bluuebunny/crossref_metadata_2025 huggingface dataset:
2957. Decreased microbial diversity and baseline intestinal inflammation are associated with worse outcome in aged, female mice infected with Clostridioides difficile
Authors: Nguyen Nhu , Vendrov Kimberly , Abernathy-Close Lisa , Dieterle Michael , Young Vincent B
Published: November 2023

Background

C. difficile infection is more common and severe in people over 65-years old. Understanding the pathogenesis within the triangle of host, pathogen, and the microbiota in aged population will help decrease the disease severity.

Methods

Young (3-month-old) and aged (22 to 25-month-old) male and female C57BL/6 mice were treated with 0.5g/L cefoperazone for ten days to render them susceptible to C. difficile infection. Antibiotic-treated mice were challenged with 103 to 104 spores of C. difficile via oral gavage. Three C. difficile strains were selected for challenge. These strains vary in the severity of disease observed in young, cefoperazone-treated mice; CD630 (mild disease), R20291 (moderate), and VPI10463 (severe). Mice were monitored for weight loss and clinical signs of disease following challenge. The degree of intestinal inflammation was determined by fecal lipocalin-2 measurement. The microbiota of animals before challenge was monitored by 16S rRNA-encoding gene sequence analysis.

Mouse model of C. difficile infection

Results

Overall, there was no significant difference in weight loss between young and aged mice following challenge. However, aged female mice lost significantly more weight than male mice when infected with C. difficile CD630 (p = 0.031) and R20291 (p = 0.0027). Microbiota analysis revealed that alpha diversity was lower in female aged mice compared to male aged mice. No sex differences were noted in young mice. Measurement of fecal lipocalin revealed that aged female mice had baseline inflammation not seen in aged male mice (p = 0.02). Finally, we found a strong negative correlation between species richness (Sobs) and maximum weight loss (R-squared=0.74) in aged mice. Lipocalin-2 levels were moderately correlated with maximum weight loss (R-squared=0.51).Figure 1.Weight loss comparing between male and female mice across age group and C. difficile strains.Figure 2.The microbiota of young and aged mice before challenging with cefoperazone. Alpha diversity indexes A) Sobs, B) Shannon index, C) Chao when comparing between male and female mice across age group. D) Linear regression between species richness (Sobs) and maximum weight loss from aged mice group.

Conclusion

The combination of a predisposed low diversity microbiota and baseline inflammation gut may contribute to a more severe outcome for female aged mice infected with C. difficile.Figure 3.The degree of baseline intestinal inflammation in young and aged mice. A) Lipocalin-2 measurement at baseline comparing between male and female mice, B) linear regression between fecal lipocalin-2 at baseline and maximum weight loss in aged mice group.

Disclosures

Vincent B. Young, MD/PhD, ASM: Senior Editor|Debiopharm: Advisor/Consultant|Vedanta Biosciences: Advisor/Consultant
2348. Identifying Barriers Against COVID-19 Vaccination: A Prospective Study
Authors: Generette Gabriela S , Graft William , Gomez Kayeromi , Muhan Basil , Kim Jeana , Polikaitis Kovas , Price Megan , Aguilar Samantha , Al Zoubi Moamen
Published: November 2023

Background

As of April 26th 2023, there have been 104,445,294 reported cases of COVID-19 in the United States. The percentage of fully vaccinated people in the U.S is 69.4%, despite wide availability of COVID-19 vaccines. In Winnebago County, IL only 60.2% of the population is fully vaccinated. The medical community’s approach towards increasing the rate of vaccination has necessitated understanding which factors persist that prevent a greater willingness to vaccinate.

Intent to be vaccinated against COVID-19 survey items

Motivators behind getting vaccinated for COVID-19 survey items

Methods

Between June 2022 to March 2023, a daily report from the Electronic Medical Record (EMR) showing COVID 19 vaccination status was generated. The report was filtered to identify patients who did not have COVID-19 vaccine doses logged in the EMR. A medical student thenadministered the study survey to each of these patients. Patients who chose not to participate in the study were excluded. Patients also had an opportunity to discuss their concerns about COVID-19 infection and/or vaccination.

Results

A total of 120 patients were consented for this study, with 73.33% (n=88) self-identified as White, and 15.83% (n=19) as Black. As for the reason why they decided not to get the vaccine, 48.76% (n=59) stated that the reason was because the vaccine would make them sick. 14.05% (n=17) did not trust the vaccine and 8.25% (n=10) thought the vaccine is being used to manipulate people (see Table 1.) An overwhelming 61.34% (n=73) also said that nothing would change their mind about getting vaccinated. 84% (n=104) of the respondents stated they would not be interested in getting more information about COVID-19 vaccine, while 66.67% (n=82) said they will not consider getting vaccinated in the future (see Table 2.).

Conclusion

Vaccine hesitancy affects public health and the well-being of communities. Importantly, vaccine hesitancy is a decision made by an individual affected by a myriad of factors permeating their environment. Additionally, a person is more likely to get vaccinated if they perceive vulnerability, and ultimately, if they trust that a scientific advancement.

Disclosures

All Authors: No reported disclosures
2360. Factors Affecting COVID-19 Vaccine Uptake in People Living with HIV
Authors: Kunkel Victoria N , Summers Nathan A , Singh Nupur
Published: November 2023

Background

There is a lack of available data regarding COVID-19 vaccination rates in people living with HIV (PLWH). We examined a group of PLWH to evaluate the association between specific demographics and COVID-19 vaccine uptake.

