bluuebunny/crossref_metadata_2025_split huggingface dataset:
1505. Antiviral and Antibiotic Prescribing Among Patients at an Ambulatory Cancer Center with Laboratory-Confirmed Influenza
Authors: Sorey Woody , Krantz Elizabeth M , Morris Jessica , Klaassen John , Sweet Ania , Tverdek Frank , Pergam Steven A , Liu Catherine 
Published: January 2021

Abstract

Background
Cancer patients are at high risk for serious complications due to influenza. Early treatment with neuraminidase inhibitors (NAIs) is recommended for high-risk patients with suspected or documented influenza. Limited data exist on timing of presentation to care and ambulatory management of cancer patients with influenza. We sought to characterize antimicrobial prescribing and outcomes among patients with influenza at a large cancer center.

Methods
We selected consecutive patients seen in the ambulatory cancer clinic with laboratory confirmed influenza between January 1, 2016 and December 31, 2018 for chart review. A lab-developed multiplex PCR assay was used with a turnaround time of about 24 hours. We obtained demographics, symptoms at first clinic encounter (day 0), viral testing, NAI and antibiotic prescribing, and clinical outcomes.

Results
Of 138 charts reviewed, 133 (96%) were eligible for analysis. 109 (82%) had an underlying hematologic malignancy. 84 (63%) tested positive for influenza A and 49 for influenza B. 58 (44%) presented to care within 48 hours of symptom onset (F1). The most commonly reported symptoms were cough (83%), fever (41%), and rhinorrhea (40%) (F2). 110 (83%) were prescribed oseltamivir, with 24 (22%) receiving empiric therapy on day 0, and 63 (57%) prescribed on day 1 (F3). Among 109 patients with known symptom onset date, 34 (31%) were prescribed oseltamivir within 48 hours of symptom onset. 23 (17.3%) were prescribed antibiotics, 17 (74%) on day 0 (F3). Levofloxacin (26%), azithromycin (21%) and vancomycin (18%) were most commonly prescribed. Nine (6.8%) patients progressed to lower respiratory tract infection, 1 complicated by bacterial pneumonia. There were 11 (8.3%) influenza-related hospitalizations, 1 (0.7%) ICU admission, and no influenza-related deaths.
Figure 1. Time From Symptom Onset to Date of First Clinical Encounter

Figure 2. Symptoms Reported at First Clinical Encounter

Figure 3. Time from First Clinical Encounter to Oseltamivir and Antibiotic Prescription

Conclusion
NAIs were frequently prescribed among cancer patients, but less than a third received treatment within 48 hours of symptom onset. Most were prescribed NAIs only after test results were available, while antibiotics were prescribed empirically. Delayed presentation to care is an obstacle to early NAI use; patient and provider education along with rapid diagnostics are needed to improve early NAI use among cancer patients with influenza.

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)
124. Acute Uncomplicated Cystitis in Urgent Care Centers: Changes in Antibiotic Prescribing Practices Before and After Provider Education
Authors: Cofsky Rebecca S , Goodman David , Morton Arianna , Powell Debra L , Blanchard Edward 
Published: January 2021

Abstract

Background
Acute uncomplicated cystitis (AUC) is a frequent infection that requires antibiotic treatment that is seen in women who seek care at urgent care centers.1 The Infectious Diseases Society of America (IDSA) has published guidelines for the management of AUC. They recommend nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin as the first-line agents for the treatment of AUC in healthy adult women.1 Previous evaluation of prescribing practices at Tower Health Urgent Care Centers demonstrated a 16% compliance rate with treatment guidelines for AUC. Subsequently, provider education and an AUC medication order set in the electronic medical record (EMR) were implemented. The purpose of this study was to evaluate the effectiveness of these interventions on prescribing practices for AUC.

Methods
A retrospective electronic chart review was performed evaluating the antibiotic treatment of patients diagnosed with AUC between January 1, 2018, to June 30, 2019, excluding July 2018 to September 2018, the washout period during which education was provided. Inclusion criteria included age ≥ 18 years, female, and treated at one of three Tower Health Urgent Care Centers.

