bluuebunny/crossref_metadata_2025 huggingface dataset:
1347. Comparison Between SARS-Cov-2, non-SARS-Cov-2 Coronavirus, Influenza and RSV Infections Among Solid Organ Transplant Recipients
Authors: Mendoza Maria A , Gabriel Motoa , Raja Mohammed , Anjan Shweta , Fernandez Anmary A , Courel Steve , Chandorkar Aditya , O’Brien Christopher , Phancao Anita , Sinha Neeraj , Vianna Rodrigo , Gaetano Ciancio , Loebe Mathias , Simkins Jacques , Camargo Jose F , Morris Michele I , Abbo Lilian M , Guerra Giselle , Natori Yoichiro
Published: December 2021

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been raging since the end of 2019 and has shown worse outcomes in solid organ transplant recipients (SOTR). The clinical differences as well as outcomes between these respiratory viruses have not been well defined in SOTR.

Methods

This is a retrospective cohort study of adult SOTR with nasopharyngeal swab or bronchoalveolar lavage PCR positive for either SARS-CoV-2, non-SARS-CoV-2 coronavirus, influenza, or respiratory syncytial virus (RSV) from January 2017 to October 2020; both inpatient and outpatient. The follow up period was up to three months. Clinical characteristics and outcomes were evaluated. Development of lower respiratory tract infection (LRTI) was defined as new pulmonary infiltrates with or without symptoms. For statistical analysis, Fischer’s exact test and log rank test were performed.

Results

During study period, 157 SARS-CoV-2, 72 non-SARS-CoV-2 coronavirus, 100 influenza, 50 RSV infections were identified. Patient characteristics and outcomes are shown in tables 1 and 2, respectively. Secondary infections were not statistically significantly different between SARS-CoV-2 vs. non-SARS-CoV-2 coronavirus and influenza (p=0.25, 0.56) respectively, while it was statistically significant between SARS-CoV-2 and RSV (p=0.0009). Development of LRTI was higher in SARS-CoV-2 when compared to non-SARS-CoV-2 coronavirus (p=0.03), influenza (p=0.0001) and RSV (p=0.003). Admission to ICU was higher with SARS-CoV-2 compared to non-SARS-CoV-2 coronavirus (p=0.01), influenza (p=0.0001) and RSV (p=0.007). SARS-CoV-2 also had higher rates of mechanical ventilation when compared to non-SARS-CoV-2 coronavirus (p=0.01), influenza (p=0.01) and RSV (p=0.03). With time to event analysis, higher mortality with SARS-CoV-2 as compared to non-SARS-CoV-2 coronavirus, influenza, and RSV (p=0.01) was shown (Figure 1).

Figure 1. Kaplan Meier Curve: Comparison of Mortality between SARS-CoV-2, non-SARS-CoV-2 coronavirus, influenza and RSV

Conclusion

We found higher incidence of ICU admission, mechanical ventilation, and mortality among SARS-CoV-2 SOTR vs other respiratory viruses. To validate these results, multicenter study is warranted.

Disclosures

All Authors: No reported disclosures
1350. Characterization of the Type of Specimen Used for Testing of Sexually Transmitted Infections in Outpatient Clinics
Authors: Sittig Katherine , Cunningham Victoria C , Rosa Rossana , Veach Lisa A
Published: December 2021

Background

Screening and diagnosis of Sexually Transmitted Infections (STIs) requires use of nucleic acid amplifications tests (NAATs) on optimal anatomical specimens. Vaginal or cervical swabs are preferred in women and first-catch urine in men. Furthermore, extra-genital testing is recommended for men who have sex with men (MSM) and for men who have sex with women (MSW) based on exposure history. Increasingly, STI care is being provided in non-STI specialized settings such as Urgent Care (UC) and Primary Care clinics (PC). Therefore, we aimed to characterize the types of anatomical specimens being utilized for the diagnosis of STIs in non-STI specialized clinics.

Methods

We conducted a retrospective analysis of all Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) tests obtained at 46 adult outpatient clinics (PC, UC and Obstetrics & Gynecology [OB/Gyn]) part of an integrated health system in Des Moines, Iowa, between January 1, 2019 and December 31, 2019. In this database, no information was available regarding patient history of sexual exposure site(s). Descriptive statistics, including counts, percentages, and differences in proportions were estimated and stratified by outpatient clinic type.

Results

We identified a total of 18,503 encounters involving 2,802 men and 15,701 women. Rates of extragenital testing were overall low, but higher in male patients (14.6%) than in female patients (0.20%). Among male patients, extra-genital testing was obtained in 21.1% of patients seen in PCs compared to 5.2% in UCs (p< 0.0001) (Table 1). Notably, 177 (50.9%) of the extra-genital samples collected at PCs were obtained at a clinic specializing in the care of MSM. Among female patients, the proportion of urine-based tests was highest in PC (32%), while non-urine genitourinary samples were more frequently obtained at Ob-Gyn clinics (92.7%) (p< 0.0001) (Table 2).

Conclusion

Extragenital site testing for GC and CT remains an uncommon practice across all clinic setting types, and high proportions of female patients evaluated at PC and UC clinics were tested using urine specimens. Our results indicate a need for effective education and implementation processes for optimal testing modalities in primary care clinics.

Disclosures

All Authors: No reported disclosures
1354. Antibiotic Resistance and Coinfections Among Women with Sexually Transmitted Infections
Authors: Carpenter Brittany L , Peacock Jacqueline D , Dubiak Kyle , Fecteau Heather , Carlson Robert
Published: December 2021

Background

Sexually transmitted infections (STIs) represent a growing epidemic, particularly among America’s youth. Traditional single or dual organism STI testing is limited in its utility compared to PCR panel-based vaginitis testing. PCR panel testing can identify up to 99% of vaginitis associated organisms, while simultaneously providing information about antibiotic resistance.

