bluuebunny/crossref_metadata_2025 huggingface dataset:
1016. A Qualitative Study of Patient Perspectives on the Use of Antibiotics Without a Prescription
Authors: Laytner Lindsey , Chen Patricia , Nash Susan G , Salinas Juanita , Olmeda Kiara , Zoorob Roger , Paasche-Orlow Michael , Trautner Barbara , Grigoryan Larissa
Published: November 2023

Background

Using antibiotics without medical guidance (nonprescription use) can be unsafe and increase antimicrobial resistance rates. Few studies have qualitatively examined patient perspectives of nonprescription use in the US. To understand the reasons and motivations underlying patients’ nonprescription use, we explored the perceptions and experiences of sociodemographically diverse patients served by two US healthcare systems.

Methods

We conducted semi-structured interviews with outpatients who had endorsed nonprescription use on a previous survey in public and private healthcare systems in Texas. Interviews were conducted remotely in English or Spanish from May 2020 through October 2021. We used inductive coding and the Kilbourne framework for health disparities research to guide our thematic analysis.

Results

Overall, 86 participants completed interviews. Over 70% of participants were female, Hispanic or African American, educated (high school or above), and attended publicly-funded clinics (Table 1). In-depth interviews revealed seven themes (reasons/motives) driving nonprescription use (Figure 1). Participants reported using nonprescription antibiotics to relieve respiratory symptoms or pain, bypass healthcare-access barriers, and for convenience. Participants stated that they “know their bodies” when sick and expressed that antibiotics are “like gold” (valuable/effective) and can be used when over-the-counter medicines do not work and when the antibiotics or source of the antibiotics are “trusted.” Table 2 highlights representative participant quotes by theme.Table 1.Sociodemographic characteristics of participants by healthcare system (HCS)Table 2.Representative participant quotes by themeFigure 1.Overview of themes: Reasons to use nonprescription antibiotics by healthcare system (HCS)

Conclusion

Qualitative analyses revealed the beliefs, practices, and healthcare system-related obstacles underlying nonprescription use. The concept of taking antibiotics for symptom relief (including for viral infections and pain) gives antibiotic stewardship programs a new direction with patient education. In addition, promoting more accessible primary care by reducing healthcare-access barriers may reduce patients’ usage of antibiotics outside of a healthcare setting.

Disclosures

Barbara Trautner, MD, PhD, Genentech: Grant/Research Support|Peptilogics: Grant/Research Support
1020. A Novel Quality Control Solution for Gram Stain Through Integration of Deep Learning Vision Technology: A Proof-of-Concept
Authors: Hata Jane , Reed Jessica , Magee Kyle
Published: November 2023

Background

Gram stain (GS) is essential for preliminary bacterial identification. The lack of a standardized quality control method for GS is a significant drawback. By utilizing a deep convolutional neural network (CNN) design, we present a proof-of-concept for a novel solution to GS quality assurance. Using this approach, current manual GS, and potentially automated GS methods, may possess a standardized method of quality control.

Methods

Twenty-nine GS from positive blood cultures encompassing the spectrum of GS quality (acceptable, over/under decolorization, smear thickness, stain artifact) were selected by two expert microbiologists.

A total of 197 images were obtained using a Cognex D-900 camera and Olympus BX-43 microscope at 1000X magnification. Images were classified using deep learning software (Cognex, ViDi Suite 4.1). Eighty-one images were classified as suboptimal and 116 were classified as optimal by expert review.

To address background variation due to manual GS, we implemented a screening classification tool to separate images into 5 distinct classes (pale, rose, orange, indigo, variegated). The training and test sets consisted of 100 and 97 images respectively.

Using a chaining technique, a second classification tool was added after the screening classification tool. The second tool further divided the 197 images into two dataset classes: optimal and suboptimal. The second tool used 105 images for training and 92 images for the test set. Model performance was compared to expert microbiology review, with GS verified by organism identification using MALDI-TOF.

Results

Cognex ViDi Suite 4.1 could discriminate between optimal and suboptimal GS images. The chained classification tool was able to be trained with 100% recall and 100% accuracy, with a resulting F-score of 1.00.

Figure 1

VisionPro GUI with optimal image (MRSA)

Conclusion

Deep learning enabled image analysis is an effective method for sorting GS which are acceptable for further interpretation and suboptimal smears which require rework. Additional study is warranted to develop deep learning image analysis tools for the interpretation of GS on multiple specimen types and incorporate into automated GS systems.

Disclosures

Jane Hata, PhD , D(ABMM), Roche Molecular Systems: Grant/Research Support Kyle Magee, MLS(ASCP), SeluxDx: Employee
1027. At-Home vs. In-Clinic Receipt of Cabotegravir and Rilpivirine Long-Acting: An Implementation Science Trial
Authors: Williams Jamila K , Young Christina , Hanson Rochelle F , Moreland-Johnson Angela , Adekunle Ruth O , Kirk Stephanie , Meissner Eric G
Published: November 2023

Background

Cabotegravir plus rilpivirine long acting (CAB + RPV LA) is administered as an intramuscular injection every 1 or 2 months for treatment of HIV-1 infection. The need for frequent travel to a clinic could impair treatment access. We hypothesized that receiving treatment at-home would be as safe and effective as receiving treatment in clinic and that having different options for where to receive treatment would result in high patient satisfaction.

