bluuebunny/crossref_metadata_2025 huggingface dataset:
896. Examining the Impact of the COVID-19 Pandemic on Delivery of HIV Care and Prevention Services Among Patients in a Ryan White Clinic
Authors: Zhang Michelle , Butler Sharlay , Kennedy Jason , McKune Molly , Haidar Ghady , McMahon Deborah
Published: December 2021

Background

We sought to characterize the impact of the COVID-19 pandemic on HIV-related outcomes in a cohort of patients by examining rates of viral load (VL) suppression, retention-in-care, PrEP access, and STIs.

Methods

This was a single center, retrospective study of adults receiving HIV treatment or HIV/STI prevention services from 01/2019 - 12/2020. HIV outpatient visits were identified through HRSA’s CareWARE. Visits (in-person, telehealth) only included HIV primary care. HRSA core performance measures were utilized (Table 1). STI positivity rates and descriptive characteristics were calculated. New and refill PrEP prescriptions were tabulated. Chi-square tests compared unmatched non-parametric variables; McNemar’s test matched non-parametric variables. Multivariable logistic regression identified variables associated with retention in care and viral suppression.

Results

1721 patients received care; 1234 were seen in both years, 334 only in 2019, 153 only in 2020. The number of telehealth visits increased significantly: video (0% to 31%, < 0.001), phone (0% to 0.4%, p < 0.001). Though the proportion of kept appointments increased (57.2% vs 61.2%), the annual retention in care rate decreased from 74.5% to 70.9% (p = 0.002). Overall, 9.7% of patients had detectable VLs at any point. Compared to 2019, a lower proportion of patients maintained VL suppression in 2020, (91.6% vs 83.5% p = 0.075). More patients did not have a VL drawn in 2020 than in 2019 (10.3% vs 2.0 %, p < 0.001). Patients with detectable VLs in 2019 were more likely than those who were undetectable to have detectable VLs in 2020 (OR 18.2, 95% CI 9.91-33.42). Black race was associated with higher likelihood of lack of VL suppression (OR = 2.0; 95% CI 1.10-3.66). There were no significant differences between gender or age groups in rates of viral suppression, number screened for bacterial STIs or positive results. Visits for new and refill PrEP prescriptions decreased by 59% and 7%, respectively.

Conclusion

Rates of viral load suppression and retention in care decreased in 2020 compared to 2019. The proportion of clinic visits attended increased after the integration of telemedicine in 2020. These data may be used to inform evidence-based interventions to improve the HIV continuum of care through telehealth.

Disclosures

Ghady Haidar, MD, Karuys (Grant/Research Support)
905. Risk of Hepatitis B Reactivation in Patients Receiving Ibrutinib: The National VA Cohort
Authors: Chen Ting-Yi , Jacob David , Coppin John David , Jinadatha Chetan
Published: December 2021

Background

Ibrutinib, a bruton tyrosine kinase inhibitor was approved by Food and Drug Administration (FDA) in 2013 and became the first-line treatment for chronic lymphocytic leukemia in 2014. The risk Hepatitis B Virus (HBV) reactivation after initiation of ibrutinib is unclear. Here, we report the results of national Veterans Health Administration (VHA) pharmacy database review estimating the incidence of HBV reactivation after initiation of ibrutinib.

Methods

Veterans who received ibrutinib between Feb 1, 2014 through October 31, 2019 were included in our study. Possible reactivations were identified by change of Hepatitis B Virus surface antigen (HBV sAg), HBV core antibody (Ab) or HBV viral load from no data or negative to positive after starting ibrutinib. Individual chart review was conducted to verify HBV reactivation due to ibrutinib. Cumulative incidence was calculated by identifying HBV reactivation cases among at risk patients, which was defined as prior exposure by positive HBV core Ab regardless of HBV sAg or HBV viral load status. For patients without any HBV serology, an estimated prevalence of HBV exposure in veterans from the literature is used.

Results

A total of 4130 veterans were on ibrutinib during the study period. Of 4130 patients, 1875 patients with HBV core Ab negative and 68 patients on antivirals against HBV prior to ibrutinib were excluded. Among the remaining 2187 patients, there were 170 patients with positive HBV core Ab and 2017 patients without HBV core Ab tested regardless of HBV sAg or HBV DNA status. We used the estimated 13.6% (95%CI 11.5-16.1) of HBV exposure in veterans and estimated that 274 (95%CI 232-325) out of 2017 patients would be at risk of HBV reactivation. Thirty-nine patients were identified to have HBV reactivation after ibrutinib. After detailed review, 7 HBV reactivations were attributable to initiation of ibrutinib. The cumulative incidence of HBV reactivation after ibrutinib was estimated as 1.5% (95% CI 1.4-1.7).

Conclusion

In this large VHA study, we identified 7 cases of HBV reactivations among 444 at risk patients. The cumulative incidence of HBV reactivation after ibrutinib was 1.5% in patients with prior HBV exposure with positive HBV core Ab irrespective of HBV sAg or HBV DNA status, indicating a moderate risk of HBV reactivation.

Disclosures

All Authors: No reported disclosures
111. Duration of Antibiotic Therapy after Debridement and Implant Retention in Patients with Periprosthetic Joint Infections
Authors: Tai Don Bambino Geno , Berbari Elie , Abdel Matthew P , Lahr Brian , Tande Aaron J
Published: December 2021

Background

Debridement, antibiotics, and implant retention (DAIR) is appropriate for select acute postoperative and hematogenous periprosthetic joint infections (PJIs). However, the optimal duration of antimicrobial therapy in patients treated with DAIR has not been defined. Therefore, we aimed to identify the ideal duration of parenteral and oral antibiotics after DAIR.

