bluuebunny/crossref_metadata_2025_split huggingface dataset:
945. Bacteremia in Patients with Solid Tumors: Epidemiology, Clinical Features and Risk Factors for Mortality. Results from a Multicenter Study in Argentina
Authors: Costantini Patricia E , Torres Diego , Dictar Miguel , Nenna Andrea , Valledor Alejandra , Jordán Rosana , Laborde Ana , Lambert Sandra , Benso José , Carena Alberto , Luck Martín , Racioppi Agustina , Barcan Laura , Eusebio María José , Gonzalez Ibañez María Luz , Tula Lucas , Pasteran Fernando , Corso Alejandra , Rapoport Melina , Bronzi Marcelo , Nicola Federico , Valle Sandra , Chaves María Laura , Greco Graciela , Monge Renata , Damiano María Cristina García , Blanco Miriam , Herrera Fabián 
Published: December 2021

Abstract

Background
Current information regarding bacteriemia in patients with solid tumors is scarce

Methods
To assess the etiology, clinical features and outcome in patients with solid tumors and bacteremia, we carried out a prospective multicenter study. Episodes of bacteriemia in adult cancer patients in 9 centers, from May 2014 to February 2021, were recorded. To identify factors associated with 30-day mortality, variables with p &lt; 0.05 in univariate analysis were included in a logistic regression model for multivariate analysis

Results
Three hundred and thirty-two episodes of bacteremia were included, with 51% being women (mean age 59). The state of underlying disease was: recent diagnosis 27%, remission 27%, relapsed 29% and refractory 17%. Seventy-three percent had received chemotherapy in the last 30 days, 25% were receiving steroids. Neutropenia was present in 23% (mean duration 3 days). The most frequent sources were: abdominal 39%, urinary tract 21%, respiratory 15%, catheter 10% and skin and soft tissue 9%. The microorganisms were: Gram negative bacilli (GNB) 67% (Enterobacterales 84%), Gram positive cocci 36% (Staphylococcus aureus 33%) and polimicorbial 11%; 20% were multidrug resistant organisms (MDR-O), being 88% of them GNB (MDR-GNB). ESBL and KPC carbapenemase producing were the most frequent mechanisms of resistance. Mortality at day 7 and day 30 was 16% and 27%, respectively. In the univariate analysis, the risk factors for 30-day mortality were Charlson index, refractory underlying disease, use of steroids, polimicrobial bacteremia, Staphylococcus aureus, GNB resistant to carbapenems, APACHE and Pitt scores, hypotension, respiratory source and ICU admission. In multivariate analysis, risk factors for 30-day mortality were refractory underlying disease, GNB resistant to carbapenems and ICU admission, while 7-day clinical response was associated with lower mortality

Conclusion
Bacteremia is a serious complication in cancer patients, with high mortality. The state of underlying disease, infection caused by GNB resistant to carbapenems, and the severity of presentation are associated with increased mortality. Our results stress the importance of infection control measures and antibiotic stewardship to prevent colonization with MDR-O

Disclosures
All Authors: No reported disclosures
947. Nocardiosis in Renal Transplant Recipients Linked to Decreased Utilization of Trimethoprim/Sulfamethoxazole During COVID-19
Authors: McSweeney Terrence , Marvin Jennifer , Cohen Elizabeth A , Do Vincent , Belfield Kristen , Virmani Sarthak , Davis Matthew , McManus Dayna , Tirmizi Samad , Topal Jeffrey E 
Published: December 2021

Abstract

Background
The renal transplant population is at increased risk of Nocardiosis due to impaired T-cell mediated immunity with immunosuppression. Pneumocystis jirovecii (PJP) prophylaxis with trimethoprim/sulfamethoxazole (TMP/SMX) provides coverage against Nocardia spp. unlike alternative agents such as atovaquone (ATQ), aerosolized pentamidine (AP), and dapsone. During the COVID-19 pandemic, patients receiving AP were transitioned to ATQ to avoid the use of nebulized medication. This, in turn, led to decreased use of TMP/SMX as patients on oral ATQ were not reassessed for the use of TMP/SMX as would have occurred while on AP. Additionally, an increased incidence of Nocardia infections was observed during this time. The objective of this study was to determine the association between the incidence of Nocardia infections and number of TMP/SMX prophylaxis-days in pre- versus COVID-19 cohorts.

