bluuebunny/crossref_metadata_2025_split huggingface dataset:
620. Identifying the Role for a Pharmacist on an Outpatient Parenteral Antimicrobial Therapy (OPAT) Team in an Academic Teaching Hospital
Authors: Hino Garret H , Abdul-Mutakabbir Jacinda , Hamada Norman , Zhou Anna , Tan Karen K 
Published: December 2021

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) is currently an emerging practice to continue effective treatment after hospital discharge for patients requiring parenteral (IV) treatment. Pharmacists can collaborate with outpatient services like home infusion services to allow for safe administration and monitoring of IV antibiotics. The role of pharmacists in an OPAT team has been shown to improve patient outcomes such as optimizing antimicrobial therapy and reducing hospital length of stay and readmissions. We sought to define the utility of an OPAT pharmacist at an academic teaching hospital that currently does not have an OPAT service.

Methods
Patients receiving IV therapy via home infusion from 1/4/21 to 3/4/21 were screened for inclusion and excluded if antimicrobials were not prescribed. Infection characteristics and antimicrobial therapy were recorded. Interventions on day of and after discharge were noted. Duration of therapy (DOT) was calculated by the difference between start and stop dates of appropriate antibiotics. Discharge delays due to OPAT-related reasons were recorded. Continuous data are expressed as median (IQR). Categorical data are expressed as frequencies (%).

Results
Of the patients screened, 77 of 123 patients met inclusion criteria. Most patients were treated for a bone/joint infection (29/77, 38%). Ceftriaxone (18/82, 22%) and vancomycin (13/82, 16%) were the most frequently prescribed agents. The median DOT was 30 days (IQR 15, 42). On day of discharge, 52 opportunities for a pharmacist initiated intervention were identified with majority being clarifying DOT (19/52, 37%), streamlining or escalating antibiotic (8/52, 15%), and optimizing drug dose (8/52, 15%). OPAT-related discharge delays resulted in an excess of 58 hospital days and over 25% of patients (20/77) were readmitted 30 days after discharge. The most common post-discharge issues (n=56) were worsening infection (11/56, 20%), PICC line issues (9/56, 16%), and drug related adverse events (8/56, 14%).

Conclusion
A pharmacist on a dedicated OPAT service can assist with antimicrobial selection, treatment duration, and drug monitoring to promote patient safety in patients discharged on antimicrobials.

Disclosures
All Authors: No reported disclosures
623. Exploring ‘Slicer Dicer’, an Extraction Tool in EPIC, for Clinical and Epidemiological Analysis
Authors: Saini Vikram , Jaber Tariq , Como James D , Lejeune Keith , Bhanot Nitin 
Published: December 2021

Abstract

Background
Electronic Health Record (EHR) implementation has created an unprecedented library of patient data. Data extraction tools provide an opportunity to retrieve clinico-epidemiological information on a wide scale. Slicer Dicer is a data exploration tool in the EPIC EHR that allows one to customize searches on large patient populations. This software contains a variety of models that present de-identified information from EPIC’s Caboodle database. We explored the applicability and potential utility of this tool utilizing the diagnosis of Lyme disease as an example.

Methods
The following steps outline an overview of data extraction utilizing ICD-10 codes around Lyme disease at our health system. Step 1-3: Denominator chosen as ‘All Patients’ over a 3-year period, ‘Slicing’ of the data by ‘Lyme disease, unspecified’ was applied to these results, and the ‘sliced’ data was categorized by year of diagnosis (Slide 1). Step 4: This data was further arranged by month of diagnosis for trend analysis (Slide 2). Step 5: Sub-diagnosis was applied for Lyme arthritis (Slide 3). Step 6: Further ‘slicing’ was/can be done by other variables, such as ‘Hospitalization,’ ‘Encounter Diagnosis,’ and ‘ED Diagnosis’ (Slide 4). Step 7-8: Output was ‘sliced’ by ‘Age’ (Slide 5) and ‘Postal Code’ (Slide 6).
Slide 1. EPIC EHR screen capture showing 3-year period data

Data shown here represents 'All patients' chosen as the denominator further sliced by 'Lyme disease, unspecified' and categorized by the year of diagnosis.
Slide 2. EPIC EHR screen capture showing data further arranged by month of diagnosis

Results
Macro-level data of period prevalence on Lyme disease over 3 years (Slide 1), seasonal trends (Slide 2), specific sub-diagnosis (Slide 3), output by setting of diagnosis (Slide 4), and demographic information of our patient population (Slides 5, 6) was revealed by application of these parameters.
Slide 3. EPIC EHR screen capture showing application of sub-diagnosis for Lyme arthritis

