bluuebunny/crossref_metadata_2025 huggingface dataset:
1464. Adjuvant Systemic Steroid Therapy and Length of Hospital Stay in Pneumonia Patients: A Retrospective Cohort Study in a Community Hospital
Authors: Mahatanan Rattanaporn
Published: January 2021

Background

Pneumonia is a leading cause of morbidity and mortality worldwide resulting in a substantial healthcare expenditure. Antimicrobial agents are the main treatment. Recent studies showed the benefits of steroid therapy as an adjuvant therapy for patients with pneumonia; however, the overall evidence is still controversial.

Methods

Electronic medical records of hospitalized patients (age >18) at a community hospital in a rural Maine with the discharge diagnosis of pneumonia in 2015 and 2016 were reviewed. Demographics, comorbidities, physical examination, initial laboratory, and Pneumonia Severity Index (PSI) were collected for each patient. The exposure was a systemic steroid administered by either oral or intravenous. The outcomes included length of hospital stay (LOS), inpatient mortality, and transfer to tertiary care center. Competing-risks regression was utilized to examine the association between steroid and LOS. Multivariable logistic regression analysis adjusted for propensity score was used for other outcomes.

Results

A total of 414 patients were included. 277(63%) patients received systemic steroids. Overall, steroid use was significantly associated with shorter LOS (HR 1.26, 95%CI 1.03-1.54, p=0.02) and decrease inpatient mortality (OR 0.11, 95%CI 0.03-0.45, p< 0.01). In subgroup analysis, steroid associated with shorter LOS only in patients with PSI class IV (HR 1.38, 95%CI 1.02-1.89, p=0.04) and PSI class V (HR 2.04, 95%CI 1.11-3.74, p=0.02). There was an association of steroid and shorter LOS in subgroup of COPD patients (HR 1.42, 95%CI 1.02-1.97, p=0.03).

Table 1: The baseline characteristics of hospitalized patients with a diagnosis of pneumonia who received steroid vs non-steroid

Figure 1: Subgroup analysis the effect of steroid and lenght of hospital stay (LOS)

Conclusion

Our study concluded that adjuvant steroid therapy associated with a decrease in length of hospital stay and improved inpatient mortality in hospitalized pneumonia patients. Steroid was most beneficial to those with severe pneumonia (PSI class IV-V) and COPD patients.

Disclosures

All Authors: No reported disclosures
1466. Antibiotic utilization reports may reduce prescribing practices for Upper Respiratory Infections
Authors: Salcedo David Augusto Terrero , Kelly Allison , Tate Victoria
Published: January 2021

Background

More than 90% of Upper respiratory tract infections (URI) have a viral etiology; nonetheless, these represent the most common reason for ambulatory antibiotic prescription. This translates in higher risk of antibiotic-related adverse events and promotion of antimicrobial resistance.

Methods

A prospective single-center intervention surveying and providing individual, face-to-face comparative reports of antibiotic utilization, for any of the 4 diagnostic entities that constitute upper respiratory tract infection (common cold, pharyngitis, acute rhinosinusitis and acute bronchitis), was performed in our Emergency Department.

Example of monthly provider reports used which included general and individualized goals.

Results

A total of 12 health care providers were followed for 12 months. Education, prescribing reports and individual goals were provided. The pre-intervention prescription rate from September to December 2018 averaged 74.75% (SD 20.59, 95% CI 61.6-87.8), with a post-intervention rate of 55.5% from September to December of 2019 (SD 19.20, 95% CI 43.3-67.7) that was statistically significant (p=0.0036). A higher use of antibiotic was observed in physicians when compared to non-physician providers in both pre and post intervention stages (reduction of 16.6% vs 23% after intervention respectively), with no statistical difference between the two groups (CI 95% of -38.82 to 2.395, p=0.0773). A proposed target of 50% or less was observed in 5 of 12 providers (41.6%), and 2 out of 12 (16.7%) had increase in their antibiotic utilization rate.

Comparative use of antimicrobials in the pre (September-December 2018) and post (September-December 2019) - intervention periods.

Average individual antimicrobial use rate before and after intervention.

Conclusion

Routine face-to-face utilization reports may constitute an effective approach in reducing antibiotic prescription practices in the Emergency Department, and potentially, in other outpatient healthcare settings.

Disclosures

All Authors: No reported disclosures
1475. Impact of a Routine Infant PCV Program on the Serotype Distribution of Episodes of Invasive Pneumococcal Disease (IPD) and Non-bacteremic Pneumococcal Pneumonia in Adults
Authors: McGeer Allison
Published: January 2021

Background

Herd immunity from pediatric pneumococcal conjugate vaccine (PCV) programs has resulted in substantial reductions in IPD due to PCV serotypes (ST). We assessed whether similar changes in ST distribution occur in non-bacteremic pneumococcal pneumonia (NBPP).

Methods

The Toronto Invasive Bacterial Diseases Network performs population-based surveillance for IPD and hospitalized, culture-confirmed NBPP in Toronto/Peel Region, Canada (Pop 4.5M). Patient data are collected by interview/chart review; illness associated with respiratory isolates is categorized using Musher criteria.

Results

Since 2002, 6627 episodes of IPD, and 7323 non-bacteremic episodes with a respiratory isolate of S. pneumoniae (2180 meeting modified Musher criteria for NBPP) have occurred in adults. Distributions of vaccine-type serotypes in IPD and NBPP pre-PCV7 (2002-2004), post-PCV7 (2006-2009) and late post-PCV13 (2014-2019) are shown in the Figure. There were no significant changes in distribution of vaccine serotype groups from 2014-2019 in IPD or NBPP. From 2014-2019, serotypes included in PCV13 and PCV20 were associated with 33% and 59% of IPD cases, and 29% and 49% of NBPP cases in adults..

