bluuebunny/crossref_metadata_2025 huggingface dataset:
933. Antibiotic Prescribing Changes in Adults During COVID-19 in Outpatient Patient-Centered Medical Homes (PCMH) in Arkansas
Authors: Johnson Jill , Peng Cheng , Dare Ryan K , Painter Jacob T , Maples Holly , Thomas Jeremy , Teeter Benjamin , Shoptaw Earnest , Golden William
Published: December 2022

Background

Outpatient antibiotic (OP Abx) prescribing in adults in Arkansas (AR) was among the country’s highest in 2019. AR Medicaid analyzed prescription (Rx) claims data and communicated the relative prescribing intensity as an informational metric to each patient-centered medical home (PCMH) beginning in 2020. We describe the Abx prescribing patterns in calendar years 2019 and 2020, during the COVID-19 pandemic.

Methods

Data from AR Medicaid paid claims for OP Abx Rxs in adult patients attributed to a PCMH practice for > 6 months were analyzed. Annual Abx Rx claims per 1000 patients were calculated for rural or urban status and by 2019 prescribing rate histories, defined as the low-, middle-, and high-rate prescribers based on 1st, 2nd - 3rd, & 4th quartiles, respectively. The five most common classes in 2019 and fluoroquinolones were explored. A paired t-test, Wilcoxon signed rank test, and one-way ANOVA with post hoc least significant difference test were used to determine statistical significance.

Results

183 PCMHs qualified for analysis. There was a significant decrease in overall annual Abx claim rate, from 1034 to 910 (-12.0%, p< 0.0001). Claim rates decreased in rural (-10.9%, p< 0.0001) and urban areas (-13.3%, p< 0.0001) with no difference between groups (p=0.240). Low-rate prescribers did not change practice from 2019 to 2020, with claim rates of 666 to 665 (-0.2%, p=0.957), while middle- and high-rate prescribers decreased, from 1032 to 897 (-13.1%, p< 0.0001), and from 1404 to 1183 (-15.7%, p< 0.0001), respectively. Claim rates significantly decreased for penicillins (-16.0%, p< 0.0001), fluoroquinolones (-15.5%, p< 0.0001), sulfonamides (-13.1%, p< 0.0001), macrolides (-9.9%, p=0.0001), and tetracyclines (-6.3%, p=0.021). First-generation cephalosporins down trended (-7.9%, p=0.111).

Conclusion

OP Abx Rx claims significantly decreased from 2019 to 2020 in middle and high-rate prescribers. Low-rate prescribers maintained low Abx Rx claim rates throughout 2020. Future analyses are needed to highlight any rebound effect of Abx prescribing when the pandemic subsides, discerning the informational metric effect versus COVID-19, and informing the next steps for antimicrobial stewardship for PCMHs in AR.

Disclosures

Jill Johnson, Pharm.D., BCPS, Pew Charitable Trust: Pew provided financial support for authors, analysis, and presentation. Cheng Peng, MPA, MS, PhD, Pew Charitable Trust: provided financial support for the authors, analysis, and presentation. Holly Maples, Pharm.D., Wolters Kluwer-LexiComp: Advisor/Consultant Jeremy Thomas, Pharm.D., Pew Pew Charitable Trust: Grant/Research Support.
940. First situational diagnosis of the implementation of Antimicrobial Stewardship Programs in Mexican Hospitals, 2021
Authors: Dreser Anahí , Hegewisch-Taylor Jennifer , Cortés-Ortíz María Alejandra , Romero-Mónico Julián , Levy Gabriel
Published: December 2022

Background

The development of antimicrobial stewardship programs (ASP) can help to improve the quality of care and contain the growing problem of antimicrobial resistance (AMR). In Mexico, there is little evidence on the design, implementation and evaluation of hospital ASP. The objective of this study is to present a situational diagnosis of the ASP structure, processes implemented and monitoring of results obtained in a sample of Mexican hospitals.

Methods

An online survey directed to ASP teams was applied to a purposive sample of 40 hospitals that perform regular antimicrobial stewardship activities in Mexico, during the last trimester of 2021. The survey was based on the ‘core elements’ instruments developed by the CDC and WHO.

Results

Forty hospitals (62% public and 38% private) were surveyed in 13 states in Mexico regarding ASP basic elements. Infrastructure and Organization elements: on average 52% of these hospitals carry basic actions that refer to: written ASP document and annual plan (46%); allocated human resources (68%); availability of material resources (59%) and use of technological platforms (37%). Processes: development of hospital treatment guidelines (49%); educational interventions (40%); persuasive and feedback interventions (42%); and in greater proportion, restrictive interventions (77%). Monitoring activities: interventions (25%); antimicrobial consumption (73%) and AMR (85%)

Conclusion

This first diagnosis serves as a baseline to determine the current state of ASP implementation per hospital and in the country. It also reflects on the ASP heterogeneity, that should be addressed by national policies. The greatest challenge lies in the program governance, and the systematic monitoring of the implementation of ASP interventions.

Disclosures

Anahí Dreser, PhD, MSD: Grant/Research Support.
948. Impact of a Multi-pronged Approach to Antimicrobial Stewardship on the Vascular Ward at a Tertiary Hospital
Authors: Wong Maggie O , Bowles Wendy L , Lee Kevin , Afra Kevin
Published: December 2022

Background

Up to 50% of inpatient antibiotic use may be inappropriate, and guideline concordance for antibiotic prescribing in surgical wards tends to be lower than medical wards. As such, our study describes a multi-pronged approach to antimicrobial stewardship (AMS) targeting a vascular ward and its impact on improving antibiotic use.

