bluuebunny/crossref_metadata_2025_split huggingface dataset:
27. Hepatitis B Virus Screening and Vaccination in Patients with HIV: A Survey of Physicians’ Current Clinical Practices
Authors: Hastie Elizabeth , Wooten Darcy 
Published: January 2021

Abstract

Background
Hepatitis B virus (HBV) and HIV co-infection is associated with high morbidity and mortality, but data and guidelines vary in terms of the best vaccination, re-vaccination, and monitoring practices. The purpose of this study was to evaluate the current HBV monitoring and vaccination practices of physicians who care for patients living with HIV.

Methods
A Web-based survey was distributed to the University of California San Diego (UCSD) Infectious Diseases division via the UCSD ID listserv, Infectious Disease Society of America (IDSA) members via the IDea Exchange listserv, and to ID and HIV social network members via Twitter and Facebook. The survey consisted of demographic questions followed by two sets of case-based questions. The case questions focused on type, timing, and dosage of HBV vaccination administration among people living with HIV, HBV monitoring post-vaccination, and clinical approach to patients with isolated hepatitis B core antibody.

Results
A total of 67 clinicians from 24 states completed the survey (Table 1). Most (55%) provide care for more than 20 patients living with HIV per month. The majority of participants (82%) would not defer HBV vaccination until HIV virologic suppression. Almost half of participants (43%) indicated they would use Heplisav-B over older HBV vaccine formulations (Energix-B or Recombivax-HB) for initial vaccination of susceptible patients. The majority (88%) would repeat a vaccination series if the patient does not seroconvert; 23% would repeat with a standard dose series of Energix-B or Recombivax-HB, 24% with a double dose series of Energix-B or Recombivax-HB, and 45% would repeat with Heplisav-B. Approach to management of a patient living with HIV with isolated hepatitis B core antibody was varied. The majority would check a HBV DNA level (42%), while 25% would initiate a vaccination series and 24% would not pursue further intervention (Table 2).
Table 1: Clinician Demographics

Table 2: HBV Vaccination Practices of Physicians Caring for People Living with HIV

Conclusion
This study provides insight into current HBV vaccination and monitoring practices of physicians who care for patients with HIV. The results revealed varied practice preferences and opportunities for improvement through standardization. Additional research is needed to elucidate the impact these various practices have on patient outcomes and healthcare expenditure.

Disclosures
All Authors: No reported disclosures
31. Influenza Vaccination During Pregnancy: A Descriptive Cross-sectional Survey of the Knowledge, Beliefs, and Attitudes of Mexican Gynecologists and Family Physicians
Authors: Lopatynsky-Reyes Erika Z , Costa-Clemens Sue Ann , Chacon-Cruz Enrique , Greenberg Michael 
Published: January 2021

Abstract

Background
Influenza in pregnancy is associated with elevated morbidity and mortality. Influenza vaccines are both safe and effective in pregnancy, supporting routine use in this population. Even though influenza vaccination in Mexico is recommended for pregnant women, there are no publications of influenza vaccine coverage in pregnancy.
This is the first Latin American survey done only in physicians aiming to assess the knowledge, beliefs, and attitudes that Mexican Obstetrics-Gynecologists (OBG) and Family Physicians (FP) have towards influenza and influenza immunization during pregnancy.

Methods
A cross-sectional survey was conducted, both paper-based and online. The questionnaire was composed of 35 questions, which addressed general knowledge of influenza, recommendations for vaccination during pregnancy, and beliefs and attitudes concerning the acceptability of the vaccine in pregnant women.

Results
A total of 206 completed surveys were available, 98 (47.6%) from OBG, 108 (52.4%) from FP. Regarding current practicing medical institutions, 76 (37%), 69 (34%), 31 (14.5%), 30 (14.5%) reported working for the Mexican Institute of Social Security, Private Sector, Secretariat of Health, or a combination of all respectively, representing an estimated 2,472 daily pregnancy consultations.
About a quarter (26.2%) reported not having a notion that influenza is more severe among pregnant women. More than half (51.5%) ignored the potential side effects of influenza infection on the fetus. The majority (56.8%) did not know when vaccination during pregnancy should occur.
Pregnancy as a risk factor for developing influenza complications was known only in 48.1%. Also, 46.1 % believed that vaccination only confers protection to the mother, but not to the fetus. Nevertheless, 96.1% considered that immunization against influenza during pregnancy is a safe and effective preventive intervention.
A results’ summary is shown in Figure-1.