Figure. distribution of serotype groups included in different pneumococcal vaccines in cases of IPD and non-bacteremic pneumonia

Conclusion

Eight years post routine infant PCV13 implementation, PCV13 type IPD and NBPP persists in adults. The distribution of vaccine-type strains is similar in IPD and NBPP; although non-vaccine-type strains are more common in NBPP.

Disclosures

Allison McGeer, MD, FRCPC, GlaxoSmithKline (Advisor or Review Panel member, Research Grant or Support)Merck (Advisor or Review Panel member, Research Grant or Support)Pfizer (Research Grant or Support)
1478. Impact of Short versus Long Treatment Durations for Respiratory Tract Infections Caused by Non-fermenting Gram-negative Bacilli in Lung Transplant Recipients
Authors: Derringer Jon , Anderson Eve , Hage Chadi , Desai Armisha
Published: January 2021

Background

In lung transplant recipients, respiratory tract infections are associated with faster progression through stages of bronchiolitis obliterans syndrome and mortality. Common causative pathogens for respiratory tract infections (RTIs) include non-fermenting gram-negative bacilli (NFGNB). Data to guide optimal treatment durations for NFGNB RTIs in this population are limited.

Methods

This was a single-center, retrospective, cohort study of adult lung transplant recipients who received systemic antibiotic treatment for RTIs caused by NFNGB and had at least 28 days of post-treatment follow-up. Analyses were conducted for each patient’s initial NFGNB RTI as well as all independent NFGNB RTIs episodes. Groups were divided into NFGNB RTIs treated for a short (≤ 10 days) versus long (> 10 days) duration of effective antibiotic therapy. The primary outcome was the incidence of recurrent NFGNB RTIs within 28 days post-treatment. Recurrence was defined as isolation of the same organism in a respiratory culture requiring treatment with systemic antibiotics as determined by the prescribing physician.

Results

We included 207 lung transplant recipients with 334 NFGNB RTIs (n=129 short; n=205 long) from a period of January 1, 2010 to July 1, 2019. The most common causative pathogen was P. aeruginosa (77% and 82%) and most NFGNB RTIs were treated inpatient (60% and 53%) in both groups. The median duration of therapy was 10 days and 14 days for the short and long treatment durations, respectively. The primary outcome occurred in 14/129 (11%) of the NFGNB RTIs treated for ≤ 10 days and 28/205 (14%) of those treated for > 10 days. No difference in recurrence within 28 days was detected in NFGNB RTIs treated for ≤ 10 days (aOR, 0.69; 95% CI, 0.34-1.4; p=0.149). Use of adjunctive inhaled antibiotics was associated with reduced recurrence (aOR, 0.38; 95% CI, 0.16-0.92; p=0.032).

Conclusion

In lung transplant recipients with NFGNB RTIs, no difference in infection recurrence was detected between treatment durations for ≤ 10 days compared to > 10 days. Further investigation analyzing treatment durations for respiratory tract infections as well as the utility of adjunctive inhaled antibiotics are warranted in this patient population.

Disclosures

All Authors: No reported disclosures
1481. Incidence of Pertussis in Older Adults in England and the United Kingdom: A Large, Retrospective Database Analysis
Authors: Aris Emmanuel , Akpo Esse Ifebi , Bhavsar Amit , Harrington Lauriane , Merinopoulou Evie , Sawalhi-Leckenby Nicola , Turriani Elisa , Meszaros Kinga , Lambrelli Dimitra , Mukherjee Piyali
Published: January 2021

Background

Pertussis affects people of all ages and can lead to severe complications in adults, including hospitalization. Pertussis immunity, whether vaccine-induced or from natural infection, wanes over time. Therefore, despite extensive pediatric vaccination against pertussis, adults remain susceptible to the disease. Here we present the reported incidence of pertussis in people ≥ 50 years old (≥ 50yo) in England and the United Kingdom (UK).

Methods

We performed an observational, retrospective database analysis using the UK Clinical Practice Research Datalink GOLD and Aurum primary care databases, and Hospital Episode Statistics database when available for English subjects (HES-Eng), 2009-2018. Occurrence of pertussis was identified by diagnostic codes recorded in primary care only for the UK subset, and primary care and/or secondary care for HES-Eng.

Results

In the ≥ 50yo UK population, a total of 47.1 million (m) person-years of follow-up (PYFU) including 28.5m PYFU for HES-Eng, were included. In the UK, the pertussis Incidence Rate (IR) across all years was 5.44 per 100,000 PYFU. Yearly IRs ranged from 0.79 – 11.40 per 100,000 PYFU and reflected the cyclic epidemiology of pertussis. A peak of IR was observed in 2012, known to be an outbreak year, and observed IRs were higher in 2013-2018 (4.75 – 9.73 per 100,000 PYFU) than 2009-2011 (0.79 – 1.48 per 100,000 PYFU). In the HES-Eng population, overall IR was 5.76 per 100,000 PYFU. IRs were highest in the younger age groups (HES-Eng: 8.88 in 50-54 yo; 1.42 in ≥ 85 yo) (see table 1 and 2).

Table 1

Table 2

Conclusion

The observed reported IR of pertussis was similar in the UK and HES-Eng populations, noting the inclusion of secondary care diagnoses in the latter. The dynamics of IRs across years are consistent with estimated IRs from Public Health England data. Considering the burden of pertussis established elsewhere in older adults, and their non-negligible contribution to the whole population incidence, strategies for the prevention of pertussis should include this age group.

