bluuebunny/crossref_metadata_2025 huggingface dataset:
2945. Audit and Feedback Informed ASP Interventions Lead to Sustained Reductions in Suboptimal Antibiotic Prescribing at Hospital Discharge
Authors: Puckett Lauren M , Bio Laura , Cornell Sean , Schwenk Hayden T
Published: November 2023

Background

Antimicrobial stewardship programs (ASPs) have traditionally focused on the inpatient setting; however, a significant proportion of antibiotics initiated during hospital stays are continued at the time of discharge. Previous studies have found that rates of suboptimal antibiotic prescribing at the time of hospital discharge may be as high as 30%. Our study aimed to implement ASP interventions targeted at reducing suboptimal prescribing at the time of hospital discharge and to assess the effectiveness and durability of these interventions over time.

Methods

Beginning 11/2020, our ASP began audit and feedback of both enteral and parenteral hospital discharge antibiotic prescriptions. A prescription was determined to be suboptimal if the dose, frequency, duration, selection, or formulation were inconsistent with institutional and/or national guidelines or based on the clinical judgment of the ASP pharmacist. Findings from this process were used to develop interventions, including targeted provider and medical service education, institutional guideline development, and electronic health record modifications. The rate of suboptimal discharge antibiotic prescribing from 12/2020-4/2023 was plotted on a statistical process p-chart, including a historical baseline (9/2020-10/2020).

Results

A total of 4347 prescription audits were performed over a 28-month period and included 4211 enteral and 136 parenteral antibiotics. Reasons prescriptions were identified as suboptimal are included in Figure 1. A p-chart (Figure 2) identified a decline in suboptimal prescribing from a baseline rate of 29% to 15% after implementation of audit and feedback, modification of medication order entry panels, and targeted interventions to surgical services. After implementation of all interventions (Table 1), a centerline shift was detected, with a decrease in suboptimal prescribing from 15% to 8%.

Figure 1.

Reasons discharge prescriptions were identified as suboptimal (N=568). A prescription may have more than one reason for being considered suboptimal.

Figure 2.

Suboptimal Antibiotic Prescriptions at Hospital Discharge, 2020 – 2023: P-chart for suboptimal prescription rate. The yellow line indicates mean suboptimal prescription percentage for the study period (15% and 8%, respectively). The purple dashed line indicates literature reported rate of suboptimal prescribing (30%). Interventions annotated 1-7 within figure are found in Table 1. LCL, lower control limit; UCL, upper control limit.

Conclusion

Suboptimal antibiotic prescribing rates decreased by 72% over a 2.5-year period through a mix of audit with feedback and targeted interventions. These new processes may demonstrate a potentially effective sustained reduction in suboptimal prescribing. ASPs should consider implementation of hospital discharge prescription review as part of ambulatory stewardship efforts.

Disclosures

All Authors: No reported disclosures
2220. High burden of antibiotic exposure in left ventricular assist device (LVAD) recipients: A call for enhanced antimicrobial stewardship
Authors: Moore William J , Kling Kendall , Zembower Teresa , Jirak Alison , Nonog Gretchen , Magliola Grace , Harap Rebecca S , Wilcox Jane , Pham Duc , Wu Tingqing , Byrd Heather , Stosor Valentina
Published: November 2023

Background

LVAD patients are at high-risk for complications including hospitalization and infection, resulting in increased empiric use and lower thresholds for initiation of antibiotics (ABX). ABX utilization and risk for resistance development in this vulnerable patient population is not well established. We aimed to describe ABX exposure targeting early healthcare-associated infections (HAI) that occur in a complex patient population.

Methods

This was a review of ABX use among a prospective cohort of patients with recent LVAD to assess antibiotic burden. Study patients are being followed longitudinally to assess microbiota changes that occur with duration of LVAD support, development of any LVAD-related and unrelated infection, and ABX exposure. Included patients were enrolled from 7/2022 to 3/2023. World Health Organization’s AWaRe criteria, which groups agents based on potential for resistance development and need for stewardship prioritization, was used to classify antibiotic use. Summary and descriptive statistics were performed.

Results

Seventeen LVAD recipients were included with 53% having reported infection, totaling 21 distinct HAI. Infection types and antibiotic burden, including spectrum and duration are provided in Figure 1, with leading infection sites including respiratory (n=8), intra-abdominal (n=3), urine (n=3), and bloodstream (n=3). ABX courses exceeded most recommended durations, with a median of 11 days (IQR 8-16). Majority of episodes resulted in receipt of broad-spectrum antibiotics, including meropenem (n=7), piperacillin-tazobactam (n=6), and cefepime (n=4), despite limited occurrence of pathogens requiring these agents, Enterobacter spp (n=2), Pseudomonas aeruginosa (n=1). Observed ABX agents corresponded to WHO AWaRE Access (n=11.1%), Watch (n=83.3%), and Reserve (n=5.6%) groups, indicating frequent use of agents with high potential for resistance development.Figure 1.Antibiotic Burden & Infections following LVAD

Frequent use of broad-spectrum antimicrobials with high risk for resistance development observed in LVAD patients. WHO AWaRe criteria were used to identify higher risk agents, labeled as Watch and Reserve.

Conclusion

We found high rates of early HAI and broad-spectrum antibiotic use in patients with recent LVAD placement. These findings demonstrate potential opportunities for enhanced antimicrobial stewardship in this population to optimize therapy selection, mitigate risk of subsequent multidrug-resistant infections, and to preserve essential agents for future use.

