bluuebunny/crossref_metadata_2025 huggingface dataset:
1168. Are the Staphylococcus aureus Isolates that Recolonize Infants in a NICU Following Successful Decolonization the Same or Different from the Initial Colonizing Isolate?
Authors: Rubin Lorry G , Balamohan Archana , Gomez-Simmonds Angela , Boyar Vitaliya , Chong Alexander , Uhlemann Anne-Catrin
Published: December 2021

Background

Staphylococcus aureus is an important pathogen of infants in a neonatal intensive care unit (NICU). Colonization precedes infection and decolonization may prevent infection. The origin of colonizing organisms may be the NICU environment or personnel or visitors. We have observed infants who became recolonized after successful decolonization. The purpose of this study was to determine the proportion of infants who become recolonized with the same strain or a different strain.

Methods

Eligible infants were consecutive infants who 1. were colonized with methicillin-susceptible S. aureus and were successfully decolonized with topical mupirocin ointment (nares and umbilicus) as evidenced by 2 or more consecutive negative weekly surveillance cultures (in the absence of a course of systemic antibiotics with activity against MSSA), 2. subsequently became recolonized, and 3. the pair of isolates was available for analysis. Isolates were analyzed by staphylococcal protein A (spa) typing and pairs with concordant spa types were subjected to whole genome sequencing (WGS; Illumina MiSeq) and phylogenetic analyses. Pairs of isolates with fewer than 25 single nucleotide polymorphism differences were considered closely related.

Results

There were 19 occurrences of MSSA recolonization in 17 infants following 2-6 (median, 2) negative weekly intervening surveillance cultures. Based upon spa typing (that identified 19 spa types), in 11 (58%) there was a concordant spa type and in 8 (42%) there was a discordant spa type. Of the 11 pairs of isolates with concordant spa types that were compared after WGS, 10 were closely related resulting overall in recolonization with a closely related strain in 53% of episodes.

Conclusion

Among MSSA colonized infants who become recolonized after successful decolonization, the recolonizing strain is the same as the original strain in over half of cases. In such cases the source is more likely to be a visitor than the NICU environment or staff. The possibility that some cases classified as recolonization were in fact persistent low level colonization or carriage in another body site not detected by surveillance cultures cannot be excluded.

Disclosures

Anne-Catrin Uhlemann, MD, PhD, Merck (Grant/Research Support)
137. Risk Factors of B-lactams Associated Cytopenias during Outpatient Parenteral Antimicrobial Therapy: Results from a Large National Sample
Authors: Hamad Yasir , Nickel Katelin B , George Ige , Burnett Yvonne J , Olsen Margaret A
Published: December 2021

Background

Cytopenias are rare complications of prolonged beta-lactam use; however, incidence and associated risk factors are not well described.

Methods

Patients aged 18-64 years in the 2010-2016 IBM MarketScan Commercial Database discharged from the hospital on cephalosporin, penicillin, or carbapenem outpatient Parenteral Antimicrobial Therapy (OPAT) were included. The primary endpoint was hospital admission coded for neutropenia, leukopenia, or thrombocytopenia within the first 6 weeks post index discharge and within 7 days of beta-lactam discontinuation. Patients with history of malignancy and those who are on chemotherapy were excluded. Significant factors in univariate analysis were incorporated into a multivariable logistic regression model with sequential exclusion of variables with p > 0.1.

Results

A total of 35,102 patients received beta-lactam OPAT; median age was 52 years and 53.6% were male. The primary outcome occurred in 150 (0.43%) patients at a median of 19 days (IQR 10-28 days after index discharge), which included 63 (0.18%) neutropenia, 85 (0.24%) thrombocytopenia, and 23 (0.07%) leukopenia admissions. Factors independently associated with readmission cytopenias included chronic liver disease (OR 4.61 [CI 2.93-7.25]), valvular heart disease (2.69 [1.71-4.24]), receipt of vancomycin (2.10 [1.42-3.12]), or antifungal therapy (4.42 [2.01-9.68]); lower risk was associated with carbapenem therapy (0.49 [0.32-0.75]) and diabetes (0.48 [0.31-0.74]) (Table 1).

Conclusion

Readmissions with cytopenias during beta-lactam OPAT were rare and carbapenem use was associated with lower risk compared to other classes of beta-lactams. Combination of beta-lactam with vancomycin was associated with an increased risk of cytopenias, and those patients might benefit from closer monitoring.

Table 1. Factors Associated with Cytopenias during Beta-Lactams Outpatient Parenteral Antimicrobial Therapy (OPAT)

Disclosures

Margaret A. Olsen, PhD, MPH, Pfizer (Consultant, Research Grant or Support)
1185. Oseltamivir Prescribing Patterns for Infants with Influenza and Factors Associated with Guideline Adherence
Authors: Zaheer Haniah A , Chamseddine Sarah , Liu Hui , Williams John V , Martin Judith M , Rick Anne-Marie
Published: December 2021

Background

The Centers for Disease Control and Prevention (CDC) recommends oseltamivir be given to children < 2 years old with confirmed or suspected influenza as they are at high risk for complications. We sought to analyze oseltamivir prescribing patterns and to describe factors associated with adherence and non-adherence to CDC guidelines.

Methods

We used a retrospective cohort of infants ≤ 12 months old born from January 1, 2011 to December 31, 2019 within the University of Pittsburgh Medical Center health system in Southwestern Pennsylvania and who had ≥ 2 well-child visits during their first year. Infants with laboratory-confirmed influenza from January 1, 2011 to April 30, 2020 were included. Electronic health records were reviewed to describe oseltamivir prescriptions and influenza-related characteristics. Factors associated with adherence and non-adherence to CDC influenza treatment guidelines were assessed with univariate logistic regression.

