bluuebunny/crossref_metadata_2025 huggingface dataset:
1310. Prediction of Surgical Site Infection Following Ankle Fracture: A Machine Learning Approach
Authors: Nassour Nour , Tatara Alexander M , Jones Sumner V , Leatherman Hadley , DiGiovanni William , Ashkani-Esfahani Soheil , Nelson Sandra B
Published: November 2023

Background

Surgical site infections (SSI) are a common complication in foot and ankle surgery. In the US, ankle fracture incidence is 4.22/10,000 person-years. The development of a predictive model for SSI in foot and ankle surgery may provide insights that would enable the prevention of wound complications to reduce their burden. In this study, we analyzed a patient data set to compare 5 different machine learning models and determine which is most effective in determining the risk for surgical site infection after ankle fracture.

Methods

We included 935 ankle fracture patients, of whom 114 patients developed SSI in the case group. We used the risk factors for SSI obtained from univariate analysis to develop 5 sets of models using the following machine learning (ML) methods: Decision Tree (DC), Random Forest (RF), Neural Network (NN), Gradient Boosting (GB), and Adaboost.

Results

In univariate analysis, older mean age (58.1 y.o. vs 49.3 y.o, p< 0.001), higher mean American Society of Anesthesia score (2.1 vs 1.9, p< 0.001), and longer hospital stay relating to the ankle fracture (6.3 days vs 4.1 days, p< 0.001) were correlated with SSI risk when compared to non-infected patients. We also demonstrated that factors such as the presence of an external fixation prior to the ORIF (OR=2.91, p< 0.001), diabetes (OR=2.00, p=0.03), oral steroid use (OR=3.45, p< 0.001), multiple fractures (OR=2.29, p=0.003), liver disease (OR=2.76, p=0.02), hypertension (OR=2.05, p< 0.001), illicit drug use (OR=2.31, p=0.01), smoking (OR=1.71, p=0.02), open wounds (OR=3.32, p< 0.001), and CCI (OR=1.73, p=0.04) were also correlated with a higher incidence of SSI as compared to our control group. Our machine learning models performed well, with AUCs ranging from 0.74 to 0.86. GB had the highest AUC (0.86) and other favorable metrics including an accuracy of 0.88, F1-score of 0.89, precision of 0.91, sensitivity of 0.88, and specificity of 0.77 (table 1).Table 1.Performance Metrics of the Machine Learning Prediction Model for SSI following Ankle Fracture

Conclusion

Early prediction of SSI risk may lead to strategies to prevent complications in high-risk patients after ankle fracture fixation. With the goals of enhancing patient outcomes, lowering healthcare costs, and optimizing the use of healthcare resources, machine learning models may enable the identification of patients at high risk of SSI for tailored preventive treatments.

Disclosures

All Authors: No reported disclosures
1320. Pneumococcal Meningitis Before and During Covid – 19 Pandemic in Uruguay, South America (2017 – 2022).
Authors: Delfino Marcos , Méndez Ana P , Ferrer Monica Pujadas , Pírez María Catalina
Published: November 2023

Background

In Uruguay, universal vaccination of children with 7/13 valent pneumococcal conjugate vaccines was introduced between 2008 and 2010 (2 + 1 schedule), achieving nationwide coverage of 95%. This has caused a significant decrease in pneumococcal meningitis (PM).

The Covid-19 pandemic led to worldwide quarantines and isolation during 2020 and 2021. This resulted in a significant decrease in other infections. With the mass vaccination campaign worldwide, in 2022 we could return to a society life like before 2020. However, in 2022 there was an unusually high circulation of infections caused by other viruses and bacteria.

The objective of this study is to compare the number of cases of PM before and during the early and late pandemic of Covid-19 in the general population in Uruguay.

Methods

This descriptive, retrospective study includes all cases reported to the Department of Health Surveillance of the Ministry of Public Health with PM between January 1, 2017, and December 31, 2022. It also includes all SARS CoV 2 infections informed in Uruguay. PM variables are cases per year, sex, age (≤ 15 years and > 15 years), and deaths by period. The PM average rates of cases per 100,000 inhabitants are described in three periods: Period 1 or pre – pandemic (P1, 2017 to 2019); Period 2 or early – pandemic (P2, 2020 and 2021), and Period 3 or late – pandemic (P3, 2022). Statistical analysis were established based on frequency distribution and statistical significance tests as appropriate, considering a value of p equal to or less than 0.05 as statistically significant. The institutional Ethics Committee approved the research.

Results

The total number of cases PM is 100, 62% are men. The N for P1 is 59, for P2 it is 12 and 29 in P3.

Table 1 shows the main incidence and mortality results by age group in the three periods. Graph 1 shows the evolution of PM in relation to the development of the Covid-19 pandemic in our country. Lethality remains high (24% average for the total period).

Incidence rates of pneumococcal meninigtis and mortality by period and age.

Conclusion

There was statistically significant changes in cases of PM in the general population, in individuals > 15 and mortality. It is very likely that social distancing and the use of facemasks influenced these phenomena. These measures cease after the massive vaccination campaign against Covid-19, which could explain the 2022 increase in PM.