Methods

We performed a retrospective study of patients >18 years of age with hip or knee PJI managed with DAIR between January 1, 2008, and December 31, 2018, at Mayo Clinic. PJI was defined using criteria adapted from the International Consensus Meeting on PJI. The outcome was defined as either PJI recurrence or unplanned reoperation due to infection. Joint-stratified Cox proportional hazards regression models with time-dependent covariates were used to assess nonlinear effects of antibiotic duration. Hazard ratios were computed based on prespecified time points for comparison, whereas p-values represented the overall effect across the entire range of durations.

Results

There were 247 unique episodes of PJI in 237 patients during the study period. Parenteral antibiotics were given in 99.2% of cases (n=245). This was followed by chronic oral antibiotic suppression in 92.2% (n=226) with a median duration of 2.2 years (1.0-4.1).

DAIR failed in 65 cases over a median follow-up of 4.4 years, with a 5-year cumulative incidence of 28.1%. After adjustment for risk factors, there was no significant association between duration of parenteral antibiotics and treatment failure (p=0.203), with no difference between four versus six weeks (HR 1.11; 95% CI 0.71-1.75) (Figure 1). However, both use and longer duration of oral antibiotic therapy was associated with a lower risk of failure (p=0.006). To account for the possibility that this association was driven by results during early follow-up, conditional analyses at one- and two-year follow-up were performed. Both showed a significantly lower risk for a longer duration of antibiotics (Figure 2).

Figure 1. Time-Dependent Analysis of Parenteral Antibiotic Duration

Figure 2. Time-Dependent Analysis of Oral Antibiotic Suppression Duration

Conclusion

After DAIR, efficacy from four weeks of parenteral antibiotics was no different from six weeks when followed by chronic oral antibiotic suppression. Our results could not establish an optimal duration but suggested that continuing suppression portends a lower risk of failure of DAIR.

Disclosures

Elie Berbari, MD, Uptodate.com (Other Financial or Material Support, Honorary unrelated to this work) Matthew P. Abdel, MD, Stryker and AAOS Board of Directors (Board Member, Other Financial or Material Support, Royalties) Aaron J. Tande, MD, UpToDate.com (Other Financial or Material Support, Honoraria for medical writing)
917. Accessible HCV Care for People Who Inject Drugs: Randomized Clinical Trial Comparing Low-Threshold Treatment at a Syringe Service Program Versus Facilitated Referral
Authors: Eckhardt Benjamin , Aponte-Melendez Yesenia , Fong Chunki , Kapadia Shashi , Davis La , Smith Melinda , Mateu-Gelabert Pedro , Marks Kristen , Marks Kristen
Published: December 2021

Background

To achieve hepatitis C virus (HCV) elimination, treatment programs need to be developed to engage, treat, and cure people who inject drugs (PWID).

Methods

We present final data from the Accessible Care Trial for curing HCV in PWID. The randomized clinical trial compared on-site, low-threshold HCV treatment with care-coordination at a NYC syringe service program (Accessible Care) with facilitated referral to local providers through a patient navigation program (Usual Care). Eligible participants were HCV RNA+ and had injected drugs in the past 90 days. Participants were randomized 1:1 to the Accessible Care or Usual Care arm. The primary endpoint was achievement of sustained virologic response (SVR12) within 12 months of enrollment. Secondary endpoints examined rates HCV care cascade step completion from referral to clinician, attending clinical visit, baseline lab testing, treatment initiation, and cure.

Results

Among the 572 participants screened, 167 met eligibility criteria and were enrolled, with two excluded post-randomization (N=165). Demographics were similar with a median age of 41 years; 22% women; 59% Hispanic and 5% non-Hispanic black. At baseline, 84% of participants had injected drugs in the past 30 days with those averaging 22 injections/month, 70% were receiving either methadone or buprenorphine, 57% were recently homeless, 7% were HIV+, and 11% were HCV treatment experienced. In the intention-to-treat analysis, 55/82 (67.1%) of the Accessible Care arm and 19/83 (22.9%) of the Usual Care arm achieved SVR12 (p< 0.001). The SVR12 rates of those starting therapy were 55/64 (85.9%) and 19/22 (86.3%) in the two arms (p=0.96). Loss to follow-up (12.2% and 16.9%, p=0.51) was similar in the two arms. Significantly more participants in the Accessible Care arm achieved all steps in the care cascade with the greatest attrition in the Usual Care arm seen in referral to clinician and attending clinical visit.

Conclusion

Among HCV RNA+ PWID significantly higher rates of cure were achieved using the Accessible Care model focused on low-threshold, destigmatized, flexible HCV care compared to facilitated referral. To achieve HCV elimination, expansion of treatment programs specifically geared toward engaging PWID is paramount.

Disclosures

Benjamin Eckhardt, MD, MS, Gilead Sciences (Grant/Research Support) Shashi Kapadia, MD, Gilead Sciences Inc (Grant/Research Support) Kristen Marks, MD, Gilead Sciences (Grant/Research Support)
930. Clinically Significant CMV Infections in Patients with Lymphoma or Multiple Myeloma
Authors: Sassine Joseph , Khawaja Fareed , Shank Brandon R , Lovell Alexandra , Lee Jenessa , DiPippo Adam , Rausch Caitlin R , Spallone Amy , Heredia Ella Ariza , Chemaly Roy F
Published: December 2021

Background

Clinically significant CMV infections (CS-CMVi) among patients with lymphoma and multiple myeloma (MM) have not been clearly defined, especially considering the new cancer therapies that have revolutionized cancer outcomes of these patients. This study aims at describing clinical outcomes of CS-CMVi in this patient population and identify risk factors for CS-CMVi.

