bluuebunny/crossref_metadata_2025 huggingface dataset:
1769. Characterizing Antibiotic Prescribing for Nursing Home Residents with SARS-CoV-2 Infection, April 2020-November 2021
Authors: Gouin Katryna A , Clouse Ronald M , Mandley Cameron C , Lawal Olakunle , Yi Sarah H , Li Qunna , Boehmer Tegan , Hicks Lauri A , Kabbani Sarah
Published: December 2022

Background

Increased prescribing of antibiotics commonly used for respiratory infections, including azithromycin, ceftriaxone, and doxycycline was observed in nursing homes (NH) during the COVID-19 pandemic however antibiotic prescribing was not linked to resident diagnosis. Therefore, our objective was to characterize antibiotic prescribing in residents with SARS-CoV-2 infection in a large cohort of US NHs.

Methods

We conducted a retrospective cohort study using PointClickCare (PCC) data containing longitudinal NH electronic health records. We included 4,891 NHs that reported ≥1 medication order/month from April 2020-November 2021. We identified the first onset of SARS-CoV-2 infection using ICD-10-CM diagnosis code U07.1. To validate the number of SARS-CoV-2 infections per facility captured in PCC, we compared the total number of SARS-CoV-2 infections documented in PCC to those reported to the National Healthcare Safety Network (NHSN). Antibiotic orders were determined to be associated with a SARS-CoV-2 infection if 3 days before or ≤7 days after diagnosis. We characterized the proportion of residents with a SARS-CoV-2 infection with an associated antibiotic by month.

Results

We included 2,086 (43%) NHs that had ≤20% difference in total number of SARS-CoV-2 infections documented in PCC and reported to NHSN. From April 2020-November 2021, a total of 118,180 residents with a SARS-CoV-2 infection were identified and 24% had an associated antibiotic prescription (N=27,972). The highest prescription rate (30%, 95% Confidence Interval [29%-31%]) was observed in April 2020 and varied by less than 8% from May 2020-November 2021 (Fig.1). The most commonly prescribed antibiotics were azithromycin (53%), doxycycline (13%) and ceftriaxone (10%).

Conclusion

An antibiotic prescription was linked to up to a quarter of NH residents with SARS-CoV-2 infection, highlighting potential opportunities for avoiding unnecessary antibiotic prescribing for viral infections in NHs. Appropriate antibiotic prescribing in NH populations is important to reduce potential harm when antibiotics offer no treatment benefit to the resident. Identifying facility-level characteristics that lead to variability in antibiotic prescribing is a next step to inform antibiotic stewardship interventions.

Disclosures

All Authors: No reported disclosures.
1776. Overcoming barriers and expanding an existing Antimicrobial Stewardship Program: Allergy Collaboration to de-label Penicillin allergy
Authors: Adenew Ayne , Liappis Angelike P , Gillion Amanda , Barcelo Michelle , Vanlancker Janine , Sheth Dipa
Published: December 2022

Background

The pandemic placed barriers to face-face visits and repurposed Antimicrobial Stewards. During the pandemic, our existing Antimicrobial Stewardship Program: Allergy PCN or beta-lactam de-labeling program (PDLP) collaborated with a medical center within our network to adopt an existing EMR-based screening tool and CDSS tracking system to overcome barriers.

Methods

Between April 2021-March 2022 we expanded our PDLP by off-loading the workload through EMR beta-lactam assessment (BLA) notes targeting inpatient PharmDs. The ability to de-label was expanded by ‘chart’ delabeling using a BLA note template adopted from the Memphis VAMC. The BLA allowed historical allergy (duration, tolerability of other beta-lactams) or drug-related side effect to be challenged. Referrals to allergy were identified using the BLA; ASP Pharmacists conducted PharmD training and fielded referrals to either de-label with BLA vs PCN testing. BLA notes were tracked over time in CDSS (TheraDoc, DSS Inc) and after evaluation, the EMR was updated to reflect PCN allergy status post-assessment.

Results

Over one year the new BLA note was used in 113 patients; assessments were completed by the targeted audience (Inpatient Medicine PharmD) by the 3rd month of the adoption period; subsequently BLA use increased 180% compared to the 3 month lead-in period. BLAs gave inpatient providers guidance on drug selection, referral for formal PCN-testing or Pharmacist/Allergy review, a “chart only” de-label . With pandemic constraints few patients (17/113, 15%) were referred for skin testing with 65% of those successfully de-labeled. Among those not requiring PCN testing, when EMR records demonstrating tolerability to other beta-lactam agents, non-allergic reactions were clarified and/or patients were well enough during the hospital stay to provide accurate historical information nearly a third of those patients (19/66, 29%) were successfully de-labeled.

Conclusion

The pandemic provided clinical barriers, however we successfully adopted an EMR-based BLA tool. Engagement and buy-in from providers resulted in chart documentation and allergy de-labeling. Allergy working with ASPs can leverage both EMR and CDSS tools to de-label allergies to beta-lactams.

Disclosures

All Authors: No reported disclosures.
1788. COVID-19 and Antibiotic Prescriptions in the United States: A County-level Analysis
Authors: Hamilton Alisa , Poleon Suprena , Cherian Jerald , Cosgrove Sara E , Laxminarayan Ramanan , Klein Eili Y
Published: December 2022

Background

Declines in outpatient antibiotic prescribing were reported during the beginning of the COVID-19 pandemic in the United States; however, the overall impact of COVID-19 cases on antibiotic prescribing remains unclear.

Methods

We conducted an observational, ecological study to assess the impact of COVID-19 cases and pandemic-related, non-pharmaceutical interventions (NPIs) (e.g., school closures and facemasks) on antibiotic prescribing from February to December 2020 in the US. A random effects panel regression of county-level monthly reported COVID-19 case data and corresponding systemic antibiotic prescription data from IQVIA was used. The model controlled for county demographics, NPIs, and prior years’ prescribing.