Results

Of 422 infants with laboratory-confirmed influenza, 86% were prescribed oseltamivir. The proportion of infants prescribed oseltamivir increased from an average of 63% during 2011-2016 to 90% during 2016-2020 (OR:5.2; 95%CI: 2.9-9.5). 96% of prescriptions instructed twice daily dosing, 2% had once daily, and 2% were unknown frequency. 91% of prescriptions were for 5 days, 7% had no duration, and 2% were for > 5 days. Infants ≥ 6 months of age compared to < 6 months were less likely to be prescribed oseltamivir (83.3% vs. 100%; p< 0.001); tested for influenza in the emergency room/urgent care (OR: 0.3; 95%CI: 0.2-0.6), or admitted to the hospital (OR:0.5; 95%CI:0.2-0.9). Infants were more likely to be treated with oseltamivir if they had a known influenza positive contact (OR:2.3; 95%CI:1.0-5.2) or had fever ≥ 38.0C (OR:2.0; 95%CI:1.2-3.5). There was no difference in prescribing practices based on history of prematurity or chronic medical conditions.

Conclusion

Adherence to CDC influenza treatment guidelines for infants is high and has improved over time. However, targeted education at high-risk contact points may further improve guideline adherence.

Disclosures

John V. Williams, MD, GlaxoSmithKline (Advisor or Review Panel member, Independent Data Monitoring Committee)Quidel (Advisor or Review Panel member, Scientific Advisory Board) Judith M. Martin, MD, Merck Sharp and Dohme (Consultant)
138. Tele-COVID Rounds and Tele-Stewardship Surveillance Reduces Antibiotic Use in COVID-19 Patients Admitted to 17 Small Community Hospitals
Authors: Veillette John J , Shealy Stephanie C , Gelman Stephanie , Stenehjem Edward A , Throneberry Steven K , Pirozzi Michael , Webb Brandon J , Waters Dustin , Stanfield Valoree K , Grisel Nancy A , Vento Todd J
Published: December 2021

Background

Early bacterial co-infection is rare in hospitalized COVID-19 patients, yet antibiotics are commonly prescribed. Antibiotic stewardship (AS) intervention is needed, especially in small community hospitals (SCHs), which often lack access to AS expertise.

Methods

We implemented daily remote multidisciplinary tele-COVID rounds (synchronous case review between SCH providers and ID clinicians) and tele-stewardship surveillance (ID pharmacist review of COVID patients on antibiotics) on 6/24/2020 in 17 SCHs. We retrospectively included adult symptomatic COVID-19 admissions between 3/2020 and 4/2021. The primary outcome was early use of antibiotics for pneumonia (started within 48 hours of admission); mean monthly days of therapy per 1,000 patient days (DOT) were compared pre- (3/2020-6/2020) and post-intervention (7/2020-4/2021). Secondary outcomes were early use of antibiotics for any indication, estimated days of antibiotics avoided (comparing pre- and post-intervention DOT), and in-hospital mortality. Analyses were conducted using a two-tailed unpaired t-test (antibiotic use) or Fisher’s exact test (mortality).

Results

Of the 1,976 patients included (124 pre- vs. 1852 post-intervention), 55.4% were male and 85.5% were white. Patients in the pre-intervention group were more likely to require hospital transfer [21.8% vs 8.8% (p< 0.001)] and ICU admission [18.5% vs. 9.7% (p=0.003)]. We observed a significant decrease in mean use of early antibiotics for pneumonia [656.9 vs. 240.1 DOT (p< 0.001)], including among non-ICU patients only [603.6 vs 240.2 DOT (p< 0.001)]. Early antibiotic use for any indication also decreased [686.2 vs. 359.3 DOT (p< 0.001)]. An estimated 3,697 days of unnecessary antibiotics for pneumonia were avoided in the 10-months post-intervention [370 days per month (95% CI 304 – 435)]. Unadjusted in-hospital mortality was not different pre- vs post-intervention (0.8% vs. 2.0%, p=0.511), but was higher among those prescribed early antibiotics (4.4% vs 0.5%, p< 0.001).

Conclusion

A significant, sustained reduction in antibiotic use among COVID-19 patients at 17 SCHs was observed after implementation of tele-COVID rounds and tele-stewardship surveillance without an observed difference in mortality.

Disclosures

All Authors: No reported disclosures
1196. A Multi-faceted, Iterative Program to Increase COVID-19 Vaccine Uptake in a Midwestern HIV Clinic
Authors: Bares Sara H , Carr Rachelle , Jones Samantha L , Regan Nichole N , Orduna Valentina , Cramer Daniel W , Tran Christine D , Fadul Nada
Published: December 2021

Background

The National Institutes of Health Office of AIDS Research recommend that patients with HIV be prioritized for COVID-19 vaccination due to high rates of co-morbidities and sociodemographic risk factors that place them at increased risk for severe disease. However, COVID-19 vaccines were not distributed specifically to those in high-risk medical categories in Nebraska, and HIV clinics were not included in the state’s COVID-19 vaccine delivery system. As a result, barriers to vaccine uptake emerged and interventions to mitigate them were needed.

