bluuebunny/crossref_metadata_2025 huggingface dataset:
951. Virtually the Same: Our Experience Teaching Abx Before and During the Pandemic
Authors: Schafer Katherine R , Shen E , Peters Timothy R
Published: December 2021

Background

Understanding core principles of empiric antibiotic (abx) therapy is essential for abx stewardship. Pre-pandemic, the “Abx 101” workshop taught students an initial approach to empiric abx. Due to the pandemic, the session became virtual. We hypothesized that the face-to-face version (FTF) would be more effective and more positively reviewed by students compared to the virtual.

Methods

For the FTF, 3 faculty facilitated workshops of 50 3rd year medical students. The intro reviewed the typical microbiota of body areas (or common pathogens for community-acquired disease in sterile spaces). Student small groups were assigned a category of abx coverage (e.g. “MRSA drugs”), and completed a worksheet to identify abx in the assigned category from a reference list of abx. Groups taught back to the class (jigsaw technique) about abx for their respective categories. Next, faculty facilitated a large group discussion in which they matched initial abx therapy for each body area’s typical microbiome or pathogens. Finally, groups presented cases to the class and identified likely diagnosis, most likely organisms, and appropriate empiric abx to target those organisms. For the virtual version, the format was adapted for a 1 hour online interactive session with 1 MD facilitator, 20-25 students, and no breakout groups/jigsaw technique. The content was unchanged other than fewer cases.

Results

26 of 140 (19%) students completed the survey (n=13 FTF, n=13 virtual). An independent-samples t-test compared FTF and virtual overall satisfaction scores. There were no significant differences in satisfaction from the FTF (M=8.54, SD=1.04) and virtual sessions (M=8.62, SD=1.94); t(24)=-.126. p=0.901. 100% of both groups rated the session as quite/extremely relevant to their training and 100% of respondents in both groups deemed the format of the sessions appropriate for the content. In the FTF group, 76% of respondents felt the session was quite/extremely effective for learning about abx spectra of activity, compared to 69% in the virtual group (X2 (1, N = 26) = .195, p = .658).

Conclusion

“Abx 101” was relevant, effective, and formatted well for learning about empiric abx, in FTF and virtual versions. These findings suggest that this curriculum is effective overall and adapts well for in-person and remote learning.

Disclosures

All Authors: No reported disclosures
952. Validating a Novel Framework to Classify Inpatient Infectious Diseases Consultation Requests
Authors: Merchant Elisabeth A , Patell Rushad , Hale Andrew , Azim Ahmed Abdul , Cool Josephine , Persaud Brian , Ricotta Daniel N , Dodge Laura E , Freed Jason
Published: December 2021

Background

Consistent classification of consult requests may lead to more efficient and collegial conversations about patient care, which could improve work satisfaction and enhance the learning environment. The authors propose a framework of 7 consultation types (Table 1). We aimed to obtain validity evidence for this rubric to consistently classify consultation requests.

Table 1. Framework for classifying consults into 7 types

Methods

A randomly selected sample of 100 de-identified infectious diseases (ID) consult requests from a single academic center were independently coded as 1 of the 7 consultation types by 3 ID specialists and 3 hospitalists. Perfect concordance (6/6 coders) and partial concordance (4/6 or 5/6 coders) was calculated. Total (3/3 coders) and partial (2/3 coders) concordance based on consult subtypes and provider specialty was also calculated. We compared proportions between groups using a chi square test.

Results

Perfect concordance was 30%, and partial concordance was 60% (Figure 1). Total concordance among ID specialists was 44% and among hospitalists was 54% (Table 2). In cases without perfect concordance (n=70), ID specialists had 20% total concordance and 70% partial concordance, while hospitalists had 34% total concordance and 59% partial concordance. ID specialists were less likely than hospitalists to have perfect concordance for ideal consults (52% vs 73%, P=0.01). ID specialists and hospitalists were similarly likely to classify a consult as ideal (65% vs 69%, P=0.34), but ID specialists were more likely to classify a consult as S.O.S. (25% vs. 17%, p=0.02), and less likely to classify a consult as confirmatory (3% vs 7%, P=0.02) (Table 3).

Figure 1. Concordance overall by consensus consult type among hospitalists and infectious disease specialists

Table 2. Concordance by consult type stratified among infectious disease specialists and hospitalists

Table 3. Consult type by physician subspecialty, among infectious disease specialists and hospitalists

Conclusion

ID consults can be classified into a novel rubric of 7 subtypes. Overall, partial or perfect concordance between hospitalists and ID consultants was 90%. ID specialists were more likely to classify consult requests as S.O.S than hospitalists, and hospitalists were more likely to classify consults as confirmatory. Opportunities exist to utilize the rubric to improve provider communication and interprofessional education.

Disclosures

All Authors: No reported disclosures
953. Online Medical Education Improves Knowledge of Monoclonal Antibody Treatment for COVID-19 Among Physicians
Authors: Armagan Allison , Uravich Maria B
Published: December 2021

Background

Treatments aimed at patients with mild to moderate COVID-19 offer an opportunity to improve rates of hospitalizations and progression to severe disease. The aim of this study was to assess the educational impact of a series of continuing medical education (CME) activities on the knowledge, competence, and confidence of primary care (PCP), infectious disease (ID), and ER/critical care physicians regarding the management of COVID-19 with monoclonal antibody (mAb) therapy.