Methods
This was a single center retrospective chart review of all renal transplant recipients between September 2018 – August 2019 (pre-COVID-19 cohort) and April 2020 – March 2021 (COVID-19 cohort). Patients were included if they were at least 18 years of age and a recipient of a cadaveric or living donor kidney transplant. Exclusion criteria included multi-organ transplant, pediatric patients, and repeat transplants. The primary outcome was incidence of Nocardiosis within the first 6 months post-transplant in the pre- and COVID-19 cohorts.

Results
A total of 218 patients were included (Table 1). Induction therapy and initial immunosuppression did not differ significantly between groups, nor did rates of rejection within 180 days of transplant (Table 2). Although the pre-COVID-19 cohort had a higher rate of neutropenia, there was no difference in median absolute lymphocyte count between the two groups. The COVID-19 cohort had a decreased percentage of TMP/SMX prophylaxis-days (59.2% vs. 72.5%, p &lt; 0.0001) and an increased incidence of Nocardia infections in the first 6 months post-transplant (4% vs. 0%, p=0.0292). All 4 cases of Nocardia infections occurred in patients receiving ATQ.

Conclusion
The increased incidence of Nocardiosis was associated with a decreased use of TMP/SMX for PJP prophylaxis which may have been an unintended consequence of increased use of ATQ in lieu of AP during COVID-19.

Disclosures
All Authors: No reported disclosures
950. The Challenge of Fellowship Interviews During COVID-19: An Online Post-interview Survey
Authors: Mahatanan Rattanaporn , Vergo Maxwell , Zuckerman Richard A 
Published: December 2021

Abstract

Background
COVID-19 has significantly disrupted social and personal interactions, including fellowship recruitment. In-person interviews were replaced by virtual interviews, which created uncertainties for both programs and candidates. We distributed a survey to interviewees for fellowship programs in an effort to gather data and improve the process.

Methods
An anonymous online survey on the Qualtrics® platform assessed satisfaction with the interview process, evaluated the advantages and disadvantages of virtual interviews, and requested comments to improve the process. Surveys were sent out to candidates within 7 days of interview for Infectious Disease and Palliative care fellowship programs at our institution.

Results
Surveys were sent to 51 candidates, 24 (47%) responded; 8 (33%) from Palliative care and 16 (67%) from ID. All candidates felt that they had a good sense about the programs and enough information to make a decision for ranking. Most candidates felt that they conveyed themselves well (71%) to very well (25%) during interview except one person who did not. 63% of candidates felt that the process was seamless, although 3 (12.5%) mentioned technical difficulties during the interviews. While 79% felt that the time spent on the interview was about right, 16% of candidates felt that interviews were too long and 1 person felt that it was too short. Cost-saving was the top advantage of the virtual interview with time-saving second. Interestingly, ability to interview at more programs was not ranked as highly as an advantage. Despite these advantages, 19 of 24 (79%) of candidates would have preferred an in-person interview if it was available. Lack of personal interaction and inability to see the location were equally chosen to be the greatest disadvantages of the virtual process by most of the candidates.

Conclusion
Despite the challenges of the virtual interview process, our survey showed positive feedback from candidates regarding their experiences. The lack of social interaction and inability to explore the location were important, prompting 79% of candidates to prefer an in-person interview if that was an option. Many factors should be considered to ensure an equitable and comprehensive process where candidates and programs can make decisions to optimize outcomes.

