bluuebunny/crossref_metadata_2025 huggingface dataset:
2572. Adherence to Evidence-based Guidelines for the Management of Pneumonia in a Tertiary Teaching Hospital in Saudi Arabia
Authors: Alhifany Abdullah A
Published: November 2023

Background

Abstract:

Background

Adherence to therapeutic guidelines is crucial when treating pneumonia, as it reduces mortality rate, length of hospital stay and duration of antibiotic therapy. However, the high non-adherence rate to treatment guidelines, in general, and Infectious Disease Society of America (IDSA) guidelines, are still reported globally. According to our knowledge, no existing data is available regarding the rate of physicians' adherence to the IDSA guidelines for managing pneumonia in Saudi Arabia. Therefore, we aim to assess the adherence rate and the clinical outcomes among patients treated according to the IDSA guidelines, in a tertiary care center in Riyadh.

Methods

Methods

A single-centered, retrospective observational study was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia. All data were extracted from the hospital's electronic information system, known as Esihi. Adult patients (≥18 years old) who have been diagnosed and treated in the hospital for community-acquired pneumonia, hospital-acquired pneumonia, or ventilator-associated pneumonia from Nov 2019 to Nov 2021 were included.

Results

A total of 148 patients were included in this study, with an average age of 65 ± 20 years. Demographics and baseline characteristics of the included patients are shown in Table 1. The data showed that only 74 (50%) were treated according to the guidelines' recommendations, while the other 74 (50%) were not. The former group had a statistically higher cure rate and lower mortality compared to the latter (95% vs. 84%; p = 0.034) and (5% vs. 14%; p = 0.022), respectively (Figure 1). Nevertheless, patients who were treated according to the guidelines had a higher CURB-64 score for pneumonia severity and Average Calculated Charlson comorbidity index than patients who were treated irrespectively of the guidelines (1.86 vs 1.39) and (4.62 vs 3.28), respectively, yet, no statistically significant difference was observed (Table 1 and 2).

Demographics and Clinical outcomes of included patients n=148

Conclusion

Conclusion

Non-adherence to the evidence-based guidelines has been observed in 50% of patients treated for pneumonia. In addition, higher clinically cure rate, shorter length of stay and lower mortality rate have been observed in patients who were treated based on the evidence-based guidelines.

Disclosures

All Authors: No reported disclosures
2573. The Use of MRSA PCR for De-escalation of Anti-MRSA therapy for CAP and HAP at a Community Hospital: a Quality Improvement Analysis for Antibiotic Stewardship
Authors: Browne Angelina M , Rasnake Mark , Ducas Stephanie
Published: November 2023

Background

The use of nasal MRSA PCR is beneficial in reducing the duration of anti-MRSA therapy, since it can rapidly be attained and has excellent negative predictive value. There is scarcity of literature regarding the potential impact of MRSA PCR on the length of stay and cost of care at a community hospital, when considering empiric treatment of CAP or HAP.

Methods

This retrospective analysis was conducted at Naples Community Hospital, a 588-bed facility. We assessed 134 patients that were admitted for treatment of pneumonia who received anti-MRSA therapy for CAP or HAP from March to April 2023. Our approach was to employ a pharmacy-driven protocol whereby adult patients who had received either vancomycin, linezolid, or both during their hospitalization were screened with MRSA nares PCR shortly after initiation of anti-MRSA therapy. The primary outcome was the duration of anti-MRSA treatment in hours. Secondary outcomes assessed included time from MRSA colonization status result to the discontinuation of anti-MRSA therapy, with subgroup analyses of the percentage of patients with vancomycin trough levels drawn in the vancomycin group, the incidence of acute kidney injury and hospital length of stay pre- and post-implementation.

Results

Our analysis showed a primary outcome with a statistically significant reduction in the hours of anti-MRSA therapy duration when comparing pre- and post-implementation of MRSA PCR (64 vs. 40 hours, P= 0.0008). A considerable improvement was noted in the total duration of anti-MRSA therapy (26 vs. 11 hours, P=0.0006). Our study showed a reduced in length of stay; however, was not statistically significant between the two groups (206 vs 142 hours, P=0.066). No statistical difference was noted in the incidence of AKI between groups.

Conclusion

Our study suggests that pharmacy-driven protocols employed in community hospitals can significantly aid in reduction of inappropriate use of anti-MRSA empiric therapy and reduce costs associated with unnecessary antibiotics. Our analysis showed a trend to shorter length of stay post-implementation, which shortened duration of anti-MRSA therapy. Further investigation with a larger sample size, may also show a significant reduction in length of stay.

Disclosures

All Authors: No reported disclosures
147. Opportunities for Improving Urine Culturing Practices in U.S. Acute Care Hospitals, 2017-2020
Authors: Asonganyi Nyawung , Kazakova Sophia V , Baggs James , Hatfield Kelly M , Reddy Sujan , Fridkin Scott , Lutgring Joseph D
Published: November 2023

Background

Inappropriate urine cultures (UCs) lead to misdiagnosis and unnecessary antibiotic use and can impact surveillance. The absence of pyuria on a urinalysis (UA) has a high negative predictive value for urinary tract infections (UTIs) in certain settings and can reduce unnecessary UCs. UCs performed without UA or with a negative UA indicate opportunities for diagnostic stewardship. Understanding facility variability and patient characteristics associated with inappropriate UCs can inform improvements in acute care hospitals (ACHs).