Methods

The educational series consisted of 9 online, CME activities in multiple formats. At the individual activity level, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 3-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question, with each participant serving as his/her own control. To assess changes in knowledge, competence, and confidence data from all clinicians who completed both pre- and post-questions were aggregated across activities and stratified by learning themes. McNemar’s test (P< .05) assessed educational effect. Data were collected from 12/20 to 5/21.

Results

To date, the 9 activities have reached over 24,000 physicians. Selected improvements in knowledge and competence measured as relative % change in correct responses pre/post education across the learning themes are reported here. (i) 45% improvement in PCPs and a 31% improvement in ID specialists’ knowledge/competence in identifying patients who would benefit from mAbs (P < .01). (ii) 83% improvement in PCPs and a 42% improvement in ID specialists’ confidence in identifying patients who would benefit from mAbs (P < .001). (iii) 15% improvement in ID specialists’ knowledge/competence on the clinical data on mAbs for COVID-19 (P < .001). (iv) 32% improvement in PCPs knowledge/competence in understanding the mechanism of action (MOA) of mAbs for COVID-19 (P < .001)

Conclusion

This series of online, CME-certified educational activities delivered in multiple formats resulted in significant improvements in knowledge and competence regarding the management of patients with mild to moderate COVID-19. This analysis also uncovered remaining educational gaps; 55% of content related to identifying patients who would benefit from mAbs was not retained post-education.

Disclosures

All Authors: No reported disclosures
954. Resources Needed by Critical Access Hospitals to Address Identified Infection Prevention and Control Program Gaps
Authors: Salman Ashraf M , Soma Mounica , Scebold Jody , Vasa Angela , Tyner Kate , Beach Sue , Lalam Satya Kumar , Fitzgerald Teresa Ann
Published: December 2021

Background

Critical Access Hospitals (CAH) may face challenges with limited resources in their infection prevention and control (IPC) program. As part of the Project Firstline collaborative, the University of Nebraska Medical Center and its clinical partner Nebraska Medicine sought to identify needs and develop resources to mitigate IPC program gaps in small and rural hospitals, including CAHs. Since, little is known about the resources needed by CAHs to strengthen their IPC program, a needs assessment survey was deployed to Federal Emergency Management Agency Region VII CAHs.

Methods

A 49-question Research Electronic Data Capture (REDCap) survey was distributed via email to infection preventionists in Region VII CAHs. The survey had 4 sections with questions focused on IPC program infrastructure, competency-based training, audit and feedback, and identification and isolation of high-risk pathogens/serious communicable diseases. An IPC practice score was assigned to each CAH by totaling “yes” responses. A “no” or “not sure” response was considered an IPC gap. Respondents who selected “no” were asked to identify resources that would assist in mitigating identified gaps. Descriptive analyses evaluated frequency of gaps and most cited resources. Welch t-test was used to study differences in IPC practice score between states.

Results

50 CAHs (33 in NE, 16 in IA and 1 in KS) and 1 small NE hospital (not licensed as CAH but included in the analyses as CAH) participated in the survey. Majority (n=38) responded to all sections with IPC scores ranging from 13 to 48. There was no significant difference between IPC practice scores of CAHs in NE and IA (average score 33 vs 36; p = 0.38). Specific IPC practice gaps present in > 50% of CAHs were related to audit and feedback practices (Table 1). Additional gaps included lack of drug diversion program, absence of input from IPC team prior to purchasing equipment and failure to conduct risk assessment for the laboratory. Most CAHs cited a standardized audit tool and staff training materials as much needed resources (Table 1).

Table 1. Needs/Resources for the identified Infection Prevention and Control Gaps.

Conclusion

Major IPC gaps exist in CAHs with many of them related to implementing audit and feedback practices that are an essential component of a successful IPC program. Focus should be directed on developing resources to mitigate identified IPC gaps.

Disclosures

M. Salman Ashraf, MBBS, Merck & Co. Inc (Grant/Research Support, I have recieved grant funding for an investigator initiated research project from Merck & Con. Inc. However, I do not see any direct conflict of interest related to the submitted abstract)
956. Neurosurgical Infectious Disease Curriculum for Infectious Disease Fellows and Application of a Novel Surgical Infectious Disease Framework
Authors: O’Neil Jessica , Larsen Christian , Paras Molly L
Published: December 2021

Background

Infectious disease (ID) consultations from surgical services account for 30-41% of all ID consults at academic medical centers. However, adult ID fellows in the United States complete residency training in Internal Medicine and may have limited prior exposure to patients on surgical services. We surveyed 16 first and second-year fellows of the combined Massachusetts General Hospital/Brigham and Women’s Hospital ID Fellowship to evaluate their self-perceived ability to approach ID consults from surgical services. While 75% self-reported confidence in their ability to approach general surgery consultations, only 33% reported confidence with neurosurgical related consultations.