Methods

This is a single-center, cohort study of all patients with lymphoma and MM who developed CS-CMVi between January 2017 and October 2020. Data was collected from the electronic medical records. CMV outcomes were defined according to the standardized definitions for clinical trials. Data was analyzed on IBM® SPSS version 26 using a logistic regression model for multivariate analysis.

Results

We identified 84 patients; 60 (71%) had lymphoma and 24 (29%) had MM (Table 1). CMV end organ disease was diagnosed in 53 (63%) patients as the initial CMV episode and the most common site was the lungs (68%). In our cohort, 25 (30%) patients had autologous HCT and 14 (17%) had CAR T cells infusions prior to CS-CMVi. Recurrent CS-CMVi occurred in 16 (19%) patients (Table 2). A 100-day all-cause mortality was 55%, at a median of 76 days (range 3 -1330 days) after the initial episode of CS-CMVi. CMV related mortality was 11% amongst patients with end organ disease. In multivariate analysis, female gender was associated with a higher risk of CMV end organ disease (OR 3.42, 95% CI 1.14-10.3) and MM with a lower risk of CMV end organ disease compared to lymphoma (OR 0.27, 95% CI 0.07-0.97) (Table 3). Interestingly, 16 (19%) patients received letermovir as secondary prophylaxis for a median of 94 days (range 5 to 339 days) and only 1 patient had recurrent CS-CMVi while on letermovir.

Conclusion

CS-CMVi, particularly end organ disease, are not uncommon among patients with lymphoma or MM. Routine CMV surveillance and the use of letermovir for secondary prophylaxis in this patient population should be evaluated in further studies.

Disclosures

Fareed Khawaja, MBBS, Eurofins Viracor (Research Grant or Support) Ella Ariza Heredia, MD, Merck (Grant/Research Support) Roy F. Chemaly, MD, MPH, FACP, FIDSA, AiCuris (Grant/Research Support)Ansun Biopharma (Consultant, Grant/Research Support)Chimerix (Consultant, Grant/Research Support)Clinigen (Consultant)Genentech (Consultant, Grant/Research Support)Janssen (Consultant, Grant/Research Support)Karius (Grant/Research Support)Merck (Consultant, Grant/Research Support)Molecular Partners (Consultant, Advisor or Review Panel member)Novartis (Grant/Research Support)Oxford Immunotec (Consultant, Grant/Research Support)Partner Therapeutics (Consultant)Pulmotec (Consultant, Grant/Research Support)Shire/Takeda (Consultant, Grant/Research Support)Viracor (Grant/Research Support)Xenex (Grant/Research Support)
936. Risk Factors and Clinical Outcomes for Extended-Spectrum Beta-Lactamase Producing Enterobacterales Blood Stream Infections in Patients with Hematologic Malignancies
Authors: Lefemine Amanda , Meredith Jacqueline , Hammer Katie , Kachur Ekaterina , He Jiaxian , Speight Carly C , shahid zainab
Published: December 2021

Background

Hematologic malignancy patients have high rates of antibiotic exposure, and increasing resistance is a major concern, particularly with extended-spectrum beta lactamases (ESBL) in Enterobacterales blood stream infections (BSIs). Identifying risk factors for ESBL-producing Enterobacterales (ESBL-E) BSIs may facilitate faster appropriate antibiotic use and decrease mortality.

Methods

This was a retrospective study of patients with hematologic malignancies and Escherichia coli or Klebsiella spp. bacteremia admitted to Carolinas Medical Center in Charlotte, NC from January 2010 through September 2020. The primary objective was to compare 30-day mortality rates for patients with ESBL-E BSIs to those with non-ESBL-E BSIs. Fisher’s exact or Mann-Whitney U tests were used for primary and secondary clinical outcomes as appropriate. Risk factors associated with 30-day mortality and ESBL production were assessed as secondary objectives using logistic regression models.

Results

A total of 28 patients with ESBL-E BSIs and 60 patients with non-ESBL-E BSIs were included. The 30-day mortality rate with ESBL-E BSIs was 25% compared to 15% with non-ESBL-E BSIs (P = .373). In-hospital mortality, 30-day infection recurrence, intensive care unit (ICU) admission, and length of stay after culture were not significantly different. However, time to optimal therapy was longer in the ESBL-E group (median 42.3 vs 1.9 hr; P < .001). Multivariate logistic regression analysis showed an association of 30-day mortality with ICU admission (OR 16.7; 95% CI, 3.56-78.4; P < .001) and longer time to optimal therapy (OR 1.03; 95% CI, 1.0-1.05; P = .026). Prior ESBL-positive culture was associated with ESBL-E BSI in the univariate logistic regression (OR 9.83; 95% CI, 1.05-92.56; P = .046). Additionally, prolonged neutropenia (OR 3.05; 95% CI, 1.01-9.23; P = .049) and prior intravenous antibiotic use (OR 2.96; 95% CI, 0.96-9.09; P = .059) were associated with ESBL-E BSI in the multivariate analysis.