Disclosures

Emmanuel Aris, PhD, the GSK group of companies (Employee, Shareholder) Esse Ifebi Akpo, n/a, the GSK group of companies (Employee, Shareholder) Amit Bhavsar, MBBS, MHA, the GSK group of companies (Employee) Lauriane Harrington, n/a, the GSK group of companies (Employee) Evie Merinopoulou, MSc, Evidera Ltd (Employee)the GSK group of companies (Consultant) Nicola Sawalhi-Leckenby, MSc, Evidera Ltd (Employee)the GSK group of companies (Consultant) Elisa Turriani, PhD, the GSK group of companies (Employee) Kinga Meszaros, MBA, the GSK group of companies (Employee, Shareholder) Dimitra Lambrelli, PhD, MPharm, Evidera Ltd (Employee)the GSK group of companies (Consultant) Piyali Mukherjee, MBBS, MPH, the GSK group of companies (Employee, Shareholder)
1484. Microbial Etiology of Community-acquired Pneumonia in Immunocompromised Patients
Authors: Deshpande Abhishek , Yu Pei-Chun , Rothberg Michael
Published: January 2021

Background

Community-acquired pneumonia (CAP) is a leading cause of infection related mortality. Few studies have specifically evaluated the microbial etiology of CAP in immunocompromised patients. Using a large national inpatient database, we compared the microbial etiology of CAP in immunocompromised patients compared to immunocompetent patients.

Methods

We included adult patients admitted with pneumonia from 2010-2015 to 176 US hospitals participating in Premier. Patients were identified as having CAP if they had a chest X-ray and were on antimicrobials on the first day. Immunocompromised was defined by the receipt of immunosuppressive medications or ICD-9 codes for neutropenia/ hematological malignancy/ organ transplantation or comorbidities with AIDS. For microbial etiology, patients were included if they had a positive culture or test collected by hospital day 0 through 3. Patients with identical bacteria in blood and urine were excluded.

Results

A total of 168,159 patients had a diagnosis of CAP with a culture/test performed on first 3 days. A pathogen was detected in 18.8% of patients. Among pathogen positive patients, 4,851 patients were identified as immunocompromised and 26,752 as immunocompetent. Almost all patients (99%) had at least one culture, blood (96%) and respiratory (51%). Among patients who were immunocompromised, the most common bacterial pathogens (compared to immunocompetent patients) were, S. pneumoniae (17.7% vs 19.0%), MRSA (13.1% vs 14.4%), MSSA (12.0% vs 11.8%), P. aeruginosa (12.0% vs 9.9%), E. coli (7.4% vs 6.4%), K. pneumoniae (5.8% vs 4.9%), H. influenzae (5.5% vs 5.5%), M. pneumoniae (3.0% vs 3.0%) and L. pneumophila (0.93% vs 1.2%). Among viral pathogens, while the most common were influenza virus (12.9% vs 14.1%) followed by rhinovirus (1.5% vs 0.89%), immunocompromised patients has a higher prevalence of noninfluennza viruses (3.42% vs 2.43%).

Conclusion

In a large US inpatient sample, the causative organisms in immunocompromised patients did not differ much from those in immunocompetent patients. CAP pathogens in immunocompromised patients were more likely to involve gram-negative bacilli such as P.aeruginosa and E.coli, than gram-positive cocci. These findings may have implications when deciding on empiric therapy in these patients.

Disclosures

Abhishek Deshpande, MD, PhD, Ferring Pharmaceuticals (Advisor or Review Panel member)Merck (Consultant)
1485. Mobile Bedside Ultrasound (mBSUS) and Use of an Artificial Intelligence Algorithm for Diagnosis of Pediatric Pneumonia in Limited Resource Settings
Authors: Camelo ingrid Y , Gill Christopher , Pieciak Rachel
Published: January 2021

Background

In low and middle-income countries (LMICs) pneumonia is by far the leading cause of death among children < 5 years of age. A key factor is the challenge of pneumonia diagnosis. Chest X-Ray is the gold standard for pneumonia diagnoses but exposes children to ionizing radiation and is mainly restricted to hospital settings.

advances in artificial intelligence (AI) render possible the automated interpretation of mobile bedside US (mBSUS) images on a smartphone, obviating the need for a radiologist.

Ultraspund findings in pneumonia

Artificial intelligence feature recognition

Methods

We measured the accuracy of mBSUS for the diagnosis of pneumonia using chest X-Ray as the gold standard. Children 1-59 mo presenting at the University Teaching Hospital in Lusaka, Zambia with ages ranging from aged 1-59 months and meeting WHO criteria for severe/very severe pneumonia were enrolled. Clinical data is collected in RedCap. Digital X-Rays were done at the University Teaching Hospital and saved as JPEG images. Pulmonary mBSUS images are taken using a butterfly, a mobile device system, and stored in the butterfly iCloud of the Butterfly app and transmitted to an iOS phone or tablet. Images are stored locally and saved to a secured/encrypted cloud platform for remote viewing with a HIPAA (Health Insurance Portability and Accountability Act) compliant secure cloud.

Images are currently extracted from the clips stored in the butterfly icloud, radiologists annotate the images that have abnormal findings and they are then sent to the AI lab where they are analyzed and organized to build a platform of similar images that could be recognized by the machine learning system.

Imaging correlation CXR Vs mobile bedside ultrasound mBSUS

Butterfly ultrasound system

Results

Of the 11 patients enrolled so far, ll have been having ultrasound images that correlated with chest x-ray findings. In three of those patients, the ultrasound has shown pulmonary findings not recognized or hardly seen on chest x-ray. The artificial intelligence lab is developing a pull of images that will be used to recognize patterns of consolidation from mBSUS images.