Methods

We created a novel framework for approaching surgical ID consult questions (Figure 1). We then developed two interactive case-based discussion sessions for first-year fellows to address common neurosurgical consult scenarios (post craniotomy/ craniectomy surgical site infections and cerebral spinal fluid shunt infections). The session materials, including images of common surgical approaches and risk factors for infection, were reviewed by a neurosurgeon content expert. An ID faculty member facilitated the discussions. Each discussion took place during a 30-minute teleconference. The learners then completed a self-assessment survey to evaluate the extent to which they could meet the educational objectives (Table 1) using a 1-5 Likert scale.

Figure 1. Surgical Infectious Diseases Framework

Table 1. Educational Objectives for Case 1 and 2

Results

All sixteen learners (eight per case) completed the educational objective self-assessment surveys. The educational objectives were achieved with all questions reaching a mean response of 4 or greater indicating that the mean of learners agreed (4) or strongly agreed (5) that they were able to meet the outlined educational objectives after participating in the discussion session for Case 1 (Figure 2) and Case 2 (Figure 3).

Figure 2. Educational Objective Self-Assessment Scores for Case 1

Figure 3. Educational Objective Self-Assessment Scores for Case 2

Conclusion

Based on self-assessment surveys, our educational objectives were achieved. In turn, these first-year fellows may be better prepared to address ID consults from neurosurgical services in the future. While the case-based discussions were designed to address specific neurosurgical ID cases, our standardized framework could be adapted to a variety of surgical ID cases.

Disclosures

Molly L. Paras, MD, Deckermed (Other Financial or Material Support, Payment for book chapter)
957. Evaluation of Chagas Disease Knowledge Among Providers Caring for At-risk People with HIV
Authors: Hayon Jesica , Weatherhead Jill E , Clark Eva
Published: December 2021

Background

Chagas disease (CD) is underdiagnosed in the United States due to limited healthcare provider awareness of the disease. Improving provider CD knowledge is important because >200,000 people living in the US are estimated to have CD, and 20-30% of those will develop related cardiac or gastrointestinal disease. People with HIV (PWH) and CD additionally are at risk for CD reactivation, which carries a >70% mortality rate.

Methods

The overall objective of this quality improvement project was to improve provider knowledge of CD prior to implementation of a CD screening initiative at a large HIV clinic in Houston, TX where >5,000 PWH are seen annually (~60% Latinx). We administered the survey to providers at this clinic before and after a 1-hour CD educational session, which included information about CD epidemiology, risk factors, transmission, screening, diagnostic strategies, and available treatments.

Results

Of 33 providers who took the pre-survey (16 faculty, 14 fellows, and 3 medical students), 27 (81.8%) completed all questions. Of 21 providers who took the post-survey (12 faculty, 6 fellows, and 3 medical students), 19 (90.5%) completed all questions. We identified the following CD knowledge gaps (i.e., questions initially answered incorrectly by >25% in the pre-educational session survey): CD transmission, regions of CD endemicity, CD risk factors, organ systems impacted by CD in PWH, and CD testing/follow-up procedures. In the post-educational session survey, we observed significant improvement in providers’ knowledge of CD epidemiology (correct selection of estimated number of people living with CD in the US improved from 26.7% to 90.5%, Fisher’s exact p< 0.0001), transmission (correct selection of “mother-to-child” answer improved from 73.3% to 100%, p=0.0150), and selection of correct CD testing answers improved from 51.9% to 85%, p=0.0286.

Conclusion

Improved CD awareness among healthcare providers and reliable systematic screening protocols are important in at-risk populations. Through simple administration of a 1-hour educational session, we identified and improved several CD knowledge gaps. We noted significant improvement in providers’ confidence in their CD knowledge, specifically in epidemiology, transmission, and diagnostic and screening testing.

Disclosures

All Authors: No reported disclosures
959. Online CME Successful at Improving Knowledge, Competence and Confidence on Incorporating mAbs for COVID-19 Among a Global Audience
Authors: Armagan Allison , Bell Elaine , Uravich Maria B , Voorn Shanthi
Published: December 2021

Background

The incorporation of effective treatments is critical to improving patient care for COVID-19. We assessed the educational impact of a series of continuing medical education (CME) activities on knowledge, competence, and confidence changes in US and OUS physicians related to the use of monoclonal antibodies (mAbs) for COVID-19.

Methods

10 online, CME-certified activities were delivered in multiple formats. For individual activities, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 1 to 7-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question. To assess changes in knowledge, competence, and confidence, data were aggregated across activities and stratified by learning theme. McNemar’s test or paired samples t-test (P< .05) assessed educational effect. The activities launched between November 2020 and May 2021; data were collected through May 2021.

