bluuebunny/crossref_metadata_2025_split huggingface dataset:
113. Impact of Urinalysis with Reflex to Culture on Antimicrobial Prescribing Patterns for Patients with a Positive Urine Culture
Authors: Diehl Nicolette , Yu Daohai , Gallagher Jason C , Sullivan Kaede V , Mueller Daniel , Lu Xiaoning , Cavaretta Marissa 
Published: January 2021

Abstract

Background
Temple University Hospital recently implemented a protocol in which a urinalysis will reflex to culture only in the presence of pyuria. The purpose of this study is to compare appropriate antimicrobial use for patients with positive urine cultures before and after implementation of the urinalysis with reflex to culture protocol.

Methods
This is a single center, observational chart review. Adult internal medicine patients with a urinalysis and positive urine culture before and after the intervention were included in the pre- and post-intervention groups. Patients in the intensive care unit, undergoing urologic or surgical procedures, with leukopenia, being treated for another infection, who were discharged within 72 hours of the urine culture order, or pregnant were excluded. The primary endpoint was the percentage of patients with appropriate antimicrobial management of the positive urine culture before and after implementation of the protocol. Appropriate management was defined as antimicrobial treatment for a symptomatic urinary tract infection or no antimicrobial treatment for asymptomatic bacteriuria. Duration of therapy was also assessed. A sample size of 334 cultures was needed to detect a 15% difference in initiation of antibiotics between groups. Comparisons of categorical variables were analyzed by Chi-Square/Fisher exact test while continuous variables were analyzed by Wilcoxon test.

Results
Patient characteristics and outcomes are listed in the tables below.
Table 1: Patient Characteristics

Table 2: Outcomes

Conclusion
The urinalysis with reflex to culture intervention appeared to have minimal impact on the management of patients with a positive urine culture, with a possible increase in inappropriate management. Duration of therapy was significantly reduced by approximately one day with the intervention. Additional interventions to improve appropriate management of bacteriuria should be explored.

Disclosures
Jason C. Gallagher, PharmD, FIDP, FCCP, FIDSA, BCPS, Allergan (Consultant)Astellas (Consultant)Merck (Consultant, Grant/Research Support)Nabriva (Consultant)Qpex (Consultant)scPharmaceuticals (Consultant)Shionogi (Consultant)Spero (Consultant)Tetraphase (Consultant)
1403. The Pediatric Emergency Room as a Promising Setting for Receiving the Flu Shot
Authors: Miller Christine M , McMahon Erin , Parrillo Marissa , Sobelman Celia , Golenia Peter , Kirchner Rory , Hermos Christina , Mathews Bonnie 
Published: January 2021

Abstract

Background
Children are the most likely population to get influenza, and are two times more likely compared to adults aged 65 and greater (attack rate by age group: 0-17 yo 9.3%, 18-74 yo 8.8%, 65 + 3.9%). Additionally, children are at high risk of suffering complications from influenza. According to the CDC, the overall effectiveness of the 2018-2019 flu vaccine for both strains A and B was 48% in children aged 6m-8 years and 7% in children aged 9- 17 years. Currently our Pediatric Emergency Department (PED) does not routinely offer influenza vaccine to unvaccinated patients. Our project goals are to identify barriers to the administration of influenza vaccine in the PED and to offer and administer influenza vaccine to eligible patients.

Methods
After performing root cause analysis with key stakeholders, the first countermeasure implemented in a Plan-Do-Study Act (PDSA) cycle was the development of a screening form including eligibility criteria, history of influenza vaccine, consent for vaccine or reason for declining vaccine. The screening form was administered by resident physicians in our PED from October to November who then went on to order the vaccine for eligible patients who consented. Primary outcome measures included number of patients screened per month, percent of patients who desired the vaccine, and the percent of patients who received the vaccine in the ED during their visit. Secondary outcome measures included length of PED stay.

Results
Preliminary results show that 75% (42/56,CI: 62%-86%) of children screened in the PED between October and November were eligible for the influenza vaccine. Of those eligible, 59% (29/42, CI: 43%-74%) received the vaccine. The average length of stay was comparable between those that received influenza vaccine and those that did not (p value 0.4756).

Conclusion
A subset of eligible patients are now being offered and receiving the flu shot in our PED. Over half of eligible patients received the influenza vaccine, demonstrating that a resident administered screening form has been a successful countermeasure for increasing vaccine rates. Future PDSA cycles will focus on further increasing the number of patients screened and capturing patients who consented but did not receive vaccine.

