bluuebunny/crossref_metadata_2025_split huggingface dataset:
1103. Respiratory Virus Infections In Solid Organ Transplant Recipients: A Single Center Experience
Authors: Mendoza Maria A , Raja Mohammed A , Rosello Gemma , Anjan Shweta , Simkins Jacques , Camargo Jose F , Morris Michele I , Sinha Neeraj , Guerra Giselle , Abbo Lilian M , Abbo Lilian M , Natori Yoichiro 
Published: January 2021

Abstract

Background
Community acquired respiratory virus infections (RVI) are a major concern in solid organ transplant (SOT) recipients due to severe complications such as lower respiratory tract infection (LRTI), superimposed fungal and bacterial pneumonia, intensive care admission and mortality. Besides influenza and respiratory syncytial virus (RSV), there is paucity of data of RVI in SOT recipients.
Table 1: Patients characteristics

Table 2: Concomitant infections

Methods
Retrospective cohort study of a single large transplant center was performed. Data of multiplex qualitative PCR-based respiratory viral panel (RVP) samples collected between January 2017 and December 2019 were included. It is important to mention that our institution generally performs the RSV/influenza rapid detection assay as an initial test; if negative, the multiplex PCR panel is usually done. We did not include results from the RSV/influenza rapid test in this study.

Results
One hundred transplant patients with a single positive RVP were included (table 1). Transplanted organs include kidney (40%), followed by lung (33%) and liver (9%). Most common presenting symptoms were cough (52%), shortness of breath (28%) and rhinorrhea (26%). Of note fever was seen in only 24%. Most common RVI was Rhinovirus/Enterovirus (RHV/ENT) (59%), followed by non-SARS-CoV-2 Coronavirus (19%) and Parainfluenza (PIV) (14%). None of the patients had neutropenia, however, 52% had lymphocytopenia. Lung transplant patients developed LRTI in 70% of cases compared to non-lung transplant 64% (p=0.412). Multivariate analysis showed patients with PIV 3 were less likely to develop LRTI (p= 0.038). Significant Cytomegalovirus DNAemia (&gt;137 IU/mL) was noted in 9.8% of the recipients. No proven or probable pulmonary fungal infection were noted within 3 months after diagnosis of RVI. Five patients were admitted to the Intensive care unit due to septic shock. Three patients died at 4, 5 and 35 days after diagnosis of RHV/ENT, PIV-3 and RHV/ENT respectively.

Conclusion
Most of the cases of RVI were due to RHV/ENT. Patients with PIV 3 were less likely to develop LRTI. Lung transplant recipients developed LRTI with similar incidence to non-lung recipients. Our data shows a very low mortality of 3% after RVI in our SOT cohort, which warrants larger studies.

Disclosures
Michele I. Morris, MD, Viracor Eurofins (Advisor or Review Panel member)
84. T2Candida Panel Use Evaluation: a Quality Improvement Project
Authors: Schwarz Erika Reategui , Rana Meenakshi , Chasan Rachel , Gitman Melissa R 
Published: January 2021

Abstract

Background
Invasive candidiasis is a life-threatening infection with 40% mortality despite antifungal therapy[1] A retrospective chart review of results from our T2Candida Panels from March 2019 to March 2020 was conducted. We compared demographics, co-morbidities, days of antifungal use, length of stay (LOS) and mortality in patients with positive and negative assays.

Results
271 assays were performed, 27 were positive and were compared to 81 negatives. Baseline demographics and co-morbidities were similar in both groups. All patients tested had &gt;1 risk factor for candidemia.
78% were positive for C. albicans/C. tropicalis and 11% positive for C. glabrata/C. krusei and C. parapsilosis respectively. Blood cultures were positive in 8 individuals, of which 5 had a positive assay; among the other 3, one grew C. auris. All species in the T2Candida matched the blood cultures when available.
β-D-glucan was positive in 82% of patients with positive T2 results vs 46% in the T2 negative group (p = 0.016).
Antifungal administration within the time of assay collection was 54% in the negative group vs 74% in the positive group (p = 0.030). Mean duration of antifungal use were significantly lower in the negative group than the positive group (5.98 vs 17.55 days, p = 0.04).
Demographics and Comorbidities

Outcomes

Cultures

Conclusion
T2Candida was an effective diagnostic and antimicrobial stewardship tool, leading to testing in high risk patients and reducing unnecessary antifungal use. Additional education is required for improved ordering of concurrent blood cultures. Negative results should be interpreted with caution in suspected invasive candidiasis with consideration for species not included in the panel.

