bluuebunny/crossref_metadata_2025_split huggingface dataset:
32. Influenza Vaccination Prevalence Among Adults with and without HIV by Race, Age, and Sex
Authors: Levine-Hall Tory , Hood Nicole , Alexeeff Stacey , Anderson Alexandra , Hojilla J Carlo , Horberg Michael A , Horberg Michael A , Lam Jennifer , Satre Derek , Silverberg Michael 
Published: January 2021

Abstract

Background
People with HIV (PWH) may be more likely than people without HIV (HIV-) to receive influenza vaccinations. However, it is unknown if there are demographic differences in vaccination rates and whether this varies by HIV status.

Methods
We identified all adult PWH (≥18 years) and 20:1 race-, age- and sex-matched HIV- adults enrolled in Kaiser Permanente Northern California between 2013 - 2017. We evaluated prevalence of influenza vaccinations during the 2013 – 2016 flu seasons (September 1 to March 31). We used Poisson regression models with repeated measures (subjects contributed to multiple flu seasons) to estimate the relative risk [RR] of influenza vaccinations by race, age, and sex within HIV status strata. Multivariable models included terms for HIV status, race, age, sex, unhealthy alcohol use, smoking status, calendar year, alcohol use disorder, census-based education/income, depression, insurance type, and outpatient visits, and interaction terms for HIV*race, HIV*age group, and HIV*sex.

Results
The study sample included 7,422 PWH and 152,305 HIV-. 90% of PWH and 91% of HIV- were men; mean age at baseline was 49.4 (PWH) and 50.6 (HIV-) years; and 45% of PWH and 44% of HIV- were non-White. In adjusted models, PWH were more likely to receive the influenza vaccine compared with HIV- (RR 1.51; 95% CI 1.50–1.54). Among HIV-, Blacks were less likely to receive the vaccine compared with Whites (RR 0.77; 0.76–0.78); this effect was attenuated in PWH (RR 0.88; 0.84–0.92) (Figure, panel a). Among HIV-, older age groups were more likely to receive the vaccine compared with the 18 – 29 age group, with attenuated RRs among PWH (Figure, panel b). Among HIV-, females were more likely to receive the vaccine compared to males (RR 1.11; 1.09–1.13) while among PWH, females were less likely compared to males (RR 0.94; 0.89–1.00; p=0.04) (Figure, panel c).
Adjusted relative risk of influenza vaccination by race, age, and sex

Conclusion
PWH were more likely to be vaccinated against influenza than HIV-. In both PWH and HIV-, Blacks and younger age groups were less likely to be vaccinated, although these associations were attenuated in PWH. The effect of sex varied by HIV status with increased vaccination rates for female HIV- but reduced rates for female PWH. Targeted efforts are needed to continue to close the gap in demographic disparities regarding influenza vaccination rates among PWH.

Disclosures
Michael Silverberg, PhD, MPH, Gilead Sciences, Inc. (Grant/Research Support)
41. Impact of the Development of a Perioperative Antibiotic Pathway on Antibiotic Duration of Therapy, C.difficile Infection Rates and Surgical Site Infection Rates in the Adult Facial Reconstruction Population
Authors: McDonnell Lindsay , Kennedy Leigh A 
Published: January 2021

Abstract

Background
There is variability in the duration of peri-operative antibiotic prophylaxis for free flap reconstructions (FFRs) of the head and neck. Complications of FFRs such as surgical site infections (SSIs), can be devastating and lead to vessel thrombosis and flap loss. Infection rates for head and neck free flap reconstructions have been reported to be as high as 20–50% of cases.1
Despite recommendations from ASHP, IDSA and CDC, postoperative antibiotics are often prolonged at the clinician’s discretion, with many clinicians administering &gt;24 hours of prophylactic antibiotics in cases of FFRs.

Methods
The departments of infectious disease, otorhinolaryngology and antimicrobial stewardship, developed a pathway for perioperative antibiotics for adult patients undergoing FFRs. Patients with criteria that put them at high risk for SSIs post-operatively, were given up to 72 hours of antibiotics. Patients without these risk factors, were allowed a maximum of 24 hours of antibiotics post-operatively.
Next, dissemination and education of the pathway occurred. Our group then collected post –intervention data on antibiotic duration of therapy, C. difficile infections and SSIs in these patients. We collected data over a 6 month period (10/1/2018 to 3/31/2019) for patients undergoing FFRs who received ampicillin/sulbactam (n=33) and compared it to our baseline/pre-intervention data.
Perioperative Antibiotic Recommendations for Adult Facial Reconstructive Surgery Pathway

Results
The mean duration of ampicillin-sulbactam usage decreased from 6.82 days to 4.24 days (p=0.0039). The hospital acquired C.difficile rate decreased from 6.06% to 0% (p=0.4923). The rate of SSIs increased from 3.13% pre-intervention to 9.09%, but this did not reach statistical significance (p=0.6132). One patient in the pre- intervention group and one patient in the post intervention group required a return to the operating room due to SSIs.