Disclosures

Marcos Delfino, Pediatrician, Pediatric Infectious Diseases, Pfizer: Finna María Catalina Pírez, Pediatrician, Pediatric infectologist, microbiologist Professor of pediatric, Degree V, Merck, Pfizer: Expert Testimony|Merck, Pfizer: Honoraria
1321. CT Brain Prior to Lumbar Puncture in Patients with Suspected Meningitis: A Single Centre Study of Compliance with Expert Guidelines and Diagnostic Yield of Imaging.
Authors: Dempsey Philip J , O’Herlihy Fergus , Gibney Brian Thomas
Published: November 2023

Background

Neuroimaging prior to lumbar puncture (LP) in suspected meningitis was once thought necessary to outrule raised intracranial pressure (ICP) which would risk brainstem herniation. However, the frequency of a lesion causing raised ICP is low and the risk of herniation post LP is minimal. The inappropriate use of neuroimaging prior to LP can delay diagnosis and reduce the diagnostic yield of CSF culture results. Several expert groups have published guidelines to reduce unnecessary neuroimaging in these patients. The purpose of this study was to review the use of CT brain prior to LP in our institution to identify which guidelines can be safely followed and the diagnostic yield of neuroimaging.Table 1:Criteria for CT Brain before Lumbar Puncture

The recommendations for when neuroimaging is indicated before lumbar puncture in suspected meningitis as per the UK, European Society of Clinical Microbiology and Infectious Diseases and Infectious Diseases Society of America guidelines.

Methods

The picture archiving and communications system was retrospectively reviewed from March 2013 to March 2023 to identify patients who had been referred for CT brain to facilitate LP for suspected meningitis. The referral information was reviewed and compared to the UK, Infectious Disease Society of America and European guidelines. The imaging findings were recorded to assess for any abnormality and the patient EMR was reviewed to assess for any clinical deterioration post LP.

Results

196 patients were included. The mean time from presentation to CT was 6.5 hours. 19, 28 and 65 of the 196 studies were indicated as per the UK, EU and IDSA guidelines respectively, resulting in a 90%, 85% and 67% reduction in imaging if these guidelines were followed. Of the 177 studies deemed inappropriately performed by the UK guidelines, 164 (93%) were normal. 12 (7%) had findings that did not preclude LP. One patient (< 1%) had a perimesencephalic haemorrhage. 19 (10%) studies were indicated, 16 of which were normal (84%). Of the remaining 3 (2%), none of the CT findings precluded LP. The application of the IDSA and European guidelines did detect any additional findings that precluded LP.

Conclusion

The use of expert guidelines is an important tool in reducing unnecessary neuroimaging and delays to lumbar puncture and treatment for patients with suspected meningitis. This study supports the use of the UK guidelines over other guidelines, which resulted in higher numbers of patients imaged without any additional clinical benefit. Red flag symptoms for intracranial haemorrhage should be carefully screened for.

Disclosures

All Authors: No reported disclosures
1324. Impact of Implementation of CSF PCR Panel in Patients with Meningitis
Authors: Hsu Eric , Abeydeera Nirusha , Faiz Samia , Ayutyanont Napatkamon , Meadows Robyn , Mallela Sudhakar
Published: November 2023

Background

Cerebrospinal fluid (CSF) Polymerase chain reaction (PCR) panel is routinely used for etiologic diagnosis of meningitis. While its role in this setting has been proven, there is no data on its benefits on duration of antibiotic use and hospital length of stay.

Methods

Retrospective cohort study was performed to compare meningitis patients who received the CSF PCR panel versus those who did not in a large database of HCA hospitals across the United States.

Data was collected from January 2014 to May 2022 on all patients diagnosed with meningitis with a CSF WBC greater than 10. Using logistic regression and negative binomial regression, the study compared utility of CSF PCR panel use versus non-use with regards to length of stay, antibiotic duration, resolution of fever and leukocytosis, and hospital readmission rate.

Demographics by Panel Use

A total of 4895 patients were included in the study, of which 379 received the CSF PCR Meningitis Panel.

Results

A total of 4895 distinct patient encounters were included, of whom 379 patients had the CSF PCR panel. CSF PCR use was associated with a significant decrease in readmission rates within 30 days (x2 5.64, p< 0.05) and had decreased log count days of antibiotic duration (x2 17.56, p< 0.0001) with a mean duration of antibiotic use of 73.91 hours in CSF PCR panel patients versus 82.05 hours. Panel use was not significantly associated with length of stay (x2 0.96, p 0.328). The likelihood of fever resolution and leukocytosis resolution was the same for those who received the CSF PCR Panel versus those who did not.

Antimicrobial Medications Received by Panel Use

Antimicrobial Duration and Clinical Presentation by Panel Use

There was a decrease in antibiotic use of 73.91 hours in CSF PCR panel patients versus 82.05 hours. There was also a significant decrease in hospital readmission rates within 30 days

Conclusion

CSF PCR panel benefits included reduced antibiotic duration of use and reduced 30-day readmission rates. Fever resolution and leukocytosis or leukopenia resolution was not impacted by CSF PCR panel use.

Disclosures

All Authors: No reported disclosures
1990. Evaluating the Impact of Directed Provider Outreach Urging Polio Vaccination During a Polio Outbreak – Rockland County New York, 2022
Authors: Masters Nina B , Fast Hannah , Hamid Sarah , Lueken James , Doss Shani K , de Coteau Adina L , Hoefer Dina , Meek Haillie , Mita-Mendoza Neida , Miller Susan , McKay Kevin T , Punjabi Chitra , Souto Maria , De Luna-Evans Tatiana , Stokley Shannon K , Dooling Kathleen L
Published: November 2023

Background

On July 18, 2022, a case of paralytic polio was reported in a person from Rockland County, New York. In August 2022, the proportion of children in Rockland County with 3 doses of polio vaccine by age two was 60.3%. That month, Rockland County, New York State, and CDC initiated a campaign to conduct physician-mediated patient outreach to improve Inactivated Polio Vaccine (IPV) coverage in Rockland County.