Methods

We analyzed 10,011 vaginosis panel cases released between April 2020 and May 2021. The PCR-based vaginosis panel consists of organisms associated with bacterial vaginosis, aerobic vaginitis, yeast infections, STIs, and Lactobacillus species. This panel simultaneously detects evidence of antibiotic resistance for nine classes of drugs.

Results

Of 9405 cases from vaginal swabs, 618 (6.8%) were positive for at least one STI including Chlamydia trachomatis (CT), Haemophilus ducreyi, Herpes Simplex Virus 1 or 2 (HSV2), Neisseria gonorrhoeae (NG), and/or Trichomonas vaginalis. Of 603 urine samples, 7.6% were positive for at least one STI and represented a younger population. Patients younger than age 25 (33% of the cohort) were disproportionately affected by STIs, consistent with CDC findings. About 50% of all positive STI cases were in patients under 25. Evidence of bacterial vaginosis was also present in 89% of CT and NG cases, and 75% of HSV2 cases. Strikingly, we found the presence of an antibiotic resistant marker(s) to first line treatment in 76.2% of CT and 19.3% of NG cases.

Conclusion

Our data illustrates the advantages of utilizing a PCR-panel approach to STI detection over a targeted approach for individual organisms. Coinfections with bacterial vaginosis were common and if left unidentified, patients may receive incomplete treatment. Additionally, our data suggests that antibiotic resistance testing is imperative for effective treatment planning and antibiotic stewardship in suspected STI cases.

Disclosures

Brittany L. Carpenter, PhD, NxGen MDx (Employee) Jacqueline D. Peacock, PhD, MB(ASCP)CM, NxGen MDx (Employee) Kyle Dubiak, PhD, NxGen MDx (Employee) Heather Fecteau, MS, LCGC, NxGen MDx (Employee) Robert Carlson, MD, FCAP, NxGen MDx (Employee)
1367. Management of Patients Presenting with Purulent Skin and Soft Tissue Infections in the Emergency Department (ED)
Authors: Son Andrea , Hecker Michelle
Published: December 2021

Background

Incision and drainage (I&D) is the primary treatment for purulent skin and soft tissue infection (SSTI). Empiric adjunctive treatment of purulent SSTI targets methicillin-resistant Staphylococcus aureus (MRSA). In light of increasing antibiotic resistance, culture and sensitivity (C&S) from drained specimen and consideration of the local antibiogram are recommended.1 Our primary objective was to assess the utilization of C&S from drained specimen in out institution’s ED. Our secondary objectives were to describe antibiotic choice and duration of therapy upon discharge, to evaluate the appropriateness of antibiotic choice based on C&S and local antibiogram, and to assess the need for adjunctive antibiotic based on available literatures.

Methods

A retrospective cohort study was performed on a random sample of unique patients who underwent I&D procedure in the ED from January 2019 through December 2019. Demographic and clinical data were collected from the electronic medical record.

Results

Of 120 patients evaluated, only 14 patients (11.7%) had C&S performed on the initial I&D specimen (Table 1). Five patients received inappropriate antibiotic(s) based on C&S. Of 108 patients who were discharged from ED, antibiotic(s) was prescribed in 97 patients (Table 2). Mean duration of therapy was 7.8 days with 27.8% of patients prescribed a duration of therapy longer than 7 days. Despite high clindamycin resistant rate for MRSA (35%), clindamycin was the second most prescribed antibiotic. Adjunctive antibiotic(s) may have been unnecessary in 9.5% patients. Five patients reported possible adverse reaction related to prescribed antibiotic. Additional antibiotic course was prescribed in 15 patients for the same infection. Fifteen patients were readmitted to ED within 30 days and five of them required hospital admission

Conclusion

At our institution, majority of patients were discharged after I&D with adjunctive antibiotic(s) without microbiologic testing. Despite high local clindamycin resistance, it was the second most commonly prescribed empiric treatment. Developing a clinical pathway that emphasizes the importance of timely microbiologic testing and local antibiogram consideration along with the need for appropriate adjunctive antibiotics may improve patient outcomes.

Disclosures

All Authors: No reported disclosures
1374. Clinical Outcomes of Sepsis According to Race at University of Minnesota Medical Center
Authors: Meyer-Mueller Cameron , Williams Darlisha A , Westerhaus Michael , Rajasingham Radha
Published: December 2021

Background

Sepsis is a life-threatening condition associated with significant in-hospital mortality. Sepsis disproportionately affects Black Americans and is a top-10 leading cause of death for Black people. Previous studies examining sepsis mortality rates by race have yielded inconsistent findings. This retrospective study evaluates the relationship between race and in-hospital sepsis-related mortality in adults at University of Minnesota Medical Center.

Methods

We reviewed all sepsis diagnoses in adults between January 1, 2020 and June 30, 2020 at the University of Minnesota Medical Center. Demographic information including age, sex, race, insurance status, primary language, expected and observed mortality score, discharge status, treatment information, and in-hospital mortality were also recorded. Self-reported race was categorized as African American, White, American Indian or Alaska Native, Asian, African, Hispanic or Latino, Hawaiian or other Pacific Islander, “some other race,” and “two or more races.” Statistical tests including χ  2 test, Student t test, Kaplan-Meier estimator, and binary logistic regression were performed.

Results

We identified 780 cases of sepsis. Black patients were consistently younger than White patients (median age of 50 years, compared to 61 years, p< 0.001). Black patients were more likely to have comorbidities at baseline. However, logistic regression analyses, after controlling for language, race, primary payer, and expected mortality, showed no association between sepsis outcome and race.