Methods

Using clinical microbiology data from 279 ACHs reporting UC and UA data to the PINC AI Healthcare Database, we assessed appropriateness of the first UC collected during adult hospitalizations, excluding pregnant and urologic procedure patients identified using ICD-10-CM diagnosis codes. Each UC was categorized as follows: (1) UC with at least 1 positive UA (WBC ≥10/HPF, presence of leukocyte esterase or nitrite) 24 hours before/after UC (UA+ UC), (2) UC with negative UA in 24 hours (UA- UC), and (3) UC without UA in 24 hours (no-UA UC). Overall percentages of UC categories were described by year and patient characteristics. Monthly facility-specific percentages of UCs were calculated, and facility-level variability was described by medians, quartiles 1 and 3 (Q1:Q3).

Results

1.2 million incident UCs were included. Of those, 65% were UA+, 21% UA-, and 14% no-UA UCs. From 2017 to 2020, UA+ UCs increased from 60.5% to 68.2%, no-UA UCs decreased from 19.3% to 10.5%, and UA- UCs stayed at 21%. UA- and no-UA UCs were more common among male, younger age, and Medicaid patients (Figure 1). No-UA UCs were more commonly obtained on day 4 or later. The median monthly facility-level percentages of UA+, UA-, no-UA UCs were 75 (Q1:Q3, 55.6-86.5), 15 (Q1:Q3, 6.5-28.6), and 5.3 (Q1:Q3, 2.1-10.5), respectively (Figure 2).

Overall Percentages of Urine Cultures

Variability in Hospital Monthly Percentages of Urine Cultures (UC) in Each Category, 2017-2020, N hospital-months = 9,863

Hospital-level Variability

Conclusion

During the study period, urine culturing practices improved; however, 35% of incident UCs had no UA or negative UA. The high proportion of these UCs and facility-level variability of the monthly proportions call for diagnostic stewardship to identify and address causes of the potentially suboptimal UC practices. This will support the efforts to decrease UTI overdiagnosis and antibiotic overuse.

Disclosures

All Authors: No reported disclosures
2586. Comparison of Antimicrobial Regimens for Critically Ill Patients with Suspected or Confirmed Hospital-Acquired or Ventilator-Associated Pneumonia: A Retrospective, Cohort Study
Authors: Kosharek Abigail , Betthauser Kevin , Juang Paul , Micek Scott , Igles Dan , Kollef Marin
Published: November 2023

Background

Hospital-acquired and ventilator-associated pneumonia (HAP/VAP) remain significant causes of morbidity and mortality among patients admitted to a medical facility. Consensus guidelines for the treatment of HAP/VAP recommend patients with certain risk factors be empirically treated with an anti-methicillin resistant Staphylococcus aureus (MRSA) and anti-pseudomonal antibiotic. The most commonly utilized anti-pseudomonal agents at BJC hospitals include cefepime, followed by piperacillin/tazobactam and meropenem. The purpose of this study is to determine if there is a difference in clinical outcomes between cefepime and the other most commonly used anti-pseudomonal antibiotics, piperacillin/tazobactam or meropenem, at these institutions for the treatment of HAP/VAP.

Methods

This retrospective, multicenter cohort study included adult patients with HAP/VAP who received cefepime, meropenem, or piperacillin/tazobactam. Major exclusion criteria included patients that received antibiotics within 48 hours of hospital admission or less than 48 hours of empiric antibiotics. The primary outcome was in-hospital mortality. Secondary outcomes included change in initial antibiotic, mechanical ventilation-free days, ICU length of stay, hospital length of stay, hospital readmission, and new C. difficile infection.

Results

Of 1,117 included patients, 1,008 patients received cefepime and 109 received meropenem or piperacillin/tazobactam. Incidence of in-hospital mortality was not observed to be significantly different among empiric Gram-negative regimens (cefepime group 19.4% vs. meropenem or piperacillin/tazobactam 22%, p=0.521. Change in initial antibiotic, ICU length of stay, and hospital length of stay were observed to be significantly higher in the cefepime group.

Conclusion

We observed no difference in in-hospital mortality between cefepime and piperacillin/tazobactam or meropenem. However, there was a significantly higher incidence of change in initial antibiotic, ICU length of stay, and hospital length of stay observed in the cefepime group, though additional research is needed to corroborate these observations.

Disclosures

Kevin Betthauser, PharmD, La Jolla Pharmaceutical Company: Advisor/Consultant|La Jolla Pharmaceutical Company: Grant/Research Support Paul Juang, Pharm.D., Merck & Co: Grant/Research Support
2594. Rate of Methicillin-Resistant Staphylococcus aureus Infection Among Patients Hospitalized for Community-Acquired Pneumonia
Authors: Poole Rachel M , Lee Helen , Park Steven
Published: November 2023

Background

National clinical practice guidelines for community-acquired pneumonia (CAP) suggest empiric treatment for methicillin-resistant Staphylococcus aureus (MRSA) among hospitalized patients with risk factors including prior respiratory isolation of MRSA, recent hospitalization with receipt of IV antibiotics within 90 days, or based on a locally validated model. This study aims to assess the rate of MRSA infection among patients hospitalized with CAP to aid clinical decision-making regarding empiric treatment.

Methods

This is a retrospective, observational, population-based, descriptive study at an academic medical center. Patients will be included in the study if they were admitted between 1/01/2021 to 3/18/2023, are at least 18 years old, present with bacterial pneumonia, have a respiratory or blood culture obtained within 48 hours of admission, and complete an MRSA nasal screen, stratified by admission to an ICU vs. non-ICU ward. The primary outcome will be the rate of MRSA infection in patients hospitalized for CAP. The secondary outcome is to determine the negative predictive value (NPV) of MRSA nasal screening. Subgroup analyses will be performed for patients with respiratory MRSA isolation within 1 year of admission, mechanical ventilation within 24 hours of admission, and IV antibiotic use within 90 days of admission.