Results

Total antibiotic prescriptions fell 26.1% between March and December 2020 compared to this period from 2017 to 2019. Prescribing rates dropped most among children (Figure 1). A 1% increase in county-level monthly COVID-19 cases was associated with a 0.9% increase (95% CI 0.7%, 1.1%; p< 0.01) in monthly prescriptions dispensed to adults and a 1.2% decrease (95% CI -1.7%, -0.8%; p< 0.01) in prescriptions dispensed to children (Table 1). Counties with schools open for in-person instruction were associated with a 4.4% increase (95% CI 2.3%, 6.4%; p< 0.01) in prescriptions among children compared to counties that closed schools. Internal movement restrictions and requiring facemasks were also associated with lower prescribing among children. Figure 1A) Total prescriptions per 100,000 population by month (2017-2020). B) Mean prescriptions per 100,000 population for seven age groups (2017-2019 vs 2020).Table 1

Conclusion

Though the number of antibiotic prescriptions in 2020 was lower than previous years, the positive association of COVID-19 cases with prescribing for adults and the negative association for children indicates increases in prescribing occurred primarily among adults. The rarity of bacterial co-infection in COVID-19 patients suggests a large fraction of these prescriptions may have been inappropriate. Facemasks and school closures were correlated with reductions in prescribing among children, likely due to the prevention of other upper respiratory infections (e.g., the cold and influenza). Despite reductions, the strongest predictors of prescribing were prior years’ prescribing trends, suggesting the possibility that behavioral norms are an important driver of prescribing practices.

Disclosures

Sara E. Cosgrove, MD, Basilea: Member of Infection Adjudication Committee Ramanan Laxminarayan, PhD, HealthCubed: Board Member|HealthCubed: Ownership Interest.
2310. Clinical Characteristics of Patients with Calcified Parenchymal Neurocysticercosis and Perilesional Edema in a large non-endemic cohort
Authors: Berto Moreano Cesar G , Coyle Christina , Machiavello Francisco J
Published: December 2022

Background

Perilesional edema (PLE) around calcified parenchymal neurocysticercosis (NCC) lesions is a transient inflammatory event that accounts for recurrent symptoms in NCC. Previous reports in endemic regions suggest that 50% of seizures in NCC are due to PLE. Its occurrence in non-endemic regions is largely unexplored.

Methods

A retrospective review of medical records of patients with confirmed NCC followed at Jacobi Medical Center (Bronx, NY) from 1993 to 2021 was performed. Epidemiological, clinical and radiological data were obtained.

Results

180 patients were identified with calcified parenchymal NCC at any time during their course. PLE was documented in 37/180 patients (20.5%). Of these, 27 patients (72.9%) had PLE on presentation; ten patients presented with PLE after a median follow-up of 16.5 (9–36) months. 28 patients (75.6%) with PLE had only calcified parenchymal disease; the remaining 9 patients had mixed forms of NCC concurrently (viable parenchymal, subarachnoid or intraventricular NCC). 8 patients (21.6%) had more than 1 PLE episode with a median number of 3 (2–4) episodes; interval to recurrence was 9 (3.5–11) months. In 6 patients, the recurrence occurred in a calcification different to that of the first PLE episode. 2 patients had multiple calcifications simultaneously displaying PLE. 86.5% of PLE episodes were symptomatic; seizures were the most common symptom (70.3%). Clinical manifestations of PLE often varied during recurrent episodes, with only 2 patients displaying the same symptoms. 10 patients were treated with steroids, and 6 recurrent episodes of PLE occurred during a taper of steroids started for a prior PLE occurrence.

Conclusion

PLE was a frequent phenomenon among NCC patients in our non-endemic cohort. Its clinical course is variable, occurring as a presenting feature in calcified disease. Treatment with steroids may not always be warranted given recurrence during taper periods. Many experts think this may be due to antigens "leaking" from the calcified lesion leading to inflammation, but the true pathophysiology is not known. Further studies are needed to elucidate the etiology and natural history of PLE in NCC patients.

Disclosures

All Authors: No reported disclosures.
1792. Different Patterns of Antibiotic Use in Different Administrative Categories: An Overview of 10 years (2009/2018) of a Statewide Surveillance Program in Sao Paulo, Brazil
Authors: Assis Denise , Madalosso Geraldine , Boszczowski Icaro , Piastrelli Filipe
Published: December 2022

Background

To describe intensive care unit (ICU) antibiotic use in different administrative categories based on data reported to the Nosocomial Surveillance System of the State Health Department (SHD) in the State of Sao Paulo.

Methods

This ecological study describes at an aggregated level the antibiotic use in adult ICU reported to São Paulo SHD, from 2009 to 2018. ICUs were categorized by hospital administrative category (private, public, and philanthropic). Public hospitals were subdivided into two administrative sub-categories as Social Health Organization (SHO), which administration is private but public funded, or direct public administration (DPA). Resistance phenotype incidence and antibiotic use correlation was calculated for meticilin-resistant Staphylococcus aureus (MRSA) and glycopeptide use, third generation cephalosporin (3GC)-resistant Enterobacterales and carbapenem use, carbapenem-resistant gram-negative bacilli (CR-GNB) and polymyxins use.

