

Methods

The modeling method used by the US Centers for Disease Control and Prevention (CDC) for estimating overall burden averted due to influenza vaccination was extended to a relative vaccine effectiveness (rVE) context. The model utilized CDC data on influenza vaccine uptake, influenza incidence, influenza-related healthcare resource use and deaths. CDC estimates of absolute vaccine effectiveness (aVE) (any vaccine) were used as the aVE of IIV4. Based on previously published rVE estimates generated from the same real-world database, the rVE of IIV4c vs IIV4 was assumed to be 19.3% (95% Confidence interval: 9.5 to 28) in 2017-2018, 7.6% (6.5 to 8.6) in 2018-2019, and 17.2% (15.8 to 18.6) in 2019-2020. Base-case results were validated with deterministic (DSA) and probabilistic (PSA) sensitivity analyses.

Results

Figure 1 shows the anticipated number influenza-related cases and complications that would be averted if all vaccinated people 0-64 years of age received IIV4c or IIV4. Across the 3 influenza seasons, use of IIV4c would result in prevention of an additional 12,706,837 symptomatic illnesses, 6,222,820 outpatient visits, 80,390 hospitalizations, and 2,765 deaths. DSA results showed that the rVE estimate was associated with the most variability while the burden estimates were most influential in the other two seasons. Mean PSA results were all within a 0.5% difference of base-case results.Figure 1.Number of Outcomes Prevented from Use of IIV4c Compared to IIV4 Among People 0-64 Years of Age: 2017-2018 Through 2019-2020 Seasons

Conclusion

Use of IIV4c instead of IIV4 during the 2017-2020 influenza seasons in the US would have had a substantial public health impact due to a 28.5% to 49.1% increase in influenza cases prevented.

Disclosures

Ian McGovern, MPH, CSL Seqirus: Employment|CSL Seqirus: Stocks/Bonds Alexandra Taylor, MSc, CSL Seqirus: Advisor/Consultant Aditya Sardesai, MSc, CSL Seqirus: Advisor/Consultant|Merck & Co. Inc: Grant/Research Support|Merck & Co. Inc: Grant/Research Support Hector Toro-Diaz, PhD, CSL Seqirus: Advisor/Consultant Mendel Haag, PhD, PharmD, CSL Seqirus: Stocks/Bonds
153. Sensitivity of MRSA Nasal Screening in Patients with Staphylococcus aureus Pneumonia: Impact of a More Sensitive Comparator
Authors: Papamanolis Irene-Constantina , Decano Arnold , Zacharioudakis ioannis , Dubrovskaya Yanina , Siegfried Justin , Marsh Kassandra , Mazo Dana , Inglima Kenneth
Published: November 2023

Background

Staphylococcus aureus (S. aureus) pneumonia (PNA) is associated with significant morbidity and mortality. Methicillin-resistant Staphylococcus aureus (MRSA) nasal screening has been considered a valuable tool in guiding the de-escalation of antibiotics, particularly vancomycin, among patients with PNA by identifying patients with MRSA colonization in light of its high sensitivity and negative predictive value in earlier studies. However, the performance of MRSA/MSSA nasal screening has yet to be re-evaluated after more sensitive molecular methods for microbiologic diagnosis of PNA have become available. This study aims to determine the sensitivity of MRSA/MSSA nasal screening in patients diagnosed with S. aureus PNA based on the BIOFIRE® FILMARRAY® Pneumonia Panel results.

Methods

We conducted a retrospective cohort study involving 346 patients with a positive BIOFIRE® FILMARRAY® Pneumonia Panel for MRSA or MSSA. Inclusion criteria were age >18 and use of MRSA/MSSA nasal screening by the culture within 48 hours of symptom onset. Exclusion criteria included polymicrobial PNA detected by the Pneumonia panel, infection(s) at other sites and known recurrent S. aureus infections.

Results

A total of 56 patients with S. aureus PNA met the inclusion criteria. Of the 56 patients, 22 had mecA/C or MREJ detected, indicating MRSA infection. Among these 22 patients with MRSA PNA, 11 (sensitivity 50%) were screened positive by nasal culture. Among the 34 patients with MSSA PNA, 16 screened positive by nasal culture (sensitivity of 47.1%).