Results

A total of 1,053 patients met inclusion criteria for the study. The overall rate of MRSA infection was 3.3% (16/490) for ICU patients and 1.1% (6/563) for non-ICU patients. In patients with prior respiratory MRSA isolation, prevalence was 0% (0/7) and 28.6% (2/7) for the ICU and non-ICU groups, respectively. Among mechanically ventilated patients, prevalence was 2% (9/457). For prior IV antibiotic recipients, prevalence was 2.8% (3/109) and 0.5% (1/189) for the ICU and non-ICU groups, respectively. The combined NPV of MRSA nasal screening was 99%.

Conclusion

Overall prevalence of MRSA infection was low among patients hospitalized for CAP, without excluding patients based on underlying comorbid conditions or admission from a skilled nursing facility. MRSA nasal screening was associated with an overall high NPV. Empiric use of vancomycin is unlikely to be warranted for most patients admitted for CAP at our institution.

Disclosures

All Authors: No reported disclosures
2608. Circulating Respiratory Syncytial Virus Genotypes in Hospitalized Children with Bronchiolitis in the United Arab Emirates
Authors: Alsamri Mohammed , Narchi Hassib , AlDhanhani Huda , George Junu , Collyns Timothy , Al Dhaheri Klaithem , Al-Hamad Sania , Alsuwaidi Ahmed R
Published: November 2023

Background

Respiratory syncytial virus (RSV) is a major cause of acute respiratory illness in young children and elderly people worldwide. It has a complex molecular epidemiology with multiple strains cocirculating during a single epidemic. Whole genome sequencing is a valuable tool for monitoring genetic diversity and providing genomic information essential for antiviral and vaccine development. In the United Arab Emirates (UAE), little is known about the RSV circulating genotypes, their evolution, and transmission dynamics. Using next-generation sequencing, this study aims to identify RSV genotypes circulating among young children with bronchiolitis in Al Ain City, UAE.

Methods

This cross-sectional study involved 100 children under two years of age who were hospitalized at a tertiary care facility between April and December 2021 with RSV-positive bronchiolitis. Nasopharyngeal samples were obtained, within 24 hours of hospitalization, for RSV genotyping. MinION nanopore sequencer was used to analyze the whole viral genome. We only sequenced samples with cycle threshold (Ct) < 30 (n=70). After sequencing, 7 samples were not analyzed due to long gaps and small lengths. The remaining 63 samples included 59 RSV-A and 4 RSV-B isolates.

Results

The median age of the studied children was 4.3 months, interquartile range (2.1-10.4), with 56% below the age of 6 months. There was no significant difference in the clinical characteristics of children having RSV-A compared to those infected with RSV-B. Phylogenetic analysis showed that out of the 59 RSV-A sequences, 58 clustered with the NA1 genotype, and 1 sequence clustered with the GA1 genotype. All RSV-B sequences were classified as BA2 genotypes. The amino acid sequence alignment of the G gene revealed that all 58 NA1 genotypes had 24 amino acid duplication regions from 247 to 282 amino acid positions. We also found four substitutional changes at L248I, H258Q, L274P, and P276Q.

Conclusion

Phylogenetic analysis revealed that the subtype A NA1 genotype was the dominant strain among the studied children in Al Ain, UAE during the 2021 season. As vaccine development advances, further sequencing of RSV is needed to better understand viral origin, transmission, and genetic recombination, particularly in under-studied populations.

Disclosures

All Authors: No reported disclosures
2611. Risk Factors Associated with Longer Hospital Stay in Adult Patients with Respiratory Syncytial Virus Infections
Authors: Bhargava Ashish , Malik Ambreen , Szpunar Susan M , Johnson Leonard B , Sharma Mamta
Published: November 2023

Background

Respiratory Syncytial Virus (RSV) is known to cause severe disease in elderly individuals and patients with underlying cardiopulmonary or immunocompromised conditions. Little is known about the factors that are associated with the length of hospital stay (LOS).

Methods

A multicenter historical cohort study was conducted on adult patients hospitalized for laboratory-confirmed RSV-related diseases in Ascension hospitals in Southeast Michigan between January 2017 and December 2021. Hospitalized patients were identified using ICD 10 codes for RSV-related diseases. Electronic medical records were reviewed after IRB approval. LOS was categorized as below the mean LOS or at the mean or above. Data were analyzed using Student’s t-test, the chi-squared test, the Mann-Whitney U test and logistic regression using SPSS v. 29.0.

Results

Of 360 patients, the mean (sd) age of the cohort was 69.9 + 14.7 years, 228 (63.5%) were female and 227 (63%) were white. The mean body mass index (BMI) was 30.6 + 9.7 kg/m2 . The mean Charlson Weighted Index of Comorbidity (CWIC) score was 2.2 + 1.9. The mean hospital LOS was 7.1 + 5.4 days. Factors associated with longer hospital LOS (< =7) in univariable analysis were older age on admission, smoking status, CWIC score, home oxygen, encephalopathy, oxygen requirement during hospitalization, qSOFA score, lower respiratory tract infection, abnormal chest imaging, acute kidney injury, liver injury and respiratory failure requiring intubation. The multivariable logistic regression revealed that predictors for prolonged hospital LOS were age on admission (odds ratios [OR], 1.034; 95% CI 1.01-1.06), smoking status (OR, 2.2; 95% CI 1.2-3.9), CWIC (OR, 1.1; 95% CI 0.99-1.30), liver injury (OR, 4.7; 95% CI 1.16-19.33), oxygen requirement during hospitalization (OR, 2.9; 95% CI 3.02-7.72). and respiratory failure requiring intubation (OR, 9.9; 95% CI 3.02-39.20).

