bluuebunny/crossref_metadata_2025_split huggingface dataset:
123. Utilization of the BioFire® FilmArray® Pneumonia Panel in Critically Ill Patients with Influenza Pneumonia
Authors: Ereshefsky Benjamin , Raju Mina 
Published: January 2021

Abstract

Background
Severe influenza pneumonia is associated with poor clinical outcomes and may be complicated by bacterial co-infections. Traditional culture techniques may fail to identify organisms, especially if antibiotics were administered prior to culture collection. In critically ill patients, negative cultures may lead to prolonged use of empiric, broad-spectrum antibiotics.

Methods
This is a single-center descriptive study on the use of the BioFire® FilmArray® Pneumonia (PNA) panel in critically ill patients with influenza. All intubated patients diagnosed with influenza pneumonia admitted to an ICU between December 1, 2019 and March 31, 2020 were included for analysis. The purpose of this study was to compare the results from rapid diagnostic testing with traditional culture results, and to describe the impact on time to results and the time to de-escalation of antibiotics.

Results
A total of 21 patients with 22 PNA panels were included. The mean age was 64 years, and 43% were female. Diabetes and COPD were present in 29% and 33%, respectively. A majority of patients (91%) had influenza A. Bacterial co-infection was found in 82% of cases, with all having bacteria identified on the PNA panel. Polymicrobial results from the PNA panel occurred 32% of the time. The most frequently identified bacterial pathogens by PNA panel were S. pneumoniae (41%), MSSA (27%), H. influenzae (14%), and P. aeruginosa (9%). Respiratory cultures had no growth 50% of the time, with MSSA most commonly identified at 23%. P. aeruginosa and MRSA were the only organisms that were detected by both PNA panel and respiratory culture with 100% agreement. PNA panel results were available 5.1 (2.7–11.3) hours after respiratory culture collection, compared to 45.8 (31.5–55.6) hours for culture results. De-escalation of empiric antibiotics occurred 13.2 (1.7–24.0) hours after PNA panel results in the 18 evaluable patients.
Table 1: Pathogens Identified by BioFire Pneumonia Panel and Respiratory Culture

Conclusion
The PNA panel identified a high rate of bacterial pathogens in this cohort of critically ill patients with influenza. It also provided actionable results much quicker than traditional respiratory cultures. Further study is needed to evaluate the significance of positive molecular tests when cultures are negative.

Disclosures
All Authors: No reported disclosures
1518. Real-World Comparative Effectiveness of Baloxavir Marboxil versus Oseltamivir on Influenza-Related Complication and Resource Utilization
Authors: Neuberger Eddie , Wallick Chris , Chawla Devika , Castro Rita de Cassia 
Published: January 2021

Abstract

Background
In the 2018-19 season, there were an estimated 490,500 hospitalizations and 24,000 deaths from influenza in the US. Understanding how antiviral use affects rates and severity of complications is crucial to inform clinical practice. The objective of this study was to compare the frequency and costs of complications in influenza patients treated with baloxavir compared with oseltamivir-treated patients. This is one of the first analyses to examine comparative effectiveness of baloxavir in a real-world setting.

Methods
This retrospective cohort study used IBM MarketScan US administrative claims data from the 2018–19 influenza season. Patients were required to have an outpatient visit for influenza followed by a prescription for baloxavir or oseltamivir within 2 days. Baloxavir- and oseltamivir-treated patients were propensity score matched based on key baseline clinical and demographic characteristics. All-cause, all respiratory-related, and select respiratory-related (infection, asthma, and COPD) HRU in the 15 and 30 days following prescription fill were assessed using chi-square and Fisher’s exact tests for categorical measures and Wilcoxon signed-rank tests for counts and costs.

Results
We included 5,080 baloxavir-treated patients and 10,160 matched oseltamivir-treated patients in the analysis. Statistically significantly lower HRU was associated with baloxavir compared with oseltamivir therapy (15-day: respiratory-related ED visits, select respiratory-related ED visits and outpatient visits; 30-day: all-cause hospitalization, respiratory-related ED visits, select respiratory-related ED visits and outpatient visits (Table 1). Similarly, associated costs were generally lower in the baloxavir-treated group. Baloxavir-treated patients had lower mean per-patient all-cause 15-day costs (ED visits: $30 [95% CI: $21–$39] vs $42 [95% CI: $32–$51]; hospitalizations: $31 [95% CI: $6–$55] vs $74 [95% CI: $43–$104]) and 30-day costs (ED visits: $46 [95% CI: $35–$57] vs $67 [95% CI: $55–$79]; hospitalizations: $47 [95% CI: $15–$80] vs $119 [95% CI: $78–$161]).
Table 1. Proportion of patients with at least one event

Conclusion
These findings suggest that treatment of influenza with baloxavir may improve outcomes and lower HRU costs compared with oseltamivir treatment.