Methods

This is a quality improvement study at a tertiary hospital in British Columbia, Canada. All patients admitted to the vascular surgery ward for any vascular related issues and who received piperacillin-tazobactam or a carbapenem were included. Patients were excluded if admitted to the ward for < 48 hours. The primary outcome is appropriateness of carbapenem and piperacillin-tazobactam use in concordance with local policies. Secondary outcome is consumption of these agents.

The pre-intervention period was March 2020 to June 2020. The AMS team prospectively reviewed included patients to establish the baseline level of appropriate antibiotic use. The intervention period was from July 2020 to February 2021.

Aside from presentations to surgeons, the main intervention was regular audit and feedback to a nurse practitioner who rounds with the surgeons. Mandatory ID consultation for carbapenems was the last resort if AMS recommendations were not accepted.

Results

During the pre-intervention period, 19 out of 25 prescriptions (76%), either carbapenem or piperacillin-tazobactam, had appropriate indications. In the intervention period, 121 prescriptions were reviewed and the appropriateness level increased to 87% (Figure 1). Eleven mandatory ID consultations were generated. The mean days of therapy (DOT) per 1000 patient-days for carbapenem decreased from 94.6 to 56.6 for pre- and intervention periods, respectively. For piperacillin-tazobactam, the mean DOT per 1000 patient-days decreased from 209.9 to 138.5 for pre- and intervention periods. The reduced usage of piperacillin-tazobactam remained sustainable post-intervention (Figure 2). Figure 1:Summary of patient characteristics and outcomes during intervention period (July 2020 to February 2021)Figure 2:Usage of piperacillin-tazobactam from June 2019 to June 2021

Conclusion

A multi-pronged approach, consisting of education, prospective audit and feedback to the surgical team, and mandatory ID consult in selected cases, is effective in decreasing inappropriate broad-spectrum antibiotic use on the vascular ward at a tertiary centre.

Disclosures

All Authors: No reported disclosures.
950. Impact of the COVID 19 pandemic on antimicrobial stewardship program, broad-spectrum antibiotics consumption and Clostridioides difficile diarrhea incidence
Authors: Ferreiro Jose Luis Lamas , Otero Judith Álvarez , Rivo Ana Sanjurjo , de Salamanca Holzinger Ignacio Enríquez , Cavero Jorge , de Miguel Bouzas Jose Carlos , Soneira María Fernández , Conde Irene Rodríguez , Fernández Emilia Fernández , Vila Marta Costas , de la Fuente Aguado Javier
Published: December 2022

Background

The aim was to evaluate the impact of the COVID 19 pandemic on the antimicrobial stewardship program of our hospital, analyze changes in broad-spectrum antibiotics consumption, and analyze the evolution of the incidence of Clostridioides difficile (CD) diarrhea.

Methods

Database with the following variables was created: monthly percentage of broad-spectrum antibiotic prescriptions that were evaluated by the antimicrobial stewardship team (AMST), monthly consumption of antimicrobials and monthly incidence of diarrhea due to CD. Pre-pandemic period was considered from March 1th, 2018 to February 29th, 2020 and the pandemic period from March 1th, 2020 to February 28th, 2022.

Time series analysis was performed with ARIMA models to assess the association of the pandemic period with a change in the monthly activity of AMST, in the monthly antibiotic consumption, and in the monthly incidence of CD diarrhea.

The correlation of the percentage of monthly broad-spectrum antibiotic prescriptions reviewed by AMST with the monthly broad-spectrum antimicrobials consumption was also evaluated, using the Spearman coefficient.

Results

During the pandemic period, there was a significant reduction in monthly percentage of broad-spectrum antibiotic prescriptions reviewed by the AMST (28% vs 82%; P< 0.01). There was a 29% increase in consumption of broad-spectrum antibiotics in the pandemic period (15.7 vs 12.1 DDD per 100 bed-days; P=ns). The following antibiotics showed a significant increase in their consumption: antipseudomonal carbapenems (2 vs 1.4 DDD per bd; P< 0.01), daptomycin (1.8 vs 0.5 DDD per bd; P< 0.01), cefepime (1.1 vs 0.6 DDD per bd; P< 0.01), aztreonam (0.4 vs 0.3 DDD per bd; P=0.04), antibiotics with anti-MRSA activity (35.6 vs 12.9 DDD per bd; P< 0.01). There was a 41% increase in the incidence of nosocomial CD diarrhea (1.02 vs. 0.7 cases per 1000 bd; P=0.03). The percentage of broad-spectrum antibiotic prescriptions reviewed by the AMST correlated well with the consumption of this group of antibiotics (cc -0.63; P< 0.01).

Conclusion

COVID-19 pandemic has had a significant impact on the antimicrobial stewardship program at our hospital, with an increase in broad-spectrum antimicrobials consumption and a significant increase in the incidence of Clostridioides difficile diarrhea.

Disclosures

All Authors: No reported disclosures.
957. Interactive Antibiogram Decision Support Tool Predicated Upon Infection Site and Probable Pathogens
Authors: Legenza Laurel , Zunenshine Jared , Safdar Nasia , Safdar Nasia , Guest Colin , Jadhav Harshvardhan , Fritsche Thomas R , Lee John D D
Published: December 2022

Background

Current methods for displaying summary antibiograms are static, have limited utility and are not user friendly. We present an interactive web application for visualization of antibiogram data.