Results

The average number of hospitals reporting annual data on antibiotic use was 386. A total of 17.490.966 patient-days were included. Total antibiotic use in ICUs increased from 588.16 in 2009 to 943.12 DDD/1000pd in 2018 (p< 0,01). The DDD (defined daily dose) of antibiotic was higher in public hospitals (mean 889.11 DDD/1000pd), than in the private hospitals (mean 849.07 DDD/1000pd) and in the philanthropic hospitals (mean 48 785.12 DDD/1000pd) (p< 0.05). Positive correlations were detected between glycopeptide use and MRSA incidence, polymyxins use and CR-GNB incidence. A weak negative correlation between carbapenems use and 3GC-resistante Enterobacterales incidence were found. Figure I:Antimicrobial use by therapeutic class between 2009 and 2018 in DDD / 1000 patient-daysTable I:Antibiotic use by therapeutic class by administrative type in DDD/1000 patients-dayTable II:Antibiotic use in public hospital by subgroup between 2009 and 2018 in DDD/1000 patients-day

Conclusion

We found higher use of antibiotics in public hospitals than in private and philanthropic. Differences in antibiotic use were observed among SHO e DPA public hospitals. These data provide important information for formulating hypotheses and public health strategies to improve antimicrobial prescription.

Disclosures

All Authors: No reported disclosures.
1797. Evaluation of Intravenous vs Oral Antibiotic Therapy at Discharge for the Treatment of Urinary Source Gram-Negative Bacteremia
Authors: Yan Xuping , Song Matthew , Moore Sarah E , Swingler Elena A , Wilde Ashley M , Bohn Brian C
Published: December 2022

Background

Retrospective studies demonstrate similar efficacy between oral (PO) and intravenous (IV) antibiotics at discharge for gram negative bacteremia (GNB), with reduced duration of hospitalization, hospital costs, and duration of therapy with PO. Understanding current physician discharge practices can help guide future antimicrobial stewardship initiatives.

Methods

A multicenter, retrospective cohort study was conducted on adult inpatients admitted between July 1, 2020 and June 30, 2021 with urinary source GNB. Patients with both blood and urine cultures positive for Escherichia coli, Klebsiella species, or Proteus mirabilis and a PO antibiotic available at discharge were included. The primary outcome was the percentage of patients discharged on PO antibiotics. Secondary outcomes included duration of hospitalization, total length of therapy, and 30-day readmission secondary to clinical failure or therapeutic complication in the IV and PO at discharge groups.

Results

Of the 157 included patients, 128 (82%) were discharged on PO antibiotics. Patients discharged on IV and PO had similar median quick Pitt bacteremia scores [1(IQR, 0 – 2) vs. 1 (IQR, 0 – 1), p=0.420]. Mean duration of hospitalization for patients discharged on IV vs. PO therapy was 5 (SD, 2.91) days vs. 4 (SD, 2.75) days, p=0.001, respectively. Mean total length of antibiotic therapy was 21.6 (SD, 13.80) days as compared to 13.5 (SD, 4.94) days, p=0.017, for the IV vs. PO arms, respectively. Thirty–day readmission rates were 11/29 (38%) and 23/128 (18%), p=0.035, in the IV and PO arms, respectively. Notably, 21/29 (72%) of the IV arm had an organism from blood culture that was susceptible to trimethoprim-sulfamethoxazole (TMP-SMX).

Conclusion

Most patients with urinary source GNB were discharged on PO antibiotics. Patients discharged on IV antibiotics were more likely to be readmitted within 30 days. Future efforts to decrease IV antibiotic use may focus on increasing TMP-SMX use at discharge.

Disclosures

Matthew Song, PharmD, BCIDP, Merck: Stocks/Bonds|ObsEva: Stocks/Bonds.
1798. Impact and Sustainability of Antibiotic Prescribing Feedback with Peer Comparison to Hospitalists in a Community Hospital
Authors: Jones Travis M , Patel Kevin , Birkhimer Amy , Spires Steven Shaefer , Ashley Elizabeth Dodds
Published: December 2022

Background

Antibiotic prescribing feedback with peer comparison has been shown to reduce antibiotic prescription rates in the outpatient setting, but data regarding its impact in community hospitals are lacking. We previously developed novel denominator metrics to control for differences between physician practices such as patient volume or workload. Using these metrics, we provided regular antibiotic prescribing feedback with peer comparison to hospitalists in a community hospital over four years and evaluated its impact on targeted antibiotic prescribing.

Methods

Antibiotic days of therapy (DOT) for all antibacterials and targeted agents (aztreonam, antipseudomonal beta-lactams, vancomycin, and the fluoroquinolones (FQ)) were obtained from electronic medication administration records and linked to the ordering hospitalist. Physician-specific shifts worked data by month were calculated from local administrative datasets. De-identified data were presented in DOT/shifts worked, and trends in facility-wide and hospitalist-specific antibiotic prescribing were evaluated.

Results

A total of 37,938 antibiotic DOTs were prescribed by hospitalists from January 2018 to March 2022. De-identified feedback was shared in-person (4/2018, 4/2019, 3/2020, 11/2021) or virtually (9/2020) in small group sessions, and education, including local antibiogram data and recommended alternatives, was provided for targeted agents. Of the 31 hospitalists that received feedback, trends in FQ use for 7 hospitalists with longitudinal data are shown (Figure 1). In the month following feedback sessions, hospitalist antibiotic use data demonstrated substantial reductions in FQ prescribing, and similar trends were observed among all targeted agents. A single hospitalist’s prescribing trend for targeted agents is shown in Figure 2. Facility-wide, targeted agent use decreased 31% from 2017 to 2021 and was primarily driven by reductions in use by hospitalists.

Conclusion

Regular antibiotic prescribing feedback with peer comparison and education was associated with a reduction in targeted agent prescribing by hospitalists at a community hospital.