Methods

Persons prescribed CAB + RPV LA in the Infectious Diseases Clinic at the Medical University of South Carolina (MUSC) were offered enrollment in this implementation science study between August 2021 and December 2022. This study was approved by the MUSC IRB. After receiving the initial injection in clinic, study participants chose to receive each subsequent injection over the 12-month intervention in clinic or at home, with option to switch during the study. For home injections, CAB + RPV LA was shipped to participants’ homes and stored refrigerated until preparation and administration by a home health provider. For clinic injections, CAB + RPV LA was shipped to the clinic and stored until the injection visit. Monthly surveys were completed by study participants.

Results

The thirty-three patients enrolled in the study were primarily Black (64%) and male (73%). Two participants stopped CAB + RPV LA and transitioned to oral therapy due to allergy (n=1) and efficacy (n=1) concerns. Nearly an equal number of participants elected to receive treatment primarily in clinic (n=16) relative to at home (n=14). Contrary to our expectations, switching the primary location of treatment receipt during the study was uncommon (n=2 to date). Most survey responses to date indicated extreme satisfaction (93%) with treatment. Consistent with reported clinical experience, the most common side effect has been injection site pain/soreness (52% of injections). No differences in safety, efficacy, or satisfaction have been observed based on treatment location with results accruing.

Conclusion

Administering CAB + RPV LA at home is associated with high satisfaction and thus far is safe and effective.

Disclosures

Jamila K. Williams, MHA, Viiv Healthcare: Grant/Research Support Stephanie Kirk, PharmD, Viiv Healthcare: Advisor/Consultant|Viiv Healthcare: Grant/Research Support Eric G. Meissner, MD, PhD, Viiv Healthcare: Advisor/Consultant|Viiv Healthcare: Grant/Research Support
1033. Unexpected Allies: Vancomycin and Cefazolin Combination Therapy in Methicillin-Resistant Staphylococcus aureus Bacteremia
Authors: Caniff Kaylee E , Kunz Coyne Ashlan J , Rybak Michael J
Published: November 2023

Background

Vancomycin (VAN) monotherapy is regarded as first-line treatment of bloodstream infections (BSIs) due to methicillin-resistant Staphylococcus aureus (MRSA). However, in vitro and clinical evidence indicate synergy is achieved against MRSA when certain beta-lactam antibiotics are combined with VAN. In 2016, a MRSA BSI treatment pathway was implemented at the Detroit Medical Center (DMC) which incorporates early use of combination therapy with VAN and cefazolin (CFZ). This study assesses clinical outcomes among patients receiving VAN vs. combination therapy with VAN + CFZ in MRSA BSI.

Methods

This is a retrospective, observational cohort study of patients hospitalized with MRSA BSI at the DMC from 2006-2021. Included patients were initiated on VAN within 72 hours of the index culture. Patients were excluded if they received < 5 days of VAN, transferred to an outside hospital, received an alternative anti-MRSA antibiotic, received > 5 days of non-CFZ beta-lactam, or initiated on CFZ > 120 hours after index culture. Patients were compared by VAN therapy (no receipt of CFZ during treatment course) to VAN + CFZ combination therapy (CFZ initiated within 120 hours of index culture). Multivariable logistic regression was performed to identify independent predictors of 30-day mortality.

Results

Overall, 359 patients were included; 145 received VAN + CFZ and 214 received VAN. There were no significant differences between groups when comparing baseline demographics, infectious source, comorbid conditions, MRSA risk factors, or illness severity. However, VAN + CFZ patients were more likely to have an infectious diseases consult (98.6% vs. 82.7%, p < 0.001). VAN + CFZ was associated a lower 30-day mortality rate (3.4% vs. 9.8%, p = 0.022) and shorter duration of bacteremia (49.0 [35.0-74.0] hours vs. 62.0 [42.0-95.8] hours, p = 0.005). After adjusting for confounders, VAN + CFZ receipt was independently associated with reduced 30-day mortality (aOR 0.31, 95% CI 0.11-0.93).

Conclusion

In patients with MRSA BSI, the addition of CFZ to VAN within 120 hours of index culture was associated with improved outcomes. To our knowledge, this is the first study specifically examining VAN + CFZ in this population. Further research is warranted to determine the utility of this therapy combination in MRSA BSI.

Disclosures

Michael J. Rybak, PharmD, PhD, MPH, Abbvie, Merck, Paratek, Shionogi, Entasis, La Jolla, T2 Biosystems: Advisor/Consultant
1098. COVID-19 Reinfections in Older Adults: Risk Factors for Poor Outcomes
Authors: Lando-King Elizabeth , Morris Keeley , Seys Scott , Zirnhelt Zachary , Talsma Elle , Wienkes Haley , Como-Sabetti Kathryn , Meyer Stephanie
Published: November 2023

Background

Older adults are at higher risk for hospitalization and death from COVID-19. The impact of COVID-19 reinfections on older adults is less clear. As more of the population experiences at least one COVID-19 infection, understanding risk factors associated with severe outcomes at reinfection is critical for improving patient care.

Methods

We examined the risk of hospitalization, ICU admission, and death among MN residents aged 65+ experiencing 2nd infections (reinfection) during the Omicron wave (12/26/2021-10/1/2022; n = 9311). We first performed log binomial regressions to examine risk of hospitalization, ICU admission, and death across the entire study period. We then stratified the sample by variant wave at 1st infection (Table 1). All models were adjusted for time from 1st infection to reinfection, gender (male vs. female), vaccination status at reinfection (vaccinated vs. unvaccinated), age group (65-74, 75-84, 85+), metro vs. outstate, and infection severity at 1st infection (hospitalized vs. not hospitalized).

