bluuebunny/crossref_metadata_2025_split huggingface dataset:
2. Median Income is Associated with Need for Mechanical Ventilation in COVID-19
Authors: Shallal Anita , Quan Daniel , Wong Lucía Luna , Opara Ijeoma N , Zervos Marcus 
Published: January 2021

Abstract

Background
The coronavirus disease 2019 (COVID-19) pandemic unmasked the devastating impact of social and health disparities on communities of color. Black race, body mass index (BMI), and presence of comorbidities have been associated with increased severity of disease and need for mechanical ventilation (MV). We examined socioeconomic variables including social support, highest level of education, median income, housing, food insecurity, and employment status, and poverty rate to determine their impact on the need for MV.

Methods
Retrospective cohort study of 2,038 adult patients with positive SARS-CoV2 test admitted to four large hospitals within the Henry Ford Health System from March 12-April 24 and followed until May 27, 2020. Collected data included patient demographics, employment status, health insurance status, and comorbidities via Charlson Comorbidity Index (CCI). Census tracts were obtained from patient addresses and used to obtain socioeconomic data from the 2018 American Community Survey and the Food Access Research Atlas. The primary outcome assessed was frequency of MV. Univariate and multivariate analysis was performed on prehospital variables to identify independent predictors for mechanical ventilation.

Results
Patients who required MV were significantly more likely to be male (p=0.0006), black race (p=0.012), and have higher CCI (p&lt; 0.0001) and BMI (p&lt; 0.0001). Using census tract data, patients who required MV lived in neighborhoods with lower median income (p&lt; 0.0001), educational attainment (p&lt; 0.0001), and higher levels of food insecurity (p=0.0007). Multivariate analysis revealed male sex, high BMI, CCI, and lower median income to be independent predictors of need for MV. The remaining results are summarized in Tables 1 and 2.
Table 1

Table 2

Conclusion
This study demonstrates the significant impact of socioeconomic status on frequency of MV in COVID-19 patients. Healthcare providers must be aware of disparities in order to address the systematic inequities that harm vulnerable populations.

Disclosures
Marcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)
6. MF59 ASSURANCE 2: A Real-world Study to Estimate the Relative Vaccine Effectiveness of Adjuvanted Trivalent Influenza Vaccine Compared to Egg-based Trivalent High-dose Among U.S. Older Adults During 2018–19 Influenza Season
Authors: Pelton Stephen I , Postma Maarten , Divino Victoria , Shah Drishti , Mould-Quevedo Joaquin F , DeKoven Mitchell , Krishnarajah Girishanthy 
Published: January 2021

Abstract

Background
In the 2018–19 influenza season, influenza resulted in almost 280,000 hospitalizations and over 25,000 deaths in U.S. adults &gt; 65 years. This study aimed to evaluate the relative vaccine effectiveness (rVE) of adjuvant trivalent influenza vaccine (aTIV) compared to high-dose trivalent influenza vaccine (TIV-HD), against influenza-related hospitalizations/emergency room (ER) visits, office visits and hospitalization/ER visit for cardio-respiratory disease (CRD) among older adults for the 2018–19 flu season.

Methods
A retrospective cohort analysis of older adults (&gt; 65 years) was conducted using professional fee, prescription claims and hospital charge master data in the U.S. Baseline characteristics included age, gender, payer type, region, Charlson Comorbidity Index (CCI), comorbidities, indicators of frail health status, and pre-index hospitalization rates. Adjusted analyses were conducted through inverse probability of treatment weighting (IPTW) to control for selection bias. Poisson regression was used to estimate the adjusted pairwise rVE against influenza-related hospitalizations/ER visits and office visits and any hospitalization/ER visit for CRD (based on diagnoses codes). An unrelated outcome, urinary tract infection (UTI) hospitalization, was assessed.

Results
During 2018–19 flu season, following IPTW analyses, 561,315 recipients of aTIV and 1,672,779 of TIV-HD were identified. After IPTW adjustment and Poisson regression, aTIV was more effective in reducing influenza-related office visits compared to TIV-HD (6.6%; 95% CI: 2.8%-10.3%). aTIV was statistically comparable to TIV-HD (2.0%; 95% CI: -3.7%-7.3%) for prevention of influenza-related hospitalizations/ER visits but more effective than TIV-HD (2.6%; 95% CI: 2.0%-3.2%) in reducing hospitalizations/ER visits for CRD. No treatment effect was identified for control condition (UTI hospitalization).

