bluuebunny/crossref_metadata_2025_split huggingface dataset:
125. Effect of Body Temperature Before Hospital Discharge on the Readmission Rate
Authors: Geneva Ivayla I , Lupone Christina , Wegman Adam D , Paolino Kristopher M 
Published: January 2021

Abstract

Background
One of the goals of the Affordable Care Act is to decrease readmission rates, which lead to wasting of resources and are associated with worse patient outcomes. While widely adhered to, there is no published research to support the practice of delaying discharge if the patient exhibits fever or hypothermia in the previous 24 hours. Our study quantifies the effect of abnormal body temperature before discharge on the readmission rate.

Methods
Retrospective analysis of the minimal (Tmin) and maximal (Tmax) body temperatures during the last 24 hrs before discharge of all patients over 1 year period from our tertiary medical center were analyzed with T-test, ANOVA, uni-and multivariate logistic regression. Fever was defined as Tmax &gt; 100.2F(2SDs from mean Tmax), hypothermia as Tmin &lt; 96.7F(2SDs from mean Tmin).

Results
Descriptive analysis of the data from 19,038 inpatients are featured in Table 1 and Figure 1. The overall readmission rate was 10.2% (highest for General Medicine and Pediatrics); 4.7% of patients had an abnormal temperature 24 hrs before discharge; body temperature declined with age. ANOVA showed that 1st, the average number of days to readmission was not different between those with fever, hypothermia, and normothermia (mean+/-SD: 10.6+/-8.6; 12.1+/-8.6; 12.5+/-8.1, respectively); 2nd that the rate of readmission was not different between these groups, although there was trend for higher readmission among normothermic patients (2.9%; 0.3%; 7%, respectively). Table 2 features regression analyses that model readmission. Univariate analysis revealed that higher Tmax and age are associated with lower readmission probability. Both uni- and multivariate analysis showed that the presence of fever is associated with lower readmission probability and that compared with General Medicine, the other major primary services have lower readmission probability, when correcting for all the other listed variables.

Figure 1

Conclusion
Our data clearly showed that abnormal body temperature measured within 24 hrs before discharge is not useful for predicting the chance for readmission. Therefore, delaying patients’ discharge based on Tmax or Tmin alone, taken outside the specific clinical context, may lead to wasting of hospital resources.

Disclosures
All Authors: No reported disclosures
130. increase in Multidrug Resistance (2011–2018) and the Emergence of Extensive Drug Resistance (2020) in shigella Sonnei in the United States
Authors: Logan Naeemah Z , Karp Beth E , Tagg Kaitlin A , Burns-Lynch Claire , Chen Jessica , Garcia-Williams Amanda , Marsh Zachary A , O’Laughlin Kevin , Plumb Ian D , Schroeder Morgan N , Webb Hattie E , Zenas Hannah , Draper Jenny , Ginn Andrew , Martinez Elena , Partridge Sally R , Sim Eby , Sintchenko Vitali , Iredell Jonathan , Watkins Louise Francois 
Published: January 2021

Abstract

Background
Multidrug-resistant (MDR) Shigella sonnei infections are a serious public health threat, and outbreaks are common among men who have sex with men (MSM). In February 2020, Australia’s Department of Health notified CDC of extensively drug-resistant (XDR) S. sonnei in 2 Australian residents linked to a cruise that departed from Florida. We describe an international outbreak of XDR S. sonnei and report on trends in MDR among S. sonnei in the United States.

Methods
Health departments (HDs) submit every 20th Shigella isolate to CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory for susceptibility testing. We defined MDR as decreased susceptibility to azithromycin (MIC ≥32 µg/mL) with resistance to ampicillin, ciprofloxacin, and cotrimoxazole, and XDR as MDR with additional resistance to ceftriaxone. We used PulseNet, the national subtyping network for enteric disease surveillance, to identify US isolates related to the Australian XDR isolates by short-read whole genome sequencing. We screened these isolates for resistance determinants (ResFinder v3.0) and plasmid replicons (PlasmidFinder) and obtained patient histories from HDs. We used long-read sequencing to generate closed plasmid sequences for 2 XDR isolates.