Methods

This is a retrospective observational study which included PLWH who were seen in an HIV clinic at an academic medical center in Memphis, TN. 300 randomly selected PLWH who had been seen at least once in the clinic within an 18-month study period during the COVID-19 pandemic were included. Univariate analysis using Chi Square and T tests followed by multivariable regression including significant results from univariate analysis identified factors associated with COVID-19 vaccine uptake.

Results

300 PLWH between January 2021 to June 2022 were included in the study. 248 (82.67%) were Black, 27 (9%) were White, 2 (0.67%) were Asian, and 23 (7.67%) were of multiracial/other races. The average age was 47 years old. 243 (81%) were retained in care, defined as 3 visits within the 18-month period with 2 of them being at least 6 months apart. 239 (81.29%) of the participants had a suppressed HIV viral load, defined as HIV RNA < 200 copies/mL. The mean number of total vaccinations in the previous 3 years was 4.61, and the mean number of influenza vaccinations in the past 3 years was 1.64. 207 (69%) of the participants received at least 1 COVID-19 vaccine, with 187 (62.33%) being fully vaccinated, defined as 2 doses of mRNA or 1 adenovirus vector vaccine. Age, number of attended clinic visits, retention in care, viral suppression, and number of previous vaccinations were associated with receiving at least one COVID-19 vaccine in univariate analysis, while only age (odds ratio (OR) 1.07, p< 0.0001), number of influenza vaccinations in the past 3 years (OR 0.58, p=0.03), and total number of vaccinations in the prior 3 years (OR 2.29, p< 0.0001) were significant in multivariable analysis.Table 1.Demographics and COVID-19 vaccine uptake, N=300.Table 2.Multivariable analysis, N=294.

Conclusion

Age and total number of vaccinations in the past 3 years were positively correlated with having at least one COVID vaccine. Number of influenza vaccinations in the past 3 years was negatively correlated with having at least one COVID vaccine. Further study is needed to identify targeted interventions to improve vaccine uptake in this population.

Disclosures

All Authors: No reported disclosures
2376. Trends in COVID-19 vaccination among reproductive-aged in Jamaica: a comparison of two time periods
Authors: Pinkney Jodian , Bogart Laura , Carroll Kamali , Bryan Lenroy , Witter Givana , Ashour Dina , Hurtado Rocio M , Goldfarb Ilona T , Hyle Emily P , Psaros Christina , Ojikutu Bisola
Published: November 2023

Background

In Jamaica, COVID-19 vaccines have been recommended for pregnant women since August 2021, yet data detailing COVID-19 vaccination behaviors among pregnant Jamaican women have been limited. Specifically, it is unknown if COVID-19 vaccination among pregnant Jamaican women has increased over time, similar to trends observed in the United States.

Methods

A convenience sample of reproductive-aged Jamaican women were recruited from a teaching hospital during two distinct time periods (TP): (1) February 2022 and (2) May-July 2022. Participants self-identified as pregnant (versus nonpregnant) and completed a web-based survey that assessed self-reported COVID-19 vaccination and medical mistrust beliefs. We analyzed the relationship between TP and a predetermined set of variables using chi-square or Fisher’s exact tests. We used logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for self-reported COVID-19 vaccination by TP, adjusting for age, education, and comorbidities.

Results

Of the 429 participants, 178 (41%) completed the survey in TP1 and 251 (59%) in TP2 (Table 1). Self-reported data, including trusted sources of COVID-19 vaccination and type of COVID-19 vaccine received, did not differ significantly between TP1 and TP2 (Table 1). Self-reported COVID-19 vaccination among pregnant women was 35% in TP1 vs. 60% in TP2 (aOR (95% CI): 2.78 (1.40 - 5.50). Pregnant women were less likely to agree with the medical mistrust belief, “I don’t trust the COVID-19 vaccine,” in TP2 compared with TP1 (aOR (95% CI): 0.43 (0.18 - 0.99). Self-reported vaccination and medical mistrust beliefs among nonpregnant women did not differ between TP1 and TP2.

Conclusion

Self-reported COVID-19 vaccination among pregnant Jamaican women was significantly higher in TP2 compared with TP1, while medical mistrust related to COVID-19 vaccination was lower. To improve the efficacy of vaccination campaigns and enhance the communication of vaccine safety between pregnant women and their healthcare providers in the future, it is crucial to identify trends in COVID-19 vaccination and medical mistrust beliefs among pregnant women over time.

Disclosures

Emily P. Hyle, MD MSc, UpToDate.com: Royalties
2377. The Influence of the COVID-19 Infodemic on Vaccine Hesitancy: A Prospective Survey-Based Study
Authors: Quon Cameron , Walker Macey , Graves Lisa
Published: November 2023

Background

The COVID-19 pandemic was an "infodemic" of accurate and inaccurate information as termed by the World Health Organization. Media engagement has been correlated with greater belief in misinformation and lower vaccination rates.

The aim of this study was to investigate how individuals make decisions regarding the COVID-19 vaccine with a particular focus on specific media outlet consumption.

Methods

We conducted an online survey via the Western Michigan Homer Stryker M.D. School of Medicine Facebook account from August 1, 2021 to August 30, 2021. The primary outcome was the choice to take the COVID-19 vaccine. Respondents were assigned a media score based on the companies they used to receive COVID-19 information. The score was calculated based on a Pew Research Center study on the political leaning of various news outlets.

A Sampling of the Political Spectrum of Media Outlets

Some of the major media outlets assessed in our survey with the left being more liberal and right being more conservative.

