bluuebunny/crossref_metadata_2025_split huggingface dataset:
1705. Treatment of Disseminated Adenovirus with Cidofovir in a Patient with HIV and ESRD
Authors: Dieringer Thomas D , Pham Christine , Goodman-Meza David 
Published: January 2021

Abstract

Background
Adenovirus is a common cause of upper respiratory infections and gastroenteritis. Severe adenovirus infections and disseminated disease are known to occur in immunocompromised hosts. Cidofovir has been associated with clinical improvement in patients with severe or disseminated disease in which immunosuppression cannot be readily reversed or those unresponsive to supportive care. However, a narrow therapeutic index has limited its clinical use particularly in patients with end-stage renal disease (ESRD).

Methods
We present a case of disseminated adenovirus in a well-controlled person living with HIV (PLWHIV) treated successfully with dose-reduced cidofovir in the setting of ESRD on hemodialysis (HD) at the University of California Los Angeles. A literature review was conducted to investigate the treatment of severe adenovirus disease and use of cidofovir in patients with ESRD.

Results
Our patient is a 59 year-old woman who presented with fever, non-productive cough, and diarrhea. She is living with HIV/AIDS with virologic control and CD4 count of 470 treated with dose adjusted lamivudine, tenofovir alafenamide, and dolutegravir in the setting of ESRD on HD, chronic hepatitis B, and group I pulmonary hypertension. Her course was complicated by development of multifocal pneumonia with hypoxemic respiratory failure requiring high-flow nasal cannula. Adenovirus PCR was detected in stool, respiratory, and serum samples. Given high risk intubation, dose-reduced cidofovir 0.5 mg/kg weekly was given twice over three weeks with symptomatic improvement, elimination of serum adenovirus DNA, and without development of adverse medication-related effects.
Sixteen primary and review articles were identified discussing adenovirus pathology and treatment. A single pharmacokinetic study outlined a dosing regimen for cidofovir of 0.5 mg/kg weekly which provided comparable serum drug levels in asymptomatic patients with ESRD on HD compared to controls with adequate renal function.

Conclusion
This case report illustrates although there is limited data to establish the efficacy and safety of cidofovir for treatment of disseminated adenovirus infections in ESRD patients, dose-reduced cidofovir 0.5 mg/kg weekly while on HD appears to have been effective and well tolerated.

Disclosures
All Authors: No reported disclosures
1709. Influenza Surveillance in the U.S. Department of Veterans Affairs (VA): 2019-2020 Season
Authors: Lucero-Obusan Cynthia , Schirmer Patricia , Oda Gina , Holodniy Mark 
Published: January 2021

Abstract

Background
VA conducts annual surveillance for seasonal influenza. VA’s large elderly population is at higher risk for influenza complications, including hospitalization and death. Herein we summarize VA’s 2019-20 national surveillance data for influenza activity and vaccinations.

Methods
Influenza telephone triage, influenza-like-illness (ILI) encounters and antiviral prescriptions plus outpatient visits, laboratory testing (antibody tests excluded), hospitalizations and deaths for influenza were obtained from VA data sources (9/29/19-5/16/20) and compared to prior seasons and national CDC FluView data. Influenza vaccinations were captured starting 8/1/2019. Vaccination rates were calculated based on VA users during the fiscal year.

Results
Surveillance metrics are presented (Table). ILI visits ranged from 0.9%-3.1% during the season. Influenza activity peaked during 2020 Weeks 6-7 and dropped rapidly beginning in Week 12, matching trends reported by CDC for influenza activity (Figure 1). Testing revealed 23,357 influenza positives out of 162,102 tests performed (14.4%). 17% of laboratory-confirmed influenza cases were hospitalized (compared to 23% during the prior season) with a median length of 3 days. Total influenza positives, telephone triage encounters, outpatient visits and antiviral use were higher than the prior season, whereas coded hospitalizations and deaths were fewer (Table, Figure 2).
Table. VA Influenza Surveillance Measures, 2014-2015 through 2019-2020 Seasons.

Figure 1. Comparison of select VA and CDC Influenza Indicators. Influenza positive laboratory tests and % positive (top) and influenza hospitalizations (bottom), by Season.

Figure 2. Comparison of Key VA Influenza Indicators, by Season.