Disclosures

Valentina Stosor, MD, DiaSorin S.p.A.: Advisor/Consultant|Eli Lilly & Company: Grant/Research Support
2231. Point Prevalence Survey on Antimicrobial Appropriateness in a Tertiary Care Hospital in Saudi Arabia
Authors: AlMahasnah Reem , AlQassim Hussain , AlQaysum Ibtihal , Atta Manal , AlRashidi Faris , Abufara Hanan , Hashhoush Mai , AlAjmi Noura , AlJishi Yamama
Published: November 2023

Background

Antimicrobial resistance is a significant global health problem. Optimizing the use of antimicrobial agents is a key strategic objective for any antimicrobial stewardship program (ASP). In the literature, 9-64% of antimicrobials prescriptions were inappropriate the hospital setting. We aim to evaluate antimicrobial utilization practices and subsequently implement informed interventions to optimize antimicrobial use by conducting a point prevalence survey (PPS).

Methods

This is a single-center PPS at King Fahad Specialist Hospital-Dammam, Saudi Arabia. The hospital is specialized in Transplant, Oncology/hematology, and Neuroscience, with approximately 350 beds. All inpatient wards were conducted over one week period ward by ward. All inpatients on active antimicrobials were included. Data were collected from patients’ electronic medical records based on the WHO methodology for PPS on antibiotic use in hospitals. The outcome (appropriateness of antimicrobial treatment) included five elements: indication, duration, administration route, spectrum, and dosing. Assessments were made according to the local and international guidelines and the ASP team (Infectious diseases consultant and pharmacist).

Results

A total of 316 patients’ medical records were screened. Of whom 121 were included. Nineteen (16%) patients were pediatrics, and 102 (84%) were adults. Patients’ characteristics are presented in Table 1. A total of 207 systemic antimicrobials were recorded, 117/207 (57%) therapeutic and 90/207 (43%) prophylactic. The antimicrobials were inappropriate in 73 /207 (35%) antimicrobial orders that included 84 elements. Eleven out of the 73 orders have more than one inappropriate element. The main reasons were inappropriate indication 31/84 (37%), followed by the antimicrobial spectrum 21/84 (25%). Figure 1Table 1:Characteristics of patients receiving systemic antimicrobial treatment, n (%)Figure 1:Elements of antimicrobials inappropriateness

Conclusion

This point prevalence survey showed 35% of the antimicrobial prescription in the inpatient setting was inappropriate. The most common reasons were the indication followed by the spectrum and duration of antimicrobials. These findings provide valuable insight into stewardship's best approach and interventions to improve antimicrobials appropriateness.

Disclosures

All Authors: No reported disclosures
2236. Evaluation Of Antibiotic Utilization For Urinary Tract Infections In Two Community Hospitals In Miami
Authors: Boatwright Renata , Salazar Veronica , Quintana Elianis , Rosa Rossana , Abbo Lilian M
Published: November 2023

Background

Antimicrobial Stewardship (ASP) of urinary tract infections (UTIs) remain a challenge as UTIs continue to be over-diagnosed. Lack of documentation of symptoms, unclear clinical indication for cultures and improper culture collection are some of the contributing factors. Thus, over-diagnosis of UTIs leads to unnecessary antimicrobial exposures adding to increased risk of Clostridioides difficile infection and antimicrobial resistance. Our study aimed at assessing the magnitude of inappropriate antimicrobial exposures related to UTIs at Jackson South (JSMC) and Jackson North (JNMC) Medical Centers, two mid-size hospitals in the Miami area, to guide future stewardship measures.

Methods

A retrospective chart review of 18% of UTI orders during March 2023 was conducted. The orders were evaluated for four criteria: documentation of UTI symptoms; antimicrobial selection, dose and frequency; treatment duration including antibiotic prescriptions upon discharge and appropriateness of testing. Antibiotic orders were deemed appropriate if all criteria were met. Prescribing pattern was also evaluated for critical care status.

Results

A total of 3,472 antibiotic orders were prescribed during the study period of which 10% were indicated for UTI. The study was powered at 95% confidence interval. Inappropriate testing was the most common occurrence at 42%, followed by treatment duration 32%. JNMC prescription orders contributed to 72% of inappropriate treatment length compared to 40% at JSMC. Lack of UTI symptom documentation represented 28% of the cases and lastly antibiotic choice, dose and frequency contributed with 16%. Overall, 36% of the UTI orders were deemed appropriate at JSMC versus 20% at JNMC (Fig. 01).The majority of the orders were outside of critical care units for both centers (Fig. 02).

Conclusion

UTI over-diagnosis has led to inappropriate antibiotic usage. Excessive laboratory testing, prolonged treatment duration and lack of assessment of UTI symptoms were the main opportunities identified. Leveraging algorithm technology for increased compliance with symptom assessment and reduced screening as well as implementation of outpatient prescription stewardship would be beneficial to the health system.

Disclosures

Lilian M. Abbo, MD, MBA, Ferring: Advisor/Consultant|Pfizer: Advisor/Consultant|Regeneron: Grant/Research Support|Shionogi: Advisor/Consultant
2255. The Effect of Penicillin Allergy Labels on Perioperative Antibiotics for Elective Procedures
Authors: Hasse Eileen , Zhang Minhua , Stone Cosby A , Weaver Sheena Marie , Wanderer Jonathan , Staub Milner , Nelson George E
Published: November 2023

Background

As many as 20% of patients in the United States report a penicillin (PCN) allergy, of which 4% or less are true allergies. Previously, cephalosporins and PCN were estimated to have 10% cross-reactivity, but recent studies show lower rates. Patients with reported PCN allergy have increased surgical site and urinary tract infections, emergency room visits, and readmissions post-operatively, possibly due to unnecessary cefazolin avoidance. At Vanderbilt University Medical Center (VUMC), patients have an appointment with Vanderbilt Perioperative Evaluation Clinic (VPEC) to review medical history prior to elective procedures.