Conclusion

The MRSA nasal screening culture demonstrated a sensitivity of 50% in patients with MRSA PNA, which is lower than what has been reported, including those using PCR. When using culture screening methods, risk factors for MRSA PNA and clinical and radiographic features will need to be considered for empiric antimicrobial therapy pending microbiologic test results. Future studies should focus on refining MRSA screening methodologies, evaluating their clinical utility in managing empiric antimicrobial therapy in patients with pneumonia, and studying the clinical outcomes in patients who received inappropriate therapy based on negative MRSA screening results.

Disclosures

All Authors: No reported disclosures
2648. Taming the Cytokine Storm: Baricitinib versus Tocilizumab for COVID-19 Hyperinflammation
Authors: Radziszewski Skyler , Swamy Siddharth , Jain Ruchi , Bicking Keri , Nyirenda Themba
Published: November 2023

Background

Baricitinib and tocilizumab are potent immunomodulators that can reduce mortality in severe and critical COVID-19. The objective of this study was to compare the outcomes of patients with COVID-19 who were treated with either baricitinib or tocilizumab.

Methods

This was a single-center, retrospective chart review. Patients were included if they were adults hospitalized with COVID-19 between January 2021 and October 2022 and received baricitinib or tocilizumab. Patients were excluded if they received both agents. Data collection included patient demographics and the predominant variant circulating at time of admission. The primary outcome was the percentage of patients with clinical improvement at day 14 after immunomodulator initiation. Clinical improvement was defined as a two point improvement on a six-point ordinal scale or hospital discharge. Secondary outcomes included clinical improvement at days 7 and 28 after immunomodulator initiation, progression to mechanical ventilation or ICU care, in-hospital mortality, and incidence of venous thromboembolism (VTE).

Results

Four hundred eleven patients were included, of whom 168 received baricitinib and 243 received tocilizumab. Due to availability, baricitinib was used when the Delta and Omicron variants were dominant, and tocilizumab was used throughout the entire study period. There was no significant difference in percentage of patients with clinical improvement at day 14 after immunomodulator initiation (35% versus 36%, p=0.82). Progression to mechanical ventilation (MV) or ICU care occurred significantly less frequently in baricitinib recipients compared to tocilizumab recipients (47% versus 57%, p=0.04). No significant differences were observed for in-hospital mortality, clinical improvement at days 7 and 28 after immunomodulator initiation, and incidence of VTE.

Conclusion

Baricitinib and tocilizumab appear to produce similar clinical outcomes in patients with severe or critical COVID-19. Baricitinib recipients had decreased progression to MV or ICU care, however, it remains unclear whether this outcome was influenced by changes in standard of care and circulating variants at different time points throughout the pandemic.

Disclosures

All Authors: No reported disclosures
2650. Characteristics of In-Hospital Care and Immediate Post-Discharge Care Status among Older Adults Hospitalized with Respiratory Syncytial Virus Infection, Seasonal Influenza, Acute Myocardial Infarction, and Stroke in the US
Authors: Sato Reiko , Judy Jennifer , Yacisin Kari , Begier Elizabeth , Sardana Poorva , Agrawal Neha , Goswami Anchita , Sharma Manvi
Published: November 2023

Background

Despite increased recognition of the morbidity, mortality, and economic burden of respiratory syncytial virus (RSV) in adults, few studies have documented the status of post-discharge care after RSV hospitalization. This study assessed in-hospital and immediate post-discharge care status in older adults hospitalized with RSV in the US and compared it with other serious medical conditions (influenza, acute myocardial infarction (AMI), and stroke) that have long-standing disease prevention efforts.

Methods

This retrospective cohort study used data from Premier Healthcare Database between January 1, 2015, to December 31, 2019. Adults aged ≥ 65 years hospitalized due to primary diagnosis of RSV, influenza, AMI, or stroke were included. Discharge statuses were used to categorize the levels of immediate post-discharge care as shown in Figure 1. Descriptive statistics and Sankey diagrams were used to summarize the four cohorts.