Methods

Antibiotic susceptibility data for first, non-duplicate patient infection isolates with source/site data were collected from 2009–2018 at an integrated health system for the visualizations. Iterative user-centered design sessions were held with healthcare providers to guide prototype development, including assessment of source groupings and rational for aggregating data. Three providers participated in initial and follow-up sessions (6 total) with study personnel. Data were aggregated by agreed-upon infection-source and pathogen; antibiotic results with < 30 isolates were excluded.

Results

The multi-year dataset included 119,333 non-duplicative isolates from 194 unique infection sites; nearly half were E. coli (n=50,404). Final infection source groupings with interactive data visualization fields are shown in Figure 1. First an infection source is selected; the visualization then shows pathogen prevalence in descending order. Providers can view susceptibility results for all antibiotics or deselect all and view only those under consideration, such as the four displayed in Figure 1. Resulting bar charts allow providers to view which pathogens tested have greater than 80% or 90% susceptibility to each antibiotic. Susceptibilities for multiple pathogens can also be visualized with the dodged feature (Figure 2). The large dataset collected supports source-specific susceptibility results (e.g. eye infections). The visualization allows providers to see how susceptibility by pathogen may cross clinically meaningful thresholds of 80% and 90% for different infection sources, such as urinary tract compared to bloodstream infections. Feedback from providers on the prototype was overwhelmingly positive. Figure 1.Visualization of urine isolates, E. coli and user selected antibiotics

Final source groupings: Urine, Skin/Soft Tissue, Blood, Respiratory Secretions, Fluid, Ear, Bone, Vaginal/Perianal, Eye, and Abscess. Figure 2.Selected antibiotic susceptibilities for multiple pathogens can be visualized simultaneously with the dodged feature.

Conclusion

Our interactive antibiogram data clinical decision support tool extends the utility of the traditional lab-generated antibiogram. Importantly, future iterations will include visualizing changes by year, by clinical setting (inpatient vs. outpatient) and an assessment of uptake of this tool in the clinical setting.

Disclosures

All Authors: No reported disclosures.
981. Inducing Antimicrobial Resistance with Long-Term Antibiotics at Stage 2 Revision for Periprosthetic Joint Infection
Authors: Payne Judd , Sutton Jesse , Blackburn Brenna , Imlay Hannah , Spivak Emily S , Anderson Lucas , Gililland Jeremy , Pupaibool Jakrapun , Certain Laura
Published: December 2022

Background

Studies have shown reduced rates of recurrence of periprosthetic joint infection (PJI) with the use of oral antibiotics after stage-two revision. We examined the effects of these antibiotics on the antibiotic susceptibility patterns of subsequent PJI.

Methods

We conducted a retrospective cohort study of patients who underwent two-stage exchange for PJI in the Veterans Affairs system from 1/1/2015 – 6/1/2020. We compared patients who were prescribed oral antibiotic prophylaxis for ³14 days following stage-two revision arthroplasty with those who received < 14 days of antibiotics. The primary outcome was the presence of antibiotic-resistant organisms isolated in cultures from subsequent infections of the same joint. Secondary outcomes included comparisons of rates of recurrent PJI and time-to-subsequent PJI between each group. We used Chi square and Fisher exact tests to compare the two groups.

Results

605 patients met inclusion criteria. Of these, 154 received ³14 days of oral antibiotics following stage 2 surgery. Tetracyclines (48.1%), beta-lactams (27.3%) and trimethoprim-sulfamethoxazole, TMP-SMX (18.8%) were the most common antibiotics used. There was decreased susceptibility to tetracyclines (58 vs 73%, p 0.24), TMP-SMX (48 vs 70%, p 0.059), and clindamycin (38 vs 57%, p 0.22) in organisms isolated from subsequent PJI in the antibiotic prophylaxis group compared to the control group. Subsequent PJI was diagnosed in 29 out of 154 (18.8%) in those who received antibiotic prophylaxis, compared with 80 of 451 (17.7%) who did not. Days to subsequent infection was higher for those who received antibiotics compared to those who did not (101 vs 65 days, respectively).

Conclusion

Prophylactic antibiotics following stage 2 revision for PJI may increase the risk for drug-resistant organisms in subsequent index joint infections, most notably against tetracyclines and TMP-SMX. Based on our data, antibiotics given after stage 2 revision postponed, rather than prevented, subsequent infection.

Disclosures

All Authors: No reported disclosures.
987. Retrospective Evaluation of Calcaneal Osteomyelitis Outcomes and Factors for Treatment
Authors: Fong Rebecca , Moenster Ryan P , McDonald Jay
Published: December 2022

Background

Calcaneal osteomyelitis (OM) accounts for 3-10% of all cases; however, there is limited data comparing clinical outcomes between patients with calcaneal OM and non-calcaneal OM of the foot.

Methods

This was a retrospective, observational cohort study of patients treated with at least 4 weeks of antibiotic therapy or surgical intervention for calcaneal or non-calcaneal OM at the VA St. Louis Health Care System between 1 January 2010 and 30 June 2021.

The primary outcome was treatment failure, defined as a follow-up encounter for new surgical intervention or re-initiation of antibiotics within 6 months of completion of initial surgical intervention or antibiotic therapy. Secondary outcomes included individual components of the primary outcome and antibiotic adverse events. The variables of calcaneal OM, poorly controlled diabetes, severe peripheral vascular disease, treatment for ≥2 weeks at a skilled nursing facility, and amputation as part of treatment were included in a univariate analysis and any variables with a p< 0.2 were subsequently placed into a multivariate regression model to determine if any stated variables were independently associated with treatment failure.