Disclosures
All Authors: No reported disclosures
85. The Impact of Carbapenem-Sparing Interventions on the Evolution of Resistance in Pseudomonas aeruginosa in the USA
Authors: Townsend Jeffrey , Pandey Abhishek , Tang Amber B , Chen Yiziying , Foster Eric M , Nathwani Dilip , Merchant Sanjay , Sarpong Eric , Fitzpatrick Meagan C , Galvani Alison 
Published: January 2021

Abstract

Background
Carbapenem resistance (CR) among Pseudomonas aeruginosa infections is a pressing public health concern in the United States. Therapeutic alternatives for CR infections are limited. Implementation of a key antimicrobial stewardship intervention such as formulary restriction, which is one of the many stewardship strategies, can minimize selection pressure for resistance. We evaluate the consequent impact of this intervention on bacteremia patients infected with P. aeruginosa in the US.

Methods
We developed a population-genetic model of selection for CR. Increases in CR were modeled as a consequence of inappropriate prescription. Inappropriate empiric therapy, i.e. antibiotic, did not cover the organism or appropriate coverage not started within 2-days, was estimated from a published study and future projections were based on historical resistance frequencies and yearly carbapenem consumption associated with P. aeruginosa bacteremia. We projected peak P. aeruginosa CR frequencies and cumulative CR cases from 2020–2040. We compared scenarios without carbapenem restriction to usage decreased linearly by an amount demonstrated in a previous hospital study (51.7%) over 5 years of implementation starting in 2020 (early implementation) or 2030 (late implementation).

Results
Early and late implementation of carbapenem restriction leads to CR frequencies that ascend as high as 42% and 74% respectively eventually mitigating those frequencies by bringing them down to 23% and 37% respectively. By 2045, early carbapenem restriction could prevent 29,600 CR cases of P. aeruginosa bacteremia, compared to 15,200 prevented by late implementation.

Conclusion
We demonstrate that early restriction of carbapenem consumption could markedly reduce future CR in P. aeruginosa bacteremia patients. Implementing early carbapenem restriction should be expected to result in a lower ultimate frequency of CR and a lower number of cumulative cases of resistant infections, thereby decreasing the overall burden of CR cases that will be encountered in the future.

Disclosures
Jeffrey Townsend, PhD, Merck (Consultant)Merck (Consultant) Sanjay Merchant, PhD, Merck & Co., Inc. (Employee) Alison Galvani, PhD, Merck (Consultant)
1119. Impact of Real-World and Real-Time Interdisciplinary Cases on Infectious Diseases Content Knowledge and Confidence in Pharmacy Students Enrolled in an Infectious Diseases Elective Course
Authors: Rybakov Ilya , Seadler Jessica L , Srivastava Sneha , Tucker Natalie , Cady Beth 
Published: January 2021

Abstract

Background
The Accreditation Council for Pharmacy Education (ACPE) requires students to demonstrate competence in interprofessional education. In 2018, an “interdisciplinary” active learning infectious disease (ID) elective course was created for pharmacy students in the fall semester of the third professional year. Through the use of real-time patient cases and acting healthcare professionals, students are able to have multiple interdisciplinary experiences without leaving the classroom. The objectives of this course are to improve both content knowledge and levels of confidence in making recommendations to healthcare providers. The purpose of this study was to assess those objectives.

Methods
The course meets once weekly for 3 hours. Maximum enrollment is 35 students. All activities are performed in groups of 3-5 students and each group is assigned a case on day 1. Cases are intentionally developed to give each group a nominal amount of information, similar to a real world experience where there is minimal patient data available on day 1 of a hospital admission. Students are given the phone numbers to the microbiology lab and attending physician. The attending physicians are represented by ID pharmacists across the country who have volunteered to serve in the roles. Students are to call the physicians/lab daily for updates and to make pharmacotherapy recommendations as the patient progresses through their hospital stay. The case is complete when a full care plan is accepted by the physician. Student groups then give a formal case presentation to their classmates. Students voluntarily take a pre- and post-survey at the beginning and end of the course to assess ID content knowledge and rate their perceived level of confidence in making recommendations to a physician. This study was IRB approved.