Conclusion
In conclusion, through the development of a pathway for perioperative antibiotics for adult patients undergoing FFRs, the duration of postoperative antibiotic therapy decreased significantly. The rates of SSIs increased after the pathway was introduced, but this was not statistically significant. The rates of C.difficile infections decreased, but this did not reach statistical significance.

Disclosures
All Authors: No reported disclosures
44. Antibiotic Class-Based Distribution and Analysis of Reported Beta-Lactam Allergies amongst Hospitalized Patients
Authors: Hornak Joseph Patrik , Reynoso David 
Published: January 2021

Abstract

Background
Reported β-lactam allergy (BLA) is very common, yet less than 10% of these patients exhibit true hypersensitivity. When faced with reported BLAs, physicians often choose alternative antibiotics which can be associated with C. difficile infection, drug-resistance development, poorer outcomes, & increased costs. Effective identification of these patients is necessary for subsequent, appropriate BLA “de-labeling.” Here, we conducted a single-center analysis of alternative antibiotic utilization amongst patients reporting BLA and compare the frequency of drug-resistant infections and C. difficile infection in allergic & non-allergic patients.

Methods
This is a retrospective review of adult patients hospitalized at The University of Texas Medical Branch from 1/1/2015 to 12/31/2019. Pooled electronic medical records were filtered by antibiotic orders and reported allergies to penicillins or cephalosporins. Patients with drug-resistant and/or C. difficile infection (CDI) were identified by ICD-10 codes. Microsoft Excel & MedCalc were used for statistical calculations.

Results
Data were available for 118,326 patients and 9.3% (11,982) reported a BLA, with the highest rates seen in those receiving aztreonam (85.9%, 530/617) & clindamycin (33.7%, 3949/11718). Amongst patients reporting BLA, high ratios-of-consumption (relative to all patients receiving antibiotics) were seen with aztreonam (7.0), clindamycin (2.7), cephalosporin/β-lactamase inhibitors (2.4), & daptomycin (2.1). Compared to the non-BLA population, BLA patients more frequently experienced MRSA infection (3.0% vs 1.5%, OR 1.99, 95% CI 1.79–2.23, p&lt; 0.0001), β-lactam resistance (1.2% vs 0.6%, OR 2.07, 95% CI 1.72–2.49, p&lt; 0.0001), and CDI (1.2% vs 0.7%, OR 1.85, 95% CI 1.54–2.23, p&lt; 0.0001).

Conclusion
Our measured BLA rate matches approximate expectations near 10%. Moreover, these patients experienced significantly higher frequencies of drug-resistant bacterial infections and CDI. Targeted inpatient penicillin allergy testing stands to be particularly effective in those patients receiving disproportionately utilized alternative agents (e.g. aztreonam, clindamycin, daptomycin). β-lactam allergy “de-labeling” in these patients is likely a valuable antimicrobial stewardship target.

Disclosures
All Authors: No reported disclosures
48. Association of Rapid Pathogen Identification and Pharmacist Intervention on Time to Optimal Antimicrobial Therapy for Bloodstream Infections at Two Community Hospitals
Authors: Froberg Bryant M , Torney Nicholas 
Published: January 2021

Abstract

Background
As many as 1 in 3 patients with bloodstream infections at community hospitals receive inappropriate empiric antimicrobial therapy. Studies have shown that the coupling of real-time intervention with rapid pathogen identification improves patient outcomes and decreases health-system costs at large, tertiary academic centers. The aim of this study was to assess if similar outcomes could be obtained with the implementation of real-time pharmacist intervention to rapid pathogen identification at two smaller, rural community hospitals.

Methods
This was a pre-post implementation study that occurred from September of 2019 to March 2020. This study included patients ≥18 years of age admitted with one positive blood culture. Patients were excluded if they were pregnant, had a polymicrobial blood culture, known culture prior to admission, hospice consulted prior to admission, expired prior to positive blood culture, or transferred to another hospital within 24 hours of a positive blood culture. Endpoints of patients prior to intervention were compared to patients post-implementation. The primary endpoint was time to optimal antimicrobial therapy. Secondary endpoints included time to effective antimicrobial therapy, in-hospital mortality, length of hospital stay, and overall cost of hospitalization.

