bluuebunny/crossref_metadata_2025_split huggingface dataset:
85. A Virtual Platform for Mentoring Clinician Educators at IDWeek is as Effective as In-Person
Authors: Riedel David J , Luther Vera , Luther Vera , Armstrong Wendy , Armstrong Wendy , Bonura Erin , Melia Michael , Schwartz Brian 
Published: December 2021

Abstract

Background
Career mentorship for clinician educators (CE) may be difficult to obtain within one’s home institution. During IDWeek 2018 and 2019, a mentoring program pairing junior faculty pursuing careers as CEs with more experienced CEs from other institutions was found to be feasible and effective. During IDWeek 2020, the program was transitioned to a virtual format. We assessed the feasibility and efficacy of this virtual mentoring program.

Methods
Junior and established CEs were recruited through the IDSA listserv and Medical Education Community of Practice and paired. Mentees completed an individual development plan (IDP) and identified discussion topics for their meeting. Mentors received training on successful mentoring and their mentee’s IDP and CV prior to meeting. Mentor and mentees met via videoconference for one hour during IDWeek 2020, created an action plan, and scheduled a follow-up call. Post-participation surveys were sent to mentees and mentors.

Results
30 mentor and mentee pairs were matched; 1 pair did not meet. Compared to IDWeek 2018 (17) and 2019 (20), the 2020 program had more mentees (30). 24 (80%) mentees completed the pre-session survey; 17 (59%) mentees and 20 (69%) mentors completed the post-session survey. When compared to survey results from mentees in 2018-19 who met in-person, mentees in the virtual format reported similarly high rates of satisfaction, planned to make changes at work, had an increase in confidence, and felt it was a valuable experience (Table 1). Mentors also reported high rates of satisfaction with the experience in 2020 and were likely to participate in the program next year (Table 2). Only 1 (6%) mentee reported that the virtual format negatively impacted their experience, although 6 (30%) mentors reported some negative impact of the virtual format (Table 3).

Table 1. Post-session mentee survey responses across 2 in-person years (2018, 2019) compared to the virtual mentoring program (2020)

Table 2. Post-session mentor survey responses across 2 in-person years (2018, 2019) compared to the virtual mentoring program (2020)

Table 3. Experience of mentees and mentors with the 2020 virtual mentoring program

Conclusion
A virtual mentoring program for CEs was feasible and as effective for mentees as an in-person format. Some mentors felt that the virtual nature did negatively impact the experience although it had minimal negative impact on mentees.

Disclosures
David J. Riedel, MD, MPH , Gilead (Advisor or Review Panel member)ViiV (Advisor or Review Panel member) Vera Luther, MD, Nothing to disclose Wendy Armstrong, MD, Nothing to disclose Brian Schwartz, MD, Nothing to disclose
86. Making the APPropriate Choice: Utilization of a Smartphone Application to Optimize Antimicrobial Decisions Among Internal Medicine Trainees
Authors: Brooke Thomas , Pfaeffle Herman , Guillory Walter , raiciulescu Sorana , Ressner Roseanne 
Published: December 2021

Abstract

Background
Use of an application (App) to shape antimicrobial stewardship (AS) practice is largely unknown. Walter Reed National Military Medical Center (WRNNMC) is a tertiary military academic medical center where 2020 AS guidelines transitioned to a mobile App platform. This project aimed to determine barriers to AS and the impact of an App combined with educational sessions (ES) on Internal Medicine (IM) trainee prescribing practices for common Infectious Diseases (ID) syndromes.

Methods
After an orientation, participants completed a pre-intervention survey. Once weekly ES reinforcing App content was implemented over 12 weeks after which a post-intervention survey was completed. Each weekly session covered a specific ID syndrome. Survey data was analyzed using SPSS Version 27 with paired t-test.

Results
Amongst 81 IM trainees, 59 (73%) completed both pre- and post-intervention surveys, of whom 39% were PGY1, 31% PGY2, and 27% PGY3. Common AS barriers included lack of knowledge, deference to seniority, established habits, and time needed to make an informed decision. The App and ES improved performance of an antimicrobial timeout (78%), IV to PO switch (61%), therapy de-escalation (56%), and antibiogram knowledge (68%) with 90% of trainees reporting increased access. Weekly ES led to 75% reporting it had at least a moderate impact on learning. Across all ID syndromes, each PGY year reported increased confidence in management post-intervention (P&lt; 0.001) but PGY1s in particular saw the largest gain in confidence with antibiogram, febrile neutropenia, and hospital/ventilator acquired pneumonia categories. Usage of the App increased from 42% to 90% after the intervention, and 95% modified their prescribing practice based on the App. The most common barrier to App usage was forgetting to use the App.