Results
Survey completion rate was 100%. There was a statistically significant increase in students’ confidence levels in making real-time recommendations to providers after completing the course (P&lt; 0.001). A significant increase was also seen in ID content knowledge (P&lt; 0.0001).

Conclusion
After taking an interdisciplinary ID elective course, pharmacy students’ ID content knowledge improved and they felt more confident in making therapy recommendations to physicians.

Disclosures
All Authors: No reported disclosures
1125. Innovative Virtual Learning in the Midst of a Pandemic - Patients, Populations, and Pandemics: Responding to COVID-19
Authors: Kohlenberg Lucille K , Solberg Muriel J , Ali-Mirza Fatima N , Shenoi Sheela , Omer Saad 
Published: January 2021

Abstract

Background
The COVID-19 pandemic has posed a unique challenge to undergraduate medical education. Medical schools postponed student participation in direct patient care in mid-March 2020, creating the need for rapidly-designed, virtual, and innovative learning experiences.

Methods
Utilizing Kern’s six-step approach to curriculum development, faculty and medical student liaisons rapidly designed a six-week online and interactive course for clerkship-year students and above, launched on March 30th, 2020. “Patients, Populations, and Pandemics: Responding to COVID-19” emphasized honing higher level skills of Bloom’s taxonomy, namely evaluating, synthesizing, and creating. Following weekly faculty-led lectures, student groups identified research questions, analyzed literature, presented data, critiqued peer presentations, and created infographics for the public.

Results
We aimed to maintain quality and interactiveness despite challenges posed by our timeframe, the evolving COVID-19 literature, and the virtual setting. We recruited frontline faculty and designed the course to facilitate discussion, thereby promoting real-time exploration of public health and clinical challenges. Encouraging student participation, we incorporated group synthesis sessions and instructed use of video, hand-raising, and chat features. In a survey administered at the end of the first week, 85.7% (18/21) of students strongly agreed or agreed that small group presentations successfully enabled synthesis of new and emerging data. Among the 29 enrolled students, 82.8% (24/29) of students completed final course evaluations, with 87.5% (21/24) agreeing that the learning activities “usually” or “always” helped meet the learning objectives identified at the beginning of the course. The course was rated as “excellent” or “very good” by 83.3% (20/24) of students.

Conclusion
Lessons learned include providing students with increased direction on critically reviewing peer presentations and imparting guidance on best practices for data synthesis. This course model will be disseminated throughout our institution and beyond to address challenges in remote learning and to serve as a paradigm during future health crises.

Disclosures
All Authors: No reported disclosures
1127. Medical School in the Era of COVID-19: Innovations in Direct Near Peer Teaching of Immunology/Microbiology Content During the Pandemic
Authors: Hampshire Karly , Phinney Lauren , McCarthy Elizabeth E , Schwartz Brian , Chin-Hong Peter , Chin-Hong Peter 
Published: January 2021

Abstract

Background
Near-peer teaching (NPT) is increasingly utilized in undergraduate medical education. At our institution’s NPT program, teachers are recruited and trained in the final block of their first year, involving simultaneous learning and teaching of Immunology and Microbiology content to classmates. This year, in-person training and teaching was conducted virtually due to COVID19. This study aims to understand how NPT in a newly virtual curriculum impacted student experiences of learning infectious disease content.

Methods
We conducted one-on-one interviews with student-learners and direct-peer student-teachers at the end of their first year in June 2020. Using constructivist grounded theory, we coded, reconciled, and analyzed interview transcripts to identify themes.