Results
Of 212 patients screened, 88 patients were included with 44 patients in each group. Both groups were similar in terms of comorbidities, infection source, and causative microbial. No significant difference was seen in the mean time to optimal antimicrobial therapy (27.3±35.5 hr vs 19.4± 30 hr, p=0.265). Patients in the post-implementation group had a significantly higher mean hospitalization cost ($24,638.87± $11,080.91 vs $32,722.07±$13,076.73, p=0.013). There was no significant difference in time to effective antimicrobial therapy, in-hospital mortality, or length of hospital stay.

Conclusion
There were no between-group differences in the primary outcome of time to optimal therapy, with a higher mean hospitalization cost after implementation. These results suggest further antimicrobial stewardship interventions are needed, along with larger studies conducted in the community hospital settings.

Disclosures
All Authors: No reported disclosures
49. Clinical Utility of Oseltamivir Restriction Policy
Authors: Kale-Pradhan Pramodini , Manuel Martin , Johnson Leonard B 
Published: January 2021

Abstract

Background
Inappropriate use of oseltamivir and antibiotics for upper respiratory tract infections may increase risk of microbial resistance. Restriction policies have been used to curtail inappropriate use of oseltamivir and antimicrobials in suspected or confirmed influenza patients. We assessed the impact of Infectious Diseases (ID) consult on the management of oseltamivir and concomitant antibiotics.

Methods
A single-center, retrospective study of patients ≥ 17 years, admitted for greater than 24 hours who received oseltamivir from October 1, 2018 to May 1, 2019 were evaluated. Demographics, Charlson Weighted Index of Comorbidity (CWIC), length of hospital stay (LOS), discharge disposition, rapid flu test, respiratory viral panel, sputum and blood cultures, antibiotic regimen and duration were collected. Continuous variables were analyzed using Students t-test and categorical variables with Chi square test.

Results
298 patients were screened and 182 patients met the inclusion criteria. Please see table below for results. Oseltamivir was appropriately continued in 92.9% in the ID consult group compared to 89.3% in the non-ID consult group (p = 0.51). Antibiotic interventions were appropriate in 63.2% of the ID consult group compared to 40% in non-ID group (p = 0.36).
Results Summary

Conclusion
Oseltamivir interventions were appropriate and similar in between groups. Further, there was higher percentage of appropriate antibiotic interventions in the ID physician group. Duration of antibiotics was longer in the ID physicians consulted group which may be due to higher severity of illness in the group.

Disclosures
All Authors: No reported disclosures
52. Development and Implementation of a Short Duration of Antibiotic Therapy Algorithm for Uncomplicated Gram-Negative Bacteremia
Authors: Bae Esther Y , Bernice Fidelia , Dzintars Kathryn , Cosgrove Sara E , Tamma Pranita D , Avdic Edina 
Published: January 2021

Abstract

Background
Recent literature suggests no difference in clinical outcomes between short (7 days) and prolonged course (14 days) antibiotic therapy for the treatment of uncomplicated Gram-negative bacteremia (GNB).

Methods
The objectives of the study were to develop and implement a treatment algorithm that identifies patients who are eligible for 7-day therapy for uncomplicated GNB and evaluate its impact on patient outcomes at The Johns Hopkins Hospital (JHH) in Baltimore. The algorithm was developed and implemented at JHH on 11/11/2019. From 11/11/2019 to 3/31/2020, the Infectious Diseases (ID) Pharmacy Resident and ID pharmacists reviewed cases of GNB on weekdays and contacted teams to provide algorithm-compliant treatment recommendations. To quantify the impact of the intervention on clinical outcomes, data from the same time period during the previous year (baseline) were collected and compared to those collected during the intervention. The primary outcome was duration of antibiotic therapy for GNB. Secondary outcomes included: duration of intravenous (IV) antibiotics, length of hospital stay (LOS), and recurrent bacteremia.