Conclusion
In adjusted analyses, aTIV reduced influenza-related office visits and CRD hospitalizations/ER visits compared to TIV-HD. aTIV and TIV-HD demonstrated comparable reductions in influenza-related hospitalizations/ER visits.

Disclosures
Stephen I. Pelton, MD, Merck vaccine (Consultant, Grant/Research Support)Pfizer (Consultant, Grant/Research Support)Sanofi Pasteur (Consultant, Other Financial or Material Support, DSMB)Seqirus Vaccine Ltd. (Consultant) Maarten Postma, Dr., IQVIA (Consultant) Victoria Divino, PhD, Seiqrus Vaccines Ltd. (Consultant) Drishti Shah, PhD, Seqirus Vaccines Ltd. (Consultant) Joaquin F. Mould-Quevedo, PhD, Seqirus Vaccines Ltd. (Employee, Shareholder) Mitchell DeKoven, PhD, Seqirus Vaccines Ltd. (Consultant) Girishanthy Krishnarajah, PhD, Seqirus Vaccines Ltd. (Employee, Shareholder)
10. The Impact of the Verigene® Gram-positive Blood Culture Panel on the Management of Vancomycin Resistant enterococci Bloodstream Infections in a Multi-site Cohort Study
Authors: Jackson Christopher , Bandy Sarah , Godinez Will , Gawrys Gerard , Lee Grace 
Published: January 2021

Abstract

Background
Vancomycin-resistant Enterococcus (VRE) bloodstream infections (BSIs) are associated with high morbidity and mortality. PCR-based rapid diagnostic tests provide prompt identification of infectious etiologies within hours. This study evaluated the impact of the Verigene® Gram-positive blood culture (GP-BC) panel on the outcomes on patients with VRE BSIs.

Methods
A multi-center pre- and post-implementation retrospective cohort study was conducted at four large HCA Healthcare facilities. The implementation of Verigene® GP-BC and VigiLanz® surveillance software with real-time notifications to clinical pharmacists occurred in 2015. Adults &gt; 18 years with VRE BSIs were evaluated over two time periods; pre-implementation (Pre; May 2011 - May 2013) and post-implementation (Post; May 2015 - May 2017). Patients were excluded if not admitted or were discharged/deceased before blood culture results. The primary outcome of this study was to compare time to optimal therapy (TOT). Secondary outcomes included hospital mortality, length of stay (LOS), and TOT comparing clinical pharmacy staffing models. Multivariable logistic regression models were used to identify independent predictors. Adjusted ORs (aOR) and their 95% CIs were reported.

Results
A total of 104 patients with VRE BSIs were included in the study; 50 and 54 in the pre- and post-implementation periods, respectively. There were no differences in baseline characteristics between the groups. TOT was significantly shorter in the post vs. pre group (29 hrs ± 36 vs. 67 hrs ± 124, p=0.03). There was significantly lower hospital mortality when comparing the pre- and post-implementation periods (32% vs. 11%, p&lt; 0.01). After adjusting for age, sex, severity of illness, treatment/dose, the post implementation period was independently associated with reduced hospital mortality (aOR 0.21, CI 0.61–0.73, p=0.01). There were no significant differences in LOS or clinical pharmacy staffing models on TOT.
Baseline Characteristics

Primary and secondary outcomes data

Conclusion
The implementation of the Verigene® BC-GP with VigiLanz® substantially decreased TOT for VRE BSIs and was associated with reduced hospital mortality. This study highlights the positive impact of RDTs on shorter TOT and associated clinical outcomes.

Disclosures
All Authors: No reported disclosures
13. Evaluation of Etest for Antibiotic Susceptibility and Minimum Inhibitory Concentration (MIC) Agreement Against pseudomonas Aeruginosa (psa) from Patients with Cystic Fibrosis (CF)
Authors: Lasko Maxwell J , Huse Holly , Kuti Joseph L , Nicolau David P 
Published: January 2021

Abstract

Background
CF acute pulmonary exacerbations are often caused by PSA, including multi-drug resistant strains. Optimal antibiotic therapy is required to return lung function and should be guided by in vitro susceptibility results. There are sparse data on the performance of Etest relative to reference broth microdilution (BMD) for many newer drugs against CF PSA. Herein, we describe Etest performance with 10 anti-PSA antibiotics against CF isolates.