Methods

In this retrospective cohort study, we evaluated patients ≥ 18 years old seen at VPEC prior to an elective procedure from 1/1/2022-1/1/2023. We excluded patients who did not receive perioperative antibiotics, did not undergo elective procedure, and patients with cephalosporin allergies. We compared demographics, clinical characteristics, and perioperative antibiotics received based on PCN allergy label presence in the electronic medical record (EMR). All variables were analyzed in R programming language with chi square or Fisher exact test.

Figure 1. Exclusion Criteria Table 1. Demographics and Clinical Characteristics by Cohort

Results

A total of 12,938 non-PCN allergy and 1,657 PCN allergy patients were included. Patients with PCN allergies were more often older (55 years vs 57 years; P = 0.001), women (53% vs 63.5%; P < 0.001), and white (83.3% vs 86.4%; P = 0.03). Antibiotic use differed between those with and without PCN allergies across all surgical services and in all classes except carbapenems, most notably cefazolin (80.4% vs 37.4%; P < 0.001), clindamycin (2.5% vs 48.3%; P < 0.001), and vancomycin (16.7% vs 19.5%; P = 0.005). There was also a difference in patients receiving ≥ 2 perioperative antibiotics (21% vs 32.5%; P < 0.001).Figure 2.Relative Proportion of Antibiotic Administration by CohortFigure 3.Cefazolin, Clindamycin, and Vancomycin Administration by CohortFigure 4.Relative Proportion of Cefazolin, Clindamycin, and Vancomycin Administration by Cohort and Surgical Service

Conclusion

Patients with PCN allergies receive less perioperative cefazolin, more clindamycin, and more vancomycin for elective surgeries at VUMC. We have created a PCN allergy risk questionnaire to identify those with low-risk allergies at their VPEC appointment. This will be documented in their perioperative note and allergy section of the EMR. We plan to measure post-implementation cefazolin use, antibiotic exposure, and adverse outcomes.

Disclosures

Cosby A. Stone, Jr., MD, MPH, American Academy of Allergy, Asthma, and Immunology Foundation: Grant/Research Support Milner Staub, MD, MPH, Gilead: Stocks/Bonds|Johnson & Johnson: Stocks/Bonds
2259. Reversal of antimicrobial consumption: long-term impact of COVID-19 pandemic
Authors: Koizumi Ryuji , Tsuzuki Shinya , Asai Yusuke , Ohmagari Norio
Published: November 2023

Background

The global decrease in antimicrobial consumption (AMC) in 2020 has been associated with the COVID-19 pandemic.

However, it is not clear whether this downward trend will continue.

Several reports, including ESAC-Net, have documented an increase in antimicrobial use after a decrease in antimicrobial consumption following the COVID-19 pandemic in some countries.

The aim of this study is to examine the global trend in AMC following the emergence of COVID-19 in the long term.

Methods

After comparing the change rate of AMC in 67 countries’ using IQVIA MIDAS® monthly sales data of antimicrobials between 2019 and 2020 and between 2021 and 2022, changepoint detection was conducted in time-series data from November 2016 to October 2022.

Additionally, we examined the impact of implementation and lifting of movement restriction in G7 countries by interrupted time-series analysis (ITSA).

Results

In the IQVIA MIDAS sales data, 65 among 67 countries have one or two changepoints (Table1).

59 among 65 countries experienced a decrease in AMC after the beginning of COVID-19 pandemic.

However, 50 among 59 countries showed reversal increase trend of AMC in 2022 (Figure1).

ITSA showed that implementation of movement restriction had negative impact on AMC in all G7 countries (Figure2).

Table 1. Number of antimicrobial consumption changepoints after COVID-19 pandemic Figure 1. Change rate in monthly antimicrobial consumption in each country from 2019 to 2020 and 2021 to 2022, March-August Figure 2. Interrupted time series analysis of antimicrobial consumption data in G7 countries

Conclusion

The global decrease in AMC in 2020 may not be due to COVID-19 itself, but to non-pharmaceutical interventions such as movement restrictions.

Human mobility may be one of the key determinants of antimicrobial use at the population level.

Disclosures

All Authors: No reported disclosures
2262. Evaluation of Ceftriaxone Versus Cefazolin as a Surrogate Marker for Cefpodoxime Susceptibility in Enterobacterales Isolates
Authors: Lambert Kaitlyn , Demkowicz Ryan , Slain Douglas , Murray Amanda , Howard Catessa A
Published: November 2023

Background

Cefpodoxime is increasingly being explored as an option for intravenous-to-oral step-down therapy in Enterobacterales infections, but it is rarely included in routine susceptibility testing. The Clinical and Laboratory Standards Institute (CLSI) states that cefpodoxime susceptibility among urinary isolates can be inferred from the result for cefazolin. However, cefazolin resistance may overcall resistance to cefpodoxime. Studies directly comparing ceftriaxone, cefazolin, and cefpodoxine susceptibilities are lacking. The purpose of this study was to determine correlation of ceftriaxone or cefazolin susceptibilities as a surrogate marker for cefpodoxime susceptibility in Enterobacterales.