Methods

We contacted 38 Vaccines for Children enrolled providers, serving patients aged 3-60 months who were overdue for polio vaccinations, to send reminders to parents. Providers contacted parents by phone, text message, or mailed personalized letter. To assess success of the intervention on vaccine uptake, we retrospectively identified cohorts of patients missing >1 dose of polio vaccine in the New York State Immunization Information System as of August 9, for baseline years 2017 and 2018, and for intervention year 2022. We used logistic regression to compare the odds of receiving polio vaccine among under-vaccinated cohorts during August 15–October 31 of the baseline and intervention years.

Results

Thirty providers conducted patient outreach using phone calls (19 providers), text messages (4 providers), and letters (14 providers). At the outset, 4,887 patients aged 3-60 months were missing 1 or more recommended doses of polio vaccine. During the 10 weeks following initiation of outreach, 1,292 (26.4%) of these patients received an IPV dose; 7.1% were 3-6 months old, 17.9% 7-11 months, 27.9% 1 year, 47.1% 2-5 years. Of the IPV doses received, 1st, 2nd, and 3rd doses accounted for 7.5%, 33.1% and 59.4%, respectively. The odds of an un- or under-vaccinated patient receiving a dose of polio vaccine during the 10-week analysis period were significantly higher in 2022 compared to 2017 (OR=1.41, 95% CI [1.27-1.56]) and 2018 (OR=1.46, 95% CI [1.32-1.62]).

Conclusion

Following physician-mediated patient outreach urging vaccination among under-immunized children in August 2022, 26% of undervaccinated children received polio vaccine in the 10 weeks after outreach. This reflected an increased odds of vaccination by 40% compared to baseline years 2017 and 2018, highlighting the positive impact of conducting this type of outreach during a polio outbreak in an area with low vaccine coverage.

Disclosures

All Authors: No reported disclosures
1339. Effects of Tixagevimab-Cilgavimab in Clinical Practice is Consistent with Preliminary Neutralization Studies
Authors: Dluzynski Daniela , Ssentongo Paddy , Shaheen Shareef , Maglakelidze Natella , Hale Cory , Henao Maria Paula , Chinchilli Vernon M , Paules Catharine I
Published: November 2023

Background

Emergency use of tixagevimab-cilgavimab was based on data collected prior to the emergence of SARS-CoV-2 omicron variant and subvariants. Dosing recommendations changed twice based on neutralization data alone, leading to patients receiving different doses at varying intervals. We provide real-world data on efficacy of tixagevimab-cilgavimab in immunocompromised patients throughout 2022, including the incidence and timing of infection based on dosing scheme.

Methods

Charts of 471 patients who received and 126 patients who declined administration of tixagevimab-cilgavimab were analyzed through December 14th, 2022. We evaluated incidence of SARS-CoV2, severity, risk factors and vaccination status. For analysis, we grouped patients with similar dosing: Group A received one initial dose of 150mg/150mg of tixagevimab-cilgavimab, Group B received at least 300 mg/300 mg of tixagevimab-cilgavimab before July 1st, and Group C patients were up to date with the FDA dosing guidelines.

Results

The tixagevimab-cilgavimab group had higher incidence of stem cell transplant or CAR T-cell therapy (115/471, 24% compared to 18/126, 14% p < 0.01) and had higher vaccination status (411/471, 89% compared to 37/126, 29%, p < 0.0001). Patients that received tixagevimab-cilgavimab had a trend towards higher incidence of SARS-CoV-2 infection (70/471, 15% compared to 11/126, 9%; p = 0.08). Incidence of SARS-CoV-2 was similar amongst all dosing groups (6/21, 29% in Group A; 37/251, 15% in Group B, and 27/199, 14% in Group C, p = 0.188). Group C experienced the most infections in November and early December 2022.Figure 1.Number of SARS-CoV-2 infections per month based on dosing regimen

Group A patients received one initial dose of 150 mg/150mg of tixagevimab-cilgavimab. Group B patients received at least 300 mg/300 mg of tixagevimab-cilgavimab before July 1st, 2022 . Group C patients were up to date with the FDA dosing guidelines.

Conclusion

The tixagevimab-cilgavimab group demonstrated increased incidence of SARS-CoV-2. This may reflect increased healthcare system utilization, as most infections were self-reported in this study. Those with the FDA recommended dose were most likely to develop SARS-CoV-2 in November and December 2022 when circulating variants were not neutralized by tixagevimab-cilgavimab in vitro. This suggests in vitro neutralization data correlates with clinical efficacy.