Results

Overall, 2,559 RSV, 174,826 influenza, 208,448 AMI, and 274,102 stroke hospitalizations were identified with similar mean patient ages of 79.8, 76.8, 76.3, and 78.0 years, respectively. Almost all patients ( > 90%) had underlying comorbidities. The mean inpatient length of stay (LOS) was similar in the four cohorts (4.0, 4.4, 3.7, and 4.1 days, respectively), but the prevalence of mechanical ventilator use varied, i.e., 0.4%, 13.7%, 5.9%, and 1.4%, respectively. Intensive Care Unit (ICU) admissions during RSV hospitalizations were infrequent (3.0%) as compared to influenza (16.8%), AMI (24.5%), and stroke (20.5%). The mean ICU LOS for these four cohorts were 2.3, 2.8, 1.7, and 1.7 days in the same order. Immediately following discharge, moderate care was required for 23.9%, 22.9%, 14.1%, and 17.5% of RSV, influenza, AMI, and stroke hospitalizations, respectively. Elevated care was considerably more frequent for stroke hospitalizations (48.1%) than RSV (18.8%), influenza (21.4%), and AMI (19.3%) hospitalizations (Figure 2).

Conclusion

Older adults discharged from RSV hospitalizations require considerable care with needs comparable to influenza and AMI discharges. Given the substantial care requirements of RSV hospitalizations in older adults, focus on disease prevention efforts for RSV are needed.

Disclosures

Reiko Sato, PhD, Pfizer Inc: employee|Pfizer Inc: Stocks/Bonds Jennifer Judy, MS, PhD, Pfizer: Stocks/Bonds Kari Yacisin, M.D., Pfizer: Employee|Pfizer: Stocks/Bonds Elizabeth Begier, M.D., M.P.H., Pfizer: EB is an employee of Pfizer, the sponsor of this study|Pfizer: Stocks/Bonds Poorva Sardana, MSc, Pfizer Inc: Contracted Research Neha Agrawal, MA, Pfizer Inc: Contracted Research Anchita Goswami, MSc, Pfizer Inc: Contracted Research Manvi Sharma, RPh, MBA, PhD, Pfizer Inc: Contracted Research
2668. Real-World Test-of-Cure Practices for Oropharyngeal Gonorrhea in People with HIV
Authors: Wooten Darcy , Hill Eddie
Published: November 2023

Background

Most reported ceftriaxone-based treatment failures of gonorrhea occur in cases of oropharyngeal (OP) gonorrhea. Consequently, the CDC now recommends a test-of-cure (TOC) 7-14 days after initial treatment of OP gonorrhea. There is a lack of data on adherence to these guidelines. The purpose of this study was to examine the repeat testing practices for people with HIV (PWH) who were diagnosed with and treated for OP gonorrhea.

Methods

We conducted a retrospective cohort study at the University of California at San Diego among PWH who tested positive for OP gonorrhea between 12/01/2020 and 09/05/2022. We measured the time elapsed between treatment of OP gonorrhea, ordering of repeat testing, and completion of repeat testing. We calculated the proportion of patients who had a repeat test completed within the guideline-recommended window of 7-14 days. We also measured the following secondary outcomes: 1) the rate of repeat tests that showed persistent positivity, and 2) the repeat testing completion rate after the roll-out of a home self-testing program on 01/31/2022.

Results

We identified 223 PWH who tested positive for OP gonorrhea. 10.3% (23/223) of patients completed repeat testing 7-14 days after treatment. The mean duration between treatment and repeat testing was 74.2 days (range 0-530 days). 4.3% (1/23) of patients who completed repeat testing within 7-14-days of treatment and 7.5% (15/200) of patients who completed repeat testing after this period showed persistent positivity (P-value 0.58). There was no difference in adherence to TOC guideline recommendations before versus after the implementation of the home self-testing program (13.3%, 14/105 versus 8.9%, 7/79; P-value 0.16).