Conclusion

Significantly longer time to optimal therapy was seen in ESBL-E BSIs and was associated with mortality in patients with hematologic malignancies. The identified ESBL risk factors create an opportunity to decrease delay in optimal therapy through risk stratification during initial antibiotic selection.

Disclosures

Ekaterina Kachur, PharmD, BCOP, Bristol Myers Squibb (Advisor or Review Panel member)Genentech (Employee)Glaxosmithkline (Advisor or Review Panel member)Kyowa Kirin (Advisor or Review Panel member)
115. The Utility of (1→3)-β-D-glucan Assay in the Diagnosis of Severe Coccidioidomycosis Infections among Immunocompromised Hosts
Authors: Ayazi Parham , Zangeneh Tirdad , Shi Aishan , Campanella Matthew A , Obaidi Mohanad Al
Published: December 2021

Background

Coccidioidomycosis is associated with increased morbidity and mortality in immunocompromised (IC) patients. The diagnosis of invasive fungal infections can be challenging in IC hosts. Culture results may take time to identify Coccidioides species, and serologic based tests are less sensitive in IC patients. (1-3)-β-d-glucan (BDG) has been reported to be detected in patients with coccidioidomycosis. We hypothesized that BDG in combination with serology may assist in the early detection of coccidioidomycosis in IC patients.

Methods

After the institutional review board approved the study, we conducted a retrospective chart review from 10/1/2017 through 09/15/2020, including ≥18 years old IC patients with a confirmed diagnosis of coccidioidomycosis by culture. Information regarding demographics, comorbidities, immunosuppression, medications, BDG, serology, and clinical presentation was collected. Patients with infusions that can result in possible false-positive BDG were excluded. Patients with other fungal infections were also excluded. Chi-square test was used to compare categorical variables, Wilcoxon rank-sum and Kruskal-Wallis tests were used to compare non-parametric variables, accordingly.

Results

Over the study period, 269 encounters with positive Coccidioides spp. cultures were identified, 78/269 of patients were IC patients, 55/78 were excluded, and 23 cases were included in the final analysis. Among the 23 IC patients, the median age was 64, 43% were female, 74% were White. There were 8 post solid organ transplantation, 7 with a hematological malignancy, and 8 with other types of IC conditions. 19/23 had a pulmonary infection. 4/23 patients died within one month of their encounter. There was no statistical significance difference between positive BDG and serology tests, with 12/23 had positive BDG, and another 12/23 had positive serology. Combined serology and BDG detected 18/23 of the Coccidioidomycosis cases. 17% of the cohort died within the one-month follow-up.

Conclusion

The combined use of BDG assay and Coccidioides serology increases the sensitivity of coccidioidomycosis diagnosis to 78% in IC patients. Future prospective studies are needed to further evaluate the utility of serum BDG in diagnosing coccidioidomycosis in IC patients.

Disclosures

Mohanad Al Obaidi, MD, Shionogi Inc. (Advisor or Review Panel member)
955. Trends in Top COVID-19 Questions Among a National Audience of Primary Care Clinicians
Authors: Madore Aylin , Oliverio Margaret , Nock Steven
Published: December 2021

Background

As COVID-19 took the world by storm, primary care clinicians (PCCs) played a critical role in identification and management of this disease. Yet, knowledge around COVID-19 is constantly evolving, leaving clinicians with many unanswered questions. We sought to examine what questions PCCs had about COVID-19 and whether there were any trends over time.

Methods

We sought to examine what questions PCCs had about COVID-19 and whether there were any trends over time. We collected questions from PCCs during 4 live virtual 60-minute continuing medical education (CME) panel discussions on COVID-19 led by infectious disease experts from November 2020 to February 2021. Questions were independently sorted and analyzed by 2 MDs using constant-comparison and tie-break methodology.

Results

A total of 600 questions pertaining to COVID-19 were collected across 4 sessions. Top questions asked by PCCs ranked in descending order related to the following topics, with most common themes listed in parentheses: 1. Vaccines (efficacy, safety in pregnancy, indications/contraindications, timing of administration, side effects/adverse events) 2. Medication-Specific Treatment (monoclonal antibodies, ivermectin, steroids, convalescent plasma, supplements [vitamin D, zinc, vitamin c]) 3. Testing (false positive/false negatives, use in travel, quarantine, and gatherings) 4. Other Management (role of anticoagulation, use of chronic medications, guidelines) 5. Personal Protective Equipment (masks, eye protection, post-vaccination, use in travel). [Table 1] The percentage of questions around vaccination increased from 5% of total questions in October 2020 to 67% in February 2021. Questions related to Treatment declined from 20% to 6%, Testing declined from 21% to 3%, Other Management declined from 6% to 1% and PPE increased from 3% to 8% during this period.

Table 1. Top 5 topics of questions listed in descending order of frequency across all 4 COVID-19 panel sessions.

Table 2. Percentage of questions in the top 5 topics for each of the 4 COVID-19 panel sessions, with associated trendline.

Conclusion

PCCs nationally have gaps in knowledge around COVID-19 which can impact clinical decision-making. Based on our analysis of questions submitted by PCCs to infectious disease experts in a CME setting, the greatest gaps in knowledge were around vaccination, treatment, and testing with vaccination showing the greatest shift in interest over time.