Disclosures

All Authors: No reported disclosures
1348. Identification of GB-0669, a Novel S-2 Targeted Spike Monoclonal Antibody in Development for SARS-CoV-2 Prophylaxis
Authors: Borriello Francesco , Marden Grace , Li Hongru , Carlin Eric , Sharma Geetika , Menzenski Monica , Jecrois Anne , Palovcak Eugene , Lord Dana , Tao Jenhan , Grigoryan Gevorg , Root Adam , Hopson Kristen , Hazuda Daria , Van Epps Heather A , Ramos Alex , Joh Nathan H , Russell Pamela , Garlick Joseph D
Published: November 2023

Background

The clinical benefit of anti-spike mAbs for prophylaxis and treatment of SARS-CoV-2 is now well established (Baum 2020, Loo 2022, Westendorf 2022, Jones 2021, Kreuzberger 2021, Cathcart 2021, Hirsch 2022, Shi 2020); However, the evolution of SARS CoV-2 due to immune pressure has compromised the utility of all previously approved mAbs which target the variable, immune dominant receptor binding domain of the Spike protein. Despite the success of vaccination protecting the general population, the immunocompromised and elderly remain at high risk of serious disease and mortality from SARS CoV-2 infection. Therefore, there is a need to develop mAbs that remain active across current and emergent SARS CoV-2 variants for such populations.

Methods

The Generate Platform uses machine learning (ML) models to generate therapeutics with desirable properties. We used this platform to explore the amino acid sequence landscape compatible with the binding conformation and breadth of neutralization for mAbs targeting the conserved S-2 stem helix of Spike. While S-2 directed antibodies can broadly neutralize diverse coronaviruses, they are generally limited by potency. We employed an iterative computation- experimentation loop to design antibodies that bind to the S-2 stem helix, optimizing for potency, breadth and developability.

Results

The Generate Platform was employed to identify S-2 targeted Spike antibodies with high potency and breadth of neutralization resulting in GB-0669. GB-0669 exhibits sub-nM neutralization against all SARS-CoV-2 variants and Omicron sublineages including the highly immune evasive strain XBB. GB-0669 also displays sub-nM neutralization against sarbecoviruses associated with previous epidemics (SARS-CoV-1) and those of pandemic potential (WIV1, bat SARS-like coronavirus). The GB 0669 epitope was mapped by co-crystallization and is consistent with the observed breadth; all key interactions are >99% conserved with no evidence of immune escape.

Conclusion

GB-0669, a novel mAB targeting the conserved S-2 region of Spike, is hypothesized to be effective for prophylaxis of COVID-19 across all Omicron sublineages and future variants as well as CoVs with pandemic potential.

Disclosures

Francesco Borriello, MD PhD, Generate Biomedicines: Employee Gevorg Grigoryan, PhD, Generate Biomedicines: Chief Technology Officer|Generate Biomedicines: Ownership Interest|Generate Biomedicines: Stocks/Bonds Daria Hazuda, PhD, Generate Biomedicines: Employee|Generate Biomedicines: Stocks/Bonds|Merck and Co: Employee|Merck and Co: Stocks/Bonds Nathan H. Joh, PhD, Generate Biomedicines: Employee at Generate Biomedicines
1992. Two Decades of Lyme Disease in the U.S. Veterans Health Administration Detected Via Automated Surveillance Methodology, October 1999 - September 2022
Authors: Oda Gina , Lucero-Obusan Cynthia , Schirmer Patricia , Holodniy Mark
Published: November 2023

Background

Lyme disease is the most common vector-borne disease in the U.S. Incidence of Lyme disease is rising, partly due to climate change, and is likely underreported. We evaluated an automated method to analyze Lyme disease trends over two decades in the Veterans Health Administration (VHA).

Methods

We included individuals receiving VHA outpatient and/or inpatient care during fiscal years (FY) 2000-2022 (10/1/1999 – 9/30/2022). Automated case-finding was performed via ICD 9/10 Lyme Disease code plus a prescription for ≥7 days of appropriate antimicrobial treatment within 30 days of encounter AND/OR confirmatory lab testing (Table 1). Data was extracted from VHA Corporate Data Warehouse. We calculated FY incidence and prevalence per 10,000 individuals in VHA care and analyzed demographic trends. Positive Predictive Value (PPV) of case-finding methodology and clinical characteristics of identified cases was determined by review of 75 randomly selected case records.Table 1.Methodology

*Nelson, C.A., et al. Emerging Infectious Diseases. Vol. 21, No. 9, September 2015

Results

Automated methodology detected a total of 24,349 Lyme disease cases. Incidence rose steadily, peaking at 3.25 per 10,000 in FY 2017, with prevalence reaching 32.72/10,000 in FY 2022 (Fig. 1). States with highest average incidence per 10,000 in care were RI (12.65), ME (10.61), VT (9.81), and WI (8.51). Distribution of Lyme disease incidence expanded nationally, particularly in the Northeast and Northern Midwest. Demographic groups with highest average incidence per 10,000 in care included individuals in rural/highly rural areas (2.41), non-Hispanic Whites (2.26), age groups 55-64, 65-74, and 25-34 (2.30, 2.20, and 2.08, respectively), and males (1.95) (Fig. 2). Overall PPV of automated case-finding was 85.3%, with ICD 9/10 code + appropriate antimicrobial treatment AND confirmatory lab testing being the most accurate method (PPV 100%) (Table 2).Figure 1.Incidence and Prevalence of Lyme Disease in VHA, Fiscal Years 2000 - 2022Figure 2.VHA Lyme Disease Average Incidence rates by Demographic Variable, FY 2000 - 2022Table 2.Positive Predictive Value of Automated Case-Finding, N=75

*CSTE case definition = the current surveillance definition used by the Centers for Disease Control and Prevention Lyme Disease (Borrelia burgdorferi) 2022 Case Definition | CDC, based on 2021 Council of State and Territorial Epidemiologists Position Statement 21-ID-05: “Modification of Lyme Disease Case Definition”.