Methods

A multi-faceted and iterative program aimed at improving COVID-19 vaccine uptake was implemented at the University of Nebraska Medical Center’s (UNMC) HIV clinic in Omaha, Nebraska in January 2021. A multidisciplinary task force was established in late January 2021 and met on a weekly basis to provide staff and patient education, linkage to vaccines, and review and analysis of vaccine completion rates as shown in the figure. Outreach interventions were continuously revised based on patient and staff feedback as well as updated data and vaccine availability.

Multidisciplinary COVID-19 Task Force Overview

Overview of the outreach interventions and activities conducted by the COVID-19 task force

Results

All 1188 patients of the UNMC HIV clinic were ultimately eligible for the COVID-19 vaccine, but availability was on a rolling basis by age group, profession, county, and, ultimately, co-morbidities. 76% were male, 45.8% non-white, median age 48, and 73% had income less than 400% of federal poverty level. Of the 1188 eligible patients, 63.1% (n=751) had received at least one dose the COVID-19 vaccine and 59.3% (n=705) had completed the COVID-19 vaccine series by June 4, 2021. In comparison, 49.32% of the population of the state of Nebraska had initiated the COVID-19 vaccine series and 43.12% had completed the vaccine series by that date. Among our clinic patients, 27.9% (n=261) of those who had received at least one vaccine were assisted by our task force. 4.5% were noted to have a potential barrier at the time of outreach and these included hesitancy (3.5%), language (1.2%) and transportation (0.9%).

Conclusion

A multi-faceted and iterative program to improve COVID-19 vaccine uptake in a high-risk patient population resulted in high rates of vaccine completion.

Disclosures

Sara H. Bares, MD, Gilead Sciences (Grant/Research Support)Janssen (Grant/Research Support)ViiV Healthcare (Grant/Research Support)
1200. Healthcare Claims-Based Lyme Disease Case-Finding Algorithms in the United States: A Systematic Literature Review
Authors: Nam Young Hee , Willis Sarah J , Mendelsohn Aaron , Forrow Susan , Brown Jeffrey , Gessner Bradford D , Stark James , Pugh Sarah
Published: December 2021

Background

Lyme disease (LD) is the fifth most common notifiable disease in the US with 30,000-40,000 LD cases reported annually via public health surveillance. Recent healthcare claims-based studies utilizing case-finding algorithms estimate national LD cases are >10-fold higher than reported by surveillance. The reliability of claims-based data depends on the accuracy of the case-finding algorithms using the information available in the claims primarily generated for the administrative purposes. To assess the true burden of LD, it is imperative to use validated well-performing LD case-finding algorithms (“LD algorithms”). We conducted a systematic literature review to identify LD algorithms based upon healthcare claims data in the US and their respective performance.

Methods

We searched PubMed and Embase for articles published in English from January 1, 2000 through the most recent date as of February 20, 2021. We selected articles including all of the following search terms: (1) “Lyme disease”; (2) “claim*” or “administrative* data”; and (3) “United States” or “the US*”. We then reviewed the titles, abstracts, and full texts to identify articles describing LD algorithms developed for claims data. Figure 1 shows the flow diagram following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Results

We found 15 articles meeting the inclusion criteria. Of these, 7 study algorithms used only LD diagnosis codes (ICD-9, 088.81; ICD-10, A69.2 or A69.2x), 4 studies additionally used antibiotic dispensing records, and 4 studies additionally used serologic test order codes (CPT 86617, 86618). Three studies used different algorithms for inpatient and outpatient settings. Only one study (in Tennessee, a low-incidence state for LD) provided validation results for their algorithm, which only used a LD diagnosis code (ICD-9, 088.81), with reported sensitivity=50% and positive predictive value=5%.

Conclusion

Validation data on the LD algorithms developed for healthcare claims data are limited, and suggest algorithms using only LD diagnosis codes may not perform well. Further validation of high-performance claims-based LD algorithms is critical to inform the true burden of LD overall and within subgroups.

Disclosures

Bradford D. Gessner, MD, MPH, Pfizer Inc. (Employee) James Stark, PhD, Pfizer Inc. (Employee) Sarah Pugh, PhD, Pfizer Inc. (Employee)
1210. Recommendations for Screening and Diagnosis of Chagas Disease in the United States
Authors: Forsyth Colin , Manne-Goehler Jen , Manne-Goehler Jen , Bern Caryn , Whitman Jeffrey , Edwards Morven S , Hochberg Natasha , Marcus Rachel , Beatty Norman , Castro Yagahira , Coyle Christina , Granados Paula Stigler , Hamer David H , Maguire James , Gilman Robert , Meymandi Sheba
Published: December 2021

Background

Over 300,000 people in the United States are infected with Trypanosoma cruzi, the protozoan parasite that causes Chagas disease (CD). Only about 1% of estimated U.S. cases have been identified, usually through blood donor screening, and most people are unaware they have the infection. Screening is critical for increasing case detection and ensuring patients receive appropriate and timely care, but awareness of CD management strategies among healthcare providers is low. Diagnostic guidelines for CD in the United States are needed to increase provider-directed screening and diagnosis.

Methods

Screening recommendations were prepared by the U.S. Chagas Diagnostic Working Group, which consists of clinicians, researchers, and public health experts involved in CD programs. The group agreed on six main questions based on the PICO method (Population, Intervention, Comparison, and Outcome). Subgroups discussed each and proposed initial recommendations, which were then shared and validated within the larger group. The recommendations used the GRADE methodology, assigning two sets of ratings: 1) strength of the recommendation, and 2) quality of the evidence.