Conclusion

Our study finds that age on admission, patient’s smoking status, their CWIC, liver injury, oxygen requirement during hospitalization and respiratory failure requiring intubation were significantly associated with prolonged hospital LOS among adult patients with RSV infection. Every one unit increase in age and CWIC increased the risk for prolonged hospital LOS by 3.4% and 13.9% respectively.

Disclosures

All Authors: No reported disclosures
2615. Effect of Early NSAID and Aspirin Use on Clinical Outcomes in Patients Hospitalized with Influenza: A Retrospective Study
Authors: Chan-Colenbrander Suk Yin , Wang Qi
Published: November 2023

Background

Seasonal influenza infection causes significant morbidity and mortality worldwide. This study evaluates the effect of early nonsteroidal anti-inflammatory drug (NSAID) and aspirin use in patients hospitalized with influenza.

Methods

We performed a retrospective chart review of patients (age 18 years and older) admitted between January 1, 2016, and December 31, 2019, to the University of Minnesota Medical Center, who were tested positive for influenza. Data were summarized using median and interquartile range (IQR) for continuous variables, frequency and percentage for categorical variables. Groups were compared using two-sample Wilcoxon test for continuous variables and Chi-square test (or Fisher's exact test for sparse data) for categorical variables.

Results

Out of 320 patients tested positive for influenza, 180 were vaccinated against influenza. The median age of those tested positive and vaccinated was 64 (IQR 49-74) and those unvaccinated, 58 (IQR 35-71), p=0.0074. 97.8% of the vaccinated and 94.3% of the unvaccinated, received oseltamivir. More unvaccinated patients were admitted to the intensive care unit (ICU) (p=0.0029) and required ventilatory support (p=0.0097) compared to those vaccinated.

Among the vaccinated, early NSAID use was associated with fewer cardiovascular complications, but this was not significant (p=0.0758). NSAID use was also associated with a higher chance of survival at 1 year (p=0.0004) and 3 years (p< 0.0001) post hospitalization. Among the unvaccinated, NSAID use led to fewer ICU admissions (p=0.0401), fewer cardiovascular complications (p=0.0156) and fewer renal complications (p=0.0006).

Those who were vaccinated and not on aspirin, had a better chance of surviving the hospital stay compared to those on aspirin (p=0.0452). Those who were unvaccinated and not on aspirin, had a higher chance of survival at 3 years post hospitalization than those on aspirin (p=0.0131). No significant difference was observed with aspirin use between these 2 groups in cardiovascular, respiratory or renal complications, ICU admission, 30 days readmission or survival at 1 year post hospitalization.

Conclusion

Our findings show better outcomes with early NSAID use but worse outcomes with aspirin in patients hospitalized with influenza

Disclosures

All Authors: No reported disclosures
2619. Impact of Positive Real-Time Polymerase Chain Reaction Respiratory Viral Panel on the Duration of Antimicrobials
Authors: Dass Akshith , Diaz-Cardona Yahira , Patel Sunita
Published: November 2023

Background

Viral pathogens are increasingly identified as the most common cause of respiratory infections. Viral respiratory panels, such as the real-time polymerase chain reaction (RT PCR), have high specificity and sensitivity for infections due to detected pathogens and are a safe tool to detect viral pathogens. The American Thoracic Society (ATS) recognizes that detecting viral pathogens or mixed viral and bacterial infections in patients with lower respiratory infections can promote appropriate antibiotic use. Optimizing the use of antibiotics is critical to effectively treat infections, protect patients from harm caused by unnecessary antibiotic use, and combat antibiotic resistance. The primary objective of this study is to determine the impact of viral respiratory panel results on the duration of antibiotic use and outcomes in patients with respiratory tract infections.

Methods

A retrospective cohort study of adult patients admitted to Cleveland Clinic Mercy Hospital from November 2021 through May 2022 with a diagnosis of suspected respiratory infection and ordered an RT PCR panel was performed. Patients with a confirmed bacterial co-infection were excluded. The primary outcome of this study is the median duration of antibiotic use. Secondary outcomes include all-cause hospital mortality, hospital length of stay, all-cause hospital readmission within 30 days, and Clostridioides difficile infection within 60 days.

Results

A total of 113 patients were included in the study, of those, 44 patients had a negative viral respiratory panel and 69 patients had a positive viral respiratory panel. The patient population was predominantly male (53%), with a median age of 69 years. The RT PCR negative group had a higher proportion of patients with COPD and CHF compared to the RT PCR positive group (84% vs 38%, p< 0.001 and 50% vs. 28%, p=0.018, respectively). The primary outcome of median duration of antibiotics was significantly lower in the RT PCR positive group (0 [0-5] days vs. 6 [0-8] days, p=0.0001). There were no statistically significant differences observed between groups for any of the secondary outcomes.

Conclusion

A viral respiratory panel is a safe tool for de-escalation of inappropriate antibiotic use in patients with respiratory tract infections.

Disclosures

All Authors: No reported disclosures
2624. The Usual Suspects: A Retrospective Analysis of Pediatric Respiratory Viral Testing During the Pandemic
Authors: Cazali Iris , Erdmenger Diego , roldan Karin
Published: November 2023

Background

Contention measures implemented during the pandemic drastically changed the epidemiology of viral respiratory infections. Some reports have shown a sharp decrease in Emergency department visits for respiratory illnesses in the first months of the pandemic with an increase in Respiratory Syncytial Virus (RSV) and Enterovirus (EV) in subsequent months.