Results

There were 1,757 responses with a prevalence of 89.6% vaccine acceptors. Respondents were predominantly White, female, and liberal with an average age of 44. There was a 1.06 (95% CI 1.04, 1.07) multiplicative increase in odds of choosing the vaccine for every point towards more liberal media consumption. Both media score (c=0.77) and political leaning scale (c=0.81) had a strongly positive correlation with vaccination choice. Attitudes of vaccine acceptors and non-acceptors aligned with the viewpoints of their friends and family. While both groups had good relationships with their doctors, there were no significant differences in vaccine choice.

Respondent Demographics and Political Spectrum

The demographics and political spectrum of the survey's respondents.

Likelihood of choosing the vaccine

The prevalence of vaccine acceptors, the odds ratio for media use, and the correlation between media and vaccination and political affiliation and vaccination.

Conclusion

This study demonstrates that individuals who prefer more liberal leaning media outlets are more likely to choose to receive the vaccine. They also suggest the physician's voice must compete with the media in terms of vaccine messaging.

While this study is limited by a respondent demographic that did not necessarily reflect that of the country, it is at least reflective of those who engage with the medical school's outreach. Performing a study of this nature within local communities can provide population insights enabling customized communication strategies.

Future studies should explore ways physicians can use media to enhance their voice and counter misinformation. Access to reliable information about the COVID-19 vaccine is critical in helping individuals make informed decisions about vaccination.

Disclosures

All Authors: No reported disclosures
2378. Use of Natural Language Processing to Extract Published Real World Data on a COVID Vaccine and Antiviral Treatment
Authors: Raghuram Anupama , Ssentongo Anna , Pereira Lenon Mendes , Kuang Yuting , Uyei Jennifer , Park Peter
Published: November 2023

Background

The COVID-19 global pandemic generated an exponential increase in scientific publications over the last 3 years. LitCovid includes ∼350,000 articles related to COVID-19, vaccine and antiviral medicine development, and real-world data (RWD). The need to identify and extract medical data from relevant articles presents an opportunity to use natural language processing (NLP) and machine learning to analyze large volumes of text related to COVID-19. We evaluated the use of NLP to rapidly identify and extract RWD from vaccine and antiviral effectiveness studies to summarize the data for healthcare professionals.

Methods

We used a two-step approach comprised of (1) an automated NLP system with machine learning and rule-based methods to extract medical data from articles and (2) a manual evidence synthesis approach to confirm accuracy by expert review to create a RWD dataset for effectiveness related to BNT162b2 (Pfizer-BioNTech COVID-19 Vaccine) and nirmatrelvir/ritonavir (Paxlovid). NLP linguistic models for automatic data extraction were developed for topics related to vaccine effectiveness, boosters, fourth dose, variant-adapted vaccines, antiviral treatment effectiveness, and long COVID. RWD were captured into a novel data excel template.

Results

NLP model training and development was conducted on CORD-19 Open Research Dataset, and NLP-based extraction has been applied on 100 studies. Elapsed NLP-based extraction time was compared to manual extraction by 6 scientific experts over a 10 day test, and speed gains of 2.5-3.0x were achieved. NLP-based and manual extraction of data from >130 publications was then used to present individual study results and summarize effectiveness results into two publicly available websites (www.vaccinemedicaldata.com; www.antiviralmedicaldata.com) with high data accuracy. NLP also allowed for automated labeling and output normalization of data into a scalable model using ontologies.

Conclusion

NLP is an efficient technology for automated extraction of medical data from published literature for vaccine and antiviral effectiveness topics. Automated medical data mining using NLP may support end-to-end extraction of study results to quickly educate prescribers and improve vaccine and antiviral healthcare decision making.

Disclosures

Anupama Raghuram, MD, Merck: Employee|Merck: Stocks/Bonds|Pfizer: Employee|Pfizer: Stocks/Bonds Anna Ssentongo, PhD, IQVIA: Employee Lenon Mendes Pereira, PhD, IQVIA: Employee Yuting Kuang, PhD, IQVIA: Employee Jennifer Uyei, PhD, MPH, IQVIA: Employee|IQVIA: Stocks/Bonds Peter Park, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds
2384. Exploring COVID-19 Vaccine Hesitancy in Unvaccinated Adults within a Semi-Urban Population of South India: A Qualitative Investigation
Authors: Sathyapalan Dipu T , Nair Sivapriya , Nampoothiri Vrinda , Moni Merlin
Published: November 2023

Background

This qualitative study examines COVID-19 vaccine hesitancy among unvaccinated adults in a semi-urban region of South India. Despite broad vaccination coverage in India, vaccine hesitancy persists, contributing to the ongoing transmission. By conducting region-specific in-depth qualitative research, we aim to identify barriers to vaccination, to address this public health menace.

Methods

This grounded theory-based qualitative study explores COVID-19 vaccine hesitancy among unvaccinated adults in semi-urban regions of Ernakulam, Kerala, India. Conducted from April to May 2022, the study used purposive sampling to enrol participants with the help of ASHA workers. Semi-structured face-to-face interviews were carried out, utilizing an open-ended questionnaire-based interview guide. Audio files of the interviews were transcribed verbatim, and the data underwent a multistage thematic analysis using the constant comparative method.

Results

In our study with 35 unvaccinated individuals, vaccine hesitancy factors were categorized into three themes: vaccine-related (33.33%), social/environmental (31.67%), and individual factors (35%). Individual factors included medical conditions (26.67%) and attitudes towards vaccines (8.33%). Vaccine-related factors involved safety concerns (15%), efficacy (6.67%), and administration mode (5%). Social/environmental factors covered accessibility/availability (16.67%) and influencers like healthcare workers, friends, and family (15%). Table 1, Figure 1, and Figure 2 provide further details on themes, subthemes, and their overlap.