Sepsis Cases at UMMC between January and June 2020 by Self-Reported Race

*Other includes the categories “Some other race” and “Two or more races.”

Hospital Outcomes by Race

Patient Demographics by Race

Conclusion

While there was no significant difference between in-hospital mortality and race, Black patients were more likely to present at a younger age with more medical comorbidities than White patients.

Disclosures

All Authors: No reported disclosures
157. Impact of Pharmacist-Generated Oral Antimicrobial Test Prescription on Discharge Medication Access and Outcome
Authors: Mulugeta Surafel , Davis Susan L , Davis Susan L , Kenney Rachel
Published: December 2021

Background

Cost barriers to accessing discharge oral antimicrobials (ABX) may delay discharges and result in suboptimal discharge ABX. Use of electronic test prescriptions (eTP) or “price checks” is controversial due to potential for erroneous dispensing. This study evaluated discharge ABX access and outcome after implementation of a standardized, inpatient pharmacist-initiated ABX eTP process in collaboration with discharge pharmacy.

Methods

IRB approved, retrospective, cross-sectional cohort pilot-study. Inclusion: home bound adults admitted for ≥ 72 hours from 1/1/18-2/28/19 and discharged on oral ABX. Patients with an ABX eTP prior to discharge were compared to those discharged on ABX but no eTP. Data were reported using descriptive statistics and bivariate analysis. Primary endpoint: discharge delay after medical stability. Secondary endpoints: medication access, unplanned encounters, and % of patients discharged on first-line ABX.

Results

84 patients included: 43 no-ETP and 41 eTP. 75 ABX eTP evaluated among 41 patients. Patients in the no-eTP group had higher Charlson comorbidity index (P = 0.004) and immunosuppression (24% vs. 12%; P = 0.014). Median length of stay, days: 6 (5 – 9) eTP vs. 8 (5 – 15) no-eTP (P = 0.026). Most common eTP requested by pharmacist: linezolid (17, 23%) and oral vancomycin (12, 16%) (Figure 1). eTP results were documented in the medical record in < 24 hours for 66 (88%) of inquiries. 49 (65%) prescriptions were approved by insurance; 16 (21%) had no out of pocket cost and 8 (11%) required prior authorization (PA) (Table 1). Linezolid (5, 35%) and public insurance (10, 71%) were frequently associated with barriers. 29 (70%) patients were discharged on the same ABX as the eTP. There were no discharge delays or erroneous dispensing. 14 (33%) no-eTP and 15 (37%) eTP patients experienced unplanned healthcare encounters after discharge. 9/84 (11%) patients were discharged on suboptimal ABX. Non-white race 8/9 (89%) P = 0.047 and public insurance 8/9 (89%) P = 0.063 were associated with suboptimal discharge ABX.

Figure 1. Oral Antimicrobial Test Prescription Pattern (n=75)

Table 1. Oral Antimicrobial Test Prescription Result (n=75)

Conclusion

A standardized eTP process appears to be a safe way to evaluate out of pocket cost without prolonging length of stay. Future work will focus on inequity in access to first line ABX.

Disclosures

Susan L. Davis, PharmD, Nothing to disclose Rachel Kenney, PharmD, Medtronic, Inc. (Other Financial or Material Support, spouse is an employee and shareholder)
1381. Do Gut Microbiome Profiles Correlate with Hospital Length of Stay During Hematopoietic Stem Cell Transplantation?
Authors: Mendy Angelico , Tierney Kitty , Mink Tara , Hussein Walaa , Monaco Peter , Weinstein Claire , Kandala Prathyusha , Wilkinson Racheal , Patel Kavya , Apewokin Senu
Published: December 2021

Background

Length of stay is not only an indicator of how successful a hospitalized patient’s treatment and recovery is, but is also an indicator of fiscal costs to the hospital. Hematopoietic stem cell transplants (HSCT) patients typically experience extended hospital admissions that can vary significantly patient to patient with hospital discharge dependent upon a recovered white blood cell count. Recent literature suggests a gut microbial influence on hematopoiesis. We sought to explore potential associations between gut microbiome diversity and the length of stay in patients undergoing HSCT in the inpatient setting.

Methods

Within two healthcare systems, we identified patients who would receive conditioning chemotherapy and subsequent HSCT in the inpatient setting. Pre-chemotherapy stool was collected, sequenced with shotgun metagenomics, and analyzed for gut microbial diversity using Inverse-Simpson index. The length of admission or length of stay during their transplant process was recorded. We assessed whether there was an association with gut microbial diversity and length of stay.

Results

24 patients we evaluated for diversity and length of stay. There was no significant correlation between age or gender and length of stay. Significant difference in length of stay was seen between allogenic vs autogenic transplants (p value ≤0.01). Within the 24 patients, lengths of stay ranged from 8 to 36 days with a mean average of 20.9 days. Gut diversity ranged from 1.8 to 23.9. An overall negative association between length of stay and diversity was seen, though this was determined not statistically significant (p value 0.09).

Length of Stay correlation with pre-chemotherapy Gut Microbiome diversity

Conclusion

Our study showed no significant association between gut microbial diversity and inpatient length of stay during HSCT. Overall, a trend towards increased length of stay in patients with decreased diversity was noted. Additional studies of greater participant size are necessary to confirm or further study these findings.

Disclosures

All Authors: No reported disclosures
1384. Practice Variations in Pre-Hematopoietic Stem Cell Transplantation Infectious Disease Evaluation
Authors: Conway-Pearson Liam S , Pisano Jennifer , Sica Roberto A , McCort Margaret E
Published: December 2021

Background

Hematopoietic stem cell transplantation (HCT), and other forms of cellular therapies such as chimeric antigen receptor T cell therapy (CAR-T), while of critical therapeutic value, confers significant, long-term risk of infectious complications. Recipients would benefit from evaluation by infectious disease (ID) specialists. However, amidst many existing guidelines from ID and oncology societies, pre-transplant ID evaluation and management practices vary across US institutions. To better understand these variations and identify targets for standardization, we conducted a survey of ID and oncology providers at transplant centers in the US.