Results
A total of 345 patients with GNB were identified (142 baseline; 203 intervention) of which 59 and 55 patients met criteria for 7-day therapy, respectively. The Pitt bacteremia score (median 1), bacteremia source [urinary (43%), abdominal (23%)], and organisms [E. coli (48%) and Klebsiella spp. (33%)] were similar between the periods. More patients in the intervention period were treated for ≤8 days (60.0% vs. 37.3%; p=0.015), and the median duration of therapy was 2 days shorter (8 vs. 10 days; p=0.04). Median duration of IV antibiotic therapy (4 vs. 7 days; p=0.004) and median LOS (4 vs. 7 days; p=0.029) were also shorter in the intervention period. There were no differences in the rate of 30-day recurrent bacteremia between the periods (3.4% baseline vs. 1.8% intervention; p=0.60).

Conclusion
Our pharmacist-led intervention successfully shortened the duration of therapy, increased conversion from IV to PO therapy, and reduced LOS, without negatively impacting the number of patients with recurrent GNB.

Disclosures
All Authors: No reported disclosures
813. The Reduction of the acquisition rate of carbapenem resistant Acinetobacter baumannii after room privatization in the intensive care unit
Authors: Jung Jongtak , Choe Pyoeng Gyun , Kang Chang Kyung , Song Kyung Ho , Park Wan Beom , Bang Ji-Hwan , Kim Eu Suk , Park Sang Won , Kim Hong Bin , Kim Nam-Joong , Oh Myoung-don 
Published: January 2021

Abstract

Background
Acinetobacter baumannii is one of the major pathogens of hospital-acquired infection recently and hospital outbreaks have been reported worldwide. On September 2017, New intensive care unit(ICU) with only single rooms, remodeling from old ICU with multibed bay rooms, was opened in an acute-care tertiary hospital in Seoul, Korea. We investigated the effect of room privatization in the ICU on the acquisition of carbapenem-resistant Acinetobacter baumannii(CRAB).

Methods
We retrospectively reviewed medical records of patients who admitted to the medical ICU in a tertiary care university-affiliated 1,800-bed hospital from 1 January 2015 to 1 January 2019. Patients admitted to the medical ICU before the remodeling of the ICU were designated as the control group, and those who admitted to the medical ICU after the remodeling were designated as the intervention group. Then we compared the acquisition rate of CRAB between the control and intervention groups. Patients colonized with CRAB or patients with CRAB identified in screening tests were excluded from the study population. The multivariable Cox regression model was performed using variables with p-values of less than 0.1 in the univariate analysis.

Results
A total of 1,105 cases admitted to the ICU during the study period were analyzed. CRAB was isolated from 110 cases in the control group(n=687), and 16 cases in the intervention group(n=418). In univariate analysis, room privatization, prior exposure to antibiotics (carbapenem, vancomycin, fluoroquinolone), mechanical ventilation, central venous catheter, tracheostomy, the presence of feeding tube(Levin tube or percutaneous gastrostomy) and the length of ICU stay were significant risk factors for the acquisition of CRAB (p&lt; 0.05). In the multivariable Cox regression model, the presence of feeding tube(Hazard ratio(HR) 4.815, 95% Confidence interval(CI) 1.94-11.96, p=0.001) and room privatization(HR 0.024, 95% CI 0.127-0.396, p=0.000) were independent risk factors.
Table 1. Univariate analysis of Carbapenem-resistant Acinetobacter baumannii

Table 2. Multivariable Cox regression model of the acquisition of Carbapenem-resistant Acinetobacter baumannii

Conclusion
In the present study, room privatization of the ICU was correlated with the reduction of CRAB acquisition independently. Remodeling of the ICU to the single room would be an efficient strategy for preventing the spreading of multidrug-resistant organisms and hospital-acquired infection.

Disclosures
All Authors: No reported disclosures
814. A Quasi-Experimental Study on Stethoscopes Contamination with Multidrug-Resistant Bacteria: Its Role as a Vehicle of Transmission
Authors: Lee Raeseok , Choi Su-Mi , Jo Sung Jin , Han Songyi , Park Yun Jeong , Choi Min A 
Published: January 2021

Abstract

Background
Stethoscopes have been suggested to be a possible vector of contact transmission. However, only a few studies have focused on the prevalence of contamination by multidrug-resistant (MDR) bacteria and the effectiveness of disinfection training to reduce. The aim of this study is to investigate the burden of stethoscope contamination with nosocomial pathogens and multidrug-resistant (MDR) bacteria and to analyze habit changes in the disinfection of stethoscopes before and after education and training.