Management Care Cascade of Oropharyngeal (OP) Gonorrhea in People with HIV (PWH)

Conclusion

We found that just one tenth of patients completed repeat testing 7-14 days after receiving treatment for OP gonorrhea. The rate of guideline-recommended repeat testing did not improve with the implementation of home self-testing kits for OP gonorrhea. These findings are concerning given the rising rates of antimicrobial-resistant gonorrhea and the impact that gonorrhea has on facilitating HIV transmission. Additional studies are needed to identify and understand the barriers impacting adherence to the CDC’s TOC recommendations.

Disclosures

All Authors: No reported disclosures
2669. Improving Trichomoniasis Screening Among Cis- and Transgender Women with HIV
Authors: Igwe Nnamdi , Goris Yuderka , Olivier Berlinda , Abrams-Downey Alexandra
Published: November 2023

Background

In 2020, the Primary Care Guidance for Persons with HIV added the recommendation for annual trichomoniasis screening. We identified a low trichomoniasis annual screening rate among cis- and transgender female patients living with HIV at the Institute for Advanced Medicine – Morningside Clinic, a New York State Designated AIDS Center with over 1200 patients with HIV in the Mount Sinai Health System in Manhattan. The primary aim of this prospective quality improvement pilot project was to increase the clinic’s annual trichomoniasis screening rate to 25% over the six-month intervention period.

Methods

A gap analysis identified lack of efficient workflow as the major reason for low trichomoniasis screening. We developed and implemented an intervention as outlined in Figure 1. The intervention began on October 15, 2022. The data was reviewed on April 19, 2023 after the intervention period ended.

Results

At baseline, there were 423 cis- and transgender women with HIV engaged in care at the Morningside Clinic eligible for annual sexually transmitted infection screening, including trichomoniasis. Pre-intervention screening for trichomoniasis was low at 13.7% (n=58). During the six-month intervention period, there were 280 cis- and transgender women with HIV who required annual trichomoniasis screening and seen at least once for a clinic visit with a primary care provider. Of these 280 eligible patients, 178 were tested for trichomoniasis, a significantly increased screening rate of 63.6%.

Conclusion

The intervention successfully increased the clinic’s annual trichomoniasis screening rate from 13.7% to 63.6% among women with HIV. The observed increase within six months was above our goal and demonstrates the effectiveness of a low-intensity and highly sustainable intervention to improve annual trichomoniasis screening rates among women with HIV. Despite the intervention, there are still a number of patients who remain unscreened for trichomoniasis as well as other sexually transmitted infections such as gonorrhea, chlamydia and syphilis. We will continue this intervention longitudinally and further identify and address barriers to sexually transmitted infection screening among people living with HIV.

Disclosures

All Authors: No reported disclosures
2683. Follow-up Testing for Chlamydia trachomatis and Neisseria gonorrhea Infections in Female Basic Military Trainees
Authors: Townsend Lisa , Stahlman Shauna , Oh Gitaik , Escobar James , Osuna Angela , Casey Theresa , Winkler Erin , Kieffer John , Yun Heather , Okulicz Jason F , Marcus Joseph
Published: November 2023

Background

The Centers for Disease Control and Prevention recommends follow-up testing for Chlamydia trachomatis (CT) and Neisseria gonorrhea (GC) infections 3 months after initial positive test or within one year if repeat testing is not possible at 3 months. Follow-up testing compliance in the United States is incompletely understood and has been reported below 35%, even in universally insured populations. The rates of follow-up testing in military populations are unknown.

Methods

During the study period from January 1, 2006-December 31, 2021, all female Air Force Basic Military Trainees provided a urine sample which underwent nucleic acid amplification testing (NAAT) for CT and GC. Those who tested positive were evaluated to determine demographic information as well as follow-up testing rates. Patients who were evaluated with a repeat CT/GC NAAT test within 12 months after a positive CT/GC test result were considered to have received appropriate follow-up. Nominal variables were compared by the Chi-squared test. A p-value of < 0.05 was considered significant.

