bluuebunny/crossref_metadata_2025 huggingface dataset:
1402. NTM Infections; A Rising Global Health Problem/Clinical Characteristics and Outcomes of Patients with Non-Tuberculous Mycobacterial Infections at Two Tertiary Academic Medical Centers
Authors: Nawwar Abdelhameed , Madrid-Morales Julieta , Velez-Mejia Carolina , Pizarro Rigoberto De Jesus , Cepeda Victor , Reveles Kelly R , Cadena-Zuluaga Jose , Javeri Heta
Published: December 2021

Background

Non-Tuberculous Mycobacteria (NTM) cause infections in immunocompetent as well as immunocompromised individuals affecting pulmonary and extra pulmonary sites. These pathogens are widely distributed globally and recent reports have shown their rise in many developed countries. Our study aimed to assess the disease magnitude, describe patient characteristics and risk factors, assess diagnostic and therapeutic measures and review outcomes furthering our understanding of the overall disease process.

Methods

We conducted a retrospective, multicenter review of patients with positive NTM cultures treated at University Hospital System and South Texas Veterans Health Care System (STVHCS) from 2011 to 2018. Infections were classified as pulmonary or extrapulmonary, and we recorded demographics, microbiological data, treatment regimens, duration, complications, follow-up and mortality. All categorical variables were described using percentages and compared between groups using the chi-square test.

Results

A total of 176 patients were included for analysis, of which 111 (63.1%) met criteria for NTM disease (2020 ATS/IDSA). The most common cultured mycobacterium was M. Avium Complex (MAC). M. abscessus-chelonae was more commonly associated with clinical disease and isolated from an extra pulmonary site whereas M. simiae complex had similar distribution between the infected and un-infected groups. Over 50% of patients received treatment (80% in the infected group). Cure was seen in 47.2%, all-cause mortality was 27% at last follow-up. Median duration of therapy was 10 months. 47% of patients experienced adverse effects which led to treatment discontinuation in one third of patients. Patients who were able to achieve a cure received a longer duration of therapy (12 vs 7 months; not statistically significant) and treatment was halted more commonly in the group that did not achieve eventual cure (42.6% vs. 16.7%, p=0.007).

Conclusion

NTM infections represent a therapeutic challenge with low cure rates and high mortality. An understanding of the risk factors, treatment options and outcomes is essential to guide appropriate management. Our study highlights high rates of adverse effects and discontinuation which precludes prolonged courses of therapy required to achieve cure.

Disclosures

All Authors: No reported disclosures
1418. Single Center Treatment Patterns for Asymptomatic Bacteriuria and UTIs in Kidney Transplant Recipients: Are We Still Overtreating?
Authors: Azeem Meena , Cowman Kelsie , Pynadath Cindy , Bartash Rachel
Published: December 2021

Background

In February 2019, the American Society of Transplantation (AST) published guidelines on the management of asymptomatic bacteriuria (AB) and urinary tract infections (UTIs) in kidney transplant (KT) recipients. These recommendations include avoiding treatment of AB > 2 months post-transplant and outline the duration of treatment (DT) for uncomplicated and complicated UTIs. We reviewed management of these syndromes and guideline concordance at our institution.

Methods

We conducted a single-center, retrospective cohort study of KT recipients age > 18 years who underwent transplantation between June 2016 - June 2020. Patients were obtained through query of our electronic medical record for documented UTI syndromes and included if a diagnosis was confirmed between March 2019 - December 2020 upon chart review. Definitions of AB, complicated UTI, and uncomplicated UTI were based on AST definitions. Patients with AB < 2 months post-transplant were excluded. Outcomes included treatment of AB, DT, 30-day hospital admission and re-admission, and 30-day mortality. Bivariate analysis was conducted using chi square and t test.

Results

Seventy-four patients (mean age 55.4 years, 62.0% female) were included. Twenty-one patients had AB, 90% of whom received antibiotics. Distribution of diagnoses and median DT among those treated with antibiotics is outlined in Table 1.

Overall DT was similar in patients whose care included infectious disease (ID) input and those who did not (10.0 vs. 10.0 days, p=0.12), although ID involvement was more common in complicated UTIs. There was no difference in 30-day admission rates for those receiving < 7 days vs. > 7 days of antibiotics (p=0.53) (Table 2) including those with complicated UTIs (5/15 in < 7 days (33%) vs. 4/18 in > 7 days (22%) p=0.49). There were no deaths within 30 days of diagnoses.

Conclusion

Despite guidelines, treatment of AB is common and uncomplicated UTIs often receive prolonged courses of antibiotics. There was no increased risk of admission or mortality with shorter DT, though these results should be interpreted cautiously given the small sample size. Greater stewardship efforts are needed in this high-risk population.

Disclosures

Kelsie Cowman, MPH, Merck (Research Grant or Support)
1426. Empiric Antimicrobial Prescribing for Urinary Tract Infections in Patients Discharged from the Emergency Department
Authors: Rech Megan A , Faine Brett , Vakkalanka Priyanka , Talan David A
Published: December 2021

Background

Urinary tract infections (UTIs) are commonly treated infections in the emergency department (ED), accounting for 3 million visits annually and 15% of outpatient antibiotic prescriptions. The purpose of this study was to characterize empiric and definitive antimicrobial therapy for treatment of UTIs in a nationally representative sample of ED patients.

Methods

This was a multicenter, retrospective cohort study utilizing the Emergency Medicine PHARMacy Research NETwork (EMPHARM-NET), a network of 15 geographically diverse EDs. Patients ≥18 years presenting to and discharged home from the ED with primary diagnosis code of cystitis, pyelonephritis, or UTI from 2018-2020 were included. We describe empiric intravenous (IV) and oral antibiotics used for the treatment of UTI in patients seen and discharged from the ED.