Results

Eighty patients were included, 40 treated for calcaneal OM and 40 treated for non-calcaneal OM. More patients in the calcaneal group had a bone biopsy obtained (62% vs. 35%; p=0.014) and were treated with definitive therapy (77.5% vs. 47.5%; p=0.005). Conversely, more non-calcaneal patients received initial amputations for treatment (12.5% vs. 32.5%; p=0.032). Sixteen (40%) of calcaneal OM patients and 17 (42.5%) of non-calcaneal foot OM patients failed initial therapy (p=0.82). There was no statistically significant difference between the two groups in the re-initiation of antibiotics within 6 months for an infection of the same site (20% vs. 40%; p=0.051) or for unplanned surgery for same site within 6 months (30% vs. 15%; p=0.108). None of the factors in the univariate analysis met criteria to be included in the multivariate logistic regression.

Conclusion

The clinical outcomes of patients treated for calcaneal OM were not different from those treated for non-calcaneal OM of the foot.

Disclosures

All Authors: No reported disclosures.
996. Assessment of First-Dose Antimicrobial Infusion Reactions in Outpatient Parenteral Antimicrobial Therapy (OPAT) Service Patients
Authors: Kovacik Carrie , Shah Megan , Thomas Tania A , Eby Joshua C
Published: December 2022

Background

The 2018 Infectious Diseases Society of America (IDSA) OPAT guidelines recommend that an outpatient-initiated first dose may be administered at home under the supervision of healthcare personnel who are trained to respond to IgE-mediated hypersensitivity reactions. This may involve a home health nurse, but if resources are limited, agencies may require a first-dose infusion to be completed in a monitored healthcare setting. The objective of this study is to assess the incidence of immediate reactions in UVA OPAT patients who received a supervised outpatient first-dose infusion as part of care for long term antimicrobial management.

Methods

This single center, retrospective case series evaluated adult patients enrolled in the UVA OPAT program who received a first-dose antimicrobial infusion for initiation of or change in IV antimicrobial therapy at a UVA-affiliated infusion center between January 2019 and October 2021. The primary endpoint is the percentage of UVA OPAT patients who experienced an immediate reaction, which includes IgE-mediated and infusion-related reactions, after receiving a supervised first-dose infusion outpatient. Secondary endpoints include the percentage of UVA OPAT patients who previously received the same antimicrobial and timing of receipt in patients who experienced an immediate reaction and in those who tolerated the first-dose antimicrobial infusion. Data were analyzed using descriptive statistics.

Results

There were 93 OPAT patients who received 115 first-dose infusions during the study timeframe. Daptomycin, ceftriaxone, and vancomycin accounted for 64% of first-dose infusions. Six patients (6%) experienced an immediate reaction, which included itching, erythema, and nausea. All patients received treatment for their reaction and were able to complete their infusion. Two patients who experienced an immediate reaction had received the same antimicrobial more than 12 months prior.

Conclusion

After receiving a first-dose antimicrobial infusion, few UVA OPAT patients experienced an immediate reaction, none of which were consistent with IgE-mediated reactions. These findings support the IDSA guidelines recommending a monitored first-dose infusion at home, particularly among those who recently tolerated the same agent.

Disclosures

All Authors: No reported disclosures.
999. Clinical Outcomes of Off-label Dalbavancin Use within an Outpatient Parenteral Antibiotic Therapy (OPAT) Program
Authors: Igwilo-Alaneme Rita , Bao Hongkai , Nori Priya
Published: December 2022

Background

Dalbavancin is approved for the treatment of acute bacterial skin and soft structure infections (ABSSSI). There is less data on outcomes of off-label use of dalbavancin for orthopedic and other complex infections. In this case series, we aim to analyze clinical outcomes of deep-seated infections treated with IV dalbavancin instead of long-term IV antibiotics post-discharge.

Methods

We conducted a retrospective review of adult patients treated with off-label IV dalbavancin between January 2020 and February 2022 at an academic center in the Bronx, NY within a long-standing outpatient parenteral antibiotic therapy (OPAT) program. Outcomes of interest included 90-d infection recurrence, prothesis retention, mortality, adverse events, and characteristics of antibiotic regimens.

Results

Nineteen patients received dalbavancin for off-label indications. Dalbavancin was used primarily for hardware, bone and joint, and complicated soft tissue infections (table 1). The predominant pathogen was Staphylococcus aureus. Source control was achieved in 12 (63%) patients via debridement alone (5), debridement with prosthetic device retention (4), or debridement and complete hardware removal (3). The most common dosing regimen was two-doses (1000-mg, 500-mg) one week apart. Two (11%) patients (both with initial prosthesis retention) had infection recurrence within 90 days of dalbavancin and eventually required removal (table 2). One patient experienced recurrence after 90 days and required removal. The remaining patient with prothesis retention has not experienced infection recurrence to date. Concomitant antibiotics while on dalbavancin and suppressive antibiotics following therapy were common. No patient died within 90 days of therapy and no adverse drug effects were reported.

Conclusion

Dalbavancin use for hardware infections, osteomyelitis, complicated soft tissue infections, and spinal infections is associated with favorable cure rates, safety profile, and tolerability. Improved outcomes may be achieved with hardware removal. Dalbavancin off-label use within an OPAT program may facilitate early discharge or prevent admissions in eligible patients, although further study is needed.

Disclosures

All Authors: No reported disclosures.
1003. Curbsiding Twitter: Potential Value and Patient Confidentiality Implications of Infectious Diseases Clinician Peer Consultations via Social Media
Authors: Boyland Ryan , Cortes-Penfield Nicolas W , Marcelin Jasmine R
Published: December 2022

Background

Infectious Disease (ID) clinicians increasingly collaborate via social media and have adopted Twitter and the hashtag #IDTwitter for community-wide conversation. We investigated clinicians’ use of #IDTwitter for peer consultation, examining both the utility of responses and how frequently discussions risked compromising patient privacy.