Protocol fro obtaining images

Conclusion

Mobile pulmonary ultrasound mBSUS is a feasible, non radiation technique that could be used in limited-resource settings to diagnose pneumonia in children. Images obtained from mBSUS can be used to build a pattern of recognition based on consolidation findings.

Disclosures

All Authors: No reported disclosures
1487. Pneumonia due to Co-Infection in the ICU: Detection and Clinical Significance
Authors: Zelus Casey S , Blaha Michael , Samsom Kaeli , Marcelin Jasmine R , Van Schooneveld Trevor C , Kalil Andre C , Cawcutt Kelly
Published: January 2021

Background

Pneumonia is a significant cause of morbidity and mortality, with increasing interest in the detection and clinical significance of co-infection. However, the impact of methodology to obtain lower respiratory samples along with the utility of various microbiological diagnostic testing remains unclear.

Methods

A single-center retrospective analysis was performed on bronchoalveolar lavage (BAL) samples obtained from mechanically ventilated adults treated in critical care units from August 2012 to December 2017. BAL methodology (bronchoscopic vs blinded), microbiological diagnostic testing, and outcomes measures were obtained. Associations between categorical variables were assessed using Chi-Square or Fisher’s exact tests. Kruskal Wallace tests analyzed differences in distributions of measures between categories based on number of organism types detected. SAS software version 9.4 (SAS Institute Inc., Cary, NC).

Results

Analysis of the 803 samples that met inclusion criteria found a significant linear association between mortality and number of organism types detected by BAL, with 30 day mortality rates of 43.0%, 47.8%, and 58.3% among those with zero, one, and two or more organisms respectively (p = 0.003). Comparing BALs with at least one organism isolated, the detection of viruses specifically was associated with increased mortality, with the presence and absence of viral organisms corresponding to 56.3% and 46.5% mortality at thirty days (p = 0.03). No association was found between mortality and isolation of acid-fast bacilli, bacteria, or fungi. Co-infection was detected more frequently among bronchoscopic BALs than blinded BALs (26.3% vs 8.6%, p < 0.0001), with more viruses detected bronchoscopic BALs (41.9% vs 13.1%, p < 0.0001), and more bacteria in blinded BALs (41.8% vs 33.0%, p = 0.01).

30 Day Mortality vs Isolation of Specific Organism Types from BAL

Number of Organism Types Isolated from BAL Compared to BAL Methodology

BAL Methodology vs Isolation of Specific Organism Types

Conclusion

Co-infection in mechanically ventilated adult patients with pneumonia appears to be a significant risk factor for mortality, with the detection of viral organisms potentially playing an independent role. Within this population, bronchoscopic BALs may have a valuable diagnostic and prognostic methodology.

Disclosures

All Authors: No reported disclosures
122. The Buck Stops Here. PICC Line Utilization: Stewardship Is Not Only About Antimicrobials Any More
Authors: Ridder Mark , Cawcutt Kelly
Published: January 2021

Background

The Choosing Wisely guidelines recommend avoiding placement of PICCs in patients with GFRs less than 45. A recent study found that 1 in 4 PICCs are placed in patients with CKD and the majority of PICCs are for antibiotics. Recent studies have demonstrated early and safe transition from IV to PO antibiotics forgoing PICC use. To our knowledge no studies assess opportunities to reduce PICC use and adverse events through infectious disease. This study aims to identify opportunities for improved PICC utilization.

Methods

This was a single center retrospective analysis of all PICCs in adults from January 2017 to October 2019 at the University of Nebraska Medical Center (UNMC). Data was abstracted via chart review including demographics, index hospital stay, PICC details, PICC indication(s), PICC duration, GFR prior to PICC placement. If present, antimicrobial indication, and infection information.

Results

211 patients were included. PICC lines were placed in 18.0% (n=38) of patients with GFR < 45. 123 PICCs were for antibiotics. Breakdown of IV antibiotic duration in Figure 1. Infection types treated in < 7 days noted in Figure 2. Infection types treated in 7 – 13 days noted in Figure 2. There was a statistically significant finding of increased duration of antibiotics when infectious disease was consulted with 90.0% (n=63) of cases 14 + days, 60.9% (n = 14) for 7 – 13 days, and 56.7% (n=17) in cases < 7 days (p=0.002).

Figure 1

Figure 2

Figure 3

Conclusion

Infectious disease providers are trained to consider antimicrobial stewardship. Antimicrobials directly impact therapeutic choices for patients. However, less frequently considered is the insertion of PICCs in patients with tenuous renal function. Given the prevalence of PICCs in patients with GFR < 45, contrary to guideline recommendations, as well as increasing evidence for use of shorter durations and oral antibiotics for treatment there is opportunity for quality improvement and intersectional synergy.

Disclosures

All Authors: No reported disclosures
1489. Safety and Performance of a Pharmacist-Driven Nasal MRSA PCR Protocol for De-escalation of Empiric Vancomycin for Suspected Pneumonia at an Academic Medical Center
Authors: Meng Lina , Pourali Samaneh , Hitchcock Matthew M , Ha David R , Mui Emily , Alegria William , Diep Calvin , Banaei Niaz , Chang Amy , Deresinski Stan , Holubar Marisa
Published: January 2021

Background

Limited published data supports the de-escalation of empiric anti-methicillin resistant Staphylococcus aureus (MRSA) antibiotics for suspected pneumonia upon negative nasal MRSA screening. Besides limited sample sizes, special populations, such as those who are immunocompromised and/or critically ill, have been underrepresented in these reports. We describe real-world efficacy and safety of a pharmacist-driven nasal MRSA PCR testing protocol implemented at Stanford Health Care in May 2018 across a diverse patient population.