Methods

A 38-question, anonymous, voluntary, online survey was distributed via Google Forms to a professional organization e-mail list of ID providers as well as to followers of relevant Twitter accounts. Responses were collected and analyzed.

Results

A total of 51 responses were received, the majority of which (68.6%) came from ID providers. 60.8% of respondents worked at healthcare facilities with over 500 beds. 43 respondents (84.3%) reported that their center performed autologous and allogeneic HCT as well as CAR-T. 56.8% of CAR-T centers use a standardized template, compared to 70.8% of those providing HCT. For allogeneic HCT centers, 8% reported that no ID evaluation is offered; 34% reported that it is offered “sometimes.” Practices varied for treatment of latent tuberculosis infection prior to HCT: 26.5% treat “All the time;” 10.2% treat “Very rarely.” In assessing risk factors, only 63% and 54% identified HIV infection and healthcare occupation, respectively, as epidemiologic risk factors for tuberculosis infection. 59.2% answered that < 10% of patients are screened for Strongyloides. Only 5 respondents reported universal Strongyloides screening prior to transplant. COVID-19 vaccination for family is recommended “Always” by 95.5% of respondents. 25% have offered influenza vaccination to family through the transplant clinic.

Table 1

Differences in ID evaluation practices by type of cellular therapy candidate.

Table 2

Characteristics of survey respondents.

Conclusion

Practices around pre-HCT infectious disease evaluation and management are heterogenous among the centers surveyed. The adoption of standardized screening for and management of infectious diseases in this patient population would likely be beneficial.

Disclosures

All Authors: No reported disclosures
1386. Seroprevalence of Strongyloidiasis in Liver Transplant Candidates at a Tertiary-Level Hospital in Newark, NJ
Authors: Robledo Jorge , O’Shaughnessy Michael , Varughese Tilly , Finkel Diana
Published: December 2021

Background

The liver transplant center at University Hospital (Newark, NJ) is one of the busiest in northern NJ. Current guidelines for Strongyloides stercoralis (Ss) screening in solid transplant recipients recommend targeted testing. We propose a high seroprevalence of this infection in our facility given its significant percentage of foreign-born patients from Ss endemic areas such as Latin America, the Caribbean, and Africa.

Methods

Descriptive study from secondary data. We obtained the total number of Strongyloides antibody tests performed at University Hospital in the last two years (08/2018-10/2020). Subsequently, medical charts were reviewed to obtain epidemiological and clinical data.

Results

A total of 388 patients underwent screening for Strongyloides antibody, of whom 71 (18%) were positive. The test was mainly performed in male (58%) and foreign-born (55%) patients. More than half (55%) of the US-born individuals had history of travel overseas. The main reasons for testing were transplant evaluation (65%), immunosuppression (14%) and eosinophilia (9%). There was no association between transplant evaluation and seropositivity (81% vs 81%, p = 0.994). Being foreign-born was not associated with a positive test (19% vs 20%, p = 0.834), but for US-born patients, having a history of travel was associated with a positive test (33% vs 14%, p = 0.039). For the Ss positive patients, 34% had a HTLV-I/II test, 48% had at least one stool test, and 76% were given treatment.

Conclusion

There is a significant seroprevalence of Ss in our transplant candidate population, both non-foreign and foreign-born, prompting the indication for universal screening at our facility.

Disclosures

All Authors: No reported disclosures
159. Improving Antibiotic Use for Sinusitis and Upper Respiratory Tract Infections: A Virtual Visit Antibiotic Stewardship Initiative
Authors: Wasylyshyn Anastasia , Kaye Keith S , Chen Julia , Haddad Haley , Nagel Jerod , Petrie Joshua G , Gandhi Tejal N , Petty Lindsay A
Published: December 2021

Background

Asynchronous virtual patient care is growing in popularity; however, the effectiveness of virtually delivering guideline-concordant care in conjunction with antibiotic stewardship initiatives remains uncertain. We developed a bundled stewardship intervention aimed at improving antibiotic use in E-visits for upper respiratory tract infections (URTIs).

Methods

In this pre-post study, adult patients who completed an E-visit for “cough,” “flu,” or “sinus symptoms” at Michigan Medicine between 1/1/2018 and 9/30/2020 were included. Patient demographics, diagnoses, and antibiotic details were collected. The multi-faceted intervention occurred over 6 months (Figure 1).

We performed segmented linear regression to estimate the effect of the intervention on the level and trend of appropriate antibiotic use for URTI diagnosis (defined as no antibiotic prescribed) and sinusitis (defined as guideline-concordant antibiotic selection and duration). Regression lines were fit to data before (March 2019) and after (May 2019) the physician championing period.

Results

Among 5151 E-visits, the mean age was 46 years old, and most patients were female (71.3%, N=3674). 3405/5151 E-visits were for URTI. Inappropriate antibiotic use for URTI was stable in trend prior to the audit and feedback intervention (Figure 2), followed by a 12% (P-value = 0.01) decrease in inappropriate antibiotic use post-intervention. The trend in inappropriate antibiotic use continued to decrease after the intervention by 1.1%/month (P-value = 0.02) (Figure 2a).

Of 2493/5151 E-visits specifically for sinus symptoms, guideline-concordant antibiotic use was low (intercept = 8%) pre-intervention (Figure 2b). Post-intervention, there was an estimated 47% increase (P-value < 0.001) in patients receiving guideline-concordant antibiotics.