Conclusion
Based on this survey, current knowledge of OBG and FP for influenza morbidity and mortality during pregnancy, and the importance of influenza vaccination in pregnant women, is poor.
Mandatory recommendations to educate medical providers regarding influenza vaccination during pregnancy in Mexico are necessary, even as imperative for CME credits.

Disclosures
All Authors: No reported disclosures
38. Strategies to Improve HPV Vaccination Rates Among Eligible Undergraduates and Graduate Students at Johns Hopkins University
Authors: Gentile John P , Kessler Roanna , Auwaerter Paul , Auwaerter Paul 
Published: January 2021

Abstract

Background
Completed Poster Presentation

Methods

Results
Study period (8/15/2018 – 5/31/2019) was compared to prior year as a historical control (8/15/2017 – 5/31/2018). During the study, 888 HPV vaccines were administered vs. 504 in the control period (76.1 % increase). The difference between # of vaccines given during these 2 years was statistically significant at p&lt; 0.01. The increase was particularly notable among male students: 383 vaccinations vs. 120 (219.2% increase). About half of the students who completed the EMR form saw the marketing materials on campus: 1,579 out of 3,228 responses. Of the marketing materials, the greatest number of students noticed the yard signs (596). The most frequently cited reason that providers did not give the HPV vaccine during their visit was that the patient already completed the HPV vaccine series (1,603).

Conclusion
A well-coordinated campaign with extensive awareness efforts and focused clinical interventions can dramatically impact the number of HPV vaccinations on college campuses.

Disclosures
Paul Auwaerter, Collidion (Consultant)DiaSorin (Consultant)Johnson and Johnson (Shareholder)MicroB-Plex (Research Grant or Support)Shionogi (Consultant)
39. Survey of Hepatitis B Vaccination Rates in Adult Patients with Diabetes at a Large Internal Medicine/Geriatrics Clinic
Authors: Rivard Kaitlyn , Ohtola Jennifer A , Pallotta Andrea , Jolly Stacey E , Rehm Susan J 
Published: January 2021

Abstract

Background
The Advisory Committee on Immunization Practices (ACIP) recommends immunization with hepatitis B vaccine (HBV) for diabetic adults aged 19–59 years and advises HBV at the discretion of the treating clinician for those 60 years or older. Current HBV rates are suboptimal. In one 2015 survey, only 24.4% of diabetic adults aged 19–59 years were immunized.

Methods
This is a single center, retrospective cohort of patients seen in an internal medicine/geriatrics clinic at Cleveland Clinic Main Campus between January 1, 2017 and December 31, 2017. Patients included were at least 19 years of age and had a diagnosis of diabetes mellitus (type I or type II) as determined by ICD-10 code. Patients with acute or chronic hepatitis B infection were excluded from the primary analysis. Data collected included demographics, HBV status, pneumococcal vaccination status, and risk factors for hepatitis B virus infection (chronic liver disease, end stage renal disease (ESRD)). Primary objective evaluated rate of HBV, defined as documented completion of 3-dose series or positive qualitative anti-HBs. Descriptive statistics included number (percentage) or mean + standard deviation.

Results
A total of 3104 patients, aged 65 + 1.5 years, male (50.2%) or white (72.6%) with Type II diabetes (88.9%) were enrolled. Of these, 171 (5.5%) received one dose of HBV, with 62 (2.0%) completing the immunization series. There were 806 (26%) patients with hepatitis B screening, of those 10 (0.3%) and 177 (5.7%) were HbsAg positive or anti-HBs seropositive, respectively. Overall, 221 (7.1%) patients received the 3-dose series or were anti-HBs positive. In comparison, 1719 (55.4%) patients received at least one dose of either pneumococcal vaccine. Comorbid liver disease or ESRD yielded higher rates of HBV immunity (3-dose series completion or anti-HBs positive) at 28.8% (46/160) and 57.8% (52/90) respectively.