Disclosures
Eddie Neuberger, PharmD, Genentech, Inc. (Employee) Chris Wallick, PharmD, MS, Genentech, Inc. (Employee) Devika Chawla, PhD MSPH, Genentech, Inc. (Employee) Rita de Cassia Castro, MD, Genentech, Inc. (Employee)
1521. Risk factors associated with complications of influenza A or B infection, southern Puerto Rico, 2016-2019
Authors: Perez-Caro Angel L , Toro Frances Quiñones-Del , García-Burgos Marilyn , Rivera-Amill Vanessa , Alvarado-Domenech Luisa I 
Published: January 2021

Abstract

Background
Influenza is one of the most common viral respiratory diseases in the United States with 9–45 million cases per year. In Puerto Rico, more than 18,000 cases of influenza were reported during the 2019/20 season. The Sentinel Enhanced Dengue Surveillance System (SEDSS) conducts acute febrile illness surveillance for inpatient and outpatients at a southern Puerto Rico tertiary care hospital.

Methods
We performed a retrospective analysis of disease severity among laboratory-confirmed influenza cases enrolled in SEDSS. Cases with complications such as pneumonia or bronchitis evidenced by chest x-ray or clinical diagnosis were classified as severe.

Results
Between January 2016 and December 2019, there were 2,835 laboratory-confirmed influenza cases. More than half (1,662, 59%) were aged 0–20 years, 51% (n=1,447)were female, and 4% (n=124)required hospital admission. Among all influenza cases, influenza A virus was most common (n = 1,963, 69%) followed by influenza B virus (n = 872, 31%). Odds of having influenza A were higher among adults (OR=1.62; 95% CI:1.38-1.92). Chronic disease history among influenza cases included: asthma (n= 507, 18%), hypertension (n = 337, 12%), hypercholesterolemia (n = 157, 6%), coronary heart disease (n = 79, 3%), immunodeficiency (n = 11, 1%), and kidney disease (n = 10, 1%). Overall, 61(2%) influenza cases developed complications, 21 developed pneumonia of which 85% had chest x-ray performed. One-third of influenza cases with pneumonia or bronchitis had preexisting conditions like asthma (33%) and hypertension (34%). Seventy five percent of Influenza A cases with asthma developed bronchitis or pneumonia. The odds of having severe Influenza were higher among patients with underlying hypertension compared to those without hypertension (OR= 3.8; 95% CI:2.0–7.1). Moreover, influenza cases with asthma had a higher odd of developing pneumonia or bronchitis as compared to those without asthma (OR=2.3; 95% CI: 1.3–4.0). While asthma is a recognized risk factor for influenza complications, isolated hypertension is not.

Conclusion
Identifying people at risk for influenza complications provides a guide for clinicians and public health officials to implement preventive measures and improve clinical outcomes.

Disclosures
All Authors: No reported disclosures
1522. Safety and Efficacy of CR6261 in an Influenza A H1N1 Healthy Human Challenge Model
Authors: Han Alison , Czajkowski Lindsay , Rosas Luz Angela , Cervantes-Medina Adriana , Xiao Yongli , Gouzoulis Monica , Lumbard Keith , Hunsberger Sally , Reed Susan , Athota Rani , Baus Holly , Lwin Amy , Sadoff Jerald , Taubenberger Jeffery , Memoli Matthew J 
Published: January 2021

Abstract

Background
Influenza virus infections cause significant morbidity and mortality during yearly seasonal epidemics and during sporadic pandemics. It is imperative to identify new targets for vaccines and therapeutics. One such target is the relatively conserved stalk region of the influenza A hemagglutinin (HA) surface protein.

Methods
We conducted a randomized, double-blind, Phase II placebo-controlled trial of a monoclonal antibody that targets the HA stalk (CR6261) in a H1N1pdm09 healthy volunteer human challenge model. CR6261 was infused 24 hours after challenge with H1N1pdm09 and the primary efficacy outcome was area under the curve (AUC) of viral shedding.