Results

A total of 97,168 women were tested over the 16-year study period. Of those tested, 4,687 (4.8%) tested positive for either CT (n=4,584, 94.5%), GC (n=134, 2.7%), or both (n=131, n=2.7%). Of those who tested positive, 3,268 (69.7%) had repeat testing within 12 months of their initial positive test. There was no significant difference in follow-up by age, race, educational level, marital status, or organism. Compared to 2006-2009, 2018-2021 had significantly more follow-up testing (66.0% vs. 77.7%, p=< 0.0001) (Figure).

Follow-up Testing Rates for Chlamydia trachomatis and Neisseria gonorrhea Infections in Female Basic Military Trainees 2006-2021

Conclusion

Follow-up testing among female Air Force Basic Military Trainees is significantly higher than in other universally insured populations and has been improving with time. However, this study shows remaining barriers to adherence to recommended guidelines. Future efforts should clarify remaining barriers to follow-up testing in both military and civilian populations.

Disclosures

Jason F. Okulicz, MD, Gilead Sciences: Advisor/Consultant
2693. Epidemiology of Infections with Multidrug-Resistant Organisms in Patients with Left Ventricular Assist Devices (LVADs)
Authors: Axell-House Dierdre B , Ranadive Radhikesh , Nisar Tariq , Kassi Mahwash , Guha Ashrith , Arias Cesar A
Published: November 2023

Background

Left ventricular assist devices (LVADs) constitute one of the limited options available to patients with refractory heart failure. Infection is the most common adverse event after LVAD placement, and difficult to eradicate when attributable to the LVAD itself. LVAD-attributable infections (LVADI) thus lead to significant antibiotic exposure and higher risk for antibiotic resistance. However, the epidemiology of multidrug-resistant organisms (MDROs) causing LVADI has not been described.

Methods

We conducted a retrospective cohort study of patients (pts) ≥18 years old with LVADs implanted from 2016 to 2022 at our institution. Infections were defined as LVADI if i) there was a positive culture from LVAD components, with or without concomitant blood cultures, or ii) there were positive blood cultures with radiologic evidence of LVADI. MDROs were defined according to the Centers for Disease Control (CDC) criteria. Primary outcome was mortality, and multivariate logistic models were built and adjusted for patient demographics and Charlson’s Comorbidity Index.

Results

A total of 252 pts were implanted with new LVADs, with 104 (41.2%) pts developing LVADI. Of the 52 episodes of bloodstream infection (BSI) in 41 pts, 36.5% were caused by MDRO, with Methicillin-Resistant Staphylococcus aureus (MRSA) and MDR Pseudomonas aeruginosa most frequent. There were an additional 64 pts with 99 infections with positive LVAD component cultures, with a total of 115 pathogens isolated. Of these, 20% were MDRO, with MRSA and MDR Enterobacterales most frequent. Multivariate logistic models showed that pts with LVADI did not have higher odds of mortality (OR =1.61; 95% CI [0.92 – 2.81]; p=0.1), however pts with MDRO LVADI had a greater than 3 times odds of mortality (OR = 3.34; 95%CI [1.68 – 6.64]; p< 0.001) compared to pts without MDRO LVADI.

Conclusion

Our review provides initial insight as to the burden of antibiotic resistance among bacteria causing LVADI. The frequency of LVADI in our cohort is higher than what has previously been reported, possibly due to higher vigilance. The MDROs MRSA, MDR Pseudomonas aeruginosa, and MDR Enterobacterales are prominent in this population. Further study is needed to elucidate the risk factors for acquiring MDRO LVADIs and contributing factors to mortality in LVAD pts.

Disclosures

All Authors: No reported disclosures
2699. Risk of Bacterial Bloodstream Infection from a Urinary Source Among Kidney Transplant Recipients
Authors: Eichenberger Emily , Karadkhele Geeta , Johnson Aileen C , Pouch Stephanie M , Larsen Christian P
Published: November 2023

Background

Bacteriuria is common among kidney transplant recipients (KTR). Bloodstream infection is a feared complication of bacteriuria. Risk factors and outcomes associated with bloodstream infection due to a urinary source (BSIU) in KTR are poorly understood.