Methods

We reviewed English-language posts on www.twitter.com with the hashtag #IDTwitter over a 6-week period ending August 31st, 2021. We collected posts that we deemed examples of peer consultation, recording the post’s author, topic, engagement produced, and patient information disclosed. Finally, we recorded whether (by consensus) we judged a question meaningfully answered.

Results

We identified 108 instances of peer consultation; 91 posts (84%) were consultations about a clinical scenario, 17 (16%) included a specific request for medical literature, and seven (6%) included a request for literature interpretation. Twenty-four posts (22%) contained polls, which received a mean 107 (SD 104) votes. We judged 71% of questions meaningfully answered; of these, 68% received responses including explicit justification or reasoning and 35% included citations of supporting literature. Questions were more likely to be meaningfully answered if they included polls (91.7% vs 65.5%; p=0.01). Receipt of a meaningful answer was not predicted by the questioner’s professional role and follower count, the question topic, or the post’s number of likes and shares.

A total 28/108 posts (26%) referenced the care of a specific patient, with details shared including gender (74%), age (26%), radiographic or clinical images (7%), and other potentially identifying data (7%). Patients were stated or implied to be currently under the clinician’s care in 70% of cases, and 61 clinicians (92.4%) had their employer listed in their profile or immediately available via internet search.

Conclusion

ID clinicians’ peer consultations via #IDTwitter appeared frequently useful, particularly when questions were accompanied by polls. However, most participants sharing patient data were readily identifiable, and best practices to limit sharing of nonessential data and safeguard patient privacy are needed.

Disclosures

Jasmine R. Marcelin, MD, Pfizer (Grant reviewer): Honoraria.
1021. The post-sign-off events of Infectious Diseases (ID) consultation and the incidence of non-adherence to ID consultation during the post-sign-off period: A retrospective cohort study
Authors: Honda Hitoshi , Takamatsu Akane
Published: December 2022

Background

Infectious Diseases (ID) consultation has contributed to improving the quality of care in inpatient settings. ID physicians traditionally examine patients and provide the final treatment recommendations (i.e., sign-off ID consultation). However, patients may acquire antimicrobial-associated adverse drug events (AAADE) and healthcare-associated infections (HAI) after the sign-off ID consultation. Moreover, it is unclear how these events that occurred during the post-sign-off period were managed. The study aims to scrutinize the post-sign-off events and the current epidemiology of non-adherence to ID recommendations during the post-sign-off period.

Methods

The retrospective cohort study was performed at a Japanese tertiary care center. Among all ID consultation cases from January to December 2019, those with general ID consultation with treatment recommendations given for the definitive or suspected infectious diseases were included for analysis. The instances of post-sign-off events included AAADE, HAI, and treatment failure of established infections. Non-adherence to ID consultation was defined as the failure of the primary care team to complete ID final recommendations. The incidence of the post-sign-off events and outcomes associated with nonadherence to ID consultations were investigated.

Results

Among 762 ID consultations that occurred, 367 cases were included for analysis. The incidence of the post-sign-off events was 10.9% (40/367), and AAADEs accounted for 62.5% (25/40) of cases. Non-adherence to ID consultation occurred in 105 (28.6%) cases, and prolonged antimicrobial therapy beyond ID consultation was the most common reason for non-adherence. The primary care team modified antimicrobial therapy in approximately two-thirds of cases (71/105) without ID re-consultation. The length of hospital stay was longer in patients with non-adherence to ID consultation than in those with adherence (36 versus 29 days; p=0.002).

Conclusion

The post-sign-off events of ID consultation commonly occur, leading to nonadherence to ID consultation during the post-sign-off period. Because nonadherence may be associated with worse clinical outcomes, attention after the sign-off ID consultation is needed to ensure patient safety.

Disclosures

All Authors: No reported disclosures.
1026. What Proportion of Infectious Diseases Physicians Have Buprenorphine Waivers to Treat Opioid Use Disorder in the United States?
Authors: Fujita Ayako W , Loughry Nora , Moore DeLante , Colasanti Jonathan , Sheth Anandi N
Published: December 2022

Background

Since the onset of the COVID-19 pandemic, opioid-related overdose deaths have increased. Buprenorphine, a medication for opioid use disorder (OUD), is safe and effective but is underutilized and requires qualifying physicians to obtain a waiver. Infectious diseases (ID) physicians are uniquely positioned to treat OUD, as persons with OUD may present with infectious complications from injection drug use. We sought to understand the proportion and distribution of ID physicians with waivers in the United States (US).

Methods

This was a cross-sectional study merging data from the Centers for Medicare & Medicaid Services and the Drug Enforcement Agency Substance Abuse and Mental Health Services Agency. Our primary outcome was proportion of ID physicians who possess buprenorphine waivers. We used multivariable regression models to identify individual and county-level characteristics associated with buprenorphine waiver possession. We used geospatial analysis to describe county-level distribution of buprenorphine-waivered ID physicians.