Results

Of the 3779 ED patients treated for UTI, most were discharged from the ED (n=2483, 66%). Most patients were female (76.3%) and common comorbidities were hypertension (47.8%) and diabetes (26.5%). Most patients had uncomplicated (39.4%) or complicated (40.9%) cystitis. 1134 (45.6%) had a positive urine culture, most commonly E. coli (63%) and K. pneumoniae (13%). The most common antibiotics administered in the ED were ceftriaxone (19.7%), nitrofurantoin (6.2%), cephalexin (5.8%), and sulfamethoxazole/trimethoprim (SMX/TMP, 4.8%). The most common antibiotics prescribed at discharge where cephalexin (33.9%), nitrofurantoin (20.6%), SMX/TMP (12%), ciprofloxacin (8.2%), and cefdinir (8%). The mean length of treatment was 7.1 days (standard deviation 2.5 days). Overall, 454 patients returned to the ED within 30 days. The odds of returning to the ED within 30 days was higher in those that did not have appropriate empiric antibiotics based on susceptibilities (OR 1.37, 95% confidence interval 1.06, 1.78).

Conclusion

This multicenter, retrospective cohort study describes ED patients discharged from the ED after UTI diagnosis. Patients presented most commonly for cystitis. Nearly half of discharged patients were culture positive. Antimicrobial selection varied; IV ceftriaxone and oral cephalexin were most commonly empirically utilized to treated patients with UTI. Inappropriate antimicrobial selection increased odds of a return ED visit within 30 days.

Disclosures

Megan A. Rech, PharmD, MS, BCCCP, FCCM, Spero (Research Grant or Support) Brett Faine, PharmD, Spero Therapeutics (Research Grant or Support) David A. Talan, MD, AbbVie (Consultant)GSK (Consultant)SPERO Therapeutics (Grant/Research Support)
1441. Significant Decrease in the Incidence Rate of Common Outpatient Upper Respiratory Tract Infection Diagnoses per Clinic Visit in the First Respiratory Season of October 2020 to March 2021 During the Covid-19 Pandemic. A Report From an Outpatient Antimicrobial Stewardship Program at a community hospital in Brooklyn
Authors: Shah Jilan M , Badem Olga , Thet Zeyar , Wai Thinzar , Seetharam Karthik , Akande Olawale , Pathickal Sherin , Orris Maxine , Kanu Ngozi , Ward Laurie , Mir Tanveer
Published: December 2021

Background

As part of our outpatient Antimicrobial Stewardship Program, we do surveillance of diagnoses and antibiotic use for common upper respiratory tract infections such as acute upper respiratory tract infection, acute bronchitis, sinusitis, and pharyngitis. We sought to evaluate the impact of the Covid-19 pandemic on the incidence rate of upper respiratory tract infection diagnoses per clinic visit during October 2020 to March 2021 season compared to the three prior respiratory seasons. We also sought to reflect of impact of increase in televisits and overlapping symptoms of COVID 19 and upper respiratory tract infections.

Methods

Our cohort study extending from October 2017 to March 2021. We collected number of diagnoses of upper respiratory infections and number of unique clinic visits during four consecutive respiratory seasons at our primary care sites via electronic health records.

Results

During the recent October 2020 to March 2021 respiratory season which coincided with the second NYC Covid-19 wave, we had 11569 unique clinic visits and 39 diagnoses of an upper respiratory tract infection - incident rate of 1.29. In the three prior respiratory seasons combined, we had 40939 unique clinic visits and 833 diagnoses of an upper respiratory tract infection – incident rate of 1.49. The incident rates showed a dramatic decline using the test based method and the chi square-statistic p< 0.0001 with an incident rate ratio using a poisson exact method of 6.0359. Statistical comparisons of the current season to each prior individual season yielded similar results. The percentage of Tele-visits during the current season was 19% compared to 0% in the 3 prior seasons.

Conclusion

During the first respiratory season from October 2020 to March 2021 in midst of the Covid-19 pandemic which also coincided with the second Covid-19 wave in New York, we saw a statistically significant decrease in incidence of common upper respiratory tract infection diagnoses per clinic visit compared to the three prior respiratory seasons. Overlapping signs and symptoms of upper respiratory tract infections and Covid-19 with the added percentage in Tele-visits did not cause an increase in incidence rates of upper respiratory tract infection diagnoses. Covid-19 related mitigation efforts may have played a role.

Disclosures

All Authors: No reported disclosures
167. Efficacy of Investigational Microbiota-Based Live Biotherapeutic RBX2660 in Individuals with Recurrent Clostridioides difficile Infection: Data from Five Prospective Clinical Studies
Authors: Bancke Lindy , Su Xin
Published: December 2021

Background

Microbiota-based treatments have shown promise to reduce recurrence, morbidity, and mortality for recurrent Clostridioides difficile infections (rCDI), but consistent and reliable clinical efficacy data are needed to support regulatory approvals that broaden patient access. Here we provide cumulative data from 5 prospective clinical studies evaluating RBX2660—a standardized, microbiota-based investigational live biotherapeutic—for reducing rCDI recurrence.

Methods

This analysis included three phase 2 (PUNCH CD, PUNCH CD2, PUNCH CD Open Label) and two phase 3 trials (PUNCH CD3, PUNCH CD3-OLS ad hoc analysis). All participants were ≥18 years old with documented rCDI who completed standard-of-care (SOC) oral antibiotic therapy prior to treatment with RBX2660. Depending on the trial, assigned study treatment was 1 or 2 doses of RBX2660 or placebo, with Treatment Success (TS) defined as remaining recurrence-free for 8 weeks after treatment. Treatment responders were monitored for additional recurrence through at least 6 months after receiving the last RBX2660 dose. Treatment non-responders were administered SOC antibiotic treatment and/or additional RBX2660 treatment and monitored for recurrence for 8 weeks after the last received RBX2660 treatment.