Methods

In a single center retrospective review, we included all KTR at Emory Transplant Center who had bacteriuria between 06/2007-09/2022. BSIU included KTR with concordant positive blood and urine cultures. BN included KTR with bacteriuria who never developed a bloodstream infection (Figure 1). For subjects with more than one episode of BSIU or BN, only the first episode was included. Clinical characteristics were compared using Kruskal Wallis and fisher exact test. Multivariate logistic regression was used to determine factors associated with BSIU.

Results

Among 4071 unique KTR, 1133 developed bacteriuria of which 263 (23.2%) were BSIU and 870 (76.8%) were BN (Table 1). KTR with BSIU were older (median age 54 vs 50, p=0.002) and more likely to have diabetes mellitus as the primary kidney disease (35.4% vs 23.2%, p=0.0004) than those with BN. Males comprised 49.4% of BSIU vs 30.8% of BN (p < 0.0001). Baseline renal function was significantly lower prior to BSIU than BN (glomerular filtration rate (GFR) 40.3 vs 46.8, p=0.0071). Enterobacterales caused 83.3% of BSIU vs 60.5% of BN, p < 0.0001 (Figure 2), of which 19.3% and 11.5% were extended spectrum beta-lactamase producing, respectively (p=0.007). After adjustment, male sex, decreased GFR, primary kidney disease secondary to diabetes mellitus, and presence of Enterobacterales were significantly associated with BSIU (Male: aOR 2.66 (95%CI 1.94, 3.64), diabetes aOR 1.86 (95%CI 1.33, 2.60), GFR aOR 0.99 (95% CI 0.99, 1.00), Enterobacterales aOR 3.55 (95%CI 2.23, 5.64), Table 2).

30-day mortality was 3% for BSIU vs 0.9% for BN (p=0.0168). Rate of acute cellular rejection at 90 days and graft failure 1-year post culture did not significantly differ between BSIU vs BN (rejection: 1.9% vs 3.6%, p=1.000; graft failure: 5.3% vs 3.1%, p=0.1292).Figure 2.Microbial Etiology of bloodstream infection secondary to a urinary source (BSIU) compared to bacteriuria without bloodstream infection (BN) among Kidney Transplant Recipients

Conclusion

Male sex, history of renal disease due to diabetes mellitus, decreased GFR and Enterobacterales were associated with BSIU among KTR. Mortality among BSIU was low, and there was no increased risk of graft failure or rejection relative to BN.

Disclosures

All Authors: No reported disclosures
2708. Infectious Complications Among CD19 Chimeric Antigen Receptor T-cell Recipients
Authors: Huggins Jonathan , Messina Julia A , Saullo Jennifer , Andermann Tessa , Smith Melody , Schrum Daniel , Eberwein Erin , Kennedy Erin , Rowe-Nichols Krista , Kelsey Christopher , Choi Taewoong , McKinney Matthew , Galal Ahmed , Kang Yubin
Published: November 2023

Background

Current data on infectious complications of chimeric antigen receptor (CAR) T-cell therapy are limited to single center retrospective cohort studies. Presented here is a subset of patients from a multicenter retrospective cohort study including recipients of CAR T-cell therapy at Duke University, University of North Carolina at Chapel Hill, and Stanford University.

Methods

In a retrospective cohort of 66 patients who received CD19 CAR T-cell therapy Duke University between January 1, 2018 and August 31, 2021 rates and characteristics of bacterial, viral, and fungal infections within the first year after CAR T-cell infusion are described. Demographic, baseline clinical, and outcome variables are compared between patients who developed infection and those who did not.