Results
1,455 patients met inclusion criteria during our study period. Our three-month washout period included 273 of those patients. 421 patients were included in the pre-education analysis with 761 patients in the post-education analysis. When both first and second-line antibiotic prescriptions were evaluated in conjunction with considering patient allergies and concomitant infections, compliance was 59% in our post-education analysis (improved from 16% compliance at baseline).

Conclusion
Provider education and an AUC medication order set in the EMR were successful in increasing the compliance rate with antibiotic treatment guidelines for the management of AUC in adult females in the urgent care setting.

Disclosures
All Authors: No reported disclosures
1512. Influenza vaccine effectiveness wanes over the influenza season: results from five military treatment facilities
Authors: Richard Stephanie A , Schofield Christina , Colombo Rhonda , Fairchok Mary P , Maves Ryan C , Arnold John , Danaher Patrick , Deiss Robert , Lalani Tahaniyat , Rajnik Michael , Millar Gene , Coles Christian L , Burgess Timothy 
Published: January 2021

Abstract

Background
Influenza vaccination can reduce influenza burden, but questions have arisen about the duration of vaccine protection. While the timing of vaccination varies, annual receipt of influenza vaccine is mandated for active duty military personnel. The goal of this analysis is to determine if influenza vaccine effectiveness decreases over time. A secondary goal of this analysis is to determine if repeated influenza vaccination is associated with risk for influenza.

Methods
Otherwise healthy individuals presenting for treatment of acute respiratory infections at 5 military treatment facilities from 2009 to 2018 were enrolled in the Acute Respiratory Infection Consortium (ARIC) study. Individuals with complete demographics, influenza vaccination in the two years prior to illness, and influenza laboratory results were included in this analysis (n=1,273). Multivariate logistic regression was used to calculate the odds of an influenza diagnosis according to time since influenza vaccination, categorized in 90-day periods. The model also included age, race, month of diagnosis, influenza season, and whether the participant received 4+ influenza vaccinations in the past 5 years.

Results
One hundred and ninety-two individuals (15%) had laboratory confirmed influenza (Table 1). Participants were mostly active duty, male, and white. Over half of the participants received 4+ influenza vaccinations in the past 5 years. Participants who were vaccinated 90-179 and 180+ days ago had greater odds of being diagnosed with influenza than did individuals who were vaccinated &lt; 90 days prior to illness onset (Table 2). Participants who were 18-24 years old had lower odds of influenza than individuals in other age groups. Vaccine experience (vaccinated against influenza for at least four of the past five years), race, and ethnicity were not statistically significantly associated with influenza diagnosis.
Table 1. Characteristics of individuals included in the analysis of waning influenza vaccine effectiveness in the ARIC study

Table 2. Multivariate logistic regression results from model using influenza diagnosis as the outcome variable. Also included in the model are season and month of diagnosis.

Conclusion
Influenza vaccination was most effective 14-89 days post-vaccination and effectiveness decreased thereafter. Repeat influenza vaccination, however, was not significantly associated with greater odds of influenza. The waning effectiveness of influenza vaccination indicates additional consideration be given to the timing of vaccination.
Disclaimer

Disclosures
All Authors: No reported disclosures
125. Comparison of Diagnosis and Prescribing Practices between Virtual Visits and Office Visits for Adults Diagnosed with Uncomplicated Urinary Tract Infections within a Primary Care Network
Authors: Johnson Kaitlyn , Dumkow Lisa E , Salvati Lisa , Johnson Kristen , Yee Megan , Egwuatu Nnaemeka 
Published: January 2021

Abstract

Background
Urinary tract infections (UTIs) are one of the most common infectious indications for antibiotic prescribing in the outpatient setting. With the exponential growth of virtual visits over the past decade, virtual visits represent an important ambulatory care target for antimicrobial stewardship programs outside of traditional office visits. This study aimed to compare the appropriateness of antimicrobial therapy between virtual visits and office visits for adult females diagnosed with uncomplicated UTIs within a primary care network.