Methods
Contemporary, clinical PSA (n=105) isolated during pulmonary exacerbation from patients with CF were acquired from 3 US hospitals. MICs were assessed by BMD (reference) and Etest for aztreonam (ATM), cefepime (FEP), ceftazidime (CAZ), ceftazidime/avibactam (CZA), ceftolozane/tazobactam (C/T), ciprofloxacin (CIP), levofloxacin (LVX), meropenem (MEM), piperacillin/tazobactam (TZP), and tobramycin (TOB). Each respective MIC was completed in at least triplicate using the same inoculum between methods. Modal MICs for each method were compared by rates of essential agreement (EA), categorical agreement (CA), minor error (miE), major error (ME), and very major error (VME) rates. All miE, ME and VME were adjusted if within EA.

Results
Of the 105 PSA, 46% had a mucoid phenotype. Results are summarized in the Table. Median modal Etest MICs read 0–1 dilution higher (IQR: 0–1) than BMD. CA and EA ranged from 64–93% and 63–86%, respectively. Single VMEs occurred for ATM (2.9%) and CAZ (4.2%). For CZA, 2 VMEs were observed and both were within EA. Major errors were ≤3% except for ATM (3.3%), MEM (3.3%), CZA (5.3% with adjusted ME 2.1%*), and FEP (13%). Minor error rates were &lt; 10% except for TZP, CIP, LEV, TOB, and FEP (13–29%), for which majority of miE were within EA (3/14, 11/16, 10/18, 13/19, 20/31, respectively). Performance was similar for non-mucoid and mucoid populations.
Etest Performance

Conclusion
Etest methods performed well for most antibiotics against this challenging collection of PSA from CF patients. Laboratories should be cautious of miE and ME that may occur with certain antibiotics. Furthermore, our observations suggest laboratories confirm CZA results for isolates with MICs near the breakpoint.

Disclosures
Joseph L. Kuti, PharmD, Allergan (Speaker’s Bureau)bioMérieux (Research Grant or Support, Other Financial or Material Support, Speaker Honorarium)Melinta (Research Grant or Support)Merck & Co., Inc. (Research Grant or Support)Paratek (Speaker’s Bureau)Summit (Other Financial or Material Support, Research funding (clinical trials)) David P. Nicolau, PharmD, Cepheid (Other Financial or Material Support, Consultant, speaker bureau member or has received research support.)Merck & Co., Inc. (Consultant, Grant/Research Support, Speaker’s Bureau)Wockhardt (Grant/Research Support)
15. Leveraging Data to Explore the Consequences of Urine Testing and Antibiotic Use During the Spinal Cord Injury Annual Evaluation
Authors: May Sarah B , Walder Annette , Holmes S Ann , Poon Ivy , Evans Charlesnika T , Trautner Barbara , Skelton Felicia 
Published: January 2021

Abstract

Background
The Veterans’ Health Administration (VHA), currently mandates that every spinal cord injury and disorder (SCI/D) patient receives a screening urinalysis and urine culture (UC) during the annual evaluation (AE). Our pilot study at a single VHA center showed that 87% of the UCs obtained during the AE represented asymptomatic bacteriuria (ASB), and that 35% of those UC were treated with antibiotics unnecessarily. The objective of the current study is to determine the association between UC and antibiotic use using a national VHA sample of SCI/D patients.

Methods
Retrospective cohort of Veterans who presented to a VHA SCI/D clinic for their AE in FY18 or FY19. Demographic and clinical characteristics as well as information on primary outcomes (receipt of urine culture and antibiotics) were extracted from the VHA Corporate Data Warehouse. Associations between covariates and outcomes were assessed using logistic regression. P values &lt; 0.05 were considered significant.