Methods

This was an observational cohort study of adult patients who received vancomycin for empiric pneumonia before (PRE) vs after (POST) implementation of a pharmacist-driven nasal MRSA PCR testing protocol (between 05/01/2017 - 08/31/2017 (PRE) and 5/7/2018 - 12/31/2019 (POST). The primary outcome measure was duration of vancomycin administration. Secondary outcomes included time to vancomycin discontinuation, frequency of restarting vancomycin for empiric pneumonia within 7 days, acute kidney injury (defined as “risk” by RIFLE criteria), and MRSA respiratory cultures. Statistical methods are described in Figure A.

Figure A. Statistical methods

Results

Total of 610 patients were included in this study with 116 in the PRE group and 494 in the POST group. Over 40% were critically ill and approximately 37% were immunocompromised in both groups (Table 1). For the primary outcome, median vancomycin duration was significantly shorter in the POST group (1.29 days; 95% CI 1.13-1.45) vs. PRE group (1.98 days; 95% CI 1.49-2.46) (p < 0.0005), a 34.8% reduction (Figure 1). Median vancomycin duration was lower in patients with a negative vs positive nasal MRSA PCR (1.20 days [95% CI 1.08-1.33] vs 2.53 days [95% CI 1.77-3.29], p < 0.0005), a 52.6% reduction (Figure 2). MRSA was recovered in respiratory cultures in 1.7% vs 1.4% in the PRE vs POST groups. One (0.002%) patient had a negative nasal MRSA PCR but culture-confirmed MRSA pneumonia and recovered after completing a treatment course. Secondary safety outcomes were similar between groups (Table 2).

Tables 1 and 2: Baseline Characteristics and Secondary Outcomes

Figure 1. Primary Outcome: Kaplan–Meier Estimates of Cumulative Active Vancomycin Therapy Before and After Implementation of Nasal MRSA PCR protocol

Figure 2. Secondary Outcome: Figure 2. Kaplan–Meier Estimates of Cumulative Active Vancomycin Therapy in Patients with Negative vs Positive Nasal MRSA PCR

Conclusion

Pharmacist-driven nasal MRSA PCR testing is effective and safe in early de-escalation of empiric vancomycin used for pneumonia treatment in a diverse population including critically ill and immunocompromised patients.

Disclosures

All Authors: No reported disclosures
1495. Aspergillosis Complicating Severe Influenza in ICU Patients: A Retrospective Cohort Study
Authors: Visek Caitlin , Nam Hannah , Ison Michael G
Published: January 2021

Background

Invasive pulmonary aspergillosis (IPA) has been recognized as a complication of influenza infection even in immunocompetent patients. We aimed to understand the incidence of IPA among critically ill patients with influenza infection over multiple seasons.

Methods

A retrospective cohort study was conducted in a single center in Chicago. Data was collected over 9 seasons (March 2009-March 2018) from all adult patients admitted to the ICU at a large urban tertiary care center with influenza. Patients were included if they had a positive influenza PCR test, were ≥ 18 years, were admitted to the ICU with respiratory distress, and treated for IPA. IPA was defined per both the EORTC/MSG criteria as well as the revised AspICU criteria. Descriptive statistics were calculated. In univariable analysis, we compared categorical variables by Fisher’s exact test and continuous variables by Wilcoxon Rank Sum where appropriate.

Results

A total of 224 patients with influenza were admitted to the ICU over the study period. The overall rate of IPA in the study population was low at 3.1% (7/224). Factors associated with development of IPA in those with severe influenza pneumonia were history of stem cell transplant (p=0.015). There was a numerical trend towards significance in those with history of hematological malignancy (p=0.09), lung disease (p=0.098) and obesity (p=0.051). There was significantly increased length of stay in those with IPA (p=0.046). There were no significant difference in outcomes such as need for mechanical ventilation, renal replacement therapy, or death. Other coinfections were common with incidences of 31.3% (bacterial), 7.6% (viral), and 8.9% (non-aspergillosis fungi).

Baseline Characteristics and Mortality/Morbidity

Patient Characteristics in Invasive Pulmonary Aspergillosis

Conclusion

The incidence of IPA was significantly lower (3.1%) in our study over 9 influenza seasons than has been reported in similar studies. History of stem cell transplant was a risk factor strongly associated with the development of IPA. IPA did not significantly predict morbidity and mortality among critically ill influenza patients.

Disclosures

Michael G. Ison, MD MS, AlloVir (Consultant)
1497. Epidemiology of RSV infection in Japan: A nationwide claims database analysis
Authors: Kobayashi Yasuhiro , Togo Kanae , Agosti Yasmeen , McLaughlin John M
Published: January 2021

Background

Respiratory syncytial virus (RSV) is the major global cause of hospitalization for bronchiolitis and pneumonia in infancy around the globe. In Japan, the occurrence of RSV infection is monitored under the national pediatric sentinel surveillance system. However, this system does not provide detailed information about patient distribution by month of birth and clinical features. We aimed to describe the national epidemiology and clinical features of RSV infection in children < 24 months of age utilizing a nationwide healthcare claims database in Japan.

Methods

We retrospectively analysed anonymized claims data from the Japan Medical Data Center (JMDC) of medical insurance beneficiaries who had at least one confirmed RSV-related diagnosis by ICD10 codes between January 2017 and December 2018. In children < 24 months of age, the number of patients by age in Japan was estimated using the prevalence of patients in the database and national population data by age.