Disclosures
All Authors: No reported disclosures
951. Virtually the Same: Our Experience Teaching Abx Before and During the Pandemic
Authors: Schafer Katherine R , Shen E , Peters Timothy R 
Published: December 2021

Abstract

Background
Understanding core principles of empiric antibiotic (abx) therapy is essential for abx stewardship. Pre-pandemic, the “Abx 101” workshop taught students an initial approach to empiric abx. Due to the pandemic, the session became virtual. We hypothesized that the face-to-face version (FTF) would be more effective and more positively reviewed by students compared to the virtual.

Methods
For the FTF, 3 faculty facilitated workshops of 50 3rd year medical students. The intro reviewed the typical microbiota of body areas (or common pathogens for community-acquired disease in sterile spaces). Student small groups were assigned a category of abx coverage (e.g. “MRSA drugs”), and completed a worksheet to identify abx in the assigned category from a reference list of abx. Groups taught back to the class (jigsaw technique) about abx for their respective categories. Next, faculty facilitated a large group discussion in which they matched initial abx therapy for each body area’s typical microbiome or pathogens. Finally, groups presented cases to the class and identified likely diagnosis, most likely organisms, and appropriate empiric abx to target those organisms. For the virtual version, the format was adapted for a 1 hour online interactive session with 1 MD facilitator, 20-25 students, and no breakout groups/jigsaw technique. The content was unchanged other than fewer cases.

Results
26 of 140 (19%) students completed the survey (n=13 FTF, n=13 virtual). An independent-samples t-test compared FTF and virtual overall satisfaction scores. There were no significant differences in satisfaction from the FTF (M=8.54, SD=1.04) and virtual sessions (M=8.62, SD=1.94); t(24)=-.126. p=0.901. 100% of both groups rated the session as quite/extremely relevant to their training and 100% of respondents in both groups deemed the format of the sessions appropriate for the content. In the FTF group, 76% of respondents felt the session was quite/extremely effective for learning about abx spectra of activity, compared to 69% in the virtual group (X2 (1, N = 26) = .195, p = .658).

Conclusion
“Abx 101” was relevant, effective, and formatted well for learning about empiric abx, in FTF and virtual versions. These findings suggest that this curriculum is effective overall and adapts well for in-person and remote learning.

Disclosures
All Authors: No reported disclosures
952. Validating a Novel Framework to Classify Inpatient Infectious Diseases Consultation Requests
Authors: Merchant Elisabeth A , Patell Rushad , Hale Andrew , Azim Ahmed Abdul , Cool Josephine , Persaud Brian , Ricotta Daniel N , Dodge Laura E , Freed Jason 
Published: December 2021

Abstract

Background
Consistent classification of consult requests may lead to more efficient and collegial conversations about patient care, which could improve work satisfaction and enhance the learning environment. The authors propose a framework of 7 consultation types (Table 1). We aimed to obtain validity evidence for this rubric to consistently classify consultation requests.
Table 1. Framework for classifying consults into 7 types

Methods
A randomly selected sample of 100 de-identified infectious diseases (ID) consult requests from a single academic center were independently coded as 1 of the 7 consultation types by 3 ID specialists and 3 hospitalists. Perfect concordance (6/6 coders) and partial concordance (4/6 or 5/6 coders) was calculated. Total (3/3 coders) and partial (2/3 coders) concordance based on consult subtypes and provider specialty was also calculated. We compared proportions between groups using a chi square test.

Results
Perfect concordance was 30%, and partial concordance was 60% (Figure 1). Total concordance among ID specialists was 44% and among hospitalists was 54% (Table 2). In cases without perfect concordance (n=70), ID specialists had 20% total concordance and 70% partial concordance, while hospitalists had 34% total concordance and 59% partial concordance. ID specialists were less likely than hospitalists to have perfect concordance for ideal consults (52% vs 73%, P=0.01). ID specialists and hospitalists were similarly likely to classify a consult as ideal (65% vs 69%, P=0.34), but ID specialists were more likely to classify a consult as S.O.S. (25% vs. 17%, p=0.02), and less likely to classify a consult as confirmatory (3% vs 7%, P=0.02) (Table 3).