Conclusion
The 2019-20 influenza season was of moderate severity when compared to prior seasons and continues to track well with national CDC data. Overall, vaccination levels have increased modestly and high-dose/adjuvanted vaccine administration increased from 6 to 26% of total vaccine given over the seasons evaluated. Influenza activity dropped precipitously after Week 12 even though testing for influenza remained high in the setting of COVID-19. This may have been influenced by widespread social distancing and masking measures adopted in response to COVID-19.

Disclosures
All Authors: No reported disclosures
144. Little evidence of same-day, oral antibiotic prescribing at ambulatory surgery centers
Authors: King Laura M , Hicks Lauri , Tsay Sarah Kabbani; Sharon , Fleming-Dutra Katherine E 
Published: January 2021

Abstract

Background
The objective of our study was to describe oral antibiotic prescriptions associated with procedures in ambulatory surgery centers (ASC) to evaluate if there are major national opportunities to improve antibiotic use in this setting.

Methods
We identified surgical procedures in ASCs and oral antibiotic prescriptions in the IBM® MarketScan® Commercial 2018 database, a large convenience sample of privately-insured individuals aged &lt; 65 years. We excluded visits with same-day hospitalizations and those with infectious diagnoses that may warrant antibiotic treatment. We included only antibiotic prescriptions dispensed on the same day as an ASC visit. We calculated the number of visits and oral antibiotic prescriptions and the percent of visits with oral antibiotic prescriptions overall, and by patient age group (&lt; 18 and 18–64 years), antibiotic class, and procedure type. We also calculated median antibiotic course length. Across-group comparisons were evaluated using chi-square tests.

Results
In 2018, 918,127 ASC visits with surgical procedure codes were captured, of which 37,032 (4.0%) were associated with same-day oral antibiotic prescriptions. The percent of visits with antibiotic prescriptions was significantly higher among children compared to adults (9.4% vs 3.8%; p&lt; 0.01); however, adults accounted for 89% of prescriptions. Respiratory/nasal and urinary tract system procedures were most frequently associated with antibiotic prescriptions (Figure). Median course length was 5 (interquartile range 3–7) days. The most common antibiotic class was cephalosporins (49.6% of prescriptions), followed by penicillins (12.6%) and fluoroquinolones (10.9%).
Figure. Percent of ambulatory surgery center visits with same-day antibiotic prescriptions by procedure category, IBM® MarketScan® Commercial Database, 2018

Conclusion
Only 4% of ASC procedures were associated with same-day oral antibiotic prescriptions, suggesting antibiotics are not commonly prescribed in ASCs on the day of surgical procedures. Additionally, the observed 5-day median duration may suggest that some of these courses are intended for treatment rather than prophylaxis. Our estimates represent lower bounds for oral antibiotic prescriptions in this setting, as we only captured same-day prescriptions. However, our findings suggest that ASC facilities may not be high-impact targets for national, public health antibiotic stewardship efforts.

Disclosures
All Authors: No reported disclosures
1713. Factors Associated with Viral Rebound post Blip in Patients from a Community HIV Clinic
Authors: Sanchez Eduardo , Borgman Jody , Joffe Aviva , Holdsworth Catherine 
Published: January 2021

Abstract

Background
Blips are detectable increases in the HIV viral load (VL) that occur after therapy has effectively suppressed the virus to an undetectable level. There is no clear etiology for the development of blips. The association between blips and viral failure remains unclear.

Methods
This retrospective chart review aimed to clinically characterize patients who developed blips in a community HIV clinic in north Philadelphia between 2014-2018. A blip was defined as a single detectable VL &lt; 500 copies/mL which appears between two undetectable VL measurements. Multivariate analysis was performed to examine the relationship of certain variables and viral rebound (VR) in patients with blips. Viral rebound was defined as post blip VL &gt; 200 copies/mL that was not followed by an undetectable viral load.