Results
NARMS tested 2,781 S. sonnei surveillance isolates during 2011–2018; 80 (2.9%) were MDR, including 1 (0.04%) that was XDR. MDR isolates were from men (87%), women (9%), and children (4%). MDR increased from 0% in 2011 to 15.3% in 2018 (Figure). In 2020, we identified XDR isolates from 3 US residents on the same cruise as the Australians. The US residents were 41–42 year-old men; 2 with available information were MSM. The US and Australian isolates were highly related (0–1 alleles). Short-read sequence data from all 3 US isolates mapped to the blaCTX-M-27 harboring IncFII plasmids from the 2 Australian isolates with &gt;99% nucleotide identity. blaCTX-M-27 genes confer ceftriaxone resistance.
Increase in Percentage of Shigella sonnei Isolates with Multidrug Resistance* in the United States, 2011–2018†

Conclusion
MDR S. sonnei is increasing and is most often identified among men. XDR S. sonnei infections are emerging and are resistant to all recommended antibiotics, making them difficult to treat without IV antibiotics. This outbreak illustrates the alarming capacity for XDR S. sonnei to disseminate globally among at-risk populations, such as MSM.

Disclosures
All Authors: No reported disclosures
132. Emergence and Spread of Multidrug-resistant salmonella Serotype Infantis Infections in the United States, 2003–2018
Authors: Medalla Felicita , Payne Daniel C , Sundararaman Preethi , Birhane Meseret , Classon Andrew , Caidi Hayat , Folster Jason , Friedman Cindy R , Watkins Louise Francois 
Published: January 2021

Abstract

Background
Infantis re-emerged as a leading Salmonella serotype when a multidrug-resistant (MDR) strain with a rare extended spectrum β-lactamase (ESBL) blaCTX-M-65 gene emerged among returned travelers from Peru in 2012 and then spread domestically. This strain has been isolated from chickens at slaughter and retail, and humans in outbreaks traced to chicken. We reviewed national surveillance data to determine incidence trends and antibiotic resistance among Infantis infections.

Methods
We reviewed data from 2003–2018 from the Foodborne Diseases Active Surveillance Network to determine the incidence and epidemiology of infections in 10 sites under surveillance; PulseNet to determine pulsed-field gel electrophoresis (PFGE) patterns; and National Antimicrobial Resistance Monitoring System (NARMS) to determine antimicrobial susceptibility testing (AST) results and resistance genes of isolates identified by whole genome sequencing (WGS). We defined MDR Infantis as having ceftriaxone resistance by AST and either the blaCTX-M-65 gene or one of 18 PFGE patterns linked to that gene by WGS.

Results
The 2,154 patients with Infantis infection had a median age of 36 years and 57% were female; 86% had isolates from stool, 9% from urine, and 3% from blood. Only 10% reported foreign travel and 27% were hospitalized. The incidence of infections began increasing in 2010 and by 2017–2018 was 2-fold higher than the average during 2003–2009. During 2003–2018, 856 (88%) of 970 NARMS isolates had PFGE or WGS data; 48 isolates were MDR Infantis, and in addition to ceftriaxone and ampicillin resistance (by definition), all 48 were resistant to 3 or more antibiotic classes, 94% had decreased susceptibility to ciprofloxacin, and 67% were resistant to cotrimoxazole. During 2012–2016, 2% of isolates were MDR Infantis; this increased to 17% during 2017–2018 (Figure).

Conclusion
During the past decade, the incidence of Infantis infections markedly increased. This was likely driven by the emergence of an ESBL-producing strain that was initially associated with travel, and is now mostly domestically acquired and associated with consuming chicken. MDR Infantis now accounts for 1 in 5 Infantis infections. Public health strategies to reduce Salmonella contamination of chicken could help prevent these infections.

Disclosures
All Authors: No reported disclosures
133. validation of a Global Respiratory Severity Score in Infants with Primary RSV Infection
Authors: Qiu Xing , Wang Lu , Walsh Edward E , Caserta Mary T 
Published: January 2021

Abstract

Background
We recently developed a global respiratory severity score (GRSS) as a research tool from (n=139) infants with primary respiratory syncytial virus (RSV) infection enrolled prospectively in the Assessing Predictors of Infant RSV Effects and Severity (AsPIRES) study. The objective of the present study was to validate our original findings that the GRSS correlates well with clinical outcomes including hospitalization and length of stay (LOS) utilizing an independent cohort.

Methods
Clinical and demographic data on infants with primary RSV infection were abstracted from the electronic medical record. The GRSS was calculated by applying the original training data formula to the new data set. We compared the mean GRSS between the hospitalized and non-hospitalized group with Welch two sample t-test, and correlated it with hospitalization and LOS using Pearson’s correlation test.

