bluuebunny/crossref_metadata_2025_split huggingface dataset:
590. Persisting COVID-19 vaccination hesitancy in the South Bronx
Authors: D' Aza Danelly Gomez , Shariff Masood A , Santibanez Israel Duran , Horowitz Raquel , Asad Hina , Mensah Dennis , Rabiee Lara , Pillai Anjana , Shah Vipul , Menon Vidya 
Published: December 2021

Abstract

Background
Minority groups have the lowest vaccination rates when compared to the overall population. We aim to study the attitudes and perceptions of COVID-19 vaccination, about six months after vaccine rollout in the South Bronx.

Methods
Cross-sectional anonymized online survey evaluating knowledge, attitude and perception about COVID-19 vaccination using SurveyMonkey™ was conducted in South Bronx community from April - June 2021.

Results
Of the 281 participants, 67% were Latinx and 16% were African American (AA); 69% (195) were fully vaccinated (FV) and 31% (86) with vaccine hesitancy (VH). The common reasons for hesitancy were “concerns about side effects” (38%), “vaccine is not safe” (27%) and “vaccine was approved too fast” (26%) (p&lt; .001). VH were more likely to rely online/mobile apps (30%) and friends and family (23%) as compared to FV. VH were more likely to be AA, younger age (&lt; 35 yrs), high school or lower education, single, unemployed, without comorbidities, not current on other eligible vaccines, and did not believe “vaccine is necessary to end the pandemic.” Majority of participants from both cohorts trusted their primary care providers. Mistrust with healthcare and pharmaceutical companies was higher in VH (p=0.009). Both groups preferred to continue wearing mask and practice social distancing despite vaccination status.

Table 1b: COVID-19 Vaccine Survey Summary

Table 1c: COVID-19 Vaccine Survey Participant Characteristics

Conclusion
Persisting vaccine hesitancy is concerning in minority communities. Identifying the target population and implementation of innovative methods to improve COVID-19 vaccination acceptance leveraging primary care providers would be a possible solution.

Disclosures
All Authors: No reported disclosures
591. Comparison of Fluconazole to Other Antifungal Agents in Allogeneic Hematopoietic Cell Transplant Recipients: A Meta-Analysis of Randomized Clinical Trials
Authors: Cheng Ce , Chineke Iloabueke , McBride Ali , Recio-Boiles Alejandro , Ainapurapu Lakshmi Saritha , Sun Chenyu , Vennelaganti Niharika 
Published: December 2021

Abstract

Background
Invasive fungal infections (IFI) are adverse complications of allogeneic and autologous hematopoietic stem cell transplantation (HSCT) with significant mortality and morbidity. Randomized Controlled Trials (RCT) have addressed the optimal anti-fungal prophylaxis regimen. However, the consensus for an anti-fungal prophylaxis regimen has remained elusive. Hence, we performed a meta-analysis of currently available RCTs comparing the efficacy of fluconazole vs. other antifungal agents including voriconazole, micafungin, and itraconazole in the endpoint of preventing IFI.

Methods
Randomized controlled trials were retrieved from PubMed, according to our inclusion criteria. The relative risk (RR), hazard risk (HR), and 95% confidence intervals (CI) were calculated. A random effect or fixed-effect model was used to calculate the pooled HR, based on heterogeneity. All statistical analyses were performed using RevMan software and R Core Team, and all p-values were two-tailed, and the significance level was 0.05.