Results

Among the 5 trials with a total of 629 participants, RBX2660 consistently reduced the recurrence of rCDI, with TS rates ranging from 50 to 78.9% (Figure 1). Among primary non-responders, additional RBX2660 treatments further reduced recurrence and overall rates of TS ranged from 75.0% to 84.4% (Figure 2). Among CD, CD3, and CD3-OLS, a majority of primary responders remained CDI-free to 6 and up to 24 months with success rates ranging from 74.4% to 92.1%.

Conclusion

Among 5 trials with consistent investigational product and clinical endpoints, RBX2660 consistently reduced rCDI recurrence, with a majority of treatment responders remaining CDI-free for at least 6 and up to 24 months. Further, initial lack of response to RBX2660 did not preclude clinical benefit of additional RBX2660 treatment. Collectively, these data demonstrate consistency and reliability of the potential benefit of RBX2660 across an entire clinical program.

Disclosures

Lindy Bancke, PharmD, Rebiotix, a Ferring Company (Employee) Xin Su, MD, Rebiotix/Ferring (Employee)
179. Identification and Whole Genome Sequencing Analysis of an Oxacillinase (OXA)-48-like-producing Acinetobacter baumannii Outbreak in California, January-May 2021
Authors: Holden Diana , Sylvester Matthew , Crandall John , Xu Fengfeng , Schneider Emily C , Watson Hillary Berman , Zhang Peng , Bacud Jaclyn , Mejia Rafael , Epson Erin , Berrada Zenda , Mitsunaga Tisha , Mukhopadhyay Rituparna
Published: December 2021

Background

In January 2021, a California acute care hospital (ACH A), a sentinel site for Acinetobacter baumannii (AB) surveillance, identified OXA-48-like-carbapenemase producing (CP) AB in a patient admitted from a ventilator-equipped skilled nursing facility (vSNF A); OXA-48-like AB had not been previously reported in the United States.

Methods

Our investigation included onsite infection control (IC) assessments, contact tracing, and point prevalence surveys (PPS) at vSNF A. The Antibiotic Resistance (AR) Laboratory Network performed carbapenemase testing on AB isolates (including those from ACH A) and PPS swabs. A case was defined as a patient with an OXA-48-like AB isolate, or an epidemiologically-linked patient with an OXA-48-like gene detected via screening. We performed whole genome sequencing (WGS) of OXA-48-like AB and other CP organisms on the Illumina MiSeq and Oxford Nanopore MinION for short and long read sequencing, respectively.

Results

Since January 2021, we have identified five OXA-48-like AB cases (including the index), six OXA-48-like cases (no organism recovered), and six patients with other CP organisms at ACH A and vSNF A. Since August 2019, vSNF A has concurrently been experiencing an OXA-109 AB outbreak. A second vSNF A patient, Patient 2, who overlapped with the index patient, had OXA-48-like Klebsiella pneumoniae (KP) (November 2019) and OXA-109 AB (May 2020) isolates. WGS of the index patient’s AB and Patient 2’s KP isolates identified a rare OXA-48-like gene located on the AB chromosome and a KP plasmid. The OXA-48-like AB was also carrying an OXA-109 gene, and hqSNP analysis indicated it varied by 9-44 single-nucleotide polymorphisms (SNPs) from 14 OXA-109 AB isolates linked to that outbreak, and 0-3 SNPs from the other OXA-48-like AB case isolates.

Figure 1. Phylogenetic Tree Comparison of OXA-109 AB and OXA-48-like AB Isolates

Figure 2. Epidemic Curve of OXA-109 AB, OXA-48-like AB, and Other CP Organism Cases, 2019-2021

Conclusion

The first reported case of OXA-48-like AB in the US was identified through public health sentinel laboratory surveillance, allowing prompt response to contain spread of a novel multidrug-resistant organism (MDRO). WGS detected a rare OXA-48-like gene in AB and KP and provides evidence for possible interspecies transfer of this gene from KP to AB through plasmid transfer followed by chromosomal integration.

Disclosures

All Authors: No reported disclosures
193. Impact of COVID-19 Pandemic on Pulmonary Tuberculosis Evaluations and Diagnosis at a Large Safety Net Hospital in Los Angeles, California
Authors: Jones Aditya J , Jones-Lopez Edward C , Bulter-Wu Susan , Wilson Melissa L , Rodman John , Voyageur Christian , Jones Brenda E
Published: December 2021

Background

There is significant global concern that the COVID-19 pandemic may negatively impact tuberculosis (TB) control. This is a descriptive analysis of TB evaluations and diagnosis during 2019 (pre COVID-19 period) and 2020 (COVID-19 period) at the largest safety net hospital in Los Angeles County (LAC+USC Medical Center).

Methods

The medical records of patients diagnosed with pulmonary TB from January 1, 2019 to December 31, 2020 were identified through laboratory and electronic medical records. We included all patients with ≥ 1 sputum positive result for Mycobacterium tuberculosis (MTB) culture and reviewed their Xpert MTB/RIF MTB PCR.

Results

Table 1 shows summary of results. During the COVID-19 period, the number of patients evaluated for pulmonary TB decreased by 64% compared to the previous year (Figure 1). The proportion of patients with culture-confirmed TB disease however, was nearly identical (P=0.913) (Table 1). Sputum acid-fast bacilli (AFB) smear positivity increased 52% to 64% during COVID-19 (P=0.324) and disease severity as measured by chest radiograph, was significantly higher during the COVID-19 period (P = 0.031) (Figure 2).

Trend of sputum AFB smear and culture samples collected from January 1, 2019 to December 31, 2020.

Summary of results of patients diagnosed with pulmonary TB from January 1, 2019 to December 31, 2020 at LAC+USC Medical Center.

Results of two-sample test for proportions of 2019 vs 2020 for cavitary lesions, extent of disease, and sputum positive AFB smear microscopy.