Results

In the full model, people with 1st infections during each of subsequent variant waves were at increased risk of hospitalization during reinfection relative to people whose 1st infection occurred during the initial wild-type wave (Alpha: 1.27, 0.96-1.68, Delta: 1.29, 1.13-1.48, Omicron: 1.93, 1.72-2.18; Table 2). A similar effect was observed for ICU admission. In stratified analyses, age and severity at 1st infection were significant predictors of hospitalization, ICU admission and death across some variant waves (Tables 3 and 4).

Conclusion

In a preliminary examination of all Omicron reinfections, each subsequent variant wave of 1st infection was associated with an increase in hospitalization. However, given the lack of substantial temporal overlap between variant waves, it is not possible to distinguish whether characteristics of the variant or time between 1st and 2nd infections is impacting magnitude of risk. Stratifying by variant wave allowed us to examine whether potential risk factors varied by variant of 1st infection. Our stratified results indicate that greater age and hospitalization at 1st infection significantly increase negative outcomes at reinfection regardless of the variant of 1st infection.

Disclosures

All Authors: No reported disclosures
1110. Why has Utilization of Novel Gram-negative Antibiotics been Sluggish in U.S. Hospitals? A Retrospective Cohort Study to Inform Future Antibiotic Development and Market Entry Rewards
Authors: Strich Jeffrey R , Ullah Mishuk Ahmed , Lawandi Alexander , Diao Guoqing , Warner Sarah , Li Willy , Demirkale Cumhur Y , Mancera Alex , Walker Morgan , Yek Christina , Neupane Maniraj , De Jonge Nathaniel , Kadri Sameer S
Published: November 2023

Background

Sluggish uptake of novel gram-negative antibiotics has jeopardized their future development and supply potentially risking patient lives. Understanding underutilization patterns might better inform unmet needs and market entry rewards. We studied patterns and drivers of use of recently U.S. FDA-approved novel gram-negative agents in patients with gram-negative infections (GNI) displaying difficult-to-treat resistance (DTR; resistance to all first line B-lactams including carbapenems, and fluoroquinolones).

Methods

Using the all-payer PINC-AI database, quarterly percent change in the post-approval use of seven gram-negative agents and secular trends in colistin use were calculated. For inpatients with DTR GNI at microbiology reporting hospitals, we compared novel vs older/reserve agent use by infection site and pathogen. At hospitals that use novel agents, generalized linear mixed models with weighting identified patient and hospital factors associated with the use of any novel (vs older/reserve) agents as targeted therapy against DTR GNI.

Results

At 619 hospitals, while colistin use declined between 2016Q1 and 2021Q2, post-approval use grew variably for each novel agent (Fig1); compared to the first novel anti–Klebsiella pneumoniae carbapenemase (KPC) agent ceftazidime-avibactam (approved 2015), usage was relatively sluggish for subsequently approved anti-KPC-agents meropenem-vaborbactam and imipenem-cilastatin-relebactam and zero for plazomicin. At 302 microbiology reporting hospitals, 44.4% of 2830 overall DTR cases including 70.2% of 627 DTR-A. baumannii cases received only older/reserve agents (Fig2). The odds of use of novel (vs older/novel) agents were greater in patients displaying hemodynamic instability and higher comorbidity burden, but similar across race categories and insurance status, and lower at Western(vs Midwestern) hospitals (Table1).

Conclusion

Nearly half the patients in US hospital with DTR-GNIs are still receiving targeted therapy with older/reserve agents. While the value of novel agents is indicated by clinicians preferring them over older/reserve agents in sicker patients, future agents with distinctly novel mechanisms and activity against DTR-A. baumannii are needed to bridge the utilization gap.

Disclosures

Morgan Walker, MD, Cytovale: Advisor/Consultant
1933. Characteristics of Community-Associated Extended-Spectrum β-Lactamase Producing Enterobacterales Infections in Monroe County, NY, 2020-2021
Authors: Tellerman Julia , Russ Savanah , Che Looi Hsioa , Tsay Rebecca , Myers christopher J , Dumyati Ghinwa
Published: November 2023

Background

Extended-spectrum β-lactamase–producing Enterobacterales (ESBL) have emerged as a serious multidrug resistant threat to the community. Epidemiologic data for community-associated (CA) ESBL infections are limited compared to that for healthcare-associated (HA) infections. We examined characteristics of CA ESBL cases over a two-year period and compared them to those of HA cases to guide prevention.

Methods

CA ESBL cases from 1/2020-12/2021 were identified via laboratory and population-based surveillance in Monroe County as part of the CDC Emerging Infections Program. Cases were defined as the first instance of positive culture in a county resident from a normally sterile site or urine of Escherichia coli, Klebsiella pneumoniae, or K. oxytoca resistant to ≥ 1 3rd-generation cephalosporin and nonresistant to carbapenems. Epidemiologic data were collected through medical record abstraction. Cases were classified as HA if they had prior healthcare exposures (e.g. hospitalization, surgery, chronic dialysis, indwelling devices, or external catheters) and CA if they did not. Case addresses were geocoded to the census tract level to obtain Social Vulnerability Index (SVI) percentiles. Chi-square analyses were conducted to quantify the difference in distribution of these characteristics between CA and HA cases.