Results

In the JMDC database, 9,711 and 8,509 children < 24 months of age had an RSV-related diagnosis in 2017 and 2018, respectively. Of which, 2,473 (25%) and 2,083 (24%) were hospitalized. When extrapolated to the entire Japanese population, an estimated 138,059 and 119,205 RSV-related diagnoses and 33,355 and 27,339 RSV-associated hospitalizations occurred in Japan in 2017 and 2018, respectively. Infants < 6 months of age accounted for between 39% and 42% of total hospitalisations for RSV. A peak in RSV hospitalization was observed at age 2 months. Only 10% of all children < 24 months of age who were hospitalised with an RSV infection had a specific underlying medical condition (preterm infant, bronchopulmonary dysplasia, Down syndrome, chronic heart disease, immunodeficiency). The estimated rate of RSV-associated hospitalization was 35.4 per 1000 population per year among infants < 6 months of age.

Conclusion

In conclusion, 3 to 4 out of every 100 Japanese children aged < 6 months were hospitalized for RSV. Ninety percent of children < 24 months of age hospitalised with RSV infection did not have a recognised underlying medical condition. The peak of hospitalization for RSV infection occurred at 2 months of age. Thus, broad-based prevention strategies targeting young infants are needed.

Disclosures

Yasuhiro Kobayashi, MS, Pfizer (Employee, Shareholder) Kanae Togo, PhD, Pfizer (Employee) Yasmeen Agosti, MD, Pfizer (Employee, Shareholder) John M. McLaughlin, PhD, Pfizer (Employee, Shareholder)
1500. Population-based incidence, health care resource utilization and cost among children < 5 years of age hospitalized with RSV, Utah
Authors: Ampofo Krow , Choi Yoonyoung , Heller Evan G , Platt-Koch Alexander G , Gesteland Per H , Adua Lazarus , Finelli Lyn
Published: January 2021

Background

Respiratory Syncytial Virus (RSV) is one of the most common causes of childhood lower respiratory tract infection (LRTI) worldwide. Accurate data are critical to inform the rationale for RSV vaccine and immunoprophylaxis development. We evaluated the burden of laboratory-confirmed RSV from hospitalized children.

Methods

During the 2019-2020 RSV season, we prospectively identified children < 5 years of age hospitalized with laboratory-confirmed RSV LRTI at Primary Children’s and Riverton hospitals in Salt Lake City, Utah. Outcomes included Salt Lake county RSV hospitalization rates, adjusted for market share, health care resource utilization including intensive care unit (ICU) stays, mechanical ventilation, length of stay (LOS), and total hospital costs.

Results

A total of 284 children had laboratory-confirmed RSV LRTI hospitalizations during the 2019-2020 RSV season: 106 (37%) < 6 months of age; 67 (24%) had high-risk medical conditions (HMC); 70 (25%) children had an ICU stay; 18 (6%) required mechanical ventilation; 132 (46%) received antibiotics and median hospital LOS of 2.3 days (IQR 1.6- 3.6). Population-based incidence rates of RSV hospitalization were 4.6/1000 (range 0.7/1000 to 17/1000). The highest rates were in children < 6 months, and rates decreased with increasing age. The mean hospital cost was $12,974.6 (standard deviation: $19869.7), with a total for the cohort was $3.7 million; 42% was accounted for by children < 6 months. Median age of children with HMC’s were significantly older (18.7 mon vs. 12.7 mon; p=0.001) than healthy, but comparable mean hospital cost ($14208.5 vs. 12593.2) and median hospital LOS (2.4 vs. 2.3).

Conclusion

Hospitalized RSV LRTI among children < 5 years remains significant, and is associated with substantial HCRU, antibiotic use and morbidity. Nationwide, the mean hospital costs may total $1.1 billion. Our data support the need for RSV vaccines and immunoprophylaxis to prevent RSV hospitalization.

Disclosures

Krow Ampofo, MBChB, Merck (Grant/Research Support) Yoonyoung Choi, PhD, MS, RPh, Merck (Employee) Lyn Finelli, DrPH, MS, Merck & Co Inc, (Employee)
1504. Risk of Influenza-Associated Hospitalization Among Older Adults Living with Diabetes — United States, 2012–2017
Authors: Owusu Daniel , Rolfes Melissa A , Velezmoro Carmen S Arriola , Reed Carrie , Kirley Pam Daily , Alden Nisha B , Anderson Evan J , Monroe Maya , Kim Sue , Lynfield Ruth , McMullen Chelsea L , Spina Nancy , Bennett Nancy M , Billing Laurie M , Thomas Ann , Talbot Helen , McCaffrey Keegan , Yousey-Hindes Kim , Garg Shikha
Published: January 2021

Background

Older adults account for tens to hundreds of thousands of influenza-associated hospitalizations annually. Diabetes mellitus (DM) is common among patients hospitalized with influenza, yet data are limited on the impact of DM on influenza-associated hospitalizations. We compared influenza-associated hospitalization rates among older adults living with and without DM

Methods

We included adults ≥65 years hospitalized with influenza during 2012–13 through 2016–17 from the Influenza Hospitalization Surveillance Network (FluSurv-Net), a population-based surveillance system for laboratory-confirmed influenza-associated hospitalizations conducted in defined catchment areas within 13 states. Influenza testing is clinician-directed, and surveillance officers identify cases through infection control logs, laboratory records and other disease reporting systems. Data on underlying conditions, including DM, were abstracted from medical records Population denominators were calculated using county-specific estimates of DM prevalence from the Centers for Medicare and Medicaid Services. We calculated hospitalization rates by state and season, and present pooled rates and rate ratios, with 95% confidence intervals (CI), using meta-analysis with state as a random effect.

