bluuebunny/crossref_metadata_2025_split huggingface dataset:
1484. Microbial Etiology of Community-acquired Pneumonia in Immunocompromised Patients
Authors: Deshpande Abhishek , Yu Pei-Chun , Rothberg Michael 
Published: January 2021

Abstract

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

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

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

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

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

Abstract

Background
In low and middle-income countries (LMICs) pneumonia is by far the leading cause of death among children &lt; 5 years of age. A key factor is the challenge of pneumonia diagnosis. Chest X-Ray is the gold standard for pneumonia diagnoses but exposes children to ionizing radiation and is mainly restricted to hospital settings.
advances in artificial intelligence (AI) render possible the automated interpretation of mobile bedside US (mBSUS) images on a smartphone, obviating the need for a radiologist.
Ultraspund findings in pneumonia

Artificial intelligence feature recognition

Methods
We measured the accuracy of mBSUS for the diagnosis of pneumonia using chest X-Ray as the gold standard. Children 1-59 mo presenting at the University Teaching Hospital in Lusaka, Zambia with ages ranging from aged 1-59 months and meeting WHO criteria for severe/very severe pneumonia were enrolled. Clinical data is collected in RedCap. Digital X-Rays were done at the University Teaching Hospital and saved as JPEG images. Pulmonary mBSUS images are taken using a butterfly, a mobile device system, and stored in the butterfly iCloud of the Butterfly app and transmitted to an iOS phone or tablet. Images are stored locally and saved to a secured/encrypted cloud platform for remote viewing with a HIPAA (Health Insurance Portability and Accountability Act) compliant secure cloud.
Images are currently extracted from the clips stored in the butterfly icloud, radiologists annotate the images that have abnormal findings and they are then sent to the AI lab where they are analyzed and organized to build a platform of similar images that could be recognized by the machine learning system.
Imaging correlation CXR Vs mobile bedside ultrasound mBSUS

Butterfly ultrasound system

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

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

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

Abstract

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

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

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

Number of Organism Types Isolated from BAL Compared to BAL Methodology

BAL Methodology vs Isolation of Specific Organism Types

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

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

Abstract

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

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

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

Figure 2

Figure 3

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

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

Abstract

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

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

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

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

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

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

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

Abstract

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

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

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

Patient Characteristics in Invasive Pulmonary Aspergillosis

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

Disclosures
Nisha B. Alden, MPH, CDC (Grant/Research Support) Evan J. Anderson, MD, Sanofi Pasteur (Scientific Research Study Investigator) Sue Kim, MPH, Council of State and Territorial Epidemiologists (CSTE) (Grant/Research Support)