bluuebunny/crossref_metadata_2025_split huggingface dataset:
616. Patients Experiencing Homelessness and Opioid Use Disorder with Infectious Complications Treated with OPAT at Medical Respite: Evaluation of Retention in Care at 30 days and Role of Addictions Consultation
Authors: Beieler Alison M , Beieler Alison M , Klein Jared W , Bhatraju Elenore , Iles-Shih Matthew , Enzian Leslie , Dhanireddy Shireesha , Dhanireddy Shireesha 
Published: January 2021

Abstract

Background
Patients experiencing homelessness and opioid use disorder (OUD) admitted for severe infections often require prolonged hospital stays. These patients, typically evaluated by Infectious Disease (ID) providers, are often excluded from Outpatient Parenteral Antimicrobial Therapy (OPAT) due to social risk factors. Medical respite, near Harborview Medical Center (HMC), offers a supportive environment for patients to receive OPAT with daily nurse administered antibiotics. For further support, our institution created a dedicated Addiction medicine consult service March 1, 2019 to assist with initiation of medications for opioid use disorder (MOUD) and linkage to outpatient care for interested patients.

Methods
We performed retrospective review of all patients &gt; 18 years with OUD admitted for procedure/inpatient stay from 1/31/2018 – 1/31/2020 who discharged to medical respite for OPAT. The minimum follow up period was 90 days. We recorded demographics, OUD history, diagnosis, discharges against medical advice (AMA), and total readmissions. We evaluated outcomes of 4 care interventions (ID consult, Addiction consult, linkage to case management and/or mental health, linkage to MOUD) in relation to successful OPAT completion, clinical cure, and retention in MOUD at 30 days.

Results
Fifty-three patients had 63 OPAT episodes of care (Table 1). Median length of stay (LOS) was 19 days inpatient, and 33 days at medical respite. Common diagnosis included, osteomyelitis 46 (73%), bacteremia 27 (43%), septic joint 17 (27%), epidural abscess 10 (16%), and endocarditis 10 (16%). There were 24 OPAT episodes which received all 4 interventions (Table 2). Episodes during which 4 interventions occurred were more likely to result in clinical cure (p = 0.03) and retention in MOUD treatment at 30 days (p = 0.003) compared to episodes where 3 or fewer interventions occurred (Table 3).
Table 1. Demographics

Table 2. OPAT Care Interventions, n =63

Table 3. Summary of Outcomes, n =63

Conclusion
Patients discharged to medical respite who received the combination of ID consult, Addiction consult, case management and/or mental health, and MOUD had higher rates of clinical cure compared to those who did not receive all four interventions. Developing a patient-centered comprehensive care plan, including ongoing support and access to MOUD should be a priority to ensure successful treatment of infections.

Disclosures
All Authors: No reported disclosures
621. Reporting Behaviors and Perceptions Towards the National Healthcare Safety Network Antimicrobial Use (AU) and Antimicrobial Resistance (AR) Options
Authors: Werth Brian J , Werth Brian J , Dilworth Thomas J , Escobar Zahra Kassamali , Gross Alan E , Suda Katie , McGregor Jessina C , Morris Andrew M , LaPlante Kerry , Kuper Kristi 
Published: January 2021

Abstract

Background
Antibiotic use (AU) and antibiotic resistance (AR; AUR) reporting to National Healthcare Safety Network (NHSN) is suboptimal by US hospitals. The Society of Infectious Diseases Pharmacists (SIDP) and the Society for Healthcare Epidemiology of America (SHEA) conducted a survey of their membership to 1) Identify characteristics of US health systems that report AUR data 2) Determine how NHSN AUR data are used by health systems and 3) Identify barriers to AUR reporting.

Methods
An anonymous survey was posted on SurveyMonkey from 1/21- 2/21/2020 and links were emailed to SIDP and SHEA Research Network members. Data were analyzed in Excel and RStudio. Respondent and hospital data were reported as frequencies and percentages. Fisher’s Exact test was used to compare survey responses from NHSN AUR reporters to non-reporters.