Methods
This retrospective cohort study evaluated adult female patients diagnosed with a UTI within a primary care network comprised of 44 outpatient sites. The primary objective was to compare guideline-concordant antibiotic prescribing between virtual visits and office visits. Guideline-concordance was determined based on local antibiogram-based treatment recommendations. Secondary objectives included comparing appropriate treatment duration and use of diagnostic testing resources between groups. Additionally, patient outcomes were compared between groups including 48-hour, 7-day, and 30-day re-visits, or development of Clostridioides difficile infection within 30 days.

Results
A total of 350 patients were included in this study, with 175 patients in each group. Patients treated for a UTI via a virtual visit were more likely to be prescribed a first-line antibiotic (74.9% vs 59.4%; P = 0.002). Additionally, virtual visits were more likely to prescribe an appropriate duration (100% vs 53.1%; P= &lt; 0.0001). Patients treated via office visits were more likely to have a urinalysis (0% vs 97.1%; P &lt; 0.001) and urine culture (0% vs 73.1%; P &lt; 0.0001) ordered. There was no difference between groups in 48-hour or 30-day revisits, however, patients completing office visits were more likely to have a revisit within 7 days (18.9% vs 5.1%; P &lt; 0.0001). In multivariate logistic regression, UTI care via office visit was the only independent risk factor for 7-day revisit (OR 3.74, 95% CI 1.31 -10.67).

Conclusion
In adult female patients presenting with uncomplicated UTIs, care at a virtual visit was associated with significantly improved antimicrobial prescribing compared to office visits and decreased utilization of diagnostic and follow-up resources.

Disclosures
All Authors: No reported disclosures
1519. Reduction of healthcare-associated viral infections during COVID-19 pandemic
Authors: Handy Lori , Ehritz Carly , Hei Hillary , Brennan Lauren K , Wilson Kimberly , O’Callaghan Kevin P , Coffin Susan E , Coffin Susan E , Sammons Julia S 
Published: January 2021

Abstract

Background
Healthcare-associated viral infections (HAVI) are a common cause of preventable harm, particularly in pediatric patients. We utilized routine hospital-wide surveillance data for HAVIs at a quaternary care pediatric hospital in order to assess the impact of enhanced public health measures on rates of HAVI at our institution during the COVID-19 pandemic.

Methods
Patient cases of HAVI were detected through routine house-wide microbiologic surveillance. Compliance with our institutional prevention bundle, which includes hand hygiene, appropriate use of isolation precautions and personal protective equipment (PPE), maintaining a clean and clutter free environment, employee illness policy, and restrictions on sick visitors, was measured through use of Kamishibai-card rounding.

Results
During the most acute period of the COVID-19 pandemic, intensification of the majority of elements of the HAVI bundle occurred by nature of our institutional response, including use of PPE monitors in certain locations, increased used of eye protection, universal masking for staff and caregivers, re-education for employees on not coming to work sick, and further restrictions to visitation. The monthly HAVI rate in the acute phase of the COVID-19 pandemic was lower in March (0.76), April (0.27) and May (0.0) 2020 compared to the same time period last year (0.8, 0.8, 0.56). Bundle compliance during those months in 2020 was 83%, 89%, and 100%, respectively. In May, zero HAVIs were identified. (Figure 1)
Healthcare-associated viral infections rate and bundle compliance after COVID-19 prevention measures

Conclusion
The intensification of routine infection prevention practices aimed at minimizing the transmission of COVID-19 may also reduce rates of HAVI. During our COVID response, we identified a decrease in our institutional HAVI rate compared to the same time last year, reaching lower special cause in May with a rate of 0. We will have ongoing measurement of the HAVI rate throughout the pandemic to determine if this reduction can be sustained and understand which intensified bundle elements need to be maintained in non-pandemic hospital operations.