Figure 1

Representation of identified themes and subthemes among the vaccine hesitant individuals

Figure 2

Schematic representation of identified themes and its overlap among the vaccine hesitant individuals.

Table 1

Excerpts of 35 study participants outlining the factors for Covid-19 vaccine hesitancy exploring themes and sub-themes of quotes

Conclusion

Our study finds three main factors contributing to COVID-19 vaccine hesitancy: vaccine-related concerns, social/environmental influences, and individual factors. To tackle hesitancy, it's crucial to address safety concerns, engage with various medical systems, and leverage community influencers. Focusing on vaccine equity and addressing the needs of vulnerable populations is essential for the success of vaccination programs. Targeted communication strategies and behaviour change interventions should be employed to promote vaccine acceptance, and public health authorities must provide accurate, transparent information on vaccine safety and efficacy.

Disclosures

All Authors: No reported disclosures
2390. Factors Affecting Parental COVID-19 Vaccine Hesitancy in Cancer Parents with Minor Children
Authors: Umetsu Kazue , Kosugi Kazuhiro , Takahashi Tomoko , Fujisawa Daisuke , Kawaguchi Takashi , Kubo Emi , Inoue Yujiro , Ishizuka Keisuke , Harada Mariko , Inoue Tomonori , Ohtake Kento , Yamaya Shiori , Takehana Jun , Matsuo Takahiro , Okinaka Keiji , Yamaguchi Takuhiro , Miura Tomofumi
Published: November 2023

Background

Cancer patients are vulnerable to COVID-19 infection. Parents living with their minor children in general are at an elevated risk of infection. Thus, cancer patients with minor children (“cancer parents”) are at high risk of contracting COVID-19 and experiencing a severe course. Vaccination is the best clinical approach for preventing COVID-19 infection. However, still, they may hesitate to get their children vaccinated, as parents without cancer does. This study aims to explore the factors associated with parental COVID-19 vaccine hesitancy in cancer parents.

Methods

This study was a secondary analysis of an online cross-sectional survey conducted from December 2022 to January 2023. The eligible participants were cancer patients whose children were aged between 5 and 17. They were recruited through an online peer-support group. The participants were asked to self-report sociodemographic characteristics, medical history, previous COVID-19 infection, vaccination status, fear of COVID-19 scale, and the reasons for COVID-19 vaccine hesitancy. We conducted a multivariate logistic regression analysis to explore the factors associated with COVID-19 vaccine hesitancy. The factors were selected based on a literature review, and variables with a p-value < 0.1 in univariate analysis were retained in the final regression model.

Results

Overall, 199 participants were included [84.9% female; mean age 45.8 years]. The participant’s COVID-19 vaccination rate was 90.5 % (n = 180), but 95 participants (47.7%) were hesitant to vaccinate their child. The factors positively associated with vaccine hesitancy were a younger age of child (adjusted odds ratio (aOR) = 0.66 (95% confidence interval (CI): 0.56–0.77); p< 0.001), lower family income (aOR = 0.22 (95% CI: 0.08–0.62); p=0.004), and fewer participant’s vaccination doses (aOR = 0.34 (95% CI: 0.23–0.50); p< 0.001). The main reasons for vaccine hesitancy were concerns about safety and adverse reactions of the vaccines (Figure 1).

Conclusion

Although most cancer parents had been vaccinated themselves, approximately half of them were hesitant to get their children vaccinated. It is essential to provide cancer parents with detailed information regarding the safety of COVID-19 vaccines to minimize vaccine hesitancy toward their children.

Disclosures

All Authors: No reported disclosures
2392. Impact of Vaccination Against SARS-CoV-2 on Severity and Mortality in Hospitalized Patients with COVID-19 in a Referral Hospital in Nicaragua
Authors: VEGA-JARQUIN N O R V I N G , Porras-Cortés Guillermo D
Published: November 2023

Background

On October 2021, the World Health Organization exhorted countries to evaluate the effectiveness of vaccination against SARS-CoV-2 and its impact on severity and mortality caused by COVID-19. A previous study in Nicaragua had demonstrated that 78.5% of a sample of the Nicaraguan population had antibody titers against SARS-CoV-2. The present study was conducted with the aim of estimating the impact that vaccination had on severity and mortality in hospitalized patients with a diagnosis of COVID-19 in the Hospital Dr. Fernando Vélez Paiz, a referral hospital in Nicaragua.

Methods

This is a retrospective cohort study. A total of 510 patients diagnosed with COVID-19 were hospitalized in the respiratory ward of the Hospital Dr. Fernando Vélez Paiz between January 2022 and October 2022. After applying the inclusion criteria, 220 patients were analyzed in the study. For the purpose of the study, the population that received at least one dose of vaccine against SARS-CoV-2 was denominated vaccinated. The national database of immunization was checked. The primary outcomes to evaluate were severity of illness (scores qCOVID, NEWS, and CXR), and mortality in vaccinated and unvaccinated populations. An analysis of risk relative (RR) in the exposed population (vaccinated) was done.