Methods

The study was conducted on clinical isolates of E. coli, Klebsiella spp., and Proteus spp. from urine, blood, respiratory, surgical, or wound cultures. Susceptibility testing was conducted by manual Kirby Bauer disk diffusion for cefpodoxime, ceftriaxone, and cefazolin (in duplicate) following standard procedures. The VITEK 2 automated system was used to adjudicate discrepancies between duplicates. Breakpoints from the current CLSI M100 were used to assign categories (S, R, I) for the different methods of susceptibility testing. Categorical agreement, very major, major, and minor error rates between ceftriaxone or cefazolin and cefpodoxime were calculated.

Results

A total of 88 clinical isolates were evaluated. The categorical agreement rate was 64% for cefazolin and 97% for ceftriaxone (P =0.0001). The major error rate was 15% (11/74) for cefazolin and 0% for ceftriaxone. The very major error rate was 7% (1/14) for cefazolin and 21% (3/14) for ceftriaxone. The minor error rate was 22% (19/88) for cefazolin and 0% for ceftriaxone.

Isolate Characteristics

Conclusion

Ceftriaxone appears to be a better surrogate marker for predicting cefpodoxime susceptibility, when compared to cefazolin. In addition, ceftriaxone demonstrated lower major and minor error rates.

Disclosures

All Authors: No reported disclosures
2276. Utilization of Vancomycin in the Emergency Department at a Community Hospital and Implications of its Use
Authors: Snodgrass Danielle , White Kristina E , Azar Aline , Sudhindra Praveen
Published: November 2023

Background

Antimicrobial Stewardship in the Emergency Department has many challenges. Our region performed a utilization review of vancomycin prescribed in the Emergency Department over a 2-month period in 2022.

In this utilization review, we sought to examine vancomycin continuation when a patient was admitted from the Emergency Department, whether vancomycin was indicated for the suspected diagnosis, and if a potential vancomycin-induced adverse drug event (ADE) occurred from its administration.

Methods

A retrospective chart review across three campuses of a hospital system examined 265 emergency room encounters where vancomycin was ordered and administered. Data was recorded on concurrent antibiotic administration, the order set utilized and indication when ordering, admission versus discharge of the patient, continuation of vancomycin upon admission, and appropriateness of vancomycin for the documented indication. Adverse drug event data (Table 2) was recorded, when possible, within seven days of vancomycin administration. This included the presence of acute kidney injury, thrombocytopenia, neutropenia, or a possible drug-induced rash.

Results

Results are summarized in Tables 1-3.

Conclusion

Our findings showed that there are negative implications associated with vancomycin use from the Emergency Department. Data revealed that only 51.7% of patients who received vancomycin truly had indications for its use based on the suspected diagnosis, and 29.4% of patients who were admitted subsequently had vancomycin discontinued upon admission. In addition, 19.6% of patients were discharged directly from the Emergency Department, never being admitted.

More importantly, 21% of patients experienced an ADE following vancomycin administration. With half of vancomycin use being categorized as unnecessary, this number emphasizes that harm can, and often does, occur with unnecessary vancomycin administration. The most common ADEs were thrombocytopenia at 12.8% and acute kidney injury at 9.4%. This review brings further attention and awareness to the need for Antimicrobial Stewardship in the Emergency Department. More guidance should be offered for triaging appropriate empiric antibiotics when infection is present.

Disclosures

All Authors: No reported disclosures
2279. Appropriateness of Antibiotic Prescribing Before vs. After Minimum Inhibitory Concentration (MIC) Suppression in Culture Reports: A Quasi-experimental Study
Authors: Aljedaani Huda Jamaan , Thabit Abrar K , Al Munjem Manea , Bazuqamah Mohammed
Published: November 2023

Background

Culture and susceptibility results are essential to identify the offending organism and optimize antibiotic treatment; hence, decrease the emergence of antibiotic resistance and achieve better clinical outcomes. Antibiotic prescribers should learn how to interpret MIC breakpoints to prescribe a suitable antibiotic as different antibiotics have different MIC breakpoints against different microorganisms. No study to date has evaluated the impact of MIC suppression in culture reports while keeping interpretation results on the appropriateness of antibiotics choice by non-infectious diseases prescribers. We assessed the impact of MIC suppression on the appropriateness of antibiotic prescriptions.

Methods

This was a quasi-experimental study (pre-post intervention) that was conducted over 14 months on hospitalized patients in the medical floor who had a symptomatic infection with a positive culture and were prescribed a full course of definitive antibiotics by prescribers not specialized in infectious diseases pre and post MIC suppression in culture reports. The primary outcome was appropriateness of antibiotic selection (the de-escalation to the narrowest spectrum antibiotic to which the organism is susceptible with appropriate dose). Secondary outcomes were clinical cure (resolution of signs and symptoms, including defervescence and normalization of white blood cells count), length of stay (LOS), and antibiotics expenditure as defined daily dose (DDD) per 1,000 patient days and days of therapy (DOT) per 1,000 patient days.

Results

100 patients were included, 50 in each phase. No difference was observed in the baseline characteristics, including age, sex, infection site, isolated organism, and prescribers’ departments. Appropriate antibiotic selection was significantly higher in the post-intervention phase compared to the pre-intervention phase (62% vs. 40%; P=0.028). LOS was shorter in the post-intervention phase compared to the pre-intervention phase (5 vs. 9.5 days; P=0.011). No difference was reported in the other outcomes.

Conclusion

Our study showed that suppressing MIC values from cultures reports was helpful in choosing the appropriate antibiotic and minimizing the LOS. Future research is needed to confirm these findings.

