bluuebunny/crossref_metadata_2025_split huggingface dataset:
1322. Quantifying the Effects of Frequently Prescribed Antimicrobials with Perceived Potential for QT Interval Prolongation during the COVID-19 Era
Authors: Sy Hendrik , Woods Krystina L , Yassin Arsheena , Ciummo Francesco , Shah Ami , Freites Christian Olivo , Farkas Andras 
Published: January 2021

Abstract

Background
Countless diseases and medications have been implicated in the past as causing prolongation of the QT interval. Their unique role through the means of quantifying the definite magnitude of relative risk they contribute during hospitalization still requires further investigation. The aim of this study was to describe the impact of commonly used anti-infectives on the QT interval in hospitalized patients during the COVID-19 era.

Methods
Demographic information, medical history, laboratory data, medication administration history and ECG recording data was collected from the electronic records of adult patients admitted to two urban hospitals. A mixed effects approach with four sub-models for the QT interval comprised of: heart rate, circadian rhythm, gender, and the drug (regressed as the cumulative mg dose administered over time) and disease effects was used. Fixed and random effects with between occasion variability were estimated for the parameters with a Bayesian approach using the STAN software.

Results
Data from 2180 patients were used with baseline characteristics shown in Table 1. Observed vs. predicted plots based on the training (Figure 1.A) and validation data set (Figure 1.B) showed excellent fit. The parameters for QTc0, α, gender, and circadian rhythm were identified within the range previously described (Table 2.). Similarly, the model correctly identified the impact of acute or chronic diseases on the QT interval. Model coefficient estimates [mean (95% CI) of 0.010 (0.006, 0.15) and 0.0045 (0.0013, 0.01100) msec/mg cumulative dose, respectively] suggest that patients treated with conventional regimens of fluconazole and levofloxacin are most likely to present with a QT interval increase &gt; 5 msec, the cutoff threshold of regulatory concern.
Figure 1. A-B

Table 1.

Table 2.

Conclusion
The model developed accurately identified the impact baseline risk factors and concomitant medications have on the QT interval. When adjusted for these confounding variables, estimates of QT interval prolongation show that treatment with fluconazole and levofloxacin pose a considerable risk; while treatment with azithromycin or hydroxychloroquine is of moderate risk for QT interval prolongation.

Disclosures
All Authors: No reported disclosures
1335. Accuracy of Outpatient Antibiotic Prescriptions for Urinary Tract Infection in Pediatric Ambulatory Care
Authors: Polischuk Emily , Mannix Mary Kathryn , Islam Shamim 
Published: January 2021

Abstract

Background
Antimicrobial stewardship programs have typically focused on inpatient care, but antibiotics are frequently prescribed at pediatric ambulatory care centers. Ensuring accurate pediatric antibiotic dosing is important to optimize outcomes while minimizing adverse drug effects. Outpatient pharmacists often lack the resources to recommend optimal antibiotic dosing for pediatric infections. The primary objective was to evaluate the accuracy of antibiotic dose, frequency and formulation prescribed. The secondary objective was to describe the most commonly prescribed treatment durations.

Methods
A retrospective review of electronic medical records was conducted at two suburban pediatric practices. Patients diagnosed with uncomplicated UTI over a two year period were identified using ICD-10 codes N39, R30 and R35. Patients 2 months-18 years were included if prescribed an oral antibiotic for the treatment of UTI. Data collected included baseline demographics, antibiotic, dose (mg and mg/kg), frequency, formulation, and duration. Antibiotic dose, frequency and formulation were considered accurate if they were consistent with clinical guidelines and tertiary dosing references, allowing for 10% rounding in weight-based doses.

Results
A total of 472 outpatient prescriptions met inclusion criteria. Overall, 24% of dosing regimens were found to be inaccurate. Patients were most commonly prescribed doses that were too low (54/118, 45%) or too high (41/118, 35%). Less frequently, doses exceeded the maximum total dose (9/118, 8%), were given at the wrong frequency (8/118, 7%), or the wrong dosage form was selected (6/118, 5%). Of the commonly prescribed antibiotics, dosing errors were most likely to occur with ciprofloxacin (24/27, 89%) and amoxicillin (33/64; 55%). The majority of patients completed a 10 day course of antibiotics (381, 80%), followed by 7 days (66, 13.9%). Durations of 3 days (20, 4.2%), 5 days (7, 1.5%) and 14 days (2, 0.4%) occurred less frequently.