Results
Ten RCTs were selected involving 2654 pts. Our results showed fluconazole is statistically inferior to other agents that include voriconazole, micafungin, and itraconazole with regards to the endpoint of a lower incidence of IFI (RR: 1.05; 95%CI: 1.02, 1.08; p=0.0002, I2=5%). However, subgroup analysis showed no statistical difference between fluconazole vs. other agents to prevent breakthrough proven IFI (HR: 0.76; 95%CI: 0.47, 1.23; p=0.27, I2=0%). Our subgroup analysis further showed that other agent’s group might have a superior role in preventing aspergillus compared with fluconazole (HR: 0.64; 95%CI: 0.44, 0.94; p=0.02, I2=0%), but no significant advantages over fluconazole for candidiasis (HR: 0.96; 95%CI: 0.45, 2.07; p=0.92, I2=0%).
Successful Rate Without Incidence of IFI

Figure 1. Successful Rate Without Incidence of IFI
Proven IFI vs. Suspected IFI

Figure 2. Proven IFI vs. Suspected IFI
Candidiasis vs. Aspergillus

Figure 3. Candidiasis vs. Aspergillus

Conclusion
This meta-analysis yield data that suggests fluconazole might be inferior to other agents in preventing IFI in all intent to treat patients undergoing HSCT. However, fluconazole is non-inferior in preventing proven IFI and candidiasis IFI based on our results. Thus, we continue to recommend fluconazole in selected patients who require anti-fungal prophylaxis. More RCTs are needed in the future to demonstrate the drug of choice for anti-fungal prophylaxis and address patient selection characteristics.

Disclosures
All Authors: No reported disclosures
592. Antimicrobial Utilization in Solid Organ Transplant Recipients 12-Months Post-Transplantation
Authors: Parraga Acosta Tommy J , Greenlee Sage , Makowski Charles , Kenney Rachel , Mayur Ramesh , Alangaden George J 
Published: December 2021

Abstract

Background
Antimicrobials are widely used in solid organ transplant recipients (SOTr). Yet, antimicrobial utilization in the transplant (TP) population is not well characterized. National Healthcare Safety Network antimicrobial use (NHSN-AU) does not provide data specific to SOTr. This study sought to describe inpatient antibiotic use among SOTr up to 1-year post-TP.

Methods
A cross-sectional study was performed of all SOTr who received a TP between January 2015 to December 2016. Demographics, TP type, antibiotic use variables, hospital days, and Clostridioides difficile infection (CDI) are described. Inpatient antibiotic administration was measured for 365 days starting from date of TP surgery. Automated data generated for NHSN-AU reporting was utilized, and SOTr data was abstracted by cross-matching with the transplant database. Transplant-patient days was used as the denominator for metrics. Variables included duration of therapy (DOT), DOT/1000 patient days, antimicrobial free days (inpatient days no antimicrobials were administered), and NHSN-AU reporting targets of anti-methicillin resistant S. aureus (MRSA), broad spectrum, and high-risk CDI agents. Data was analyzed using descriptive statistics via Microsoft Excel®.

Results
A total of 530 SOTr were analyzed. Baseline characteristics are shown in Table 1. Median age was 61, male gender 64%, median Charlson Comorbidity Index was 5. Kidney TP (43%), liver TP (32%), lung (9%) and heart (8%) were most common TP types. Among these four TP types: Lung TP had the highest median DOT (13 days), DOT/1000 patient days (6.6) and ratio of DOT/total patient (1.9) (Table 2). Liver TP had the most antimicrobial free days (34%). Proportionally, anti-MRSA agents use was highest in thoracic TP (lung/heart), broad-spectrum agent use was common in all but kidney TPs, and high-risk CDI agents use was highest among kidney TP (Table 3). A total of 34 SOTr had CDI, 76% in kidney/liver TPs.

Table 1. Antimicrobial usage and SOT - ID Week 2021

Table 2. Antimicrobial usage and SOT - ID Week 2021

Table 3. Antimicrobial usage and SOT - ID Week 2021

Conclusion
Our study provides preliminary and important data of inpatient antibiotic utilization specifically in SOTr, generated using automated NHSN-AU data cross-matched to transplant database. These metrics can be utilized to promote antimicrobial stewardship efforts directed to specific TP types.