Slide 4. EPIC EHR screen capture showing further slicing by multiple variables like hospitalization and diagnosis

Slide 5. EPIC EHR screen capture showing slicing of data by demographic information (Age)

Conclusion
Slicer Dicer can provide a snapshot for preliminary data analysis prior to investing time and commitment to a project. The appeal of this tool is that it mines de-identified data and thus does not require initial IRB approval. This opens an avenue for potential full research projects based on the results obtained and helps generate preliminary hypotheses through analysis of healthcare.
Slide 6. EPIC EHR screen capture showing slicing of data by demographic information (Postal Code)

Disclosures
All Authors: No reported disclosures
645. Rapid Diagnosis of Disseminated Mycobacterium kansasii infection in Renal Transplant Recipients Using Plasma Microbial Cell Free DNA Next Generation Sequencing
Authors: Ogunsiakan Tosin , Fajgenbaum Kristen D , Phadke Gautam , Montgomery Thomas , Gajurel Kiran 
Published: December 2021

Abstract

Background
Disseminated Mycobacterium kansasii infection is rare in kidney transplant recipients. The diagnosis may not be suspected readily due to non-specific clinical presentation. The diagnosis and treatment can be further delayed due to poor sensitivity of culture (especially of extra-pulmonary sites) and slow growth in culture media. Accurate and rapid diagnosis of disseminated M. kansasii infections in transplant recipients is important for antimicrobial management.

Methods
Two cases of disseminated M. kansasii infections with unusual presentation in which rapid diagnosis was made using the Karius test (KT) are presented. The KT is a CLIA certified/CAP-accredited next-generation sequencing (NGS) plasma test that detects microbial cell-free DNA (mcfDNA). After mcfDNA is extracted and NGS performed, human reads are removed, and remaining sequences are aligned to a curated database of &gt;1400 organisms. Organisms present above a statistical threshold are reported.

Results
Case 1: A 31-year female kidney transplant recipient presented with a thyroglossal duct cyst, as well as swelling of her right metacarpophalangeal joint and left 3rd finger. AFB culture of the thyroglossal cyst aspiration done on post admission day (PAD) 2 took 27 days to be identified as M. kansasii (on PAD 29) whereas plasma sent for KT on PAD 5 reported a positive test for M. kansasii at 284 molecules/microliter (MPM) in 4 days (on PAD 9). Case 2: A 59-year male kidney transplant recipient presented with generalized weakness, arthralgia, pericardial effusion, cytopenia, weight loss and intermittent fevers. Plasma sent for KT on PAD 12 was reported positive for M. kansasii at 1314 MPM in 3 days (on PAD 15). PET CT done simultaneously was consistent with an infection of an old AV graft in the left upper extremity. The AFB culture of the resected graft was confirmed as M. kansasii in 22 days on PAD 36. After the KT was available (before confirmation of M. kansasii on culture), the first patient underwent modification of empiric treatment and the second patient was started on specific treatment for M. kansasii.
Table of M. kansasii cases

Rapid diagnosis of disseminated M. kansasii infection

Conclusion
Open-ended NGS plasma testing for mcfDNA identified disseminated M kansasii infection much earlier than standard microbiology and thus helped in initiation and modification of pathogen directed treatment.

Disclosures
All Authors: No reported disclosures
652. Comparison of QuantiFERON-TB Gold Plus and T-SPOT.TB in the Diagnosis of Active Tuberculosis
Authors: Zhang Lifan , yang zhengrong , Liu Xiaoqing , Ma Huimin , Ge Qiping , Zhang Yueqiu , Shi Xiaochun , Cao Qifei , Gao Mengqiu 
Published: December 2021

Abstract

Background
Objective: To compare the accuracy of Quantiferon ®- TB Gold Plus (QFT-Plus) and T-SPOT.TB in the diagnosis of active tuberculosis (ATB).

Methods
From April 2020 to May 2021, patients with pathologically confirmed or clinically diagnosed ATB in Peking Union Medical College Hospital and Beijing Chest Hospital were enrolled as case group, while patients excluded from ATB in the same period were enrolled as control group, The clinical and laboratory information were collected. QFT-Plus and T-SPOT. TB were tested simultaneously to evaluate the consistency of the results and compare the sensitivity, specificity, predictive values and likelihood ratios for diagnosing ATB.