Disclosures

All Authors: No reported disclosures.
1802. Off-label Use of Antimicrobial Agents at the University Hospital for Infectious Diseases, Zagreb, Croatia
Authors: Matković Iva , Santini Marija
Published: December 2022

Background

Antimicrobial agents' (AMAs) off-label use can be associated with the prescriber's education. Little is known about the AMAs' off-label use by infectious disease (ID) specialists. We have conducted research at the University Hospital for Infectious Diseases (UHID), Zagreb, Croatia, a 230-bed tertiary center where ID specialists primarily prescribe AMAs.

Methods

A retrospective cross-sectional analysis was conducted on the day with the highest hospitalization number, January 17, 2019. Any use of AMA not complying with the SmPC was considered off-label and evaluated regarding modality (indication, dose, regimen, route of administration, and age) and justification by institutional or/and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines.

Results

The study included 155 patients, 63 (40.6%) adults and 92 (59.4%) children. 61 (96.8%) adult patients had at least one AMA. There were 134 AMA prescriptions in adults, 42 (31.3%) off-label. AMAs were most frequently prescribed off-label regarding regimen (21), dose (17), and indication (14). Institutional guidelines justified off-label in 5 cases regarding dose, 4 regarding indication, and 2 regarding regimen. ESCMID guidelines justified off-label prescriptions in 5 cases regarding indication. The rest of the off-label was not supported by the existing guidelines. 60 (65.2%) pediatric patients had at least one AMA. There were 73 prescriptions, 31 (42.5%) off-label. AMAs were most frequently prescribed off-label regarding indication (19), dose (12), and age (2). Institutional guidelines justified 3 off-label cases regarding indication and 1 regarding dose. ESCMID guidelines justified no off-label in children. The lack of guidelines was the leading cause of the off-label AMAs use in children.

Conclusion

One-third of AMAs are prescribed off-label regarding SmPC by ID specialists. However, institutional and international guidelines can justify part of this use.

Disclosures

All Authors: No reported disclosures.
1809. Treatment Outcomes in Piperacillin-tazobactam Non-susceptible (TZP-NS)/Ceftriaxone Susceptible (CRO-S) Infections
Authors: Dubrovskaya Yanina , Cao John , Siegfried Justin , Decano Arnold , Mazo Dana , Hochman Sarah , Zacharioudakis Ioannis , Solomon Sadie , Papadopoulos John
Published: December 2022

Background

Piperacillin-tazobactam-non-susceptible/ceftriaxone-susceptible (TZP-NS/CRO-S) Escherichia coli (Ec) and Klebsiella pneumoniae (Kp) phenotypes are hypothesized to be due to hyperproduction of TEM-1/2 and SHV-1 penicillinases. Limited available literature evaluating treatment outcomes in patients with TZP-NS/CRO-S infections may lead to unnecessary carbapenem use.

Methods

This was a retrospective study of non-critically ill adults hospitalized between 2013-2021, and treated for at least 48 hours for TZP-NS/CRO-S Ec or Kp infections. Patients with concomitant multi-drug resistant gram-negative infections were excluded. The primary composite endpoint included the need for escalation to intensive care unit (ICU), infection- or treatment-related readmission, mortality, and infection recurrence. Outcomes were compared between groups who received carbapenem (CG) vs carbapenem-sparing agents (CSG) as targeted therapy.

Results

Out of 1062 patients screened, 200 were included, with 51 in the CG and 149 in the CSG. Baseline characteristics, including Charlson Comorbidity Index (6 [IQR 3-10] vs 6 [4-9], p=0.64), were similar between groups, except for more immunocompromised patients in the CG (29% vs 11%, p=0.001). The most common infection sources were urinary (31% vs 57%, p=0.002), bloodstream (BSI) (18% vs 17%, p=0.887) and intra-abdominal (IAI) (20% vs 8%, p=0.023). Eighty-eight percent of the CG received meropenem, while the most common targeted therapy in the CSG was ceftriaxone (58%) followed by cefepime (24%). The primary composite endpoint was numerically higher in the CG (27% vs 17%, p=0.123), with no differences based on infection type (urine 25% vs 18%, p=0.495; BSI 33% vs 16%, p=0.348; IAI 40% vs 33%, p=1). More patients in the CSG were switched to oral therapy (15 [29%] vs 100 [67%], p< 0.001), with numerically 2 days shorter time to oral switch (6 [3-9] vs 4 [3-7] days, p=0.196). Out of those switched to oral therapy, most had a urinary source (8/15 [53%] vs 59/100 [59%]).

Conclusion

Our study did not find better clinical outcomes with carbapenem therapy for TZP-NS/CRO-S infections, thus CS agents may be considered to spare carbapenems in non-critically ill patients. Further studies are warranted to compare these outcomes in the critically ill.

Disclosures

All Authors: No reported disclosures.
1831. Longitudinal Changes in Antimicrobial-resistant Bacterial Bloodstream Infections in the US Military Health System from 2010-2019
Authors: Vostal Alexander C , Grance Melissa , Powers John H , Carson Leigh , Chukwuma Uzo , Lanteri Charlotte , Seliga Nicholas , Poitras Beth , Parmelee Edward , Mende Katrin
Published: December 2022

Background

The epidemiology of antibiotic-resistant pathogens guides antimicrobial therapy for bacterial bloodstream infections (BSI). We describe changes in antimicrobial-resistant BSI pathogens over time within the US Military Health System (MHS), which prospectively captures clinical and microbiological data from both retired and active-duty US Uniformed service members and their beneficiaries.

Methods

The study population included MHS beneficiaries with blood cultures positive for any bacterial pathogens (Jan 2010 – Dec 2019). Microbiological data were obtained from the Navy and Marine Corps Public Health Center and antibiotic resistance was interpreted using CLSI breakpoints corresponding to collection year. Blood contaminants were excluded. Difficult to treat resistance (DTR) was defined in Gram-negative bacteria (GNB) as isolates with in vitro resistance to three classes of antibiotics: carbapenems, extended-spectrum cephalosporins, and fluoroquinolones.

