bluuebunny/crossref_metadata_2025_split huggingface dataset:
971. Online Medical Education Improves Knowledge of Data on Appropriate and Timely Use of Influenza Antiviral Medications to Patients at High Risk for Influenza-Related Complications and Morbidity
Authors: Armagan Allison , Smith Roderick 
Published: December 2021

Abstract

Background
Many patients are at a higher risk of influenza complications because of age and comorbidities. We sought to assess whether online education, focused on appropriate and timely use of influenza antiviral medications to patients at high risk for influenza-related complications and morbidity, could improve knowledge, competence, and confidence of clinicians.

Methods
Primary care physicians (PCPs) and pediatricians participated in a 30-minute video lecture with synchronized slides. Educational effect was assessed using a repeated-pairs design with pre-/post-assessment. Three multiple choice questions assessed knowledge/competence, and 1 question assessed confidence. Statistical tests to assess significance: Paired samples t-test for overall average number of correct responses and for confidence rating; McNemar’s test for individual questions (5% significance level, P &lt; .05). Cohen’s d estimated the effect size impact on number of correct responses (&lt; .20 modest, .20-.49 small, .59-.79 moderate, ≥.80 large). Data were collected from 10/28/20 to 12/23/20.

Results
Average knowledge/competence improved from 29% to 43% (N=430, P&lt; .001, Cohen’s d = 0.46) among primary care physicians and from 31% to 43% (N=226, P&lt; .001, Cohen’s d = 0.38) among pediatricians. Post participation, 12% more PCPs and pediatricians answered all questions correctly. Relative improvements post-participation in specific areas were as follows (P&lt; .001): (i) 105% improvement among PCPs and 100% improvement among pediatricians in findings associated with the efficacy of treatment with antivirals for influenza in hospitalized patients. (ii) 117% improvement among PCPs and 104% improvement among pediatricians in identifying the antiviral with the greatest activity against influenza B viral strain as reported in a phase 3 clinical trial. (iii) 34% of PCPs and 46% of pediatricians had a measurable improvement in confidence after completing the program.

Conclusion
This study demonstrated the success of a video lecture with synchronized slides at improving PCPs and pediatricians knowledge, competence and confidence related to appropriate and timely use of influenza antiviral medications to patients at high risk for influenza-related complications and morbidity.

Disclosures
All Authors: No reported disclosures
973. Utilization of Project ECHO for COVID-19 Medical Knowledge and Best Practices for Health Professionals serving an Underserved Population
Authors: Rodriguez Natalia , Goebel Melanie , Bhushan Sheena , Patel Shital 
Published: December 2021

Abstract

Background
During the global COVID-19 pandemic, the release of research and data particularly to guide clinical care evolved rapidly and highlights the critical need for timely, and equitable access to medical knowledge and best practices. Specialized medical knowledge has historically been confined to specialists in academic medical centers and disconnected from healthcare professionals in underserved areas. It is important to bridge this gap and democratize knowledge through a model that supports rapid dissemination of best practices to build capacity in areas of need.

Methods
A Project ECHO partnership was implemented between academic infectious diseases specialists and local healthcare professionals involved in COVID-19 screening, diagnosis and management serving an underserved population. BCM COVID-19 ECHO supported the Access2Health SmartPod COVID-19 clinical operations staffed by a charitable community organization. The SmartPod clinical team were engaged in weekly one-hour ECHO sessions with didactic presentations and case discussions on diverse COVID-19 topics. The program was evaluated at 6 months.
COVID 19 ECHO Model

BCM COVID-19 ECHO Telementoring Program with the United Health Partners in the community
BCM COVID-19 ECHO Telementoring Session Topics

Curriculum developed for the health professionals seeing patients in the SmartPOD and clinics in underserved communities.

Results
In Fall 2020, BCM COVID-19 ECHO facilitated 10 sessions with an average attendance of 8 healthcare professionals per session. Evaluation results indicated high levels of satisfaction with session content and telementoring partnerships, with 80% expressing intent to apply the knowledge and skills acquired from the sessions to their clinical practice.

Conclusion
The Project ECHO model successfully engaged healthcare professionals in a continuous learning loop. With the rapid and vast amount of information during the COVID-19 pandemic, it is important to ensure health professionals have equitable access to medical knowledge and feel empowered to implement best practice changes.