Results

To date, the 10 activities have reached over 50,000 clinicians, including 24,627 physicians. Selected improvement/reinforcement in knowledge/competence measured as relative % change in correct responses pre/post education across the learning themes are reported. (i) 89% improvement/reinforcement among US ID specialists in knowledge/competence incorporating mAbs into patient care and 83% improvement among outside the US (OUS) ID specialists (P < .001). (ii) 70% improvement/reinforcement among US PCPs in knowledge/competence incorporating mAbs into patient care and 55% improvement among OUS PCPs (P < .001). (iii) 52% improvement/reinforcement in knowledge/competence among US PCPs regarding clinical data for mAbs and 44% among OUS PCPs (P < .001). (iv) 42% of US ID specialists and 29% of OUS ID specialists had a measurable improvement in confidence in identifying patients who would benefit from mAbs (P < .001).

Conclusion

This series of online, CME-certified educational activities resulted in significant improvements in knowledge, competence, and confidence regarding the appropriate use of mAbs for SARS-CoV-2 in clinical practice. These results demonstrate the effectiveness of global curriculum-based education for clinicians designed to address specific gaps in care.

Disclosures

All Authors: No reported disclosures
960. Creation of an Infection Prevention and Control (IPAC) Elective for Infectious Disease (ID) Fellows
Authors: Kiley John L , Barsoumian Alice E , Thompson Bernadette , Markelz Elizabeth
Published: December 2021

Background

ID specialists often function as leaders of IPAC for healthcare systems, with variable training. Our graduates have noted feeling underprepared for this role despite completion of a computer-based training course on IPAC basics. We developed a 2-4 week IPAC elective (IPACe) rotation to address this gap to increase familiarity with key IPAC concepts, introduce learners to approaches to IPAC investigations, and develop understanding of common IPAC challenges and controversies.

Methods

Methodology followed Kern’s 6-step approach. A reading list focusing on key areas in infection prevention was developed. Instructional methods included flipped classroom, learner led discussions, performing tracers, and integration with the IPAC team. Key hospital processes including High Level Disinfection (HLD) and Sterile Processing Department (SPD) were reviewed in detail with and observed by learners. In addition to an IPACe, periodic required IPAC essay questions on real-world investigations as they arose were delivered to the learners. Learner Assessment: Learners were assessed on elements of IPAC consistent with the ACGME 6 core competencies at the end of their rotation. Program Assessment: Anonymous narrative feedback was solicited post rotation completion and at semi-annual program evaluations. Additionally, learners were asked to rate the elective on a 5 point Likert scale (1 lowest, 5 highest) and specific feedback was solicited for improvement. Finally, feedback was solicited from graduates in IPAC roles.

Results

8 learners participated over from 2017-2021: 2 for 4 weeks, and 6 for 2 weeks. 4 of 8 surveys included a response to the questionnaire, all survey respondents (4/4) rated the elective 5: “rotation should be required of all trainees in the program.” Narrative assessments revealed the elective was highly valuable. Graduates reported feeling well-prepared after the IPACe for their roles as IPAC leaders. Highlights identified were: exposure to interdisciplinary teamwork, participation in tracers in identifying gaps, and using real-world IPAC challenges as cognitive frameworks for outbreak investigation.

Conclusion

An IPACe was highly valued by fellow learners and narrative assessments identified key areas for further focus.

Disclosures

All Authors: No reported disclosures
961. Experience, Lessons, and Strategies in Developing a High-Impact Real-Time Learning Network for Clinicians Caring for Patients with COVID-19 Infection
Authors: Kullar Ravina , Patel Payal K , Connolly Marjorie , Jallah Coran , Levy Gayle , Phadke Varun , Phadke Varun , Weld Ethel , Werbel William , Weddle Andrea , Wollins Dana , Chida Natasha
Published: December 2021

Background

Accurate and rapid dissemination of clinical information is vital during pandemics, particularly with novel pathogens. To respond to the high volume and constantly evolving knowledge during the COVID-19 pandemic, the Infectious Diseases Society of America (IDSA) created an online educational COVID-19 Resource Center for frontline clinicians.

Methods

In February 2020, IDSA launched an online resource center for COVID-19, which housed relevant clinical guidance, institutional protocols, and clinical trials. Then, in September 2020, IDSA leveraged a CDC grant to transform the resource center into the COVID-19 Real Time Learning Network (RTLN), a user-friendly, up-to-date microsite that contains clinically focused original content, guidelines, resources, and multimedia (Figure 1). The RTLN is supported by a team consisting of a Medical Editor, Associate Editors, an Online Editor, and IDSA staff. As of June 2021, the RTLN housed 12 sections, 7 of which are comprised of original content; these 7 sections contain a total of 37 subsections. A Twitter account (@RealTimeCOVID19) was also created in October 2020 to share information from RTLN in real-time.

Figure 1. COVID-19 Real Time Learning Network Microsite

Results

As of June 2021, the most visited page of the RTLN was the Moderna Vaccine page, with 486,969 page views (Figure 2). Peak monthly page views are displayed in Figure 3. Between October 2020 and June 2021, the RTLN Twitter account had 2,911 followers, 2,135,783 impressions, and 41,793 engagements. The account had also hosted 2 Twitter Chats on COVID-19 vaccines; these chats resulted in 19 million and 5.3 million impressions, respectively. Twitter engagements by month are displayed in Figure 4.