Results

The mean age of the population was 67.2 ± 15.6 years old. Of the 220 patients, 157 (71.4%) had received at least one dose of the vaccine, and 63 (38.6%) had not been vaccinated. The most frequent vaccine recorded was ChAdOx1 (Astra Zeneca or CoviShield), in 102 patients (65%) (Table 1). There was no difference in severity of illness at admission in the qCOVID score, NEWS score, and CXR score. There were 47 patients (21.4%) who died. The mortality rates in the unvaccinated and vaccinated patients were 30.2% and 17.8%, respectively (Table 2). The RR (CI95%) for mortality in the vaccinated patients was 0.59 (0.35-0.97), showing that vaccination is a significant factor for protection against the probability of dying. The Kaplan-Meier analysis shows higher chance of survival in vaccinated patients (Figure 1).Table 1.Types of Vaccines Recorded in Patients Hospitalized with COVID-19Table 2.Mortality in Vaccinated and Unvaccinated Patients and Risk Relative for MortalityFigure 1.Survival Curve of Vaccinated and Unvaccinated Patients with COVID-19

Conclusion

This study demonstrated that the mortality rate was lower in vaccinated versus non-vaccinated patients that were hospitalized in a respiratory ward due to COVID-19 in a hospital in Nicaragua.

Disclosures

All Authors: No reported disclosures
2399. Changing Demographics of Infective Endocarditis in South Carolina: An Ecological Study
Authors: Garrison Phillip G , Royer Julie , Habicht Max , Battle Sarah , Antosz Kayla , Burch Anna-Kathryn , Al-Hasan Majdi N , Justo Julie Ann , Bailey Pamela
Published: November 2023

Background

The opioid epidemic in America is likely changing the demographics of patients with infective endocarditis (IE). Traditionally, IE is attributed to older patients and those with prosthetic heart valves or cardiac devices. Rising rates of opioid use (OU), usually via injection, has resulted in younger patients being diagnosed with IE, which raises treatment challenges.

Methods

This retrospective ecological study analyzed hospitalization records from the South Carolina Revenues and Fiscal Affairs Office (SC RFA) from 2016-2021. ICD-10 codes for the diagnosis of IE yielded 7,175 hospitalizations with 5,066 unique patients. Cases of IE with concurrent OU were identified. Rurality of hospital county, hospital teaching status, hospital bed size, length of stay, total costs, discharge status, and distance to hospital zip were reviewed. Data was analyzed by year and age group (18-34, 35-49, 50-64,65-79, and 80+). Poisson regression was used to examine change in trends.

Results

From 2016-2021, inpatient stays related to IE showed no significant trend for age groups 35 years and older (p > 0.19), while showing a significant positive trend in the 18-to-34 age group (p = 0.04). Of the 7,175 IE hospitalizations, 977 (13.6%) had a concurrent diagnosis of OU. The percentage of patients with concurrent IE and OU diagnosis increased from 7% to 17% of patients/year. The rate of inpatient stays related to concurrent IE and OU increased from 3.8 to 11.1 (p = 0.01) and 2.5 to 8.7 per 100,000 of SC population (p = 0.01), for the 18–34 year-old and 35-49 year old groups, respectively, while not significantly changing in patients 50 years and older over the study period (p = 0.57).

Rate Per 100,000 SC Population of Inpatient Stays Related to IE and OU by Age Group

Conclusion

There are few epidemiologic studies of IE since the 2015 Infectious Diseases Society of America treatment guidelines, though significant concern about the juxtaposition of the opioid epidemic with diseases like IE. There are major changes in the demographics of IE patients. This study supports the need for updated guidelines to specifically address IE in the setting of OU, particularly in younger patients. This includes possible disparities in treatment due to lack of access to ID physicians in rural communities and challenges in providing prolonged intravenous antibiotic therapy.

Disclosures

Julie Ann Justo, PharmD, MS, FIDSA, BCPS, Gilead Sciences: Advisor/Consultant|Shionogi: Advisor/Consultant|Vaxart: Stocks/Bonds
2405. Extended Incubation of Blood Cultures in the Identification of Cutibacterium acnes as the Causative Pathogen in Infective Endocarditis
Authors: Garcia Sofia Molina , Shrestha Nabin K , Gordon Steven M
Published: November 2023

Background

Cutibacterium acnes is an uncommon cause of infective endocarditis (IE). Blood cultures are sometimes held for extended incubation (beyond the standard 5 days) with an expectation that such incubation might allow C. acnes to grow. Extended incubation of blood cultures consumes resources, and a justification of such extension requires a demonstration that it increases the likelihood of identifying a causative pathogen.

The purpose of this study was to examine the association between extended incubation of blood cultures and the identification of C acnes as the causative pathogen in patients with IE possibly caused by C. acnes.

Methods

This was a retrospective case-control study. Episodes of surgically treated IE among patients admitted from July 1, 2007, through Jan 1, 2022 were identified from the Cleveland Clinic Infective Endocarditis Registry, were screened for inclusion in the study. Patients with C. acnes IE were case subjects. Controls were selected from patients without an identified pathogen, by propensity score matching on age, gender, admission year, and IE category (native valve endocarditis or prosthetic valve endocarditis), using the nearest neighbor method, from among episodes of IE for whom a causative pathogen was not identified. Extended incubation was defined as incubation of blood cultures for longer than 5 days. The association between extended incubation of blood cultures and C. acnes identification was examined using logistic regression.

Results

Thirty-five subjects with C. acnes IE were matched to 35 control subjects. Nine of 35 subjects in the C. acnes group had at least 1 blood culture held for >5 days compared to only 1 of 35 controls. Five (50%) of those held for extended incubation grew C. acnes. Extended incubation was associated with a significantly higher odds of identification of C. acnes as the cause of IE (OR 11.8, 95% C.I. 2.0 – 224.1, p-value 0.02).