Disclosures

All Authors: No reported disclosures
958. A Required Infectious Diseases Rotation Improves Antimicrobial Stewardship Knowledge for Internal Medicine Interns
Authors: Gottesdiener Lee S , Stoeckle Kate , Loo Angela , Mazur Shawn , Gudi Kirana , Marks Kristen , Marks Kristen , Simon Matthew
Published: December 2021

Background

Exposure to Infectious Diseases (ID) education is highly variable in post-graduate medical training. We report our experience with a required one-week ID consult rotation for Internal Medicine (IM) interns with a focus on antimicrobial stewardship education.

Methods

Since 2018 all IM interns at our institution have participated in a required one-week ID consult rotation. Antimicrobial stewardship is a core feature of this rotation, with educational resources on antibiotic spectrum and decision-making, and interdisciplinary rounding with ID pharmacists. Between March 2020 and May 2021 we piloted an 11-item pre-rotation and post-rotation quiz with distinct but paired questions on key stewardship topics. The quiz was administered anonymously in SurveyMonkey. Mean pre/post rotation scores were compared using a paired T-test and the McNemar test of paired proportions was used to compare the pre/post change in percentage of correct responses for each topic.

Results

Among 47 interns who completed the rotation, 16 interns completed both pre- and post-rotation quizzes (response rate=34%). Mean scores on the pre-rotation quiz were 60%, compared to 77% on the post-rotation quiz (p=0.01), indicating significant improvement at the end of the rotation (Figure 1). Among 11 residents who scored below 65% on their pre-rotation quiz, all achieved an increased score on their post-rotation quiz (mean pre-test of 49% to mean post-test 79%). Table 1 displays the question topics and pre/post test change in percentage correct. The most difficult pre-test topics were ‘Recognition of AmpC-Expressing Organisms’ and ‘Antibiotics with activity against Pseudomonas aeruginosa,’ which improved, from 31% to 81% correct (p=0.03) and 50% to 100% correct (p=0.01), respectively.

Figure 1. Mean score of interns on pre-rotation vs post-rotation antimicrobial stewardship quiz from March 2020 to May 2021 (n=16; p=0.01).

Table 1. Question topics and change in percentage correct on pre-rotation and post-rotation quizzes.

Conclusion

A required one-week ID consult rotation for IM interns improved antimicrobial stewardship knowledge. Our experience may serve as a model for other institutions interested in increasing IM housestaff exposure to ID and antimicrobial stewardship.

Disclosures

Kristen Marks, MD, Gilead Sciences (Grant/Research Support)
964. Impact of the COVID-19 Pandemic on Bedside Medical Education: A Mixed-Methods Study
Authors: Clark Eva , Freytag Jennifer , Hysong Sylvia J , Dang Bich , Giordano Thomas P , Kulkarni Prathit A
Published: December 2021

Background

The COVID-19 pandemic obligated academic medical programs to substantially alter the traditional Internal Medicine (IM) rounding model to decrease risk of inpatient nosocomial viral transmission. Our study aimed to describe how IM rounding practices changed during the COVID-19 pandemic and to understand the impacts of these changes on medical education.

Methods

We conducted a two-phase, mixed-methods study of inpatient IM rounding team practices at a large academic hospital in Houston, TX. In the first phase (January-February 2021), we organized and audio-recorded 4 virtual (Zoom) focus groups. Each included 5-6 rounding team members, divided by: attendings; senior residents; interns; and medical and physician assistant students. In the second phase (March-May 2021), we performed 6 direct observations of IM teams during rounds. Two observers systematically recorded variables such as time spent on non-bedside versus bedside rounds, number of each team member type entering patient rooms for bedside teaching, and types of personal protective equipment (PPE) worn.

Results

Topics discussed during focus groups included comparisons of rounding team size, rounding duration, physical distancing and PPE use, bedside education, communication methods, and patient safety before and after March 2020. Perceptions of changes in each topic were generally consistent across groups (Table 1). Direct observation data showed that team rounding styles remained diverse in the proportion of rounding time spent in an office versus on the wards, and in the number and types of team members entering patient rooms. IM team members uniformly wore respiratory PPE when entering all patient rooms; use of eye protection varied. Teams spent more total time discussing patients with or suspected to have COVID-19 compared to patients without COVID-19 (median 24 min versus 13 min, p< 0.0001).

Conclusion

Our results suggest that the COVID-19 pandemic adversely impacted bedside medical education, even into Spring of 2021. Conclusions from this study can be used to 1) address educational gaps related to COVID-19 pandemic-associated rounding changes and 2) create innovative methods of providing high-quality clinical education that will be minimally impacted by future respiratory virus pandemics.

Disclosures

Prathit A. Kulkarni, M.D., Vessel Health, Inc. (Grant/Research Support)
967. Interprofessional Education of Medical Students in a Comprehensive HIV Care Coordination Elective
Authors: Goebel Melanie , Rodriguez Natalia , Robinson Felicia , Patel Shital
Published: December 2021

Background

Interprofessional education (IPE) is critical in undergraduate medical student curriculum to promote teamwork, increase effective communication, and improve patient-centered care especially in medically underserved populations, including those living with HIV.

Methods

Medical students participated in 2-week elective rotations at a freestanding, multidisciplinary HIV clinic providing comprehensive HIV care for more than 6,000 people in an urban, ethnically diverse, resource-limited population. The interprofessional faculty included physicians, pharmacists, case managers, social workers, service-linkage workers, substance use counselors, and medication access specialists. Students interviewed patients, rotated with at least four multidisciplinary health professionals at the clinic, and rounded with the HIV inpatient consult team and service linkage worker in the hospital. Each student completed a reflection paper on the barriers and facilitators of HIV care engagement. Student feedback was collected through course evaluations and debriefing sessions with course directors. Knowledge and ability to perform HIV-related services were assessed through student assessments at baseline and within 2 weeks of completing the rotation.