Figure 2. Literature Review of Moderna COVID 19 Vaccine on RTLN

Figure 4. RTLN Twitter Engagements By Month

Conclusion

A comprehensive educational microsite housing clinically relevant COVID-19 information had high uptake, and an accompanying Twitter account had significant engagement. Rapid curation is labor-intensive and required expansion of our editorial team. To ensure we continue to serve the needs of our users a qualitative survey is planned. Our experience launching the RTLN can serve as a roadmap for the development of accessible and nimble educational resources during future pandemics.

Disclosures

Varun Phadke, MD, Nothing to disclose
962. Essential Consultants’ Skills and Attitudes (Willing CONSULT): A Cross-Sectional Survey
Authors: Matsuo Takahiro , Hayashi Kuniyoshi , Uehara Yuki , Mori Nobuyoshi
Published: December 2021

Background

There is an increasing number of studies that infectious diseases consultations improve patients’ outcomes, but few studies have investigated the quality of consultations. The aim of this study was to identify important skills and attitudes for consultants to improve the quality of consultations.

Methods

We conducted our research in two phases: a preliminary survey (May 1 to 14, 2020) and the main survey (June 1 to 14, 2020). As a preliminary survey, first-year postgraduate residents at St. Luke’s International Hospital in Tokyo, Japan, were first asked an open-ended question about the types of skills and attitudes that are important for consultants. After eliminating duplicate answers, there were 19 skills and attitudes in total. In the main survey with residents who completed their residency training at our institute, from 2014 to 2018, and current residents (2019–2020), we first asked them about their demographic characteristics (gender, years of postgraduate education, and type of specialty). Then, they answered how important each skill and attitude are for consultants. All 19 items were scored on a seven-point Likert scale that ranged from 0 (completely disagree) to 6 (totally agree) (Figure 1). Cronbach’s alpha confirmed the internal consistency of the questionnaire items. Principal component analysis and exploratory factor analysis were performed.

Figure 1. Skills and attitudes required in consultants according to residents

Results

The survey included 107 individuals (61.1%, 175 potential participants). The median postgraduate years of education were four (interquartile range: 2-5), and 64.5% were men (n = 69). Seven key elements for consultants were identified and termed Willing CONSULT. These included (1) willingness (willingness to accept consultation requests), (2) contact (easy access to consultants), (3) needs (consideration of consulters’ needs), (4) suggestions and support (providing clear recommendations and suggestions, following up on the patients, and supporting the consulters continuously), (5) urgency (considering the situation’s urgency and responding appropriately), (6) learning opportunities (providing teaching points), and (7) text (writing medical records appropriately and quickly) (Figure 2).

Conclusion

We propose Willing CONSULT, which are important skills and attitudes for consultants.

Disclosures

All Authors: No reported disclosures
963. Antibiotic Talk on TikTok: An Opportunity for Patient Education?
Authors: Biehle Lauren R , Evans Emma , O’Kane Aislinn
Published: December 2021

Background

Antimicrobial resistance is increasing at an alarming rate. Patient education is a critical component of stewardship and many patients access resources online. TikTok is a video-sharing social media platform with 700 million monthly users and contains videos that discuss health information. The objective of this study was to evaluate antibiotic-themed TikTok videos for their validity and reliability.

Methods

In March 2021, a search on TikTok using the term “antibiotics” was performed and the top 300 consecutive videos were identified. Data collected included: number of likes, associated disease state, medications, educational aim, mention of COVID-19, and if performed by a healthcare professional (HCP). Non-English videos were excluded. The DISCERN score was used to evaluate all videos for reliability.

Results

The first 300 consecutive videos were assessed using the DISCERN score. Of the 300 videos, most (n=224) were not created by HCPs (non-HCPs). The number of “likes” per video ranged from 1 like to 2 million likes with a mean of 34,949 ± 143,482. Videos produced by HCPs were significantly more valid and reliable (mean DISCERN score of 1.65 vs 1.17, p < .00001) than non-HCPs. They were found to be more relevant (p< .00001), have clearer aims (p< .00001), and were more balanced/unbiased (p=.00188). Videos created by HCPs were more likely to have an educational focus (p< .0001). There was no difference between groups in clarity of sources utilized or risk/benefits discussed of each treatment. Across all videos, the most common disease states mentioned were urinary tract infection, skin and soft tissue infection, and upper respiratory tract infection. Natural products, penicillins, and sulfa antibiotics were the most commonly discussed medications.

Conclusion

Videos created by HCPs were significantly more valid and reliable than those created by non-HCPs. The videos created by HCPs were also more likely to have clear aims and be more relevant. However, the majority of the videos evaluated were created by non-HCPs. It may be beneficial for HCPs to provide TikTok videos that are valid and reliable for patient education.

Disclosures

All Authors: No reported disclosures
116. Characterization of small colony variants from a patient with bloodstream infection of Candida glabrata
Authors: Cheng Shaoji , Hassan Badrane , Liu Guojun , Clancy Cornelius J , Nguyen Minh-Hong
Published: December 2021

Background

Bacterial small colony variants (SCVs) that are tolerant to commonly used antibiotics are well recognized. Clinical SCV Candida have been rarely reported. We describe SCV C. glabrata (CG) strains recovered from within a population causing bloodstream infection (BSI) in a patient (pt), which were not recognized by the micro lab. Pt J developed CG BSI shortly after liver transplant (OLTX), which was treated with voriconazole (VOR). VOR was also used for post-OLTX mold prophylaxis. 67 d after BSI, he developed intra-abdominal infection due to VOR-resistant CG. We hypothesized that BSI might be caused by an unrecognized mixed population of azole-susceptible and –resistant strains.