The concern caused by COVID-19 during the beginning of the pandemic may have led healthcare professionals to underdiagnose other respiratory viral infections. The aim of this study is to evaluate the behavior of viral infection through the pandemic.

Methods

A retrospective analysis was conducted to determine temporal changes in respiratory panel use and viral epidemiology in the pediatric ED from 2018 to 2022. Medical records were used to determine ICU admission and mortality in those with a positive respiratory panel.

Results

During the study period, a total of 10,000 respiratory PCR panels were performed in the pediatric ED. There was a significant increase in mean number of panels performed per year during the pandemic period compared to two years prior (2899 vs 198 panels/year). However, the Positivity rate decreased considerably during the pandemic (38.27% vs. 63.54%).

Of the 10,000 panels performed, COVID-19 was identified in in 993 cases (9.93%), while other respiratory viruses were identified in 31.27% of cases. The most prevalent virus identified were EV (n=1411, 14.9%) and RSV (n=483, 5.1%). These viruses also had the highest rate of ICU admission and mortality.

Patients that tested positive for COVID-19 had a lower rate of ICU admission compared to those infected by other viruses (RR=0.88; CI95%=0.78-0.99). Additionally, the mortality rate associated with COVID-19 was significantly lower than that of other viruses (RR=0.62; CI95%=0.49-0.79).

PCR Panel Positivity Rate and Viral Infections in Pediatrics ED from 2018-2022

PCR viral panel tests performed, positive tests, and viral isolates from 2018 to 2022

Conclusion

The pandemic increased the use of PCR testing for respiratory illnesses, providing a better picture of seasonal epidemiology of viral infections. Although COVID-19 infection in children was a major of concern, this report shows that throughout the pandemic other viruses were more prevalent and significantly more severe. This study serves as a reminder than even in times of emerging infections, healthcare professionals shouldn’t forget the usual causes of infection.

Disclosures

All Authors: No reported disclosures
151. Gastrointestinal infections among US Veterans in the era of multiplex PCR testing
Authors: Munir Maryam , Thorne Monique , Psevdos George
Published: November 2023

Background

Infectious gastroenteritis remains a common cause of morbidity in the US. While stool culture had been the standard tool for microbiological diagnosis, known for its time consuming and often lower yields, rapid diagnostic tests have now been developed. Individual and multiplex gastrointestinal (GI) polymerase chain reaction (PCR) are commercially available that can provide rapid and accurate results. We reviewed the GI infections in US Veterans (VET) assessing the use of GI PCR

Methods

Retrospective chart review from 10/1/2021 to 3/31/2023 of US VET at Northport VAMC who had positive results on Biofire® GI PCR panel; positive ova and parasites (O+P), positive stool cultures, C-difficile GDH/toxin B assays and H.pylori stool antigens

Results

In the study period there were 264 GI PCR and 224 O+P tests. 86 VET had GI infections. GI PCR identified 26 viral infections with norovirus being the most common. 16 coinfections identified. The median age was 58.5 years. 77% White, 19% Black. 81 were men. 78/86 had presented with diarrhea, 31 with abdominal pain/dyspepsia. 30 VET were treated as inpatient. 18/86 had Diabetes, 32, GERD, 11 Asthma, 13 COPD, 45 HTN, 46 HLD, 3 HIV, 20 CAD, 7 with malignancies (carcinoid, MALT lymphoma, Non-Hodgins lymphoma, lung, tonsil, prostate, multiple myeloma). 25 VET had recent exposure to antibiotics. 10 had recent travel. 59 received antibiotic therapy. 25 had prior history of C. difficile infection (CDI). Of the 30 positive tests by GI PCR, 19 were clinically treated for CDI: 14 with oral vancomycin 5 with fidaxomicin. Of the 6 campylobacter infections by GI PCR, 4 were confirmed by culture. Of the 2 positive vibrio spp by GI PCR: one vibrio cholera was not confirmed by culture and toxin assay (this patient was not included in the analysis); the other vibrio spp by PCR, culture confirmed V. parahaemolyticus. 1 VET with multiple myeloma and CDI died due to multiorgan failure. One dual infection with salmonella and Yersinia by PCR: only salmonella (non typhi) was confirmed by culture

GI Infections

Travel History, Co-Infections

Conclusion

GI PCR can offer a rapid diagnosis for viral etiologies and can be more sensitive as compared to culture for campylobacteriosis. However, vibrio and Yersinia spp results would need to be confirmed by culture. Also diagnosis of CDI would need interpretation of GDH/toxin and clinical judgement

Disclosures

All Authors: No reported disclosures
2632. Duration of viable SARS-CoV-2 shedding in immunocompromised COVID-19 patients during the widespread vaccination era
Authors: Kanai Osamu , Fujita Kohei , Hata Hiroaki , Odagaki Takao , Mio Tadashi
Published: November 2023

Background

Individuals with COVID-19 who are immunocompromised have been reported to experience prolonged shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared to those who are immunocompetent. However, it remains unclear how long viable SARS-CoV-2 shedding persists in immunocompromised individuals during the era of widespread vaccination against COVID-19. This study aimed to evaluate the association between the duration of viable SARS-CoV-2 detection among immunocompromised individuals and their COVID-19 vaccination status.

Methods

We retrospectively reviewed patients who admitted to our institute for COVID-19 treatment between November 2022 and March 2023. We defined immunocompromised individuals as those who had received corticosteroids, immunosuppressants, or cytotoxic chemotherapy. We performed daily COVID-19 rapid antigen detection tests (RAD) on immunocompromised patients from 10 days after the onset of COVID-19 until two consecutive negative results were obtained.