Results
Of a total of 666 patients, 225 (33.7%) had at least 1 blip. 59% were male and 41% were female. The majority were African American (84.4%). Sixty seven percent were heterosexuals and 25.7% were MSM. Analyzing CD4 counts at the moment of blip, 68% had &gt;500 cells/mm3. The average value of the blips was 85 copies/mL with 48.8% of the patients having a blip between 20-50 copies/mL. Most of the patients were on INSTIs (49.5%) followed by NNRTIs (35.6%). Of the 225 patients, 148 had at least 1 year of follow up post-blip. Those who were followed for less than 1-year post-blip were not included in the statistical analysis to find potential factors associated with VR. Thirty-two (21.6%) patients developed rebound. The multivariate analysis showed that being male and having a higher blip value were factors associated to increased likelihood of VR. Factors associated to decreased likelihood of rebound were the use of NNRTIs at blip and an HIV transmission factor that was not heterosexual sex (MSM and IDU). All of these associations were noted to be statistically significant.

Conclusion
The variables that were found to be associated to viral rebound could help guide clinicians during the surveillance of patient’s with blips. Further research in larger cohorts would help clarify the role of these variables in patients who develop treatment failure.

Disclosures
All Authors: No reported disclosures
1717. Relationship between Neighborhood Census-tract Level Poverty and Respiratory Syncytial Virus (RSV)-associated Hospitalizations in U.S. adults, 2015-2017
Authors: Holmen Jenna , Reingold Art , Bye Erica , Kim Lindsey , Anderson Evan J , Bennett Nancy M , Chai Shua , Kirley Pam Daily , Muse Alison , Talbot Helen , Monroe Maya , Rothrock Gretchen , Whitaker Michael , Bryanna Cikesh 
Published: January 2021

Abstract

Background
In the U.S., RSV is increasingly recognized as a cause of hospitalization for adults with respiratory illness. In adults &gt; 50 years of age, it accounts for up to 12% of medically-attended acute respiratory illnesses and has a case fatality proportion of ~ 6–8%. Poverty can have important influences on health on both the individual level as well as the community level. Few studies have evaluated the relationship of RSV and poverty level, and no identified studies have evaluated this relationship among adults. We evaluated the incidence of RSV-associated hospitalizations in adults across multiple sites in the U.S. by census-tract (CT) level poverty.

Methods
Medical record data abstraction was conducted for all adults with a laboratory-confirmed RSV infection admitted to a hospital within the Centers for Disease Control and Prevention’s Emerging Infections Program catchment areas within California, Georgia, Maryland, Minnesota, New York, and Tennessee during the 2015–2017 RSV seasons (October-April). Patient addresses were geocoded to their corresponding CT. CTs were divided into four levels of poverty, as selected in prior publications, based on American Community Survey data of percentage of people living below the poverty level: 0–4.9%, 5–9.9%, 10-19.9%, and ³20%. Incidence rates were calculated by dividing the number of RSV cases in each CT poverty-level (numerator) by the number of adults living in each CT poverty level (denominator), as determined from the 2010 US census, and standardized for age.

Results
There were 1713 RSV case-patients with demographic characteristics (Table 1). The incidence of RSV-associated hospitalizations of adults increased with increasing CT level poverty (Figure 1 and Table 2). The risk of RSV-associated hospitalization was 2.58 times higher in census tracts with the highest (20%) versus the lowest (&lt; 5%) percentages of individuals living below the poverty level.
Table 1: Demographic characteristics of adults with an RSV-associated hospitalization, 2015-2017.

Figure 1. Age-adjusted incidence rate of RSV-associated hospitalizations of adults by census-tract poverty level, 2015-2017

Table 2. Incidence rate ratios for RSV-associated hospitalizations of adults by census-tract poverty level, 2015-2017.

Conclusion
The incidence rate of RSV-associated hospitalization in adults appears to have a positive association with increasing CT level of poverty; however, this trend reached significance only among cases living in CTs with higher percentages of poverty (≥ 10%).

Disclosures
Evan J. Anderson, MD, Sanofi Pasteur (Scientific Research Study Investigator)
147. Pharmacist Attitudes Towards Using Clinical Decision Support in Community Pharmacies to Promote Antibiotic Stewardship in the Treatment of Uncomplicated UTI
Authors: Sayood Sena , Suda Katie , Durkin Michael 
Published: January 2021

Abstract

Background
Prior studies of prescribing practices have shown that providers frequently choose non-guideline concordant treatment regimens to treat uncomplicated urinary tract infection (UTI). It has also been shown that uncomplicated UTI can be treated safely, and in a guideline concordant manner, by non-physician providers using an algorithm over the phone. The purpose of this study was to assess pharmacist attitudes towards using a clinical decision support (CDS) tool that would be used to evaluate and manage patients presenting with complaints of UTI in the community pharmacy setting.