Results

Of 31,934 patients included in the analysis, 34% had DM. DM prevalence in the FluSurv-Net source population aged ≥65 years was 25%. Accounting for variability by state, the average influenza-associated hospitalization rate per 100,000 person years from 2012-13 through 2016-17 was 276 (95% CI: 230–330/100,000) in those with DM and 181 (95% CI:150–217/100,000) in those without DM. Though the magnitude of the association varied by season, hospitalization rates among those with DM was consistently greater than those without DM (pooled rate ratio: 1.57; 95% CI: 1.43–1.72; P< .0001).

Conclusion

Older adults have high influenza-associated hospitalization rates, and those with DM have a 57% increased risk compared to those without DM. These findings reinforce the importance of annual influenza vaccination in adults ≥65 years of age, particularly those with DM.

Disclosures

Nisha B. Alden, MPH, CDC (Grant/Research Support) Evan J. Anderson, MD, Sanofi Pasteur (Scientific Research Study Investigator) Sue Kim, MPH, Council of State and Territorial Epidemiologists (CSTE) (Grant/Research Support)
1505. Antiviral and Antibiotic Prescribing Among Patients at an Ambulatory Cancer Center with Laboratory-Confirmed Influenza
Authors: Sorey Woody , Krantz Elizabeth M , Morris Jessica , Klaassen John , Sweet Ania , Tverdek Frank , Pergam Steven A , Liu Catherine
Published: January 2021

Background

Cancer patients are at high risk for serious complications due to influenza. Early treatment with neuraminidase inhibitors (NAIs) is recommended for high-risk patients with suspected or documented influenza. Limited data exist on timing of presentation to care and ambulatory management of cancer patients with influenza. We sought to characterize antimicrobial prescribing and outcomes among patients with influenza at a large cancer center.

Methods

We selected consecutive patients seen in the ambulatory cancer clinic with laboratory confirmed influenza between January 1, 2016 and December 31, 2018 for chart review. A lab-developed multiplex PCR assay was used with a turnaround time of about 24 hours. We obtained demographics, symptoms at first clinic encounter (day 0), viral testing, NAI and antibiotic prescribing, and clinical outcomes.

Results

Of 138 charts reviewed, 133 (96%) were eligible for analysis. 109 (82%) had an underlying hematologic malignancy. 84 (63%) tested positive for influenza A and 49 for influenza B. 58 (44%) presented to care within 48 hours of symptom onset (F1). The most commonly reported symptoms were cough (83%), fever (41%), and rhinorrhea (40%) (F2). 110 (83%) were prescribed oseltamivir, with 24 (22%) receiving empiric therapy on day 0, and 63 (57%) prescribed on day 1 (F3). Among 109 patients with known symptom onset date, 34 (31%) were prescribed oseltamivir within 48 hours of symptom onset. 23 (17.3%) were prescribed antibiotics, 17 (74%) on day 0 (F3). Levofloxacin (26%), azithromycin (21%) and vancomycin (18%) were most commonly prescribed. Nine (6.8%) patients progressed to lower respiratory tract infection, 1 complicated by bacterial pneumonia. There were 11 (8.3%) influenza-related hospitalizations, 1 (0.7%) ICU admission, and no influenza-related deaths.

Figure 1. Time From Symptom Onset to Date of First Clinical Encounter

Figure 2. Symptoms Reported at First Clinical Encounter

Figure 3. Time from First Clinical Encounter to Oseltamivir and Antibiotic Prescription

Conclusion

NAIs were frequently prescribed among cancer patients, but less than a third received treatment within 48 hours of symptom onset. Most were prescribed NAIs only after test results were available, while antibiotics were prescribed empirically. Delayed presentation to care is an obstacle to early NAI use; patient and provider education along with rapid diagnostics are needed to improve early NAI use among cancer patients with influenza.

Disclosures

Steven A. Pergam, MD, MPH, Chimerix, Inc (Scientific Research Study Investigator)Global Life Technologies, Inc. (Research Grant or Support)Merck & Co. (Scientific Research Study Investigator)Sanofi-Aventis (Other Financial or Material Support, Participate in clinical trial sponsored by NIAID (U01-AI132004); vaccines for this trial are provided by Sanofi-Aventis)
124. Acute Uncomplicated Cystitis in Urgent Care Centers: Changes in Antibiotic Prescribing Practices Before and After Provider Education
Authors: Cofsky Rebecca S , Goodman David , Morton Arianna , Powell Debra L , Blanchard Edward
Published: January 2021

Background

Acute uncomplicated cystitis (AUC) is a frequent infection that requires antibiotic treatment that is seen in women who seek care at urgent care centers.1 The Infectious Diseases Society of America (IDSA) has published guidelines for the management of AUC. They recommend nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin as the first-line agents for the treatment of AUC in healthy adult women.1 Previous evaluation of prescribing practices at Tower Health Urgent Care Centers demonstrated a 16% compliance rate with treatment guidelines for AUC. Subsequently, provider education and an AUC medication order set in the electronic medical record (EMR) were implemented. The purpose of this study was to evaluate the effectiveness of these interventions on prescribing practices for AUC.

Methods

A retrospective electronic chart review was performed evaluating the antibiotic treatment of patients diagnosed with AUC between January 1, 2018, to June 30, 2019, excluding July 2018 to September 2018, the washout period during which education was provided. Inclusion criteria included age ≥ 18 years, female, and treated at one of three Tower Health Urgent Care Centers.