Disclosures
All Authors: No reported disclosures
974. The Use of Social Media for Medical Education During the COVID-19 Pandemic; A Vision to the Future
Authors: Fentanes Maria Jose Reyes , Guerra Paula Amescua , Villalobos Armelle Perez Cortes 
Published: December 2021

Abstract

Background
The COVID-19 is the first pandemic in history where technology and social media can be used to keep people safe and informed. The correct management of information has been recognized as a critical part of controlling the COVID-19 pandemic. The objective of this study is to create a source of information about COVID-19 that is reliable, accessible, and easy to share while providing literature references.

Methods
An Instagram account named @cienciacontracovid19 was created in 2020. In this account, the most relevant up-to-date medical information of COVID-19 is published daily in Spanish. All the account’s content is made by two infectious diseases specialists and a general practitioner. After 6 months since the creation of the account, we performed a survey to assess the followers perception of the usefulness of @cienciacontracovid19 during the pandemic.

Results
The account was opened in November 2020. Figure 1 QR to access. Currently, the account has 9,534 followers from 5 Latin-American countries; 48% are between 25-34 years old, 76.6% are women, and 52% are healthcare workers. Until May 2021, 142 educational slides, 3 educational videos and 5 webinars have been posted. In the last 30 days, @cienciacontracovid19 has had 10,540 interactions and growth of +125% reaching 22,000 users. We conducted a survey in April 2021, in which 3,556 people answered. The following results were obtained: 76% considered that the information was always useful in their daily lives and 17% frequently useful. 77% affirmed that the information shared was always reliable and 47% consider that the information differed from other sources of information since it is easy to understand and 34% because it has bibliographic references to support it. 85% responded that the information shared in the account kept them from putting themselves at risk. When asking if the information shared has made them feel safer by being informed, 49% answered always and 44% frequently.
QR to access the instagram account

Conclusion
@cienciacontracovid19 has been a valuable source of scientific information with a positive impact on its users. Its implementation has been a practical medical education tool during the COVID-19 pandemic. By being informed, people could potentially modify some of their behaviors to stay out of risk from COVID-19.

Disclosures
All Authors: No reported disclosures
117. Trends in Four-class HIV Drug Resistance in Treatment-experienced Patients in the United States
Authors: Curanovic Dusica , Lai Johnny , Petropoulos Christos J , Walworth Charles M 
Published: December 2021

Abstract

Background
Despite the availability of potent antiretroviral therapy, only 56% of people living with HIV in the US were virally suppressed in 2018. Drug resistance can hinder suppression, especially among treatment-experienced patients, in whom the prevalence of 4-class drug resistance (4CR) is unknown.

Methods
Genotypic results of PhenoSense GT® Plus Integrase (Monogram Biosciences, South San Francisco, CA) obtained from Apr 2014 to Dec 2020 were used to assign susceptibility to nucleos(t)ide reverse transcriptase, non-nucleoside reverse transcriptase, integrase, and protease inhibitors (NRTIs, NNRTI, INIs, and PIs). Data were analyzed using summary statistics, 2 proportion Z test, one-way ANOVA and Tukey-Kramer; p &lt; 0.05 was significant.

Results
Among 13,651 patients with 15,372 tests, median age was 43 years; most had HIV-1 subtype B infection (95.09%), followed by AG (1.32%).
Among 12,303 patients with only one test, 4CR prevalence was 1.55%. Among 1,348 patients with more than one test, 4CR was seen in 3.64% of patients, and in 4.60% if cumulative resistance reports were assembled for each patient. Patients with 4CR were significantly older than those with less resistance.
The incidence of 4CR fluctuated, with a decline from 2.61% of patients tested in 2014 to 1.38% in 2017, an increase to 2.36% in 2018, and a decline to 1.56% in 2020. Among patients with more than one test, 21.01% gained resistance to a drug in a new class over an average of 19.5 months.
Most new resistance each year was to NNRTIs, followed by NRTIs, INIs, and PIs. The incidence of PI resistance declined for PIs from 13.34% of patients tested in 2014 to 11.82% in 2020, but increased for INIs from 14.56% in 2014 to 16.49% in 2020. The regimen expected to be suppressive in the greatest proportion of patients was dolutegravir + darunavir/cobicistat (94.51%).

Conclusion
The prevalence of 4CR has declined over time, but remains clinically relevant, particularly in older patients who may struggle with adherence due to complex regimens, comorbidities and polypharmacy. New drug classes may benefit this group. The concurrent increase in INI and decline in PI resistance may reflect changes in prescribing practices. Drug resistance may be underestimated unless cumulative resistance is determined.