Results

From 2020-2021, 1729 incident cases were identified; 854 (49%) were classified as CA. Compared to HA cases, CA cases were younger (median 59 vs. 70 years), more likely to be female (89.8% vs 65.3%), less likely to have a urinary tract abnormality (27.0% vs 56.8%) or underlying comorbidities (73.2 % vs 95.8%), and less likely to have received prior antibiotics (24.0% vs 55.1%). Interestingly, CA cases were more widely spread across SVI quartiles compared to HA cases; a higher proportion of HA cases resided in census tracts in the 3rd or 4th SVI quartiles (Table 1).

Conclusion

Patient-specific risk factors classically associated with HA ESBL are less commonly associated with CA ESBL in Monroe County. Community-based preventions may need to target different populations than hospital-based strategies. As ESBL incidence increases, continued surveillance to identify at-risk groups and explore the association of specific social determinants of health is necessary.

Disclosures

Rebecca Tsay, MPH, CDC: Grant/Research Support Ghinwa Dumyati, MD, Pfizer: Grant/Research Support
1943. RSV Prophylaxis for 29-34 Gestational Preemies. Are Current Guidelines Justified? Lessons from an Israeli Multicenter Off-seasonal Study
Authors: Armoni Domany Keren , Mandelberg Avigdor , Burrack Nitzan , Tripto Golan Inbal , Masarweh Kamal , Rochman Mika , Prais Dario , Mor Meirav , Weinberger Opek Moran , Nasrallah Elias , Megged Orli , Shatzman Steuerman Rachel , Stein Michal , Steinberg Zohar , Shehadeh Shereen , Tasher Diana
Published: November 2023

Background

Respiratory syncytial virus (RSV) prophylaxis provided during the winter to infants born at 29–34-week gestational age (wGA) is controversial. We utilized the unprecedented opportunity of high load off-season RSV admissions with no prophylaxis given during the summer of 2021, to assess the impact of withholding palivizumab on the relative burden of hospitalized 29-34 wGA infants.

Methods

This was a national multi-center observational retrospective study in 11 medical centers in Israel. We included infants under 1 year-old, who were hospitalized with RSV between November 2017 and August 2021. Demographics and clinical data were extracted from the medical records. We categorized our cohort into a seasonal admissions group (November- March) when palivizumab was indicated, and an off-season admissions group (April-October) when palivizumab was not indicated. The primary outcome was the proportion of 29-34 wGA hospitalizations in each group. Secondary outcomes included clinical severity parameters.

Results

We included 4,340 children in our study; 57% were males, 61% were Jewish, and the median age at admission was 2.9 months (IQR 1.4-6.4). A total of 3,296 infants were admitted during the RSV season, and 1,044 were admitted off-season. The proportion of 29-34 wGA preemies was significantly higher in the off-season admissions group compared to the in season patients (7% vs 2.1%, p< 0.001). We found a significantly higher prevalence of Jewish (77% vs 57%, p=0.001) and higher socioeconomic status (55% vs 45%, p< 0.001) children in the group admitted off-season compared to those in season. Logistic regression analysis revealed that the relative-odds of 29-34 wGA preemies to be hospitalized off-season was 2.67 (95% CI: 1.8-3.9, p< 0.001) fold higher than in season, independent of ethnicity, socioeconomic-status, gender, age, or institution. Clinical severity parameters did not differ significantly between the groups.

Flow chart of study participants

The proportion of 29-34 wGA preterm infants out of total admissions categorized into seasonal and out of season RSV infections

Clinical severity in the subgroup of 29-34 wGA preterm infants

Conclusion

Our results reveal a significant higher proportion of 29-34 wGA preemies among the children hospitalized during off-season periods, when RSV immunoprophylaxis was not indicated. These findings may support the current broad Israeli policy of administration.

Disclosures

All Authors: No reported disclosures
1160. Comparative Effectiveness of Pneumococcal Vaccination Strategies to Prevent Invasive Pneumococcal Disease: A Cohort Study at the Veterans Health Administration
Authors: Goto Michihiko , Kakiuchi Satoshi , Perencevich Eli N , Hasegawa Shinya , Jones Michael
Published: November 2023

Background

The direct impact of a combined vaccination strategy pneumococcal 13-valent conjugate vaccine (PCV13) and 23-valent polysaccharide vaccine (PPSV23) for adults in preventing pneumococcal infections has yet to be thoroughly investigated. We aimed to estimate the comparative effectiveness of preventing the most severe form of pneumococcal infections, invasive pneumococcal disease (IPD), by comparing the risk of IPD stratified by the use of PCV13, PPSV23, and their combinations.

Methods

We included all patients who were 65 years or older, had established primary care within the Veterans Health Administration (VHA) between 2005 and 2021, and had not received any prior pneumococcal vaccination. We measured time-to-event from cohort enrollment to the onset of culture-proven IPD, considering death a competing risk event, and constructed a Cox regression model to estimate cause-specific hazards. PCV13 only, PPSV23 only, and PCV13 + PPSV23 were incorporated into the model as a time-dependent exposure variable, and we estimated hazard ratios (HRs) associated with them. We also considered a waning effect by incorporating time-by-vaccine interaction terms in the model to estimate continuously changing time-dependent hazards.

Results

5,069,917 patients were enrolled in the cohort (male: 96.5%; median age: 72 [IQR: 65-79]). 1,217,349 patients received at least one dose of pneumococcal vaccine during the study period. The overall incidence rate of IPD was 9.1 per 100,000 patient-years. In crude analysis, all pneumococcal vaccines were associated with lower HRs for IPD, and there was an additive benefit of PCV13 and PPSV23 (Tables 1 and 2). In multivariate analysis, associations between PCV13 alone and PPSV23 alone were no longer statistically significant after adjusting for age and comorbidities, but PCV13 + PPSV23 was significantly associated with lower HR for IPD. No time-by-vaccine interaction term was significant.