Disclosures
All Authors: No reported disclosures
114. Implementation of an Empiric Organism Specific Guidelines for Gram-negative Bacteremia in conjunction with Rapid Diagnostic Testing
Authors: Bernice Fidelia , Avdic Edina , Dzintars Kathryn , Cruz Aliyah 
Published: January 2021

Abstract

Background
The objective of this study was to confirm the validity of institution specific treatment recommendations targeting organisms identified by GenMark Dx® ePlex® blood cultures identification (BCID) Gram-negative panel prior to susceptibility results.

Methods
We developed and implemented institution specific guidelines for empiric antibiotic therapy for Gram-negative organisms targeted by GenMark Dx® ePlex® BCID. We utilized blood culture antibiograms, existing evidence for the most optimal agent for each pathogen, probable resistance mechanisms and patient clinical status to create these guidelines. From December 16, 2019 through May 31, 2020, infectious diseases pharmacists reviewed all positive blood cultures; assessed compliance with guidelines and intervened as needed. The primary objective was to determine how frequently guideline recommend agents would be ineffective against targeted pathogens based on susceptibilities. Secondary objectives were compliance with guidelines and frequency of therapy escalation or de-escalation.

Results
GenMark® testing was completed on 222 cultures positive for Gram-negative rods with target organisms identification in 195 (88%) blood cultures. Two hundred and five organisms were identified; most commonly E. coli (40%) and K. pneumoniae (21%).Resistance markers were detected in 30 aerobic blood cultures; 28 CTX-M, and 2 KPC. Our institutional guideline provided appropriate empiric coverage in 93% of bacteremia episodes. The most common reason for ineffective therapy was the presence of resistance mechanisms not detected by GenMark® test (e.g. non-CTX-M extended spectrum beta-lactamases). The compliance rate with the guidelines was 55%; the most common reason for non-compliance was the use of an anti-pseudmonal beta-lactams in neutropenic patients.. The system failed to identify panel organisms in only 5 (2%) of blood cultures.

Conclusion
The institution-specific guidelines providing empiric coverage for each organism identified by rapid diagnostic tests can aid antimicrobial stewardship efforts to de-escalate therapy while still providing effective coverage in &gt;90% of cases.

Disclosures
All Authors: No reported disclosures.
1408. Enterovirus D68 RNA Visualized in the Anterior Horn of the Spinal Cord of a Pediatric Patient with Flaccid Paralysis
Authors: Vogt Matthew R , Wright Peter , Hickey William , Crowe James E , Boyd Kelli 
Published: January 2021

Abstract

Background
Acute flaccid myelitis (AFM) is a polio-like paralyzing illness of children. AFM incidence is increasing during every other year outbreaks that occur in the United States simultaneously with outbreaks of enterovirus D68 (EV-D68) infection. Demonstrating that EV-D68 directly causes AFM has been challenging due to rare detection of the virus in the cerebrospinal fluid (CSF) of patients despite frequent detection at nonsterile sites. Murine studies have shown that EV-D68 can infect spinal cord anterior horn motor neurons and cause paralysis, similar to poliovirus. However, a key outstanding question is whether EV-D68 causes AFM in humans by direct viral pathogenesis or by indirect host immunopathogenesis.

Methods
We investigated the pathogenesis of AFM using tissues from a previously reported case of a 5-year-old boy who presented in fall 2008 with four days of progressive limb and voice weakness followed by incontinence, apnea, and death. He had a CSF pleocytosis of 2094/µL with EV-D68 identified in the CSF by sequencing of the VP1 gene. We designed probes for in situ hybridization (ISH) based on this sequence to stain formalin fixed paraffin embedded tissues from his autopsy. For immunohistochemistry (IHC) we used both commercial polyclonal anti-EV-D68 antibodies and our own human monoclonal antibodies that stain virus infected cells in vitro. Immunophenotyping was done by IHC.

Results
With ISH we identified EV-D68 RNA in the anterior horn of the patient’s spinal cord, corresponding to the location of motor neuron cell bodies. This area was highly inflamed, with an infiltrate of lymphocytes and macrophages. Viral RNA was in low abundance, and we could not detect viral surface proteins by IHC. Neither RNA nor viral antigen was detected in the lungs, which had extensive inflammatory infiltrate.