Solid line represents time of the webinar, dashed line represents time of modified questionnaire roll out and electronic medical record “nudges”, and shaded area is time of physician champion intervention. Guideline-concordant antibiotic prescribing for sinusitis included amoxicillin/clavulanate or doxycycline prescribed for a duration of 5-7 days

Conclusion

A multifaceted stewardship bundle for E-visits improved guideline-concordant antibiotic use for URTIs. Changes implemented in the EMR are most beneficial after a period of audit and feedback. This approach can aid stewardship efforts in the ambulatory care setting particularly with regards to telemedicine.

Disclosures

Tejal N. Gandhi, MD, Blue Cross Blue Shield of Michigan (Individual(s) Involved: Self): Grant/Research Support Lindsay A. Petty, MD, Nothing to disclose
1400. Pretomanid in the Treatment of Patients with Tuberculosis in the United States: the Bedaquiline, Pretomanid and Linezolid (BPaL) Accelerated Monitoring (BAM) Project
Authors: Goswami Neela , Peddareddy Lakshmi Praveena , Jereb John , Semidey Angel Colon , Darnall Elaine , Macias Patricia , Jasuja Supriya , Landers Karen , Dasgupta Shom , Oxtoby Margaret , Spitters Christopher , Dov Lana , Narita Masa , DaSilva Malini , Cropper Tracina , Gullickson Cricket , Ashkin David , Haley Connie
Published: December 2021

Background

In August 2019 the U.S. FDA approved pretomanid as part of a 6-month all-oral BPaL (bedaquiline, pretomanid, and linezolid) regimen for treating pulmonary extensively drug-resistant (XDR) or treatment-intolerant or nonresponsive multidrug-resistant (MDR) tuberculosis (TB). In the study supporting approval, 89% of patients had a favorable outcome, and all reported ≥ 1 adverse event. We describe the reported use of BPaL in the United States.

Methods

Using the 2020 CDC Report of a Verified Case of Tuberculosis (RVCT) MDR TB supplemental form, TB programs and providers submitted data for patients who began taking BPaL between Aug 1, 2019 and May 1, 2020, for retrospective descriptive analysis.

Results

Programs and providers reported 17 TB patients aged a mean of 41 years (range 23–76) who received BPaL: 11 (65%) were male; 15 (88%) were non-U.S. born; 15 (88%) had pulmonary TB disease only; two (12%) had both pulmonary and extrapulmonary disease. Of all patients, 16 had Mycobacterium tuberculosis isolated from sputum and 7 (44%) had cavitary disease. The preliminary drug susceptibilities were 8 MDR patterns, 8 pre-XDR, and 1 unreported. Three patients received BPaL as their only treatment; six first received treatment for drug-susceptible TB, and eight received other regimens for MDR TB before BPaL. Eleven (65%) patients had ≥ 1 side effect reported during any TB treatment, including peripheral neuropathy (n=5), depression (n=4), vestibular dysfunction (n=3), and vision changes (n=3). Timing related to specific TB drug use was not reported. Sixteen (94%) patients received less than the approved initial dose of 1200 mg linezolid daily, and 15 (88%) patients underwent monitoring of linezolid exposure. All 16 patients with M. tuberculosis in initial sputa converted to negative culture results within 6 months of starting treatment. At 12 months after BPaL initiation, all patients had completed treatment, without TB recurrences or deaths reported.

Conclusion

In the early period after FDA approval, most U.S. patients received BPaL off-label with an initial linezolid dose lower than the approved 1200mg yet still achieved good outcomes. Most reported patients underwent some monitoring of linezolid exposure. Monitoring of BPaL use is important and should continue.

Disclosures

All Authors: No reported disclosures
1403. Tuberculous sacroiliitis: Clinical and Imaging Characteristics
Authors: Hammami Fatma , Koubaa Makram , Chakroun Amal , Marrakchi Chakib , Smaoui Fatma , Jemaa Mounir Ben
Published: December 2021

Background

Osteoarticular tuberculosis remains a common disease among which the spine is the most affected site. Less frequently, sacroiliac joint is involved. Its diagnosis is often delayed due to misleading and varied symptoms. The aim of this work was to study the clinical features and the contribution of imaging results in the diagnosis of tuberculous sacroiliitis.

Methods

We conducted a retrospective study including all patients hospitalized in the infectious disease department for tuberculous sacroiliitis. The diagnosis was based on clinical, laboratory and radiological features.

Results

In total, we encountered 12 women with a median age of 51 [39-63] years. Three patients had a family history of tuberculosis (25%). The median diagnostic delay was 155 [48-331] days. The revealing symptoms were lower back pain (75%) and hip pain (25%) associated with fever (83.3%) and weight loss (75%). Reduced mobility was noted in 3 cases (25%). Pulmonary tuberculosis and tuberculous spondylodiscitis were associated with tuberculous sacroiliitis in 5 cases (41.7%) and 4 cases (33.3%), respectively. Tuberculin skin test was positive in 6 cases (50%). Laboratory investigations revealed elevated C-reactive protein levels in 11 cases (91.6%) and accelerated erythrocyte sedimentation rates in 9 cases (75%). Needle biopsy of the sacroiliac joint (41.7%) and soft tissues abscess puncture (16.6%) were performed. Computed tomography scan revealed joint space widening (83.3%), peripheral joint erosions (83.3%) and osteolysis (58.3%). Soft tissue abscesses were noted in 66.7% of the cases. Magnetic resonance imaging was performed in 4 cases (33.3%). Sacroiliac joint was hypointense in T1-weighted images (75%), hyperintense in T2 weighted images (50%) and in STIR images (50%). Bone scintigraphy, performed in 5 cases, revealed hyperfixation of the sacroiliac area (100%). All patients received antitubercular therapy. Percutaneous abscess drainage was indicated in 4 cases (33.3%).