Methods
We conducted semi-structured interviews of community pharmacists (n = 21) from 2019 to 2020 until thematic saturation was reached. Pharmacists were questioned about their attitudes towards stewardship, workflow, interactions with patients and providers, and interest in using a computerized CDS tool. Interviews were recorded, transcribed, and de-identified. Coding and analysis of the interviews was performed using NVivo version 12.

Results
Pharmacists were interviewed with practice experience ranging from 2 to 54 years (median 13, IQR 6, 27). All pharmacists expressed interest in using CDS to assist with patient evaluations and stewardship. They reported that patients routinely use the community pharmacy as a first stop for medical advice and that they have several interactions per day with patients in which they counsel them on a variety of issues, including UTI. Their assessment and management decisions of UTIs were based on personal knowledge and not on any standard of care. Communication difficulties with primary care offices often delayed management of these patients and lack of information sharing made it difficult for pharmacists to engage in stewardship practices.

Conclusion
Community pharmacies are an important point of contact for patients and represent a significant opportunity to implement outpatient stewardship interventions. Pharmacists had an overwhelmingly favorable response to the prospect of using a CDS tool, both to help in patient evaluation and to promote antimicrobial stewardship. Based on these results we can conclude that it would be feasible to pilot a CDS tool in community pharmacies to further evaluate its safety and efficacy in the treatment of UTI.

Disclosures
All Authors: No reported disclosures
149. Unmet Informational Needs among Nursing Home Residents Receiving Antibiotics: A Qualitative Study
Authors: Carter Eileen , DeForge Christine E , Pogorzelska-Maziarz Monika , Mackson Grace , Stone Patricia W , Shang Jingjing 
Published: January 2021

Abstract

Background
Antibiotics are commonly used in the nursing home (NH) setting and increase residents’ risk for opportunistic and painful infections. Existing evidence of NH residents’ experiences and attitudes towards antibiotic use is limited. We aimed to explore NH residents’ experiences and perceptions of the benefits and risks to antibiotic treatment.

Methods
Two researchers conducted one-on-one semi-structured interviews with residents residing in a large not-for-profit NH in New York City. Interviews were audio-recorded and transcribed verbatim. Researchers coded the transcripts using thematic analysis in NVivo 12.

Results
A total of 26 residents engaged in individual interviews. Participants had a mean age of 76. Most were white (81%), female (58%) and had attended college (58%). Four thematic findings emerged: 1) participants’ involvement in antibiotic treatment decisions; 2) perceived benefits and risks to antibiotics; 3) unmet informational needs; and 4) suggestions to overcome informational needs. Participants described varied involvement in antibiotic treatment decisions, in which some participants described insisting antibiotics from their clinicians and others described leaving antibiotic treatment decisions entirely to the judgement of clinicians. Benefits of antibiotics were well-articulated, yet risks (side effects including antibiotic resistance) to antibiotics were poorly described. Participants reported unmet information needs, including concerns regarding potential drug interactions. Information needs were described to result from a lack of communication with NH staff and/or poor memory among NH residents. Participants suggested that NH residents receive written material regarding their antibiotic prescriptions and provided the types of information that would be helpful for NH residents to know. Descriptions of themes and representative quotes are provided in Figure.
Table. Thematic Findings and Representative Quotes

Conclusion
NH residents expressed a lack of understanding of risks to antibiotic use, unmet informational needs regarding their antibiotic treatments and articulated suggestions to address these information needs.

Disclosures
All Authors: No reported disclosures
151. An Electronic Algorithm to Better Target Antimicrobial Stewardship Program (ASP) Efforts for Children Hospitalized with Community-Acquired Pneumonia (CAP)
Authors: Gerber Jeffrey , Grundmeier Robert , Hamilton Keith W , Hicks Lauri , Neuhauser Melinda M , Frager Nicole , Menon Muida , Kratz Ellen , Jaskowiak Anne , Cressman Leigh , James Tony , Omorogbe Jacqueline , Lautenbach Ebbing 
Published: January 2021

Abstract

Background
Pediatric antibiotic stewardship programs (ASPs) have been successful in decreasing inappropriate antibiotic use. However, they require considerable time and effort. Approaches to increase ASP efficiency are urgently needed. We developed and validated an electronic algorithm to identify inappropriate antibiotic use in children hospitalized with community-acquired pneumonia (CAP).