Conclusion

In this large cohort study at the VHA, neither vaccine by itself appeared to lower the risk of IPD, but the combination of PCV13 and PPSV23 was associated with a significantly lower risk. In addition, we did not observe evidence of a waning effect to prevent IPD. Further studies are needed to evaluate the effect of newer pneumococcal vaccines.

Disclosures

Michihiko Goto, MD MSCI, Merck & Co.: Grant/Research Support
1161. Effectiveness of the Influenza Vaccine for Preventing Laboratory-Confirmed Influenza Infections in Outpatient Immunocompromised Adults, 2017-2018
Authors: Kramer Kailey Hughes , Zimmerman Richard K , Nowalk MaryPatricia , Silveira Fernanda P , Balasubramani G K , Chung Jessie R , Belongia Edward , Martin Emily T , Gaglani Manjusha , Haggerty Catherine L , Phillips C Hallie
Published: November 2023

Background

While the number of immunocompromised (IC) individuals continues to rise, the existing literature on influenza vaccine effectiveness (VE) in IC populations is limited. IC individuals have a higher risk of severe influenza and influenza-related hospitalizations, and understanding the VE of the seasonal influenza vaccines in IC populations remains paramount.

Methods

Using 2017-2018 US Flu VE Network (US Flu VE) data, we examined the VE of the 2017-2018 seasonal influenza vaccine against symptomatic influenza in outpatient settings among IC adults. Patients were enrolled from outpatient sites in five states. IC status was determined by ICD-10 codes. We used logistic regression and adjusted for enrollment site, race, self-reported general health status, age, and onset date of symptoms. Separate models were used to calculate and compare the VE for non-IC and IC among outpatient adults >18 years.

Results

5671 participants were included in the adult analytic dataset, and 455 (8%) were IC. The VE among non-IC was 31% (95% CI: 22, 39) and among IC participants was -4 % (95% CI: -66, 35). P-value for interaction by IC status was 0.100.

Conclusion

We observed lower VE against symptomatic influenza among non-hospitalized patients with immunocompromising conditions though the difference was not statistically significant. This study demonstrates the capacity to study a large IC population using an existing influenza VE network and contributes to the literature to support large, multicenter VE studies for IC populations.

Disclosures

Richard K. Zimmerman, MA; MD; MPH; MS, Sanofi Pasteur: Grant/Research Support MaryPatricia Nowalk, PhD, RDN, Merck & Co.: Grant/Research Support|Merck & Co.: Honoraria|Sanofi: Grant/Research Support Fernanda P. Silveira, MD, Ansun: Grant/Research Support|Eurofins Viracor: Advisor/Consultant|Janssen: Advisor/Consultant|Merck: Grant/Research Support|Regeneron: Grant/Research Support|Takeda: Advisor/Consultant Emily T. Martin, PhD, MPH, Merck: Grant/Research Support
1162. Influenza Vaccination Among Pregnant People in the Vaccine Safety Datalink, 2016-17 through 2022-23 Influenza Seasons
Authors: Irving Stephanie , Crane Bradley , Weintraub Eric , Kauffman Tia L , Brooks Neon , Patel Suchita A , Razzaghi Hilda , Belongia Edward , Daley Matthew F , Getahun Darios , Glenn Sungching C , Hambidge Simon , Jackson Lisa , Kharbanda Elyse , Klein Nicola P , Zerbo Ousseny , Naleway Allison L
Published: November 2023

Background

Estimates of influenza vaccination coverage during pregnancy vary, but studies in the US prior to the 2020-21 influenza season show increasing coverage over time. However, there are limited data on influenza vaccination coverage among pregnant people during the COVID-19 pandemic.

Methods

Within the Vaccine Safety Datalink, we examined influenza vaccination coverage among people ages 18-49 years identified as pregnant with a live birth using a validated algorithm. For primary analyses covering the 2016-17 through 2021-22 influenza seasons, we captured all influenza vaccination between July 1 and March 31 of each season, irrespective of the timing of administration relative to pregnancy (i.e., prior to, during, or after pregnancy), and assessed crude coverage; demographic and clinical characteristics associated with vaccination; and vaccination patterns by calendar month of pregnancy start. Secondary analyses included crude coverage estimates for the 2022-23 season, using data through January 2023, stratified by race and ethnicity.

Results

In primary analyses, among cohorts of pregnant people ranging from 128,267 to 139,927 each season, crude annual influenza vaccination coverage ranged from a high of 71% (2019-20) to a low of 56% (2021-22). In each of the six seasons, coverage was lowest among 18-24-year-olds (Figure) and among non-Hispanic Black pregnant people. The 2021-22 season had the lowest coverage estimates across all age and race and ethnicity groups. Coverage differed based on the calendar month of pregnancy onset, with the lowest coverage observed among pregnancies starting in January-March during each influenza season. In secondary analyses, overall coverage as of January 2023 was 47.9%, a decrease of 7.7 percentage points from January 2022 estimates.