Disclosures

All Authors: No reported disclosures
2281. Trends in Antibiotic Prescriptions in U.S. Nursing Homes, 2018-2020
Authors: Vo Quynh , Dionne Brandon , Doron Shira , Noubary Farzad , Briesacher Becky
Published: November 2023

Background

An estimated 25% of U.S. nursing home residents may have an antibiotic resistant infection. Antibiotic resistance is primarily driven by antibiotic use, thus, increasing our understanding of trends in antibiotic use within nursing homes is needed to address this public health threat. Our study examined changes in antibiotic prescriptions among nursing home residents using claims data from January 2018 through December 2020.

Methods

Linked files from Medicare Part D and the Minimum Dataset 3.0 covering years 2018-2020 were used to describe antibiotic use in U.S. nursing homes via nationwide trend analysis. Over two million adults, aged 65 years and older, who were covered by Medicare Part D for the entire duration of their stay were included. Changes in trends by antibiotic class and U.S. region were also assessed.

Results

The majority of antibiotics prescribed in U.S. nursing homes were administered by the oral route (98%), and cephalosporins were the most prescribed class of antibiotics (38.6%). The overall proportion of orally administered antibiotics prescribed across U.S. nursing homes increased from January 2018 through December 2020 by 2.6%. There were 155 DOT/1000 patient days in 2018, 166 in 2019, and an increase to 269 in 2020 for oral antibiotics. Intravenous (IV) antibiotic prescribing increased by 71% during this time but only accounted for 2% of all antibiotic prescriptions. There was 1 DOT/1000 patient days in 2018 and 2019 and 3 DOT/1000 patient days in 2020 for IV antibiotics. Variations in prescribing were seen by U.S. region, with the largest increase in oral antibiotics in the West (4.6% increase); and by antibiotic class, with increases in the use of carbapenems (82%), cephalosporins (11.3%), oxazolidinones (70.1%), and Daptomycin (65.3%). All changes were statistically significant at the 0.05 cutoff level.

Conclusion

From 2018 through 2019, antibiotic prescribing rates remained relatively unchanged in U.S. nursing homes. However, there were differences by antibiotic class and U.S. region. There was a large increase in the use of both oral and IV antibiotics in 2020, most likely due to confounding factors introduced by the COVID-19 pandemic.

Disclosures

All Authors: No reported disclosures
2283. COVID-19 among Febrile Patients Presenting without Respiratory Symptoms in Six Hospitals along the Thai-Lao and Thai-Myanmar Borders, 2021-2011
Authors: Bhengsri Saithip , Bloss Emily , Skaggs Beth , Sawatwong Pongpun , Chuenchom Nuttagarn , Lertwitayakumjorn Tanaphat , Piralam Barameht , Chaoprasert Samkan , Simmali Tuwan , Bungkanjana Pornpan , Boonlong Sutthinee , Heffelfinger James D , Sujariyakul Anupong
Published: November 2023

Background

Thailand’s national surveillance system to detect COVID-19 infection typically relies on a combination of fever, respiratory symptoms, and risk factors. We describe the frequency, epidemiologic characteristics, and risk factors for COVID-19 in patients without respiratory symptoms and the utility of saliva and nasal swabs (NS) to detect SARS-CoV-2.

Methods

During June 2021-December 2022, a period of high COVID-19 incidence in Thailand, we enrolled patients aged >2 years presenting with a temperature ≥37.5 °C or a history of fever ≤14 days and no cough, dyspnea, or sputum production at 6 hospitals in Nakhon Phanom and Tak provinces, Thailand. Saliva, NS, and nasopharyngeal/oropharyngeal swabs (NP/OP) were collected to detect SARS-CoV-2 using real-time RT-PCR. Multivariable analysis was done to assess factors independently associated with COVID-19 infection. Cases were defined as persons with SARS-CoV-2-positive RT-PCR specimens.

Results

Cases were detected in 358/1,648 (22%) persons. The median age among cases was 31 (IQR 21-45) years; 210 (59%) were female. Compared to non-cases, cases were more likely to present with malaise (52% vs. 40%, p< 0.001), hyposmia (10% vs. 1.4%, p< 0.001), dysgeusia (11% vs. 4.8%, p< 0.001), and muscle pain (53% vs. 47%, p=0.04); cases were less likely to have chills (41% vs. 50%, p=0.002), low appetite (29% vs. 41%, p< 0.001), nausea/vomiting (17% vs. 29%, p< 0.001) and abdominal pain (4.7% vs. 16%, p< 0.001). Cases were more likely to have been in contact with persons with COVID-19 infection (adjusted odds ratio [95% confidence interval]: 12 [8.1-16]), febrile household members (2.6 [1.8-3.8]), and persons with respiratory symptoms (2.2 [1.4-3.7]), have a history of travel (1.7 [1.0-2.7]), current alcohol consumption (1.7 [1.2-2.4]) and obesity (1.5 [1.1-1.9]). Among cases, SARS-CoV-2 was detected in 95% of saliva, 92% of NS, and 99% of NP/OP specimens; RT-PCR was positive in all 3 specimen types from 319 (89%) cases. Compared to NP/OP, the sensitivity of testing saliva and NS were 96% and 93%.

Conclusion

SARS-CoV-2 was detected in more than one-fifth of febrile patients without respiratory symptoms. A broader national surveillance case definition would increase case detection. Saliva and NS demonstrated high sensitivity for SARS-CoV-2 detection.

Disclosures

All Authors: No reported disclosures
2284. SARS-CoV-2 Transmission in Utah Nursing Homes
Authors: Bohman Julia , Khader Karim , Thomas Alun , Ferraro Jeffrey , Samore Matthew H
Published: November 2023

Background

The goal of this study was to apply a dynamic modeling approach to assess the impact of COVID-19 control measures in nursing homes. Utah's strategy for COVID control in nursing homes included serial point prevalence surveys, triggered when a staff or resident case was detected. However, implementation of the policy varied across nursing homes.