Results
Fifty-seven ATB patients and 159 non-ATB patients were included. 33 (57.9%) ATB patients were pathologically confirmed. The proportions of indeterminate results in QFT-Plus and T-SPOT.TB were 3.7% vs 0%, respectively. The agreement between the results of the QFT-Plus and T-SPOT.TB was substantial (kappa=0.644, p＜0.001). The area under the ROC curve of the QFT-Plus and T-SPOT.TB for diagnosing ATB was 0.759 (95%CI 0.689-0.829) vs 0.810 (95%CI 0.742-0.877), respectively, and there was no significant difference (p=0.303). the sensitivity of the QFT-Plus and T-SPOT.TB was 85.2% vs 89.5%, while the specificity was 61.7% vs 52.2%, respectively. In 33 Patients with pathologically confirmed ATB, the sensitivity of QFT-Plus and T-SPOT.TB was 87.9% vs 93.9% (p=0.669), respectively. In 78 patients (36.1%) who received glucocorticoid / immunosuppressive / biological agents, the positive rate of QFT-Plus was 35.9% (28/78), which was significantly lower than that of those who did not receive these agents (77 / 138pm,55.8%) (p=0.005), but there was no significant difference in the positive rate of T-SPOT.TB between the two groups (52.6% vs. 62.3%, p=0.162). The positive rate for both tests was independent of the peripheral blood lymphocyte count (p=0.675 for QFT-Plus vs. P=0.138 for T-SPOT.TB).

Conclusion
There was no significant difference between the QFT-Plus and T-SPOT.TB in the diagnosis of ATB. QFT-plus might be prone to indeterminate results and influenced by the immunosuppressive status. The results need to be verified by a prospective cohort study with large sample.

Disclosures
All Authors: No reported disclosures
659. Correlate Clinically and More-Use of Interpretative Comments in Clinical Microbiology Reporting
Authors: Kochhi Raksha 
Published: December 2021

Abstract

Background
Microbial identification & antibiotic susceptibility testing is an important investigation in clinical microbiology laboratory. In many centres in India the report has only the isolate and antibiotics tested. The additional comments if added give guidance to the clinicians to utilize the results. Pre-analytical issues of adequate & relevant clinical history, appropriate sampling techniques, timely transport & storage, history of antibiotic usage along with post analytical issues of recommended line of antibiotic therapy and infection control practices are better addressed with this practice.

Methods
This was a prospective qualitative study from the period of January 2017-March 2021 where in the standard operating protocol of Clinical Microbiology was reviewed and appropriate comments were included in the Laboratory Information System once the isolate was identified using VITEK 2, automated ID/AST instrument and interfaced. The Clinical Microbiologist would then review the comments upon discussion with the clinicians and then authorize reports. The reports included sample & isolate specific details , recommended antibiotic therapy and infection control related comments. This was based on standard international and national guidelines (CLSI, EUCAST, IDSA, IAP, and National Treatment Guidelines of India).

Results
There was a gradual improvement in completion of request forms with clinical history, sample site and antibiotic history being mentioned. This was assessed through periodic audits conducted every quarter from 36% in March 2017 to 95% in March 2021. Clinical communication with the microbiology laboratory also showed improvement with documentation. Feedback from clinicians was also taken on the utility of these comments, (87/120)72.5% of the clinicians found them useful(Grade 5). (32/120) 26 %(Grade 3) of the clinicians had concerns about the turnaround time and requested for provisional reports.

Conclusion
Interpretative comments in reports act as a bridge between clinical microbiology, infectious diseases and infection control. They help us to choose the correct antibiotics or sometimes no antibiotics when the situation demands it. With all the recent advancements, the clinico-microbiological utility of culture reports is the need of the hour.

Disclosures
All Authors: No reported disclosures
676. Impact of Stratified Testing Algorithm Utilizing Rapid Testing and Polymerase Chain Reaction (PCR) Tests for Viral Infections
Authors: Khatri Akshay M , Rasul Rehana , McCann-Pineo Molly , Schwartz Rebecca , Khameraj Aradhana , Malhotra Prashant , Farber Bruce 
Published: December 2021

Abstract

Background
In 2017, the multiplex respiratory viral panel (RVP) test was the only test available for patients (pts) with respiratory symptoms in our emergency department (ED). In 2018, the more rapid influenza/respiratory syncytial virus (Flu/RSV) test was incorporated in a stratified testing algorithm (STA) – depending on clinical features and physician discretion, pts underwent either Flu/RSV or RVP. We analyzed the STA impact by comparing data between winters of 2017 and 2018.