Conclusion

These preliminary results suggest that when compared to the previous year, the number of pulmonary TB evaluations decreased by 64% during the COVID period. Whereas the proportion of patients diagnosed with TB disease was similar, TB patients during the COVID-19 period had more advanced disease at diagnosis, as measured by sputum smear AFB microscopy and disease severity on chest radiograph (P=0.031). These data suggest potentially consequential interruptions and delays in pulmonary TB diagnosis during the COVID-19 period.

Disclosures

Susan Bulter-Wu, PhD , Cepheid (Consultant)
19. Delivery of Flu Immunizations to Healthcare Workers During COVID-19 Pandemic Using a Multidisciplinary Flu Team Approach in a Tertiary Center in the Middle East
Authors: Cardona Lyssette , Mohammed Shafii , Nour Samah , Alkhalaileh Mu’ed
Published: December 2021

Background

Compliance with influenza immunization in HCW remains a global challenge, uptake in the Middle East has been reported at 24.7% due to limited access and awareness (1). We aim to report a successful campaign by establishing a multidisciplinary Flu Team during ongoing COVID-19 pandemic.

Methods

A multidisciplinary Flu team taskforce was assembled representing all stakeholders to include: Occupational Health, Nursing, Operations, Infomatics, Pharmacists and Administrative staff in July 2020. A pivot was made to switch location from previous year visits to an established vaccine center (ballroom) to a mobile campaign. From July to November 1st, the team met on a regular basis with 90 stakeholders to launch and monitor the ongoing immunizations. Electronic medical record (EPIC) tools such as One Click and Express Lane facilitated nursing check-in, documentation and immunization at one stop and eliminated previously used registration by other staff. EPIC Clarity feature facilitated reporting of compliance for managers and leadership. Ongoing education and awareness of immunization were ongoing through various platforms of communication such as huddles, phone screens, elevators, lounges, virtual grand rounds and corporate intranet communication and website videos.

Results

Of the 3578 healthcare workers, 3,399 were immunized (95%) from September 2020 until the end of October 2020. There were 86 (2.4%) employees exempted during this period due to medical reasons or excused leaves ( e.g military, maternity), Figure 1. Compliance differed among functions, 95.86% physicians, 97.2% clinical and nursing, 92% academics, 94.96% finance, 91.15% human resources, 92.1% infomatics, 60% legal, 80.6% operations. Only 93 (2.6%) were non-compliant.

Employee Flu Immunization

Hospital Overall Compliance in 2020

Compliance by Function in 2020

Conclusion

Influenza illness adds an additional burden to the healthcare workforce during COVID-19. A multidisciplinary and collaborative team of teams approach delivered higher compliance for flu immunization than reported in the Middle East and enhanced by the use of state of the art technology. Convenience, educational awareness, free and safe access supported further the compliance with vaccination. To our knowledge, our 2020 flu campaign is the first successful experience reported in the Middle East during the current pandemic.

Disclosures

All Authors: No reported disclosures
21. Systematic Review and Meta-Analysis of Pneumococcal Vaccine Effectiveness against Invasive Pneumococcal Disease among Adults
Authors: Farrar Jennifer Loo , Kobayashi Miwako , Childs Lana , Pilishvili Tamara
Published: December 2021

Background

Two new pneumococcal conjugate vaccines (PCVs), PCV15 and PCV20, are anticipated to be licensed for use in U.S. adults in 2021. To help inform the U.S. Advisory Committee on Immunization Practices’ discussions on pneumococcal vaccine use among adults, we conducted a systematic review and meta-analysis. We specifically looked at efficacy or effectiveness of PCV13 and pneumococcal polysaccharide vaccine (PPSV23) against invasive pneumococcal disease (IPD) in adults.

Methods

We conducted a search of English literature published from 1998 – February 2021 on PCV13 and PPSV23 efficacy or effectiveness studies using eight major databases. Studies targeting adults with immunocompromising conditions were excluded. Title and abstract screening of identified studies and data abstraction were performed by two reviewers. Results were stratified by vaccine product, outcome evaluated (vaccine type (VT) or all IPD), study design, and effect measure. Random effects models were used to pool estimates by stratum.

Results

Of 3,422 citations reviewed, we identified 26 IPD studies; 4 on PCV13, 22 on PPSV23, 18 with all IPD, and 17 with VT-IPD (Table) as an outcome. Only one randomized-controlled trial (RCT) was identified for PCV13 with an efficacy of 52% (95% CI: 22%, 77%) against all IPD and 75% (95% CI: 41%, 91%) against VT-IPD. A pooled vaccine effectiveness (VE) estimate from three observational studies evaluating PCV13 was 56% (95% CI: 32%, 71%; I2 =12.8) against VT-IPD.

Two RCTs evaluating PPSV23 reported efficacies against all IPD ranging between 79-86%; an additional RCT reported no IPD cases during RCT. Vaccine effectiveness estimates from 14 observational studies evaluating PPSV23 ranged between 29-76% against all IPD. Pooled VE estimates from 12 observational studies showed PPSV23 effectiveness against VT-IPD was 38% (95% CI: 28% to 46%; I2 =40.8).

Table. Efficacy and effectiveness studies against vaccine-type invasive pneumococcal disease

Conclusion

Evidence suggests both pneumococcal vaccines are effective against VT-IPD in adults. Given that PCV15 and PCV20 are expected to be licensed based on immunogenicity data and no clinical efficacy data are available for these new vaccines, the findings from this review will help inform policy discussions on use of the new PCVs among adults.

Disclosures

All Authors: No reported disclosures
23. ZOE-50 and ZOE-70 Placebo Groups Data Shows that Burden of Pain Associated with Herpes Zoster Interferes with Activities of Daily Living
Authors: Cabrera Eliazar Sabater , Curran Desmond , Matthews Sean , Boutry Céline , Lecrenier Nicolas , Cunningham Anthony L
Published: December 2021

Background

Adults ≥ 50 years of age (YOA) are at increased risk of herpes zoster (HZ), a condition which can cause long-term pain and discomfort. In this analysis, we assessed the burden of pain associated with HZ and its interference with activities of daily living (ADL) in patients ≥ 50 YOA.