Methods

We used state-collected testing data from 70 different Utah nursing homes from March 2020 to April 2021 to estimate a facility specific transmission. Data included facility id, COVID-19 test results, number of days since the first covid test administration, and a December 2020 population census. We constructed a stochastic Reed Frost based model, using the stan library in R using the Hamiltonian Monte Carlo algorithm to estimate parameter values.

Results

COVID attack rates tended to peak between 50-100 days from the onset of included data, averaging 14.2% (Figure 1). A high degree of day-to-day variability in SARS-CoV-2 test collection was observed, consistent with uneven implementation of serial point prevalence surveys. Nonetheless, we were able to achieve excellent model calibration and estimate the basic reproductive number (R0) in all included facilities. The stochastic model captured differences between facilities; the estimated facility R0 ranged from 1.4 to 2.5 (Figure 2). We did not find evidence that a delay in collection of point prevalence survey was associated with an increased R0.

Conclusion

Fitting simple dynamic models to COVID surveillance data enables a comparison of nursing homes with respect to facility R0 and an evaluation of the effect of different control policies. More complex models are needed to yield insights about the relative importance of alternative transmission pathways, such as combinations between staff and residents.

Disclosures

All Authors: No reported disclosures
2312. COVID-19 risk factors before and after the vaccines among hospital workers: Have they changed?
Authors: Rosso Fernando , Rebellon-Sanchez David E , Llanos-Torres Julio , Tafurt Eric
Published: November 2023

Background

COVID-19 has been a major public health concern globally, and risk factors have played a crucial role in determining the outcomes of the disease. With the introduction of vaccines, the impact of these risk factors could change and alter the course of the pandemic.

Methods

Ambispective observational study performed among hospital workers of a university hospital in Cali, Colombia. From March 6th, 2020, to February 28th, 2022. Risk factors were assessed with a self-reported survey. Using the aRR calculated for each of the five waves of COVID-19 in Colombia, mixed-effects models were constructed to obtain the association strengths in the pre- and post-vaccination era.

Results

A total of 480 patients, 71.8% were females. The median age was 32 years (27 - 39). In the pre vaccination era there were 169 (35.21%) COVID-19 cases and 165 cases (34.3%) in the post vaccination. In the pre-vaccination era, associated factors were being a healthcare worker (HCW) (aRR 2.12 (95%CI: 1.19-3.79)), technician (aRR 1.73 (1.26-2.38)), living with COVID-19 patients (aRR 2.10 (1.39-3.18)), immunosuppressive medication(aRR 3.88 (1.90-7.70)), self-perceived continuous exposure to COVID-19 patients (aRR 0.28 (0.21-0.37)), and a first COVID-19 episode during the first wave (aRR 0.05 (0.01-0.35)). In the post-vaccination era, COVID-19 history (aRR 0.49 (0.34-0.70)), vaccination in the past 6 months (aRR 0.13 (0.07-0.24)), positive anti-S antibodies in the last 3 months (aRR 0.55 (0.31-0.97)), and positive anti-N antibodies in the last 6 months (aRR 0.35 (0.17-0.74)) were associated.

Figure 1. Risks factors for COVID-19 in pre and post vaccination era.

In the pre-vaccination era, being a healthcare worker (HCW), technician, living with COVID-19 patients, immunosuppressive medication, self-perceived continuous exposure to COVID-19 patients and a first COVID-19 episode during the first wave were risk factors. while in the post-vaccination era, COVID-19 history, vaccination in the past 6 months positive anti-S antibodies in the last 3 months, and positive anti-N antibodies in the last 6 months were associated with COVID-19.

Conclusion

This study highlights the dynamic nature of risk factors after the introduction of vaccination. Educational level, being a healthcare worker, working in hospitalization areas, and living with COVID-19 patients were significant risk factors before vaccination. While increased positivity and S-antibody levels linked to vaccination were associated to lower risk of COVID-19 in the post-vaccination era.

Disclosures

All Authors: No reported disclosures
2316. SARS-CoV-2 N-antibody Seropositivity in Healthcare Personnel without a Known History of COVID-19
Authors: Tiwary Sajal K , O’Neal Carrie , Peacock Kate , Bosserman Rachel , Cass Candice , Amor Mostafa , Hock Karl , Wallace Meghan , Macdonald David , Arter Olivia G , Alvarado Kelly , Vogt Lucy , Stewart Henry B , Park Daniel , Dalton Claire , Burnham Carey-Ann , Farnsworth Christopher , Kwon Jennie H
Published: November 2023

Background

Healthcare personnel (HCP) are at risk for SARS-CoV-2 exposure in both the healthcare and community setting, and the rate of unconfirmed infection in HCP is unknown. Our objective was to measure the rate of SARS-CoV-2 seropositivity in HCP with no history of COVID-19, but who work with COVID-19 patients and/or specimens.

Methods

This was a prospective cohort study of HCP at a tertiary care academic medical center in St. Louis, MO. Asymptomatic HCP who work with COVID-19 patients and/or specimens and no history of known COVID-19 were enrolled between September 22, 2020 to October 10, 2021. Follow-up visits were conducted between December 1, 2020 to March 3, 2022, at a 1-6 month interval from enrollment. At enrollment, participants completed a survey with questions about demographics, employment, and pre-existing medical conditions. At both visits, a blood sample was obtained for SARS-CoV-2 anti-N testing and participants provided information about SARS-CoV-2 exposures, social distancing behaviors, travel and social event history, and symptoms of COVID-19. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to examine associations between N-antibody test results and HCP characteristics.