Disclosures
All Authors: No reported disclosures
1520. Respiratory Syncytial Virus Hospitalizations (RSVH) and All-Cause Bronchiolitis Hospitalizations (BH) Among Children Aged ≤ 24 Months at the Start of RSV Season With Bronchopulmonary Dysplasia/Chronic Lung Disease of Prematurity (BPD/CLDP) Before and After the 2014 American Academy of Pediatrics (AAP) Policy
Authors: Fergie Jaime , Gonzales Tara , Suh Mina , Jiang Xiaohui , Fryzek Jon , Howard Ashley , Bloomfield Adam 
Published: January 2021

Abstract

Background
The AAP, in 2014, stopped endorsing palivizumab for use in children with BPD/CLDP born at &lt; 32 weeks’ gestational age (wGA) between the ages of 12 to 24 months not requiring medical support during the 6 months before the start of RSV season and all children with BPD/CLDP born at &gt; 32 wGA. We sought to understand the impact of the guidance change on RSVH and BH in children no longer advised for RSV immunoprophylaxis with palivizumab.

Methods
Children with BPD/CLDP aged ≤ 24 months at the RSV season start and hospitalized for RSV or bronchiolitis during the 2010-2017 RSV seasons (November-March) were studied. RSVH, BH, and BPD/CLDP were defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM codes. ICD-9 codes for wGA combine 31 and 32 wGA into one code. Therefore, for BPD/CLDP, we classified group 1 as children aged 12 to 24 months who were born at &lt; 31 wGA and group 2 as those born at ≥ 31 wGA. The Children’s Hospital Association’s Pediatric Health Information System® (PHIS) data set was used to describe frequency and characteristics of RSVH and BH and disease severity (including intensive care unit [ICU] admission and mechanical ventilation [MV]) before and after the 2014 AAP policy. Statistical analyses were done using z-tests; SAS version 9.4.

Results
Among children with BPD/CLDP, RSVH rates were 1.7% (1035/59,217) before 2014 and 2.1% (973/45,470) after 2014 (P&lt; 0.0001). RSVH rose after the policy change vs before among children with BPD/CLDP in both group 1 (0.40% vs 0.26%; P&lt; 0.0001) and group 2 (0.22% vs 0.14%; P=0.002). Similarly, BH also increased for both group 1 (P&lt; 0.0001) and group 2 (P=0.002) after the guidance change vs before. Although ICU admissions increased significantly for children with BPD/CLDP in both group 1 (P&lt; 0.0001) and group 2 (P=0.0004), use of MV (P=0.002) increased after 2014 for children with BPD/CLDP in group 1 only. Similar results were observed for BH.

Conclusion
This analysis highlights the increase in RSVH, BH, and associated severity among BPD/CLDP subgroups within the PHIS health system after 2014. Further study of long-term complications associated with RSVH in these children is warranted.

Disclosures
Jaime Fergie, MD, AstraZeneca (Speaker’s Bureau)Sobi, Inc. (Speaker’s Bureau) Tara Gonzales, MD, Sobi, Inc. (Employee) Mina Suh, MPH, International Health, EpidStrategies (Employee) Xiaohui Jiang, MS, EpidStrategies (Employee) Jon Fryzek, PhD, MPH, EpidStrategies (Employee) Adam Bloomfield, MD, FAAP, Sobi, Inc. (Employee)
1526. The economic impact of respiratory syncytial virus (RSV) in infants in the United States: systematic literature review
Authors: Bowser Diana , Gervasio Reissa , Glaser Elizabeth , Harihan Dhwani , Rowlands Katie , Buckley Lauren , Rizzo Christopher , Nelson Christopher 
Published: January 2021

Abstract

Background
Respiratory syncytial virus (RSV) is a human orthopneumovirus spread by direct contact with symptomatic, infected individuals. An estimated 587,000 RSV LRTIs result in inpatient or outpatient encounters annually among US infants (Rainisch et al 2019). The health care costs associated with RSV include medical costs to insurers, governments, and households, travel, and loss of wages.
Initial summary of Inpatient and Ambulatory Medical Costs p Infant w RSV.JPG Jun 17th, 2020 @ 2:44 PM 852 x 572 122.3 Kb

Methods
A systematic literature review of the costs associated with children who have RSV was conducted. Following PRISMA methodology, key search terms were searched within article titles and abstracts through PubMed, EconLit, and Scopus. A total of 1,942 unique abstracts were screened independently by two authors and reduced to 180 articles after applying inclusion and exclusion criteria. The number of included articles after reviewing the full text was 66. Costing results were adjusted to USD2020 based on the Medical Care Consumer Price Index.