Results

The group recommended screening anyone who was born or lived for >6 months in South America, Central America and Mexico (Figure 1). Recent community-based studies found a prevalence of 1-3.8% in this population. Within this population, having a family member with CD, or having clinical conditions suggestive of CD, including electrocardiographic abnormalities, suggest an elevated risk. Screening women of childbearing age and infants born to seropositive women is important for preventing congenital transmission. Test performance may vary depending on several factors, including whether patients are from South America, Central America or Mexico. Confirmation therefore requires positive results on at least two serological tests based on different antigens or formats, in line with Pan American Health Organization (PAHO) recommendations. Once CD is confirmed, patients should receive an electrocardiogram and echocardiogram to monitor for development of cardiac complications.

Conclusion

These CD screening recommendations are meant to be a resource for U.S. healthcare providers to simplify testing of at-risk patients.

Disclosures

Jen Manne-Goehler, MD, DSc, Regeneron (Individual(s) Involved: Self): Scientific Research Study Investigator Caryn Bern, MD, MPH, UpToDate (Wolters Kluwer) (Other Financial or Material Support, Author Royalties)
1221. Genomic Factors Affecting the Efficacy of Antimicrobial Therapy in Daptomycin-, Linezolid-, Vancomycin-Resistant Enterococcus faecium (DLVRE)
Authors: Gatesy Samuel W , Pincus Nathan B , Moore William Justin , Al-Heeti Omar , Joshi Tejas , R Bachta Kelly E
Published: December 2021

Background

Nosocomial acquisition of vancomycin-resistant Enterococcus (VRE) is one of the most challenging problems in healthcare. As Enterococcus isolates are increasingly resistant to vancomycin, clinicians now rely on alternative antimicrobial therapies including linezolid and daptomycin (DAP) to treat infections. For multidrug-resistant (MDR) VRE, combination therapy with beta-lactams and daptomycin has been shown to be effective.

Methods

Following initiation of empiric DAP and ceftaroline (CPT) for an MDR E. faecium bloodstream infection (VRE_001), we aimed to determine if there existed in vitro synergy between both agents that supported their clinical use. Combination synergy testing was performed using E-test strips and minimal inhibitory concentrations (MICs) were read at 24 hours. For whole genome sequence-based analysis (WGS), genomic DNA from VRE_001 was used for both short read (Illumina MiSeq) and long-read sequencing (MinION, Nanopore). The complete genome was assembled and the NCBI AMRFinderPlus program used to identify known resistance mechanisms.

Results

Original MICs of VRE_001 from the clinical microbiology laboratory at Northwestern Memorial revealed an MDR E. faecium (Table 1). Combination synergy testing in the experimental laboratory revealed only modest amounts of synergy between CPT and DAP (Table 2). Following WGS, VRE_001 was identified as an ST-584 E. faecium with a 3.2 Mbp genome, including a single chromosome and five plasmids. WGS analysis revealed several mechanisms of antimicrobial resistance (Table 3) genetically supporting the observed MDR-DLVRE phenotype.

Conclusion

Our investigational antimicrobial testing allowed for real-time in vitro analysis of synergistic MICs in a case of DLVRE bacteremia. Despite the fact that in vitro testing of CPT and DAP did not support the clinical usage of combination antimicrobial therapy, the patient cleared their blood cultures. WGS of VRE_001 revealed a plethora of antimicrobial resistance mechanisms including three mutations that explain high levels of DAP resistance. Synergy testing is not routinely available in most clinical laboratories, but rapid implementation of investigational MIC testing paired with genomic analysis may one day successfully support real-time clinical decision making.

Disclosures

All Authors: No reported disclosures
1253. Antimicrobial Activity of Cefepime in Combination with Taniborbactam Against Clinical Isolates of Enterobacterales from 2018-2020 Global Surveillance
Authors: Hackel Meredith , Wise Mark G G , Sahm Daniel F
Published: December 2021

Background

Taniborbactam (formerly VNRX-5133) is a novel cyclic boronate-based broad-spectrum β-lactamase inhibitor with potent and selective direct inhibitory activity against both serine- and metallo-β-lactamases (Ambler Classes A, B, C and D). Taniborbactam restores the activity of cefepime against many difficult to treat organisms, including cephalosporin- and carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa. The activity of the investigational combination cefepime-taniborbactam (FTB) and comparator agents was evaluated against clinical isolates of Enterobacterales from a 2018-2020 global surveillance study.

Methods

MICs of cefepime with taniborbactam fixed at 4 µg/mL and comparators were determined following CLSI M07-A11 guidelines against 10,543 Enterobacterales. Isolates were from community and hospital infections collected from 259 sites in 56 countries in 2018-2020. Resistant phenotypes were based on 2021 CLSI breakpoints. A set of 827 isolates with meropenem MIC ≥4 µg/mL (n=421) or with cefepime and/or ceftazidime MIC ≥2 µg/mL (n=406) was evaluated for the presence of MBLs, KPC, ESBLs, and OXA-48 group genes via PCR and sequencing. Forty-eight isolates with FTB MIC values of 16 µg/mL or greater were interrogated by WGS.

Results

Overall, 23.0% and 15.9% of isolates were nonsusceptible (NS) to cefepime and piperacillin-tazobactam (TZP), respectively (Table). FTB had potent activity against all Enterobacterales, with MIC50/90 values of 0.06/0.25 µg/mL and 99.5% inhibited at ≤8 µg/mL. FTB maintained activity against MBL-, KPC-, OXA-48 group, and ESBL-positive isolates (MIC90 range, 1 to >16 µg/mL; 80.5% to 100% inhibited at ≤8 µg/mL). Isolates with elevated FTB MICs had IMP-type enzymes, variation in the cefepime target (penicillin binding protein 3), permeability defects in combination with acquired β-lactamases, and/or possible up-regulated efflux.

