bluuebunny/crossref_metadata_2025_split huggingface dataset:
622. Risk Factors for 30-Day Unplanned Readmissions in Patients Discharged with Outpatient Parenteral Antimicrobial Therapy
Authors: Shah Megan , Kidd Catherine , Thomas Tania A , Eby Joshua 
Published: January 2021

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) programs have shown to reduce hospital readmissions; however, 20-25% of OPAT patients are readmitted. As 30-day readmissions is a healthcare quality measure, it is important to recognize predictors for readmissions in OPAT patients in an effort to minimize risk factors and optimize patient outcomes. The aim of this study was to identify modifiable and non-modifiable risk factors for 30-day unplanned readmission in patients discharged with OPAT.

Methods
This was a retrospective cohort study of patients admitted to University of Virginia (UVA) Health System between March 2019 and December 2019 who were discharged home with intravenous antimicrobials followed by the UVA OPAT program. Data collected included patient demographics, comorbidities, infection diagnosis, source control, and antimicrobial class. Variables were compared between patients with a 30-day unplanned readmission and those without a readmission. Mann-Whitney U, Pearson chi-squared, and Fisher’s exact tests were utilized, as appropriate. A multiple logistic regression analysis was performed to determine predictors of 30-day unplanned readmission.

Results
There were 334 OPAT patients who met inclusion criteria. Median age was 58 years, 58% were male, and the most common infection diagnoses were bone/joint (49%), bloodstream (22%), and endovascular (13%). There were 64 (19%) patients who had an unplanned 30-day readmission. The most common reasons for readmission included non-infection related (45%), worsening infection (28%), and antimicrobial-related complication (17%). Readmitted patients were more likely to have a higher Charlson Comorbidity Index (CCI); prior admissions; bloodstream, endovascular, or pulmonary infection; no source control; and an infection caused by a multi-drug resistant organism. CCI was found to be an independent predictor of readmission (OR 1.096, 95% CI 1.001-1.200).

Conclusion
Unplanned readmissions were common in patients discharged with OPAT. There should be an emphasis on interventions to prevent readmissions in OPAT patients, particularly those with high-risk clinical characteristics.

Disclosures
All Authors: No reported disclosures
623. Self-Administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) in Uninsured Patients
Authors: Hamad Yasir , Min Jaspur , Burnett Yvonne 
Published: January 2021

Abstract

Background
Uninsured patients requiring long-term intravenous (IV) antimicrobials do not have access to outpatient parenteral antimicrobial therapy (OPAT) and often remain hospitalized for the duration of their treatment, transition to inferior oral antimicrobials, or leave against medical advice. A hospital-supported self-administered OPAT (S-OPAT) program was piloted in uninsured patients to decrease hospital length of stay and improve access to care.

Methods
Uninsured adult patients requiring IV antimicrobials were enrolled in an S-OPAT pilot study from July 2019 to April 2020. Patients with drug use history or documented non-adherence were excluded. S-OPAT patients attended weekly clinic visits for blood draws, dressing changes, and medication supply. The measured outcomes were hospital days saved, and potential income generated by earlier discharges. The latter was calculated by multiplying the number of hospital days saved by the daily charge for a hospital bed to insured patients.

Results
Seventeen patients were enrolled in S-OPAT, 14 (82%) were males, 8 (47%) were black, and the mean age was 39 years. The most common indication for OPAT was bone and joint infections in 12 (71%), and most commonly used antibiotic was ceftriaxone in 12 (71%) patients (Table). Early discontinuation occurred in 3 (17%) patients due to clinic visit non-adherence resulted in 2 (12%) and adverse drug events in 1 (6%). Only one (6%) patient had unplanned hospital readmission during OPAT. Transition to S-OPAT resulted in 533 hospital days avoided, and a net saving of approximately $900,000.