Conclusion

Because of its deep localization, the diagnosis of tuberculous sacroiliitis is mainly based on imaging results associated with epidemiological, clinical and laboratory features. Antitubercular therapy initiated promptly leads to recovery.

Disclosures

All Authors: No reported disclosures
1407. The Latent Tuberculosis Infection Cascade of Care during the COVID-19 Pandemic Response in a Mid-Sized US City
Authors: Stantliff Trevor M , Houshel Lauren , Goswami Rinki , Millow Serenity , Cook Gabrielle , Knapmeyer Robin , Easton Christa , Mooney Jennifer , Huaman Moises A
Published: December 2021

Background

The COVID-19 pandemic response may unintendedly disrupt multiple public health services, including tuberculosis control programs. We aimed to assess the cascade of care of latent tuberculosis infection (LTBI) in an urban US city during the COVID-19 pandemic response.

Methods

We conducted a retrospective cohort study of adult patients who presented for LTBI evaluation at the Hamilton County Public Health Tuberculosis Clinic in Ohio between 2019 and 2020. We defined 01/2019 to 02/2020 as the pre-COVID-19 response period, and 04/2020 to 12/2020 as the COVID-19 pandemic response period. We reviewed electronic medical records and extracted sociodemographic information, medical history, and follow-up and treatment data to define steps within the LTBI cascade of care. Logistic regressions were used to assess factors associated with LTBI treatment acceptance and completion, adjusted by potential confounders and COVID-19 period.

Results

Data from 312 patients were included. There was a significant decrease in the number of monthly LTBI referrals (median, 18 vs. 8, p=0.02) and LTBI evaluations (median, 17.5 vs. 7, p< 0.01) during COVID-19. There was a decrease in the proportion of immigrants as indication for LTBI testing (30% vs. 9%; p< 0.01), and an increase in LTBI diagnoses based on interferon-gamma release assay (IGRA; 30% vs. 49%; p< 0.01) during COVID-19. The proportion of people who were recommended LTBI treatment was similar before and during COVID-19 (76% vs. 81%, p=0.41), as well as the LTBI treatment acceptance rates (56% vs. 64%, p=0.28), and LTBI treatment completion rates (65% vs. 63%, p=0.85). In multivariate analysis, LTBI treatment acceptance was associated with Hispanic ethnicity, younger age, male sex, IGRA use, no comorbidities, and non-healthcare occupation, independent of COVID-19 period. LTBI treatment completion was associated with taking a rifamycin-containing regimen, independent of COVID-19 period.

Conclusion

We observed a significant decline in the number of monthly LTBI referrals and evaluations during COVID-19. Our findings indicate an unintended negative impact of the COVID-19 response in LTBI screening efforts in our region. LTBI treatment acceptance and completion rates were not affected during COVID-19.

Disclosures

All Authors: No reported disclosures
160. Evaluation of an Intervention to Promote Guideline-Concordant Durations of Antibiotic Therapy in Two Urgent Care Centers
Authors: Shihadeh Katherine C , Vazquez Deida Axel A , Hussain Cory , Knepper Bryan C , Fish Lindsey , Breyer Michael , Zwakenberg Melody , Quinones Amy , Torok Bradley , Jenkins Timothy C
Published: December 2021

Background

Antibiotic overuse in urgent cares is common. Despite institutional guidance that recommends ≤ 5 days of therapy for most infections, a prior review found prescribed durations were often longer. This study evaluates the impact of an intervention on guideline-concordant durations of therapy.

Methods

This quasi-experimental study involved two urgent care centers (UC1 and UC2) in an integrated health care system. Prescriptions were included from January 2017 to May 2021 for patients ≥ 18 years of age for one of the following infections identified by ICD10 code: acute bacterial sinusitis, acute otitis media, cellulitis or skin abscess, COPD exacerbation, lower urinary tract infection, or pneumonia. The intervention was implemented in both urgent cares in January 2020 and included sharing baseline duration of therapy data with site directors and staff, providing in-person education on recommended durations of therapy, engaging peer champions, and posting educational flyers. An institutional smart phone application (app) with treatment recommendations for common infections was in place for the entirety of the study. The primary outcome was the proportion of antibiotic durations that were guideline-concordant during the app only and intervention periods in aggregate and by interrupted time-series analysis.

Results

On average, 1583 and 3850 antibiotic prescriptions were prescribed per year in UC1 and UC2, respectively. There was a significant increase in the proportion of guideline-concordant antibiotic prescriptions at the two sites by an absolute value of 20% (p< 0.0001) (Table). By interrupted time-series, the change in slope after the intervention was not statistically significant for UC1 (p= 0.11), UC2 (p= 0.73), or combined (p= 0.61); however, there was a significant increase in prescriptions for ≤ 5 days immediately after the intervention in UC1 (p= < 0.001) (Figure).

Conclusion

This intervention to promote institutional guideline-concordant durations of therapy resulted in a significant increase in the proportion of antibiotic prescriptions for ≤ 5 days. Preventing prolonged durations of therapy is a potentially effective strategy to reduce antibiotic overuse in urgent cares.

Disclosures

All Authors: No reported disclosures
1417. Fosfomycin Use in the Treatment of Complicated Urinary Tract Infections at a Veterans Affairs Medical Center
Authors: Lee Ryan , Tran Thuong , Tan Susanna
Published: December 2021

Background

The prevalence of multidrug resistant gram-negative urinary tract infections (UTIs) is increasing, often requiring intravenous antimicrobial therapy. Oral fosfomycin is a recommended alternative agent for the treatment of cystitis caused by extended spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli). The primary objective of this study is to evaluate the efficacy of fosfomycin in the treatment of UTIs at the Veterans Affairs Long Beach Healthcare System. The secondary objective is to assess the incidence of adverse drug reactions associated with fosfomycin.