Results

Forty-nine total infections occurred in 29 (43.9%) patients within 1 year of CAR T-cell infusion. Patients who developed infection were more likely to have an underlying malignancy other than diffuse large B-cell lymphoma (34% vs 8%, p = 0.031), and to have developed immune effector cell-associated neurotoxicity syndrome (62% vs. 32%, p = 0.016). Viral (23/49, 46.9%) and bacterial (20/49, 40.8%) pathogens predominated and infections most often involved the bloodstream (19/49, 38.8%) and lung (18/49, 36.7%).There were no statistically significant differences between rates of bacterial and viral infection based on time since CAR T-cell infusion (≤30 days vs 30 – 90 days vs >90 days), though fungal infections only occurred after 90 days in patients with relapse of their underlying disease.

Conclusion

Infectious complications after CAR T-cell therapy are common within the first year of infusion. Bacterial and viral infections predominate while fungal infections are rare and occurred only in patients with relapsed disease.

Disclosures

Melody Smith, MD, MS, BMS: Advisor/Consultant Krista Rowe-Nichols, RN, MSN, AOCNS, Bristol Myers Squibb: Advisor/Consultant|Kite Pharmaceuticals: Advisor/Consultant|Kite Pharmaceuticals: Speaker Bureau Christopher Kelsey, MD, Colgate-Palmolive: Expert Testimony|Johnson and Johnson: Expert Testimony Taewoong Choi, MD, Janssen biotech: Honoraria Matthew McKinney, MD, ADC Therapeutics: Advisor/Consultant|ADC Therapeutics: Honoraria|Beigene: Grant/Research Support|Beigene: Honoraria|Epizyme: Advisor/Consultant|Genentech: Advisor/Consultant|Genentech: Grant/Research Support|Genentech: Honoraria|Gilead/Kite: Advisor/Consultant|Gilead/Kite: Honoraria|Incyte: Grant/Research Support|Novartis: Advisor/Consultant|Seagen, Inc.: Advisor/Consultant|Takeda: Advisor/Consultant|TG therapeutics: Advisor/Consultant
160. Measuring the Impact of PCR-based MRSA Nares Screening on Vancomycin Use and Duration of Vancomycin Among Pneumonia Patients at an Academic Medical Center
Authors: Stromberg Joseph , Jones Travis , Mavrogiorgos Nikolaos , Marx Ashley H
Published: November 2023

Background

The benefits of PCR-based MRSA nares screening for de-escalation of pneumonia therapy are well-established. In late 2022, UNCMC introduced a PCR-based MRSA nares screen for inpatient use, replacing a chromogenic culture-based screen. The improved turnaround time of the PCR-based test was hypothesized to increase adoption of screening for empirical de-escalation. This project assessed adoption of this diagnostic and measured impact on patients with pneumonia who comprise a cohort followed by the ASP using a visualization dashboard.

Methods

A report was generated of patients with admission ICD-10 codes compatible with pneumonia for January-March of 2022 (pre-PCR) and 2023 (PCR). Electronic medical records of included encounters were reviewed to collect respiratory culture data, validate vancomycin exposure days within the context of the patient’s renal function, and confirm presence of clinical pneumonia. For 2022 data, MRSA screen results were manually collected from the medical record, while for 2023 data, encounters were matched with MRSA PCR results. Fisher’s exact was used to analyze categorical data.

Results

46 and 68 patients, respectively, were included for 2022 and 2023. There was a trend increase in the percentage of patients who were screened for MRSA (28% to 51%, p = 0.68; Table 1). Median turnaround time decreased from 2,022 min to 112 min. The frequency of respiratory sputum cultures, MRSA positivity, and empiric vancomycin therapy were similar. Median duration of vancomycin exposure decreased among all vancomycin recipients (3 to 2 days; Table 2). The percentage of vancomycin recipients who received just one day of coverage increased from 22% to 46%, a trend observed regardless of MRSA screening (Figure 1).

Conclusion

The PCR-based MRSA nares screen for inpatients with pneumonia has trended toward wider adoption compared to the prior screening method, and PCR has been associated with decreased durations of vancomycin therapy. However, similar trends were present in patients who did and did not undergo MRSA screening, suggesting both the new MRSA screen and broader institutional factors have contributed to a shift away from empirical anti-MRSA coverage for pneumonia.

Disclosures

All Authors: No reported disclosures