Results

The 15 most frequent bacterial pathogens, representing 15,358 BSI episodes from 12,749 individuals, were subcategorized in four groups based on shared BSI clinical features. Lactose-fermenting GNB (LFGNB) were most common, accounting for 42% of BSI pathogens, following by Streptococcus/Enterococcus spp. (33%), Staphylococcus aureus (20%), and non-lactose fermenting GNB (NLGNB, 5.5%). The rate of LFGNB BSI increased from 7.57 per 100,000 beneficiaries in 2010 to 8.42 in 2019 (peak of 8.83 in 2016), resulting in an increase of 11.3% during the study period (Figure). Rates of BSI attributed to Streptococcus/Enterococcus spp., S. aureus, and NLGNB decreased 26%, 29%, and 45%, respectively, over the study period. The average annual rates of methicillin-resistant S. aureus, vancomycin-resistant Enterococcus spp., and DTR GNB BSI were 1.30, 0.25, and 0.05 per 100,000 beneficiaries, respectively. Over the study period, these rates decreased 58.3%, 72.4% and 24.2%, respectively.

Conclusion

LFGNB BSI numerically increased over time while NLGNB BSI (e.g., Pseudomonas aeruginosa and Acinetobacter spp.) decreased. The burden of DTR GNB BSI also decreased, indicating that first-line antibiotics remain clinically available for most patients with BSI.

Disclosures

John H. Powers, III, MD, Arrevus: Advisor/Consultant|Eicos: Advisor/Consultant|Evofem: Advisor/Consultant|Eyecheck: Advisor/Consultant|Gilead: Advisor/Consultant|GlaxoSmithKline: Advisor/Consultant|OPKO: Advisor/Consultant|Resolve: Advisor/Consultant|Romark: Advisor/Consultant|SpineBioPharma: Advisor/Consultant|UTIlity: Advisor/Consultant|Vir: Advisor/Consultant.
1852. Recurrent Bacteremia after Endoscopic Injection of N-butyl-2-cyanoacrylate for Gastric Variceal Bleeding
Authors: Kim Hee Yeon , Kim Chang Wook , Kim Yang Ree , Lee Hyo-Jin
Published: December 2022

Background

Gastric variceal bleeding is associated with a high mortality rate, and sclerotherapy using N-butyl-2-cyanoacrylate is the treatment of choice. The risk of recurrent bacteremia after N-butyl-2-cyanoacrylate injection has rarely been reported. We aimed to evaluate the frequency of this complication in a real-world setting.

Methods

We analyzed retrospective data from a single-center cohort of patients with liver cirrhosis who underwent N-butyl-2-cyanoacrylate injection for the treatment of bleeding gastric varices from January 2010 to March 2021. Recurrent bacteremia was defined as repeated bacteremia caused by the same microorganism after the resolution of the first event occurring at least two weeks from the date of the final positive blood culture of the first event.

Results

A total of 232 patients receiving 338 sessions of N-butyl-2-cyanoacrylate injection were enrolled. All patients received antibiotics prophylaxis; third-generation cephalosporins were used. The average age of patients was 59.5 ± 12.2 years and the mean Model for End-Stage Liver Disease (MELD) score was 14.8 ± 7.3. Of the patients following cyanoacrylate injection, 62 patients developed primary bacteremia at a median of 294 (range, 3−3710) days from N-butyl-2-cyanoacrylate injection. Nine out of 62 patients developed recurrent bacteremia following sclerotherapy with N-butyl-2-cyanoacrylate. The identified organisms were: Extended-Spectrum ß-Lactamase (ESBL)-producing Escherichia coli (3), ESBL-producing Klebsiella pneumoniae (2), non-ESBL-producing Klebsiella pneumoniae (2), Pseudomonas aeruginosa (1), and Methicillin-resistant Staphylococcus aureus (1). The median number of episodes of recurrent bacteremia per patient was 3 (range, 2−8) during the median 972 (range, 78−1997) days of follow-up. Four of these nine recurrent bacteremia patients died.

Conclusion

Recurrent bacteremia occurred in 3.9% of cirrhotic patients following cyanoacrylate injection for the treatment of gastric variceal bleeding. Foreign-body-type infection of the polymerized N-butyl-2-cyanoacrylate should be suspected in patients who had received previous endoscopic treatment with N-2-butyl-cyanoacrylate and fails to disclose another source of infection.

Disclosures

All Authors: No reported disclosures.
1857. Risk factors for recurrent bacteremia in children undergoing chemotherapy or hematopoietic stem cell transplantation
Authors: Kim Ye Ji , Kang Hyun Mi , Kim Seong Koo , Lee Jae Wook , Chung Nack-Gyun , Cho Bin
Published: December 2022

Background

Sepsis is a complication frequently encountered in children with underlying malignancies, especially due to a majority of patients having indwelling venous catheters. Indications for catheter removal among children with central-line associated blood stream infection (CLABSI) should follow the recommendations for adults, however, difficulties in vascular access often leads to attempting treatment without catheter removal. Therefore, the primary aim of this study was to find risk factors for recurrent sepsis in children undergoing chemotherapy of HSCT and examine whether more aggressive catheter removal after CLABSI in children is necessary.

Methods

In the Pediatric Bone Marrow Transplant Center of Seoul St. Mary’s Hospital, positive blood cultures were prospectively monitored to control and prevent outbreaks. The date of culture, culture results, symptoms presented, category of blood stream infections (by the CDC/NHSN surveillance definition (2021) of Bloodstream infections), and central-line associated blood stream infection (CLABSI) events were monitored.