Methods

This is a retrospective, single-center, cohort study. Patients who received fosfomycin between June 1st, 2015 – June 30th, 2020 were included. Data collection was completed by chart review through the Computerized Patient Record System (CPRS). Descriptive analysis was used to evaluate data. Treatment outcomes were analyzed using a composite of clinical and microbiological cure. Clinical cure was defined as resolution of UTI symptoms. Microbiological cure was defined as urine sterilization within 1 month after completing treatment course with fosfomycin.

Results

A total of 62 unique patients were evaluated in this study. The mean age was 71.9 years. 56 patients (90.3%) were male, 31 patients (50.0%) had an indwelling catheter present at the time of treatment, and 48 patients (77.4%) had the presence of genitourinary tract pathology that may increase the risk of developing UTIs. Majority of patients (50%) had a urine culture result positive for E. coli prior to treatment, of which 43.5% were ESBL-producing. 60 patients (96.8%) received more than 1 dose of Fosfomycin. Out of 29 patients who were eligible to be evaluated for clinical outcomes, 20 patients (68.9%) met a positive composite outcome of either microbiological cure, clinical cure, or both. 4 patients (6.5%) experienced an adverse drug reaction of diarrhea that was self-limited.

Conclusion

Fosfomycin is an effective and well-tolerated antimicrobial agent that may be considered for treatment of complicated UTIs without evidence of pyelonephritis or bacteremia caused by multi-drug resistant organisms in the veteran population.

Disclosures

All Authors: No reported disclosures
1424. Short-Course Antibiotic Therapy for Urinary Tract Infection (UTI) in the NICU: It’s Safe and Effective!
Authors: Magers Jacqueline , Prusakov Pavel , Speaks Sunday , Sanchez Pablo J
Published: December 2021

Background

Antibiotic overuse in the neonatal intensive care unit (NICU) has been associated with adverse patient outcomes such as necrotizing enterocolitis (NEC), late-onset sepsis, invasive candidiasis, bronchopulmonary dysplasia, neurodevelopmental impairment, and death. On 11/2020 at Nationwide Children’s Hospital, Columbus, OH, the Neonatal Antimicrobial Stewardship Program Committee recommended 5 days of antibiotic therapy with a subsequent antibiotic “timeout” for uncomplicated UTI without bacteremia as part of ongoing efforts to reduce antibiotic exposure among high risk infants in 7 Level 2/3/4 NICUs.

Methods

Retrospective review of all infants who received antimicrobial therapy for UTI after implementation of a UTI Diagnosis and Management Protocol. Twice weekly NEO-ASP meetings provided prospective audit and feedback to neonatologists on appropriate antibiotic therapy and duration. Pertinent clinical, laboratory, and outcome data were obtained from the infants’ electronic health record. Safety measure evaluated include recurrence of infection with the same previously identified pathogen in the fourteen days after discontinuation of antibiotic therapy and mortality.

Results

Since implementation of the UTI protocol, 28 infants (median gestational age, 28 wk [IQR, 26-30 wk; median birth weight, 1203 g [IQR, 731-1801 g]) received antimicrobial therapy for treatment of a UTI at a median age of 50 days (IQR, 28-69 days). The most frequent pathogens were E. coli (n=8), K. pneumoniae (n=5), and Enterobacter spp. (n=4). Median duration of antibiotic therapy was 6 calendar days (IQR, 5-6 days). Only 1 (4%) infant had antibiotic therapy restarted within 14 days of discontinuation of initial therapy; infant had fever but blood, urine, and CSF cultures were sterile and antibiotic therapy was discontinued after 48 hours. One (4%) infant (23 wk gestational age) died at 6 weeks of age from NEC totalis not related to the previous UTI. 22 (81%) infants have been discharged home while 6 remain in the NICU.

Conclusion

Our preliminary data suggests that short course antibiotic therapy (with a timeout) < ![if !supportAnnotations] >[SP1]< ![endif] > for uncomplicated UTIs in the NICU is an effective and safe therapy that ultimately may lead to less antibiotic exposure among high risk infants.

Disclosures

All Authors: No reported disclosures
1430. Descriptive Epidemiology of Emergency Department Visits with cUTI in the US, 2012-2018
Authors: Zilberberg Marya , Nathanson Brian , Sulham Kate , Shorr Andrew F
Published: December 2021

Background

Urinary tract infections (UTI) represent a substantial burden to the healthcare system. In the early 2000s annual UTI admissions numbered 100,000, and these infections resulted in over 1 million emergency department (ED) visits. While only a fraction of total UTI volume, the estimated cost of complicated (cUTI) to the healthcare system exceeded &3.5 billion. We set out to evaluate the contemporary burden of cUTI in the US in terms of ED visits annually.

Methods

We conducted a retrospective multicenter cohort study within the National Emergency Department (NEDS) database, a 20-percent stratified sample of all US hospital-based EDs, from 2012-2018, to explore characteristics of patients discharged with a cUTI diagnosis. We applied a previously published algorithm to identify cUTI using administrative coding. We applied survey methods to develop national estimates.

Results

Among 3,010,997 ED visits with cUTI, 43.3% were female, and 59.0% were age 65 years or older. Commensurately, Medicare was the primary payor in 62.8% of the visits. The majority of the patients (59.1%) presented to metropolitan teaching hospitals, and plurality were in the Southern US (39.6%). There was a narrow range in the visits’ seasonal variation, from 6.4% occurring in February to 7.9% in October. cUTI was the principal diagnosis in 48.5% of all cUTI visits. In the remaining 51.5%, sepsis was the most common principal diagnosis (33.9%), but severe sepsis and septic shock codes each appeared in 4.9%. Of all cUTI ED visits, 21.4% had catheter-associated UTI. While only 19.8% had a code for pyelonephritis, 2,050,548 (68.1%) were admitted to the hospital. Mortality in the ED was 0.02%.