Results
Costing results were reported mainly for medical costs in inpatient settings. Initial results show that annual mean inpatient costs per RSV patient range among individual studies from $9,825 (SD=$25,227) for full term infants to $26,120 (SD unspecified) for late preterm infants (Table 1). Costing results vary by gestational age, with late preterm infants having an annual mean inpatient cost almost 1.6 times that of a full term infant. Inpatient costs for RSV infants are higher for commercial pay versus Medicaid, for both full term infants (commercial mean=$16,489 SD=$31,068, Medicaid mean=$10,291 SD=$64,625) and late preterm infants (commercial mean=$23,836; SD=$43,709, Medicaid mean=$18,864 SD=$28,716). Annual RSV ambulatory costs per infant vary between $4,371 (SD=$13,411) and $19,963 (SD=$27,269), depending on gestational age. Other relevant RSV costs include preventative drug costs, such as palivizumab (average $11,954 per infant).

Conclusion
The literature describes the economic impact of RSV primarily for hospitalization of children with underlying comorbidities. There is a need to better understand costing results for RSV, including the burden in ambulatory settings and indirect costs to families affected.

Disclosures
All Authors: No reported disclosures
1529. Sexually-Transmitted Infection Testing and Positivity among Adults Receiving HIV Pre-Exposure Prophylaxis within an Integrated Health Care Delivery System in the United States
Authors: Schmidt Mark A , Dickerson John F , Schmidt Suzanne B , O’Keeffe-Rosetti Maureen , Donald Judy L , Stenzel Molly S 
Published: January 2021

Abstract

Background
The goal of this project was to assess the frequency of sexually-transmitted infection (STI) testing and positivity among adult individuals initiating HIV Pre-Exposure Prophylaxis (PrEP) within Kaiser Permanente Northwest (KPNW).

Methods
We identified KPNW members, 18 years of age and older, who initiated PrEP (tenofovir+emtricitabine) between January 1, 2015 – December 31, 2018. Using data elements abstracted from the electronic health record system, we assessed demographic characteristics of those initiating PrEP and the rate of testing and positivity for HIV, chlamydia (CT) and gonorrhea (GC) and syphilis within a window around 120 days after PrEP initiation.

Results
Overall, 685 members initiated PrEP during our study period, 661 (96.5%) of whom were male. Mean and median ages were 38 and 36 years, respectively, with those 25-34 years of age comprising the highest proportion (241; 35.2%). The 460 PrEP initiators (67.2% of total) who continued use beyond 120 days were significantly older than those who discontinued use (39 vs. 36 years, p=0.0008). Among continuous users, 78.3% were tested for CT+GC and 83.9% were tested for syphilis roughly 120 days post-initiation, with positivity proportions of 6.9%, 6.7%, and 2.3%, respectively. Among those discontinuing, 39.6% were tested for CT+GC and 37.3% were tested for syphilis, with positivity proportions of 10.1%, 9.0%, and 2.4%, respectively. HIV testing was completed for 87.4% of continuous PrEP users and 40.9% of those who discontinued use; and we identified a total of three individuals who tested positive for HIV, all among the latter group. Manual chart review of these individuals confirmed that HIV exposure and infection occurred after PrEP discontinuation.

Conclusion
We found high rates of STI testing among individuals receiving PrEP, in accordance with recommendations. Our findings of a lower STI prevalence among PrEP users is encouraging, although further work is required to assess the impact of differential testing rates and age between those who continue and discontinue PrEP use as well as reasons for PrEP discontinuation. Regular testing remains an important part of comprehensive PrEP care management and should continue to be encouraged to identify and treat STI among those at high risk for disease.

Disclosures
All Authors: No reported disclosures