Figure 1. Concordance overall by consensus consult type among hospitalists and infectious disease specialists
Table 2. Concordance by consult type stratified among infectious disease specialists and hospitalists

Table 3. Consult type by physician subspecialty, among infectious disease specialists and hospitalists

Conclusion
ID consults can be classified into a novel rubric of 7 subtypes. Overall, partial or perfect concordance between hospitalists and ID consultants was 90%. ID specialists were more likely to classify consult requests as S.O.S than hospitalists, and hospitalists were more likely to classify consults as confirmatory. Opportunities exist to utilize the rubric to improve provider communication and interprofessional education.

Disclosures
All Authors: No reported disclosures
953. Online Medical Education Improves Knowledge of Monoclonal Antibody Treatment for COVID-19 Among Physicians
Authors: Armagan Allison , Uravich Maria B 
Published: December 2021

Abstract

Background
Treatments aimed at patients with mild to moderate COVID-19 offer an opportunity to improve rates of hospitalizations and progression to severe disease. The aim of this study was to assess the educational impact of a series of continuing medical education (CME) activities on the knowledge, competence, and confidence of primary care (PCP), infectious disease (ID), and ER/critical care physicians regarding the management of COVID-19 with monoclonal antibody (mAb) therapy.

Methods
The educational series consisted of 9 online, CME activities in multiple formats. At the individual activity level, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 3-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question, with each participant serving as his/her own control. To assess changes in knowledge, competence, and confidence data from all clinicians who completed both pre- and post-questions were aggregated across activities and stratified by learning themes. McNemar’s test (P&lt; .05) assessed educational effect. Data were collected from 12/20 to 5/21.

Results
To date, the 9 activities have reached over 24,000 physicians. Selected improvements in knowledge and competence measured as relative % change in correct responses pre/post education across the learning themes are reported here. (i) 45% improvement in PCPs and a 31% improvement in ID specialists’ knowledge/competence in identifying patients who would benefit from mAbs (P &lt; .01). (ii) 83% improvement in PCPs and a 42% improvement in ID specialists’ confidence in identifying patients who would benefit from mAbs (P &lt; .001). (iii) 15% improvement in ID specialists’ knowledge/competence on the clinical data on mAbs for COVID-19 (P &lt; .001). (iv) 32% improvement in PCPs knowledge/competence in understanding the mechanism of action (MOA) of mAbs for COVID-19 (P &lt; .001)

Conclusion
This series of online, CME-certified educational activities delivered in multiple formats resulted in significant improvements in knowledge and competence regarding the management of patients with mild to moderate COVID-19. This analysis also uncovered remaining educational gaps; 55% of content related to identifying patients who would benefit from mAbs was not retained post-education.

Disclosures
All Authors: No reported disclosures
954. Resources Needed by Critical Access Hospitals to Address Identified Infection Prevention and Control Program Gaps
Authors: Salman Ashraf M , Soma Mounica , Scebold Jody , Vasa Angela , Tyner Kate , Beach Sue , Lalam Satya Kumar , Fitzgerald Teresa Ann 
Published: December 2021

Abstract

Background
Critical Access Hospitals (CAH) may face challenges with limited resources in their infection prevention and control (IPC) program. As part of the Project Firstline collaborative, the University of Nebraska Medical Center and its clinical partner Nebraska Medicine sought to identify needs and develop resources to mitigate IPC program gaps in small and rural hospitals, including CAHs. Since, little is known about the resources needed by CAHs to strengthen their IPC program, a needs assessment survey was deployed to Federal Emergency Management Agency Region VII CAHs.