Conclusion
Utilization of an App combined with ES improved multiple domains of AS practice among IM trainees leading to a modification in antimicrobial prescribing practice in the vast majority of participants. PGY1 trainees in particular may see a large benefit which supports implementation of AS training early in the academic year. This model can be used to build a sustainable AS trainee curriculum augmenting the learning and management of common ID syndromes.

Disclosures
All Authors: No reported disclosures
87. Infectious Disease Diversity, Equity, and Antiracism (ID2EA): A Dedicated Curriculum for Infectious Disease Professionals
Authors: Gleeson Shana , Bathgate Meghan , Frederick Jennifer , Desruisseaux Mahalia S , Meyer Jaimie , Virata Michael D , Zapata Heidi , Shenoi Sheela , Radin Joanna , Golden Marjorie , Trubin Paul , Shaw Albert , Friedland Gerald , Aoun-Barakat Lydia A 
Published: December 2021

Abstract

Background
Systemic bias in the health care system has adverse effects on health outcomes. Educational programs examining the relationship between structural racism and health inequities are needed to translate knowledge into equitable care. The Yale School of Medicine Infectious Disease (ID) Section designed and piloted an innovative Infectious Disease Diversity, Equity, and Anti-Racism (ID2EA) curriculum to better understand and confront these issues.

Methods
The ID Section collaborated with pedagogical experts to create a curriculum. A baseline survey of ID faculty and trainees was used to gauge relevant knowledge, attitudes, skills, and topics of interest to participants. The curriculum was designed as a “roadmap” of interactive sessions (“roadmap stops”) focused on topics identified by respondents. Evaluations were performed after events to guide curriculum development and monitor its acceptance and effectiveness.

Results
All respondents (n=28) to the baseline survey agreed that discussion of race and ethnicity should be integrated into medical training. Most respondents (96%) had experience or knowledge of racial microaggressions in the workplace. Fewer (75%) felt comfortable talking to patients about race and only 68% felt confident teaching learners how to decrease bias in care. The survey identified topics of highest priority to participants, including building trust with patients (75%), providing racially sensitive care (68%) and establishing dialogue with community members (57%). Roadmap stops were constructed based on these priorities, with sessions on race-based medical experimentation and inequities, racial segregation and its impact on health, medical mistrust, and a skill building session on improving patient-centered communication. On follow-up surveys (n=18-28), most participants (93%) saw the sessions as a valuable way to spend time and the majority (91%) reported an impact on their understanding of racism in healthcare; specific changes in thinking were qualitatively coded.

Conclusion
Our findings demonstrate the positive impact of a curriculum to help understand racism and inequities in medicine. Building and implementing a diversity, inclusion, and anti-racism curriculum in ID sections is feasible, beneficial, and valued.

Disclosures
Jaimie Meyer, MD, Gilead Sciences (Scientific Research Study Investigator) Sheela Shenoi, MD, MPH, Merck (Other Financial or Material Support, SS’s spouse worked for Merck pharmaceuticals 1997-2007 and retains company stock in his retirement account. There is no conflict of interest, but it is included in the interest of full disclosure.) Marjorie Golden, MD, Iterum Pharmaceuticals (Consultant)
89. Positive Blood Culture Trends and Variability among U.S. Hospitals, 2012-2017
Authors: McCarthy Natalie , Hatfield Kelly M , Baggs James , Kazakova Sophia , Wolford Hannah , Olubajo Babatunde , Jernigan John A , Jernigan John A , Reddy Sujan 
Published: December 2021

Abstract

Background
Although studies have shown blood culture rates have remained stable in recent years, understanding the variability in positivity over time and among hospitals may inform diagnostic and antimicrobial stewardship efforts.