Conclusion

Influenza vaccination coverage among all pregnant people increased from the 2016-17 influenza season through the 2019-20 influenza season, then decreased to the lowest level in the 2021-22 season. Interim estimates for the 2022-23 season declined further. The decreases seen in recent seasons, likely due in part to the COVID-19 pandemic, were consistent across all characteristics examined, and highlight the need for continued efforts to improve influenza vaccination coverage in pregnant people.

Disclosures

Edward Belongia, MD, Seqirus: Grant/Research Support Lisa Jackson, MD, MPH, Pfizer: Grant/Research Support Nicola P. Klein, MD, PhD, GlaxoSmithKline: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi Pasteur: Grant/Research Support
1167. The Value of Influenza Vaccination in the Older Adult Population. A Stochastic Model Estimation of the benefit of vaccination to prevent the Severe Outcomes in the U.S.
Authors: Pelton Stephen I , Nguyen Van , Mould-Quevedo Joaquin F
Published: November 2023

Background

Influenza is associated with substantial morbidity and mortality in the United States. Increasing influenza vaccination rates among all persons extends the benefits of immunization programs on reducing illnesses, especially those accrued to the older adult population who has the highest risk of severe outcomes. This research assesses the value of influenza vaccination by estimating the number of severe outcomes such as, respiratory and cardiovascular hospitalizations and deaths averted through immunization in the U.S. older adult population.

Methods

Severe hospitalizations and deaths prevented were estimated through a decision-tree model using a stochastic approach. Model’s incidence rate as well as complications probabilities were calibrated to reflect the reported U.S. CDC data. This analysis compares no vaccination of older adult population against influenza immunization with either a standard-dose quadrivalent vaccine (QIVe) or an enhanced quadrivalent vaccine recommended by ACIP. Absolute vaccine effectiveness and relative vaccine effectiveness of enhanced quadrivalent vaccine vs QIVe for hospitalizations averted were obtained from a targeted literature review. Median value and 95% CI were estimated from a 1000 stochastic simulation.

Results

In comparison to no vaccination, the number of respiratory and cardiovascular hospitalizations prevented with QIVe was 49,323 (19,584-91,620) and 93,950 (41,537-186,224), respectively. In addition, the number of respiratory and cardiovascular deaths prevented with QIVe vs no vaccination was 4,481 (1,517-9,701) and 8,277 (3,124-19,548), respectively. In the case, older adults were vaccinated with an enhanced vaccine, such as aQIV, then the number of respiratory and cardiovascular hospitalizations prevented against no vaccination was 52,428 (21,354-96,922) and 99,948 (44,400-197,284), respectively. Lastly, 4,742 (1,612-10,202) and 8,787 (3,314-20,910) were the estimated deaths prevented due respiratory and cardiovascular hospitalizations, respectively.

Conclusion

Influenza vaccination in older adult population reduces almost by 50% severe complications. The use of an enhanced vaccine such as the adjuvanted formulation increases further the clinical benefits.

Disclosures

Stephen I. Pelton, MD, CSL Seqirus Inc.: Advisor/Consultant|CSL Seqirus Inc.: Honoraria Van Nguyen, PhD, CSL Seqirus Inc.: Advisor/Consultant|CSL Seqirus Inc.: Advisor/Consultant|CSL Seqirus Inc.: Honoraria Joaquin F. Mould-Quevedo, PhD, CSL Seqirus Inc.: Employee|CSL Seqirus Inc.: Employee|CSL Seqirus Inc.: Stocks/Bonds|CSL Seqirus Inc.: Stocks/Bonds
1172. Compliance with Human Papillomavirus Vaccination At The HIV Outpatient Program in New Orleans, Louisiana
Authors: Yau Tat , Frontini Maria , Hagensee Michael
Published: November 2023

Background

Guidelines recommend the human papillomavirus (HPV) vaccine for all adults through age 26, shared clinical decision-making for those aged 27 through 45 years who are inadequately vaccinated, and for all people with HIV up to age 45 years. The intent of this study is to evaluate HPV vaccination rates at the HIV Outpatient Program (HOP) at University Medical Center in New Orleans.

Methods

Immunization records from patients aged 18 through 45 years attending a physician visit in the LSU Infectious Diseases fellows’ HIV primary care clinic at HOP in 2022 were reviewed. The purpose of this project was to assess compliance with HPV vaccination recommendations among the infectious diseases fellows.

Results

Among patients under age 27, 15 of 21 visits (71%) had completed HPV vaccines series. 4 visits (19%) had incomplete status and 2 visits (10%) did not have any HPV vaccines record. Among patients aged 27 through 45 years, 73 of 194 visits (38%) had completed HPV vaccines series. 34 visits (18%) had partial vaccination records and 87 visits (45%) had no records.

Conclusion

Vaccination compliance among the LSU ID fellows was less than ideal, only 71% of visits for patient aged up to 27 years attending LSU ID fellows’ clinic had completed HPV vaccine series, compared to the Health People 2020 recommendation of 80%. Only 38% of visits for patients aged 27 through 45 years are fully vaccinated with HPV vaccines. Patients in this age group are often labeled “aged out” for HPV vaccines by health maintenance reminders however, due to having HIV, they are still eligible and should be vaccinated. These results led to the institution of quality improvement project to address HPV vaccinations. This intervention will focus on educating all HOP providers about the vaccination recommendations and updating the health maintenance care gaps reminder in the electronic medical record.