Results
A total of 238 individuals from 43 states responded to our survey. Respondents were primarily pharmacists (84%), from urban (45%), non-profit medical centers (80%) with &gt;250 beds (65%). 62% of respondents reported to the AU option while 19% reported to the AR option. Respondents not using software for local AU or AR tracking were less likely than those using any software for local tracking to report to AU (19% vs 64%) and AR (2% vs 30%) options (P&lt; 0.0001). Among AU and AR reporters 41% and 54% used clinical decision support software to aggregate compile data for upload while 54% and 38% used their electronic health record, and 5% and 8% used another method. Over half of AU (56%) and AR (51%) reporters upload data manually. Regular use of the NHSN data analysis tools was reported by 36% and 9% of those reporting AU and AR data respectively. The most common barriers to reporting were related to technical issues (software, IT support, data formatting) and time/salary support. Among non-reporters, increased expectations to report and better software solutions were most commonly identified as the best ways to increase reporting.

Conclusion
Efforts to improve AUR reporting should focus on software solutions and increasing the utility of AUR analytical tools. Increasing expectations to report may also help to improve reporting rates. The lower rate of AR vs AU reporting suggests that interventions should also target the AR option.

Disclosures
Brian J. Werth, PharmD, Shionogi Inc. (Grant/Research Support) Kerry LaPlante, PharmD, Merck (Advisor or Review Panel member, Research Grant or Support)Ocean Spray Cranberries, Inc. (Research Grant or Support)Pfizer Pharmaceuticals (Research Grant or Support)Shionogi, Inc. (Research Grant or Support)
641. Carriage and Genetics of Haemophilus influenzae Serotype A (Hia) in Alaska, 2018
Authors: Nolen Leisha , Tifffany Amanda , DeByle Carolynn , Bruden Dana , Reasonover Alisa , Simons Brenna , Castrodale Louisa , McLaughlin Joseph , Klejka Joseph , Wang Xin , Topaz Nadav , Bruce Michael 
Published: January 2021

Abstract

Background
Haemophilus influenzae serotype a (Hia) is an important cause of infection among Alaska Native children. In 2018, 4 invasive Hia cases (iHia) occurred in an Alaska community. Our response aimed to prevent more iHia and evaluate Hia carriage in the community. Whole genome sequencing (WGS) was performed to compare Hia from iHia patients across Alaska in 2018, and from healthy outbreak community members.

Methods
We collected oropharyngeal (OP) samples from outbreak community members. Children aged &lt; 10 years and people in close contact with cases (contacts) were offered rifampin prophylaxis. A second set of OP samples was collected 8 weeks later. Isolates from iHia from across the state were collected as part of the state surveillance. Hia was detected by PCR and culture, then characterized by antimicrobial susceptibility and WGS.

Results
At baseline, contacts had a higher prevalence of Hia carriage than non-contacts (4/27(14.8%) vs 7/364(1.9%), p=0.0043). Eight weeks after rifampin prophylaxis, carriage prevalence did not significantly change among contacts (5/42(11.9%) to 6/25(24%), p=0.18) or non-contacts (7/368(1.9%) to 2/114(1.8%), p=0.47). Phylogenetic analysis of 19 iHia isolates and 15 isolates from healthy outbreak community members, revealed two major clades that differed by an average of 300 core single nucleotide polymorphisms (SNPs). Invasive and carriage isolates from the outbreak community were clustered in one clade, along with 3 non-outbreak iHia isolates. Isolates from this community differed from each other by an average of 1.2 core SNPs. Comparative genomics did not reveal any genetic mutations that distinguished carriage from invasive isolates. Three (20%) community isolates were rifampin-resistant and had a previously unreported mutation in the rpoB gene.

Conclusion
We found Hia carriage prevalence was highest among persons in contact with iHia cases. Long-term community carriage was not affected by rifampin prophylaxis, possibly due to staggered prophylaxis. In the outbreak community, Hia isolates from carriers were nearly genetically identical to iHia isolates. Overall, iHia isolates from Alaska in 2018 were genetically similar. The mutation conferring rifampin resistance is concerning, as rifampin is used to prophylax contacts of iHia cases.

Disclosures
All Authors: No reported disclosures
653. Comparison of Yeasts identification by Biofire, Culture and ePlex for Quality Assurance purpose
Authors: lin jeffrey , Myint Thein , Arora Vaneet , Ribes Julie A 
Published: January 2021

Abstract

Background
At the University of Kentucky Medical center (UKMC), positive fungal blood cultures are concurrently run through the Biofire Blood Culture Identification (BCID) panel which detects 5 Candida species. The newer platform, the GenMarkDx ePlex BCID-FP (fungal panel) is designed to detect 16 fungal targets. Our study compares the performance of the Biofire BCID panel’s with culture as the gold standard method. We examine the percentage of agreement by both testing methods and predict the performance of the GenMarkDx ePlex BCID-FP panel based on culture results. We also look at the number of other yeasts not included in Biofire BCID panel that could be picked up by the GenMarkDx ePlex BCID-FP panel.