Disclosures
Dusica Curanovic, PhD, Monogram Biosciences (Employee) Johnny Lai, BS, Monogram Biosciences (Employee, Shareholder) Christos J. Petropoulos, PhD, Monogram Biosciences (Employee, Shareholder) Charles M. Walworth, MD, Monogram Biosciences (Employee, Shareholder)
977. Invasive Mucormycosis in a Tertiary Care Hospital, Western Saudi Arabia: 11-Year Retrospective Chart Review, from 2009 – 2019
Authors: Almarhabi Hassan , Alasmari Esam , Farahat Faysal , Al-Amri Abdulfattah , Al-Maghraby Hatim , Alharbi Maher , Althaqafi Abulhakeem 
Published: December 2021

Abstract

Background
Mucormycosis is a rare, life-threatening invasive fungal disease that mostly affects immunocompromised hosts. the objectives of this study to assess clinical presentations and outcomes among patients with mucormycosis in a tertiary care hospital, western Saudi Arabia.

Methods
A retrospective chart review of cases diagnosed with mucormycosis was conducted from January 2009 to December 2019 in King Abdulaziz Medical City, Jeddah, in the western region of Saudi Arabia. Data were obtained on demographic information, comorbidities including immunocompromised conditions

Results
16 cases were identified as proven or probable mucormycosis according to revised European organization for research and treatment of cancer/mycoses study group criteria (EORTC/MSGERC). Most cases (n=11, 68.75%) were categorized as proven while 5 cases (31.25 %) as probable. The median age of cases 29.5 years, with 5 cases were less than 18 years. Cutaneous mucormycosis is the predominant presentation as noted in 7 cases (43.75%), followed by rhino-orbital-cerebral mucormycosis in 4 cases (25%), and pulmonary mucormycosis in 2 cases (12.5). Rhizopus and mucor species were the two main fungal isolates. The most common underlying etiology were hematological malignancies (n=7, 43.75%) , trauma with a motor vehicle accident( n=4 ,25%) , and diabetes mellitus(n=4 ,25%) . Most of the patients treated with amphotericin B lipid complex alone or in combination with posaconazole. The average days of antifungal use were 57.2 days. Most patients (n=11, 68.75%) undergone either one or repeated surgical debridement. Overall, 11 (68.75%) patients died, 2 of them prior to a confirmed diagnosis. All pulmonary cases died, the majority (75%) of rhino-orbital-cerebral, and 57.1% of the cutaneous cases died as well.

Conclusion
Mortality among cases with mucormycosis was high. Relatively better survival was observed among the cutaneous cases. A combination of new diagnostic technologies, optimized use of available antifungal options, development of new antifungal agents, and consistent implementation of public health policies may help to reduce mortality rates from mucormycosis in Saudi Arabia.

Disclosures
All Authors: No reported disclosures
980. Universal Lifelong Fungal Prophylaxis and Risk of Coccidioidomycosis in Lung Transplant Recipients Living in an Endemic Area
Authors: Truong Clover N , Nailor Michael D , Walia Rajat , Cherrier Lauren , Nasar Aasya , Goodlet Kellie J 
Published: December 2021

Abstract

Background
Previous studies suggested that 6-12 months of universal or targeted azole prophylaxis is effective in preventing coccidioidomycosis for various organ transplant recipients. However, limited reports have described outcomes with longer prophylactic durations or using mold-active azoles in lung transplant recipients. Therefore, the purpose of this study was to investigate the incidence of coccidioidomycosis and tolerability of universal lifelong azole therapy in this high-risk patient population.

Methods
This study was an IRB-approved, retrospective cohort study of lung transplant recipients transplanted from January 2013 through December 2018. Adult recipients who were initiated on azole antifungal prophylaxis were eligible for inclusion. Recipients who died or received pre-emptive or definitive treatment for coccidioidomycosis during the transplant admission, or who received a previous transplant were excluded from the study. Outcomes were assessed through December 2019 or until the time of coccidioidomycosis diagnosis, death, second transplant, or date lost to follow-up.