Conclusion
S-OPAT model is safe and can enhance care for uninsured patients while optimizing health-system resources.
Table

Disclosures
All Authors: No reported disclosures
624. Significant Institutional Cost Savings from OPAT-Facilitated Discharge for Patients with Challenging Situations
Authors: Alexander Bryan , Bergman Scott , Van Schooneveld Trevor C , Cortes-Penfield Nicolas W 
Published: January 2021

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) programs are becoming a standard of care, however, program cost justification remains a challenge. One area of focus for institutions is facilitating timely discharge from the inpatient setting, and difficult to discharge patients are a group with which OPAT teams can be particularly impactful.

Methods
This retrospective review identified patients intervened upon by the Nebraska Medicine OPAT team during the initial nine months after program implementation (4/1/19 - 12/31/19) for which routine efforts at discharge by primary teams had failed. Patients were planned for extended inpatient stays to complete the full duration of parenteral antibiotic therapy due to discharge issues given the therapy plan initially recommended by infectious disease consult teams. Outcomes evaluated included inpatient days of therapy avoided, associated financial metrics, and 30-day readmission rates. A matched cohort of patients with similar lengths-of-stay, infectious disease indications, medication use, and lack of major complications was identified to calculate a cost per inpatient day avoided.

Results
A total of 17 difficult to discharge patients were intervened on by the OPAT team, leading to avoidance of 429 planned inpatient days. Based on calculation from internal matched cohort data, these OPAT interventions avoided an estimated $943,000 in total inpatient costs. All-cause 30-day readmission was 24% (4 of 17 patients). Additionally, 15 of these therapy courses were shifted to hospital-associated outpatient infusion centers. Facilitation of enrollment for 11 of these patients in pharmaceutical manufacturer patient assistance programs resulted in replacement of outpatient medication totaling over $28,000 in value. Reimbursements for two additional patients through either governmental or private insurance generated over $11,000 in margin for the health system.

Conclusion
Attention to complex discharge facilitation by OPAT programs can be a significant contribution to program cost justification, while also transitioning patients to therapy plans that lead to similar clinical outcomes when compared to the overall OPAT population.

Disclosures
All Authors: No reported disclosures
628. The Role of the Advanced Practice Provider in Infectious Disease: Opportunities for Growth
Authors: Yoke Leah H , Yoke Leah H , Beieler Alison M , Beieler Alison M , Liu Catherine , Pergam Steven A , Wald Anna , Wald Anna , Dhanireddy Shireesha , Dhanireddy Shireesha 
Published: January 2021

Abstract

Background
Advanced Practice Providers (APPs), including nurse practitioners and physician assistants, provide high quality medical care in multiple specialties by extending the physician workforce. However, within the Infectious Disease (ID) specialty, their demographics, areas of practice, and experience are not well described. To better understand this key group, we examined APP years of experience in ID, primary practice settings, and perceived practice barriers from the APP perspective.

Methods
We created a survey using REDCap which was distributed between 12/1/2019-1/31/2020 to APPs practicing in ID by social media, direct emails to key stakeholders, and online Infectious Disease Society of America (IDSA) community forums.

Results
Ninety-three APPs responded to the posted survey from across the US (figure 1). Most respondents (45 [49%]) had between 2-9 years of overall experience as an APP, while 14 (15%) between 10-15 years, and 24 (26%) had &gt;16 years of experience. Experience specifically as an ID APP varied, with the majority (56%) having 2-9 years of experience and 25% reporting &gt;16 years of experience as an APP. Although over half of the respondents worked in an outpatient adult ID clinic, they also practiced in diverse settings and within multiple ID sub-specialties (figure 2). The other most common areas of practice included inpatient adult ID, HIV care, and outpatient parental antimicrobial therapy programs. Limited formalized ID education and misconceptions about APP scope of practice were perceived barriers to practicing in ID (figure 3). Lack of recognition as a peer amongst physician colleagues was also identified as a practice barrier.
Advanced Practice Provider Survey Response by Region

Advanced Practice Provider ID Practice Areas

Perceived Advanced Practice Provider Barriers

Conclusion
Our survey results demonstrate that the APP ID workforce is an experienced provider group, both in terms of total years as an APP and years exclusively in ID, working in a large variety of ID settings in a number of geographic locations. Creation of specific and directed ID educational opportunities, along with collaborating physician support and inclusion, are identified as significant areas of improvement. The establishment of APP-specific training programs and educational courses will create more opportunities for APPs and further expand the ID workforce.