Disclosures

All Authors: No reported disclosures
1176. Assessing the Impact of Collaborative Antimicrobial Stewardship Guidelines on the Use of Antibiotics in Hospitalized Veterans with COVID-19 from Five Veterans Health Administration (VHA) Hospitals
Authors: Thomas-Gosain Neena , Davis Kelly W , Hendrickson Sage , Hulgan Todd , Parvaz Parmida , Powers Caroline , Read John H , Staub Milner , Bennett Jessica G
Published: November 2023

Background

Limited data and resources drove collaboration among healthcare providers treating COVID-19. In July 2021 a multi-disciplinary committee representing all facilities in Veterans Integrated Service Network (VISN) 9 developed COVID-19 guidelines for bacterial co-infection in hospitalized COVID-19 patients. We assessed the impact of these guidelines on appropriate antibiotic utilization (AU) in admissions for COVID-19.

Methods

AU in COVID-19 admissions to VISN 9 facilities from 08/01/20 to 08/31/21 (pre-guidelines) were reviewed and compared to 11/01/21 to 11/30/22 (post-guidelines). COVID-19 positivity, hospitalization, and AU data were pulled from the Corporate Data Warehouse. COVID-19-specific antibiotic stewardship (AS) interventions and guideline distribution plans were collected for each facility. A weighted random sample of patients from each facility who received antibiotics was chart reviewed for appropriateness of AU. AU for non-respiratory indications were excluded from analysis (Table 1). AU was considered appropriate if at least one guideline criteria was met (Table 2). Antibiotic appropriateness was compared before and after guideline distribution for each site using t-test. The odds of appropriate antibiotic prescribing in the VISN after guidance distribution was determined by logistic regression adjusted for site.

Results

Initial rates of antibiotic use varied among facilities both pre and post guideline distribution (Table 1). Facility-specific interventions and guideline distribution also varied (Table 3). There was no significant change in the frequency of appropriateness for any individual site. Similarly, the odds of AU appropriateness for the VISN was not significantly changed in the post-guideline period (p=0.7) (Table 4).

Conclusion

AU appropriateness did not change significantly after guidance distribution, likely due to a myriad of reasons. Reprioritization of AS programs’ focus in the post-guidance period may have shifted resources away from initiatives targeting AU in COVID-19 patients. Additionally, guidance was distributed mid-2021 potentially missing the window for largest impact. Collaboration can fill in gaps for many ASPs; but the success of any intervention is multifactorial.

Disclosures

Milner Staub, MD, MPH, Gilead: Stocks/Bonds|Johnson & Johnson: Stocks/Bonds
1177. Clinical Pharmacist-Lead Amoxicillin Oral Challenges in Low-Risk Penicillin Allergy Patients
Authors: Caturano Breana , Bjork Lauren , Temino Viviana
Published: November 2023

Background

Amoxicillin direct oral challenge (DOC) without preceding skin testing in patients with low-risk penicillin (PCN) allergy histories has been shown to be a safe and effective method to delabel PCN allergies. The implementation of robust DOC programs is dependent on Allergy/Immunology oversight. Prior to this initiative, our institution primarily offered PCN skin testing to outpatients and DOC was limited. To expand upon our services, a clinical pharmacist was trained to independently interview, risk-stratify, and perform DOC in patients with low-risk PCN allergy histories.

Methods

Adult inpatients with a documented PCN allergy were evaluated by a clinical pharmacist based on the local algorithm created by Allergy (Figure 1). Patients who met criteria were offered amoxicillin 500 mg PO and observed for 60 minutes. Epinephrine and diphenhydramine were available in case of adverse reaction. If no reaction resulted, the PCN allergy label was removed.Figure 1.Penicillin Allergy History Evaluation Algorithm

Adult inpatients with a documented PCN allergy were evaluated by a clinical pharmacist based on the local algorithm created by Allergy Service.

Results

A total of 136 patients were screened from October 2021-March 2023 with a mean age of 67 and 89% were male (Table 1). The most common reaction was unknown (Table 2). Of the patients screened, 20% did not qualify for DOC and 15% were delabeled based on evaluation. During the study period, 65% of patients screened were qualified for DOC with 26% that received DOC. None of the DOC patients had an immediate adverse reaction, although one patient experienced a delayed reaction. Limitations included 34 clinically unstable patients and 22 DOC patients deferred and lost to follow-up outpatient (Figure 2).

Conclusion

Expanding the scope of practice of a clinical pharmacist to perform evaluations, risk assessments, and DOC on inpatients is a safe and effective method for those with low-risk PCN allergy histories. Institutions with adult patients may consider implementation of clinical pharmacist-led allergy delabeling program to expand upon current practices.

Disclosures

All Authors: No reported disclosures
1178. The Dalba Diary: A Retrospective Review of Dalbavancin Use, Clinical Outcomes, and Treatment Adherence Challenges at an Academic Medical Center
Authors: Black Cassandra E , Gregory Eric , Wilson Nicole , Shoemaker D Matthew , Haas Gabriel Ann , Wark Kellie , Kimball Joanna
Published: November 2023

Background

Dalbavancin is FDA-approved for skin and skin tissue infections (SSTI) and is an alternative therapy for deep-seated gram-positive infections when avoidance of long-term catheters or prolonged hospitalization for intravenous (IV) antibiotics is desired. This observational, retrospective study evaluated the utilization of dalbavancin at a large academic medical center between May 1, 2021, and November 30, 2021. The objectives were to analyze the patient characteristics, clinical outcomes (including treatment adherence), and economic impact by looking at the estimated length of stay (LOS) and cost avoidance associated with dalbavancin use.