Methods
We included all discharges from hospitals participating in the Premier Healthcare Database and Cerner Health Facts from 2012-2017 in months where a hospital reported at least one blood culture with antimicrobial susceptibility results. A blood culture episode was defined as one or more cultures drawn within 1 hour. Episodes on or before day 3 were defined as admission episodes (AE), and those drawn on day 4 or later were defined as post-admission episodes (PAE). Culture episodes yielding any organism were categorized as pathogen+ (i.e., at least 1 non-commensal organism identified) or commensal (i.e., only commensal organisms identified). Positive or commensal episode rates were calculated as the percentage of pathogen+ or commensal episodes among all blood culture episodes for AE and PAE. Logistic regression with generalized estimating equation models accounting for hospital-level clustering were used to measure time trends and facility level associations.

Results
Among 19.6 million discharges in 493 hospitals, 7.5 million blood culture episodes were identified; 336,102 (4.5%) were pathogen+, and 110,236 (1.5%) were commensals. The rate of pathogen+ AEs increased from 4.2% to 4.7% over the study period (p&lt; .0001) and there was no significant temporal trend in the rate of pathogen+ PAEs (p=.7956) (Figure 1). AE commensals decreased significantly in 2016-2017 compared to previous years (1.6% in 2012 to 1.3% in 2017; p=.0092), and PAE commensals decreased significantly over the study period from 2.0% to 1.2% (p&lt; .0001) (Figure 1). We observed substantial inter-hospital variability for each outcome (Figure 2). In addition, differences among hospital characteristics and seasonality were noted for AE and PAE pathogen+ rates and AE commensal rates (Figure 3), but not urbanicity or teaching hospital status.
Monthly Positivity Rate of Blood Culture Episodes, Premier Healthcare Database and Cerner Health Facts, 2012-2017

Adjusted Odds Ratios and 95% Confidence Intervals of Blood Culture Episode Positive (Non-Commensal) and Commensal Rates and Associated Characteristics

Conclusion
While an increase AE pathogen+ rates and decrease in commensal rates could indicate improved culture ordering and collection practices, significant seasonal, regional, and facility-level variability calls for further investigation.

Disclosures
John A. Jernigan, MD, MS, Nothing to disclose
91. Gaps and Opportunities in Antimicrobial Stewardship Programs in Asia: A Survey of 10 Countries
Authors: Chang Feng-Yee , Chuang Yin-Ching , Veeraraghavan Balaji , Apisarnthanarak Anucha , Tayzon Maria Fe R , Kwa Lay Hoon Andrea , Chiu Cheng-Hsun , Deris Zakuan Zainy , Husin Suraya Amir , Hashim Hazimah , Karuniawati Anis , Ahmed Altaf , Matsumoto Tetsuya , Nguyen Van Kinh , Huong Dinh Thi Thu 
Published: December 2021

Abstract

Background
Most studies on hospital antimicrobial stewardship (AMS) status and practices are conducted in the west, and there is a lack of such data from Asian countries. The objective of this survey was to determine existing AMS practices and gaps, and challenges in implementing AMS programs in secondary and tertiary acute-care hospitals in 10 Asian countries.

Methods
A 70-item questionnaire was disseminated to hospitals fulfilling inclusion criteria and responses were collected from 10 April 2020 to 9 April 2021. The survey, specific to the Asian hospital setting, enquired about hospital leadership support for AMS; AMS team membership and training; AMS interventions; AMS monitoring and reporting; hospital infrastructure; and education. These were subdivided into core and supplementary components, adapted from the Transatlantic Taskforce on Antimicrobial Resistance set of core and supplementary indicators for hospital AMS programs, and the US Centers for Disease Control and Prevention checklist for core elements of hospital AMS programs.

Results
A total of 349 hospitals from Cambodia, India, Indonesia, Japan, Malaysia, Pakistan, Philippines, Taiwan, Thailand and Vietnam responded. Overall, only 47 hospitals fulfilled all 12 core components, and there were inter-country differences in terms of performance. The hospitals generally did well in terms of the AMS team (ie, comprising at least a physician leader responsible for AMS activities, a pharmacist, and infection control and microbiology personnel), and access to a timely and reliable microbiology service, with mean positive response rates (PRR) of ≥ 80% for these indicators (Figure 1). In the core components of AMS program interventions, and AMS monitoring and reporting, the lower mean PRR ( &gt; 60%) revealed that Asia has wider gaps in these areas versus gold standards. Although many hospitals had formal hospital leadership statements to support AMS (mean PPR 85.6%), this was not always matched by allocated financial support for AMS activities (mean PPR 57.1%).
Figure 1

Conclusion
For all core components of an AMS program, most Asian hospitals participating in this survey fell short of international gold standards. Inter-country differences in gaps highlight that country-specific solutions are needed to improve current standards in AMS.