Results Table

Conclusion

Taniborbactam significantly restored the in vitro activity of cefepime against Enterobacterales, including isolates nonsusceptible to recently-approved BL/BLI combinations and expressing serine and metallo-β-lactamases. This support the continued development of FTB as a potential new treatment option for challenging infections due to resistant Gram-negative pathogens.

Disclosures

Meredith Hackel, PhD MPH, IHMA (Employee)Pfizer, Inc. (Independent Contractor) Mark G G. Wise, PhD, IHMA (Employee)Pfizer, Inc. (Independent Contractor) Daniel F. Sahm, PhD, IHMA (Employee)Pfizer, Inc. (Independent Contractor)
1257. Re-Evaluation of Cefepime or Piperacillin-Tazobactam to Decrease Use of Carbapenems in ESBL-Producing Enterobacterales Urinary Tract Infections (REDUCE-UTI)
Authors: Branton Alexander C , Vu Catherine H , Veena Venugopalan , Santevecchi Barbara A , Ramphal Reuben , Cherabuddi Kartikeya , Manohar Tanvi , Rodriguez David , Tello Andrea , DeSear Kathryn
Published: December 2021

Background

Carbapenems (CBP) are considered first-line for infections caused by extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E). However, recent literature suggests that cefepime (FEP) and piperacillin-tazobactam (TZP) may produce similar outcomes vs. CBPs for the treatment of ESBL-E urinary tract infections (UTIs). The goal of this study was to determine if non-carbapenem (NCBP) therapy with FEP or TZP is as effective as CBPs for the treatment of ESBL-E UTIs.

Methods

This was a retrospective observational study of patients admitted to the hospital from January 1st, 2016 to June 30th, 2020 with a urine culture positive for ESBL-E. Patients were included if they received a study antibiotic (meropenem, ertapenem, TZP, or FEP). Patients were excluded if they had any of the following: absence of pyuria, prior receipt of study antibiotic, CBP-resistant organism isolated in urine culture, polymicrobial urine culture, end-stage renal disease, or concomitant gram-negative infection. The primary outcome was clinical cure defined as complete resolution of signs and symptoms of infection. Secondary outcomes included in-hospital mortality, recurrence within 30 days, and resistance within 30 days.

Results

A total of 133 patients were included based on definitive therapy received; 69 (52%) received CBP and 64 (48%) received NCBP therapy. Of the total patient population, 17 (13%) were admitted to the intensive care unit, 84 (63%) had a complicated UTI, and 64 (48%) had pyelonephritis. Baseline characteristics were similar between the two groups. There was no difference in clinical cure between the CBP and NCBP therapy groups (96% vs. 97%, p = 1.0). Additionally, no differences in secondary outcomes were observed. Subgroup analyses were performed in patients with specific pathogens, uncontrolled genitourinary source, complicated UTI, and pyelonephritis. These analyses did not reveal any differences in primary or secondary outcomes between the two groups.

Conclusion

FEP and TZP may be reasonable CBP-sparing alternatives for the treatment of ESBL-E UTIs as clinical and microbiological outcomes were similar with these NCBP agents vs. CBPs in this study population.

Disclosures

Venugopalan Veena, PharmD, Melinta (Other Financial or Material Support, Received a stipend for participation in a drug registry)Merck (Other Financial or Material Support, Received a stipend for participation in a drug registry)
145. SARS-CoV-2 (COVID-19) Testing Experience within a Military Treatment Facility
Authors: Robinson Sara , Campbell Wesley R , Johnson Yuliya , Backlund Michael , Brooks Daniel
Published: December 2021

Background

The Walter Reed National Military Medical Center (WRNMMC) established a consolidated COVID-19 screening area (CSA) beginning in March 2020 to provide beneficiary and staff testing via a drive-through site. Testing was available to all patients and WRNMMC staff regardless of beneficiary status. Presented is a descriptive analysis of our testing operations and positivity rates within a closed medical system from March 2020 to April 2021.

Methods

For quality and process improvement, we compiled daily testing logs from March 2020 to April 2021 from the CSA. These logs included patient demographics, reason for testing, test result, testing platform, and occupational status at the hospital. We determined positivity rates in various subgroups – asymptomatic, symptomatic, pre-operative, in order to track testing use and access. Additionally, we compared the overall positivity rate to the surrounding civilian community by pulling data from the Maryland Department of Health’s COVID database.

Results

Over the course of nearly 14 months of testing availability, 34,694 beneficiaries were screened with 41,582 individual tests. After May 2020, the monthly overall positivity rate varied from 1.99% to 11.92%, peaking in December 2020 (with high rates in November 2020, 7.52% and January 2021, 9.53%), correlating with or exceeding elevated positivity rates in Montgomery County (November 2020: 4.91%; December 2020: 6.48%; January 2021: 6.51%). When examining only symptomatic individuals, the positivity rate is notably much higher, with monthly rates varying from 6.40% to 21.10%, with a similar peak in December 2020. After full implementation of pre-operative screening for procedures with aerosolization potential in June 2020, the range of positivity rates was 0.28%-1.66%. Since vaccination for COVID-19 became widely available beginning in Feb 2021, the preoperative positivity rate has remained below 0.85%.

Conclusion

Our institutional experience is unique in its ability to offer universal access to COVID-19 testing for beneficiaries and staff of the DoD under direction of the ID service. Our process serves as a model for public and occupational health response, and may guide lab resource and real-time staffing management in support of COVID-19 diagnostics at a medical center.