Results
A total of 184 (98 hospitalized and 86 non-hospitalized) subjects were enrolled. The hospitalized and non-hospitalized infants were different in general appearance, the percentage with rales, retractions, lethargy, respiratory rate and oxygen saturation. The hospitalized group had a significantly (t=9.334, p&lt; 0.0001) higher GRSS (4.20±2.10) than the non-hospitalized group (1.76±1.41). Using GRSS ≤3.5 as the classification criterion, we correctly predicted the hospitalization status of 131 (71.2%) subjects. The area under the ROC curve of the GRSS as a classifier of hospitalization is AUC=0.8265 (p&lt; 0.0001). Pearson correlation between the GRSS and LOS is (p&lt; 0.0001).
Area under the ROC curve of the GRSS

Boxplot demonstrating the difference in GRSS between hospitalized and non hospitalized infants

Conclusion
Infants hospitalized with RSV have a significantly higher GRSS than non-hospitalized subjects, and the GRSS is strongly associated with LOS. GRSS can also serve as an acceptable predictor of hospitalization. We are currently re-training the GRSS model with both datasets and believe it will lead to an improved predictive power of hospitalization.

Disclosures
All Authors: No reported disclosures
134. idweek Clinician Educator Mentoring Program for Junior Faculty
Authors: Luther Vera , Armstrong Wendy , Bonura Erin , Melia Michael , Riedel David J , Schwartz Brian 
Published: January 2021

Abstract

Background
Effective career mentorship enhances well-being, productivity, and advancement in academic medicine. The pathway to success for clinician educators (CE) is often ill-defined. Career development resources and support for this pathway vary across institutions. To address this need, we created a mentoring program pairing junior faculty pursuing careers as CEs with more experienced CEs from other institutions during IDWeek 2018 and 2019.

Methods
Prior to IDWeek 2018 and 2019, a survey was sent through the IDSA listserv to identify members pursuing CE careers interested in extra-institutional career mentorship. These faculty were paired with mentors who were established career CEs identified via the IDSA Medical Education Workgroup. Mentees completed a brief individual development plan (IDP) and identified 3 discussion topics. Mentors received the mentee’s IDP and CV prior to IDWeek and were given brief guidance on successful mentoring. One hour advising sessions were held during IDWeek and ended with the creation of a mentee action plan and a scheduled follow-up call. Post-participation surveys were sent to mentees and mentors.

Results
31 different mentees and 15 mentors participated in the program over two years. 26 (84%) mentees completed the post-session survey. 25 (96%) mentees and 14 (93%) mentors reported being very satisfied with their meetings at IDWeek. All mentees created an action plan with their mentor. 16 (62%) strongly agreed and 10 (38%) somewhat agreed that they planned to make changes based on the meeting. 21 (81%) mentees strongly agreed they received advice they were unable to get at their own institution. After the session, 18 (69%) strongly agreed they felt connected to a supportive CE community at IDSA; none strongly agreed in the pre-survey. All mentors and mentees agreed that this program was a resource that IDSA should consider expanding. Qualitative response themes from mentees emphasized the usefulness of an external perspective.

Conclusion
A mentoring program for junior faculty during IDWeek was feasible and effective for CEs. Through these interactions, mentees planned changes to enhance their careers and felt newly supported by the IDSA community. This model could be used for other ID career paths at future meetings.

Disclosures
All Authors: No reported disclosures
136. In Their Own words: a Qualitative Analysis of Factors Contributing to Gender Bias in Academic Advancement in Infectious Disease
Authors: Stead Wendy , Manne-Goehler Jennifer , Marcelin Jasmine R , Del Rio Carlos , Krakower Douglas 
Published: January 2021

Abstract

Background
Large and persistent inequities in academic advancement exist between men and women faculty in academic Infectious Diseases (ID). To identify and characterize beliefs about why these inequities persist in ID, we asked ID faculty members to share their thoughts and experiences with the advancement process.
Characteristics of Focus Group Participants

Summary of Main Emergent Themes from Focus Group Analysis

Methods
We conducted four 60-minute focus groups with ID faculty members during IDWeek 2019. We enrolled women that were diverse geographically and in academic rank (i.e., Instructor/Assistant, Associate, Full Professor). We assigned women to focus groups by rank to minimize social desirability bias across rank. Our fourth focus group included only men who were Full Professors, to capture additional perspectives about barriers to advancement and solutions. (Table 1) We analyzed focus group discussion transcripts using content analysis.