Conclusion
Errors in antibiotic dosing occurred with nearly one in four prescriptions written for outpatient UTI from pediatric primary care centers. Durations were most commonly 10 days. Education and resources should be provided to outpatient pediatric providers to optimize antibiotic dosing.

Disclosures
All Authors: No reported disclosures
1355. Resistance in Gram-Negative Bacteria in the Pediatric Patient Population by Age and Sex
Authors: Malamet Benjamin J , Sims Matthew 
Published: January 2021

Abstract

Background
Previous research within the Beaumont Infectious Diseases Research Program found an overall increase in antibiotic resistance in adult males versus females. Furthermore, there is a peak in resistance in 18-29-year-old males, not seen in females. The origin of this early peak of antibiotic resistance in adults is unclear. This study examines these trends in the pediatric patient population.

Methods
Resistance data for all Gram-negative bacterial clinical isolates from Beaumont Health System’s clinical microbiology lab between October 1st, 2010, and December 31st, 2014 was analyzed. The pediatric isolates were categorized into sextiles (0-2, 3-5, 6-8, 9-11, 12-14, 15-17) and the sensitivities for each antibiotic were compared based on gender and age and separated by urine isolates vs. non-urine isolates to account for potential bias based on an abundance of urine samples in females.

Results
There were 7878 pediatric Gram-negative bacterial isolates in the database, and 96 duplicate samples were removed, leaving 7782 isolates to be analyzed. There were more female isolates (n=6888) than male isolates (n=890) due to the preponderance of urine cultures in females. At most age ranges, antibiotic resistance was significantly higher in males than females. In males, antibiotic resistance was highest between 12-14 and 15-17 years old. When analyzing the cultures based on sample type, the peak in resistance in males is seen in urine isolates, but the patterns of resistance are chaotic in non-urine isolates. This is likely attributable to a low number of isolates.

Conclusion
Sex is an important factor in determining antibiotic resistance in the pediatric patient population, as males exhibit higher resistance. The peak in antibiotic resistance initially noted in 18-29-year-old males in previous research originates in the pediatric age group and appears to develop between 12-17 years old. Further research is needed to determine the cause of the observed gender bias, to ascertain if it is modifiable in order to reduce antibiotic resistance.

Disclosures
All Authors: No reported disclosures
1364. Effect of Cefepime Prophylaxis on Bacterial Bloodstream Infections in Neutropenic Patients with Acute Myelogenous Leukemia
Authors: Dassner Aimee , Almatrafi Mohammed , Slone Tamra , Aquino Victor M , Sebert Michael 
Published: January 2021

Abstract

Background
Bacteremia is a major cause of morbidity and mortality among children with acute myelogenous leukemia (AML) and chemotherapy-induced neutropenia. Data evaluating the utility of bacterial prophylaxis in this pediatric population are limited. In April 2014, Children’s Health (CH) implemented the use of cefepime bacterial prophylaxis for AML patients undergoing induction and intensification chemotherapy. The objective of this study was to evaluate the impact of this practice on the frequency of documented bacterial bloodstream infections (BSIs).

Methods
This was an observational, retrospective cohort study of patients &lt; 21 years of age with AML admitted at CH from January 2010 through December 2018. The primary outcome was frequency of documented BSIs before (PRE; Jan 2010 to Mar 2014) and after (POST; Apr 2014 to Dec 2018) implementation of routine bacterial prophylaxis. Secondary outcomes included differences in total antibiotic days per neutropenia days and the occurrence of neutropenia-associated C. difficile infection between groups.

Results
Of 90 patients with AML who met the cohort inclusion criteria, 38 and 52 were treated during the PRE and POST prophylaxis periods, respectively. The incidence rate of documented BSIs per 1000 neutropenia days decreased from 15.5 to 2.8 after the implementation of routine cefepime prophylaxis (incidence rate ratio 0.18, Poisson regression 95% CI 0.09 to 0.33, P&lt; 0.001). Patients were more likely to have febrile neutropenia in the PRE group (OR 11.9, 95% CI 6.6 to 20.8). The POST group had more antibiotic days per total neutropenia days (0.76 PRE vs 0.97 POST, P&lt; 0.0001), but the frequency of first-episode C. difficile infection was not significantly different between groups (OR 0.36, 95% CI 0.1 to 1.4).