Results
Of 544 lung transplants completed between 2013-2018, 493 patients were included with a mean age at transplant of 62 ± 11; 57.3% were male, 88.6% were white, and 77.1% developed post-transplant diabetes. The majority of patients ( &gt; 70%) lived in Arizona or California pre-transplant and at 1-year post-transplant, and most patients had primary transplant indication of COPD and/or pulmonary fibrosis (~75%). One proven coccidioidomycosis infection and one new asymptomatic seropositivity for Coccidioides (incidence 0.2% each) occurred during the study period with median follow-up duration of 31 months. Azole therapy changes were common but permanent discontinuation was rare (1.4%) with reasons for azole switch varying among the different agents as summarized in Table 1.
Table 1. Comparison of azole antifungal exposures and reasons for discontinuation

Conclusion
Lifelong azole antifungal prophylaxis was well-tolerated and effectively protected lung transplant recipients at an Arizona transplant center against coccidioidomycosis. Thus, in the absence of documented intolerance or contraindication, universal lifelong azole antifungal prophylaxis should be considered for all lung transplant recipients residing in a coccidioidomycosis-endemic area.

Disclosures
Michael D. Nailor, PharmD, BCPS (AQ-ID), AbbVie (Consultant)Merck (Consultant)Shionogi (Consultant) Rajat Walia, MD, Astellas (Consultant, Speaker)
981. An Investigation into Possible Nosocomial Clusters and On-Treatment Resistance Patterns in Candidemia
Authors: Erayil Serin Edwin , Todd Robert , Kline Susan E , Selmecki Anna 
Published: December 2021

Abstract

Background
Candidemia has significant clinical implications, due to high rates of mortality and increasing resistance to antifungal drugs. Candida auris shows person-to-person transmission and survival on fomites. We aimed to determine if similar hospital transmission of Candida species, other than C. auris, is occurring. We analyzed candidemia infections for species, geographical, and temporal clusters, and clonality. We also aimed to study resistance patterns in individual patients on antifungal treatment. Here we present our current data from December 2019 – March 2021.

Methods
Patients with candidemia were identified with the help of the clinical microbiology lab serving an urban health system. Isolates were stored prospectively as glycerol stocks at -80 C. Data were collected by retrospective chart review and described in terms of frequency distributions and percentages. Patient locations within the hospital setting were traced by Infection Prevention. A cluster was defined as the same species being isolated from ≥ 2 patients in the same unit within a 90-day period. Genomic DNA was isolated and whole genome sequencing was performed. Genomic data were visualized using the Yeast Mapping Analysis Pipeline. The Minimum Inhibitory Concentration (MIC) was determined using broth microdilution.

Results
105 patients were identified from six hospitals (Table 1). Seven clusters of candidemia were identified (Table 2). Genome sequencing supported that all isolates from an individual patient were genetically related. No clonality was observed for isolates from different patients, including those representing two of the seven clusters (Figure 1). Loss of heterozygosity was detected in isolates collected 15 minutes apart in the same patient, indicating distinct populations. MICs remained the same at 0.5 ug/ml over 6 days in Patients l and m (Table 1). For Patient n, MICs remained at 0.5-1 ug/ml Day 1-8, but increased to 4 ug/ml on Day 9. No copy number variation was observed in these isolates.
Table 1. Species and resistance patterns of candidemia

Table 2. Clusters of candidemia

Figure 1. Yeast Mapping Analysis Pipeline for Clusters 3 and 4 – Candida albicans

Conclusion
We have not found evidence of hospital transmission of candida isolates in our investigations to date. We plan to evaluate clonality in the remaining 5 clusters. Future single nucleotide polymorphism analysis will determine if acquisition of point mutations is causing the increased MIC in Patient n.

Disclosures
All Authors: No reported disclosures
984. Diagnostic Utility of Bronchoalveolar Lavage Pneumocystis jirovecii DNA Polymerase Chain Reaction Assay in Patients with Hematological Malignancies and Hematopoietic Cell Transplantation
Authors: Nanayakkara Deepa , Tegtmeier Bernard , Ross Justine Abella , Dickter Jana , Puing Alfredo , Ho Stephanie , Taplitz Randy , Dadwal Sanjeet 
Published: December 2021

Abstract

Background
Pneumocystis jirovecii, an ubiquitous fungus, can lead to opportunistic pneumonia (PJP) in patients with hematological malignancies (HM) and hematopoietic cell transplantation (HCT) with mild to severe presentation. Unlike patients with HIV, diagnosis of PJP pneumonia is often challenging in patients with HM/HCT possibly related to lower fungal burden versus atypical presentation. The gold standard for diagnosis of PJP from bronchoalveolar lavage fluid (BALF) is cytology, followed by direct fluorescent antigen (DFA), however, in the context of lower fungal burden, quantitative polymerase chain reaction (PCR) is increasingly used. PCR DNA load cut-off for diagnosis of PJP is not established. The objective of this study is to assess the correlation between three tests (cytology, DFA and PCR) and diagnosis of PJP (colonization, possible, probable or proven infection).