Conclusion
We found low HBV rates for adults with diabetes despite ACIP recommendations, indicating that efforts are needed to improve vaccination coverage. Patients were more likely to have received immunization if comorbid conditions were present that conferred a higher risk of hepatitis B acquisition, however rates were still suboptimal.

Disclosures
All Authors: No reported disclosures
53. Effect of rapid identification of bloodstream isolates on antibiotic management using a pharmacist-based treatment algorithm
Authors: Marshall Marybeth , Harriott Melphine , Johnson Leonard B 
Published: January 2021

Abstract

Background
The use of rapid molecular diagnostic testing to identify microorganisms and resistance markers has great potential to optimize medical care and assist with antimicrobial stewardship. We implemented the Verigene bloodstream infection testing panel along with a pharmacy notification system to clinicians and assessed efficacy of the system.

Methods
In November 2019, we implemented the Verigene gram positive and negative panels for patients with positive blood cultures. Our antimicrobial stewardship committee developed a recommended treatment algorithm for pharmacists to use when notified of Verigene results. The first positive bottle per patient and per admission was tested. Subsequent positive bottles were not tested on the Verigene unless a different morphology was noted on the gram stain. A gram stain was performed on all positive cultures and this result was called to the patient’s nurse (if inpatient) and the covering physician was notified of the result. After the Verigene result was available, an assigned pharmacist was notified of these results (organism identification and resistance markers if identified). Pharmacists notified covering physicians of the test results and the recommended antibiotic management. Pharmacists documented the frequency that the test result changed the antibiotic management, including escalation, de-escalation or no change in therapy. The data from the first six months was summarized.

Results
From 11/19/19-5/18/20, a total of 575 test results were called into the pharmacist (average 3.2/day). Among these, 165 (28.7%) were considered likely contaminants, 106 had no change in therapy and 59 had antibiotic de-escalation. Among the remaining 410 patients, 156 had de-escalation, 53 had escalation, 30 were not on any antibiotics and appropriate antibiotics were started. Overall, antibiotic management changed in 298/575 (51.8%) of isolates run by Verigene in our institution including 215 (37.4%) de-escalations. The most frequent antibiotics that were stopped included vancomycin (142) and cefepime (53).

Conclusion
Our pharmacist-based algorithm for notification and treatment recommendation based on Verigene results was highly successful in optimizing antibiotic management and improving antimicrobial stewardship in our institution.

Disclosures
All Authors: No reported disclosures
810. Resistance to the Minocycline-Rifampin-Chlorhexidine (MRCH) combination does not emerge in biofilms of Tetracycline and Rifampin resistant bacteria grown on MRCH catheters depleted below antimicrobially effective concentrations
Authors: Gerges Bahgat , Rosenblatt Joel , Truong Y-Lan , Reitzel Ruth , Hachem Ray Y , Raad Issam I , Raad Issam I 
Published: January 2021

Abstract

Background
Central Line Associated Bloodstream Infections (CLABSIs) remain a significant medical problem for critically ill cancer patients who required catheters for extended durations. Minocycline (M) -Rifampin (R) loaded catheters have shown the greatest impact on reducing CLABSIs; however, there is a risk for developing antibiotic resistant organisms when exposed to catheters whose concentration becomes depleted below antimicrobially effective levels due to extended indwells. Chlorhexidine (CH) and M-R combination catheters (MRCH) have been proposed as a next generation catheter with improved performance. Here we studied whether bacteria that were Tetracycline and Rifampin resistant became resistant to MRCH when allowed to form biofilms on MRCH catheters depleted below antimicrobially effective MRCH concentrations.

Methods
Minimum inhibitory concentrations (MICs) of Tetracycline and/or Rifampin resistant stock isolates were measured by standard microbroth dilution methods. MRCH catheters were depleted to below antimicrobially effective concentrations by soaking in serum for 6 weeks. The resistant bacteria were then allowed to form biofilm for 24 hrs on the depleted catheters in broth. Following 24 hour incubation the adherent (breakthrough) bacteria were removed by sonication and MICs were remeasured. The same organisms grown on non-antimicrobial catheters were used as controls.