Methods

Variables of interest were analyzed with descriptive statistics. A chi-square test was used to assess the relationship between no-shows and infection-related readmissions. A multivariate logistic regression analysis was used to predict factors associated with treatment nonadherence.

Results

We examined 96 cases consisting of 34 patients with IV drug use (35.4%), 47 with non-IV substance use (49.0%), and 22 with homelessness (24.0%). The most common indication for use was non-vertebral osteomyelitis (34.4%, n=33), followed by SSTI (16.7%, n=16) and endocarditis (14.6%, n=14) (Table 1). Treatment adherence was found to be 84.4% (n=81), and readmissions and adverse reactions were rare (Table 2). The average LOS avoided was 28 days (SD, 13.6). The average cost avoided was $56,000 US dollars (SD, $27,180.63). No-shows were not associated with infection-related readmissions (p =.99). In our multivariate analysis, those with non-IV substance use were significantly less likely to attend their scheduled infusion (p=.003), and those with higher Charlson Comorbidity Index (CCI) were significantly more likely to attend their infusion (p=.013) (Table 3).

Conclusion

Dalbavancin was a safe and economically beneficial alternative for deep-seated infections. Readmissions and adverse reactions were uncommon, and there were no documented deaths within 90 days of discharge. Treatment adherence was high. Those with non-IV substance use and possibly homelessness may be at higher risk for nonadherence, but treatment nonadherence did not lead to poorer outcomes.

Disclosures

All Authors: No reported disclosures
1179. Infectious Diseases Trained Pharmacist: When More Means Less
Authors: Blum Sharon , Akerman Meredith
Published: November 2023

Background

The archived Antimicrobial Stewardship Guidelines from the Infectious Diseases Society of America outline core members of the multidisciplinary team including an infectious diseases trained clinical pharmacist. Evidence exploring impact of infectious diseases (ID) training on a clinical pharmacist's ability to provide effective stewardship are lacking.

Methods

This is a time series data analyzed using control charts examining authorization patterns between ID trained clinical pharmacists and clinical pharmacists without additional ID training covering the antimicrobial stewardship prior authorization and approval requests. U-charts were used to show the proportion of approved antibiotics overall, as well as separately by antibiotic type in subgroups of various sample sizes at 3 time points including: 1. a baseline period of coverage by ID trained clinical pharmacist, 2. a transition to coverage by clinical pharmacists without specific ID training, and 3. a return to the baseline coverage. If any of the points in the chart were outside of ± 3σ limit, then the process was considered out of control at that time point. Analyses were performed using SAS PROC SHEWHART (SAS Institute Inc, Cary, NC).

Results

There was an increase in the rate of approved antibiotics, in the rate of approved Carbapenem, and in the rate of approved Quinolone during the second time period, clinical pharmacists without additional ID training, that lied outside of the ± 3σ limit. The remaining approved antibiotic rates lied within the acceptable ± 3σ limit.

Overall Antibiotic Approvals

Vancomycin approvals

Piperacillin/tazobactam Approvals

Conclusion

There was a significant difference in antibiotic approvals when Antimicrobial Stewardship coverage was provided by an ID trained clinical pharmacist compared to coverage by clinical pharmacists without additional ID training. ID trained clinical pharmacists were more successful in ability to guide providers to narrower spectrum options or to avoid antibiotic use altogether.

Carbapenem Approvals

Quinolone Approvals

Cefepime Approvals

Disclosures

All Authors: No reported disclosures
1195. "The Economic Impact of Antimicrobial Use for Surgical Prophylaxis: A Prospective Study
Authors: Gnanamani James , Rajakumar Ratheesh , Dorairajan Suresh Kumar
Published: November 2023

Background

Antibiotic prophylaxis is commonly used to prevent surgical site infections in patients. However, excessive use of antibiotics can lead to adverse effects such as the development of antibiotic resistance and increased healthcare costs.Unless there is a known infection, prophylactic antibiotics should be discontinued within 24 hours.This study aimed to evaluate the cost implications of antibiotic prophylaxis in patients who received prophylaxis for a duration longer than recommended by the World Health Organisation (WHO).

Methods

This prospective observational study was conducted in a tertiary care hospital in India for a period of two months. Data on patient demographics and Surgical antimicrobial usage were collected to surgical patient cases. Follow-up was performed to determine whether the antibiotics has been stopped after 24 hours. Financial implications, such as increase in drug costs were documented when the surgical prophylaxis was continuing after 24 hours. The necessity of antimicrobial usage and its cost effectiveness were analysed using basic statistical method.

Results

This study included 174 patients of surgical antimicrobial therapy. Out of these, 58 patients (33%) had their surgical antimicrobial therapy stopped after 24 hours, while 116 patients (66%) continued to receive surgical antimicrobial therapy beyond the recommended duration. The data was then analysed, with a focus on the cost of the antimicrobial medication (as shown in Table 1).

Conclusion

The study revealed that when surgical antibiotic prophylaxis was administered for more than 24 hours, the average expenditure per person per day increased by ₹5206 ($68.83). Additionally, patients who received antibiotic prophylaxis beyond the recommended duration incurred significantly higher costs than those who received prophylaxis for the recommended duration, with the cost of antibiotics accounting for the majority of the excess expenditure. These findings emphasise the potential cost savings associated with reducing the duration of antibiotic prophylaxis to the recommended duration, without compromising patient outcomes. Further research is necessary to evaluate the cost-effectiveness of implementing this practice.

Disclosures

All Authors: No reported disclosures