Conclusion
Deaths in AFM patients are rare and often distant from initial presentation, but this patient died four days after onset of weakness, allowing us to directly demonstrate that EV-D68 can infect the human spinal cord. Low abundance of virus suggests the virus either reached the spinal cord prior to weakness onset or was cleared rapidly by the immune response. Therefore, both direct viral pathology and immune factors likely contribute to AFM disease in EV-D68 infection.

Disclosures
James E. Crowe, Jr, MD, IDBiologics (Board Member, Consultant, Grant/Research Support)Vanderbilt University (Other Financial or Material Support, Inventor on patent related to this abstract)
1409. Genomic Variation Among Respiratory Syncytial Viruses
Authors: Anderson Christopher S , Zhang Yun , Corbett Anthony , Chu Chin-Yi , Wang Lu , Qiu Xing , McCall Mathew , Topham David , Mariani Tom , Walsh Edward E , Scheuermann Richard , Caserta Mary T 
Published: January 2021

Abstract

Background
Respiratory Syncytial Virus (RSV) can be easily classified into two subtypes (A and B) based on the nucleic acid sequence of their genome. Phylogenic approaches have shown that within both subtypes separate lineages of viruses exist and new lineages continue to emerge. The role these genomic variations play in disease severity during RSV infection is largely unknown.

Methods
Next-generation viral RNA sequencing was performed on archived frozen nasal swabs of children infected with RSV in Rochester, NY between 1977-1998. Genomic variation was compared across year-of-isolation, age of host, and inpatient/outpatient status of host. Local RSV genomic variation was compared to variation of publicly available sequences isolated from hosts residing in other parts of the world.

Results
A and B subtypes demonstrated significant differences in the genetic sequence and primary-protein structure over time. G-protein was the most variable in both subtypes, but they differed in the number of unique genotypes detected. We found a significant association with disease severity (inpatient/outpatient status) and RSV phylogenetic topology, although the magnitude of the association differed by subtype. Variation in the primary protein structure of RSV viral proteins was also significantly associated with disease severity, but depended on which viral protein, and which subtype, was investigated. Lastly, local RSV genomic and protein-structure variation was similar to what was seen globally during this time period.

Conclusion
Overall, both subtypes demonstrated significant genetic change over time and these changes were associated with disease severity. These results suggest that the genetic variability of RSV may affect RSV disease in humans.

Disclosures
All Authors: No reported disclosures
1410. Neonatal Herpes Simplex Virus (HSV) Infection: Is It the Only Pathogen?
Authors: Dendi Alvaro , Garcia Ingrith Viviana Hoyos , Mejias Asuncion , Hanlon Cory T , Sanchez Pablo J 
Published: January 2021

Abstract

Background
Neonatal HSV infection is associated with substantial morbidity and mortality. Therefore, prompt identification and treatment of infected neonates is paramount. At Nationwide Children’s Hospital (NCH), Columbus, OH all neonates admitted in the first 2 weeks (up to 2010) and 4 weeks (since 2010) of age are evaluated for HSV infection in addition to routine bacterial and other viral infections. The frequency of co-infection with HSV and other potential pathogens is not fully known.

Methods
Retrospective review of the medical records of infants admitted to NCH with a diagnosis of neonatal HSV infection from 2001 to 2019. Patients less than 6 weeks of age were identified by review of the NCH Virology and Molecular Laboratory results for all positive HSV PCRs obtained from any body site as well as by discharge ICD-9 and ICD-10 codes for HSV infection. Medical records were reviewed for demographic, clinical, laboratory, outcome data, and maternal history of genital HSV lesions at or before delivery. Occurrence of positive bacterial and/or viral co-detection were identified. The data were managed using REDCap electronic data capture tools hosted at NCH.

Results
There were 93 infants with neonatal HSV infection (mean age, 9.5 days [IQR, 7-15]; 42%, HSV1; 53%, HSV-2). 32 infants had central nervous system infection (CNS) while 31 had Skin-Eye-Mouth (SEM) infection and 30 had Disseminated Disease. Mortality was 15% (n=14). Only 3 mothers had active genital HSV lesions at delivery. Of the 93 infants, 5 (5%) had bacterial (n=2) or viral (n=3) co-infections. All of the infants only had mucosal sites positive for HSV 1 (n=4) or 2 (n=1). Of the 2 infants with bacterial infection, 1 had bacteremia due to viridans streptococci while the other one had necrotizing enterocolitis and a positive blood culture for Clostridium butyricum. The 3 infants with viral co-detection also were full term and all had positive enterovovirus PCR tests (1, blood, throat; 1, blood and ceerebrospinal fluid (CSF); 1, CSF)

Conclusion
5% of infants with neonatal HSV infection had bacterial or enteroviral co-infection. These findings have important implications in the management of neonates evaluated for possible sepsis.