Methods
At Children’s Hospital of Philadelphia (CHOP), we used ICD-10 diagnostic codes to identify inpatient patient encounters for pneumonia between 3/15/17 – 3/14/18 for which patients received a systemic antibiotic in the first 48 hours of hospitalization. Exclusion criteria included transfer from another facility, intensive care unit admission or death in first 48 hours, immunocompromising condition, or specific comorbidities. We randomly selected 150 subjects. Inappropriate antibiotic use based on chart review served as the basis for assessment of the electronic algorithm which was constructed using only data in the electronic health record (EHR). Criteria for appropriate prescribing, choice of antibiotic, and duration of therapy were based on established CHOP and IDSA/PIDS guidelines.

Results
Of 148 eligible subjects, median age was 3.8, 48% were female, and 129 (86%) were admitted to a general pediatrics service. On chart review, 147 (99%) subjects were correctly diagnosed with CAP. Of these subjects, the choice of initial antibiotic(s) was appropriate in 133 (90%). Of the 147 subjects, 137 (93%) had an appropriate duration of therapy. Test characteristics of the EHR algorithm (compared to chart review) are noted in the Table.

Conclusion
In pediatric patients hospitalized with CAP, the electronic algorithm for identifying inappropriate prescribing, antibiotic choice, and duration was highly accurate. This algorithm could have considerable utility in targeting ASP initiatives. The impact of interventions based on this algorithm should be tested in the future
Test Characteristics of Electronic Algorithm for Inappropriate Prescribing, Agent, and Duration

Disclosures
All Authors: No reported disclosures
152. Applying A Difference-in-Difference Analysis to Assess Effect of Antimicrobial Stewardship Strategies on Changes in Antimicrobial Use
Authors: Chou Ann F , Zhang Yue , Jones Makoto M , Graber Christopher J , Goetz Matthew B , Madaras-Kelly Karl , Samore Matthew H , Glassman Peter A 
Published: January 2021

Abstract

Background
About 30–50% of inpatient antimicrobial therapy is sub-optimal. Health care facilities have utilized various antimicrobial stewardship (AS) strategies to optimize appropriate antimicrobial use, improve health outcomes, and promote patient safety. However, little evidence exists to assess relationships between AS strategies and antimicrobial use. This study examined the impact of changes in AS strategies on antimicrobial use over time.

Methods
This study used data from the Veterans Affairs (VA) Healthcare Analysis & Informatics Group (HAIG) AS survey, administered at 130 VA facilities in 2012 and 2015, and antimicrobial utilization from VA Corporate Data Warehouse. Four AS strategies were examined: having an AS team, feedback mechanism on antimicrobial use, infectious diseases (ID) attending physicians, and clinical pharmacist on wards. Change in AS strategies were computed by taking the difference in the presence of a given strategy in a facility between 2012–2015. The outcome was the difference between antimicrobial use per 1000 patient days in 2012–2013 and 2015–2016. Employing multiple regression analysis, changes in antimicrobial use was estimated as a function of changes in AS strategies, controlling for ID human resources in and organizational complexity.

Results
Of the 4 strategies, only change in availability of AS teams had an impact on antimicrobial use. Compared to facilities with no AS teams at both time points, antibiotic use decreased by 63.9 uses per 1000 patient days in facilities that did not have a AS team in 2012 but implemented one in 2015 (p=0.0183). Facilities that had an AS team at both time points decreased use by 62.2 per 1000 patient days (p=0.0324).

Conclusion
The findings showed that AS teams reduced inpatient antibiotic use over time. While changes in having feedback on antimicrobial use and clinical pharmacist on wards showed reduced antimicrobial use between 2012–2015, the differences were not statistically significant. These strategies may already be a part of a comprehensive AS program and employed by AS teams. In further development of stewardship programs within healthcare organizations, the association between AS teams and antibiotic use should inform program design and implementation.

Disclosures
All Authors: No reported disclosures