Results

Among 181 patients admitted for COVID-19 treatment, 22 immunocompromised patients participated in this study. Of these, 14 (64%), 6 (27%), and 10 (46%) patients received corticosteroids, immunosuppressants, and cytotoxic chemotherapy, respectively. Twelve (55%) patients were fully vaccinated. Nine (41%) patients required oxygen therapy for respiratory failure. All patients received antiviral therapy, with 5 (23%), 12 (55%), 5 (23%) patients receiving remdesivir, ritonavir-boosted nirmatrelvir, and molnupiravir, respectively. Three (14%) patients died from COVID-19. The median duration from COVID-19 onset to confirmation of negative RAD or death was 15.5 (interquartile range: 12 to 17) days. Until 20 days after the onset of COVID-19, 17 (77%) patients had achieved two consecutive negative RAD results. There was no association between vaccination status and the duration of positive RAD results (p = 0.59) or the proportion of patients achieving negative RAD results within 20 days of COVID-19 onset (P > 0.99).

Conclusion

Most immunocompromised COVID-19 patients in our hospital achieved two consecutive negative RAD results within 20 days of COVID-19 onset. Vaccination status was not associated with the duration of detectable SARS-CoV-2 shedding.

Disclosures

All Authors: No reported disclosures
2635. Introduction of point-of-care testing for respiratory viruses in congregate living facilities
Authors: Tan Charlie , Ofner Marianna , O’Brien Jacyln , Chan Christina , Kozak Robert , Thomas Neethu , Candon Heather , Chan Adrienne , Leis Jerome A
Published: November 2023

Background

Timely diagnosis of viral respiratory infection is critical to control respiratory viral transmission in congregate care facilities. We conducted a quality improvement study to assess whether a point-of-care (POC) testing for detection of respiratory viruses could improve time to outbreak measures in congregate living facilities.

Methods

We implemented a POC cartridge based nucleic acid amplification test platform, which detects SARS-CoV-2, influenza A, and respiratory syncytial virus, at one long-term care home and three retirement homes between December 1, 2022 and April 15, 2023. Residents with respiratory symptoms underwent paired testing, whereby nasopharyngeal swabs were tested first on POC, then on multiplex respiratory virus panel (MRVP) polymerase chain reaction at an external laboratory. We determined difference in turn-around time (TAT), as well as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), using MRVP as the reference standard. We also compared time to outbreak declaration (from MRVP result) to five other congregate care facilities without access to POC testing.

Results

A total of 189 tests were performed using POC testing, of which 39.7% (75/189) were positive. SARS-CoV-2 was the most common virus identified (90.7%, 68/75). Median difference in TAT between POC and MRVP was 34.0 hours (IQR 21.8–43.5 hours). Sensitivity, specificity, PPV and NPV of POC were 0.88, 0.87, 0.83 and 0.90, respectively. There were six outbreaks during the study period (all SARS-CoV-2), of which two were declared based on POC result alone, before MRVP was resulted. Median time to outbreak declaration from MRVP result for the remaining four outbreaks was 6.6 hours (IQR 4.6–9.2 hours). In comparison, there were nine outbreaks at the non-POC comparator facilities; median time to outbreak declaration was 15.2 hours (IQR 5.5–26.0 hours).

Conclusion

We demonstrated the feasibility of implementing a POC platform in congregate living facilities for identification of respiratory viral infection. The improved TAT resulted in more expedited detection and declaration of outbreaks.

Disclosures

Jerome A. Leis, MD MSc FRCPC, Ontario Hospital Association, Ministry of Attorney General of Ontario, Seneca College: Expert Testimony
2645. Severe Human Parainfluenza Virus-associated Pneumonia in Adults, Seoul, South Korea, 2010-2019
Authors: Park Joung Ha , Hong Sang-Bum , Huh Jin Won , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Sung Heungsup , Doh Kyung Hyun , Kim Sung-Han , Lee Sang-Oh , Kim Yang Soo , Lim Chae-Man , Koh Younsuck , Choi Sang-Ho
Published: November 2023

Background

Human parainfluenza virus (HPIV) is a major cause of acute respiratory tract infections such as croup in children and pneumonia in immunocompromised patients. HPIV infections are generally regarded as mild and self-limiting in adults, however, HPIV-associated pneumonia is increasingly reported in adults. To the best of our knowledge, data on the epidemiological and clinical characteristics of severe HPIV-associated pneumonia in adults are limited. Therefore, we investigated the epidemiological and clinical characteristics and outcomes of severe HPIV-associated pneumonia over ten years in a large cohort of critically ill adults with severe pneumonia requiring intensive care.

Methods

This sutdy was performed as a part of a prospective observational cohort study regarding severe virus-associated pneumonia at the 28-bed medical intensive care unit (ICU) at a 2,700-bed hospital, in Seoul, South Korea. Patients with severe HPIV-associated pneumonia were enrolled in this study, and the clinical data of these patients were analyzed. To describe the clinical outcomes of severe HPIV-associated pneumonia, we compared the HPIV-associated pneumonia outcomes with those of severe influenza virus-associated pneumonia.

Results

A total of 143 adult patients with severe HPIV-associated pneumonia were identified. HPIV is the most common cause (25.2%) of severe viral hospital-acquired pneumonia (HAP), and it is the third most common cause (15.7%) of severe viral community-acquired pneumonia. The median age of the patients was 61.6 years old. Almost patients (97.2%) had comorbidities, and hematologic malignancy (35.0%), diabetes mellitus (23.8%), and structural lung disease (21.0%) were common cormobidities. About half of the patients (54.5%) had co-infections at the time of ICU admission. The 90-day mortality was comparable with that of severe influenza virus-associated pneumonia (55.2% vs 48.4%, p = 0.22). The use of ribavirin was not associated with lower mortality. Fungal co-infections were associated with higher mortality (82.4% [14/17]).