IPE competencies

Results

From January 20, 2020 to May 21, 2021, 17 medical students completed the 2-week elective (5 second-year students, 10 third-years, and 2 fourth-years). Student reflection papers demonstrated understanding of barriers to care, social determinants of health, and potential solutions to improve health outcomes. Open-ended feedback was positive, with many commenting on the benefits of learning from diverse healthcare professionals in HIV care. At follow up, 80% of students rated their knowledge of ideal functioning of interprofessional teams as very good or excellent. Students reported increased ability to deliver team-based care, provide services to culturally diverse people, and coordinate care for non-medical needs.

Conclusion

Interprofessional education enhanced students’ knowledge of care coordination, interprofessional communication skills, competency in teamwork, and understanding of socioeconomic barriers to care in an underserved population with HIV.

Disclosures

All Authors: No reported disclosures
978. Disease Associations and Outcomes in Hospitalized Patients with Non-Cutaneous Mucormycosis: Data from the National Inpatient Sample
Authors: White Mark
Published: December 2021

Background

Data regarding comorbidities and hospital outcomes among patients with non-cutaneous mucormycosis is primarily derived from case reports and single institution series. This study was undertaken to define the prevalence of this condition among adult inpatients in the United States and to measure the frequency of comorbid illnesses and outcomes of inpatients with mucormycosis.

Methods

The 2016 National Inpatient Sample was used to identify a cohort of patients with a hospital diagnosis of non-cutaneous mucormycosis. Patients with mucormycosis and comorbid medical illnesses were identified by ICD-10 codes. The impact of disease site and comorbid illness on inpatient mortality was measured.

Results

A cohort of 95 adults with non-cutaneous mucormycosis was identified and included patients with pulmonary (n=53), rhinocerbral (n=25), disseminated (n=17), and gastrointestinal (n=4) mucormycosis. The prevalence of non-cutaneous mucormycosis was 15.7 cases per million admissions. Frequently associated medical conditions included diabetes mellitus (45.3%), hematologic malignancy (34.7%), hematopoietic stem cell transplant (6.3%), long term use of systemic steroids (6.3%), myelodysplastic syndrome (6.3%), solid organ transplant (5.3%), non-hematologic malignancy (4.2%), and iron overload disorders (2.1%). The median age of adults hospitalized with non-cutaneous mucormycosis was 53.2 years (range 18-83); patients were predominantly male (78.9%) and Caucasian (51.8%). The median length of stay for this cohort was 20 days (range 1-190) with a median total hospital cost of &323, 470 (range &2,401-&1,958,259) and an in-hospital mortality rate of 20%. The inpatient mortality rate was increased with underlying myelodysplastic syndrome (p=0.003) but not by other associated medical conditions or by site of disease.

Conclusion

Non-cutaneous mucormycosis is associated with a high in-hospital mortality rate and should be considered in patients with suggestive clinical presentations and underlying diabetes or conditions associated immunosuppression. Prompt recognition and tissue confirmation of this diagnosis leading to early surgical intervention and systemic antifungal therapy may improve outcomes.

Disclosures

All Authors: No reported disclosures
985. Fusarium Infections in Patients with Hematological Malignancies
Authors: Krishnan Gayathri , Pande Anupam
Published: December 2021

Background

Fusarium is a ubiquitous mold that can cause invasive and disseminated fusariosis in immunosuppressed patients, especially those with hematological malignancies. The risk factors associated with mortality of patients with Fusarium infections have not been adequately assessed in literature. In this study, we sought to explore the characteristics, clinical outcomes, and risk factors for mortality in Fusarium infections in patients with hematological malignancies.

Methods

This is a retrospective study of adult hematological malignancy patients admitted to surgical/medical wards or critical units at an academic medical center from January 2010 to January 2021 and diagnosed with proven invasive Fusarium infections through positive microbiological culture data from a biopsy, surgical specimen or sterile site. Primary end point was 30-day mortality. Statistical analysis was done using Fischer’s exact test and Mann-Whitney U test.

Results

31 patients with hematological malignancies were identified with proven Fusarium infections during the 10-year period (13,390 total unique patients with diagnosis of hematologic malignancies). Two were excluded due to incomplete data. Demographic characteristics, type and status of hematological malignancy, chemotherapy, exposure to steroids, neutropenia, lymphopenia, antifungal prophylaxis, and other factors were analyzed. Mean age at diagnosis was 52.6 years. 16/29 (55.2%) had undergone stem cell transplant prior to infection with median duration of 150.5 days (range 12 to 1503) prior to infection. The most common pathologies were invasive sinusitis and disseminated cutaneous infection in 13/29 (44.8%) patients. Blood culture was positive in 5/29 (17.2%). Overall mortality was 86.2% with 30-day mortality of 44.8% and 1-year mortality of 83%. Death was attributed to fusariosis in 12/25 (48%). Median duration to death was 56 days (range 2 to 1627 days). Risk factors for 30-day mortality were assessed (table 1).

The table describes risk factors for 30-day mortaity for fusarium infections in patients with hematological malignancies. statistical analysis done using fischer’s exact test

Conclusion

Fusarium infections result in morbidity and mortality in patients with hematological malignancies. A variety of host and disease factors dictate eventual outcome of Fusarium infections in these patients. Lack of neutrophil recovery is a significant risk factor for 30-day mortality in this population.