Results
Qualitative analysis of interviews with students (n=5) and near-peer teachers (n=7) yielded the following themes:
1.Optimized learning environment: Direct peer teaching leads to students feeling more personally invested in their peers’ lessons and wellbeing, creating a safe community and increased engagement despite the virtual format and recordings.
2.Benefits of education technology: Teachers employed creative virtual learning modalities to promote students’ mastery of challenging memorization-based microbiology content.
3.COVID-19 relevance: Learning microbiology and immunology content synchronously with the COVID pandemic conferred more content relevance, but presented academic challenges due to social and personal stressors.
4.Educator development: Despite the difficulty of occupying a dual student-teacher role, teachers derived many benefits from teaching, including improved communication skills, which extended to the clinic, content mastery, and increased confidence.

Conclusion
The COVID-19 pandemic led to unprecedented disruptions in medical education. However, the shift to virtual direct peer teaching presented an opportunity for creative virtual teaching strategies and increased lesson accessibility via recordings. Unexpectedly, virtual lessons were perceived as non-inferior to in-person lessons. Findings from this study support the use of virtual near-peer teaching programs in infectious diseases medical education.

Disclosures
All Authors: No reported disclosures
87. Utilization of Methicillin-Sensitive/Resistant Staphylococcus aureus Nares Screen to Decrease Vancomycin and Linezolid Use in Hospitalized Patients with Respiratory Infections
Authors: Zaidan Noor F , Britt Rachel S , Reynoso David , Ferren R Scott 
Published: January 2021

Abstract

Background
Pharmacist-driven protocols for utilization of methicillin-resistant Staphylococcus aureus (MRSA) nares screenings have shown to decrease duration of empiric gram-positive therapy and rates of acute kidney injury (AKI) in patients with respiratory infections. This study evaluated the impact of a pharmacist-driven MRSA nares screening protocol on duration of vancomycin or linezolid therapy (DT) in respiratory infections.

Methods
Patients aged 18 years and older with a medication order of vancomycin or linezolid for respiratory indication(s) were included. The MRSA nares screening protocol went into effect in October 2019. The protocol allowed pharmacists to order an MRSA nares polymerase chain reaction (PCR) for included patients, while the Antimicrobial Stewardship Program (ASP) made therapeutic recommendations for de-escalation of empiric gram-positive coverage based on negative MRSA nares screenings, if clinically appropriate. Data for the pre-intervention group was collected retrospectively for the months of October 2018 to March 2019. The post-intervention group data was collected prospectively for the months of October 2019 to March 2020.

Results
Ninety-seven patients were evaluated within both the pre-intervention group (n = 50) and post-intervention group (n = 57). Outcomes for DT (38.2 hours vs. 30.9 hours, P = 0.601) and AKI (20% vs. 14%, P = 0.4105) were not different before and after protocol implementation. A subgroup analysis revealed a significant reduction in DT within the pre- and post-MRSA PCR groups (38.2 hours vs. 24.8 hours, P = 0.0065) when pharmacist recommendations for de-escalation were accepted.

Conclusion
A pharmacist-driven MRSA nares screening protocol did not affect the duration of gram-positive therapy for respiratory indications. However, there was a reduction in DT when pharmacist-driven recommendations were accepted.

Disclosures
All Authors: No reported disclosures
1134. Substance Use Disorder Patients’ Perspectives of a Multidisciplinary Antimicrobial Infusion Service
Authors: Juskowich Joy J , Cooper Clinton G , Bhandari Ruchi , Boyd Stephanie S , Reece Neil , Fisher Melanie A 
Published: January 2021

Abstract

Background
Injection drug use is associated with infectious diseases such as endocarditis and osteomyelitis requiring prolonged intravenous (IV) antimicrobial therapy. Few programs offer simultaneous inpatient infectious disease and addiction treatment. WVU Medicine implemented a multidisciplinary Infusion Service (IS) to provide IV antimicrobial therapy while treating substance use disorder. From 2017 through 2019, IS cared for over 840 patients. The aim of this study was to evaluate IS by assessing patients’ perspectives of overall experience, interactions with healthcare providers, and preparation for continued recovery from substance use.

Methods
Adults ≥ 18 and &lt; 90 years-old with substance use disorder on IS between November 2019 and May 2020 were eligible. Demographic, substance use, and infectious diseases data were obtained by chart review. Confidential surveys with questions about overall experience, interactions with healthcare providers, and preparation for continued recovery were administered during the first week after transfer to IS and again the week of discharge.