Methods

Ten colonies from small (SCV) and large colonies (LC) from blood culture (BC) agar plates underwent Illumina NextSeq WGS and phenotype testing.

Results

BCs from pt J harbored a diverse population of genetically distinct CG strains, differing by unique SNPs and indels [Fig. 1]. Gene variants identified were enriched for biological processes involved in mitochondrial processes (2.5e-9), cell adhesion (3.3e-5), and respiration (3.5e-4). Unlike LC, SCVs were fluconazole (FLU) resistant (MIC: 128 µg/mL), and exhibited enhanced CDR1 and PDR1 expression (257 ± 11, 15 ± 4, respectively). Compared to LCs, SCVs grew slowly in YPD, did not grow on media containing glycerol as sole carbon source, and were less adherent to agar. SCVs stained poorly with rhodamine 123 by fluorescence flow cytometry and had fewer mitochrondria by transmission electron microscopy, consistent with WGS findings and respiratory deficiency. SCVs were less susceptible to macrophage (J774) phagocytosis, and they were significantly outgrown by other strains in competitive infections in vitro and during disseminated candidiasis in mice. LCs incubated with FLU in vitro yielded SCVs in concentration-dependent manner. Likewise, LCVs passed through spleens of mice following IV inoculation yielded SCVs in both presence and absence of FLU.

Venn diagram for 5 representative stranis of C.glabrata

Conclusion

Mitochondrial dysfunction and SCVs may be under-recognized determinants of azole resistance in CG, if micro labs select single colonies from BCs for antifungal susceptibility testing, or in absence of prolonged incubation.

Disclosures

Cornelius J. Clancy, MD, Merck (Grant/Research Support) Minh-Hong Nguyen, MD, Merck (Grant/Research Support)
968. Leveraging On-Demand Digital Education to Increase ID Specialists’ Knowledge and Confidence on Appropriate Probiotic Use for CDI Prevention
Authors: Armagan Allison , Hurst Simi Thomas
Published: December 2021

Background

Probiotics are increasingly being used in healthcare. As the number of probiotic options and their potential uses increase, it has become more challenging to make an informed selection for a given disease state. This study assessed the ability of digital education to improve Infectious Disease (ID) specialists’ knowledge regarding the use of probiotics in preventing Clostridioides difficile infection (CDI) and antibiotic-associated diarrhea (AAD).

Methods

A CME/ABIM MOC certified, educational program featuring a panel of 3 expert ID faculty was developed. The program sought to clarify the role of different probiotic strains in the prevention or treatment of different disease states. Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design; each individual served as his/her own control. A chi-square test assessed changes pre- to post-assessment. P values < 0.05 are statistically significant. Effect sizes were evaluated using Cramer’s V (< 0.05 modest; 0.06-0.15 noticeable effect; 0.16-0.26 considerable effect; > 0.26 extensive effect). The activity launched on a website dedicated to continuous professional development. Data for this matched-learner analysis were collected through 09/09/20.

Results

To date, 7122 HCPs, including 5068 physicians, have participated in the activity. Data from the subset of ID specialists (n=235) who answered all pre-/post-assessment questions during the initial study period were analyzed. Following activity participation, significant improvements were observed in the proportion of ID specialists who answered assessment questions correctly (47% pre vs 69% post; P < .0001; V=.22). Improvements were also observed in several specific areas of assessment (Table) and confidence in their ability to select a probiotic-based on strain- and disease-specific efficacy (36% increase).

Conclusion

Participation in this online educational program significantly improved ID specialists’ understanding of the interplay between strain- and disease-specificity in the context of probiotics. These findings highlight the potential for well-designed online education to positively impact physicians’ knowledge and confidence

Disclosures

All Authors: No reported disclosures
970. Medical Student Engagement with the COVID-19 Pandemic Is Increased Through Participation in a Preclinical Elective
Authors: Cummins Kaelyn C , Naeger Katherine , Kulkarni Prathit A
Published: December 2021

Background

The medical field’s response to the Coronavirus Disease 2019 (COVID-19) pandemic required a multifaceted approach. Medical students were often excluded from the initial phases of pandemic response, resulting in feelings of disengagement. This study aimed to determine if offering educational experiences on current events related to the COVID-19 pandemic could increase medical students’ understanding of, and engagement with, the pandemic.

Methods

In Fall 2020, an elective course reviewing several aspects of the COVID-19 response was implemented. Preclinical medical students attended a discussion-based seminar series given by expert faculty on a variety of topics including pathophysiology, vaccine development, telemedicine, and others. Upon course completion, students were asked to complete a survey quantifying their understanding of the overall COVID-19 response, understanding of various individual facets of the response, and feelings of personal engagement on a Likert scale from 1-5, with 5 representing the most understanding or engagement. The differences in pre-course and post-course mean scores were compared using a Wilcoxon matched-pairs signed rank test for each question.