Conclusion

Automated surveillance methodology for Lyme disease provided an efficient and reasonably accurate estimation of the epidemiology of Lyme disease in VHA. The VHA pattern of Lyme disease geographic expansion in recent years is consistent with CDC national reporting. Providers should be aware of Lyme disease as an emerging threat.

Disclosures

All Authors: No reported disclosures
1369. Effect of COVID-19 on Antibiotic Consumption: An Analysis of the COVID-19 Community Research Partnership
Authors: Randazza Olivia , DeWitt Michael E , Williamson John C
Published: November 2023

Background

The COVID-19 Community Research Partnership (CCRP) is a multisite healthcare system-based study of the COVID pandemic. Community residents in this study provided consent for electronic health record (EHR) access allowing for analysis of antibiotic prescribing.

Methods

We conducted a retrospective, self-controlled cohort study to determine antibiotic consumption in the CCRP pre-COVID (Jan 2018 - Dec 2019) and post-COVID (Jan 2020 - Jan 2022). Participants were ≥18 years with an EHR record in the pre-COVID period. The primary outcome was the number of antibiotic prescriptions (AP) per 1000 patient care encounters in each time period. Secondary outcomes included the AP location of care, analysis of antibiotic classes, and COVID attributable antibiotic consumption, defined as an AP written ≤14 days before or after an EHR documented or self-reported positive SARS-CoV-2 test or COVID diagnosis.

Results

34,234 participants were included representing 2,775,711 encounters. Median age was 53 years with 70% female and 88% white. 41% lived in a rural or suburban area. There were 26,121 APs among 25,433 participants. Mean rate of AP per 1000 encounters was 12.1 and 7.6 pre vs post-COVID (p< 0.001). A decline in AP occurred at onset of the pandemic persisting through the post-COVID period (Fig 1). The prescribing rate for all antibiotics, except linezolid, decreased during the pandemic (p< 0.001, Fig 2). The largest declines were seen with antibiotics typically prescribed for respiratory illnesses. The decline in antibiotic consumption was driven by outpatient encounters (Fig 3). 6,341 participants were diagnosed with COVID and 333 APs were COVID attributable. These participants were more likely to receive a macrolide (45% vs. 22%, p< 0.001), live in a rural area (31% vs. 20%, p< 0.001), and receive care in an emergency department (12% vs. 6.1%, p< 0.001).

Figure 1.

Antibiotic Prescriptions During The Study Time Period

Figure 2.

Analysis Of Antibiotic Classes

Figure 3.

Location of Antibiotic Prescribing

Conclusion

The COVID pandemic was associated with a broad decline in antibiotic consumption. These results may be due to declines in other respiratory viruses, anchoring bias for COVID during the pandemic, improved antibiotic stewardship practices, or social isolation. Antibiotics for respiratory illnesses declined the most, suggesting this may be a target for outpatient stewardship efforts.

Disclosures

All Authors: No reported disclosures
1994. Infections following Chimeric Antigen Receptor (CAR) – T cell Therapy: 2018-2022
Authors: Keri Vishakh C , Ramakrishna Jahanavi M , Vyas Rahul , Monday Lea M , Deol Abhinav , Chandrasekar Pranatharthi , Al-Saadi Mahmoud
Published: November 2023

Background

Chimeric Antigen Receptor (CAR) T-cell therapy is an emerging therapeutic modality for relapsing and refractory haematological malignancies. We describe the infectious complications following CAR T-cell therapy.

Methods

This is a retrospective analysis of data on patients who received CAR-T cell therapy between April 2018 and December 2022 at Karmanos Cancer Institute, Detroit, Michigan. Patients’ data were collected up to their last known clinic or inpatient follow-up visit. An infectious episode was defined as any microbiologically proven or documented infection. Statistical analysis was performed using SPSS software version 28.0.

Results

Seventy-six patients received therapy with FDA-approved CAR-T cell products. Thirty-three patients (43.4%) had at least one infection with a range of 1 to 4 infectious episodes per patient. There were 61 infectious episodes during a median follow-up of 184 (96-340) days. The median duration for the onset of infection was 59 (22-209) days. Bacterial and viral infections occurred in 42.6% and 41% of the infectious episodes respectively. COVID-19 was the most common infectious complication (14.8%). Time-to-event analysis showed that most of the infections occurred within the first 100 days (Figure 2). Empirical antibiotic use in Cytokine Release Syndrome (CRS)/ Immune effector Cell-Associated Neurotoxicity Syndrome (ICANS) in the absence of documented infection was reported in 85.7% of patients. Clostridioides difficile (C.difficile) accounted for 11.5% of all infections. Out of 6 patients with C.difficile infection 5 patients had CRS and antibiotic use. There were four documented deaths during the study period. Two deaths occurred in patients who had an infection.

Conclusion

The mortality rate among patients who had an infection was 6.5%. Most of the infections occurred within the first 100 days. COVID-19 and C. difficile infection were the most common infections following CAR-T cell therapy. The rate of C. difficile infection was high in patients with CRS receiving empiric antibiotics in the absence of any documented infection, thus providing an opportunity for antibiotic stewardship in this population.

Disclosures

All Authors: No reported disclosures
1373. Health-Related Quality of Life in Outpatient Adults With Medically Attended Acute Respiratory Infection
Authors: Zhang Xueyan , Nowalk MaryPatricia , Sax Theresa M , D’Agostino Helen , Balasubramani G K
Published: November 2023

Background

The COVID-19 pandemic has caused a significant global burden. However, there is limited evidence on the physical and mental health-related quality of life after mild COVID-19 infection.