Results
Between March 2015-May 2018, 104 healthy volunteers were enrolled and randomized with 91 undergoing influenza challenge, of which 49 participants (54%) received treatment with CR6261 and 42 participants (46%) received placebo. A mean of 1x106 ng/mL of serum CR6261 was detected by 24 hours after infusion. Nasal CR6261 levels reached a peak mean of 5.97x102 ng/ml 2 days after infusion. There was no statistically significant difference in the primary outcome measure between the CR6261 group and placebo (median AUC 48.56 and 25.53 respectively, P=0.31). The severity of illness was compared between the two groups, and no significant difference was observed in number of symptoms, duration of symptoms, or FLU-PRO scores.

Conclusion
CR6261 had no statistically significant effect on AUC of viral shedding, and no clinically significant effect on overall influenza disease. Preexisting anti-neuraminidase (NA) antibody titers were most predictive of reduced influenza disease. Nasal CR6261 levels were much lower compared to serum, which may be a factor in the limited effect of CR6261 on this upper respiratory infection. These results suggest that a monoclonal anti-stalk approach to prevent or treat influenza infection may have limited efficacy. Future approaches should consider including and evaluating anti-stalk antibodies as part of a multi-faceted strategy rather than as a standalone therapeutic or vaccine strategy.

Funding
This study was funded in part by the intramural program of NIAID, NIH, by the NCI Contract No. 75N910D00024, Task Order No. 75N91019F00130, and through a CRADA with Janssen Infectious Diseases and Vaccines.

Disclosures
Amy Lwin, RN, BSN, Janssen Pharmaceutical Company of J&J (Employee) Jerald Sadoff, MD, Janssen Pharmaceutical Company of J&J (Employee)
1528. Prevalence of Human Papillomavirus Infection and Cervical Intra-Epithelial Lesions in A Subset of Arab American Women in Southeast Michigan
Authors: Shallal Anita , Trak Joseph , Kamatham Saivaishnavi , Fehmi Omar , Farooqi Sarah , Fehmi Ziad , Zervos Marcus , Ali Rouba 
Published: January 2021

Abstract

Background
The Pap smear is a screening examination that detects abnormal cervical cells and may be paired with human papillomavirus (HPV) testing in order to detect high-risk, oncogenic HPV strains. The incidence of cervical cancer varies among groups due to racial and ethnic disparities, and 80% of cases occur in developing countries. Mortality rates for cervical cancer in the Middle East are disproportionately higher when compared to developed countries. Our study aims to assess the prevalence of HPV and cervical cancer among a subset of Arab-American women in southeast Michigan.

Methods
The study is a retrospective chart review of women who presented for routine cancer screening as part of the Breast and Cervical Cancer Control Program (BCCCP), at the Arab-American Center for Economic and Social Services Clinic in southeast Michigan between 2003-2019. Paper charts were reviewed for information such as age, date of birth, monthly income, tobacco use, cervix-related gynecological examination performance, cervical cytology results, and HPV testing results. Women between the ages of 21 and 65 were included. In instances where cytology was performed, results and details of high-risk HPV testing were documented. In instances where high-risk HPV testing was performed, negative results were documented as such, and positive results were documented as either positive for HPV 16, 18, or other high-risk strains, or unknown if serotype testing was not available.

Results
A total of 464 charts from the BCCCP program were reviewed. All women included were uninsured and had immigrated from Middle Eastern countries, including Yemen and Lebanon. The average age of the women was 48.3 years. Of 464 women, 6% (n=28) of women declined to have a Pap smear. 85 women reported they had never had a Pap smear. Of the 436 women who did undergo Pap smear, 42 women (9.6%) had an abnormal pap smear. The remaining results are summarized in Table 1.
Table 1

Conclusion
Our study results show a trend toward HPV serotype 16 and other serotypes compared to HPV serotype 18 in Arab-American women who recently immigrated to the United States. However, this needs to be studied on a larger cohort of patients to determine if these serotypes are more common among this ethnicity compared to the general population.

Disclosures
Marcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)
126. Implementation of the core elements of an outpatient antimicrobial stewardship program in pediatric emergency departments and urgent care clinics
Authors: El Feghaly Rana E , Burns Alaina , Goldman Jennifer , Myers Angela , Purandare Amol , Monsees Elizabeth , Hiskey Lisa M , Lee Brian R 
Published: January 2021

Abstract

Background
We used the Center for Disease Control and Prevention’s 4 core elements (commitment, action for policy and practice, tracking and reporting, education and expertise) to establish an outpatient antibiotic stewardship program (ASP) in 2 pediatric emergency departments (EDs) and 3 urgent care clinics (UCCs) of a healthcare system.