Results

Among 6439 ID physicians in the US, 170 (2.6%) possessed buprenorphine waivers. Overall, 57.2% of ID physicians were male with a median 23 (IQR 15-33) years since medical school. Most (97.3%) practiced in metropolitan counties. In multivariable analysis, medical school graduation beyond 20 years was associated with lower odds of waiver possession compared to those graduating within 20 years (OR 0.59, 95% CI 0.43-0.80). ID physicians practicing in counties with median income > 50,000/year and in counties with higher proportion of uninsured residents also had lower odds of having a waiver (OR 0.58, 95% CI 0.35-0.97; OR 0.93, 95% CI 0.90-0.97). Among counties with at least one ID physician (n=519), 86.6% had no buprenorphine-waivered ID physicians (Figure 1). Figure 1County-Level Distribution of Infectious Diseases Physicians with Buprenorphine Waivers

Conclusion

Fewer than 3% of ID physicians in the US have obtained waivers to prescribe buprenorphine, highlighting missed opportunities to treat individuals with OUD, especially in rural America. Education on OUD management should be integrated into ID continuing medical education, and policies are urgently needed to expand buprenorphine access to persons without insurance.

Disclosures

All Authors: No reported disclosures.
1032. Janus Kinase Inhibition for Refractory Post-infectious Inflammatory Response in Previously Healthy Patients with Cryptococcal Meningoencephalitis
Authors: Anjum Seher , Williamson Peter , Hargarten Jessica
Published: December 2022

Background

Post-infectious inflammatory response syndrome(PIIRS) is a previously reported complication of non-HIV cryptococcal meningitis (CM) involving a pathological T cell-mediated neuroinflammatory response once the fungus has been cleared. Although corticosteroids have been successfully used as therapy, side effects preclude prolonged use. Additionally, alternative targeted agents may be required as adjunctive therapy in steroid-refractory PIIRS. We report the clinical course in 3 patients in whom Janus kinase (JAK) inhibitor use led to favorable outcomes when used along with corticosteroids.

Methods

Medical records of three previously healthy CM-PIIRS patients admitted to the NIH between January 2021 to December 2021 were used to prepare this report. All were transferred from another facility due to worsening neurological status. Neurological exam and radiological findings were compared at baseline and one month after ruxolitinib initiation. CSF parameters including cellular markers of T-cell inflammation (HLA-DR+ CD4+ and HLA-DR+ CD8 cells and monocytes) and soluble CSF cytokines, including IL-6 and sCD25, were also included in the comparison.

Results

One patient was on 1mg/kg oral prednisone for 8 months with no improvement in symptoms despite VP shunt placement. The other two had also been on moderate-dose oral steroids for approximately 6 weeks for a recent diagnosis of PIIRS. All three were started on ruxolitinib (5-10 mg PO BID) as an adjunct to prednisone with a significant improvement in their neurological status, CSF inflammatory markers, and radiological findings. CSF fungal cultures remained negative with no occurrence of adverse events 3 months after ruxolitinib initiation. Therapy with ruxolitinib allowed continued corticosteroid taper without clinical flairs of disease in each patient.

Conclusion

The selective JAK1/2 inhibitor, ruxolitinib, was safe in a small group of HIV-negative patients with CM. This agent may offer promise in conjunction with corticosteroids in the treatment of non-HIV CM patients with refractory PIIRS who are at risk for adverse side effects related to prolonged steroid use. Further study will be required to determine efficacy, tolerability and ability to reduce corticosteroid use.

Disclosures

All Authors: No reported disclosures.
1040. Comparative Surge Data on SARS CoV-2 Variants in a Rural Community – A Virtual Hospital Experience
Authors: Costello William A , Frank Anthony , Rhodes Regina , Loomis Gandhari , Sampath Rahul
Published: December 2022

Background

UNC Health Blue Ridge is a nonprofit community teaching hospital with 145 staffed beds. The COVID-19 pandemic has challenged rural hospitals like ours with high occupancy and periodic surges. UNC Health Blue Ridge COVID Virtual Hospital (CVH) created a home monitoring program for enrolled patients with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection utilizing disease risk stratification and pulse oximeter readings to dictate nurse and clinician follow-up. We report raw data that compare surge levels in our community for the Alpha (B.1.1.7), Delta (B.1.617.2) and Omicron (B.1.1.529) surges.

Methods

From April 2020 to present, the CVH enrolled patients diagnosed with COVID-19 based on FDA approved PCR tests. For this abstract, we defined any surge as an outpatient CVH census of greater than 50 patients or an inpatient census of >10 patients. We defined the maximum intensity of the surge as >20% outpatient SARS CoV-2 positivity and a CVH census >100 patients or >20 inpatients with SARS CoV-2 infection.

Results

For the outpatient setting, days of surge and maximum intensity were 144 / 98 days for Alpha, 92 / 71 days for Delta, 74 / 47 days for Omicron, respectively. Average daily CVH admissions during surges were 17.7 for Alpha, 26.15 for Delta, and 27.15 for Omicron. Total emergency department (ED) and urgent care visits were 12,765 and 23,696 for Delta, and 9701 and 16102 for Omicron. In the inpatient setting, days of surge and maximum intensity days were 102/76 days for Delta and 78/48 days for Omicron. Our peak inpatient COVID-19 daily census was 51 and 50 patients for Delta and Omicron.

Conclusion

Our CVH has enrolled over 8700 patients, and our hospital has not been on diversion during the COVID-19 pandemic, unlike many surrounding hospital systems of similar size. More importantly, the CVH has helped create a sustainable model that gathers local data to aid predictive algorithms and facilitate proactive rather than reactive resource allocations. This virtual model can be adapted for multiple other health conditions in the outpatient setting to improve patient safety and quality care.