Methods
We performed a prospective pre and post quasi-experimental study. All participants were surveyed on their disinfection behavior and stethoscopes were cultured by pressing the diaphragm directly onto a blood agar plate before and after education on disinfection. Pulsed-field gel electrophoresis (PFGE) was performed to determine the relatedness of MDR bacteria.
Fig. 1. Study flow for pre and post quasi-experimental study. Abbreviations. PFGE, Pulsed-field gel electrophoresis

Results
Most of the stethoscopes were contaminated with microorganisms, 97.9% before and 91.5% even after intervention. The contamination rate of nosocomial pathogens before and after education was 20.8 % and 19.2%, respectively. Stethoscope disinfection habits were improved (55.1% vs 31%; p&lt; 0.001), and the overall bacterial loads of contamination were reduced (median CFUs 15 vs 10; p=0.019) after the intervention. However, the contamination rate by nosocomial pathogens and MDR bacteria did not decrease significantly. A carbapenemase-producing Klebsiella pneumoniae from the stethoscope was closely related to isolates from the patients admitted at the same ward where the stethoscope was used.
Fig. 2. Changes in colony forming units of bacteria isolated from stethoscopes between pre and post intervention period. Abbreviations. CFUs, colony forming units; ns, non-specific

Fig. 3. Result of PFGE and dendrogram of carbapenemase-producing K. pneumoniae from the stethoscope and the patients where the stethoscope was used. Percentage similarities are shown above the dendrogram. Note. ST_7W, K. pneumoniae from the stethoscope; SM 01 to 03, K. pneumoniae isolates form the patients; PFGE, Pulsed-field gel electrophoresis

Table 1. Contamination rates caused by nosocomial pathogens and proportion of MDR bacteria

Conclusion
Stethoscopes were contaminated with various nosocomial pathogens including MDR bacteria and were very likely to be a vehicle of MDR bacteria. Healthcare workers feel the need for education and think it helps, but continuous, consistent education and training should be done in multifaceted approach to reduce the nosocomial transmission via stethoscopes.

Disclosures
All Authors: No reported disclosures
816. Effectiveness of Aseptic Stethoscope Barriers in Allowing Clean Contact for Clostridioides Difficile-Contaminated Stethoscopes
Authors: Vasudevan Rajiv S , Kalra Sarathi , Torriani Francesca J , Peacock William F 
Published: January 2021

Abstract

Background
Healthcare-associated infections (HAIs), such as C. difficile colitis, pose a significant health risk. C. difficile is a spore-forming gram-positive anaerobic bacillus capable of surviving on various surfaces. While a strong emphasis has been placed on hand-washing and environmental cleaning with bleach products to limit the spread of C. difficile, stethoscope contamination has been poorly addressed. Studies have demonstrated that the stethoscope diaphragm harbors similar levels and type of contamination to one’s hands. While a non-alcohol-based solution is recommended for stethoscope hygiene in settings at risk for C. difficile, the use of an aseptic stethoscope diaphragm barrier has not been evaluated. Our purpose is to evaluate whether C. difficile-contaminated stethoscope diaphragms remain aseptic by the placement of an aseptic diaphragm barrier.

Methods
Fresh cultures of C. difficile were diluted to 107 CFU/mL. After inoculating 16 stethoscope diaphragms with C. difficile, 8 had an aseptic diaphragm barrier applied, and 8 served as non-barrier controls. Contaminated stethoscopes were placed in an anaerobic incubator, then swabbed at 15 and 30 minutes, 2 and 4 hours, and 1, 2, 3, and 7 days after inoculation, and subsequently plated onto blood, chocolate, and cycloserine-cefoxitin fructose agar. These plates were incubated for 48 hours, and resulting colonies were manually counted. Statistical analysis was performed (RStudio version 1.0.153) by ANOVA (Analysis of Variance) with post-hoc Tukey HSD (Honestly Significant Difference).

Results
Overall, mean colony count was 33 CFU on the 8 stethoscope diaphragms without barriers, vs zero on those with barriers (p≤ 0.05). Growth rates were greatest at 48 hours, with colony counts as high as 160. While stethoscope diaphragms without barriers had increasing rates of C. difficile culture growth, the presence of the barrier resulted in no growth in 100% of stethoscope diaphragms for up to 1 week after contamination (Figure 1).
C. difficile colony counts from stethoscope diaphragms at time-points up to 1 week.

Conclusion
Aseptic barriers allow C. difficile-contaminated stethoscope diaphragms to remain without bacterial growth for up to a week. Disposable aseptic diaphragm barriers may be effective in preventing the spread of C. difficile.

Disclosures
William F. Peacock, MD, AseptiScope Inc. (Board Member)