Conclusion

Among patients with possible C. acnes IE, extended incubation of blood cultures is associated with 12-fold higher odds of identifying C. acnes.

Disclosures

All Authors: No reported disclosures
2408. Is Shorter Antibiotic Treatment Feasible in Patients with Cardiac Implantable Electronic Devices (CIED) Infections? Impact of Treatment Duration on 6-Month Recurrence and Mortality
Authors: Ponta Giacomo , Ranzenigo Martina , Marzi Alessandra , Oltolini Chiara , Din Chiara Tassan , Uberti-Foppa Caterina , Spagnuolo Vincenzo , Mazzone Patrizio , Della Bella Paolo , Scarpellini Paolo , Castagna Antonella , Ripa Marco
Published: November 2023

Background

Aim of this study is to compare the 6-month outcomes (recurrence and mortality) of patients with cardiac implantable electronic device (CIED) infections treated with short (SHORT, <14 days) or long (LONG, >14 days) duration of antimicrobial therapy after device removal.

Methods

Retrospective cohort study of patients hospitalized at IRCCS San Raffaele Hospital (Milan, Italy) from June 2011 to June 2021, who underwent device removal for CIED infection. Patients with pocket and lead infections were included, while valve endocarditis and Staphylococcus aureus infection were excluded.

The characteristics of patients in the SHORT and LONG groups were compared using the chi-square test for categorical variables and the Mann-Whitney U-test for continuous variables. A propensity score (PS) was calculated using a logistic regression that considered duration of therapy as the dependent variable; the association between patients’ characteristics and outcomes was evaluated with logistic regression analysis.

Results

The characteristics of the 150 included patients are described in table 1, the microbial etiology in table 2. Patients in the SHORT compared to the LONG group were older (75 [65-80] vs 69 [62-77], p-value=0.047), had a higher Charlson comorbidity index (5 [3-6] vs 4 [3-5], p-value=0.021), had less frequent isolation of coagulase-negative staphylococci (CoNS; 46.7% vs 68.9%, p-value=0.006), and an unknown etiology (36.7% vs 13.3%, p-value=0.001). Moreover, the duration of antimicrobial treatment after device removal was shorter (13 [9-14] vs 20 [16-29] days, p-value< 0.001). At 6 months, recurrence and mortality were not significantly different between the SHORT and the LONG group (recurrences: 2 [3.7%] vs 5 [6.7%], p-value=0.464; mortality: 2 [3.7%] vs 3 [4.0%], p-value=0.931),

At logistic regression analysis (table 3 and table 4) adjusted for PS, treatment duration was not significantly associated with either recurrence (odds ratio [OR] 0.524; 95% confidence interval [95%CI] 0.084-3.263) or mortality (OR 1.402; 95%CI 0.185-10.635).

Conclusion

A shorter duration of antimicrobial treatment after device removal may be an effective approach for treating patients with CIED infections.

Disclosures

Antonella Castagna, MD, Bristol-Myers Squibb: consultancy payments and speaking fees|Gilead: consultancy payments and speaking fees|Janssen-Cilag: consultancy payments and speaking fees|Merck Sharp & Dohme: consultancy payments and speaking fees|ViiV Healthcare: consultancy payments and speaking fees
2409. Potential candidates for partial oral treatment in patients with endocarditis at a US center
Authors: Pries-Heje Mia M , Kim Andy J , Joyce Mary-Ruth M , Hartman Dylan J , Connolly Erin M , Itoh Akinobu , Cunningham Mark , O’Gara Patrick , Sun Yee-Ping , Maguire James , Aghayev Ayaz , Weber Brittany N , Di Carli Marcelo , Suzuki Joji , Ramirez Yesenia Buenrostro , Iversen Kasper K , Baden Lindsey R , Bundgaard Henning , Woolley Ann E
Published: November 2023

Background

In the Danish POET trial, oral step-down oral antibiotics in patients with left-sided infective endocarditis (IE) was non-inferior to traditional intravenous antibiotics (IV-AB). Outpatient parenteral antimicrobial therapy (OPAT) is widely used in the US despite associated adverse events. Our aim was to assess the proportion of US patients that were potential candidates for step-down oral antibiotic treatment, i.e. POET-treatment, and number of days IV-AB antibiotics could have been reduced.

Methods

Retrospective study of patients admitted with left-sided IE at a US single center from January 2021 – June 2022 was conducted. Patients were considered candidates for POET-treatment if they were infected with S. aureus, E. faecalis, Streptococcus spp., or CoNS, had a BMI < 40 kg/m2 and survived until discharge. The primary outcome was a composite of all-cause mortality, symptomatic embolism, unplanned cardiac surgery, and relapse of bacteremia within 6 months.

Results

Out of 111 patients with left-sided IE, 71 (64%) were considered potential POET-candidates (median age 64 years (IQR 54-75), 72% male); 30% had IE caused by S. aureus, and 48% were surgically treated (Table 1). Potential candidates were older (64 vs 60 years), more often infected with Streptococcus spp. (24% vs 0%) or CoNS (23% vs 5%), and had a pacemaker/ICD at baseline (23% vs 5%), as compared to patients who were not candidates for POET-treatment. Of potential POET-candidates, 93% (66/71) were stabilized, allowing discharge to OPAT with a median of 29 days (IQR 20-36) of antibiotic treatment remaining.

The primary outcome occurred in 28% of potential POET-candidates and in 53% of non-POET candidates, compared to the occurrence of the primary outcome in 11% in the Danish POET-trial (Table 2).