Disclosures

All Authors: No reported disclosures.
1045. Longitudinal Evaluation of the QuantiFERON-TB Gold Plus Assay in Hospitalized COVID-19 Patients with a First Indeterminate Result: Resolution of Inflammation and Restoration T-lymphocyte Counts and Interferon-gamma Production
Authors: Imeneo Alessandra , Alessio Grazia , Lorenzo Andrea Di , Campogiani Laura , Lodi Alessandra , Barreca Filippo , Crea Angela , Vitale Pietro , Spalliera Ilaria , Compagno Mirko , Coppola Luigi , Malagnino Vincenzo , Teti Elisabetta , Andreoni Massimo , Sarmati Loredana , Marco Iannetta
Published: December 2022

Background

Several studies reported an increased rate of indeterminate QuantiFERON-TB Gold Plus (QFT-P) assay results in patients with severe Coronavirus Disease (COVID)-19.

Methods

Aim of the study was to longitudinally evaluate QFT-P responses in patients who survived COVID-19, with a previous indeterminate result.

Results

We observed 223 patients with an indeterminate QFT-P assay among 949 patients hospitalized because of COVID-19 (23,5%) during 2020 and 2021. 36 patients among those with an indeterminate QFT-P assay were enrolled for reassessing the test. In 12 patients peripheral blood lymphocyte subsets were also reassessed. Considering disease severity, 30 were classified as severe and 6 as non-severe. Median age was 57,5 (interquartile range [IQR]: 49,5-63,8), with a prevalence of male sex (M/F: 24/12); median Charlson Comorbidity Index was 2 (IQR: 1-3). The second QFT-P assay was performed after at least 1 month from the first assay (median time 7 months, IQR: 5-12 months). All QFT-P assays gave a determined result: 2 positive (5.5%) and 34 negatives (94,4%). A statistically significant difference was observed after comparing the laboratory parameters at the time of the first and the second QFT-P assay: the absolute counts of total lymphocyte, total CD3+, CD4+ and CD8+ T-lymphocytes were significantly increased (p< 0.001) while neutrophil absolute counts, neutrophil to lymphocyte (N/L) ratio, D-dimer, fibrinogen, ferritin, C-reactive protein (CRP) were significantly reduced (p< 0.0001). Concerning the QFT-P assay, interferon gamma (INF-γ) production in the Mitogen-Nil, TB1-Nil and TB2-Nil conditions were significantly increased (p< 0.0001; p=0.0019; p=0.0205, respectively) (Table 1 and Figure 1).

Conclusion

Once the acute phase of COVID-19 is resolved, inflammatory markers and peripheral blood leucocyte counts tend to normalize with an effective INF-γ production after specific and nonspecific stimulation. All the 36 QFT-P showed a determinate result. Moreover, we observed 2 positive QFT-P assay, supporting the importance of retesting patients with indeterminate result to identify latent tuberculosis infection and monitor patients for possible reactivation because of the immune-suppression associated with COVID-19.

Disclosures

All Authors: No reported disclosures.
1060. Duration of Seroprevalence among Individuals Previously Infected with SARS-CoV-2 and their Household Contacts
Authors: Altamirano Jonathan , Lopez Marcela , Lopez Marcela , Chun Leanne X , Tam Grace K , Robinson India , Shaikh Nuzhat , Leary Sean , Stainton Emma , Robinson Makeda L , Behl Rasika , Thiessen Rosita , Govindarajan Prasanthi , Blomkalns Andra L , Pinsky Benjamin A , Maldonado Yvonne A
Published: December 2022

Background

Serological tests directed against SARS-CoV-2 can provide information about the timing of infection and immunity against the virus. However, the kinetics of the host immune response to SARS-CoV-2 remain poorly understood. We established a household transmission study to analyze the serological responses within households, to determine longitudinal immune responses to infection.

Methods

From April 2020 to April 2022, we prospectively enrolled 76 households with at least one RT-PCR confirmed case of COVID-19. Participants were asked to provide blood samples at three time points: at baseline within 2 weeks of the index’s diagnosis of COVID-19, and at one- and three-months post-enrollment. Samples were tested for the presence of IgG antibodies against SARS-CoV-2 spike protein via an FDA EUA approved ELISA. Demographics, medical history, and symptomatology were also collected.

Results

To date, we have analyzed 238 serologic samples from 135 participants, including 82 baseline samples, 89 one-month samples, and 67 three-month samples. At baseline, 67.8% (n=40/59) of all confirmed cases tested positive for SARS-CoV-2 antibodies, which increased to 86.4% (n=57/66) at the one month, and 85.1% at three months (n=40/47). Of those confirmed infected participants that failed to seroconvert at baseline, almost all reported symptoms (n=14/19, 73.7%) and did not have chronic medical conditions (n=17/19, 89.5%). Of the 19, 3 failed to seroconvert by their third visit.

All individuals who were fully vaccinated at the time of each visit tested positive for antibodies at baseline (n=26), one-month (n=27), and three-months (n=20). Of those who were not fully vaccinated, 56 (41.1%) were positive for antibodies at baseline, 62 (59.7%) were positive at one -month, and 47 (63.8%) at three-months. Differences in seropositivity rates between pediatric and adult participants, as well as between index cases and household contacts, at each visit were also identified (Table 1).

Conclusion

Identifying differences in seroprevalence in various demographic groups can provide insight into longitudinal immune responses post-infection. Future analyses on seropositivity among previously infected individuals who received therapeutics may be of interest.