Disclosures
Tetsuya Matsumoto, MD; PhD, MSD (Speaker's Bureau)Pfizer (Speaker's Bureau)
94. Infectious Complications of Left Ventricular Assist Devices
Authors: Harris Courtney , Coakley Lara , Mehra Mandeep R , Mallidi Hari R , Baden Lindsey R , Woolley Ann E 
Published: December 2021

Abstract

Background
Left ventricular assist devices (VAD) have significantly increased survival for patients with advanced heart failure. While advancements in devices during the past 10 years have improved thrombotic and bleeding complications, infection remains a significant cause of morbidity and mortality. We assessed the incidence and risk factors of VAD infections at our institution.

Methods
A single center, retrospective study of patients who had VAD implanted between January 2007 and December 2020 was performed. Patients with concurrent right sided mechanical circulatory support devices were excluded. Patient demographics, clinical characteristics, labs, microbiology data, and antimicrobials were obtained from the electronic medical records. Clinical outcomes were adjudicated by 2 independent physicians. VAD infections were classified using the ISHLT 2011 guidelines.

Results
241 patients had durable VAD implanted in this 14-year period, with a median time of 3 years follow-up. 134 (56%) patients had a clinically significant infection; 42 (31.3%) were VAD specific infections, 42 (31.3%) were VAD related, and 50 (37.4%) were non-VAD related. 95% of VAD specific infections were driveline site infections. 98% of patients with VAD related infections had a concurrent blood stream infection. Of the 50 non-VAD infections, 72% involved either a lower respiratory, urinary tract, or Clostridium difficile infection. Median time from VAD implantation to infection was 5 months. 44 (32.8%) had their first infection during the index hospitalization, of which 27 (61.4%) were non-VAD infections. 78 (58.2%) had one infection, compared with 38 (28.4%) who had two or more infections. 17 (12.7%) had recurrence of their initial infection and 6 (35%) occurred despite being on suppressive antibiotics. 48 of 134 (36%) infected patients were transplanted. 57 of 134 (42.5%) died compared to 33 of 107 (31%) without an infection.

Conclusion
More than half of VAD patients at our center during a 14-year time period had an infectious complication and higher mortality rate compared to those without an infectious complication. Further studies are needed to assess the immunologic risk factors for the increased risk of non-device associated infections in VAD patients.

Disclosures
Mandeep R. Mehra, MD, Abbott (Consultant)Baim Institute for Clinical Research (Consultant)FineHeart (Consultant)NupulseCV (Consultant) Ann E. Woolley, MD, MPH, COVAX (Consultant)
95. Impact of Penetrating Trauma on Surgical Site Infection Standardized Infection Ratio (SIR) for Colon Procedures
Authors: Boston Kelley M , Ellsworth Misti , Thomas Jocelyn , McInnis-Cole Tawanna A , Ostrosky-Zeichner Luis 
Published: December 2021

Abstract

Background
Colon surgery (COLO) is one of the focus areas for the the Centers for Medicare and Medicaid Services (CMS) Hospital Inpatient Quality Reporting (IQR) Program. Standardized criteria from the National Healthcare Surveillance Network (NSHN) are used to define surgical site infections (SSI) and to assess and weight standardized risk variables, so that all organizations can be judged to the same standard. Performance is compared though use of a standardized infection ratio (SIR), which is the observed number of infections, divided by the “predicted” number of infections, given the number and type of surgeries performed.

Methods
A retrospective review of medical records and NHSN documentation was conducted for 778 COLO procedures that were performed at a large academic and level 1 trauma center between January 2019 and December 2020. Initial review of the data showed that the increases in SIR were primarily concentrated in trauma patients with intestinal injury and fecal spillage. SIR for adult procedures were calculated using the NHSN Complex 30-Day SSI Data for IQR Report model, which the metric used by the CMS IQR. The CDC NHSN Statistics Calculator was used to compare SIR for procedures coded as trauma and non-trauma. As a proxy for patients with penetrating trauma, SIR for patients coded as trauma who had a surgical wound class noted as dirty was compared to SIR for patients coded as trauma with surgical wound class coded as contaminated or clean-contaminated.