Results

A total of 65 students completed the course; 35 (54%) students filled out the final course survey. Results showed significant improvement in students’ perceived holistic understanding of the pandemic response (2.67 pre-course vs. 4.36 post-course; p < 0.001), and their feelings of personal engagement (3.06 pre-course vs. 4.33 post-course; p < 0.001). Students also reported significantly increased feelings of understanding for each individual facet of the pandemic response reviewed during the course (8 questions total, all p-values < 0.001).

Conclusion

Preclinical medical student participation in a course reviewing COVID-19 pandemic response significantly increased feelings of engagement with and understanding of the medical field’s response to the pandemic. Students showed improved understanding of each aspect of the pandemic response that was covered in the elective. Therefore, it appears that seminar- and discussion-based electives can be a useful tool for fostering preclinical student engagement in current events in medicine.

Disclosures

Prathit A. Kulkarni, M.D., Vessel Health, Inc. (Grant/Research Support)
971. Online Medical Education Improves Knowledge of Data on Appropriate and Timely Use of Influenza Antiviral Medications to Patients at High Risk for Influenza-Related Complications and Morbidity
Authors: Armagan Allison , Smith Roderick
Published: December 2021

Background

Many patients are at a higher risk of influenza complications because of age and comorbidities. We sought to assess whether online education, focused on appropriate and timely use of influenza antiviral medications to patients at high risk for influenza-related complications and morbidity, could improve knowledge, competence, and confidence of clinicians.

Methods

Primary care physicians (PCPs) and pediatricians participated in a 30-minute video lecture with synchronized slides. Educational effect was assessed using a repeated-pairs design with pre-/post-assessment. Three multiple choice questions assessed knowledge/competence, and 1 question assessed confidence. Statistical tests to assess significance: Paired samples t-test for overall average number of correct responses and for confidence rating; McNemar’s test for individual questions (5% significance level, P < .05). Cohen’s d estimated the effect size impact on number of correct responses (< .20 modest, .20-.49 small, .59-.79 moderate, ≥.80 large). Data were collected from 10/28/20 to 12/23/20.

Results

Average knowledge/competence improved from 29% to 43% (N=430, P< .001, Cohen’s d = 0.46) among primary care physicians and from 31% to 43% (N=226, P< .001, Cohen’s d = 0.38) among pediatricians. Post participation, 12% more PCPs and pediatricians answered all questions correctly. Relative improvements post-participation in specific areas were as follows (P< .001): (i) 105% improvement among PCPs and 100% improvement among pediatricians in findings associated with the efficacy of treatment with antivirals for influenza in hospitalized patients. (ii) 117% improvement among PCPs and 104% improvement among pediatricians in identifying the antiviral with the greatest activity against influenza B viral strain as reported in a phase 3 clinical trial. (iii) 34% of PCPs and 46% of pediatricians had a measurable improvement in confidence after completing the program.

Conclusion

This study demonstrated the success of a video lecture with synchronized slides at improving PCPs and pediatricians knowledge, competence and confidence related to appropriate and timely use of influenza antiviral medications to patients at high risk for influenza-related complications and morbidity.

Disclosures

All Authors: No reported disclosures
973. Utilization of Project ECHO for COVID-19 Medical Knowledge and Best Practices for Health Professionals serving an Underserved Population
Authors: Rodriguez Natalia , Goebel Melanie , Bhushan Sheena , Patel Shital
Published: December 2021

Background

During the global COVID-19 pandemic, the release of research and data particularly to guide clinical care evolved rapidly and highlights the critical need for timely, and equitable access to medical knowledge and best practices. Specialized medical knowledge has historically been confined to specialists in academic medical centers and disconnected from healthcare professionals in underserved areas. It is important to bridge this gap and democratize knowledge through a model that supports rapid dissemination of best practices to build capacity in areas of need.

Methods

A Project ECHO partnership was implemented between academic infectious diseases specialists and local healthcare professionals involved in COVID-19 screening, diagnosis and management serving an underserved population. BCM COVID-19 ECHO supported the Access2Health SmartPod COVID-19 clinical operations staffed by a charitable community organization. The SmartPod clinical team were engaged in weekly one-hour ECHO sessions with didactic presentations and case discussions on diverse COVID-19 topics. The program was evaluated at 6 months.

COVID 19 ECHO Model

BCM COVID-19 ECHO Telementoring Program with the United Health Partners in the community

BCM COVID-19 ECHO Telementoring Session Topics

Curriculum developed for the health professionals seeing patients in the SmartPOD and clinics in underserved communities.

Results

In Fall 2020, BCM COVID-19 ECHO facilitated 10 sessions with an average attendance of 8 healthcare professionals per session. Evaluation results indicated high levels of satisfaction with session content and telementoring partnerships, with 80% expressing intent to apply the knowledge and skills acquired from the sessions to their clinical practice.