Disclosures
Steven A. Pergam, MD, MPH, Chimerix, Inc (Scientific Research Study Investigator)Global Life Technologies, Inc. (Research Grant or Support)Merck & Co. (Scientific Research Study Investigator)Sanofi-Aventis (Other Financial or Material Support, Participate in clinical trial sponsored by NIAID (U01-AI132004); vaccines for this trial are provided by Sanofi-Aventis)
629. Understanding the Effects of Social Determinants of Health on Outcome When Discharging Veterans on Parenteral Antibiotic Therapy
Authors: Guenther Erin , Sherman Katherine , Shah Haroon , Dysart Claire , Gundacker Nathan 
Published: January 2021

Abstract

Background
Social determinants of health are conditions in which people live, including aspects of both social environments and physical environments, and how these conditions affect their health. Examples of social determinants include access to health care, social support, culture, etc. These factors are often considered when discharging a patient on IV antibiotics. The purpose of this study was to determine if social determinants of health are related to outcomes for veterans discharged from the Zablocki VA on outpatient parenteral antibiotic therapy (OPAT).

Methods
This retrospective chart review evaluated veterans discharged home from the Zablocki VA on OPAT between the years of 2013 and 2017. Variables of social determinants of health included: race/ethnicity, co-habitants, mental health diagnosis, employment, use of illicit drugs, use of tobacco, and use of alcohol. The primary outcome analyzed was completion of therapy with or without complication. Complication is defined as antibiotic change/dose adjustment, PICC line complication, or additional clinic/hospital visit.

Results
Overall, 294 veterans’ charts were reviewed. Of these patients, 188 (63.95%) had no complication and 106 (36.05%) had a complication. Univariate analyses of social determinants are summarized in Table 1. Tobacco use was the only factor significantly associated with OPAT complication (p= 0.008).
Table 1.

Conclusion
This analysis suggests that many social determinants thought to potentially impact OPAT outcomes, such as race/ethnicity, co-inhabitants, mental health diagnosis, employment status, and use of illicit drugs or alcohol were not significant contributions to OPAT complications in the Milwaukee VA population; although, veterans who were current smokers were more likely to have an OPAT complication. These results may speak to the VA’s integral social support provided to veterans upon discharge, and perhaps, the above social determinants should not be as heavily considered when deciding if a veteran can perform OPAT. However, it is important to consider that these results may reflect the careful selection of Milwaukee veterans discharged on OPAT, as questionable cases can be treated as an inpatient.

Disclosures
All Authors: No reported disclosures
631. Preliminary safety and pharmacokinetic profile of VIR-2482: a monoclonal antibody for the prevention of influenza A illness
Authors: Sager Jennifer , Hong David K , Bonavia Aurelio , Connolly Lynn , Cebrik Deborah , Fanget Marie Christine , Mogalian Erik , Griffin Paul 
Published: January 2021

Abstract

Background
VIR-2482 is a fully human immunoglobulin G1(IgG) monoclonal antibody (mAb) directed against a highly-conserved epitope in the influenza A hemagglutinin stem region and is in clinical development for the prevention of influenza A illness. The Fc region of VIR-2482 has been modified to provide an extended half-life.

Methods
This is a randomized, placebo-controlled, Phase 1/2 study of VIR-2482 administered intramuscularly (IM) to healthy adult volunteers aged 18-64 years old who have not received a current influenza vaccine. The Phase 1 portion of the study will evaluate the safety, tolerability, pharmacokinetic (PK), and immunogenicity profile of VIR-2482 following single (Part A) or multiple doses (Part B). The Phase 2 study will evaluate the efficacy of VIR-2482 in the prevention of influenza A illness as well as safety, tolerability, and PK. Part A is ongoing and consists of four single dose cohorts (N=25/cohort) randomized (4:1) to a single dose of VIR-2482 or placebo at 60, 300, 1200, or 1800 mg. Safety, tolerability, PK and immunogenicity will be evaluated for at least 52 weeks post-dose.