Conclusion
Universal cefepime prophylaxis for children with AML and chemotherapy-induced neutropenia was associated with a significant reduction in the incidence of febrile neutropenia and neutropenia-associated BSIs without increasing the incidence of C. difficile infection.

Disclosures
All Authors: No reported disclosures
1373. Vaccine Effectiveness and Pneumococcal Serotypes in Pediatric Otitis Media in the Era of Routine 13-valent Pneumococcal Vaccination in the United States
Authors: Hulten Kristina G , Barson William , Lin P Ling , Bradley John S , Peters Timothy R , Tan Tina Q , Romero Jose R , Pannaraj Pia S , Kaplan Sheldon L 
Published: January 2021

Abstract

Background
Pneumococcal acute otitis media (AOM) in children due to vaccine related serotypes (St) declined after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13).

Methods
Patients &lt; 18 years with pneumococcal OM isolates from 2014-2019 from the U S Pediatric Multicenter Pneumococcal Surveillance Group were analyzed for demographics, immunization status, antimicrobial susceptibility and St distribution. p&lt; 0.05 was considered statistically significant. Vaccine effectiveness (VE) was calculated using a standard formula: 1-([PCV13St vaccinated (≥3 PCV13 doses) x Non-PCV13St unvaccinated (0-1 PCV13 doses)]/[PCV13St unvaccinated x Non-PCV13St vaccinated])

Results
646 patients were identified. Patients with PCV13 St were older compared to patients with non-PCV13 serotypes (3.3 vs 1.5 median years, p&lt; 0.0001). Most isolates were from spontaneous drainage (71.4 %) and PE tube placements (26.9%). 36 different Sts were identified; 83.4% of isolates were non-PCV13 Sts; 35B represented 18.3% of all isolates. St 19A decreased over time (p=0.0003). 14% of isolates had penicillin MIC ≥2 µg/ml and 2.4% had ceftriaxone MIC &gt;1 µg/ml. (Figure) 633 patients had known vaccine status. VE was 86.4% (Table).
Table.

Conclusion
Non-PCV13 Sts caused most pneumococcal OM. St35B was the most common St. St 19A decreased as a cause of otitis. In this study the VE of≥3 PCV13 doses was 86% for pneumococcal OM.

Disclosures
Tina Q. Tan, MD, Pfizer (Grant/Research Support, Other Financial or Material Support, Chair, DMSB for PCV20 vaccine) Pia S. Pannaraj, MD, MPH, AstraZeneca (Grant/Research Support)Pfizer (Grant/Research Support)Sanofi Pasteur (Advisor or Review Panel member) Sheldon L. Kaplan, MD, Allergan (Research Grant or Support)Pfizer (Grant/Research Support)
1377. Perinatal Transmission Dynamics of Antimicrobial Resistance
Authors: Styczynski Ashley , Amin Md Badrul , Parveen Shahana , Pervez Md Abu , Zeba Dilruba , Akhter Akhi , Gurley Emily S , Luby Stephen 
Published: January 2021

Abstract

Background
Antimicrobial resistance (AMR) is a global health threat that disproportionately affects low- and middle-income countries. An ongoing study of childhood mortality in Bangladesh revealed a common cause of death among neonates is sepsis from Gram-negative multi-drug-resistant organisms.

Methods
To ascertain factors leading to neonatal exposure, we enrolled 100 women presenting for delivery to Faridpur Hospital during February-March 2020. We collected vaginal and rectal swabs from mothers on presentation and at least 24 hours after delivery as well as rectal swabs from newborns. Swabs were plated on chromogenic agars selective for extended-spectrum-beta-lactamase-(ESBL) producing organisms and carbapenem-resistant Enterobacteriaceae (CRE).

Results
Eight-five percent of women underwent C-section. Prior to delivery, ESBL organisms were isolated from 15% of vaginal and 63% of rectal swabs. CRE was detected in 2% of vaginal and 8% of rectal swabs. Following delivery, colonization exceeded 90% (ESBL) and 70% (CRE) in both swab sets. Similarly, among newborns, 85% were colonized with ESBL and 67% with CRE. Maternal AMR colonization on admission did not correlate with income, education, parity, prenatal care, or prior antibiotic use, but was associated with hospitalization during pregnancy (rectal CRE OR 11.9, p&lt; 0.01). Maternal colonization at discharge was positively associated with membrane stripping (vaginal ESBL OR 9.0, p&lt; 0.01; rectal CRE OR 5.0, p=0.03), C-section (OR 4.0-15.4, p&lt; 0.05), and administration of third-generation cephalosporins (OR 5.0-10.1, p&lt; 0.05). Newborn colonization correlated with maternal colonization on discharge (p&lt; 0.005) but not on admission. Among newborns delivered by C-section, there was an 8-9-fold increased risk of ESBL and CRE colonization (p&lt; 0.01).