Disclosures

All Authors: No reported disclosures
1258. Antibiotic Resistant Nontyphoidal Salmonella Infection Following International Travel — United States, 2018
Authors: Ford Laura , Shah Hazel , Chen Jessica , Eikmeier Dana , Hanna Samir , Langley Gayle , Payne Daniel C , Plumb Ian D
Published: December 2021

Background

Antibiotic resistance in nontyphoidal Salmonella can limit treatment options for patients requiring antibiotic therapy. We assessed the contribution of international travel to resistance among nontyphoidal Salmonella infections.

Methods

We describe characteristics of nontyphoidal Salmonella infections in the Foodborne Diseases Active Surveillance Network during 2018 that were also reported to PulseNet and the National Antimicrobial Resistance Monitoring System. We defined genetic resistance to first-line antibiotics as the presence of genes or mutations known to confer decreased susceptibility or resistance to ciprofloxacin, azithromycin, or ceftriaxone. We used multivariable logistic regression to assess the association between resistance to first-line antibiotics and international travel in the 7 days before symptom onset overall and by United Nations statistical region, and we estimated the contribution of travel to resistance using population attributable fractions.

Results

Among 3,238 nontyphoidal Salmonella infections, 356 (11%) were in patients who traveled internationally in the 7 days before symptom onset. Of these, 109/356 (31%) had isolates with genetic resistance to first-line antibiotics, compared with 308/2882 (11%) non-travelers. Resistance was more likely following travel, after adjusting for age and sex (OR 3.7, 95% CI 2.9–4.8). Nine genes or mutations conferred resistance to first-line antibiotics among travel-associated isolates. The risk of resistance varied by region and was highest after travel to Asia (OR 7.5, 95% CI 4.7–12.0). Overall, 17.1% (95% CI 12.2%–21.7%) of genetic resistance to first-line antibiotics was attributable to international travel.

Conclusion

For patients with nontyphoidal Salmonella infections, international travel is associated with approximately three-fold increased risk that first-line agents could be ineffective. The estimated 17% of resistance to first-line antibiotics attributable to travel is encoded by relatively few genes and mutations. Investigation of the major sources of resistant strains could help target prevention efforts. Travel region should be considered when treating empirically; treatment should be adjusted based on results from antibiotic susceptibility testing.

Disclosures

All Authors: No reported disclosures
1301. Risk Factors for Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa in Community Acquired Pneumonia
Authors: Bell Maya , Veltri Courtney , Kolychev Evelina , Hojat Leila S
Published: December 2021

Background

The 2019 American Thoracic Society and Infectious Diseases Society of America Community-Acquired Pneumonia (CAP) guidelines concluded that the major risk factors for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PsA) include prior isolation of these organisms and previous hospitalization with IV antibiotic use within 90 days. However, the guidelines recognized that results may vary by region and recommended local validation of risk factors. The primary objective of this study was to determine which potential risk factors are associated with MRSA and Pseudomonas aeruginosa in CAP in our institution. This study also evaluated appropriateness of antibiotics used for empiric CAP therapy.

Methods

This was a single-center, retrospective cohort study performed in an urban academic medical center in Cleveland, OH. Adults hospitalized for CAP who had a respiratory culture performed between January 2016 and September 2020 were included. Patients were randomized in a 1:1:1 ratio into MRSA, PsA, and non-resistant CAP (NR-CAP) groups. Patients with bacterial co-infections or resistant pathogens other than MRSA or PsA were excluded.

Results

The study included 111 patients with 37 patients in each group. The median age was 61 years (IQR 52-70), and 58.6% of patients were male. There were no independent risk factors for MRSA (Table 1). Independent risk factors for PsA included prior isolation and enteral feeding (Table 2). MRSA risk factors as defined by the 2019 CAP guidelines were found in 48.6% of patients with MRSA CAP (Figure 1). Guideline-defined PsA risk factors were found in 56.8% of patients with PsA CAP (Figure 2). In NR-CAP, 62.2% received empiric MRSA coverage while only 27% had a guideline-defined risk factor; PsA coverage was administered in 78.4% of NR-CAP patients, but risk factors were found in only 24.3% of this cohort.

MRSA and P. aeruginosa Risk Factor Analyses

Empiric MRSA and P. aeruginosa Coverage and Guideline-Defined Risk Factors

Conclusion

Our findings were consistent with the risk factors identified in the 2019 CAP guidelines, but additional risk factors may be present in our patient population. Empiric coverage for MRSA and PsA was disproportionately high relative to the rate of recovery. This study encourages local validation of risk factors; however, further analyses are needed to determine the impact on empiric therapy.

Disclosures

All Authors: No reported disclosures
1312. Evaluation of a Multiplexed PCR Pneumonia Panel in a Tertiary Care Medical Center
Authors: Su Erin , She Rosemary
Published: December 2021

Background

Syndromic PCR testing for lower respiratory pathogens may give rapid, actionable results to aid in management decisions for suspected pneumonia cases. We sought to evaluate the performance of a multiplexed PCR pneumonia panel compared to routine microbiologic work-up in a tertiary care patient population.

Methods

Sputum and bronchoalveolar lavage (BAL) samples from Keck Medical Center (Los Angeles, CA) inpatients submitted for clinical microbiology work-up Dec 2019-Jun 2020 were tested by a multiplexed PCR panel (FilmArray Pneumonia Panel, BioFire Diagnostics). We compared panel results for typical bacterial pathogens to those of quantitative culture and susceptibility testing. We retrospectively determined the incidence of non-panel respiratory pathogens as detected by standard of care tests in this patient cohort.