Methods
The outpatient ASP team consists of infectious diseases (ID) physicians, a pharmacist, and data analyst collaborating with ED and UCC providers. We placed a commitment letter in every exam room. We coach and support frontline providers to lead and sustain quality improvement (QI) projects. A monthly report evaluates rates of antibiotic use for viral infections and first-line antibiotic use for bacterial infections. We also compare rates of respiratory diagnoses and overall antibiotic use for all respiratory infections among the different sites. We developed an outpatient antibiotic handbook summarizing diagnosis and treatment recommendations for commonly encountered infections. Progress on prescribing trends and positive reinforcement are shared with providers during cookie rounds at bi-annual division meetings. We provide lectures, workshops, and newsletter articles on wise use of antibiotics.

Results
Pre-implementation data showed &lt; 5% antibiotic use for common pediatric viral infections and &gt;85% use of first-line antibiotics for common bacterial infections. Trends in the report help us identify site-specific improvement opportunities we are working with frontline providers on addressing. In 2 years, our QI efforts have resulted in an increase in safety-net antibiotic prescriptions for acute otitis media in the EDs from 0.4% to over 7.5%, and a decrease in the percentage of rapid streptococcal testing performed in children &lt; 3years old from 13% to 5% in one UCC (Figure 1). We have completed 15 cookie rounds attended by all ED/UCC core providers. In a survey completed by 61 providers, 85% found the handbook to be very beneficial, and 97% report it impacts their daily practice (Table 1).
Figure 1: Annotated control charts of 2 quality improvement projects. A. Increase in safety-net antibiotic prescriptions offered to children diagnosed with acute otitis media in the emergency department. B. decrease in the percentage of streptococcal rapid antigen detection tests performed on children younger than 3 years of age in one urgent care clinic

Conclusion
Seeking leadership support and most importantly engaging frontline providers allowed us to be successful in implementing the suggested core elements of an outpatient ASP and maximize existing resources.

Disclosures
Brian R. Lee, MPH, PhD, Merck (Grant/Research Support)
1543. Risk Reduction service delivery during the COVID Pandemic to a marginalized urban population in Newark, NJ
Authors: Rosmarin-DeStefano Corey L , Scarinci Eileen , Finkel Diana , Escabi Erika 
Published: January 2021

Abstract

Background
North Jersey Community Research Initiative (NJCRI) is a non- profit organization in Newark, NJ that provides medical care and support services for highly vulnerable and hard to reach patient populations (e.g. homeless, HIV/AIDS, transgender, MSM, injection drug users, sex workers), 83% of whom are people of color. We are in a unique position to identify critical vulnerabilities and continued risk factors in our communities and patients during pandemics especially identifying HIV, HCV and other STIs and providing support services to this population.

Methods
We assessed the impact of COVID on HIV, HCV, STI Clinical care, testing, prevention, treatment, mental health and substance abuse services and patent retention. We used our EMR data to track patient visits, prevention visits and testing pre and post covid. Post Covid we utilized Telemedicine and mobile units to continue to provide services as well as self collection kits for the patients for testing. We staggered schedules on site in our outdoor triage center for support services like syringe exchange and food pantry and made an outdoor triage center for all services. Our phone system was routed to providers who assessed provided medical care through telemedicine and remote lab orders and Medication orders were sent via EMR to pharmacies who delivered the medications.

Results
Pre Covid Jan-Feb 2020: 855 clinical visits including testing Behavioral visits 191. Syringe exchange 38,653 needles to 73 clients, Food 189 clients received food. LGBTQ service Clients Reached 779
Post Covid
March 2020 333 clinical visits including testing behavioral visits 154
April 2020 360 clinical visits including testing behavioral visits 208
May 2020 447 clinical visits including testing behavioral visits 282
Syringe exchange March- May 27,367 needles to 53 clients
Food received March-may 118 clients
LGBTQ clients reached 2035

Conclusion
Assess and implement best practices post COVID to plan for services in the event that we have another wave of COVID. STI, HIV and HCV services and testing can be successfully delivered remotely and through an outdoor triage facility in an underserved urban setting. Point of Service testing for both home and outdoor settings will be added to treatment paradigms to better serve the needs of the community.