Results
In Part A, all 100 subjects received a single dose of VIR-2482 (N=80) or placebo (N=20). Preliminary blinded safety data for all cohorts and PK data for the 300 and 1200 mg cohorts are reported here. Dosing was well tolerated; 6% (6/100) of subjects experienced mild injection site reactions, which generally resolved within 48 hrs. Through 12 weeks post-dosing, the majority (124/126; 98.4%) of adverse events (AEs) were mild to moderate in nature, no serious AEs were reported, and no subjects discontinued due to an AE. Based on available data, exposure (Cmax and AUC) between 300 and 1200 mg of VIR-2482 increased in a dose proportional manner. The PK profile of VIR-2482 is consistent with a half-life extended IgG.

Conclusion
Based on available data, VIR-2482 has been well tolerated following single IM doses of up to 1800 mg in healthy subjects. The preliminary PK profile of VIR-2482 enables once per season dosing. Overall, these data support initiation of a Phase 2 study to evaluate efficacy of VIR-2482 for the prevention of influenza A illness.

Disclosures
Jennifer Sager, PharmD, Vir Biotechnology (Employee) David K. Hong, MD, Vir Biotechnology (Employee) Aurelio Bonavia, PhD, Vir Biotechnology (Employee) Lynn Connolly, MD, PhD, Vir Biotechnology (Employee) Deborah Cebrik, PhD, Vir Biotechnology (Independent Contractor) Marie Christine Fanget, MS, Vir Biotechnology (Employee) Erik Mogalian, PharmD, PhD, Vir Biotechnology (Employee)
642. Trends and cost burden of Legionella urine antigen test
Authors: Ordaz Victor-mauricio , Lewis Hallye M , Bathina Pradeep 
Published: January 2021

Abstract

Background
Legionella urine antigen (LUAg) testing is used to identify the pathogen Legionella pneumophila serotype 1 which accounts for 50 to 70% of Legionella pneumonia and has 80% sensitivity and 95% specificity. The 2019 ATS/IDSA CAP guidelines recommend against routinely testing urine for LUAg except when indicated by epidemiological factors or severe cases of CAP; however, the recommendation is based on a low quality of evidence. In 2014 & 2015 there were 32 and 39 cases, respectively in the state of Mississippi. The purpose of this study was to evaluate the trends of ordering LUAg, positive results and estimate the cost burden at the University of Mississippi Medical Center (UMMC).

Methods
We performed a retrospective study of all patients who received the LUAg test at UMMC from January 3, 2013 to December 31, 2019. Patient Cohort Explorer was used to obtain de-identified patient data from EPIC. We obtained the number of encounters and patients on whom the LUAg test was performed during their inpatient hospitalization. Coding and billing offices provided the cost per LUAg test.

Results
LUAg test was ordered 2,642 times on 2350 patients between 2013 and 2019. 22 LUAg test results were positive in 21 patients. 2,627 tests were done on patients admitted in the hospital. Of the 1,181 tests ordered in female patients, 11 were positive and of the 1461 tests done in male patients, 11 were positive. The minimum age for ordered test was under 1 year while the oldest patient is 89 years old with a median age of 57 years. The youngest patient to be positive is 21 and the oldest patient was 72 years. 1,471 tests were done in African American patients and 1084 tests in Caucasian patients. At the end of study period 1901 were alive and 741 deceased. The median length of stay for the patient receiving the test was 7 days with 1726 patients discharged within 10 days. 174, 255, 301, 433, 467, 395, 613 tests were ordered respectively from 2013 to 2019. At self pay cost of $132.82 in 2019 USD, the total cost of 2642 tests was $350,910.44. About $15,950.47 was spent for each positive LUAg test during the study period.

Conclusion
Incidence of pneumonia from Legionella in Mississippi is low. Based on our study, we recommend to follow the current ATS/IDSA guidelines and order the test in select patients as recommended, in efforts to reduce diagnostic costs.