Methods

A prospective cohort study was conducted among adults (18 - 87 years) with acute respiratory infection from 3/30/2020 to 4/30/2021. RT-PCR tests confirmed SARS-CoV-2 infections from nasopharyngeal or nasal swab specimens. A Short Form Health Survey (SF-12), which measures physical and mental health functioning in the last four weeks, was administered at presentation for treatment in outpatient settings (enrollment) and at 6-8 weeks follow-up. Participants were classified based on enrollment SF-12 item responses using K-means clustering. Chi-square tests and ANOVAs were used to examine demographic and health characteristics by cluster. Linear regression was used to evaluate predictors of change in physical and mental health composite scores (PCS and MCS, respectively) from enrollment to follow-up.

Results

856 COVID-unvaccinated patients completed both surveys. 352 subjects were grouped in the high-functioning group (HFG) at enrollment, 362 were in the medium-functioning group (MFG), and 151 were in the low-functioning group (LFG). At enrollment, compared with HFG, LFG was more likely to be female, have a lower education level, have a history of smoking, and experience symptoms including fever, chills, shortness of breath, vomiting or nausea, diarrhea, and loss of smell or taste. Changes from enrollment to follow-up in PCS and MCS were compared across groups. Increases in PCS and MCS were significantly smaller (1.4 ± 6.0, -1.6 ± 8.1) in HFG than in the MFG (5.9 ± 8.3, 0.6 ± 10.2) and the LFG (7.1 ± 9.2, 1.9 ± 10.7; P < 0.001 for both). In regression analyses, predictors of improved PCS and MCS were having COVID-19 illness, reporting shortness of breath, and being in the LFG compared with the HFG (P < 0.05 for all).

Cluster difference identified by canonical discriminant analysis

Conclusion

Both physical and mental quality of life scores following an acute respiratory infection were better among those with mild COVID-19 illness than among those with non-COVID respiratory illnesses. Furthermore, changes in scores during follow-up were more resilient among those in the LFG, with smaller differences in scores across groups at follow-up than were evident at enrollment.

Disclosures

MaryPatricia Nowalk, PhD, RDN, Merck & Co.: Grant/Research Support|Merck & Co.: Honoraria|Sanofi: Grant/Research Support
1385. Granulomatous Mastitis: An Elusive Disease
Authors: Jara Maria Daniela Jarrin , Kladias Michael , Coyle Christina
Published: November 2023

Background

Background

Granulomatous mastitis (GM) is a chronic inflammatory disease of the breast characterized by painful and recurrent breast lesions and masses. It affects women of childbearing age with a history of breastfeeding. It is a rare diagnosis with an estimated incidence of 2.4 per 100,000 women in the United States, with a prevalence 12 times higher in Hispanic women.

Methods

Methods

We conducted a retrospective review of women with GM seen at NYC Health + Hospitals/Jacobi, a safety net hospital in the Bronx, New York City from January 2017 to March 2023. Patients were included if they had pathologic confirmation of the disease. Demographic and clinical data was extracted from the electronic medical records.

Results

Results

A total of 29 patients were included, 86.2% were Hispanic; median age was 40 years old. None of the patients was postpartum and only one patient was breastfeeding at the time of diagnosis. Pain and unilateral palpable mass were the most commonly reported symptoms. Of those who had cultures, only 42.1% reported growth and the most prevalent organisms were Corynebacterium species. 89.7% received antibiotic treatment as a first line therapy; only 37.9% of them reported improvement within a month of presentation. Trimethoprim-sulfamethoxazole, clindamycin and doxycycline were the most prescribed treatments. 27.6% of all patients received systemic steroids following failure to improve with antibiotic treatment and 17.2% received intralesional steroids. 65.5% of those reported resolution of symptoms within three months. Two patients received a trial of adalimumab. Seven patients (24%) presented with recurrence after a year.

Conclusion

Conclusions

GM occurs predominantly in Hispanic females and seems to be associated with Corynebacterium species when an organism is isolated. Recurrences occur in ¼ of patients despite therapy. The pathophysiology of this condition and optimal treatment of this disease is not well defined, but antibiotics alone do not seem to be effective. Immune modulation seems to be an important adjunctive treatment, but which agent and how long is not clear. Further studies are needed to elucidate these answers.

Disclosures

All Authors: No reported disclosures
1393. Unveiling disease trends: a ten-year analysis of mandatory notification diseases in Brazil (2013-2022)
Authors: Nardo Beatriz Barraqui , Angelo Marco Aurélio Fagundes , de Vasconcelos Débora , Lima Naísses Zóia , Carvalho Walisson Ferreira , Ladeira Ana Paula , Couto Braulio
Published: November 2023

Background

Disease surveillance is crucial for timely detection and control of diseases. In Brazil, mandatory disease notification is required through the National System of Notifiable Diseases (SINAN). This paper aims to contribute to the understanding of disease burden and patterns in Brazil, a representative region of South America and other developing countries.

Methods

The study utilized a retrospective observational study design to conduct surveillance of 54 mandatory notifiable diseases over a 10-year period, from January 2013 to December 2022. The data was collected from a reference public hospital located in Belo Horizonte, a city with a population of approximately 3,000,000 inhabitants, located in the Minas Gerais State of Brazil. Monthly incidence rates were calculated for each disease by using the number of cases as the numerator and the total number of patients admitted to the hospital as the denominator. To estimate endemic levels, the 90th percentile was used for both the monthly incidence rate and the mobile yearly average rate, which provided a threshold for identifying unusually high disease incidence levels. Secular time trends were evaluated using linear regression analysis.