Methods

ZOE-50 (NCT01165177) and ZOE-70 (NCT01165229) were phase III, observer-blind, placebo-controlled, 1:1 randomized studies in adults ≥ 50 YOA (ZOE-50) and ≥ 70 YOA (ZOE-70) who received 2 doses of the adjuvanted recombinant zoster vaccine or placebo, 2 months apart. To correctly evaluate HZ pain, the analysis was performed only on the placebo groups data of ZOE-50 (≥ 50 YOA) and pooled ZOE-50/70 (≥ 70 YOA pooled data) in the modified total vaccinated cohort (mTVC, primary population for efficacy analysis) HZ-confirmed cases. HZ pain and interference with ADL was assessed by the Zoster Brief Pain Inventory (ZBPI) instrument completed daily by patients for the first 28 days and then weekly until resolution. Time to resolution of clinically significant pain was analyzed using Kaplan Meier methods. We estimated the cumulative area under curve (AUC) of the ZBPI worst pain score and the ZBPI ADL score up to 182 days post-HZ rash onset. A high AUC reflects a higher severity/longer duration of pain.

Results

Overall, 254 patients ≥ 50 YOA and 284 patients ≥ 70 YOA were included in the mTVC HZ-confirmed cases for the ZOE-50 and ZOE-70 pooled analysis, respectively. In HZ patients ≥ 50 YOA, 94.6% reported any pain (ZBPI pain score > 0), 87.6% clinically significant pain (ZBPI pain score ≥ 3) and 65.1% severe pain (ZBPI pain score ≥ 7). Similarly, in HZ patients ≥ 70 YOA, 93.2% reported any pain, 90.9% clinically significant pain and 68.4% severe pain. It was estimated that 11.6% and 18.3% of patients aged ≥ 50 and ≥ 70 YOA, respectively, had clinically significant pain 3 months after the onset of HZ. The mean AUC at 182 days was 137.24 (≥ 50 YOA) and 190.68 (≥ 70 YOA), for the ZBPI worst pain score and 92.75 (≥ 50 YOA) and 130.89 (≥ 70 YOA), for the ZBPI ADL score.

Conclusion

Analysis of data provided by patients with confirmed HZ shows that the burden of HZ pain is high and is associated with interference on patients’ ADL.

Funding

GlaxoSmithKline Biologicals SA

Acknowledgment

M Maior/S Hulsmans provided medical writing/editorial support (Modis c/o GSK)

Disclosures

Eliazar Sabater Cabrera, MSc, GSK (Employee, Shareholder) Desmond Curran, PhD, The GSK group of companies (Employee, Shareholder) Sean Matthews, MSc, GSK (Independent Contractor) Céline Boutry, PhD, GSK (Employee) Nicolas Lecrenier, Ing, PhD, The GSK group of companies (Employee, Shareholder) Anthony L. Cunningham, F.A.H.M.S., MD, M.B.B.S., B. Med. Sci. (Hons), F.R.A.C.P., F.R.C.P.A., F.A.S.M., GSK group of companies (Grant/Research Support, Advisor or Review Panel member, Speaker’s Bureau)
25. Relative Effectiveness of Adjuvanted Trivalent Influenza Vaccine Compared to Egg-Based Trivalent High-Dose Influenza Vaccine among U.S. Older Adults during 2019-20 Influenza Season
Authors: levin myron J , Divino Victoria , Pelton Stephen I , Postma Maarten , Shah Drishti , Mould-Quevedo Joaquin F , DeKoven Mitchell
Published: December 2021

Background

According to the Centers for Disease Control and Prevention (CDC), during the 2019-20 U.S. influenza season, influenza resulted in almost 180,000 hospitalizations and over 13,000 deaths in adults ≥ 65 years. The current study evaluated the relative vaccine effectiveness (rVE) of adjuvanted trivalent influenza vaccine (aTIV) compared to high-dose trivalent influenza vaccine (TIV-HD), against influenza-related hospitalizations/emergency room (ER) visits, all-cause hospitalizations and hospitalizations/ER visits for cardio-respiratory disease (CRD) among adults ≥65 years for the 2019-20 influenza season.

Methods

A retrospective cohort analysis of older adults (≥ 65 years) was conducted using IQVIA’s professional fee, prescription claims and hospital charge master data in the U.S. Baseline characteristics included age, gender, payer type, geographic region, Charlson Comorbidity Index (CCI), comorbidities, indicators of frail health status, and pre-index hospitalization rates. To avoid any influenza outcome misclassification with COVID-19 infection, the study period ended March 7, 2020. Adjusted analyses were conducted through inverse probability of treatment weighting (IPTW) to control for selection bias. Poisson regression was used to estimate the adjusted pairwise rVE against influenza-related hospitalizations/ER visits, all-cause hospitalizations and any hospitalization/ER visit for CRD. An unrelated negative control outcome, urinary tract infection (UTI) hospitalization was included.

Results

During the 2019-20 influenza season, following IPTW, 798,987 recipients of aTIV and 1,655,979 recipients of TIV-HD were identified. After IPTW adjustment and Poisson regression, aTIV was statistically comparable to TIV-HD for prevention of influenza-related hospitalizations/ER visits (3.1%; 95% CI: -2.8%-8.6%) and all-cause hospitalizations (-0.7%; 95% CI: -1.6%-0.3%). Similar comparable outcomes were found for reduction of any hospitalization/ER visit for CRD (0.9%; 95% CI: 0.0%-1.7%). No treatment effect was identified for the negative control outcome.