Disclosures
Rachel Kenney, PharmD, Medtronic, Inc. (Other Financial or Material Support, spouse is an employee and shareholder)
593. Utility of Microbiologic Testing Obtained via Bronchoalveolar Lavage on Asymptomatic Lung Transplant Recipients: A Quality Improvement Study
Authors: Dillon William , Parraga Acosta Tommy J , Failla Andrew J , Corrales Julio , Mayur Ramesh , Alangaden George J 
Published: December 2021

Abstract

Background
The utility of surveillance bronchoscopy (SB) in asymptomatic lung transplant recipients (LTR) is controversial. Guidelines regarding the timing of SB and diagnostic testing varies across centers. Studies evaluating the role of microbiologic testing are lacking. Our transplant institute currently performs SB at week 1, and months 1, 3, 6, 9, 12, and 24 post-transplant. We evaluated if routine microbiologic testing obtained during SB impacted clinical management.

Methods
This observational cohort study was performed at Henry Ford Hospital, Detroit, MI and included all LTR done from August 2014 to August 2019. Clinical and laboratory data was abstracted from the electronic medical record Pre/post-SB. Bronchoscopies performed for new or worsening respiratory symptoms, decline in forced expiratory volume at one second ≥10%, new radiographic abnormalities and follow up bronchoscopies to assess stents or recent acute rejection were excluded. Microbiologic tests assessed are shown in Table 2. Management change was defined as reduction in immunosuppression or prescription of antimicrobials. Rate of change in clinical management based on microbiologic test positivity was the primary outcome. Data were analyzed with descriptive statistics.

Results
449 SB in 107 LTR were evaluated. Median age was 63 years, 68% were male. The average number of SB performed per patient was 4.2 (Table 1). The most common microbiologic tests performed were bacterial (435), mycobacterial (427), and fungal including Pneumocystis jirovecii (1022) (Table 2). The rate of test positivity and resultant change in management are shown in Table 3. The rate of test positivity was highest for bacterial (54%), fungal (27%) and viral tests (6%) with management changes in 12%, 2%, and 3% respectively.
Table 1. Patient Demographics

Table 2. Rate of Microbiologic Testing per Surveillance Bronchoscopy

Table 3. Rate of Microbiologic Positivity and Management Change per Surveillance Bronchoscopy

Conclusion
This is the largest study to specifically evaluate the role of routine microbiologic tests during SB in LTR. Bacterial cultures may be appropriate due to higher rates of management changes. However, routine fungal, AFB, and viral studies are unnecessary due to low true positivity, and consequent low rate of management changes. This represents an important opportunity for diagnostic and antimicrobial stewardship.

Disclosures
All Authors: No reported disclosures
594. Micafungin Prophylaxis in Acute Myeloid Leukemia Adult Patients Undergoing Induction Chemotherapy
Authors: Ross Justine Abella , Yong Jonathan , Chen Jason , Johnson Deron , Pon Doreen , Dadwal Sanjeet 
Published: December 2021

Abstract

Background
Patients (pts) with newly diagnosed acute myeloid leukemia (AML) undergoing induction chemotherapy are at increased risk for invasive fungal infections (IFI). Guidelines recommend posaconazole prophylaxis (ppx), but use is precluded by interactions and adverse effects. Micafungin (MCF) is an alternative, but data is limited by small prospective and retrospective studies. Primary objective: describe incidence of probable/proven IFI until neutrophil recovery (ANC ≥ 500 cells/µL) or 28 days after induction start date, whichever occurred first, in pts receiving MCF ppx. Secondary objective: describe incidence of clinical failure to MCF prophylaxis.

Methods
Retrospective review (January 2017 to January 2020) of newly diagnosed AML adult pts undergoing 7 + 3 using idarubicin (7 + 3-ida), 7 + 3 using daunorubicin (7 + 3-dau), venetoclax/decitabine (VEN/DEC), or venetoclax/azacitadine (VEN/AZA) receiving MCF ppx for at least 7 days included. Diagnosis of IFI &lt; 30 days prior to induction, liver function tests (LFT) 5x ULN at start of induction, or evidence of refractory disease after induction excluded. Probable/proven IFI defined by EORTC criteria. Clinical failure: changing to a different antifungal class for any reason until ANC recovery or 28 days after induction start date.