Conclusion
These results demonstrate that AMR is driven by nosocomial factors in the perinatal setting, and invasive procedures and perinatal antibiotic use increase risk of AMR colonization. These findings emphasize the urgent need for enhanced antibiotic stewardship and infection prevention and control practices to preserve the benefits of hospital-based deliveries.

Disclosures
All Authors: No reported disclosures
1384. Conceptual Economic Model Methodology for Infant Pneumococcal Conjugate Vaccine Program and its Impact on Antimicrobial Resistance
Authors: Farkouh Raymond , Nevo Arianna , Uyei Jennifer , Althouse Benjamin , Hall-Murray Cassandra , Lewnard Joseph , Wasserman Matthew 
Published: January 2021

Abstract

Background
Antimicrobial resistance (AMR) is a global threat to effective prevention and treatment of an ever-increasing range of infections. Pneumococcal conjugate vaccines (PCV) used in infant national immunization programs have been shown to decrease AMR pneumococci. Cost-effectiveness models evaluating the value for money of PCV programs have not considered the economic impact of reducing antimicrobial prescribing or prolonged infections due to treatment failures. Standardized frameworks are needed for models to address outcomes and impact on health resource utilization related to AMR.

Methods
We developed a conceptual modeling methodology suitable for a health economic evaluation of an infant PCV program. We considered impact of PCVs on pneumococcal disease (PD) specifically related to clinical management of AMR-PD, including AMR epidemiology, antibiotic prescribing patterns, and healthcare resource utilization. Model inputs were evaluated regarding optimal and available data sources considering the complex nature of AMR at the national, regional, and global level.

Results
The proposed framework considers impact of PCVs on antimicrobial prescribing due to invasive pneumococcal disease (IPD), community acquired pneumonia (CAP), and acute otitis media (AOM) across 3 pathways (Figure 1). The population and pathogen-level pathway describe epidemiology and vaccine impact. The care level pathway describes clinical disease management. The health outcomes pathway characterizes resistant or successfully treated PD costs and quality of life.
Conceptual Economic Model Methodology

Conclusion
We present a generalizable methodology to quantify impact of PCVs on cases and outcomes of PD related to AMR. Modelling vaccine-preventable burden of AMR-PD requires data extrapolations and assumptions due to the myriad of interconnected pathways (i.e. microbiology, epidemiology, environment, health systems). Further work is needed to validate assumptions and linkages across incomplete data sources.

Disclosures
Raymond Farkouh, PhD, Pfizer (Employee) Arianna Nevo, MPH, Pfizer, Inc. (Other Financial or Material Support, I am an employee of IQVIA. IQVIA received funding from Pfizer to carry out the project.) Jennifer Uyei, PhD, MPH, Pfizer, Inc. (Other Financial or Material Support, I am an employee of IQVIA. IQVIA received funding from Pfizer to carry out the project.) Cassandra Hall-Murray, PharmD, Pfizer, Inc. (Employee) Joseph Lewnard, PhD, Pfizer, Inc. (Consultant, Grant/Research Support, Advisor or Review Panel member) Matthew Wasserman, MSc., Pfizer Inc. (Employee)
1397. Long term impact of the 13-valent pneumococcal conjugate vaccine use in infant immunization program on all-cause pneumonia hospitalizations in British Columbia, Canada: a time series analysis
Authors: Vadlamudi Nirma Khatri , Patrick David M , Hoang Linda , Rose Caren , Sadatsafavi Mohsen , Marra Fawziah 
Published: January 2021

Abstract

Background
Pneumonia is a leading cause of hospitalization and in-patient mortality globally. We determined the impact of 13-valent pneumococcal conjugate vaccine (PCV13) use on all-cause pneumonia hospitalization rates eight years after the vaccine was introduced in British Columbia, Canada.