Disclosures
All Authors: No reported disclosures
643. Trends, outcomes and cost analysis of Streptococcus urinary antigen testing
Authors: Bathina Pradeep , Lewis Hallye M , Ordaz Victor-mauricio 
Published: January 2021

Abstract

Background
Streptococcus pneumoniae urinary antigen (SUAg) testing detects the capsular polysaccharide of S. pneumoniae; which has a sensitivity and specificity of about 75% and 95%, respectively. IDSA/ATS guidelines recommend empirically covering those who present with community acquired pneumonia (CAP) for common pathogens including S. pneumoniae. These guidelines also recommend against routinely performing SUAg testing in adults with CAP unless the presentation is severe. However, the guidelines acknowledge that this a conditional recommendation based on a low quality of evidence. This study aims to investigate the utility of testing patients with pneumonia for S. pneumoniae and the economic burden.

Methods
We performed a retrospective study of all patients who received the SUAg test at University of Mississippi Medical Center (UMMC) from January 3, 2013 to December 31, 2019. Patient Cohort Explorer was used to obtain de-identified patient data from EPIC. We obtained the number of encounters and patients on whom the SUAg test was performed. Coding and billing offices provided the self pay cost of $101.37 per SUAg test in 2019 USD.

Results
The SUAg was ordered 2,507 times with 105 (4.18%) total positives results. Age range was 1 to 89 years with a median age of 57 years for ordering the test. 136, 256, 314, 419, 433, 382, 566 SUAg tests were ordered respectively from 2013 to 2019. 59% of the positive results were in female patients while 54% percent of the negative results were in male patients. Current every day smokers were more likely to test positive (29% versus 18% negative). Median length of stay was longer for a negative test (6 days versus 5 days). 16% of the patients with a positive result expired compared to 10.5% with a negative result.
Over the study period, 2,507 tests cost an estimated $254,134.59 using the 2019 pricing. Therefore, approximately $2420.32 was spent in testing to identify each positive result.

Conclusion
With low positive rate and Streptococci pneumonia that is already covered with empirical antibiotics, we recommend following the current ATS/IDSA guidelines and order the test in select patients as recommended, in efforts to reduce diagnostic burden and health care costs. However a positive result showed a decreased length of stay and higher mortality.

Disclosures
All Authors: No reported disclosures
646. Adapting the modified Carbapenem Inactivation Method to assess for possible beta-lactamase mediated resistance in Piperacillin-Tazobactam resistant/ Ceftriaxone susceptible Escherichia. coli and Klebsiella pneumoniae
Authors: Lawandi Alexander , De L’Etoile-Morel Samuel , Leite Gleice C , Lee Todd C 
Published: January 2021

Abstract

Background
A cluster of piperacillin-tazobactam resistant/ceftriaxone susceptible Escherichia coli and Klebsiella pneumonaie bacteremias were noted at our institution. A review of the literature suggested this resistance phenotype was mediated by a beta-lactamase. We sought to further corroborate this phenotypically.

Methods
We adapted the “carbapenem inactivation method” utilizing piperacillin-tazobactam and ceftriaxone discs on all E. coli and K. pneumoniae isolated from blood and demonstrating piperacillin-tazobactam resistance but with ceftriaxone susceptibility. We utilized pan-susceptible and carbapenem resistance Enterobacteriaceae reference strains as well as third generation cephalosporin resistant, piperacillin-tazobactam susceptible isolates as controls.

Results
96% of the piperacillin-tazobactam resistant, ceftriaxone susceptible strains demonstrated the capacity to degrade the piperacillin-tazobactam discs while 100% spared the ceftriaxone discs. 75% of the piperacillin-tazobactam susceptible, ceftriaxone resistant control strains spared the piperacillin-tazobactam discs while degrading the ceftriaxone discs.

Conclusion
The resistance phenotype observed is due to beta-lactamase production and the modified carbapenem inactivation method can be adapted to probe for other beta-lactamases. Further study is required to definitively identify which beta-lactamase is responsible.

Disclosures
All Authors: No reported disclosures