Disclosures
Asuncion Mejias, MD, PhD, MsCS, Janssen (Grant/Research Support, Advisor or Review Panel member)Merck (Advisor or Review Panel member)Roche (Advisor or Review Panel member)
1412. The utility of respiratory viral panel testing for nosocomial fever in the neonatal intensive care unit
Authors: Palacios Carlo Fopiano , Lemmon Eric , Campbell James 
Published: January 2021

Abstract

Background
Patients in the neonatal intensive care unit (NICU) often develop fevers during their inpatient stay. Many neonates are empirically started on antibiotics due to their fragile clinical status. We sought to evaluate whether the respiratory viral panel (RVP) PCR test is associated with use of antibiotics in patients who develop a fever in the NICU.

Methods
We conducted a retrospective chart review on patients admitted to the Level 4 NICU of the University of Maryland Medical Center from November 2015 to June 2018. We included all neonates who developed a fever 48 hours into their admission. We collected demographic information and data on length of stay, fever work-up and diagnostics (including labs, cultures, RVP), and antibiotic use. Descriptive statistics, Fisher exact test, linear regression, and Welch’s ANOVA were performed.

Results
Among 347 fever episodes, the mean age of neonates was 72.8 ± 21.6 days, and 45.2% were female. Out of 30 total RVP samples analyzed, 2 were positive (6.7%). The most common causes of fever were post-procedural (5.7%), pneumonia (4.8%), urinary tract infection (3.5%), meningitis (2.6%), bacteremia (2.3%), or due to a viral infection (2.0%). Antibiotics were started in 208 patients (60%), while 61 neonates (17.6%) were already on antibiotics. The mean length of antibiotics was 7.5 ± 0.5 days. Neonates were more likely to get started on antibiotics if they had a negative RVP compared to those without a negative RVP (89% vs. 11%, p-value &lt; 0.0001). Patients with a positive RVP had a decreased length of stay compared to those without a positive RVP (30.3 ± 8.7 vs. 96.8 ± 71.3, p-value 0.01). On multivariate linear regression, a positive RVP was not associated with length of stay.

Conclusion
Neonates with a negative respiratory viral PCR test were more likely to be started on antibiotics for fevers. Respiratory viral PCR testing can be used as a tool to promote antibiotic stewardship in the NICU.

Disclosures
All Authors: No reported disclosures
1414. #Vaccine Twitter Influencers: is it Just About Reach and Followers?
Authors: Poirrier Jean-Etienne , Caputi Theodore , Ayers John , Dredze Mark , Poston Sara , Hogea Cosmina 
Published: January 2021

Abstract

Background
A small number of powerful users (“influencers”) dominates conversations on social media platforms: less than 1% of Twitter accounts have at least 3,000 followers and even fewer have hundreds of thousands or millions of followers. Beyond simple metrics (number of tweets, retweets...) little is known about these “influencers”, particularly in relation to their role in shaping online narratives about vaccines. Our goal was to describe influential Twitter accounts that are driving conversations about vaccines and present new metrics of influence.

Methods
Using publicly-available data from Twitter, we selected posts from 1-Jan-2016 to 31-Dec-2018 and extracted the top 5% of accounts tweeting about vaccines with the most followers. Using automated classifiers, we determined the location of these accounts, and grouped them into those that primarily tweet pro- versus anti-vaccine content. We further characterized the demographics of these influencer accounts.

Results
From 25,381 vaccine-related tweets available in our sample representing 10,607 users, 530 accounts represented the top 5% by number of followers. These accounts had on average 1,608,637 followers (standard deviation=5,063,421) and 340,390 median followers. Among the accounts for which sentiment was successfully estimated by the classifier, 10.4% (n=55) posted anti-vaccine content and 33.6% (n=178) posted pro-vaccine content. Of the 55 anti-vaccine accounts, 50% (n=18) of the accounts for which location was successfully determined were from the United States. Of the 178 pro-vaccine accounts, 42.5% (n=54) were from the United States.