Methods
Positive fungal blood cultures from July 1, 2018 to June 30, 2019 were run through the Biofire BCID panel. Culture results were used to extrapolate whether the GenMarkDx ePlex FP would provide any additional diagnostic benefit. Results were categorized as true or false positives and negatives as compared to culture as the gold standard.

Results
A total of 141 blood cultures were tested via the Biofire BCID panel for the identification of yeasts. Of these, 123 (87%) yielded Biofire results in concordance with culture results. We would expect these also to be positive on the GenMarkDx ePlex BCID-FP panel. In addition, 18 specimens (13%) would have tested positive on the GenMarkDx ePlex BCID-FP panel and not the Biofire BCID panel. These organisms were noted to be Candida lusitaniae (n=6), Cryptococcus neoformans (n=3), Candida dublinensis (n=2), and Candida keyfr (n=1). Organisms that were found on culture that were not detected by both GenMarkDx ePlex BCID-FP panel and Biofire BCID panel were Candida nivariensis (n=2), Pichia ohmeri (n=1), Trichospon species (n=2).

Conclusion
Based on these data, we expect that the ePlex would have correctly identified 95.9% of the yeasts in this patient population. This represents an additional 18 (13%) of specimens that could be detected rapidly from the positive blood culture if the GenMarkDx ePlex BCID-FP panel were used instead of the Biofire BCID panel. Early identification can influence the choice of antifungal agent. Less than 5 % of the yeasts would have remained unidentified by ePLex compared to 13% for Biofire.

Disclosures
All Authors: No reported disclosures
667. Multicenter Assessment of Enterobacterales, Salmonella spp. and Pseudomonas aeruginosa Using Updated CLSI Levofloxacin Breakpoints on MicroScan Dried Gram Negative MIC Panels
Authors: Garner Omai , Traczewski Maria M , Beasley Denise , Harrington Amanda , DesJarlais Sharon , Hastey Christine , Brookman Regina , Lockett Zabrina , Chau Jennifer 
Published: January 2021

Abstract

Background
Data from a multicenter clinical study with Enterobacterales, Salmonella spp. and P. aeruginosa on a MicroScan Dried Gram-negative MIC (MSDGN) Panel was evaluated with updated US FDA/CLSI levofloxacin breakpoints. MIC results were compared to results obtained with frozen broth microdilution panels prepared according to CLSI methodology.

Methods
A total of 839 Enterobacterales, Salmonella spp. and P. aeruginosa clinical isolates were tested at three clinical sites in efficacy and challenge combined. MSDGN panels were evaluated with turbidity and Prompt® methods of inoculation. MIC values obtained from the MSDGN panels were compared to MICs utilizing a CLSI broth microdilution reference panel. To assess reproducibility, a subset of 15 organisms were tested on MSDGN panels at each site. MSDGN panels were incubated at 35 ± 1ºC and read on the WalkAway System, the autoSCAN-4 instrument, and visually. Read times for the MSDGN panels were at 16-20 hours. Frozen reference panels were prepared and read according to CLSI methodology. FDA and CLSI breakpoints (µg/mL) used for interpretation of MIC results were: Enterobacterales ≤ 0. 5 S, 1 I, ≥ 2 R; Salmonella spp. ≤ 0.12 S, 0.25-1 I, ≥ 2 R; P. aeruginosa ≤ 1 S, 2 I, ≥ 4 R.

Results
Essential and categorical agreement were calculated compared to frozen reference panel results. Results for isolates tested during efficacy and challenge with Prompt inoculation and manual read are as follows:

Conclusion
Levofloxacin MIC results for Enterobacterales, Salmonella spp., and P. aeruginosa obtained with the MSDGN panel correlate well with MICs obtained using frozen reference panels using updated FDA/CLSI interpretive criteria in this multicenter study.
* PROMPT® is a registered trademark of 3M Company, St. Paul, MN USA.
BEC, the stylized logo and the BEC product and service marks mentioned herein are trademarks or registered trademarks of Beckman Coulter, Inc. in the US and other countries.