Disclosures

Andra L. Blomkalns, MD, MBA, Eli Lilly and Company: Grant/Research Support Yvonne A. Maldonado, MD, Pfizer: Grant/Research Support|Pfizer: Member, DSMB, Pfizer Meningococcal Vaccine clinical trial.
1062. Examining the impact of type 2 diabetes status and severity on in-hospital outcomes amongst patients hospitalized with COVID-19 in a southwest Virginia healthcare system
Authors: Bendetson Jesse , Baffoe-Bonnie Anthony
Published: December 2022

Background

Patients with type 2 diabetes mellitus (T2DM) who develop COVID-19 are at increased risk of hospitalization, longer hospital stays, ICU admission, and death. Additionally, measures of T2DM severity (e.g., hemoglobin A1c) have been found to be predictive of severe COVID-19. The present analysis was conducted to determine whether T2DM status and severity may be predictive of COVID-19 severity outcomes amongst patients hospitalized with COVID-19 in a southwest Virginia healthcare system.

Methods

All non-pregnant patients over the age of 18 who were hospitalized with COVID-19 on or before 6/11/2021 were included (n=2,099). T2DM status was treated as a binary variable; patients diagnosed with non-T2DM diabetes mellitus were excluded. Diabetes severity was quantified using the Diabetes Complications Severity Index (DCSI), a 13-point summary score covering 7 discrete categories of diabetes complications. We used two binary indicators of in-hospital COVID-19 severity: (1) progression to ICU admission, ventilatory assistance, and/or death; and (2) in-hospital mortality. Binary logistic regression with propensity score weighting was used to assess the relationship between diabetes status and COVID-19 severity. Multivariate logistic regression was used to assess the relationship between DCSI score and COVID-19 severity.

Results

Patients with T2DM had 1.51 times the odds of progressing to ICU admission, ventilatory assistance, and/or death (95% CI: 1.16, 1.96) and 1.39 times the odds of in-hospital mortality (95% CI: 1.02, 1.91) compared to non-diabetics. Amongst patients with T2DM (n=942), increasing DCSI score was associated with increased odds of in-hospital mortality; compared to patients with a DCSI score of 0, patients with a DCSI score of 1 had 3.23 times the odds (95% CI: 1.20, 8.70) and patients with a DCSI score of 5 or greater had 11.25 times the odds (95% CI: 4.46, 28.40) of dying in the hospital.

Conclusion

Our results indicate that diabetes status and DCSI score were both strongly predictive of in-hospital COVID-19 severity outcomes amongst this sample. Future work will focus on how changes in vaccine coverage and strain dominance over time may have affected these relationships.

Disclosures

All Authors: No reported disclosures.
1064. Intra-Host SARS-CoV-2 Evolution Dynamics
Authors: Haddad Kim El , Esper Frank , Mudiyanselage Thamali Madhushani Adhikari , Li Jing , Zheng Tu , Cheng Yu-Wei , Rhoads Daniel D , Farkas Daniel H , Ko Jennifer , Worley Sarah , Rubin Brian , Zhang Xiangyi , Leng Xiaoyi
Published: December 2022

Background

Our understanding of SARS-CoV-2 evolution is limited. Most estimates arise from analysis of global databases populated with unrelated sequences and is currently estimated at ∼27.7 substitutions/genome/year. SARS-CoV-2 polymerase contains a proofreading function encoded by NSP-14 limiting change. Additionally, virus evolution may be influenced by patient comorbidity. Intra-host mutational rate (MR) during infection remain poorly studied.

Methods

To minimize effect of vaccination and/or natural immunity on MR analysis, paired samples from adults originating from the initial pandemic wave (3/17/2020 through 5/27/2020) were retrieved and analyzed at Cleveland Clinic. Viral genome analysis was performed using next generation sequencing, and mutations between paired samples were quantified at allele frequencies (AF) ≥ 0.1, ≥ 0.5 and ≥ 0.75 and compared. MR was calculated employing F81 and JC69 evolution­­­­ models and compared between isolates with (Δ NSP-14) and without (wildtype, wt) non-synonymous mutations in NSP-14 and by comorbidity.

Results

A total of 40 patients (80 sample pairs) were identified. Median interval between paired tests was 15 days [range 5-32]. The estimated MR by F81 modeling was 317.2 (95%CI 312.0-322.3), 54.6 (95%CI 52.5-56.7) and 45.1 (95%CI 43.1-47.0) substitutions/genome/year at AF of ≥0.1, ≥0.5, ≥0.75 respectively. Rates in ΔNSP-14 (n=13) vs wt (n=27) groups were 557.7 (95%CI 537.0-578.2) vs 193.1 (95%CI 187.1-199.1) p-value 0.001, 50.8 (95%CI 44.3-57.3) vs 56.3 (95%CI 53.1-59.4) p-value 0.144, and 31.0 (95%CI 25.9-36.1) vs 51.3 (95%CI 48.3-54.3) p- value < 0.001 at AF ≥0.1, ≥0.5, ≥0.75 respectively. Patients with immune comorbidities (n=6) had significantly higher MR of 137.6 (95%CI 114.6-160.5) vs 40.5 (95%CI 38.4-42.7) p-value < 0.001, and 113.7 (95%CI 92.8-134.5) vs 33.4 (95%CI 31.5-35.4) p-value < 0.001 at AF ≥0.5 and ≥0.75 respectively. Similar results were obtained when using the JC69 model.

Conclusion

Intra-host SARS-CoV-2 mutation rates are higher than those reported through population analysis. Virus strains with altered NSP-14 have accelerated MR at low AF. Immunosuppressed patients have elevated MR at higher AF. Understanding intra-host virus evolution will aid in current and future pandemic modeling.

Disclosures

Frank Esper, M.D, Johnson and Johnson: Advisor/Consultant Daniel D. Rhoads, M.D. PhD, Luminex: Advisor/Consultant|Talis Biomedical: Advisor/Consultant|Thermo Fisher: Advisor/Consultant.