Results
We identified nine main themes regarding inequities in academic advancement of women in ID. (Table 2) In all 4 focus groups, gender bias as a barrier to academic advancement was a major theme. Women Full Professors emphasized explicit gender bias such as sexual harassment and “predatory mentoring,” whereas women Instructors/Assistant Professors more frequently cited barriers related to implicit bias, such as obscure maternity leave policies and divisional meetings scheduled during childcare hours. Women Associate Professors cited implicit and explicit gender bias, while men Full Professors focused primarily on implicit bias. Women Instructors/Assistant Professors experienced the greatest difficulty in balancing demands of family with career, though this was a prominent theme in all groups. The perception that women less often utilize negotiation to advance themselves was a dominant theme for women Associate Professors, though all groups raised examples of this theme.

Conclusion
Gender bias, both implicit and explicit, is an important and ongoing barrier to equitable academic advancement of women in ID. Difficulty balancing demands of family with career and gender differences in professional negotiation are also perceived barriers that can be targeted by innovative programs and interventions to address gender disparities in academic advancement.

Disclosures
All Authors: No reported disclosures
141. Rapid Reduction in Concomitant Vancomycin and Piperacillin-tazobactam Use: A Model for Future Antimicrobial Stewardship Interventions
Authors: Kimball Joanna , Deri Connor , Nesbitt Nesbitt J , Nelson George , Staub Milner 
Published: January 2021

Abstract

Background
Concomitant vancomycin and piperacillin-tazobactam use (CVPTU) for &gt;2 days is associated with increased nephrotoxicity. At Vanderbilt University Medical Center, a sustained decline in CVPTU was achieved. A retrospective review of CVPTU and antimicrobial stewardship (AS) interventions was performed to develop a model for future AS quality improvement (QI) initiatives.

Methods
Data for adults receiving CVPTU January 2015 - August 2019 were extracted. No patients were excluded. Change in monthly incidence of CVPTU &gt;2 days in relation to AS interventions was the primary outcome. CVPTU was analyzed with statistical process control (SPC) charts (QI Macros 2019). AS interventions were amassed from AS emails, meeting minutes, presentations and patient-specific interventions. We created a new intervention evaluation tool using the Hierarchy of Effectiveness (1-Education, 2-Policy, 3-Reminders, 4-Simplification, 5-Automation, 6-Forced Function) and a self-designed scale of impact (1-divisional subgroup, 2-division, 3-department, 4-center-wide). Scores were summed for each 6-month period and rated as low, moderate or high intervention strength. Periods were mapped against their corresponding CVPTU rate (Figure 1).

Results
CVPTU Data: During periods 1–5 (January 2015 - February 2018), an average 4% of admitted patients received &gt;2 days CVPTU, decreasing to &lt; 1% from period 5 (March 2018) onward (Figure 1). From period 1–5, an average 52.8% of patients with CVPTU received &gt;2 days and dropped to 41.3% from period 5 onward (Figure 2).
Intervention Data: There was 1 low, 3 moderate and 4 high intensity periods. Intensity decreased as initiatives transitioned from behavior change to sustained behavior (Figure 1). The main interventions were education and patient-specific feedback. Division-specific antibiotic algorithms and computerized order sets re-enforced behavior. Infectious diseases consults and team pharmacists embedded the concept in daily practice.
Figure 1: Proportion of All Admissions with Concomitant Vancomycin and Piperacillin-Tazobactam Use (CVPTU) for &gt;2 Days Mapped Against Simultaneous Quality Improvement Interventions.

Figure 2: Proportion of Patients with Concomitant Vancomycin and Piperacillin-Tazobactam Use (CVPTU) for &gt;2 Days.

Conclusion
Persistent, repetitive center-wide intervention is key to driving and sustaining change. More analysis of specific intervention types and impact of external factors would enhance understanding and future use of this AS change implementation model.

Disclosures
All Authors: No reported disclosures
143. Modification of Linezolid Restriction Criteria Reduces ICU Gram-positive Antibiotic Consumption
Authors: Boulos John M , DeSear Kathryn , Shoulders Bethany , Venugopalan Veena , Voils Stacy A , Vu Catherine , Logan Megan , Santevecchi Barbara A 
Published: January 2021

Abstract

Background
Antibiotic time out (ATO) policies have been proposed by the Centers for Disease Control and Prevention to limit unnecessary use of antibiotics. Critically ill patients are often treated empirically with MRSA-active agents for a prolonged duration. The objective of this study was to assess the impact of an ATO policy by targeting empiric gram-positive coverage.