Results
9447 veterans with SCI/D were included, of whom 5088 (54%) had a UC obtained. Of those with a UC, 2910 (57%) were classified as positive (Figure 1). 1054 (11%) veterans were prescribed antibiotics within 7 days of their AE. Of these, 515 had a positive UC, 202 had a negative UC, and 2878 did not have a UC obtained during the AE. Age, ethnicity, neurologic level of injury (NLI), comorbidity score, frequently identified organism on positive culture, and receipt of antibiotics within 7 days of AE were significantly associated with obtaining a UC during the AE. Race, NLI, bladder management strategy, comorbidity score, frequently identified organism on positive culture, and having a UC obtained during the AE were significantly associated with receipt of antibiotics within 7 days of AE.
Flowchart of SCI/D Veterans who had a urine culture and/or received antibiotics during their FY18/19 AE

Conclusion
Over half of Veterans with SCI/D presenting for their AE receive a screening UC, contrary to other national guidelines recommending against this practice. Age and type or organism identified on UC drive antibiotic use, which was similar to our previous findings and reflect themes identified during our qualitative interviews with SCI/D providers. The knowledge gained from this national VA study will assist the development of interventions to reduce unnecessary urine testing and antibiotic use in the SCI/D population.

Disclosures
All Authors: No reported disclosures
17. Comparative Safety of Antibiotic Therapy for Outpatient Treatment of Uncomplicated Urinary Tract Infections
Authors: Butler Anne M , Durkin Michael , Keller Matthew R , Ma Yinjiao , Powderly William , Olsen Margaret A 
Published: January 2021

Abstract

Background
Urinary tract infection (UTI) is one of the most common indications for outpatient antibiotic prescriptions in otherwise healthy women, yet the comparative safety of antibiotics for empirical therapy is not well established. We compared the risk of adverse drug events by antibiotic treatment regimen among premenopausal women with uncomplicated UTI.

Methods
Using the IBM MarketScan Commercial Database (2006–2015), we identified healthy, non-pregnant women aged 18–44 who were diagnosed with UTI and prescribed a same-day antibiotic with activity against common uropathogens. Patients were followed for outcomes with varying follow-up periods: 3 days (anaphylaxis), 14 days (acute renal failure, skin rash, urticaria/hives, nausea/vomiting, abdominal pain), 30 days (vaginitis/vulvovaginal candidiasis, non-C. difficile diarrhea) and 90 days (C. difficile diarrhea, pneumonia, tendinopathy, retinal detachment). We estimated propensity score-weighted hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional hazards models.

Results
Of 1,140,602 eligible women, the distribution of antibiotic receipt was fluoroquinolones (44%), trimethoprim-sulfamethoxazole (TMP/SMX) (28%), nitrofurantoin (24%), narrow-spectrum β-Lactam / β-Lactamase inhibitor combinations (“β-Lactams”) (3%), broad-spectrum β-Lactams (1%) and amoxicillin/ampicillin (1%). Of two first-line agents, we observed higher risk of outcomes among TMP/SMX vs. nitrofurantoin initiators: acute renal failure (HR 2.46, 95% CI 1.46–4.14), skin rash (HR 2.43, 95% CI 2.13–2.77), urticaria (HR 1.35, 95% CI 1.18–1.56), nausea/vomiting (HR 1.19, 95% CI 1.10–1.29) and abdominal pain (HR 1.14, 95% CI 1.09–1.19). Compared to nitrofurantoin, non-first-line agents (fluoroquinolones, broad-, and/or narrow-spectrum β-Lactams) were associated with higher risk of acute renal failure, skin rash, nausea/vomiting, abdominal pain, vaginitis/vulvovaginal candidiasis, diarrhea (C. difficile & non-C. difficile), pneumonia and tendinopathy.

Conclusion
The risk of adverse drug events differs widely by antibiotic agent, with substantial differences in first-line agents. Understanding antibiotic safety is critical to prevent suboptimal antibiotic prescribing and reduce adverse events.

Disclosures
Margaret A. Olsen, PhD, MPH, Merck (Grant/Research Support)Pfizer (Consultant, Grant/Research Support)
18. Durations of Antibiotic Therapy and Factors Associated with Longer Than Recommended Durations for Common Ambulatory Infections in an Integrated Healthcare System
Authors: Deida Axel Vazquez , Shihadeh Katherine C , Aragon Deborah , Knepper Bryan C , Jenkins Timothy C 
Published: January 2021

Abstract

Background
Duration of antibiotic therapy is an important focus for antibiotic stewardship, but the extent and drivers of excessive durations are not well understood. This project aimed to describe durations of therapy prescribed for common infections across the ambulatory care settings of an integrated healthcare system and identify factors associated with longer than recommended durations.