Methods
In a retrospective, single-center cohort study in suburban NY, admitted pts ≥18 years diagnosed with viral infections (by either test) were included. We excluded pts diagnosed at another hospital, admitted to intensive care or observation (&lt; 24 hours) units and pts with missing data. Data was collected through electronic medical chart review.
Primary outcomes were clinical evaluation time [time between triage and test order]; laboratory-turnaround (lta) time (between order and result); ED length of stay [EDLOS] (between admit order and bed assignment). Secondary outcomes included isolation time (between result to start of isolation precautions), treatment time (between result to influenza treatment). Outcome differences were assessed using Chi-Square and Mann-Whitney rank sum tests for categorical and continuous variables, respectively.

Results
734 pts were included in the study [368 in 2017; 366 in 2018]. Median age was 75 years and 55.9% were female. After implementing the STA, EDLOS was significantly lower [Table 1], with no significant differences in other parameters. Lta times were slightly higher after implementation [25 minutes (2017) v/s 29 minutes (2018)].
Table 1. Differences in clinical and laboratory turnaround times among patients admitted with viral infections in winters of 2017 and 2018

Conclusion
A stratified diagnostic algorithm may have reduced EDLOS, but without significant differences in other outcomes. A higher lta time might have been due to testing constraints, heterogeneous pt populations or other confounders. Prospective studies will help assess the real-world impact of such algorithms.

Disclosures
Prashant Malhotra, MBBS, MD,FACP, FIDSA, Gilead Sciences (Scientific Research Study Investigator, Other Financial or Material Support, Site PI for a industry funded multi center research study)
678. Rapid Molecular SARS-CoV-2 Detection by Abbott ID NOW Is Reliable in Pediatric Patients
Authors: Murphy Catherine , Scarcello Emily Sheboy , Nolan Sheila M 
Published: December 2021

Abstract

Background
The COVID-19 Pandemic demonstrated the importance of rapid, accurate, point of care testing to control spread of the virus. The availability of this testing has been crucial to re-opening schools, keeping children safely in schools, and returning children to school quickly following illness. The Abbott ID Now molecular assay to detect SARS-CoV-2 was granted Emergency Use Authorization in March 2020. Reports of lower sensitivity compared with conventional PCR prompted some school districts to require confirmatory conventional PCR for negative rapid molecular results to return children to school. In this study we aim to determine the sensitivity and specificity of the Abbott ID NOW molecular SARS-CoV-2 test in a large pediatric primary care practice.

Methods
A retrospective observational study was performed using data from 25 pediatric primary care sites in the Boston Children’s Health Physicians network, a large multispecialty pediatric practice in New York and Connecticut. Data were extracted from the electronic health record for all patients 0-22 years of age who had an Abbott ID NOW rapid molecular COVID-19 assay from October 1, 2020 - February 28, 2021. For all patients with rapid tests, we identified patients who had a conventional PCR test sent within 1 day before or 1 day after the ID NOW test. The result of the conventional PCR test was considered the “true” result. All discrepant test results were identified.

Results
During the study period, 14993 patients had ID NOW testing performed. The percent positivity was 8.5%. The percent positivity in our practices paralleled that in the surrounding community throughout the winter surge of COVID-19. 500 patients had confirmatory testing sent within 1 day before or after the ID NOW test (15 positive and 485 negative results). Based on the conventional PCR test results, 2 of 15 positive results were false positive and only 1 of 485 negative results was a false negative, resulting in a sensitivity of 93% and specificity of 99.6%. The false negative result was in a patient with nasal congestion whose mother was COVID positive.

Conclusion
Rapid, molecular, point of care testing is an important tool to identify SARS-CoV-2 in pediatric patients and limit school absences. The ID NOW assay is highly sensitive and specific in a real-world pediatric setting.

Disclosures
All Authors: No reported disclosures
683. Epidemiology and Microbiology of Infective Endocarditis: A Six Year Experience
Authors: Muhammed Niyas Vettakkara Kandy , Ananthanarayanan Rajalakshmi , Sasidharan Aswathy 
Published: December 2021

Abstract

Background
The epidemiology and microbiology of infective endocarditis (IE) is not well studied in India. Studies from developed countries report a culture positivity of more than 90% in IE, while in India it has been lower (40–70%). Viridans Group Streptococci (VGS) are the commonest organism identified from previous Indian studies. The state of Kerala in India has better health indicators compared to the rest of India and it is likely that the epidemiology of IE in Kerala may be different. We therefore studied the epidemiology and microbiology of IE in patients admitted to a tertiary care hospital in Kerala over six years (2015 – 2020).