Conclusion

More than half of patients admitted with left-sided IE were potential candidates for POET-treatment. For the vast majority of these patients, up to 4 weeks of IV-AB may have converted to oral step-down antibiotics. Prevalence of the primary outcome in potential POET-candidates was almost 3 times higher in this US cohort than in the Danish POET trial, indicating a higher baseline risk. These findings indicate a need for prospective studies of oral step-down antibiotic therapy in US patients with IE.

Disclosures

Joji Suzuki, MD, Indivior: Grant/Research Support
2414. Pulling the Cord: Removal of Urinary Catheters before Urine Culture in a Cardiothoracic-Surgery ICU
Authors: Ben-Aderet Michael , Madhusudhan Meghan , Grein Jonathan , Drucker Carissa , Nurok Michael , Chan Alice , Kalava Sowmya , Vargas Moises R , Cornett Jake , Yaung Jill , Harper-Kirksey Katrina , Granflor Eliza
Published: November 2023

Background

Detection of asymptomatic bacteriuria (ABU) can lead to significant consequences, including over-prescription of antibiotics. Numerous studies have demonstrated that urinary catheters (UCs) are quickly colonized with bacteria, even when UTI is not present, and obtaining cultures from catheters leads to increased detection of ABU and increased Catheter Associated Urinary Tract Infection (CAUTI) rates. In our Cardiac Surgery ICU (CTICU), where UC utilization is high with limited opportunities for removal, we implemented an ABU reduction intervention consisting of replacing UCs prior to urine cultures.

Methods

In July 2021, we implemented a new urine culture stewardship process in the CTICU. When a patient with a UC required a urine culture, a urinalysis (UA) was ordered. If pyuria was present, the UC would be replaced, and a new urine culture (direct culture or a UA with reflex to culture) would be drawn from the new UC. This process was implemented as a recommendation, and compliance was encouraged by physician and nursing leadership, but not prospectively monitored. Retrospective review was done comparing urine culture positivity, antibiotic use and CAUTI rates in the period after the intervention with 2 full calendar years prior to the intervention. We also looked at catheterization rates and urology consultation rates (as a marker for urinary tract injury)

Results

Post-intervention, we saw a 43% reduction in the rate of urine cultures (4.9 to 2.8 cultures / 1000 patient days, p-value < 0.001), a 67% reduction in rate of positive urine cultures (1.2 to 0.4 positive cultures / 1000 patient days, p-value < 0.001), and an 87.5% reduction in CAUTI rate (1.6 to 0.2 CAUTIs / 1000 catheter days, p-value < 0.001). There was no significant change in urinary catheterization rate, gram-negative antibiotic use, or rate of urology consultation.Figure 1:Urine culture, positive urine culture and CAUTI rate before and after the interventionFigure 2:Urinary catheter utilization ratio before and after the intervention.Figure 3:Proportion of encounters with a urology consult before and after the intervention

Conclusion

We observed a dramatic reduction in CAUTI, positive urine cultures and all urine cultures with no increase in Urology consultations or change in UC utilization. While the reduction in reportable CAUTI is important and highly relevant, further work is needed to explore the full potential for this intervention regarding antimicrobial stewardship.

Disclosures

All Authors: No reported disclosures
2416. Outcomes of Patients with Ventilator-Associated Pneumonia in For-Profit Hospitals Compared to Non-Profit hospitals: A National Retrospective Cohort
Authors: Leon Renato Bobadilla , Morel Garry Francis
Published: November 2023

Background

Healthcare-associated infections (HAI) constitute a significant burden to patient outcomes and healthcare costs. Ventilator-associated pneumonia (VAP) carries a high mortality and represents one of the costliest HAI. There is uncertainty if treating this subgroup of patients in For-Profit (FP) hospitals portents better outcomes than Nonprofit (NP) hospitals.

Methods

A retrospective cohort of patients admitted from January 2016 through December 2020 was extracted from the National Inpatient Sample database. We compared two cohorts of patients with a primary diagnosis of VAP: patients admitted to FP hospitals and patients admitted to NP hospitals. The primary end-point was all-cause inpatient mortality. A multivariate logistic regression analysis was conducted. The secondary end-points included: comparing the requirement of vasopressor use and Acute Kidney Injury (AKI) requiring hemodialysis (HD); describing associated comorbidities; and comparing if there was a difference in length of stay (LoS) and hospital cost between the 2 groups. In order to compare LoS and hospital cost, a multivariate linear regression was conducted.

Results

A total of 6 155 hospitalizations under the primary diagnosis of VAP were included. No statistically significant difference in mortality was noted (FP: 4.24 vs. NP:8; p = 0.182), but age (aOR 1.01, p = 0.020) and Charlson Comorbidity Index(CCI) (aOR 1.20; p < 0.001) were modest predictors of mortality for both groups (FP vs. NP). There was no statistically significant difference in mean LoS between these two groups (FP:10.61 days vs. NP: 9.57, p=0.398). CCI (Coef 0.64, p= 0.01) and admission to large-size hospitals (Coef 3.03, p < 0.001) were predictors of LoS for both groups. Admission to for-profit hospitals predicted higher hospitalization costs (p = 0.020). Furthermore, admission to medium-size hospitals, large-size hospitals, and urban hospitals were also predictors of higher hospital cost (p < 0.05). No statistically significant difference was found in vasopressor use and AKI requiring HD among both groups (FP vs. NP) (p < 0.05).

Conclusion

Admission to For-Profit hospitals did not portend better outcomes compared to Nonprofit hospitals. Conversely, admission to For-Profit hospitals predicted higher total hospital costs.