Results

A total of 727 participants completed an enrollment visit, with 559 also completing a follow-up visit. The median age of HCP was 35 [IQR 30, 47]. The cohort was 71% female and 82% white. At enrollment, 3.7% of HCP had a reactive SARS-CoV-2 anti-N test. HCP who were seropositive at enrollment were more likely to regularly work with COVID-19 patients (OR 2.09; 95% CI, 0.94 - 4.77) and to have had a household exposure to COVID-19 in the past 30 days (OR 7.92, 95% CI, 2.44 - 25.73). At follow-up, 10.2% of HCP were seropositive. Seropositivity at follow-up was associated with exposure to a household member with COVID-19 (OR 9.50 [5.02, 17.96]) as well as other community exposures to COVID-19 (OR 2.90 [1.31, 6.44]).

Conclusion

A small percentage of HCP with no history of known COVID-19 were seropositive for SARS-CoV-2 N-antibody, with this rate increasing later in the pandemic. Exposures to individuals with COVID-19 in and out of the workplace remains a strong risk for seropositivity in HCP. Thus, protection against COVID-19 both in and outside of the healthcare setting remains necessary.

Disclosures

Carey-Ann Burnham, PhD, Pattern Bioscience: Stocks/Bonds Christopher Farnsworth, PhD, Abbott Laboratories: Grant/Research Support|Abbott Laboratories: Honoraria|Biomerieux: Grant/Research Support|Cepeheid: Grant/Research Support|Roche Diagnostics: Grant/Research Support|Siemens Healthineers: Grant/Research Support|Werfen: Advisor/Consultant
2317. The Impact of Universal versus Targeted Symptomatic COVID-19 Arrival Testing in Basic Military Trainees
Authors: Westbrook Marquise , Aden James , Kieffer John , Winkler Erin , Casey Theresa , Frankel Dianne , Osuna Angela , Kiley John , Yun Heather , Marcus Joseph
Published: November 2023

Background

The ideal strategy for COVID-19 testing upon arrival to a congregate setting is unknown. Basic Military Training (BMT) is 7.5 weeks long and service members live in groups of 35-50 individuals in open bay dorms for the entirety of their training. The United States Air Force BMT transitioned from universal arrival antigen testing to targeted symptomatic antigen testing on October 26, 2021. This study evaluates COVID-19 positivity rates in the first two weeks of BMT when trainees underwent universal testing vs targeted arrival testing.

Methods

All COVID positive trainees were identified from August 1, 2021-December 15, 2021. The risks of an individual as well as a training group developing a case on arrival or in the first fourteen days of training were compared between those who underwent universal arrival antigen testing (August 1-October 26) vs. targeted testing (October 26-December 15). A case cluster was considered if there were > 5 cases in one training group. Nominal variables were compared by Chi-squared analysis and continuous variables were compared by Mann-Whitney U test.

Results

During the study period, 13,384 trainees began BMT, and there were 690 (5.2%) cases of COVID-19 in the first two weeks of training. Regardless of testing strategy, there was no difference in trainees testing positive on arrival (1.4% vs. 1.3%, p=0.68). However, more trainees in the universal screening group tested positive on day 2-14 of training (3.9% vs. 2.8%, p= 0.002). When evaluating training groups, universally tested training groups did not have lower rates of developing a case cluster (33/271 (12.1%) vs. 6/104 (5.8%), p=0.09) as compared to targeted symptomatic testing, respectively.

Conclusion

In this large cohort during the COVID-19 Delta wave, targeted antigen testing was not associated with increased secondary cases of COVID-19 in a congregate setting. This study supports the feasibility of the use of targeted symptomatic testing for individuals entering congregate settings.

Disclosures

All Authors: No reported disclosures
2320. Impact of Lifting School Mask Mandates on Community COVID-19 Cases and Hospitalizations: A Nationwide, Retrospective Cohort Study with an Event Study Design
Authors: Ertem Zeynep , Danesharasteh Anesh , Schechter-Perkins Elissa , Nelson Richard , Fisher Lloyd , Doron Shira , Branch-Elliman Westyn
Published: November 2023

Background

During the school re-opening process, masking mandates were widely adopted in schools in the United States to reduce spread of SARS-CoV-2 in in-school settings and in the surrounding community. The aim of this nationwide, retrospective cohort with an event study design was to evaluate the impact of masking policy de-adoption on SARS-CoV-2 cases and hospitalizations in the surrounding community.

Methods

Data collected from 9/2021-6/2022 on SARS-CoV-2 cases, hospitalizations, and vaccination rates at the county-week level obtained from the Centers for Disease Control and Prevention were combined with manually-validated, weekly district-level masking policy data obtained from Burbio and district-level school demographic data from the National Center for Education Statistics. Data were analyzed using an event study design, a causal inference method, to estimate the primary outcome: incidence of SARS-CoV-2 cases per 100,000 county residents during the 8-week period following the policy change, stratified by age (in decades). Hospitalization rates per 1,000,000 residents were estimated secondarily.

Results

N= 3,970 districts composed of 53,453 schools and an estimated 31,264,546 students were included. Prior to masking mandate de-adoption, there was no clear trend in case rates in any of the age categories evaluated. Within one-week following policy de-adoption, a small increase in case rates was seen in all age groups evaluated, ranging from 6.92 to 37.34 per 100,000 county residents in the 0-9 year old age group to 25.08 - 120.36 cases per 100,000 residents per week in the 20-49 year old age group. A small increase in hospitalization rates following masking policy de-adoption was seen in all age groups evaluated. Among 0–49-year-olds, increases were seen one week following the policy change. Increases in hospitalization rates were not evident for 50–69-year-olds and >70 year olds until 3 and 4 weeks after the policy change.