Methods
Routine administrative databases, such as, hospital discharge abstract databases, registry and demographics were used to build the cohort. Overall and age-specific all-cause pneumonia hospital admissions per month (Jan 2000 to Dec 2018) for those aged &lt; 2 years, 2-5 years, 6-17 years, 18-64 years and ≥ 65 years were obtained using International Classification of Diseases 9 and 10 codes (480-486, J12-J18). Changes in the all-cause pneumonia hospitalization incidence rates before and after the PCV13 vaccine program introduction were evaluated using a negative binomial regression and time-series modelling while adjusting for seasonality, influenza-likeness illnesses, 7-valent pneumococcal conjugate vaccine (PCV7) program and pre-PCV13 vaccine secular trends.

Results
Long term use of the PCV13 vaccine in the infant immunization program was associated with significant declines in all-cause pneumonia hospitalization rates among all children, &lt; 2 years (IRR: 0.63; 95% Confidence Interval (CI): 0.59-0.67), 2-5 years (IRR: 0.82; 95%CI: 0.77-0.87) and 6-17 years (IRR: 0.73; 95%CI: 0.69-0.78). All-cause pneumonia rates did not change significantly in those aged 18-64 years (IRR: 0.98; 95%CI: 0.96-1), whereas a modest increase was observed in those 65 years and over (IRR: 1.05; 95%CI: 1.02-1.07). Consequently, we did not observe significant change in the overall rate (IRR: 1.02; 95%CI: 1-1.02).

Conclusion
Significant reduction in all-cause pneumonia hospitalization rates in children demonstrates long term beneficial effect of PCV13 use. A modest increase in all-cause pneumonia hospitalization rates in adults aged 65 years and over indicates a need for further microbial investigation.

Disclosures
Nirma Khatri Vadlamudi, BA, BS, MPH, Pfizer Inc (Research Grant or Support) Fawziah Marra, BSc (Pharm), PharmD, Pfizer Inc (Research Grant or Support)
1402. Smart Technology and Education for Smart Protection against the Flu: Impact of a Multifaceted Quality Improvement (QI) Intervention on Influenza Vaccination Rates in Children
Authors: Kaushik Ashlesha , Beal Kristen , Gupta Sandeep , Malley Richard 
Published: January 2021

Abstract

Background
Low pediatric influenza vaccination rates are a public health challenge. It is imperative that innovative measures to promote influenza immunization are studied.

Methods
Aim: To study impact of a multifaceted QI intervention on influenza vaccination rates in children evaluated at outpatient clinics, urgent care (UC) and emergency departments (ED) at UnityPoint Health tertiary care centers (UPH) across Northwestern (NW) and Northcentral (NC) Iowa (IA). Patients aged 6 months-18 years evaluated at UPH in NW and NC IA (encompassing 5 outpatient clinics, 2 UC, 2 ED) were included. A multifaceted QI intervention was implemented on 9/1/2018 consisting of all of the following concomitantly: 1. Patient/family education: Posters about flu vaccination displayed at entrance, in waiting rooms and patient rooms throughout the clinics, UC, ED as well as patient/family handouts emphasizing importance of influenza immunization. 2. Information Technology: “Health maintenance” reminder in outpatient electronic medical record (EMR- EPIC) that appears as soon as a patient’s chart is accessed to remind nurses/providers that influenza vaccine is due. 3. Provider Education flyers at study sites about debunking flu myths. We compared pre-intervention period (P1, 09/01/2017– 05/31/2018) with intervention period (P2, 09/01/2018 – 05/31/2019) for influenza vaccination rates.

Results
A total of 10050 and 9889 patients were evaluated during P1 and P2 respectively. Influenza vaccination rate increased significantly from 56.1% (5642) in P1 to 73.3% (7252) in P2 (p&lt; 0.0001). Patients were 1.43 times more likely to get vaccinated during P2 than P1 (95% CI= 1.32-1.46). Regionally during P2, influenza vaccination rate was higher than the national (62.6%; p&lt; 0.0001) and Iowa state averages (65.8%; p&lt; 0.0001) respectively. Proportion of children aged &lt; 9 years receiving second dose of influenza vaccine increased from 43% to 69% (p&lt; 0.001). Influenza vaccination rates among children aged 6-36 months increased significantly [40% (1078/2671) in P1 to 47.2% (1287/2723) in P2; p&lt; 0.01].

Conclusion
With the combined educational and technologic intervention, pediatric influenza vaccination rates increased significantly across NW and NC IA, including proportion of patients receiving second dose of the vaccine.

Disclosures
Richard Malley, MD, Merck (Consultant)