Disclosures

All Authors: No reported disclosures
2417. Epidemiology of Central Line-Associated Bloodstream Infections Present on Hospital Admission: A Multicenter Study
Authors: Ching Patrick R , Oladapo-Shittu Opeyemi , Hsu Yea-Jen , Saunders Heather , Salinas Alejandra B , Helsel Taylor N , Mayoryk Stephanie , Gadala Avinash , Cosgrove Sara E , Rock Clare , Klein Eili , Maragakis Lisa , Pineles Lisa , Harris Anthony , Mejia-Chew Carlos , Keller Sara C
Published: November 2023

Background

National estimates of central line-associated bloodstream infections (CLABSI) focus on acute care hospital settings. Little is known about CLABSI that develop outside of hospitals and are present on admission (CLABSI-POA). We aimed to describe the epidemiology of CLABSI-POA to develop appropriate prevention strategies.

Methods

We performed a retrospective cohort study of all adult and pediatric patients admitted from 11/01/2020 to 10/31/2021 in two large medical systems in the US, one in Maryland and one in Missouri. Adapting the National Healthcare Safety Network acute care CLABSI definition, we included patients who had a central venous catheter (CVC) present on admission (or had a CVC discontinued within 72 hours prior to admission) and a positive blood culture within 72 hours before and/or after admission. We performed descriptive statistics to characterize the epidemiology of CLABSI-POA.

Results

Of 402 patients with CLABSI-POA, 52% were male, 68% were age ≥45 years, and 45% had Medicare insurance as primary payer. Half of the cases had a hospitalization 30 days prior to the index admission, 22% had at least one prior CLABSI, and 40% received chemotherapy in the last 6 months. The most common indications for catheter placement were chemotherapy (34%), total parenteral nutrition (21%), dialysis (15%), and outpatient parenteral antimicrobial therapy (11%). Attribution of CLABSI-POA based on site where the catheter was routinely accessed included oncology clinics (34%), home infusion therapy (32%), hemodialysis centers (12%), and skilled nursing facilities (9%). The most common causative microorganisms were coagulase-negative staphylococci (23%), Staphylococcus aureus (21%), Enterococcus spp. (12%), Candida spp. (11%), Escherichia coli and Klebsiella pneumoniae (10% each), and Pseudomonas aeruginosa (7%). Forty-five (11%) cases were due to multidrug resistant organisms. Overall in-hospital mortality was 10%.

Conclusion

CLABSI-POA were common in those attending oncology clinics and receiving home infusion therapy. Lack of routine surveillance of CLABSI-POAs leads to an underestimation of the burden of CLABSIs in the healthcare system. Tailored prevention strategies should be focused in those groups at higher risk.

Disclosures

Stephanie Mayoryk, MAS BSN RN CIC, PDI: Honoraria Sara E. Cosgrove, MD, MS, Debiopharm: Advisor/Consultant|Duke Clinical Research Institute: Advisor/Consultant Carlos Mejia-Chew, MD, INSMED: Grant/Research Support|RevImmune: Grant/Research Support Sara C. Keller, MD, MPH, MSPH, Pfizer: Advisor/Consultant
2429. Epidemiology and Risk Factors for Vascular Access-associated Infections in Japanese Hemodialysis Patients
Authors: Morikane Keita
Published: November 2023

Background

Surveillance of vascular access-associated infections (VAIs) in patients on hemodialysis has been well established in the United States, but not so in other countries including Japan. Our group established a voluntary VAI surveillance scheme, Dialysis Surveillance Network Japan (DSNJ), which is in operation for over 10 years. The purpose of this study is to describe the epidemiology and identify risk factors for VAI in patients on hemodialysis in Japan.

Methods

Data collected through DSNJ from January 2008 to December 2021 were used. Incidence of VAI was calculated by the number of infection per 1,000 dialysis sessions. Potential risk factors analyzed in this study included type of access, diabetes, indication of catheter use and seasonality

Results

During the study period, 4,919,834 dialysis sessions were surveyed at 52 hospitals and 1,146 VAI were observed, with an overall incidence of 0.23 per 1,000 sessions. The incidence declined over time. The incidences by the type of access were 0.05 (203 VAI in 4,285,758 dialysis sessions) for arteriovenous fistula (AVF), 0.11 (17/157,754) for superficialization of brachial artery (SBA), 0.53 (127/240,289) for arteriovenous graft (AVG), 1.33 (219/164,195) for cuffed catheter (CC) and 8.07 (580/71,838) for non-cuffed catheter (NCC). NCC had significantly higher risk for VAI than any other type of access. The most frequently accountable pathogen was methicillin-susceptible Staphylococcus aureus. The risk of diabetes for VAI was not significant in patients with either NCC or CC (NCC: RR 1.18, 95%CI: 0.98-1.43, CC: RR0.86, 95%CI: 0.64-1.16). NCC inserted at the femoral site had significantly higher risk of VAI compared to that at internal jugular site (RR 1.47, 95%CI: 1.21-1.78). This was also true for CC (RR:2.41, 95%CI: 1.34-4.34). NCC used at the induction of hemodialysis was more likely to be complicated with VAI than NCC used as a temporary substitute (RR 1.50, 95%CI: 1.22-1.84). Fifty-five percent (634/1,146) of VAI occurred in summer (May to October), indicating a seasonal variation in the incidence of VAI.

Conclusion

Our surveillance scheme revealed epidemiology and risk factors for VAI in Japanese hemodialysis patients. These findings might lead to better control VAIs in patients on hemodialysis.

Disclosures

All Authors: No reported disclosures