Results
MICs (ug/mL) of the organisms against each agent and the combination are tabulated below:
MICs (ug/mL) of the organisms against each agent and the combination

Conclusion
The M and R resistant bacteria did not develop in vitro resistance to the MRCH combination after forming biofilms on MRCH catheters depleted below antimicrobially effective concentrations.

Disclosures
Joel Rosenblatt, PhD, Cook Medical (Shareholder, Other Financial or Material Support, Inventor of the MRCH catheter technology which is owned by the University of Texas MD Anderson Cancer Center and has been licensed to Cook Medical)Novel Anti-Infective Technologies (Shareholder, Other Financial or Material Support, Inventor of the MRCH catheter technology which is owned by the University of Texas MD Anderson Cancer Center and has been licensed to Cook Medical) Issam I. Raad, MD, Citius (Other Financial or Material Support, Ownership interest)Cook Medical (Grant/Research Support)Inventive Protocol (Other Financial or Material Support, Ownership interest)Novel Anti-Infective Technologies (Shareholder, Other Financial or Material Support, Ownership interest)
56. Ertapenem Utilization: “CRE”ating Solutions for Improving Hospital Stay and Stewardship
Authors: Willner Debra M , Bengualid Victoria , Bisono-Garcia Bismarck , Berger Judith 
Published: January 2021

Abstract

Background
Ertapenem, a carbapenem offers advantages over other carbapenems. It is administered daily and can therefore facilitate home infusion discharges, it has a narrower spectrum of activity which could reduce resistance, and is more cost effective than meropenem. Our objectives were to determine whether ertapenem utilization decreased hospital length of stay and whether use had an impact on future meropenem resistance.

Methods
This was a retrospective chart review of ertapenem over 2 years for the following infections: urinary tract, skin and soft tissue (SSTI), and osteomyelitis. Evaluated pathogens, duration of inpatient therapy, discharged antimicrobials, length of discharged therapy, and positive cultures up to 90 days post treatment. Analyzed length of stay, and calculated the hospital days that were saved by discharging patients on ertapenem.

Results
70 patients were analyzed, with indications and pathogens listed in Figure 1. Patients were initially placed on empiric therapies pending culture results. On average, patients received 2.9 days of empiric meropenem. Once cultures finalized, patients were switched to ertapenem. On average, patients received 6 days of inpatient ertapenem prior to discharge. 37 patients were discharged with ertapenem, totaling 937 days of discharged therapy. Of the 36 patients readmitted within 90 days, 20 had pathogens identified, of which 4 were meropenem-resistant (Figure 2).
Infections, Pathogens, and Treatment Duration

Conclusion
In this pilot stewardship initiative, switching to and discharging patients on ertapenem saved 937 hospital days over the 2 years evaluated, with the greatest days of therapy saved in osteomyelitis and SSTIs. There were a total of 422 days of inpatient ertapenem, mostly in the SSTI and cystitis indications. Of the 20 pathogens identified on readmission, 4 (20%) were meropenem-resistant. All were Acinetobacter baumanii-often carbapenem-resistant; none of the cultures were the same pathogen as the originally identified, but this warrants further investigation. The indication associated with least days of therapy saved and the highest days of inpatient ertapenem was cystitis. 53% of the patients were discharged with ertapenem; future direction involved identifying barriers for speedy discharge across all indications.

Disclosures
All Authors: No reported disclosures
827. Does Patient Location (Rural or Urban) influence risk factors and incidence rate for 30-day readmission after gram positive pneumonia?
Authors: Kunnumpurath Anthony , Mehta Neal , Khan Shoaib , Kamoga Gilbert-roy 
Published: January 2021

Abstract

Background
In the US, pneumonia is the most common cause of a hospital admission. Prior analysis has shown that nearly one in six patients will have an all-cause 30-day readmission. Given the disparities in access to healthcare between rural and urban settings, we sought to see if patient location influenced the incidence rate for 30-day readmission after treatment for Gram Positive Pneumonia.