Results

1,455 patients met inclusion criteria during our study period. Our three-month washout period included 273 of those patients. 421 patients were included in the pre-education analysis with 761 patients in the post-education analysis. When both first and second-line antibiotic prescriptions were evaluated in conjunction with considering patient allergies and concomitant infections, compliance was 59% in our post-education analysis (improved from 16% compliance at baseline).

Conclusion

Provider education and an AUC medication order set in the EMR were successful in increasing the compliance rate with antibiotic treatment guidelines for the management of AUC in adult females in the urgent care setting.

Disclosures

All Authors: No reported disclosures
1512. Influenza vaccine effectiveness wanes over the influenza season: results from five military treatment facilities
Authors: Richard Stephanie A , Schofield Christina , Colombo Rhonda , Fairchok Mary P , Maves Ryan C , Arnold John , Danaher Patrick , Deiss Robert , Lalani Tahaniyat , Rajnik Michael , Millar Gene , Coles Christian L , Burgess Timothy
Published: January 2021

Background

Influenza vaccination can reduce influenza burden, but questions have arisen about the duration of vaccine protection. While the timing of vaccination varies, annual receipt of influenza vaccine is mandated for active duty military personnel. The goal of this analysis is to determine if influenza vaccine effectiveness decreases over time. A secondary goal of this analysis is to determine if repeated influenza vaccination is associated with risk for influenza.

Methods

Otherwise healthy individuals presenting for treatment of acute respiratory infections at 5 military treatment facilities from 2009 to 2018 were enrolled in the Acute Respiratory Infection Consortium (ARIC) study. Individuals with complete demographics, influenza vaccination in the two years prior to illness, and influenza laboratory results were included in this analysis (n=1,273). Multivariate logistic regression was used to calculate the odds of an influenza diagnosis according to time since influenza vaccination, categorized in 90-day periods. The model also included age, race, month of diagnosis, influenza season, and whether the participant received 4+ influenza vaccinations in the past 5 years.

Results

One hundred and ninety-two individuals (15%) had laboratory confirmed influenza (Table 1). Participants were mostly active duty, male, and white. Over half of the participants received 4+ influenza vaccinations in the past 5 years. Participants who were vaccinated 90-179 and 180+ days ago had greater odds of being diagnosed with influenza than did individuals who were vaccinated < 90 days prior to illness onset (Table 2). Participants who were 18-24 years old had lower odds of influenza than individuals in other age groups. Vaccine experience (vaccinated against influenza for at least four of the past five years), race, and ethnicity were not statistically significantly associated with influenza diagnosis.

Table 1. Characteristics of individuals included in the analysis of waning influenza vaccine effectiveness in the ARIC study

Table 2. Multivariate logistic regression results from model using influenza diagnosis as the outcome variable. Also included in the model are season and month of diagnosis.

Conclusion

Influenza vaccination was most effective 14-89 days post-vaccination and effectiveness decreased thereafter. Repeat influenza vaccination, however, was not significantly associated with greater odds of influenza. The waning effectiveness of influenza vaccination indicates additional consideration be given to the timing of vaccination.

Disclaimer

Disclosures

All Authors: No reported disclosures
125. Comparison of Diagnosis and Prescribing Practices between Virtual Visits and Office Visits for Adults Diagnosed with Uncomplicated Urinary Tract Infections within a Primary Care Network
Authors: Johnson Kaitlyn , Dumkow Lisa E , Salvati Lisa , Johnson Kristen , Yee Megan , Egwuatu Nnaemeka
Published: January 2021

Background

Urinary tract infections (UTIs) are one of the most common infectious indications for antibiotic prescribing in the outpatient setting. With the exponential growth of virtual visits over the past decade, virtual visits represent an important ambulatory care target for antimicrobial stewardship programs outside of traditional office visits. This study aimed to compare the appropriateness of antimicrobial therapy between virtual visits and office visits for adult females diagnosed with uncomplicated UTIs within a primary care network.

Methods

This retrospective cohort study evaluated adult female patients diagnosed with a UTI within a primary care network comprised of 44 outpatient sites. The primary objective was to compare guideline-concordant antibiotic prescribing between virtual visits and office visits. Guideline-concordance was determined based on local antibiogram-based treatment recommendations. Secondary objectives included comparing appropriate treatment duration and use of diagnostic testing resources between groups. Additionally, patient outcomes were compared between groups including 48-hour, 7-day, and 30-day re-visits, or development of Clostridioides difficile infection within 30 days.

Results

A total of 350 patients were included in this study, with 175 patients in each group. Patients treated for a UTI via a virtual visit were more likely to be prescribed a first-line antibiotic (74.9% vs 59.4%; P = 0.002). Additionally, virtual visits were more likely to prescribe an appropriate duration (100% vs 53.1%; P= < 0.0001). Patients treated via office visits were more likely to have a urinalysis (0% vs 97.1%; P < 0.001) and urine culture (0% vs 73.1%; P < 0.0001) ordered. There was no difference between groups in 48-hour or 30-day revisits, however, patients completing office visits were more likely to have a revisit within 7 days (18.9% vs 5.1%; P < 0.0001). In multivariate logistic regression, UTI care via office visit was the only independent risk factor for 7-day revisit (OR 3.74, 95% CI 1.31 -10.67).

Conclusion

In adult female patients presenting with uncomplicated UTIs, care at a virtual visit was associated with significantly improved antimicrobial prescribing compared to office visits and decreased utilization of diagnostic and follow-up resources.

Disclosures

All Authors: No reported disclosures