Results

Over 10 years, 37,081 notifiable diseases were diagnosed from 54 different diseases. Only five diseases accounted for 87% of cases: classical dengue fever, unspecified communicable disease, assault by unspecified means, toxic effect of unspecified substance, and work-related conditions (Fig. 1). Monthly endemic levels were estimated, revealing an increase in incidence for 15 diseases including HIV, Syphilis, and assault by unspecified means (Fig. 2). Analysis of pandemic phases showed consistent increase in diseases such as visceral leishmaniasis and tuberculosis between 2018 and 2022 (Fig. 3), emphasizing the need for continued vigilance and targeted interventions.Figure 1Pareto Chart illustrating the occurrence of 54 notifiable diseases over a 10-year period (2013-2022) in a reference public hospital in Belo Horizonte, Brazil.Figure 2Trend analysis of notifiable diseases with incidence changes over a 10-year period (2013-2022) in a reference public hospital in Belo Horizonte, Brazil.Figure 3Incidence rate of visceral leishmaniasis and respiratory tuberculosis during pre-pandemic, pandemic, and late-phase pandemic periods (2018-2022) in a reference public hospital in Belo Horizonte, Brazil.

Conclusion

This study provides valuable insights into the epidemiology and trends of 54 mandatory notifiable diseases in Belo Horizonte, Brazil, over a 10-year period. The findings of this study contribute to our understanding of the burden of these diseases in the study population and may inform public health strategies for disease prevention and control in the future.

Disclosures

All Authors: No reported disclosures
1405. Angel of Death - Tetanus and Rabies - Indian Experience
Authors: Srikanth V S
Published: November 2023

Background

Tetanus is an old-world disease and Rabies dated back to the Vedic period i.e 1500-500BC in ancient Indian scripture, Yama, the mythical God of Death. This is one of very few recent studies done in India on Tetanus and Rabies, the data available on Tetanus and rabies are less so we are trying to share our experience on these diseases, so it will help the physicians to get a better understanding.

Methods

This is a retrospective study, detailed 3 years case sheet review was done and the patient’s clinical presentation and prognosis was noted in pre designed format.Inclusion criteria – All diagnosed cases of tetanus and rabies,Exclusion criteria – patient already received treatment from local hospital.

Results

58 tetanus cases with average duration hospital stay 15 days, common occupation farmers(barefoot workers).The site of injury -foot in 65% cases followed by injuries to the fingers or the hand in 30% and 5%cases due to injury while tooth picking with pin, splinter removal using pins.Clinical symptoms -Trismus“Lock jaw”(41),difficulty in walking (2),limb pain/stiffness(17),back muscle, pain/stiffness(12,)Dysphagia (7) ,72% autonomic dysfunction.Opisthotonos position and riscus sardonicus developed after 7-8days of infection. 18% mortality was noted most cases were unvaccinated cases. 31 Rabies cases - age group of 35-45, most cases were unprovoked bite.Common site of injury lower limbs.68% grade 3, 32% grade.Symptoms from bite1 months High grade fever, anxiety were initial symptoms followed by hydrophobia and aerophobia. 20% cases had seizure. Minimum hospital stays 12 days,Mortality 100.

Conclusion

Tetanus and rabies are preventable diseases; if ignored can cost life .So Rabies vaccination and immunoglobulin should be administered on time

Disclosures

All Authors: No reported disclosures
1409. Understanding the Current Status and Barriers to Infection Prevention in Emergency Departments: A Survey of 71 Hospitals across the United States
Authors: Dasari Laya , Shum Julio Ma , Searle Eileen F , Boggs Krislyn M , Chen Olivia L , Sullivan Ashley , Camargo Carlos A , Shenoy Erica S , Biddinger Paul
Published: November 2023

Background

Infection prevention and control (IPC) is especially challenging in the emergency care setting due to ever-increasing emergency department (ED) crowding, boarding of patients, increasing rates of staff turnover, and other factors.

Methods

2022 IPC practices in the ED setting were queried between January and April 2023 using the National Emergency Department Inventories (NEDI)-USA survey, which is administered annually to all United States EDs. In a subset of EDs, the expanded survey assessed reported adherence to IPC policies, barriers to policy compliance, use of transmission-based precautions signage, disinfection of reusable medical equipment, use of personal protective equipment (PPE), hand hygiene (HH), staff education and training, and perceptions of safety concerning healthcare-associated infections (HAIs).

Results

Of 289 facilities surveyed, 71 (25%) have responded as of April 17, 2023, with 83% (59/71) located in suburban/urban settings (Table 1). Although compliance with IPC practices was high with 73% (49/67) reporting > 80% compliance with HH (Table 2), notably, compliance with signage was identified as a significant gap, with 25% (18/71) of EDs reporting that they rarely or only sometimes post signs for patients who required them. This issue was more pronounced with patients placed in hallways or overflow treatment spaces, where, in applicable hospitals, 71% (25/35) of EDs never, rarely, or only sometimes post transmission-based precaution signs. Despite this, most ED leaders (67%, 47/70) felt neutral or did not perceive HAIs to pose a significant risk to patients relative to other patient safety issues in the ED (Table 3).