Results
Ninety-five pts included. Baseline characteristics: mean (±SD) age 57.8 (±13.0) years; 53.6% males. 62% (59/95) 7 + 3-ida, 13.7% (13/95) 7 + 3-dau, 15.8% (15/95) VEN/DEC, 8.4% (8/95) VEN/AZA. Mean (±SD): 32.5% (±26) blasts, WBC 13.2 (±23.8), ANC 2.4 (±4.6), ALC 1.9 (±1.6), platelets 92.6 (±123.2). Incidence of probable IFI 2/95 (2.1%). No proven IFI cases identified. Clinical failure occurred in 37/95 (39%): 8 persistent febrile neutropenia, 29 due to suspected IFI. No MCF discontinuation due to adverse events.

Conclusion
Our findings suggest that prophylactic MCF is safe and effective in pts with newly diagnosed AML undergoing induction chemotherapy. Outcomes were similar to those of prophylactic posaconazole studies, indicating MCF may be considered as an alternative when interactions and adverse effects preclude use of posaconazole. Our study was limited by small numbers, retrospective, single-center design. Future opportunities include prospective trials of prophylactic MCF in this setting.

Disclosures
All Authors: No reported disclosures
597. The Impact of COVID-19 on Outpatient Intravenous Antimicrobial Therapy (OPAT) in Physician Office Infusion Centers (POICs)
Authors: Martin Clifford P , Dretler Robin H , Bernett Jorge R , Statner Barry , Sleweon Thomas K , Luu Quyen , Prokesch Richard C , Stock Kent , Schroeder Claudia P , Hardin Thomas C , Van Anglen Lucinda J 
Published: December 2021

Abstract

Background
The coronavirus disease 2019 (COVID-19) pandemic dramatically affected the provision of healthcare in the U.S. with sharp declines in routine and elective healthcare services. Outpatient clinic visits declined nearly 60% in the early pandemic. We investigated how COVID-19 impacted the provision of OPAT at various Infectious Disease (ID) POICs nationwide.

Methods
Patient (pt) records were evaluated from Jan 2019 – July 2019 and compared to Jan 2020 – July 2020. Data collected included new OPAT pts, demographics, infection type, location prior to OPAT and therapy characteristics. Statistical analysis was performed using Chi-square test with p&lt; 0.05 considered statistically significant.

Results
Fourteen POICs reported data with a total of 2410 new OPAT pts in 2019 and 1807 in 2020, representing a decrease of 25%. Table 1 shows the comparison of OPAT characteristics between 2019 and 2020. Mean age and gender were similar, but there was a significantly higher percentage of pts ≥65 years treated in 2020 (43% vs. 36%, p&lt; 0.001). Infection type and location prior to OPAT were consistent between 2019 and 2020. Primary antimicrobial use was comparable with the exception of cefepime, which showed a greater use in 2020 (14% vs. 11%, p=0.006). OPAT management differed significantly from 2019 to 2020 with fewer pts completing therapy as prescribed in 2020 (85.9% vs. 88.3%, p=0.021), driven largely by more early discontinuations and switches to oral therapy. Other reasons for those not completing therapy were also significant and due primarily to transfer of care to other settings, most commonly the home (1.9% vs. 2.9%, p=0.029). Overall length of therapy was comparable.
Table 1. Comparison of OPAT in 2019 (Pre-COVID) and 2020 (Post-COVID)

Conclusion
OPAT provided through ID POICs experienced a substantial decrease in pts treated during the first half of 2020 compared to 2019. This was expected with the decline in healthcare services, especially elective procedures. Most pt and treatment characteristics were comparable between years, but interestingly, more elderly received OPAT during the pandemic and fewer completed therapy as planned. Further analysis of these differences can help determine effects of the pandemic on overall health outcomes in the OPAT population.