Conclusion

During the seven-year span, there were over 3 million ED visits for cUTI. Although fewer than 1 in 10 patients met criteria for severe sepsis/septic shock, approximately 2/3rds of cUTI patients presenting to the ED were subsequently hospitalized.

Disclosures

Marya Zilberberg, MD, MPH, Cleveland Clinic (Consultant)J&J (Shareholder)Lungpacer (Consultant, Grant/Research Support)Merck (Grant/Research Support)scPharma (Consultant)Sedana (Consultant, Grant/Research Support)Spero (Grant/Research Support) Brian Nathanson, PhD, Lungpacer (Grant/Research Support)Merck (Grant/Research Support)Spero (Grant/Research Support) Kate Sulham, MPH, Spero Therapeutics (Consultant) Andrew F. Shorr, MD, MPH, MBA, Merck (Consultant)
1436. Overview of ESBL Enzyme Producing Infections and UTIs
Authors: Patel Premalkumar M , Rehman Aliya , Porras Angel , Rapaka Samuel , Tuda Claudio
Published: December 2021

Background

Extended-spectrum beta lactamase (ESBL) enzymes are plasmid-mediated, rapidly emerging and complex thereby posing a major therapeutic challenge in the management of urinary tract infections (UTIs) in community and hospital settings. In 2017, there were an estimated 197,400 cases of ESBL-producing Enterobacterales among hospitalized patients and 9,100 estimated deaths in the United States.

Methods

We conducted a retrospective cohort study using a publicly accessible National Inpatient Sample (NIS) database from October 2015 to December 2017. Adult patients (age >/= 18 years old) with UTI as a principal diagnosis were included. SAS 9.4 was used for univariate and multivariate linear. Logistic regression statistical analyses were used to compare mean age at the time of admission, length of stay, in-hospital mortality, hospitalization costs, and Elixhauser comorbidity indices.

Results

Of the total 5,776,156 patients included in the study, 52,765 patients had ESBL-enzyme induced UTIs. 66% were females and 34% were males. 63.3% were Caucasian, 11.6% were African-American, 18.8% were Hispanic, and 4.4% were Asian or Pacific Islander. The most common comorbidities were renal failure (22.8%), diabetes mellitus with complications (20.8%), congestive heart failure (20.5%), chronic lung disease (20.0%), neurological diseases (17.8%), obesity (12.6%), paralysis (12.5%), and depression (11.5%). In-hospital mortality was 2.5% (p< 0.0001), which was most likely due to the underlying co-morbidities. In patients without ESBL-enzyme induced UTIs, average length of stay was 7.8±8.5 days, and economic burden was &16,166.8 ± &21,183.5 USD. In comparison, patients with ESBL-enzyme induced UTIs had in-hospital mortality of 3.9%, average length of stay of 7.0 ± 9.7 days, and economic burden of &15,793.3 ± &29,268.6 USD.

ESBL and UTI data analysis image 1

ESBL and UTI data analysis image 2

Conclusion

We found that ESBL-enzyme-producing UTIs have statistically significant prolonged length of stay and economic burden, though in hospital mortality rate is low. This could be due to judicious use of antimicrobial therapy. There is a need for further research, as well as increased antimicrobial stewardship for UTIs, a globally recognized major cause of nosocomial acquired infections.

Disclosures

All Authors: No reported disclosures
1444. Influenza Surveillance in the Veterans Health Administration (VHA): 2020-2021 Season
Authors: Lucero-Obusan Cynthia A , Schirmer Patricia , Oda Gina , Holodniy Mark
Published: December 2021

Background

Veterans Health Administration’s (VHA) large elderly population is at higher risk for influenza complications, including hospitalization and death. Herein we summarize VHA’s national annual surveillance data for seasonal influenza activity and vaccinations.

Methods

Influenza telephone triage, influenza-like-illness (ILI) encounters and antiviral prescriptions plus outpatient visits, laboratory testing, hospitalizations and deaths for influenza were obtained from VHA data sources (9/27/20-5/22/21) and compared to prior years and CDC FluView data. Influenza vaccinations were captured from 8/1/2020. Vaccination rates were calculated based on VHA users during the fiscal year.

Results

Surveillance metrics are presented (Table). Vaccinations were decreased and ILI was below average (0.3%-0.7% per week). Activity was highest 2020 Weeks 46-47 but remained low the entire season with no distinct peak seen, matching national influenza activity (Fig. 1). Testing revealed 161 influenza positives from 440,553 tests performed (0.04%). Hospitalizations among laboratory-confirmed cases were similar to the prior season (16% vs 17%). Median length of stay (6 days) and deaths (17, 12%) were increased over prior seasons. Among 15 deaths where results were available, 4 had Influenza A, 10 had Influenza B and 1 had Influenza A+B. Nine were co-infected with COVID-19. Total influenza positives, outpatient visits, hospitalizations and antiviral use were extremely low compared to all prior season where national VHA data has been analyzed (Table, Fig. 2).

Conclusion

Overall, influenza vaccination levels were decreased although percent receiving high-dose formulation was stable. Despite lower vaccination rates, the 2020-21 influenza season was of historically low activity, even with markedly increased testing performed in the setting of multiplex tests for influenza with COVID-19. Deaths were primarily seen with Influenza B and among those co-infected with COVID-19. This may also have contributed to increased length of stay. VHA influenza activity continues to track closely with national CDC data and may have been impacted by mitigation measures used to contain COVID-19, which were likely effective in curbing influenza activity.

Disclosures

All Authors: No reported disclosures