Results

68 of 180 samples yielded 80 positive bacterial PCR results: 34 were detected by both PCR panel and culture and 46 by PCR panel only, yielding a sensitivity of 100% (34/34) for pathogens detected and specificity of 73.1% (114/156) among negative cultures (normal flora or no growth). Concordant results had PCR Bin values ≥10^5 copies/mL whereas all 18 targets detected at 10^4 copies/mL were culture-negative. Among resistance gene targets, the panel detected 12 MRSA specimens, of which MRSA grew in only 4 cultures; E. coli and CTX-M in 1 specimen from which grew normal flora; and multiple gram-negative organisms and KPC in 1 specimen from which culture isolated carbapenem-resistant P. aeruginosa. Quantitation from positive BAL cultures (n=25) correlated weakly with PCR Bin values (R-squared=0.17). Non-PCR panel pathogens were detected in 22 of 180 (12.2%) specimens through routine methods (16 molds, 3 AFB, and 3 non-fermenter gram-negative bacteria).

Conclusion

The pneumonia panel had excellent sensitivity for its target bacterial pathogens, but results were often positive in negative cultures. This could be due to antecedent antibiotic therapy, differences in reporting threshold versus culture, or inability of PCR to discern results from normal flora. Non-panel pathogens were detected in a significant proportion in our population. The pneumonia panel should be implemented and interpreted carefully with consideration of antimicrobial stewardship.

Disclosures

All Authors: No reported disclosures
1353. Gonorrhea and Chlamydia Testing and Case Rates Among Women Veterans in the Veterans Health Administration
Authors: Keddem Shimrit , Maier Marissa , Gardella Carolyn , Borgerding Joleen , Lowy Elliott , Chartier Maggie , Haskell Sally , Hauser Ronald , Beste Lauren
Published: December 2021

Background

United States (US) rates of sexually transmitted infection (STI) in women, especially gonorrhea and chlamydia, have increased over the past decade. Women Veterans have many risk factors associated with STIs, including high rates of childhood sexual assault, military sexual trauma and intimate partner violence. Despite the availability of effective diagnostic tests and evidence-based guidelines for annual screening among sexually active women under age 25, screening rates for gonorrhea and chlamydia remain low in the US and among Veterans.

Methods

We performed a retrospective cohort study of all women Veterans in Veterans Health Administration (VHA) care between January 1, 2018 and December 31, 2019 to examine patient characteristics and health system factors associated with gonorrhea and chlamydia testing and case rates among women Veterans in the VHA in 2019.

Results

Among women under age 25, 21.3% were tested for gonorrhea or chlamydia in 2019. After adjusting for demographic and other health factors, predictors of testing in women under age 25 included Black race (aOR: 2.11 CI: 1.89, 2.36), rural residence (aOR: 0.84, CI: 0.74, 0.95), and cervical cancer screening (aOR: 5.05 CI: 4.59, 5.56). Women under age 25 had the highest infection rates, with an incidence of chlamydia and gonorrhea of 1,950 and 267 cases/100,000, respectively. Incidence of gonorrhea and chlamydia was higher for women with a history of military sexual trauma (MST) (Chlamydia case rate: 265, Gonorrhea case rate: 97/100,000) and those with mental health diagnoses (Chlamydia case rate: 263, Gonorrhea case rate: 72/100,000.) Over a third of chlamydia cases (35.2%) and gonorrhea cases (35.5%) occurred in women who resided in the South Atlantic census division.

Chlamydia cases per 100,000 women Veterans seen in VHA (2019)

Gonorrhea cases per 100,000 women Veterans seen in VHA (2019)

Conclusion

Gonorrhea and chlamydia testing remains underutilized among women in the VHA and infection rates are high among younger women. Patient-centered, system-level interventions are urgently needed to address low testing rates.

Disclosures

All Authors: No reported disclosures
1361. Actinotignum schaalii an Under-recognized Cause of Infections: A Case Series in Calgary from 2012 - 2020
Authors: Lieu Anthony , Mah Jordan , Church Deirdre
Published: December 2021

Background

Actinotignum schaalii is a gram-positive rod that is a fastidious commensal of the urogenital tract. Infections with A. schaalii are underdiagnosed previously because phenotypic methods fail to identify it. Both MALDI-TOF mass spectrometry and 16S rRNA sequencing allow definitive identification of this opportunistic emerging pathogen. A. schaalii is an infrequent but important cause of UTIs in the elderly, particularly with urological abnormalities. The spectrum of invasive disease caused by A. schaalii is not well characterized; however, it has been isolated in severe infections including necrotizing skin and soft tissue infections, bacteremia, osteomyelitis, and endocarditis. We used a population-based approach to characterize and describe the clinical and microbiological features of invasive A. schaalii infections in our region.

Methods

All adult and pediatric cases enrolled had microbiological isolates of Actinotignum schaalii recovered from blood cultures, sterile fluids and tissue cultures from Jan 2012 to Dec 2020 by APL, a regional centralized microbiology laboratory serving the Calgary Zone in Alberta, Canada. Clinical data were retrieved and linked from administrative health databases, chart review and the laboratory information system. Standard descriptive statistics were used.