Disclosures
Lucinda J. Van Anglen, PharmD, Merck & Co. (Research Grant or Support)
598. A 3-Year Evaluation of Antibiotic Resistance Patterns in Gram-Negative Genitourinary Tract Infections Treated in Outpatient Infusion Centers (POICs)
Authors: Hengel Richard L , Metzger Brian S , Barry Baker H , Adams John S , Nathan Ramesh V , Bhattacharyya Rishi , Mandel Richard M , Couch Kimberly A , Schroeder Claudia P , Van Anglen Lucinda J 
Published: December 2021

Abstract

Background
Resistant Gram-negative pathogens (GNP) are common causes of genitourinary tract infections (GUI) often requiring outpatient parenteral antibiotic therapy (OPAT). Data are sparse regarding antibiotic resistance of GNP in patients (pts) treated with OPAT. We analyzed GNP of GUI pts treated in Infectious Disease OICs over a 3-year period stratified by location prior to OPAT.

Methods
Records from 18 POICs were queried for GUI pts with ≥1 GNP receiving OPAT from 2018 to 2020. Demographics, pt location prior to OPAT, infection type, year of therapy, and GNP were recorded. Antibiotic resistance patterns were defined as extended-spectrum beta-lactamase (ESBL) or multi-drug resistant (MDR). Chi Square and Fisher’s exact test were used to determine if ESBL status was associated with GNP or location prior to OPAT (hospital vs. community). The Cochran-Armitage test was used to analyze temporal trend in ESBL expression. Statistical significance was defined as P&lt; 0.05 for all tests.

Results
A total of 634 GNP were identified in 601 pts (mean age: 64±16, 58% female). Infections were 75% complicated urinary tract infection, 20% pyelonephritis, and 5% prostatitis/other. Overall, 56% (n=339) were treated directly from the community and 44% (n=262) following hospital discharge. GNP isolated were 56% E. coli, 19% Pseudomonas spp., 16% Klebsiella spp. and 9% others. Of the 611 GNP with potential to express ESBL, 43% (n=265) were ESBL producers (Table 1). Significantly more ESBL-producing GNP occurred in pts discharged from a hospital prior to OPAT compared to the community (53% vs. 36%, P&lt; 0.001). Overall, the incidence of MDR constituted 36% (n=231) of GNP, which did not differ by location prior to OPAT. Evaluation of ESBL incidence by year showed a significant increase from 2018 to 2020 (P=0.03). Although a slight increase in MDR was noted from 2018 to 2020, this was not significant (Figure 1).
Table 1. Frequency of ESBL and MDR by Location prior to OPAT

Figure 2. Prevalence of ESBL producers and MDR Pathogens by Year

Conclusion
Resistant GNP were observed in the OPAT setting for GUI with both ESBL and MDR pathogens. We saw a significantly higher rate of ESBL with GNP from hospital discharged pts compared to community-acquired infections and an increase in the overall incidence of ESBL over time. Management of Gram-negative genitourinary infections in the OPAT setting requires close monitoring of emerging resistance patterns.

Disclosures
Kimberly A. Couch, PharmD, MA, FIDSA, FASHP, AbbVie (Speaker's Bureau) Lucinda J. Van Anglen, PharmD, Merck & Co. (Research Grant or Support)
599. Patient Beliefs Regarding Lyme Disease and Need for Antimicrobial Treatment when Referred for Lyme Evaluation
Authors: Shere-Wolfe Kalpana D , Silk Rachel , Alexander Carla 
Published: December 2021

Abstract

Background
Controversy and confusion surround the terminology for patients who have persistent symptoms after treatment for Lyme disease (LD) or may have been misdiagnosed with Lyme disease. While Infectious Diseases (ID) use the term Post treatment Lyme disease syndrome (PTLDS), patients tend to use the term Chronic Lyme disease (CLD) to describe the syndrome associated with persistent symptoms post treatment of LD. Many ID physicians are reluctant to see patients who identify themselves as having “Chronic Lyme” disease in some part due to reluctance to prescribe repeated courses of antibiotics. The purpose of this inquiry was to assess belief regarding Lyme disease and treatment.