Methods
This was a retrospective, cross-sectional evaluation conducted from July 1, 2018 to June 30, 2019. We identified antibiotic prescriptions for adults age 18 years or older presenting to a Denver Health ambulatory care facility (urgent care, emergency department, family medicine clinic, or internal medicine clinic) for an infection with a recommended duration of therapy of 5 days or less based on institutional guidance. Infections included purulent and non-purulent cellulitis, uncomplicated subcutaneous abscess, acute bacterial sinusitis (ABS), acute otitis media (AOM), community acquired pneumonia, cystitis, and pyelonephritis treated with an indicated fluoroquinolone. Prescriptions for more than 5 days were classified as longer than recommended. We evaluated whether the following factors were associated with longer than recommended prescriptions: location of visit, type of infection, patients’ age, race/ethnicity, sex, infection type, and prescribing provider type

Results
5331 prescriptions met inclusion criteria. Of those, the duration of therapy was longer than recommended for 2095 (39%) (Table 1). Durations varied significantly across locations (p&lt; 0.0001). In the sub-group analysis family medicine clinics had the highest proportion of longer than recommended durations (46%). Durations also varied significantly by type of infection. For cellulitis, ABS, and AOM, the duration was longer than recommended in 50%, 54%, and 75% of cases, respectively. Other factors associated with longer than recommended durations included male sex (p&lt; 0.0001) and prescriptions by advanced practice providers (p = 0.0008).
Table 1: Antibiotic Duration of Therapy for Common Outpatient Infections

Conclusion
Care locations, infection types, and both patient and prescriber factors were associated with longer than recommended prescriptions suggesting specific opportunities to prevent excessive durations of therapy.

Disclosures
All Authors: No reported disclosures
19. A Global Point Prevalence Survey of Antimicrobial Use in Neonatal Intensive Care Units
Authors: Prusakov Pavel , Goff Debra A , Wozniak Phillip , Sanchez Pablo J 
Published: January 2021

Abstract

Background
Antimicrobials are one of the most commonly used medications in the NICU. We aimed to gather baseline global data on antimicrobial use to facilitate subsequent antimicrobial stewardship efforts.

Methods
We conducted a one-day global NICU point prevalence study on July 1, 2019 with a 30-day follow up. Data collection included patient demographics, antimicrobial therapy, site location, antimicrobial stewardship (AS) practices as well as the duration of antimicrobial therapy and in-hospital mortality were recorded.

Results
Eighty-one NICUs from twenty-eight different countries identified 2,163 admitted patients of which 570 (26%) were prescribed at least one antimicrobial. Three NICUs did not have any patients on antimicrobial therapy, all had less than 20 patients admitted. Level 3 and Level 4 NICUs comprised 51% and 48% respectively. Delivery units comprised 74%, the rest were referral centers. AS programs were in place in 62% of the hospitals and 47% of the units had NICU specific initiatives. Patients were on average 32.5 weeks gestational age (+/-5.3 SD), with birth weight of 1976 grams (+/- 1022 SD), and were 32 days (+/-65 SD) postnatal age at the time of the study.
Antibiotics were the most frequently used medication in 92% of patients with 931 antibiotics prescribed on the assessment day. Hospitals with any NICU AS initiative had significantly lower rates of antibiotic utilization compared to NICUs without AS (21% and 32%; p-value: &lt; 0.01). Of those on antibiotic therapy, ampicillin, gentamicin and amikacin were prescribed to 41%, 34%, and 21% of patients respectively. When only definitive treatment was evaluated, vancomycin, amikacin, and meropenem were the highest prescribed antibacterial agents at 25%, 19%, and 19% respectively. At the initial assessment, study participants indicated either 3 or 7 days (37% and 26%) for planned duration. Actual treatment duration for empiric and definitive treatment, was 7 and 14 days (29% and 19%) When comparing patients who had an established treatment course at the time of the initial assessment, the final length of treatment for culture negative sepsis was 7 (IQR:5–10) and culture positive sepsis was 11 days (IQR:10–14; p-value: 0.07).

Conclusion
Benchmarking global antimicrobial use is crucial for improving NICU-AS practices.

Disclosures
Pavel Prusakov, PharmD, Merck (Research Grant or Support) Debra A. Goff, PharmD, Merck (Research Grant or Support)