Conclusion

In conclusion, HPIV was the leading cause of severe viral HAP with substantial mortality, comparable to that of influenza virus-associated penumonia. Fungal co-infections contributed to the high mortality rates.

Disclosures

All Authors: No reported disclosures
2654. International Multi-Center Study Comparing the Effect of Obinutuzumab or Rituximab Treatment in Hematological Patients on COVID-19 Outcomes During the Omicron Surge
Authors: Shafat Tal , Grupel Daniel , Porges Tzvika , Belkin Ana , Deri Ofir , Oster Yonatan , Zahran Shadi , Horwitz Ehud , Horowitz Netanel A , Khatib Hazim , Batista Marjorie , Cortez Anita , Brosh-Nissimov Tal , Segman Yafit , Ishay Linor , Cohen Regev , Atamna Alaa , Spallone Amy , Chemaly Roy F , Ramos Juan Carlos , Chowers Michal , Rogozin Evgeny , Carmi-Oren Noga , Keske Şiran , Barchad Orit Wolfovitz , Nesher Lior
Published: November 2023

Background

Hematological malignancy (HM) patients treated with anti-CD20 monoclonal antibodies are at higher risk for severe COVID-19 and adverse outcomes. A previous single-center study showed worse outcomes in patients treated with obinutuzumab than those treated with rituximab.

Methods

This is an international, multi-center population-based study across 15 centers (Israel, USA, Spain, Brazil, and Turkey). We included patients with HM treated with obinutuzumab or rituximab between December 2021 and June 2022, when Omicron lineage variants were dominant.

Results

We collected data on 1049 patients, of which 761 (73%) received rituximab. Of the rituximab group, 191 contracted COVID-19 compared to 104 in the obinutuzumab group (fig 1). COVID-19 patients in the obinutuzumab group were younger (mean age of 61±11.7 vs. 64 ±14.5 years, p=0.037), had more favorable HM diagnosis (aggressive lymphoma: 7.7% vs. 67.0%, p< 0.001), and were on maintenance therapy at COVID-19 diagnosis (62.4% vs. 36.2%, p< 0.001). Severe COVID-19 occurred in 31.7% (n=33) of patients in the obinutuzumab group and in 22.0% (n=42) in the rituximab group (fig 2). In a multivariable analysis for severe COVID-19, adjusted for Charlson co-morbidity index, HM status, and tixagevimab/cilgavimab (T-C) prophylaxis, we observed an odds ratio of 2.06 (95% CI 1.11-3.81, p=0.021) for obinutuzumab treatment. Prophylaxis with T-C was protective (OR 0.32 95% CI 0.10-0.99, p=0.048). In the secondary outcomes analysis, more patients with COVID-19 in the obinutuzumab were hospitalized (51.9% vs. 35.1% p=0.005), required ICU admission (13.5% vs.5.3%, p=0.014), with a non-significant difference in COVID-19 related mortality (n=11, 10.6% vs. n=12, 6.3%, p=0.189).

Conclusion

This international, multi-center cohort study demonstrates that despite younger age and more favorable HM diagnoses, patients receiving obinutuzumab had more severe COVID-19 outcomes than those receiving rituximab. Our findings underscore the need to evaluate the risk-benefit when considering obinutuzumab therapy for HM patients and re-emphasize the crucial role of pre-exposure prophylaxis with effective anti-SARS-CoV-2 monoclonal antibodies during high transmission in the community.

Disclosures

Roy F. Chemaly, MD/MPH, Eurofins-VViracor: Grant/Research Support|Karius: Advisor/Consultant
2656. Longitudinal Trends in Attributable Causes of Death Among US Veteran Patients with Documented SARS-CoV-2 Infection between January 2021 and March 2023
Authors: Trottier Caitlin A , La Jennifer , Li Lucy , Fillmore Nathanael , Monach Paul , Branch-Elliman Westyn , Doron Shira
Published: November 2023

Background

COVID-19 was the third leading cause of death in the US in 2020, and as of April 2023, >1,000,000 deaths have been attributed to this disease. With widespread immunity and medical countermeasures, the attribution of a death to COVID-19 has become more complex. The aim of this study was to examine the trends in the proportion of deaths attributed to COVD-19 in both vaccinated and unvaccinated patients following a documented positive SARS-CoV-2 test.

Methods

We used an electronic tool, developed using a chart reviewed sample of national Veterans Affairs (VA) data and validated on manually adjudicated cases at Tufts Medical Center, to classify deaths as attributable to COVID-19; both deaths in which COVID-19 contributed and was the primary cause of death were captured by the tool. The tool comprises a 3-point index (remdesivir, dexamethasone, baricitinib, or tocilizumab receipt; hypoxemia with SpO2 < 90% or supplementary oxygen > 2L), for which a score 2-3 has a high positive predictive value (PPV, 0.82-0.95) for COVID-19-related death. We then applied the tool to classify all known deaths among VA patients within 30 days of a positive SARS-CoV-2 test between January 2021 and March 2023 to measure longitudinal trends.

Results

A decrease in the proportion of deaths attributable to COVID-19 between August 2021 and March 2023 was identified (p-value for trend, < 0.001). Despite an overall higher number of deaths attributable to COVID-19 in the vaccinated population (6081 versus 4697, and 2650 versus 488 in the 12 months starting March 2022, Figure 1), the proportions of deaths attributable to COVID-19 (Figure 2) was similar in both cohorts, trending from > 70% to < 50%.