Results
For the CMS model, there was a statistically significant difference (p = 0.0003) between SIR for trauma (SIR = 3.451) and non-trauma (SIR = 1.071) procedures. There was also a statistically significant difference (p=0.0014) between trauma procedures with dirty surgical wound class (SIR = 6.608), compared to those with wounds categorized as contaminated or clean-contaminated (SIR = 2.235).
NHSN Adult Complex 30 Days SIR comparison for COLO SSI with and without trauma

NHSN Adult Complex 30 Days SIR comparison for trauma COLO procedures with dirty wound class description, against COLO procedures with wound class described as clean or clean-contaminated

Conclusion
Risk factors currently included in the model for COLO SSI may not adequately account for the increased risk from penetrating trauma with fecal spillage. Trauma and wound class should be added to the CMS IQR risk model for SIR.

Disclosures
Kelley M. Boston, MPH, CIC, CPHQ, FAPIC, Infection Prevention & Management Associates (Employee, Shareholder) Luis Ostrosky-Zeichner, MD, Amplyx (Consultant)Cidara (Consultant)F2G (Consultant)Gilead (Grant/Research Support, Speaker's Bureau)Pfizer (Scientific Research Study Investigator, Speaker's Bureau)Scynexis (Grant/Research Support, Scientific Research Study Investigator)Viracor (Consultant)
96. Relative Vaccine Effectiveness Against Influenza-Related and Any Respiratory-Related Hospital Encounter During the 2019/20 High Influenza Activity Period: A Comprehensive Real-World Analysis to Compare Quadrivalent Cell-based and Egg-based Influenza Vaccines
Authors: Divino Victoria , Postma Maarten , Pelton Stephen I , Mould-Quevedo Joaquin F , Anupindi Ruthwik , DeKoven Mitchell , levin myron J 
Published: December 2021

Abstract

Background
Changes in the influenza hemagglutinin protein during replication of influenza in eggs during vaccine production may contribute to low vaccine effectiveness (VE). This phenomenon, egg adaptation, can explain VE differences between egg-based (QIVe-SD) and cell-based (QIVc) quadrivalent influenza vaccines. This research evaluated the relative vaccine effectiveness (rVE) of QIVc versus QIVe-SD in the reduction of influenza-related and any respiratory-related hospitalizations/emergency room (ER) visits among subjects 4-64 years old during the 2019/20 influenza season.

Methods
A retrospective cohort analysis was conducted among subjects 4-64 years old vaccinated with QIVc or QIVe-SD using administrative claims data in the U.S. (IQVIA PharMetrics® Plus). The adjusted number of events and rates of influenza-related hospitalizations/ER visits and respiratory-related hospitalizations/ER visits were assessed using inverse probability of treatment weighting (IPTW). Poisson regression was used to estimate relative vaccine effectiveness (rVE). In the main analysis, the study period was from Aug 4, 2019 to Mar 7, 2020 (ending early to avoid any influenza outcome misclassification with COVD-19 infection). In the assessment of the high influenza activity period (HIAP), the analysis period was restricted to Dec 8, 2019 to Mar 7, 2020.

Results
During the 2019/20 influenza season, 1,150,134 recipients of QIVc and 3,924,819, of QIVe-SD were identified following IPTW. In the main analysis, adjusted results show that QIVc was associated with a significantly higher rVE compared to QIVe-SD against influenza-related hospitalizations/ER visits (5.3% [95%CI: 0.5%-9.9%]) and respiratory-related hospitalizations/ER visits (8.2% [95%CI: 6.5%-9.8%]). Similarly, in the HIAP analysis, QIVc was associated with a significantly higher rVE compared to QIVe-SD for influenza-related hospitalizations/ER visits (5.7% [95%CI: 0.8%-10.4%]) and respiratory-related hospitalizations/ER visits (7.3% [95%CI: 5.4%-9.2%]).

Conclusion
QIVc was more effective in preventing influenza-related and respiratory-related hospitalizations/ER visits compared to QIVe-SD, using either a broad influenza season definition or restricting to the HIAP.

Disclosures
Victoria Divino, PhD, Seqirus (Consultant) Maarten Postma, Dr., Seqirus (Consultant) Stephen I. Pelton, MD, Seqirus (Consultant) Joaquin F. Mould-Quevedo, PhD, Seqirus (Employee) Ruthwik Anupindi, PhD, Seqirus (Consultant) Mitchell DeKoven, PhD, Seqirus (Consultant) myron J. levin, MD, GSK group of companies (Employee, Research Grant or Support)