Disclosures
Omai Garner, PhD, D(ABMM), Beckman Coulter (Scientific Research Study Investigator) Maria M. Traczewski, BS MT (ASCP), Beckman Coulter (Scientific Research Study Investigator) Denise Beasley, BS, Beckman Coulter (Other Financial or Material Support, Research personnel) Amanda Harrington, PhD, Beckman Coulter (Scientific Research Study Investigator) Sharon DesJarlais, BS, Beckman Coulter (Other Financial or Material Support, Research personnel) Christine Hastey, PhD, Beckman Coulter (Employee) Regina Brookman, BS, Beckman Coulter (Employee) Zabrina Lockett, MS, Beckman Coulter (Employee) Jennifer Chau, PhD, Beckman Coulter (Employee)
682. Is There a Role for the Early Use of Tocilizumab and Interleukin-6 Levels in the Management of SARS-CoV-2 Patients with Early Respiratory Failure?
Authors: Antony Suresh J , Almaghlouth Nouf K , Davis Monique G , Davis Michelle A , Guevara Roberto , Antony Nishaal , Fahad Omar , Prakash Bharat , Del Rey Fernando , Hassan Ali , Arian Muhammad 
Published: January 2021

Abstract

Background
The severity of respiratory failure in SARS-CoV-2 infection appears to be related to cytokine release syndrome (CRS), resulting in mechanical ventilation (MV). In this observational study, we investigated tocilizumab’s role in the treatment of SARS-CoV-2 and the use of interleukin-6 (IL-6) levels in the management of these patients.

Methods
Patients with positive SARS-CoV-2 PCR were prospectively observed from February 1, 2020 to May 31, 2020. Data on demographics, medical history, and clinical outcomes were collected. Tocilizumab (TCZ) 4 mg/kg/day q12h was given for 24 hours, followed by methylprednisolone 60 mg q8h for 72 hours to patients with oxygen requirement of 3 L and above. IL-6, C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and D-dimers were monitored on days: 0, 3, and 6 following the initiation of therapy. Statistical analyses were performed using a Wilcoxon signed-rank test with significance (α) less than or equal to 0.05 (P ≤ 0.05).

Results
A total of eighty patients (45 males, 56.96%) and (34 females, 43.04%) with positive SARS-CoV-2 PCR were included in this study. The median age was 63 (51 - 72) years. Seven patients expired (8.75%), and nine patients required mechanical ventilation (11.25%). The median of IL-6 levels before administration of TCZ was 342.50 (78.25 – 666.25) pg/mL compared to after administration of TCZ on day 3, 563 (162-783) pg/mL (P &lt; 0.00001). On day 6, the median dropped to 545 (333.50 - 678.50) pg/mL as compared to day 3 (P = 0.709). Moreover, CRP, ferritin, LDH, and D-dimers levels were reduced following the administration of TCZ.
TABLE 1: IL-6 of SARS-CoV-2 patients at before and after Tocilizumab treatment

TABLE 2: Laboratory findings of SARS-CoV-2 patients at before and after Tocilizumab treatment

Conclusion
Early use of TCZ may reduce the need for MV and decrease CRP, ferritin, LDH, and D-dimer levels, which may be useful inflammatory indices in the management of SARS-CoV-2 patients. Furthermore, the sequential use of methylprednisolone for 72 hours seems to potentiate the effect and prolong the suppression of the cytokine storm. The use of IL-6 levels may be helpful as a prognostic tool and in the management of acutely ill SARS-CoV-2 patients.

Disclosures
All Authors: No reported disclosures
684. The impact of rapid molecular respiratory testing on provider and parental decision making for children with respiratory illness evaluated in an ED setting
Authors: Rao Suchitra , Moss Angela , Lamb Molly , Mistry Rakesh , Dominguez Samuel 
Published: January 2021

Abstract

Background
Rapid respiratory testing (RRT) can decrease ancillary testing, length of stay and antibiotic use for hospitalized children. Less is known regarding the impact of RRT in the emergency department (ED).
Our objectives were to determine if RRT impacts ED provider clinical decision making, family acceptance, and subsequent healthcare visitation for children with influenza-like illness (ILI).

Methods
Randomized controlled trial of children 1 month-18 years of age presenting to a tertiary care pediatric ED with ILI. All children received a nasopharyngeal swab and RRT and were randomized to the intervention group (RRT result given to clinicians/families) or control group (results not available unless obtained clinically). Outcomes included provider decision-making (anti-infective prescribing, ED diagnostic testing, disposition), family acceptance of RRT (willingness to undergo future testing) and repeat healthcare visits (clinic or ED). Providers in the intervention group were surveyed after RRT results were available, and families in both arms were contacted 1 and 10 days later.