Methods
We utilized Agency of Healthcare Research and Quality’s (AHRQ) 2014 Nationwide Readmission Database to identify index admissions with a principal diagnosis of Gram Positive Pneumonia (ICD-9 codes 482.3, 482.31, 482.32, and 482.39 for streptococcus and 482.40, 482.41, 482.42, and 482.49 for staphylococcus). The 2013 NCHS Urban-Rural Classification System was used to classify if originating from an urban or rural location. Applicable admissions were all adults (age &gt;= 18) from January 1 to November 30, 2014. Patients who died during index admission and those with missing covariates were excluded. All-cause readmissions within 30-days of an index admission were analyzed. Predictors for readmission were determined using a multivariable logistic regression model.

Results
A total of 8,130 patients met criteria for inclusion of which 1,631 (20.06%) were readmitted (all-cause) within 30-days. There was no statistically significant difference in readmission between patients from a rural (18.7%) or urban (20.4%) location. The statistically significant predictors for readmission for patients from a rural location were those admitted on a weekend (OR: 1.41, CI: 1.04-1.90), discharged to short term hospital (OR: 2.70, CI: 1.18-6.19) or AMA (OR: 6.53, CI: 1.46-29.10), and those with a LOS between 7 and 14 days (OR: 1.48, CI: 1.10-2.00). For patients from an urban location, statistically significant predictors were those admitted on a weekend (OR: 1.17, CI 1.02-1.34), discharged AMA (OR: 2.89, CI: 1.74-4.78), LOS between 7 and 14 days (OR: 1.19, CI: 1.03-1.37) and those with CKD (OR: 1.20, CI: 1.03-1.39).

Conclusion
The risk factors for readmission after Gram Positive Pneumonia for patients from a rural and urban location are similar. More research is needed to develop interventions for those who are at risk for readmission after Pneumonia to reduce future morbidity and mortality.

Disclosures
All Authors: No reported disclosures
851. Compliance with Guidelines for Management of Staphylococcus aureus Bacteremia and its Effect on Mortality
Authors: Travez Robert D , Eagleston Anjuli , Brandt Dominique , Blatt Stephen 
Published: January 2021

Abstract

Background
In the US, Staphylococcus aureus Bacteremia (SAB) occurs in about 19.7 /100,000 people. A recent increase in methicillin-resistant Staphylococcus aureus (MRSA) bacteremia infections rate and mortality has led to more infectious diseases (ID) consultations. We assessed if an infectious diseases consultation within 7 days of initial blood culture results was associated to greater compliance with Infectious Diseases Society of America (IDSA) guidelines for managing Staphylococcus aureus bacteremia and a decrease in all-cause mortality and relapse within 90 days.

Methods
A retrospective cohort of patients admitted to two community hospitals from January 2014 to June 2016 with a positive blood culture for methicillin-susceptible S. aureus (MSSA), MRSA, or coagulase-negative Staphylococcus were included in the study. I. Patients were excluded if they were immunocompromised, had a polymicrobial blood stream infection, died within first 48 hours of admission, left against medical advice during treatment or participated in another study requiring an alternative treatment strategy.

Results
A total of 331 patients were included in the analysis. A significantly higher proportion of patients with complicated SAB had an ID consult (61% vs. 17.5%, p&lt; .0001) and for uncomplicated SAB the reverse was true (39% vs 79%, P&lt; .0001). An ID consult was associated with increased compliance with IDSA guidelines (75% vs. 5%, p&lt; .0001). Patients with an ID consult had a significantly higher duration of antibiotic treatment [30(14-42) vs. 5(1.5-12), p&lt; .0001], an earlier start of treatment in number of days [0(0-7) vs. 0(0-12), p=0.036] and a lower mortality within 90 days of blood culture (61% vs. 17.5%, p&lt; .0001). Logistic regression model showed than an ID consult reduced 90-day mortality by 69%, OR 0.313[CI 95 %(0.313-0.154), p=0.001] and transesophageal echography by 78%, OR 0.228[CI 95 %(0.228-0.052), p=0.05].
Population characteristics and outcomes

Conclusion
ID consultation in the setting of SAB has been shown to increase compliance with IDSA guidelines and reduce 90-day mortality.

Disclosures
All Authors: No reported disclosures