Results
Forty-two patients completed 39 initial and 12 follow up surveys. All used injection drugs, 85.7% (36/42) used opioids and 66.7% (28/42) used methamphetamine. Endocarditis was most common infection (61.9% (26/42)), with Staphylococcus aureus most often isolated (59.5% (25/42)). IS experience and care for infection were excellent or good in 97.4% (38/39) initial and 100% (12/12) follow up surveys. During IS, patients did not perceive being treated differently due to substance use in 94.9% (37/39) initial and 83.3% (10/12) follow up surveys. Before IS, patients perceived being treated differently in 84.6% (33/39) initial and 100% (12/12) follow up surveys. Patients felt IS would help with continued recovery in 84.6% (33/39) initial and 100% (12/12) follow up surveys.

Conclusion
According to patients’ perspectives, IS is effective in creating a positive overall healthcare experience, reducing stigma associated with substance use, and preparing patients for continued recovery after discharge. This study supports combining inpatient infectious disease and addiction therapy. Infectious diseases providers should be educated about this multidisciplinary approach.

Disclosures
All Authors: No reported disclosures
1136. Trends in Speaker Representation at the Infectious Diseases Society of America (IDSA) IDWeek Conference, 2013-2019
Authors: Marcelin Jasmine R , Khazanchi Rohan , Lyden Elizabeth , Cawcutt Kelly , Kullar Ravina , Kullar Ravina , Rajapakse Nipunie S , Ha David R , Ristagno Elizabeth H 
Published: January 2021

Abstract

Background
Over the last decade, there have been sustained efforts to diversify the healthcare workforce. In 2016, the IDWeek Program Committee was charged to ensure gender equity in speaker sessions. Whether this intervention also resulted in more opportunities for underrepresented speakers has not been determined.

Methods
This project was supported by IDSA, who provided demographic information on IDWeek speakers (excluding poster sessions) from 2013-2019. Data were summarized using descriptive statistics, and chi-square analysis evaluated changes over time. Each speaker slot was considered an independent event. Data was combined for 2013-2016 (≤2016) and 2017-2019 (&gt;2016). IDSA membership demographics were available from 2014 for gender, race/ethnicity, from 2016 for age, and from 2018 for professional degree.

Results
A total of 3640 speaker slots were filled by 2504 individuals from 2013-2019. A larger proportion of speaker slots were filled by women &gt;2016 (51%) vs ≤ 2016 (43%), with a linear increase from 38.6% in 2013 to 52.1% in 2019 (p&lt; 0.001). Averaged across 2013-2019, IDSA membership was 67.5% White, 20.6% Asian, 7.7% Latinx, 3.9% Black, and 0.4% Other. IDWeek Speakers during that timeframe were 77.7% White, 13.9% Asian, 4.7% Latinx, 2.7% Black, and 1.0% Other; a larger proportion of slots were filled by Asian speakers &gt;2016 (16.3%) vs ≤ 2016 (12.8%) (p=0.005). The proportion of pharmacist speakers increased over time; 5.1% of speakers in 2019 reflected IDSA pharmacist membership (5.4%). The proportion of individuals invited to speak more than once differed by age (19% in &lt; 40yo, 28% 40-49yo, 32% 50-59yo, and 22% &gt;60yo; p&lt; 0.001), and professional degree (28% physicians, 18% pharmacists, 9% other doctorates, and 7% non-doctorate speakers; p&lt; 0.001).
Figure 1: Trends in Gender Distribution of IDWeek Speakers and IDSA Members, 2013-2019

Figure 2: Trends in Race/Ethnicity Distribution of IDWeek Speakers and IDSA Members, 2013-2019

Conclusion
Intentional consideration of gender equity by the Program Committee significantly improved equitable gender representation of invited speakers at IDWeek. This effort has not resulted in increased diversity of invited speakers from groups underrepresented in IDSA membership. To ensure that invited speakers represent the membership of IDSA/IDWeek partner organizations and more importantly, the communities we serve, we call for continued application of the principles of Inclusion, Diversity, Access, and Equity at IDWeek.

Disclosures
All Authors: No reported disclosures