Results

We identified 84 unique A. schaalii infections, 35 were from bloodstream, 32 soft tissue, 7 post-operative infections. Median age and Charslon comorbidity score was higher in BSI. 54.3% of patient with BSI had a genitourinary pathology, with 51.4% caused by a complicated urinary infection, while soft and skin tissue infections caused 65.3% of non-BSI. Using EUCAST MIC cut-offs, 48% and 100% of the isolates were resistant to clindamycin and metronidazole, respectively. In contrast, all specimens were susceptible to penicillin. Hospitalization and 90-days mortality were higher in the BSI group.

Conclusion

A. schaalii is an anaerobic opportunistic pathogen that can cause life-threatening invasive infections, particularly in older adults with underlying genitourinary pathology. BSI were associated with higher rates of hospitalization and mortality. In contrast, patients with A. schaalii isolated from cutaneous sources were younger and had better clinical outcomes.

Disclosures

All Authors: No reported disclosures
1364. Microbiology of Sepsis in a Combat-Trauma Military Population
Authors: Robinson Sara , Shaikh Faraz , Stewart Laveta , Campbell Wesley R , Decker Catherine F , Yabes Joseph , Blyth Dana M , Blyth Dana M , Tribble David
Published: December 2021

Background

There are limited data on sepsis in combat casualties. We examined characteristics of sepsis, specific infections, and associated microbiology in a complex combat trauma population.

Methods

The Trauma Infectious Disease Outcomes Study collected infection-related data from military personnel wounded during deployment (2009-2014). Medevac patients transferred to participating US military hospitals with sepsis or septic shock based on the Sepsis-1 SIRS criteria were analyzed for associated potential sources and infection-associated clinical microbiology.

Results

Prevalence of sepsis was 24.7% (667 of 2699 patients) with 93 (14%) patients meeting septic shock criteria. There were 1013 sepsis/shock episodes (SSE) among 667 subjects. Infections attributed to SSE were identified in 996 (98.3%) of 1013 episodes, primarily being bloodstream infections (BSI) +/- other infections (29.5%), skin and soft tissue (SSTI)/osteomyelitis (35.3%), pneumonia (12.1%), and multiple concurrent infections (14.2%). At least 1 organism was identified in 96% of SSE and 53% were polymicrobial. Gram-positive organisms (GP) were identified in 54% of SSE: 16% with multiple GP, of monomicrobial infections 4.1% were S. aureus, 15.8% other staphylococci, and 13% Enterococcus spp. Gram-negative bacilli (GN) were identified from 74.5% of SSE: 34% with multiple GN, of monomicrobial infections 11% were Pseudomonas spp., 8% E. coli, 6% Enterobacter spp., and 6% Acinetobacter spp. Mycobacterial species were uncommon (0.9%). Yeast, mold, and anaerobes were identified from 19%, 22%, and 12.5% of SSE, respectively. Compared to sepsis, septic shock infections were more often polymicrobial (p< 0.001), and had more infections with ESKAPEE pathogens, only Mucor spp., and only Bacteroides (p< 0.05). More infections with only Pseudomonas spp. and only non-lugdunensis coagulase-negative Staphylococci were identified among sepsis patients (p< 0.05).

Conclusion

Sepsis rates, using the Sepsis-1 criteria are sensitive but lack specificity supporting reclassification using updated Sepsis-3 criteria. In a complex trauma population, sepsis is common with most frequent infections related to SSTI/osteomyelitis, as well as BSI and multiple concurrent infections with a diverse spectrum of microbiology.

Disclosures

Dana M. Blyth, MD, Nothing to disclose
1365. Clinical and Financial Implication of Dalbavancin Utilization on Length of Stay Avoidance in Acute Bacterial Skin and Skin Structure Infection
Authors: Kim Sonia S , Chen Brandon , Raja Karan , Patel Mitesh , Philips Mona
Published: December 2021

Background

Our institution admits 650 patients annually for acute bacterial skin and skin structure infection (ABSSSI). These patients may require intravenous antibiotics, potentially complicated by social factors and loss to follow up. Dalbavancin is a long-acting lipoglycopeptide given as a single dose regimen for ABSSSI. A previous review conducted at our institution identified 117 potential avoidable hospital days over 4 months with outpatient dalbavancin use. The objective of this prospective study was to evaluate the clinical and financial impact of avoided admissions with outpatient dalbavancin use.

Methods

The Institutional Review Board approved this single-site, prospective study. All patients who presented to the emergency department (ED) with ABSSSI from December 15, 2020 to April 15, 2021 were included in the study. Dalbavancin eligibility criteria were given to providers. Eligible patients were given a single dose of dalbavancin and then discharged. The primary outcome was the difference between percentage of avoidable admissions from the ED with dalbavancin use in the retrospective cohort and prospective cohort. The secondary outcomes were estimated length of stay avoidance, percentage of treatment success without ED re-visit within 30 days, estimated hospital cost avoidance and drug cost reimbursement. The primary outcome was assessed using the Chi-square test. Descriptive statistics were used for the secondary outcomes.

Results

Fourteen patients received dalbavancin and avoided hospital admissions. The percentages of admissions avoided in the retrospective and prospective cohorts were 16.02% and 6.67%, respectively (Figure 1). A difference of 9.35% was found to be statistically significant (p=0.01). The total estimated length of stay avoidance was 50 days. No patients re-visited the ED within 30 days with treatment failure. The total estimated hospital cost avoidance was &148,852 (Table 1). The net reimbursement for dalbavancin over drug cost was &5,100 (Table 2).

Conclusion

Dalbavancin use decreased avoidable admissions. At our institution, annual hospital cost savings can reach &1,015,794 if dalbavancin was utlilized to all eligible patients.

Disclosures

All Authors: No reported disclosures