Conclusion

aTIV and TIV-HD demonstrated comparable reductions in influenza-related hospitalizations/ER visits, all-cause hospitalizations and hospitalizations/ER visits for CRD.

Disclosures

myron J. levin, MD, GSK group of companies (Employee, Research Grant or Support) Victoria Divino, PhD, Seqirus (Consultant) Stephen I. Pelton, MD, Seqirus (Consultant) Maarten Postma, Dr., Seqirus (Consultant) Drishti Shah, PhD, Seqirus (Consultant) Joaquin F. Mould-Quevedo, PhD, Seqirus (Employee) Mitchell DeKoven, PhD, Seqirus (Consultant)
33. Evaluating the Safety and Effectiveness of a Non-Severe Community-Acquired Pneumonia Pharmacist Pathway
Authors: Sylvain Kelly , Polenska Jennifer , Levin James
Published: December 2021

Background

One of the main roles of the SSM Health WI Regional Antimicrobial Stewardship Program is to create infection treatment pathways based on the Infectious Diseases Society of America (IDSA) practice guidelines. Treatment pathways are used to guide provider prescribing of antimicrobials for disease states such as community-acquired pneumonia (CAP). The objective of this study was to evaluate the safety and effectiveness of a non-severe CAP pharmacist pathway based on the updated IDSA and American Thoracic Society 2019 CAP practice guideline.

Methods

A retrospective chart review was performed on all patients placed on the non-severe CAP pharmacist pathway at SSM Health St. Mary’s Hospital in Madison, WI from September 2020 through April 2021. Patients who initially started on the pathway were removed if they met prespecified criteria (Table 1). The primary outcome in this study was 30-day respiratory-related readmission rate. Secondary outcomes included average total length of antibiotic therapy, pharmacist interventions [intravenous (IV) to oral (PO) conversion, antibiotic de-escalation (including discontinuation of azithromycin with negative legionella urinary antigen), duration of therapy], and 30-day all-cause readmission rate.

Table 1. Criteria for Removal from the Pathway

Figure 1. Pharmacist Interventions

Results

A total of 119 patients were initiated on the non-severe CAP pharmacist pathway, of which 47 patients (40%) completed the pathway and 72 patients (60%) were removed from the pathway. Of the 47 patients who completed the pathway, there were no respiratory-related readmissions with a 30-day all-cause readmission rate of 6.4% (N=3/47). The average total duration of beta-lactam therapy was 6.8 days and the average total duration of macrolide therapy was 1 day due to de-escalation with a negative legionella urinary antigen result. A total of 61 pharmacist-driven interventions were completed [IV to PO conversion (N=15), de-escalation (N=27), and duration of therapy (N=19)].

Table 2. Summary of Results

Conclusion

The findings of this study suggest that implementation of a non-severe CAP pharmacist pathway is safe and effective. No readmissions were related to non-severe CAP management and pharmacists completed guideline-driven interventions related to antimicrobial de-escalation, IV to PO conversion, and duration of therapy.

Disclosures

All Authors: No reported disclosures
39. Impact of Antimicrobial Stewardship Interventions in a Community Hospital setting: An Interrupted Times Analysis
Authors: Li Jason , Chan Ken , Parvez Hina , Gorlin Margaret , Smith Miriam A
Published: December 2021

Background

Community hospitals have fewer resources for antimicrobial stewardship programs (ASP) compared to larger tertiary hospitals. At our 312-bed community hospital, Long Island Jewish Forest Hills/Northwell, a combination of modified preauthorization, prospective audit feedback, and ASP education was implemented starting in August 2019 (Monday through Friday 9 am to 5 pm).

Methods

This retrospective study evaluated the impact of ASP interventions on the rate of targeted antimicrobial use over a 7 month pre- vs 7 month post- intervention period (Aug 2018 to Feb 2019 vs Aug 2019 to Feb 2020). Targeted antimicrobials included piperacillin-tazobactam, vancomycin, daptomycin, and carbapenems. The primary outcome was the monthly mean for overall targeted antimicrobial use measured by the rate of antimicrobial days per 1000 days present. Secondary outcomes were the individual rates of antimicrobial days per 1000 days present for each of the targeted antimicrobials, and the hospital’s overall standardized antimicrobial administration ratio (SAAR). Data were analyzed as a segmented regression of interrupted time series.

Results

Pre-intervention, there was an increasing trend (positive slope, p< 0.05) in the monthly mean, hospital SAAR, vancomycin and piperacillin-tazobactam use. Post-intervention, there was a significant change in slope for these same metrics, indicating a decrease in the mean use. Immediate impact of ASP interventions, measured by the difference in antibiotic use between the end of each intervention period, was visually evident in all cases except carbapenems (Fig. 1 through 4). The immediate impact on the overall monthly mean represented a significant reduction in the rate of antimicrobial days per 1000 days present, -12.72 (CI -21.02 to -4.42, P < 0.0066). The pre- vs post- ASP gap for all measures was negative and consistent with fewer days of antibiotic use immediately following intervention.

Conclusion

A targeted, multifaceted ASP intervention utilizing modified preauthorization, prospective audit feedback, and education significantly reduced antibiotic use in a community hospital.

Disclosures

All Authors: No reported disclosures
43. Impact of a Five-Year Intervention of an Antimicrobial Stewardship Program on the Optimal Antibiotic Prophylaxis Selection in Surgery in a Hospital without Restrictions on Antibiotics Prescription in Costa Rica
Authors: Díaz-Madriz José P , Zavaleta-Monestel Esteban , Villalobos-Madriz Jorge A , Meléndez-Alfaro Alison V , Castrillo-Portillo Priscilla , Vásquez-Mendoza Ana F , Muñoz-Gutierrez Gabriel , Arguedas-Chacón Sebastián
Published: December 2021

Background

In a private hospital without restrictions on antibiotic prescription, the success of an Antimicrobial Stewardship Program (ASP) depends mainly on prospective feedback and education. Previously, the ASP of this hospital (PROA-HCB) managed to achieve a positive impact on the antibiotic prophylaxis in cesarean delivery. The purpose of this study is to characterize the impact after implementing the PROA-HCB on the optimal prophylaxis selection of all the procedures included in the clinical guideline for surgical antibiotic prophylaxis in adult patients.