Methods
In this retrospective study at City of Hope, HM/HCT patients with BALF performed to investigate pneumonia who tested positive for any of the 3 tests were included. The study period is from July 2014 to July 2020. All patients had a clinical and radiographic diagnosis of pneumonia.

Results
Eighty-five patients were identified to have at least one positive diagnostic test for PJP. Twenty (23.5%) patients had a PCR with less than 84 copies/mL, and colonization was suspected in these patients. Of the remaining 65 patients, 46 had all 3 tests done. Twenty seven (58.7%) patients only had positive PCR ranging from 106 to 588,000 copies/mL with negative DFA and cytology. Twelve (26.1%) patients had either DFA or cytology positive with a positive PCR, and in 6 patients (13%) all 3 tests were positive. All of these 18 patients had clinical presentation and radiographic findings consistent with PJP. Quantitative or qualitative serum beta-D-glucan (BDG) level was available in 28 patients and 17 had a positive test with a level &gt;80 pg/ml.

Conclusion
PJP PCR is a very sensitive test that can lead to early detection of PJP pneumonia in HM/HCT with lower sensitivity of DFA/cytology unless the fungal burden is high. However, the optimal cut off PCR value associated with disease needs to be clinically validated in our patient population and a concurrent serum BDG level can increase diagnostic yield.

Disclosures
All Authors: No reported disclosures
987. Clinical Epidemiology and Outcomes of Invasive Pulmonary Aspergillosis as a Complication of Respiratory Viral Infection in Hospitalized Patients
Authors: De Los Santos Bertha A , Barnes Brian J , Britt Nicholas 
Published: December 2021

Abstract

Background
Invasive pulmonary aspergillosis (IPA) is increasingly recognized as a complication of severe respiratory viral infections (RVIs), including influenza and COVID-19. However, the incidence and outcomes of IPA following other RVIs is not well-described. We hypothesized that IPA may be an underreported complication of non-influenza RVIs. The objective of this study was to quantify the incidence and associated outcomes of IPA following RVI in hospitalized patients.

Methods
We conducted a single-center retrospective cohort study of adult hospitalized patients with RVI diagnosed by multiplex PCR-based assay at the University of Kansas Hospital (Kansas City, Kansas) from September 2018-October 2019. Patients with a diagnosis of proven or probable IPA prior to RVI and those with hospital admission &lt; 24 h were excluded from analysis. Proven or probable IPA was defined according to EORTC/MSGERC consensus definitions. The primary outcome was 1-year all-cause mortality.

Results
A total of 195 patients met study criteria and were included in the analysis. The most common types of RVI observed were rhinovirus/enterovirus (57.9%, n=113), parainfluenza (13.3%, n=26), influenza (8.2%, n=16), and respiratory syncytial virus (7.7%, n=15). The cumulative incidence of IPA infection within 6 weeks of RVI was 5.6% (n=11). Excluding patients co-infected with multiple respiratory viruses (n=5), IPA was numerically more likely to occur following influenza compared to non-influenza RVI (12.5% [ n=2/16] vs. 4.6% [n=8/174]; odds ratio, 2.96; 95% confidence interval [CI], 0.57-15.3; P=0.176). Overall, one-year all-cause mortality was 20% (n=39/195) in this cohort. Development of IPA as a complication of RVI was associated with a significant decrease in 1-year survival (hazard ratio [HR], 3.04; 95% CI, 1.19-7.78; P=0.021), and this relationship persisted after adjustment for age (HR, 2.77; 95% CI, 1.08-7.10; P=0.034).

Conclusion
In a cohort of hospitalized patients with RVI, 5.6% of patients developed proven or probable IPA. Although IPA was more likely to occur in patients with influenza, this complication was also observed with other types of RVI. Invasive pulmonary aspergillosis may be an underappreciated complication of non-influenza RVI in hospitalized patients and warrants continued study.

Disclosures
All Authors: No reported disclosures