Results

During September 2016 to February 2021, a total 280 cases of laboratory confirmed bloodstream infections (LCBI) or Mucosal Barrier Injury LCBI (MBI-LCBI) were diagnosed in children < 18 years old with underlying malignancies. Of these, 52.9% (n=148) were male, and the mean age was 9.7 (SD±6.1) years old. CLABSI was diagnosed in 51.8% (n=145), and the most common pathogens cultured were S. mitis/oralis (24.0%, n=67), E. coli (15.4%, n=43), and coagulase negative Staphylococci (CNS) (10.4%, n=29). Recurrent sepsis occured in 17.1% (n=48), and 9.6% (n=27) had two indwelling catheters . Multivariable analysis showed that factors associated with recurrent blood stream infections were as follows: duration of indwelling catheter (OR, 1.002; 95% CI, 1.001-1.004; P< 0.001) and no removal of central lines after previous episode (OR, 51.143; 95% CI, 6.6-395.0; P< 0.001).

Conclusion

Permanent central lines should be removed as soon as possible, and more aggressive approach in permanent catheter removal after LCBSIs in children is necessary to reduce recurrent infections.

Disclosures

All Authors: No reported disclosures.
1858. Sequential Time to Positivity as a Prognostic Indicator in Staphylococcus aureus bacteremia
Authors: Comba Isin Y , Go John R , Palraj Raj , Abu Saleh Omar M
Published: December 2022

Background

The role of sequential blood culture time to positivity (TTP) as a surrogate marker for bacterial load and as a prognostic indicator in S. aureus bacteremia (SAB) is not well established in the literature.

Methods

We performed a single healthcare system, multi-site, retrospective review of adult patients with positive blood culture for S. aureus between January 2019 and December 2019. Sequential TTP was defined as the TTP of the first subsequent blood cultures obtained from patients with SAB for at least 24 hours. We adapted the previously described TTP ratio of < 1.5 as the cut-off for study groups. Infective endocarditis (IE) was defined according to modified Duke’s criteria. High-grade bacteremia was defined as the growth of the organism in two or more sets of blood cultures or growth in >50% of all bottles collected. Descriptive, comparative statistics and survival analysis were performed using Python 3 and IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp.

Results

A total of 602 patients with SAB were identified, and 186 patients who met the study criteria were included. Sixty-nine patients (37%) were female, and the mean age was 63.6 years. Patients with initial TTP < 12 hours had higher 30-day and 90-day mortality than those with initial TTP ≥ 12 hours. Patients with TTP ratio of > 1.5 had higher rates of cardiac prosthetic device (30 [26.1%] vs. 9 [12.7%], p = .03) and high-grade bacteremia (106 [92.2%] vs. 56 [78.9%], p = .01). In univariate analysis, history of myocardial infarction, cardiac prosthetic device, and findings of high-grade bacteremia and native valve vegetation in echocardiogram were significant predictors for a TTP ratio of < 1.5. In multivariate analysis, native valve vegetation (OR 2.4; 95% CI 1.2-4.84), and high-grade bacteremia (OR, 0.3; 95% CI, 0.13- 0.77) were independent predictors (Table 1 and 2). No differences in 30- day or 90-day survival based on the TTP ratio were seen (Figure 1). Figure 1.Kaplan-Meier (KM) curves and log rank test results based on time to positivity (TTP) of initial blood cultures and TTP ratio of sequential to initial blood culture

The X-axis represents the days elapsed from the initial blood culture collection. Number of patients at risk and events are given below the x-axis for each group. 30-day and 90-day survival rates were significantly lower in patients with initial TTP of < 12 hours compared with those with ≥ 12 hours. There were no statistically significant differences in survival based on TTP ratio.

Conclusion

In patients with SAB, a second TTP to first TPP ratio of > 1.5 was associated with higher rates of presence of the cardiac prosthetic device and high-grade bacteremia. Initial TTP < 12 hours was associated with lower survival; however sequential TTP ratio didn’t predict mortality.

Disclosures

All Authors: No reported disclosures.
1861. The Spectrum and Clinical Significance of Actinomyces Blood Stream Infection
Authors: Ali Maisa , Razok Almurtada , Al Maslamani Muna A , Hadi Hamad Abdel
Published: December 2022

Background

Actinomyces species are Gram-positive anaerobic branching bacilli which are commensal of oropharynx, urogenital and gastrointestinal tracts that is associated with infrequent chronic granulomatous diseases including cervicofacial, intrabdominal and genital infections. Actinomyces Blood Stream Infections (BSIs) are usually rare but becoming more frequent with advanced modern diagnostic techniques. The presented study aims to evaluate the spectrum and clinical relevance of Actinomyces BSI at Hamad Medical Corporation (HMC), Qatar.

Methods

A retrospective observational study was conducted for all reported Actinomyces species BSI at HMC between January 2016 to November 2020. Isolates were identified using modern automated BD PhoenixTM and MALDI-TOF microbiological methods.

Results

Over the five years study period, 37 episodes of Actinomyces BSIs were recorded the majority of which identified as Actinomyces odontolyticus (40.5 %, 15/37). The mean age was 32 years (range 1 month – 81 years), 62.2 % were females (23/37), 64.8 % had chronic medical conditions while 78.4 % developed fever as presenting illness. Out of the total cases, cultures were considered significant in only 48.6 % of cases (18/37), in which primary source of infection was oropharyngeal (10) followed by genitourinary (4), gastrointestinal (2) and 2 infected diabetic foot. However, 86.5 % (32/37) received antimicrobial therapy mainly as βlactam antibiotics or cephalosporins ranging between 3 days to 6 months.