Methods

A retrospective observational study that compares the selection, duration, antibiotic consumption, bacterial resistance profiles and patient’s safety outcomes regarding antibiotic use for all surgical prophylaxis prescription over six months for the periods before (pre-ASP) and after a five-year intervention of PROA-HCB (post-ASP).

Results

After a five-year intervention, the percentage of optimal selection of antibiotic prophylaxis in Surgery was 21.0% (N=1598) in the pre-ASP period and 80.0% (N=841) in the post-ASP period (59% absolute improvement, p < 0.001). Percentage of optimal duration was 69,1% (N=1598) in the pre-ASP period and 78.0% (N=841) in the post-ASP period (8.9% absolute improvement, p < 0.001). Mean ceftriaxone utilization was 217.7 defined daily doses (DDD) per 1,000 patient days DDD for the pre-ASP period and 139.8 DDD per 1,000 patient days for the ASP period (35.8% decrease; p = 0.019). Mean cefazolin utilization was 14.9 DDD per 1,000 patient days for the pre-ASP period and 153.3 DDD per 1,000 patient days for the ASP period (928.6% increase; p = 0.021). Regarding percentage of bacterial resistance, there was detected an improvement in some isolates like Escherichia coli with a decrease of ESBL detection (11% decrease; p = 0.007). In addition, no serious adverse reactions or an increase in surgical site infections were detected after the intervention.

Conclusion

The implementation of an ASP in the surgical ward showed an overall positive impact on selection and duration of antibiotic prophylaxis. Furthermore, this intervention could have had a positive impact on antimicrobial resistance and at the same time had no negative effects on the patients.

Disclosures

All Authors: No reported disclosures
68. Impact of Streptococcus pneumoniae Urinary Antigen Testing in Patients with Community-Acquired Pneumonia Admitted within a Large Academic Medical System
Authors: Greenfield Adam , Marsh Kassandra L , Siegfried Justin , Zacharioudakis Ioannis , Ahmed Nabeela , Decano Arnold , Aguero-Rosenfeld Maria E , Inglima Kenneth , Papadopoulos John , Dubrovskaya Yanina
Published: December 2021

Background

Limited data support the use of pneumococcal urinary antigen testing (PUAT) for patients admitted with community-acquired pneumonia (CAP) as a stewardship tool to curtail the use of broad-spectrum antimicrobials. At NYULH, CAP guidelines and admission order set were developed to standardize diagnostic testing, including PUAT. In this study we describe patients with positive versus negative PUAT and evaluate de-escalation and patients’ outcomes.

Methods

This was a retrospective study of adults admitted with diagnosis of CAP between January-December 2019 who had a PUAT performed. The primary outcome was incidence and timing of de-escalation of antimicrobials following PUAT result. Among patients with a positive PUAT we compared hospital length of stay (LOS), incidence of Clostridioides difficile infection (CDI), infection-related readmission within 30 days, and in-hospital mortality among those who were de-escalated versus those who were not de-escalated/required escalation.

Results

We evaluated 910 patients, of which 121 (13.3%) were PUAT positive. No difference in baseline characteristics, including severity of illness as represented by the Pneumonia Severity Index (97 [IQR 76-117] vs 89 [IQR 67-115], p=0.083) and Charlson Comorbidity Index, were observed between PUAT positive and negative groups. Time to PUAT testing occurred shortly after presentation to the hospital in both cohorts (16h [IQR 16-27] vs 13h [IQR 8-22], p=0.140). Initial de-escalation occurred in 97/117 (82.9%) and 629/775 (81.2%) of PUAT positive and negative patients, respectively (p = 0.749). Median time to de-escalation was shorter in the PUAT positive cohort (1 [IQR 0-2] vs 1 [IQR 1-2] day, p = 0.01). Among the PUAT positive group, hospital LOS stay was shorter in patients who were de-escalated compared to those who were not de-escalated/required escalation (6 days [IQR 4-10] vs 8 days [IQR 7-12], p=0.0005) with no difference in the incidence of CDI (2 [2.1%] vs 1 [3.7%], p=0.535), in-hospital mortality (4 [4.3%] vs 3 [11.1%], p=0.185), or 30-day infection-related readmission (2 [2.1%] vs 1 [3.7%], p=0.535).

Conclusion

PUAT positivity resulted in quicker time to targeted therapy for CAP. Among patients with a positive PUAT, initial de-escalation of antimicrobials did not lead to worse patient outcomes.

Disclosures

All Authors: No reported disclosures
72. Evaluation of Acclerate Pheno™ on Clinical and Antimicrobial Outcomes in Patients with Methicillin Susceptible Staphylococcus aureus Bloodstream Infections
Authors: Berg Deanna , DePasquale William P , Staicu Mary L , Stainton Sean , Hite Mindee , Laguio-Vila Maryrose R
Published: December 2021

Background

Anti-staphylococcal beta-lactams (BL) are treatment of choice for methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections (BSI) as they have superior MSSA bacteremia clearance. Based on the hypothesis that earlier initiation of anti-staphylococcal BL may improve clinical outcomes, this study compared clinical and microbiologic features of patients with MSSA BSI pre- and post-implementation of Accelerate Pheno™ (AXDX).

Methods

This was a case-control analysis of adult inpatients with MSSA BSI analyzed using AXDX compared to traditional laboratory methods. Cases were prospectively identified by the antimicrobial stewardship team between August and October 2020 post implementation of AXDX in July 2020. Patients were matched with historical controls (July 2018–July 2020) based on age (±4 years), gender, organism, and source of infection. The primary outcome was time to antibiotic (abx) deescalation to an anti-staphylococcal beta-lactam. Secondary outcomes included hospital length of stay (LOS), 30-day all-cause mortality and hospital readmission, and 60-day C. difficile infection.