Methods
Before this intervention, linezolid required pre-approval by the antimicrobial stewardship program or infectious diseases (ID) consult service before dispensing, and no automatic ATO policy was in place for any agent. In 2018, restriction of linezolid was modified to allow 72 hours of empiric use in the intensive care unit (ICU). This retrospective, single-center, pre- post-intervention study looked at eight ICUs at our institution from two equal periods. Adults (age ≥ 18 years) were included who received an IV gram-positive antibiotic (IVGP-AB), specifically linezolid or vancomycin, used for empiric therapy and were admitted to the ICU. The primary outcome was antimicrobial consumption of IVGP-AB defined as days of therapy (DOT) per patient. Secondary outcomes included in-hospital length of stay (LOS), ICU LOS, in-hospital mortality, 30-day readmission, and incidence of acute kidney injury (AKI).
Figure 1. Flowchart of patient inclusion into the study

Results
2718 patients met criteria for inclusion in the study. 1091 patients were included in the pre-intervention group and 1627 patients were included in the post-intervention group. Baseline characteristics between the two groups were similar, with ID consults being higher in the pre-intervention group. Total mean DOT of IVGP-AB in pre- and- post-intervention groups was 4.97 days vs. 4.36 days, p&lt; 0.01. Secondary outcomes of in-hospital LOS, ICU LOS, and in-hospital mortality did not vary significantly between groups. Thirty-day readmission was lower in the post-intervention group (12.9% vs. 3.9%, p&lt; 0.01). AKI did not differ significantly between groups, however the need for renal replacement therapy was higher in the pre-intervention group (1.2% vs. 0.2%, p&lt; 0.01).

Conclusion
This study assessed the impact of an ATO policy allowing 72 hours of empiric linezolid in the ICU. We found a statistically significant reduction in days of therapy of IVGP-AB without increases in LOS, mortality, readmission, and AKI.

Disclosures
All Authors: No reported disclosures
145. the Efficacy and Safety of Low Dose Trimethoprim-sulfamethoxazole for the Treatment of Pneumocystis Pneumonia: A Systematic Review and Meta-analysis
Authors: Tritle Brandon , Hejazi Andre A , Timbrook Tristan 
Published: January 2021

Abstract

Background
Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal infection causing significant morbidity and mortality in immunocompromised patients. The conventional treatment of PJP is sulfamethoxazole-trimethoprim (SMX-TMP) dosed at 15–20 mg/kg/day of the trimethoprim component. This high-dose regimen is associated with severe adverse reactions that result in patient harm or treatment discontinuation. Studies have suggested similar mortality and an improved adverse effect profile using lower dose (&lt; 15 mg/kg/day) SMX-TMP. Our objective of this meta-analysis was to evaluate the safety and efficacy of lower dose SMX-TMP for PJP pneumonia.

Methods
We conducted a systematic review and meta-analysis according to PRISMA guidelines. Pubmed and Embase databases were searched from inception to January 15, 2020, for studies in English evaluating low-dose SMX-TMP (&lt; 15 mg/kg/day) compared with conventional dosing for the treatment of PJP. Additionally, conference proceedings were reviewed to address potential publication bias. Outcomes evaluated in our meta-analysis include survival and adverse reactions. We performed a sensitivity analysis using E-values to determine the robustness of our results.

Results
After excluding studies that did not meet our inclusion criteria, four studies were analyzed for adverse reaction rates and three for mortality rates. Overall, there was no significant difference in mortality between low-dose and conventional-dose SMX-TMP groups (relative risk [RR]: 0.55, 95% confidence interval [CI], 0.18 -1.70). There was a significant decrease in the rate of adverse reactions for the low-dose group compared with the conventional-dose group (RR: 0.70, 95% CI, 0.53 - 0.91). Sensitivity analyses using E-Values reflect a confounder with RR 2.2 or greater could explain away the estimate on adverse events leading to no difference while mortality would require RR 5.6 to reflect worse outcomes with low dose.
Mortality Forest Plot

Adverse Effects Forest Plot

Conclusion
This meta-analysis shows a significant decrease in adverse reactions and similar mortality rates with lower-dose SMX-TMP compared with conventional dosing. A low-dose SMX-TMP regimen in the treatment of PJP should be considered a viable option with the potential to decrease treatment discontinuation and reduce harm.

Disclosures
All Authors: No reported disclosures