Results
There were 920 ED visits from 908 enrolled children; 629 (68%) families from both arms and 443 (96%) providers from the intervention arm completed surveys. Most providers (33%) were ED trained and &lt; 5 years post-training (37%). Clinical decisions were changed in 17% of visits based on RRT results, most commonly by ED trained physicians, advanced practice providers, and those &lt; 5 years post-training (Table). The most common decision changes were antiviral use and avoidance of diagnostic tests (Figure). Families were more willing to undergo future RRT if they were in the intervention group, or if RRT results were available in 20 minutes. In the control arm, 22 families (7%) stated they would not have sought additional medical visits if RRT results were available. In the intervention group, 20 families (6.7%) reported that the RRT influenced how their child received care, and 14 families (17%) sought additional care due to RRT results.
Figure. Provider Clinical Decision Making Based on Results of Rapid Respiratory Testing, n = 443

Characteristics of providers and patients by provider decision type

Conclusion
RRT impacts clinical decision making for 1 in 5 ED visits, specifically antiviral prescribing and reduced diagnostic testing. Most families were in favor of RRT, which impacts additional health care visits after the ED encounter.

Disclosures
Suchitra Rao, MD, BioFire (Grant/Research Support) Molly Lamb, PhD, BioFire (Grant/Research Support) Rakesh Mistry, MD, MSCE, BioFire (Grant/Research Support) Samuel Dominguez, MD, PhD, BioFire (Consultant, Research Grant or Support)
691. Results of Repeat HIV-1 DNA Resistance Tests Are Highly Concordant
Authors: Curanovic Dusica , Cai Suqin , Toma Jonathan , Petropoulos Christos J , Walworth Charles M 
Published: January 2021

Abstract

Background
DHHS guidelines recommend caution when interpreting HIV-1 DNA resistance testing because not all previously identified drug resistance mutations (DRMs) may be captured. Comparison of multiple reports from the same patient was performed to assess the ability of HIV-1 DNA testing to consistently identify wild-type and drug resistance alleles.

Methods
Patients with 3 HIV-1 DNA resistance tests (trios) and corresponding HIV-1 viral load (VL) measurements within ~3 months of each resistance test were identified in a commercial database. Concordance among trio test results was assessed for each patient. VL and trio timespan were evaluated for impact on concordance using one-way ANOVA with post-hoc analyses.

Results
Fifty-five patients with test trios were identified for analysis. Average patient age was 53 years, and 88% were male. All 3 tests within 26/55 trios were associated with VL&lt; 200 copies/mL. The average testing timespan was 100 weeks (range 17-228 weeks). Wild-type virus was identified on 3/3 reports for 11/55 (20%) patients. Among resistant viruses, DRMs were identified on average 70%, 20% and 10% on 3/3, 2/3 and 1/3 of HIV-1 DNA reports, respectively. M184V was identified on 3/3, 2/3 and 1/3 reports among 14/17, 2/17, and 1/17 test trios, respectively. K103N was identified on 3/3 and 2/3 reports among 11/12 and 1/12 test trios, respectively. The redetection rate following an initial HIV-1 DNA test was high for M184V (30/34, 88%) and K103N (23/24, 96%).
Of 178 DRMs detected across all initial HIV-1 DNA tests, 17 (9.6%) were not detected on the second, but redetected on the third test, including M184V and K103N in one trio each. The average concordance among test trios across all drug classes was 97%. No correlation between VL at time of testing and DRM redetection rates was observed. Significantly fewer DRMs were recaptured when repeat testing was performed &gt; 24 months after the initial test.

Conclusion
Repeat HIV-1 DNA drug resistance testing reliably detected archived DRMs. DRM decay related to turnover of the viral reservoir may explain some discordance between repeat HIV-1 DNA tests.

Disclosures
Dusica Curanovic, PhD, Monogram Biosciences (Employee) Suqin Cai, n/a, Monogram Biosciences (Employee) Jonathan Toma, n/a, Monogram Biosciences (Employee) Christos J. Petropoulos, PhD, Monogram Biosciences (Employee) Charles M. Walworth, MD, Monogram Biosciences (Employee)