Conclusion

This ongoing survey suggests high perceived compliance with IPC practices in the ED, which is discordant with evidence of suboptimal adherence to basic IPC practices. The findings suggest that targeted interventions and educational efforts are necessary to address the gaps in knowledge and understanding of IPC failures and risk of HAIs. The findings illustrate the importance of improving IPC practices in the ED to enhance patient safety; further research is needed to investigate the apparent discrepancy between perceived and actual practices.

Disclosures

All Authors: No reported disclosures
1410. Improved Disinfection in the Operating Room through Hydrogen Peroxide Fogging
Authors: Davis Jennifer , Bair Tina , Lapolla Brian , Bigham Michael
Published: November 2023

Background

Hospital acquired infections (HAIs), including surgical site infections (SSIs), are a major contributor to morbidity. Environmental exposure is a contributing factor to HAIs. Environmental decontamination with hydrogen peroxide fogging has proven to reduce bacterial growth and bioburden in the hospital setting. We sought to 1) implement and test feasibility of an operating room (OR)-based hybrid hydrogen peroxide fogging program and 2) assess the impact of hydrogen peroxide fogging on SSIs.

Methods

At a large freestanding midwestern Children's Hospital with a surgical volume of over 17,000 annual surgeries, a hybrid hydrogen peroxide fogging program was implemented in a risk-stratified fashion. Baseline fogging was completed to establish a post-fogging time series for bacterial regrowth (measured by culture and bioburden) and to guide the implementation schedule. Based on time-series results, room-specific fogging parameters were established. ORs received fogging either every 2 weeks (neurosurgical, cardiac and spine ORs) or every 4 weeks (all other ORs).

The fogging program was administered using a third-party vendor beginning in September 2022. The feasibility assessment was designed to identify any safety events, interruptions in care or access to the ORs due to fogging. The time series outcomes were bioburden and bacterial cultures. The primary patient outcome measure was the rate of SSIs. This is depicted in both a P chart, showing a monthly rate, and a T-chart, showing days between events. SSIs for orthopedic, spine and neurosurgeries were tracked from January 2021 to present.

Results

After implementation of the program there was a significant decrease in SSI rates from 3.38% to 0.68% and is represented by a center-line shift in the P chart. The days between SSIs moved in a favorable direction, increasing to 238 days, the longest since January 2021. The time series evaluation indicated return to baseline bacterial bioburden between 3 and 4 weeks post-fogging. The feasibility assessment identified no safety events, delays, interruptions or decreases in OR utilization.

Surgical Site Infections (Spine, Cardiac, Neurosurgical)

Since fogging began in September of 2022, we have experienced a centerline shift demonstrating a reduced rate of surgical site infections from 3.38% to 0.68%, the longest stretch between surgical site infections since January 2021.

Days Between Surgical Site Infections

Since fogging began in September of 2022, we have experienced the longest stretch between surgical site infections since January 2021

Conclusion

Hydrogen peroxide fogging is a feasible form of disinfection and reduces SSI rates when applied in the OR of a Children’s Hospital with a moderate to large surgical volume.

Disclosures

Michael Bigham, MD, ForTec Medical: Advisor/Consultant
1417. Continued Success of Legionella Water Screening for a Large Veterans Affairs Campus in Long Island, New York
Authors: Bailey Lisa , Rahman Mahfuz , Belanger Debra , Thorne Monique , Ford Florence M , Gouch Mark , Psevdos George
Published: November 2023

Background

Legionella is found in all natural water sources & has been linked to waterborne environmental outbreaks of pneumonia. Environmental surveillance in healthcare facilities is of paramount importance to prevent Legionella overgrowth and acquired infections. This can a be a challenging task for our large 268-acre Veterans Affairs campus with its own water supply wells and water distribution system, 10 buildings housing acute care, outpatient clinics, residential and nursing homes. While the COVID 19 pandemic absorbed resources & time, water testing was not neglected. We report our experience of Legionella water testing during the pandemic

Methods

Water Legionella sample testing is done quarterly involving 180 faucets & showers throughout the facility, ice machines and 4 cooling towers (CT). Cultures are performed in a reference laboratory. Annual cost $100,000. A positive detection is defined as 1 colony forming unit (CFU)/mL from faucets and 10 CFU/mL from CT. Every positive detection is managed as follows: remediation by hyperchlorination, resampling, disinfection of cooling towers, and removal of equipment (ice machines)

Results

In fiscal Years 2020-22 4853 Veterans were hospitalized and 455 were tested for Legionella via urinary antigen; 3/455 patients had legionellosis, all were community-related, & 1 had a concurrent coinfection with COVID-19. 2221 water samples were collected. Table 1 shows detections and locations. All detections were remediated by localized chlorine disinfection & then resampled. Retreatments with increased disinfectant dosage was implemented in repeat positive detections. In few instances up to 3 retreatments were required to achieve negative growth. For repeat positive detections for CTs remediation utilized addition of a 2nd biocide No employee/patient case of Legionella pneumonia has been associated with exposure to positive water testing

Table 1

Positive Legionella detections

Figure 1

Facility Diagram location of buildings and Cooling Towers

Conclusion

Preventing Legionella water overgrowth in a large Veteran Affairs campus can be a tedious and costly endeavor. L. pneumophila and non pneumophila species were detected in various locations including the CTs, nevertheless remediation protocols were immediately followed and proved successful. There were only 3 cases of Legionella pneumonia in the study period, but none were facility associated

Disclosures

All Authors: No reported disclosures