Disclosures
All Authors: No reported disclosures
1544. Sexually Transmitted Infection Laboratory Testing and Education Trends Among Physician Office Visits in the United States, 2009-2016
Authors: Zeidan Amina R , Reveles Kelly R 
Published: January 2021

Abstract

Background
Rates of sexually transmitted infections (STIs) have been rising in the United States (US). Physician offices play an important role in providing both STI prevention and education, as well as STI laboratory testing options for patients who present at risk. However, few studies have documented the extent to which physician’s offices have contributed to prevention and testing efforts. We address this gap by evaluating STI testing and education provided in US physician offices from 2009 to 2016.

Methods
This was a cross-sectional study of the Centers for Disease Control and Prevention’s National Ambulatory Medical Care Survey (NAMCS) from 2009 to 2016. Data weights were applied to extrapolate sample data to national estimates. Testing for HIV, HPV, Chlamydia (2009 – 2016) and Hepatitis and Gonorrhea (2014 – 2016) were presented as testing visits per 1,000 total visits. Subgroup analyses were performed for age group, sex, and geographical region by individual STI test and receipt of STI prevention education.

Results
A total of 7.6 billion visits were included for analysis, of which 0.6% included an STI test. Testing rates increased over the study period for Chlamydia (R2=0.27), HPV (R2=0.28), and HIV (R2=0.51). Peak testing occurred in 2015 for all tests. STI prevention education was provided to 0.5% of patients. Females were tested at a higher rate for all STIs (4.2%) compared to males (0.4%). Females also received more STI prevention education overall (0.6% versus 0.4%, respectively). While the age group 25 – 24 accounted for highest Hepatitis (15.9%) and HPV (11.3%) testing rates, the 15 – 24 age group had the highest overall testing rate (9.4%). STI testing was highest in the South region (Figure 1).

Conclusion
STI testing in US physician offices increased in recent years. Females accounted for the majority of STI testing and STI prevention education. Testing was more frequent among patients 15 – 24 years old and those seen in the South region. Further research should be conducted to determine reasons for differences in testing and education amongst sex, age group, and geographic region.

Disclosures
All Authors: No reported disclosures
1560. Microbiology of Necrotizing Fasciitis and Implications on Antimicrobial Stewardship
Authors: Huang Glen , Kim Brian , Jeng Arthur 
Published: January 2021

Abstract

Background
Necrotizing fasciitis (NF) is a rare but deadly soft tissue infection. Early diagnosis, antibiotics, and surgical management are critical in treatment. Current IDSA guidelines recommend broad empiric antibiotics (eg, vancomycin + piperacillin-tazobactam or a carbapenem). At our institution, this invariably consists of empiric treatment for methicillin-resistant Staphylococcus aureus (MRSA) and resistant gram-negative organisms (eg, Pseudomonas aeruginosa), usually with piperacillin-tazobactam. Clindamycin is the common third agent used empirically; however, the literature supports use of clindamycin only in confirmed cases of Group A Streptococcus (GAS). With the increasing dangers of antibiotic resistance, use of such broad agents may not be necessary for NF. We evaluated the microbiology of NF and the implications on empiric antibiotic treatment.

Methods
Retrospective chart review of adults (≥18 years) with a diagnosis of NF from January 2016 to May 2020.

Results
Twenty-five cases of NF in 22 patients were recorded. The median age was 54.5 (IQR 37-59.8) and 15 (60%) were male. On presentation, 24 (96%) met systemic inflammatory response syndrome criteria with a median laboratory risk indicator for necrotizing fasciitis score of 15 (IQR 9-31.3, n = 20). The median presenting white blood cell count was 17.5 x 103 cells/uL (IQR 13.5-25.2), median C-reactive protein was 321.6 mg/L (IQR 25.9-37.6) and median creatinine was 1.2 mg/dL (IQR 0.7-1.6). The most frequently isolated organisms were anaerobes (n=9, 36%) and Streptococci other than GAS (n = 9, 36%). GAS was isolated in 6 patients (24%) and S. aureus in 2 patients (8%). All cases of S. aureus were methicillin-susceptible. No Pseudomonas species (PsA) or extended-spectrum beta-lactamase (ESBL) gram negative organisms were isolated. Three patients (12%) had no organisms isolated from surgical cultures. Seven patients (28%) had positive blood cultures. Of the empiric antibiotics used, 24 (96%) patients were exposed to clindamycin and an anti-pseudomonal antibiotic.

Conclusion
Empiric treatment of PsA and ESBL organisms is not necessary in NF. This infection should be considered a priority target for antimicrobial stewardship to reduce prescribing of broad-spectrum antibiotics to empirically treat these organisms.

Disclosures
All Authors: No reported disclosures