Methods
Patients at the Integrated Lyme Program at the University of Maryland completed clinical intake forms which included questions on their familiarity and beliefs surrounding Lyme disease.

Results
We evaluated 146 patient records from our Lyme Program Registry which began in December 2018. There were 57 (34.5%) males and 108 (65.5%)females with mean age of 51 years. Forty seven percentage of patients were referred by a physician and 53 % were self-referred. Approximately 50% (71/146) were treated with less 30 days of antibiotics, 37% (54/146) were treated with 1-6 months of antibiotics and 11.6% (17/146) were treated with &gt;6months of antibiotics prior to their initial evaluation in our Lyme program. Sixty eight percentage of patients were familiar with the term CLD but only 44% percentage were familiar with term PTLDS. Approximately half of the patients ( 52%) believed that they currently had Lyme disease and 63% believed that their current symptoms were due to Lyme disease. Despite this only 18% believed that they needed antibiotics for Lyme disease at the time completing the form.

Conclusion
Patient referred to our Lyme center were more familiar with term CLD vs PTLDS. Many of them believed that they currently had LD and their symptoms were due to Lyme disease. Despite this, the majority did not feel that they needed antibiotics for Lyme Disease at the time of their clinical visit. More research is needed to better understand patient beliefs and understanding regarding Lyme disease.

Disclosures
All Authors: No reported disclosures
601. Assessment of a Nursing and Pharmacy Collaborative Outpatient Parenteral Antimicrobial Therapy Management Program
Authors: Hemenway Alice N , Stewart Rebecca L 
Published: December 2021

Abstract

Background
At our facility a collaborative team of nurse and pharmacist manage patients receiving outpatient parenteral antimicrobial therapy (OPAT). This project aims to characterize this collaboration and assess the effectiveness by reviewing interventions made by the nurse and pharmacist, and assessing patient outcomes such as OPAT or infection related hospital admissions or ED visits, infection clearance, and mortality.

Methods
A retrospective cohort study was performed on patients started on OPAT between 1/1/19 and 12/31/20. This time period was split into three: Period 1 where the clinic only included the PharmD and they saw patients for in-person appointments, Period 2 where the clinic included both the OPAT RN and PharmD and the PharmD performed in-person appointments, and Period 3 where the clinic included both but due to COVID the in-person PharmD appointments were on hold. OPAT or infection related hospital admissions, ED visits, infection clearance, and death were compared for each period.

Results
A total of 388 patients were included in the review. There were 158 (40.7%) and 148 (38.1%) OPAT-related phone calls from the PharmD and RN, respectively. The two most common reasons for both PharmD and RN phone calls were a medication stop order/confirmation, and weekly lab obtainment. The third most common reason for the PharmD was dose change, and for the RN it was patient education. During Periods 1 and 2 the PharmD had in-person appointments with 28.9% of patients. The overall OPAT/infection related hospital admission and ED visit rates were 7.7% and 5.4%, respectively. Periods 2 and 3, which utilized the combined efforts of RN and PharmD, had consistently lower hospital admissions related to OPAT/infection (46-50% vs 62% Period 1), and ED visits due to OPAT/infection (33-36% vs 47% for Period 1). Clearance of infection was high for all 3 periods (89-95%), and mean mortality was low (2.1%).

Conclusion
Collaborative management allowed for the nurse and pharmacist to function as substitutes for each other without losing the specific focus of their specialties, with the RN performing more patient education, and the PharmD performing more medication dosing. The collaboration had positive effects on OPAT patient outcomes.

Disclosures
All Authors: No reported disclosures