Methods
A 49-question Research Electronic Data Capture (REDCap) survey was distributed via email to infection preventionists in Region VII CAHs. The survey had 4 sections with questions focused on IPC program infrastructure, competency-based training, audit and feedback, and identification and isolation of high-risk pathogens/serious communicable diseases. An IPC practice score was assigned to each CAH by totaling “yes” responses. A “no” or “not sure” response was considered an IPC gap. Respondents who selected “no” were asked to identify resources that would assist in mitigating identified gaps. Descriptive analyses evaluated frequency of gaps and most cited resources. Welch t-test was used to study differences in IPC practice score between states.

Results
50 CAHs (33 in NE, 16 in IA and 1 in KS) and 1 small NE hospital (not licensed as CAH but included in the analyses as CAH) participated in the survey. Majority (n=38) responded to all sections with IPC scores ranging from 13 to 48. There was no significant difference between IPC practice scores of CAHs in NE and IA (average score 33 vs 36; p = 0.38). Specific IPC practice gaps present in &gt; 50% of CAHs were related to audit and feedback practices (Table 1). Additional gaps included lack of drug diversion program, absence of input from IPC team prior to purchasing equipment and failure to conduct risk assessment for the laboratory. Most CAHs cited a standardized audit tool and staff training materials as much needed resources (Table 1).
Table 1. Needs/Resources for the identified Infection Prevention and Control Gaps.

Conclusion
Major IPC gaps exist in CAHs with many of them related to implementing audit and feedback practices that are an essential component of a successful IPC program. Focus should be directed on developing resources to mitigate identified IPC gaps.

Disclosures
M. Salman Ashraf, MBBS, Merck & Co. Inc (Grant/Research Support, I have recieved grant funding for an investigator initiated research project from Merck & Con. Inc. However, I do not see any direct conflict of interest related to the submitted abstract)
956. Neurosurgical Infectious Disease Curriculum for Infectious Disease Fellows and Application of a Novel Surgical Infectious Disease Framework
Authors: O’Neil Jessica , Larsen Christian , Paras Molly L 
Published: December 2021

Abstract

Background
Infectious disease (ID) consultations from surgical services account for 30-41% of all ID consults at academic medical centers. However, adult ID fellows in the United States complete residency training in Internal Medicine and may have limited prior exposure to patients on surgical services. We surveyed 16 first and second-year fellows of the combined Massachusetts General Hospital/Brigham and Women’s Hospital ID Fellowship to evaluate their self-perceived ability to approach ID consults from surgical services. While 75% self-reported confidence in their ability to approach general surgery consultations, only 33% reported confidence with neurosurgical related consultations.

Methods
We created a novel framework for approaching surgical ID consult questions (Figure 1). We then developed two interactive case-based discussion sessions for first-year fellows to address common neurosurgical consult scenarios (post craniotomy/ craniectomy surgical site infections and cerebral spinal fluid shunt infections). The session materials, including images of common surgical approaches and risk factors for infection, were reviewed by a neurosurgeon content expert. An ID faculty member facilitated the discussions. Each discussion took place during a 30-minute teleconference. The learners then completed a self-assessment survey to evaluate the extent to which they could meet the educational objectives (Table 1) using a 1-5 Likert scale.
Figure 1. Surgical Infectious Diseases Framework

Table 1. Educational Objectives for Case 1 and 2

Results
All sixteen learners (eight per case) completed the educational objective self-assessment surveys. The educational objectives were achieved with all questions reaching a mean response of 4 or greater indicating that the mean of learners agreed (4) or strongly agreed (5) that they were able to meet the outlined educational objectives after participating in the discussion session for Case 1 (Figure 2) and Case 2 (Figure 3).
Figure 2. Educational Objective Self-Assessment Scores for Case 1

Figure 3. Educational Objective Self-Assessment Scores for Case 2

Conclusion
Based on self-assessment surveys, our educational objectives were achieved. In turn, these first-year fellows may be better prepared to address ID consults from neurosurgical services in the future. While the case-based discussions were designed to address specific neurosurgical ID cases, our standardized framework could be adapted to a variety of surgical ID cases.

Disclosures
Molly L. Paras, MD, Deckermed (Other Financial or Material Support, Payment for book chapter)