Results

A total of 25 cases with MSSA BSI were identified, of which 18 (72%) were matched to historical controls. Of these patients, 12 (67%) were male with an average age of 67 years (SD ±12). Other demographics were similar between groups. The median time to species identification [21.3 hours in cases (IQR 14–31.9) vs 33.3 hours in controls (29–41.7), p=0.046] and abx susceptibilities [22.5 hours (18.8 – 42) vs 60.1 hours (46–61.9), p< 0.001] were significantly shorter in cases. The average time to abx deescalation from time to organism susceptibility was 1.7 days (±1.9) for cases compared to 2.7 days (±1.5) for controls (p = 0.129). There were no significant differences detected in hospital LOS, 30-day mortality or readmission, and 60-day C.difficile infection.

Conclusion

Although time to organism identification and abx susceptibilities was significantly shorter in cases, AXDX was not associated with a statistically significant reduction in time to anti-staphylococcal BL initiation nor a difference in associated clinical outcomes. A trend in shorter time to abx de-escalation was observed and warrants further investigation in a larger population.

Disclosures

All Authors: No reported disclosures
80. The Utility of Cultures for Isolated Fevers in Patients with Influenza or COVID-19 Receiving Extracorporeal Membrane Oxygenation
Authors: Marcus Joseph E , Sams Valerie , Sobieszcyk Michal , Barsoumian Alice E
Published: December 2021

Background

Critically ill patients receiving extracorporeal membrane oxygenation (ECMO) are at elevated risk for nosocomial infection. Physiological responses to infection on ECMO are difficult to interpret as many clinical characteristics are controlled by the circuit including temperature. This study aimed to determine the culture positivity rates in patients receiving ECMO with influenza or COVID-19.

Methods

A single center retrospective study was performed on all patients who received ECMO support at a single institution between December 2014 and December 2020 with influenza or COVID-19. All cultures ordered were reviewed for indication. Patients with fever without specific clinical syndrome or signs of decompensation, such as increasing vasopressor requirement were included. Infections and contaminants were defined by treatment team.

Results

A total of 45 patients received ECMO with an admission diagnosis of influenza or COVID-19 during the study period. This cohort had a median age of 44 (interquartile range (IQR): 36-53) and was predominantly male (84%). The median time on ECMO was 360 hours (IQR: 183-666). 43/137 (31%) of infectious workups were ordered for isolated fever. The most common workup ordered for fever was combination blood cultures (BC) and urine cultures (UC) (13, 30%), followed by combination BC, UC, and respiratory cultures (RC) (11, 26%). Four (9%) infections were identified (3 blood stream, 1 respiratory) and five (12%) cultures grew contaminants (1 blood, 1 respiratory, 2 urine). Culture positivity rate was greatest for BC (3/35, 9%) followed by RC (1/19, 5%), and lowest for UC (0/26, 0%).

Conclusion

Although cultures are commonly ordered for isolated fever in patients with influenza and COVID-19 receiving ECMO, culture positivity rate is low. In particular, no urinary tract infections were identified and the screening for urinary tract infection in patients receiving ECMO with isolated fever is not beneficial. Further work identifying signs and symptoms associated with infection is needed to improve diagnostic stewardship in this population that is high risk for nosocomial infections.

Disclosures

All Authors: No reported disclosures
84. A Survey Based Assessment of Provider Practice Around Obtaining Repeat Blood Cultures
Authors: Govindan Sujeet , Strnad Luke
Published: December 2021

Background

Apart from Staphylococcus aureus and Candida species, there is little guidance on whether to obtain repeat blood cultures after an initial positive set. We have noted heterogeneity in practice amongst our Infectious Disease (ID) group at Oregon Health and Science University (OHSU) and suspect there is heterogeneity amongst adult hospitalist providers as well.

Methods

We created a survey using clinical vignettes encompassing commonly encountered scenarios among hospitalized patients on medical wards to assess provider practices in obtaining repeat blood cultures. The survey was sent to adult ID providers and adult hospitalist providers at OHSU. These vignettes represented 9 of the most common bacteria seen in positive blood cultures and asked the question of whether providers would obtain repeat blood cultures after an initial positive set. The organisms included beta hemolytic streptococcus, Enterococcus faecalis, Streptococcus gallolyticus, coagulase-negative staphylococci, alpha hemolytic strep, E coli, Proteus mirabilis, Pseudomonas aeruginosa, and Bacteroides fragilis. We then asked questions around repeat blood culture practices for Staphylococcus aureus and Candida species, understanding that while repeat blood cultures for these organisms is recommended, the manner in which individual providers implement this may vary.

Results

The survey response rate was ~45%. Results were heterogenous with only 3 questions having inter- and intra- group agreement. Those 3 questions represented a case of E faecalis bacteremia without known source, a case of asymptomatic Staphylococcus epidermidis blood culture positivity, and a case of E. coli bacteremia from a pyelonephritis. All other vignettes had inter- and intra- group differences signifying clinical uncertainty around the practice of obtaining repeat blood cultures. There was similar heterogeneity among the responses asking how providers obtain repeat blood cultures around S. aureus and Candida bloodstream infections.

Clinical vignette survey answers

Answers from 10 clinical vignettes on obtaining repeat blood cultures after an initial positive set for stable patients on medical wards.

Staphylococcus aureus

Candida sp

Conclusion

There is significant heterogeneity amongst adult ID and hospitalist providers on what organisms and situations should prompt repeat blood cultures. There are differences around how repeat blood cultures should be obtained, including for Staphylococcus aureus and Candida sp.

Disclosures

All Authors: No reported disclosures