Conclusion
This study showed that only a small proportion of Twitter accounts (A) post about vaccines and (B) have a high follower count and post anti-vaccine content. Further analysis of these users may help researchers and policy makers better understand how to amplify the impact of pro-vaccine social media messages.

Disclosures
Jean-Etienne Poirrier, PhD, MBA, The GSK group of companies (Employee, Shareholder) Theodore Caputi, PhD, Good Analytics Inc. (Consultant) John Ayers, PhD, GSK (Grant/Research Support) Mark Dredze, PhD, Bloomberg LP (Consultant)Good Analytics (Consultant) Sara Poston, PharmD, The GlaxoSmithKline group of companies (Employee, Shareholder) Cosmina Hogea, PhD, GlaxoSmithKline (Employee, Shareholder)
1415. A qualitative study of intersectional stigma among older adults living with HIV who are victims of childhood sexual abuse
Authors: Nkwonta Chigozie A , Brown Monique , James Titilayo , Kaur Amandeep 
Published: January 2021

Abstract

Background
Intersectional stigma is based upon co-occurring and intersecting identities or conditions and occurs at multiple levels of influence. Intersectional stigma has been repeatedly associated with poor health behaviors and outcomes. The effect of intersectional stigma among older adults are particularly challenging due to issues related to ageism, loss of social support, and comorbidities. We examined the impact of multiple stigmas on older adults living with HIV who are victims of childhood sexual abuse.

Methods
Semi-structured interviews were conducted with a purposefully selected heterogeneous sample of 24 adults living with HIV who are 50 years and older in South Carolina. Interviews were audio-recorded, transcribed verbatim, and coded using thematic analysis.

Results
Participants shared experiences and perceptions of stigma and discrimination most commonly related to their HIV status and sexuality at the interpersonal/familial and community levels. Four themes emerged to explain the impact of intersectional stigma: depression, lack of HIV disclosure, limited support, and reduced intimacy.

Conclusion
The complexity of multiple stigmas profoundly shapes life experiences, opportunities, and mental health of older adults living with HIV. This study highlights that public health programs need to consider the impact of intersectional stigma in order to promote the wellbeing of and improve quality of life for older adults living with HIV.

Disclosures
All Authors: No reported disclosures
1418. Injections and Infections: Understanding Harm Reduction Utilization in a Rural State
Authors: Thakarar Kinna , Murray Kim , Sankar Nityasri , Carwile Jenny , Lucas F L , Burris Debra D , Borelli Timothy J , Pinsky Robert , Liechty Cheryl , Smith Robert P 
Published: January 2021

Abstract

Background
Increasing rates of injection drug use (IDU) associated-infections suggest significant syringe service program (SSP) underutilization. Our study objective is to assess patient knowledge, attitudes, and practices of safe injection techniques and to determine predictors of SSP utilization in a rural state.

Methods
This is a fifteen-month cross-sectional study of participants hospitalized with IDU-associated infections at four hospitals in Maine. Data were collected through Audio Computer-Assisted Self-Interview survey and medical record review. Descriptive analyses were performed to characterize injection knowledge, attitudes and practices. The primary outcome was past 3-month SSP utilization, and the main independent variable was self-reported distance to SSP. Secondary outcomes were uptake of clean drug equipment, naloxone, and treatment with medication for opioid use disorder. Logistic regression analyses were performed to identify factors associated with the primary outcome, controlling for gender, homelessness, history of overdose, having primary care physician and distance to SSP.

Results
Of the 101 study participants, 62 participants (65%) reported past 3 month SSP utilization, though only 33% used SSPs frequently. Few participants (10%) reported clean needle/syringe use or clean drug equipment use (5%). Forty-eight percent of participants reported naloxone uptake, and 66% of participants were prescribed medication for opioid use disorder prior to admission. Many participants (59%) lived more than 10 miles from an SSP with 18% of participants living in rural areas. Fifty-four percent reported difficulty accessing an SSP. Participants who lived less than 10 miles of an SSP were more likely to use it (adjusted odds ratio 5.47; 95% CI 2.1- 14.3).

Conclusion
Our study highlights unsafe injection practices and lack of frequent SSP utilization among people admitted with IDU-associated infections in Maine. Especially given increasing stimulant use in our state and nationally, these results also highlight the need to promote harm reduction even among individuals prescribed medication for opioid use disorder. Particularly in rural areas where patients may live more than 10 miles from an SSP, expansion of harm reduction services should be a priority.

Disclosures
All Authors: No reported disclosures