Antimicrobial therapy was given for a short duration in 87.5% (28/32) of cases for less than 14 days with no long-term complications while only four cases received prolonged therapy. The remaining Five patients did not receive any antibiotics as the cultures were considered contaminants by the primary provider.

Conclusion

Actinomyces species blood stream infection is becoming more frequent with advanced diagnostic techniques affecting all age groups. Females and patients with chronic comorbidities are more commonly affected while A. odontolyticus is the predominant isolated species. Almost half of the cases were not clinically relevant, but most cases received short courses of antimicrobial therapy with no long-term complications.

Disclosures

All Authors: No reported disclosures.
1864. Trends in Staphylococcus aureus Bacteremia Rates among U.S. Acute Care Hospitals, January 2017- June 2021
Authors: Rose Ashley , Hatfield Kelly M , Reddy Sujan , Wolford Hannah , McCarthy Natalie L , Olubajo Babatunde , Jernigan John A , Baggs James , See Isaac
Published: December 2022

Background

Previous estimates of methicillin-resistant and -sensitive Staphylococcus aureus (MRSA, MSSA) bacteremia rates in hospitalized patients showed decreases in hospital-onset (HO) MRSA, no changes in community-onset (CO) MRSA and HO MSSA, and slight increases in CO MSSA rates from 2012–2017; more recent trends have not been well characterized.

Methods

We calculated monthly S. aureus bacteremia rates using microbiology data from hospitals reporting antibiotic susceptibility results in the Premier Healthcare Database from January 2017- June 2021. S. aureus blood isolates resistant to methicillin, oxacillin, or cefoxitin were categorized as MRSA. Positive blood cultures collected on or before hospital day 3 were categorized as CO; those collected on day 4 or later were categorized as HO. Annual rate differences were assessed using generalized estimating equation models with a negative binomial distribution adjusting for hospital bed size, teaching status, urban/rural designation, discharge month, census division, distributions of patient age, sex and race and hospital-level clustering.

Results

Among 11 million discharges from 356 hospitals, we identified 5,627 HO S. aureus bacteremia events: 2,558 (45%) MRSA and 3,069 (55%) MSSA. In 2017, we observed HO MRSA bacteremia rates of 0.41 and HO MSSA rates of 0.49 per 10,000 patient-days. Compared with 2017, adjusted rates of HO MRSA and MSSA bacteremia were significantly higher in 2019, 2020, and 2021 (Figure 1).

Of 42,587 CO S. aureus bacteremia events, 19,107 (45%) were MRSA and 23,480 (55%) MSSA. CO MRSA bacteremia rates were lowest in 2017 (1.52 per 1,000 discharges), and adjusted rates were significantly higher in all later years (Figure 2); we observed significant regional variability in annual differences (p=0.018). The observed CO MSSA bacteremia rate was 2.03 per 1,000 discharges in 2017, and adjusted rates were significantly higher in 2020 and 2021. Figure 1.Hospital-Onset MRSA and MSSA Bacteremia Incidence Rate Ratios* with 95% confidence intervals, 2017 – 2021**.*Reference year =2017.**2021 includes data during January – June.***Statistically significant at p<0.05.Figure 2.Community-Onset MRSA and MSSA Bacteremia Incidence Rate Ratios* with 95% confidence intervals, 2017 - 2021***Reference year =2017.**2021 includes data during January – June.***Statistically significant at p<0.05.

Conclusion

In contrast with previous trends, recent S. aureus bacteremia rates in this cohort have increased in comparison to 2017. Potential explanations warranting exploration include differences in regional trends and pandemic-associated changes in inpatient risk, severity of illness, length of stay, and hospital utilization

Disclosures

All Authors: No reported disclosures.
1868. Characterization of COVID-19 Symptoms and Outcomes by Variant Period in the North Carolina COVID-19 Community Research Partnership (NC-CCRP)
Authors: DeWitt Michael E , Edelstein Sharon , Tjaden Ashley H , Herrington David M , Schieffelin John , Gibbs Michael A , Weintraub William , Sanders John W
Published: December 2022

Background

We characterize the evolution of symptoms in those with self-reported SARS-CoV-2 infections and the likelihood of seeking treatment or medical care during different waves of the pandemic.

Methods

The NC-CCRP is a longitudinal observational study of 37,820 participants who completed a daily symptom log from April 2020 through February 2022, during which there were 5,167 self-reported COVID-19 infections. Three variant periods were defined as pre-delta, delta, and omicron, based on the predominant variant in North Carolina. Quasi-Poisson and logistic regression models adjusted for demographics and vaccination were used to assess COVID-19 symptoms and their duration and seeking treatment or hospitalization.

Results

Cough was the most reported symptom in all waves and increased from 77% pre-delta to 85% during omicron (p=0.001). Sore throat was more common during self-reported infections during omicron (71%), compared with 62% during delta and 54% pre-delta (p< 0.001). The largest change in proportion reporting a symptom was loss of taste or smell which decreased from 55% during pre-delta to 17% during omicron (p< 0.001). Compared with the pre-delta period, delta (incidence risk reduction, IRR 0.86; 95% CI 0.79-0.93) and omicron (IRR 0.67; 95% CI 0.61-0.73) were associated with lower symptom duration. Participants infected during the delta wave were more likely to seek treatment compared with either pre-delta (odds ratio, OR 1.32 95% CI 1.06-1.64) or omicron (OR 1.42; 95% CI 1.21-1.67). Omicron period infections were associated with a lower likelihood of self-reported hospitalization compared with pre-delta (OR 0.26; 95% CI 0.10-0.59) or delta (OR 0.26; 95% CI 0.11-0.60). Vaccination was associated with a reduced likelihood of hospitalization (OR 0.35; 95% CI 0.18-0.70).