Conclusion

The Project ECHO model successfully engaged healthcare professionals in a continuous learning loop. With the rapid and vast amount of information during the COVID-19 pandemic, it is important to ensure health professionals have equitable access to medical knowledge and feel empowered to implement best practice changes.

Disclosures

All Authors: No reported disclosures
974. The Use of Social Media for Medical Education During the COVID-19 Pandemic; A Vision to the Future
Authors: Fentanes Maria Jose Reyes , Guerra Paula Amescua , Villalobos Armelle Perez Cortes
Published: December 2021

Background

The COVID-19 is the first pandemic in history where technology and social media can be used to keep people safe and informed. The correct management of information has been recognized as a critical part of controlling the COVID-19 pandemic. The objective of this study is to create a source of information about COVID-19 that is reliable, accessible, and easy to share while providing literature references.

Methods

An Instagram account named @cienciacontracovid19 was created in 2020. In this account, the most relevant up-to-date medical information of COVID-19 is published daily in Spanish. All the account’s content is made by two infectious diseases specialists and a general practitioner. After 6 months since the creation of the account, we performed a survey to assess the followers perception of the usefulness of @cienciacontracovid19 during the pandemic.

Results

The account was opened in November 2020. Figure 1 QR to access. Currently, the account has 9,534 followers from 5 Latin-American countries; 48% are between 25-34 years old, 76.6% are women, and 52% are healthcare workers. Until May 2021, 142 educational slides, 3 educational videos and 5 webinars have been posted. In the last 30 days, @cienciacontracovid19 has had 10,540 interactions and growth of +125% reaching 22,000 users. We conducted a survey in April 2021, in which 3,556 people answered. The following results were obtained: 76% considered that the information was always useful in their daily lives and 17% frequently useful. 77% affirmed that the information shared was always reliable and 47% consider that the information differed from other sources of information since it is easy to understand and 34% because it has bibliographic references to support it. 85% responded that the information shared in the account kept them from putting themselves at risk. When asking if the information shared has made them feel safer by being informed, 49% answered always and 44% frequently.

QR to access the instagram account

Conclusion

@cienciacontracovid19 has been a valuable source of scientific information with a positive impact on its users. Its implementation has been a practical medical education tool during the COVID-19 pandemic. By being informed, people could potentially modify some of their behaviors to stay out of risk from COVID-19.

Disclosures

All Authors: No reported disclosures
117. Trends in Four-class HIV Drug Resistance in Treatment-experienced Patients in the United States
Authors: Curanovic Dusica , Lai Johnny , Petropoulos Christos J , Walworth Charles M
Published: December 2021

Background

Despite the availability of potent antiretroviral therapy, only 56% of people living with HIV in the US were virally suppressed in 2018. Drug resistance can hinder suppression, especially among treatment-experienced patients, in whom the prevalence of 4-class drug resistance (4CR) is unknown.

Methods

Genotypic results of PhenoSense GT® Plus Integrase (Monogram Biosciences, South San Francisco, CA) obtained from Apr 2014 to Dec 2020 were used to assign susceptibility to nucleos(t)ide reverse transcriptase, non-nucleoside reverse transcriptase, integrase, and protease inhibitors (NRTIs, NNRTI, INIs, and PIs). Data were analyzed using summary statistics, 2 proportion Z test, one-way ANOVA and Tukey-Kramer; p < 0.05 was significant.

Results

Among 13,651 patients with 15,372 tests, median age was 43 years; most had HIV-1 subtype B infection (95.09%), followed by AG (1.32%).

Among 12,303 patients with only one test, 4CR prevalence was 1.55%. Among 1,348 patients with more than one test, 4CR was seen in 3.64% of patients, and in 4.60% if cumulative resistance reports were assembled for each patient. Patients with 4CR were significantly older than those with less resistance.

The incidence of 4CR fluctuated, with a decline from 2.61% of patients tested in 2014 to 1.38% in 2017, an increase to 2.36% in 2018, and a decline to 1.56% in 2020. Among patients with more than one test, 21.01% gained resistance to a drug in a new class over an average of 19.5 months.

Most new resistance each year was to NNRTIs, followed by NRTIs, INIs, and PIs. The incidence of PI resistance declined for PIs from 13.34% of patients tested in 2014 to 11.82% in 2020, but increased for INIs from 14.56% in 2014 to 16.49% in 2020. The regimen expected to be suppressive in the greatest proportion of patients was dolutegravir + darunavir/cobicistat (94.51%).

Conclusion

The prevalence of 4CR has declined over time, but remains clinically relevant, particularly in older patients who may struggle with adherence due to complex regimens, comorbidities and polypharmacy. New drug classes may benefit this group. The concurrent increase in INI and decline in PI resistance may reflect changes in prescribing practices. Drug resistance may be underestimated unless cumulative resistance is determined.

Disclosures

Dusica Curanovic, PhD, Monogram Biosciences (Employee) Johnny Lai, BS, Monogram Biosciences (Employee, Shareholder) Christos J. Petropoulos, PhD, Monogram Biosciences (Employee, Shareholder) Charles M. Walworth, MD, Monogram Biosciences (Employee, Shareholder)