Methods
An electronic medical record search was conducted to identify patients who satisfied definite or possible IE criteria as per modified Duke criteria. Three sets of blood cultures were sent in BacT/Alert blood culture bottles for all suspected cases of IE. Blood culture was done using BacT-ALERT 3D automated microbial detection system (bioMérieux, France) and organisms were identified using VITEK-2 system. Transthoracic echocardiogram was done for all patients and a transoesophageal echocardiogram was done when indicated.

Results
70 patients satisfied the inclusion criteria. Majority (70.4%) were male; mean age was 50.7±16.3 years. 71% patients had underlying valvular heart disease. Diabetes mellitus (53.5%) was the most common comorbidity followed by chronic kidney disease (18.3%). Mitral valve was most commonly affected (53.5%) followed by the aortic valve (19.7%) and both valves were involved in 5.7%. Right sided valves were affected in 8.5%. Prosthetic valve endocarditis accounted for 10% of cases. No echocardiographic evidence of endocarditis was seen in 11.3%. Blood culture was positivity was 64.8%. Staphylococcus aureus (20%) was the most common organism isolated, followed by VGS (17.1%). 50% of the Staphylococcus aureus isolated were methicillin resistant. Among 57 patients in whom an outcome was recorded, mortality was 12.2%.
Microbiology profile of infective endocarditis

Conclusion
Staphylococcus aureus has emerged as the most common etiological agent of IE in our study, in contrast to previous studies from India where VGS was predominant. The high prevalence of MRSA is of concern.

Disclosures
All Authors: No reported disclosures
693. Performance of ICD Code Versus Discharge Summary based Query for Endocarditis Cohort Identification
Authors: Nina Kim H , Gupta Ayushi , Lan Kristine F , Stewart Jenell C , Dhanireddy Shireesha , Corcorran Maria A 
Published: December 2021

Abstract

Background
Studies on infective endocarditis (IE) have relied on International Classification of Diseases (ICD) codes to identify cases but few have validated this method which may be prone to misclassification. Examination of clinical narrative data could offer greater accuracy and richness.

Methods
We evaluated two algorithms for IE identification from 7/1/2015 to 7/31/2019: (1) a standard query of ICD codes for IE (ICD-9: 424.9, 424.91, 424.99, 421.0, 421.1, 421.9, 112.81, 036.42 and ICD-10: I38, I39, I33, I33.9, B37.6 and A39.51) with or without procedure codes for echocardiogram (93303-93356) and (2) a key word, pattern-based text query of discharge summaries (DS) that selected on the term “endocarditis” in fields headed by “Discharge Diagnosis” or “Admission Diagnosis” or similar. Further coding extracted the nature and type of valve and the organism responsible for the IE if present in DS. All identified cases were chart reviewed using pre-specified criteria for true IE. Positive predictive value (PPV) was calculated as the total number of verified cases over the algorithm-selected cases. Sensitivity was the total number of algorithm-matched cases over a final list of 166 independently identified true IE cases from ID and Cardiology services. Specificity was defined using 119 pre-adjudicated non-cases minus the number of algorithm-matched cases over 119.

Results
The ICD-based query identified 612 individuals from July 2015 to July 2019 who had a hospital billing code for infective endocarditis; of these, 534 also had an echocardiogram. The DS query identified 387 cases. PPV for the DS query was 84.5% (95% confidence interval [CI] 80.6%, 87.8%) compared with 72.4% (95% CI 68.7%, 75.8%) for ICD only and 75.8% (95% CI 72.0%, 79.3%) for ICD + echo queries. Sensitivity was 75.9% for the DS query and 86.8-93.4% for the ICD queries. Specificity was high for all queries &gt;94%. The DS query also yielded valve data (prosthetic, tricuspid, pulmonic, aortic or mitral) in 60% and microbiologic data in 73% of identified cases with an accuracy of 94% and 90% respectively when assessed by chart review.
Table 1. Test Characteristics of Three Electronic Health Record Queries for Infective Endocarditis

Conclusion
Compared to traditional ICD-based queries, text-based queries of discharge summaries have the potential to improve precision of IE case ascertainment and extract key clinical variables.

Disclosures
All Authors: No reported disclosures