Disclosures

All Authors: No reported disclosures
986. Incidence of Invasive Fungal Infections in Previously Untreated Patients with Acute Myeloid Leukemia Receiving Venetoclax and Azacitadine
Authors: Phupitakphol Tanit , Johnson Tanner M , Abbott Diana , Gutman Jonathan , Pollyea Daniel , Koullias Yiannis
Published: December 2021

Background

Acute myeloid leukemia (AML) is associated with poor prognosis, particularly in elderly patients with co-morbidities. Low-intensity therapies like azacitidine (aza) were the standard of care and were associated with low response rates and limited survival. Combining venetoclax (ven) with aza demonstrated significant improvements in responses and survival compared to aza alone, and represents the new standard of care for this population. However, as a myelosuppressive regimen, infectious complications, especially invasive fungal infections (IFI), are a potential concern. The incidence of IFI and the role for antifungal prophylaxis have not been well defined for newly-diagnosed AML patients receiving ven/aza.

Methods

We conducted a retrospective cohort review of AML patients treated with ven/aza at the University of Colorado Hospital from January 2014 to August 2020. Duration of therapy was defined as the time from initiation of treatment through one of the following endpoints (1) patient discontinuation, (2) progression of disease, (3) bone marrow transplantation, or (4) death. Four patients with a history of prior IFI were excluded. We assessed the impact of patient age, sex, duration of neutropenia, antifungal prophylaxis, and AML specific risk factors on the incidence of IFI as defined by the European Mycoses Study Group.

Results

One hundred forty-four AML patients were included in the study. Ten patients received antifungal prophylaxis and none developed IFI (p=0.21). Twenty-five (17%) patients developed IFI: 2 (8%) had proven IFI, 6 (24%) probable IFI, and 17 (68%) possible IFI. Invasive pulmonary aspergillosis represented all 25 cases of proven, probable, and possible IFI. There was a statistically significant association between prolonged neutropenia ( >60 days) and IFI (p=0.007), whereas age, sex, and SWOG classification were not significantly associated with IFI.

Conclusion

The incidence of IFI in our AML cohorts treated with ven/aza was 17%, lower than that reported at other institutions. Neutropenia > 60 days was significantly associated with IFI in our AML cohort treated with ven/aza. Although we were not powered to determine whether antifungal prophylaxis impacted IFI, there was no significant difference in IFI for patients who received prophylaxis.

Disclosures

All Authors: No reported disclosures
988. Is There Value of Infectious Diseases Consultation in Candidemia? A Single Center Retrospective Review From 2016-2019
Authors: Ryder Jonathan H , Van Schooneveld Trevor C , Van Schooneveld Trevor C , Stohs Erica J
Published: December 2021

Background

Candidemia is the second most common cause of healthcare-associated bloodstream infections in the US with mortality of approximately 25%. Studies demonstrate lower candidemia mortality with infectious diseases consultation (IDC). We evaluated effects of IDC on mortality and guideline-adherence at our institution to determine if mandatory IDC was warranted.

Methods

We retrospectively reviewed adults hospitalized with candidemia (≥ 1 blood culture positive for Candida) between 1/1/2016-12/31/2019. Exclusion criteria included age < 19 years, polymicrobial blood culture, or death or hospice within 48 hours. Primary outcome was all-cause 30-day mortality. Secondary outcomes included guideline-adherence and treatment choice. Guideline-adherence was assessed with a modified EQUAL Candida score (Table 1). Descriptive statistics were performed.

Table 1. Original vs Modified EQUAL Candida Score

Abbreviations. CVC: central venous catheter, BCx: blood culture

Results

Of 187 patients reviewed, 92 episodes of candidemia with 94 species of Candida were included. Patient characteristics are shown in Table 2. Central venous catheters (CVCs) were present in 66 (71.7%) patients and were the most common infection source (N=38 [41.3%]) followed by intra-abdominal (N=23 [25%]). The most isolated species were Candida glabrata (40/94 [42.6%]) and C. albicans/dublienensis (35/94 [37.2%]). 30-day mortality was 21.7%. IDC was performed in 84 (91.3%) cases. Outcomes are in Table 3. Mortality was not different between IDC vs no IDC (18 [21.4%] vs 2 [25%]); other comparisons were numerically different but not significant: repeat blood culture (98.8% vs 87.5%), echocardiography (70.2% vs 50%), CVC removal (91.7% vs 83.3%), and initial treatment echinocandin (67.9% vs 50%). All patients received antifungal therapy. IDC resulted in more ophthalmology consultations (77.4% vs 12.5%, p< 0.01). Mean modified EQUAL Candida score was higher with IDC (17.4 vs 13.9, p< 0.01).

Table 2. Patient Characteristics

Abbreviations. TPN: total parenteral nutrition, ICU: intensive care unit, AIDS: acquired immunodeficiency syndrome

Table 3. Outcomes

Abbreviations. NS: non-significant, CVC: central venous catheter

Conclusion

IDC was common in candidemic patients and not associated with significant differences in outcomes. Current antimicrobial stewardship and consultation practices at our center do not warrant mandated IDC for candidemia.