Conclusion

Throughout the pandemic, there have been a myriad of measures used to guide the ongoing public health response including case rates, hospitalization rates, and death rates. Because chart review is the only way to more definitively determine whether a hospitalization or death is directly or indirectly caused by COVID-19, much of the data, obtained through more crude means, lack accuracy. Our electronic tool gives a closer approximation to what is obtained by chart review than the other commonly used measures and reveals that overall, the proportion of attributable deaths has universally decreased.

Disclosures

Paul Monach, MD, PhD, HI-Bio: Advisor/Consultant Westyn Branch-Elliman, MD, MMSc, Gilead Sciences: Grant/Research Support
2658. Mortality among children hospitalized with suspected pneumonia during the COVID-19 pandemic in India (PREVAIL study)
Authors: Yang Yangyupei , Knoll Maria D , Agarwal Anurag , Manchanda Vikas , Higdon Melissa , Dayal Rajeshwar , Agarwal Arti , Chaurasia Deepti , Shrivastav Jyotsna , Dhingra Dhulika , Qureshi Shariqa , Sharma Rajni , Choudhary Richa , Bhattacharyya Subhashish , Saha Sudip , Mehta Kayur , Shet Anita
Published: November 2023

Background

COVID-19 has indirectly led to excess deaths attributable to other illnesses. Pre-pandemic studies in India have shown mortality rates of 3-12% amongst young children hospitalized with suspected pneumonia. Here, we describe mortality among young children hospitalized with pneumonia during the COVID-19 pandemic.

Methods

Children aged 1-35 months hospitalized with suspected pneumonia were enrolled prospectively across six sites in India. Demographic and clinical information were obtained, and children were followed until 90 days after hospital discharge.

Results

Between October 2020 and November 2022, 4,517 children with suspected pneumonia were enrolled and 4,443 (98.4%) with known mortality status were included in this analysis. Monthly average enrollment was 104 before and during the SARS-CoV-2 peak Delta period (April–June 2021) and 213 post-peak-Delta period (July 2021–November 2022). 71% had WHO-defined severe pneumonia, 26% had SpO2< 90% at admission, 39 of 3000 tested were SARS-CoV-2 positive, and 17% left against medical advice (LAMA). Of 723 total deaths (case fatality ratio (CFR)=16%), 42% were detected in-hospital, 23% occurred within 48 hours after discharge/LAMA, and 35% occurred 2-90 days after discharge/LAMA. CFR was higher among children before and during than post Delta peak (28% vs. 11%, p< 0.001) but average number of deaths per month was similar (28.2 vs. 27.6). Mortality was higher in LAMA cases (32% vs. 5.3%, p< 0.001) and accounted for most (57%) post-hospitalization deaths.

Conclusion

A high CFR (16%) was observed for young children hospitalized for pneumonia in India, with 58% of deaths occurring after discharge. Deaths were higher during the-Delta and Delta wave wave of the COVID-19 pandemic. Although very few children had COVID-19, pandemic-related restrictions and late presentation to healthcare may have contributed to high mortality from pneumonia.

Disclosures

All Authors: No reported disclosures
154. Impact of Rapid Blood Culture Identification (BCID) PCR Panel on Optimal Antibiotic Use in Methicillin-Susceptible Staphylococcus aureus (MSSA) Bacteremia
Authors: Yetukuri Jahnavi , Patel Dimple , Bandali Aiman , Giordano Pamela
Published: November 2023

Background

Optimal anti-MSSA antibiotic choices are nafcillin, oxacillin, and cefazolin. Vancomycin, often used empirically for S. aureus infections, and other broad-spectrum β-lactam antibiotics, such as piperacillin/tazobactam and ceftriaxone, are linked with suboptimal outcomes compared to anti-MSSA β-lactam therapy. BCID PCR testing allows for faster pathogen identification, which may improve antibiotic use and clinical outcomes. The objective of this study was to assess the impact of BioFire BCID PCR panel implementation on antibiotic use and clinical outcomes in patients with MSSA bacteremia.

Methods

This was a retrospective chart review of adult inpatients with MSSA bacteremia during the pre-PCR (Jun 2018 - Dec 2019) and post-PCR (Jun 2020 - Dec 2021) study periods. Patients were excluded if they did not have PCR testing performed (post-PCR group only), never achieved optimal antibiotic therapy, had a polymicrobial infection, had positive blood cultures in the prior 90 days, underwent penicillin-skin testing or β-lactam desensitization, or were transitioned to comfort care or deceased within 24 hours of the gram stain. The primary endpoint was the difference in time to starting optimal MSSA antibiotic therapy (oxacillin or cefazolin) between the pre-PCR and post-PCR groups. Secondary endpoints included duration of anti-MRSA antibiotic use, in-hospital mortality, hospital and ICU lengths of stay, duration of bacteremia, and 30-day MSSA-related and all-cause readmissions.

Results

A total of 200 patients were included in the study, with 100 patients in each group. Time to optimal therapy was reduced by 19.9 hours in the post-PCR group (p < 0.001). Fewer patients in the post-PCR group were initiated on empiric anti-MRSA antibiotic therapy than in the pre-PCR group (84% vs 98%, respectively, p = 0.001). PCR implementation was also associated with shorter empiric anti-MRSA antibiotic use and duration of bacteremia. There were no significant differences in length of stay, in-hospital mortality, or 30-day MSSA-related or all-cause readmissions (Table 1).

Table 1: Primary and Secondary Endpoints

Conclusion

In patients with MSSA bacteremia, BCID PCR panel testing decreased time to optimal MSSA antibiotic therapy and reduced durations of bacteremia and empiric anti-MRSA antibiotic therapy, including vancomycin.

Disclosures

All Authors: No reported disclosures