Proportion and Duration of Symptoms by Variant Wave; Unadjusted by Vaccination Status.

Conclusion

Our study indicates evolution in symptom presentation and duration by variant period. The omicron wave was associated with shorter duration and lower severity of illness. Longitudinal tracking of symptomology and severity of a novel pathogen provide insights into the evolution of the pathogen in the community and is vital for public health and clinical response.

Disclosures

All Authors: No reported disclosures.
1871. Clinical epidemiological characterization of patients affected by COVID-19 in a General Hospital of Veracruz, Mexico
Authors: Carpio-Orantes Luis Del , García-Mendez Sergio , Márquez-Uscanga Daniel , Sánchez-Díaz Jesús Salvador , García-Hernández Omar , Aguilar-Silva Andrés , Salazar-Lizárraga Raúl Enrique , González-Arce América Alejandrina , Martínez-Rojas Manuel , Jiménez-Flores Oscar Rodrigo , Villalobos-López Luis Roberto , Hernández-Gómez Héctor Nahín , Domínguez-Cámara Rubén
Published: December 2022

Background

Since the beginning of the pandemic and its passage through the different affected continents, there have been differences in the presentation depending in part on the characteristics of each population, so it is important to know how it behaves in the local population.

Methods

Clinical-epidemiological study in adults hospitalized for suspected COVID-19 at the General Hospital 71 of the City of Veracruz, Mexico, from April to December 2020. Demographic and clinical characteristics are studied, as well as a comparative and stratified analysis was performed by intubation and death.

Results

1212 patients are included, 53% are men, average age 49 years. 20.5% reported sudden onset of symptoms; the most frequent: fever (79.8%), headache (75.2%), cough (71%), myalgia (62%), arthralgia (58%) and dyspnea (46.3%). Comorbidities were reported in 54.7%, the most frequent: Hypertension (29.2%), Diabetes (29.1%) and obesity (13.9%). Regarding the outcomes, 120 (9.9%) required intubation and 300 (25%) died. Men requiring intubation were significantly older than women [62.5 vs 37.5%; p = 0.027]. The mean age of the intubated patients was higher compared to that of the non-intubated [60.5 vs 44.8 years; p = 0.001]. The male gender had a risk association for intubation. The group aged 60 years or older compared to those aged 59 years or younger had a higher risk of intubation. Clinical variables that had a risk association with intubation were: dyspnea, chest pain and prostration. Among comorbidities, hypertension and diabetes had a risk association with intubation. Female gender and headache had a protective association for intubation. In addition, odynophagia, rhinorrhea, and abdominal pain showed a protective association for intubation. There was no difference in terms of gender by death. The mean age of the patients who died was significantly older [64.5 vs 43.8 years; p = 0.001]. The clinical variables that had a risk association with death were: dyspnea, chest pain, polypnea, cyanosis and prostration. The protective variables were: rhinorrhea, odynophagia, headache and conjunctivitis.

Conclusion

By studying a population affected by COVID, its own characteristics and inherent risks can be known to help take local diagnosis and treatment strategies that ensure a better outcome for those affected.

Disclosures

All Authors: No reported disclosures.
1883. Epidemiological investigation of the COVID-19 outbreak in Vellore district in South India using Geographic Information Surveillance (GIS)
Authors: Rupali Priscilla , Murugesan Malathi , Mohan Venkata Raghava , Venkatesan Padmanaban , Kumar Senthil , Thangavelu Premkumar , Rose Winsley , John Jacob
Published: December 2022

Background

Geographical Information Surveillance (GIS) is an advanced digital technology tool that maps location-based data and helps in epidemiological modeling. During pandemics a rapid analysis of patterns of spread can help put in place strategies for containment and infection control. We applied GIS to analyze patterns of spread and hotspots of COVID-19 infected cases in Vellore district in Tamil Nadu, South India.

Methods

Laboratory-confirmed COVID-19 patients from Vellore district and neighboring taluks from March 2020 to June 2021 were geo coded (based on addresses) and spatial maps generated. These were then layered as points on the base map to illustrate the distribution of all COVID-19 cases. Time trends exploring urban-rural burden with age-sex distribution of COVID-19 cases and other variables were correlated with outcomes of death, symptoms and complications.

Map of undivided Vellore district showing rural and urban settlements.

Results

A total of 45,401 cases of COVID-19 were detected between 28 March 2020 to 31 June 2021 with 20730 cases during the first wave (28 March 2020 to 31 March 2021) and 24671 cases during the second wave (1 April 2021 to 30 June 2021). The overall incidence rates of COVID-19 across the study region was 462.8 per 100,000 and 588.6 per 100,000 population during the first and second waves respectively. Pattern of spread revealed epicentres in densely populated urban areas with radial spread, sparing rural areas, Heat maps also confirmed higher densities at these epicentres, however, the second wave had more peri-urban and rural area involvement. Case fatality rate was 1.89% and 1.6% during the first and second waves and increased with advancing age, i.e., 7.38% were aged more than 60 years in the first wave and 5.02% in the second wave. Incidence was higher in men, 2.40%, and 1.76% as compared to women who had 1.16% and 1.38% in the first and second waves respectively. Overall, case fatality rates were the highest among those who had >2 comorbidities (9.52%).

Subdistrict level incidence of COVID-19 during the first and second waves.

Epidemic curve of the COVID-19 pandemic during the first and the second waves.

Conclusion

Modern surveillance systems like GIS can accurately predict the trends of the outbreak and pattern of spread during future respiratory pandemics. Employing this in real time can help design risk mitigation strategies improving health care access and monitoring with prevention of spread to rural areas.

Disclosures

Priscilla Rupali, MD, DTM&H, PFIZER: Grant/Research Support|PFIZER: Grant/Research Support.