Conclusion

Lifting mask mandates in schools were associated with a small increase in case rates in the surrounding community, with the highest increase in individuals of parental age (20–49-year-olds). A small but measurable impact on severe disease, as measured by hospitalization rates, was identified.

Disclosures

Elissa Schechter-Perkins, MD, MPH, Gilead Sciences: Grant/Research Support Westyn Branch-Elliman, MD, MMsc, DLA Piper, LLC/Medtronic: Advisor/Consultant|DLA Piper, LLC/Medtronic: Expert Testimony|Gilead Sciences: Grant/Research Support
2324. COVID-19 Knowledge, Attitudes, and Practices Among People Living with HIV in Sub-Saharan Africa
Authors: Cebula Brennan R , Esber Allahna , Dear Nicole , Sing’oei Valentine , Maswai Jonah , Iroezindu Michael , Bahemana Emmanuel , Kibuuka Hannah , Crowell Trevor A , Shah Neha , Ake Julie A
Published: November 2023

Background

Infection control practices are imperative to mitigate COVID-19 transmission, and adherence likely depends on accurate understanding of their effectiveness along with the risks associated with COVID-19 infection. This is particularly important in people living with HIV (PLWH) as they may be at increased risk for severe disease and worse outcomes. There is limited understanding of the knowledge, attitudes, and practices (KAP) regarding COVID-19 risks and infection control measures among PLWH in sub-Saharan Africa.

Methods

A questionnaire with Likert scale responses for COVID-19 knowledge/attitudes and binary responses for practices was administered beginning Mar 2022 to participants enrolled in the African Cohort Study (AFRICOS), a prospective cohort of adults and adolescents living with or at risk for HIV in Kenya, Nigeria, Tanzania, and Uganda. Multivariable logistic regression with generalized estimating equations was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations between demographics and COVID-19 knowledge/attitudes with self-reported facemask use and social distancing in the preceding month.

Results

As of 1 Dec 2022, 962 PLWH enrolled in AFRICOS had COVID-19 KAP data. Facemask use was reported by 784 participants (81.5%) and social distancing by 600 (62.4%). Compared to participants in Uganda, participants in Kenya or Tanzania had lower odds of facemask use and social distancing (Table 1). Participants with lower self-assessed general health status and who were less concerned about the spread of COVID-19 had lower odds of facemask use or social distancing. Participants who more highly agreed that facemasks reduce the risk of COVID-19 had higher odds of facemask use. Compared to 176 participants not living with HIV, PLWH had higher odds of facemask use and social distancing.

Conclusion

These results provide important insight into COVID-19 KAP among PLWH in sub-Saharan Africa and suggest potential population and messaging targets to enhance future COVID-19 infection control efforts.

The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, Department of Defense, or U.S. Government. The investigators adhered to policies for protection of human subjects prescribed in AR 70–25.

Disclosures

All Authors: No reported disclosures
2328. COVID-19 and CLABSI: Riding the Pandemic Waves with an Active Infection Prevention Intervention
Authors: Thyagarajan Rama , Mondy Kristin E , Sturm Lisa K , Watson Coutney , Saake Karl , Miller Collin , Masoudi Frederick , Fakih Mohamad G
Published: November 2023

Background

The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on central line-associated bloodstream infections (CLABSI) in US hospitals.

Methods

We evaluated the impact of COVID-19 on CLABSI in 86 hospitals of a single system with an active infection prevention program. We compared pandemic CLABSI events and associated organisms, using rates and standardized infection ratio (SIR) accounting for changes based on COVID-19 prevalence, to pre-pandemic levels. The pandemic period was further divided into four waves based on the dominant COVID-19 strain. Late in the Delta wave, a system wide re-focus on a CLABSI bundle was implemented, with reformation of multi-disciplinary teams, education and monitoring, direct feedback to caregivers, and increased visibility of CLABSI at all levels.

Results

There were 1,895,534 central line-days with 1,343 CLABSI events in the entire study period. CLABSI rates increased from 0.59 pre-pandemic to 0.76 per 1,000 line-days during the pandemic (28.8% relative increase (p<0.001). Cumulative coagulase-negative staphylococcus (CNS) CLABSI increased by 102% from 0.09 to 0.19 events per 1,000 line-days (p< 0.001), and Candida sp. by 39.9% from 0.15 to 0.22 per 1,000 line-days (p=0.006) (Figure 1). Hospitals with monthly COVID-19 prevalence ≥ 20% had a SIR CLABSI that was 2.20 times higher compared to those with < 5% COVID-19 prevalence during pandemic waves (p< 0.001). With the intervention, CLABSI rates subsequently dropped, approximating pre-pandemic levels (Figure 2).

Figure 1: Comparison of pathogens associated with CLABSI across pre-pandemic and four COVID-19 pandemic waves Figure 2: CLABSI rates/1000 central line days across the pre-pandemic and four COVID-19 pandemic waves

Conclusions: A high hospital prevalence of COVID-19 was associated with increased CLABSI events in early pandemic waves. Improvements in CLABSI rates were observed in later waves concurrently with re-focused prevention efforts, underscoring that enhanced attention to infection prevention processes can achieve pre-pandemic levels of CLABSI events.

Disclosures

All Authors: No reported disclosures