Disclosures

Trevor C. Van Schooneveld, MD, FACP, BioFire (Individual(s) Involved: Self): Consultant, Scientific Research Study Investigator; Insmed (Individual(s) Involved: Self): Scientific Research Study Investigator; Merck (Individual(s) Involved: Self): Scientific Research Study Investigator; Rebiotix (Individual(s) Involved: Self): Scientific Research Study Investigator
1006. Association of Development of Pneumonia and Virulence Gene Expression in Acinetobacter baumannii Isolated from Clinical Specimens
Authors: Bae Ji Yun , Yun Ina , Jun Kang Il , Kim Chung-Jong , Lee Mi Ae , Choi Hee Jung
Published: December 2021

Background

Not all Acinetobacter baumannii isolated from respiratory specimens are true pathogens. Distinguishing between true pathogens and colonizers is important to initiate early treatment and to reduce the unnecessary prescription of antibiotics. To determine the microbiological factors contributing to the development of A. baumannii pneumonia, we investigated the association between the expression level of known A. baumannii virulence genes such as ompA and hisF and pneumonia.

Methods

Patients in whose respiratory specimens A. baumannii was identified between January 2018 and January 2019 in a tertiary university hospital were recruited into this study. Relevant radiologic findings and more than 5 days of susceptible antibiotic prescription started within 3 days of bacterial isolation were considered as having pneumonia. The absence of radiologic findings of pneumonia until 7 days after the isolation of A. baumannii was defined as colonization. The expression of ompA and hisF was determined with quantitative reverse-transcription polymerase chain reaction. Host factors known to be associated with pneumonia and expression levels of virulent genes were compared between the groups.

Results

Overall, 246 patients in whose respiratory specimens A. baumannii was identified were recruited into this study. Among them, 17 and 24 patients were assigned to the pneumonia and colonizer groups, respectively. In the univariable analysis, ompA, ICU stay, and mechanical ventilation were significantly associated with pneumonia (p = 0.03, < 0.01, < 0.01 respectively). In the multivariable analysis, mechanical ventilation was significantly associated with pneumonia (OR = 9.75, p = 0.03). ompA expression was not significantly associated with pneumonia in the multivariable analysis (OR = 1.12, p = 0.75) (Table 1). ompA and hisF were significantly associated with the 30-day in-hospital mortality (p = 0.02, < 0.01).

Table 1. Univariable and multivariable analysis of factors related to pneumonia

Conclusion

The association between increased ompA expression in A. baumannii and the development of pneumonia was not statistically significant after adjusting for patient factors. However, the relatively high expression of ompA in pneumonia patients and their association with increased mortality suggests the need for larger-scale prospective studies to draw a conclusion.

Disclosures

All Authors: No reported disclosures
1009. Biofilm Formation in Acinetobacter Baumannii Clinical Isolates
Authors: Nowak Elizabeth , Bansal Ekta , Baffoe-Bonnie Anthony , Sriranganathan Nammalwar , Kerkering Thomas , Rao Jayasimha
Published: December 2021

Background

Multidrug resistant Acinetobacter baumannii (MDR-Ab) is a Gram-negative bacterium known for causing severe nosocomial infections, attributed in part to its formation of biofilm. Siderophore is a virulence factor known to support biofilm formation by regulating iron availability. In this study, we screened 44 isolates of MDR-Ab from our Gram-negative repository to determine the strains that phenotypically form biofilm and produce siderophore. The results were compared to Pseudomonas aeruginosa PAO1, which produces both biofilm and siderophore.

Methods

Isolates were grown overnight in minimal M9 medium supplemented with casamino acids and hydroxyquinones at 37°C. Bacterial cells were normalized (to OD 600=0.01) and a standard diluted 10-3 tube was used in the study. A 96-well plate was inoculated with 100 microliters of each isolate in quadruplicates. This process was repeated in Tygon tubes with 50 microliters of each isolate in triplicates. The plate and Tygon tubes were incubated statically for 48 hours at 30°C and then stained with crystal violet. The contents were dissolved in 33% glacial acetic acid and analyzed by spectrophotometry to measure biofilm formation. Siderophore secretion was measured in supernatants with Chrome Azurol S (CAS) reagent and production was observed on CAS agar plates.

Results

High levels of biofilm formation were observed in 8 strains of MDR-Ab in the 96-well plate (3, 4, 9, 22, 61, 1010, 1012, 1022) and 6 strains in Tygon tubes (3, 4, 16, 66, 1002, 1010) (Fig. 1). There was minimal siderophore production in MDR-Ab isolates compared to PAO1 in both the 96-well plate and Tygon tubes (Fig. 2). Only 4 strains lacked siderophore production on CAS agar and were inversely negative for the secretion in medium.

Figure 1 Biofilm formation in a 96-well plate and Tygon tubes

(A) High levels of biofilm formation were observed in MDR-Ab strain numbers 3, 4, 9, 22, 61, 1010, 1012, 1022 in the 96-well plate. (B) High levels of biofilm formation were observed in MDR-Ab strain numbers 3, 4, 16, 66, 1002, 1010 in Tygon tubes.

Figure 2 Degree of siderophore production in a 96-well plate and Tygon tubes

Siderophore production of MDR-Ab was limited compared to PAO1 after inoculation in a 96-well plate (A) and in Tygon tubes (B).

Conclusion

Many strains of MDR-Ab readily form biofilm. Overall siderophore production is lower in MDR-Ab compared to consistent production by PAO1, but this does not appear to affect MDR-Ab’s ability to form biofilm. Unlike in PAO1, biofilm formation in MDR-Ab may occur independently of siderophore production. This research serves as a basis for understanding future MDR-Ab biofilm elimination in patient catheters and indwelling devices.

Disclosures

All Authors: No reported disclosures