bluuebunny/crossref_metadata_2025_split huggingface dataset:
115. The Utility of (1→3)-β-D-glucan Assay in the Diagnosis of Severe Coccidioidomycosis Infections among Immunocompromised Hosts
Authors: Ayazi Parham , Zangeneh Tirdad , Shi Aishan , Campanella Matthew A , Obaidi Mohanad Al 
Published: December 2021

Abstract

Background
Coccidioidomycosis is associated with increased morbidity and mortality in immunocompromised (IC) patients. The diagnosis of invasive fungal infections can be challenging in IC hosts. Culture results may take time to identify Coccidioides species, and serologic based tests are less sensitive in IC patients. (1-3)-β-d-glucan (BDG) has been reported to be detected in patients with coccidioidomycosis. We hypothesized that BDG in combination with serology may assist in the early detection of coccidioidomycosis in IC patients.

Methods
After the institutional review board approved the study, we conducted a retrospective chart review from 10/1/2017 through 09/15/2020, including ≥18 years old IC patients with a confirmed diagnosis of coccidioidomycosis by culture. Information regarding demographics, comorbidities, immunosuppression, medications, BDG, serology, and clinical presentation was collected. Patients with infusions that can result in possible false-positive BDG were excluded. Patients with other fungal infections were also excluded. Chi-square test was used to compare categorical variables, Wilcoxon rank-sum and Kruskal-Wallis tests were used to compare non-parametric variables, accordingly.

Results
Over the study period, 269 encounters with positive Coccidioides spp. cultures were identified, 78/269 of patients were IC patients, 55/78 were excluded, and 23 cases were included in the final analysis. Among the 23 IC patients, the median age was 64, 43% were female, 74% were White. There were 8 post solid organ transplantation, 7 with a hematological malignancy, and 8 with other types of IC conditions. 19/23 had a pulmonary infection. 4/23 patients died within one month of their encounter. There was no statistical significance difference between positive BDG and serology tests, with 12/23 had positive BDG, and another 12/23 had positive serology. Combined serology and BDG detected 18/23 of the Coccidioidomycosis cases. 17% of the cohort died within the one-month follow-up.

Conclusion
The combined use of BDG assay and Coccidioides serology increases the sensitivity of coccidioidomycosis diagnosis to 78% in IC patients. Future prospective studies are needed to further evaluate the utility of serum BDG in diagnosing coccidioidomycosis in IC patients.

Disclosures
Mohanad Al Obaidi, MD, Shionogi Inc. (Advisor or Review Panel member)
955. Trends in Top COVID-19 Questions Among a National Audience of Primary Care Clinicians
Authors: Madore Aylin , Oliverio Margaret , Nock Steven 
Published: December 2021

Abstract

Background
As COVID-19 took the world by storm, primary care clinicians (PCCs) played a critical role in identification and management of this disease. Yet, knowledge around COVID-19 is constantly evolving, leaving clinicians with many unanswered questions. We sought to examine what questions PCCs had about COVID-19 and whether there were any trends over time.

Methods
We sought to examine what questions PCCs had about COVID-19 and whether there were any trends over time. We collected questions from PCCs during 4 live virtual 60-minute continuing medical education (CME) panel discussions on COVID-19 led by infectious disease experts from November 2020 to February 2021. Questions were independently sorted and analyzed by 2 MDs using constant-comparison and tie-break methodology.

Results
A total of 600 questions pertaining to COVID-19 were collected across 4 sessions. Top questions asked by PCCs ranked in descending order related to the following topics, with most common themes listed in parentheses: 1. Vaccines (efficacy, safety in pregnancy, indications/contraindications, timing of administration, side effects/adverse events) 2. Medication-Specific Treatment (monoclonal antibodies, ivermectin, steroids, convalescent plasma, supplements [vitamin D, zinc, vitamin c]) 3. Testing (false positive/false negatives, use in travel, quarantine, and gatherings) 4. Other Management (role of anticoagulation, use of chronic medications, guidelines) 5. Personal Protective Equipment (masks, eye protection, post-vaccination, use in travel). [Table 1] The percentage of questions around vaccination increased from 5% of total questions in October 2020 to 67% in February 2021. Questions related to Treatment declined from 20% to 6%, Testing declined from 21% to 3%, Other Management declined from 6% to 1% and PPE increased from 3% to 8% during this period.
Table 1. Top 5 topics of questions listed in descending order of frequency across all 4 COVID-19 panel sessions.

Table 2. Percentage of questions in the top 5 topics for each of the 4 COVID-19 panel sessions, with associated trendline.

Conclusion
PCCs nationally have gaps in knowledge around COVID-19 which can impact clinical decision-making. Based on our analysis of questions submitted by PCCs to infectious disease experts in a CME setting, the greatest gaps in knowledge were around vaccination, treatment, and testing with vaccination showing the greatest shift in interest over time.

Disclosures
All Authors: No reported disclosures
958. A Required Infectious Diseases Rotation Improves Antimicrobial Stewardship Knowledge for Internal Medicine Interns
Authors: Gottesdiener Lee S , Stoeckle Kate , Loo Angela , Mazur Shawn , Gudi Kirana , Marks Kristen , Marks Kristen , Simon Matthew 
Published: December 2021

Abstract

Background
Exposure to Infectious Diseases (ID) education is highly variable in post-graduate medical training. We report our experience with a required one-week ID consult rotation for Internal Medicine (IM) interns with a focus on antimicrobial stewardship education.

Methods
Since 2018 all IM interns at our institution have participated in a required one-week ID consult rotation. Antimicrobial stewardship is a core feature of this rotation, with educational resources on antibiotic spectrum and decision-making, and interdisciplinary rounding with ID pharmacists. Between March 2020 and May 2021 we piloted an 11-item pre-rotation and post-rotation quiz with distinct but paired questions on key stewardship topics. The quiz was administered anonymously in SurveyMonkey. Mean pre/post rotation scores were compared using a paired T-test and the McNemar test of paired proportions was used to compare the pre/post change in percentage of correct responses for each topic.

Results
Among 47 interns who completed the rotation, 16 interns completed both pre- and post-rotation quizzes (response rate=34%). Mean scores on the pre-rotation quiz were 60%, compared to 77% on the post-rotation quiz (p=0.01), indicating significant improvement at the end of the rotation (Figure 1). Among 11 residents who scored below 65% on their pre-rotation quiz, all achieved an increased score on their post-rotation quiz (mean pre-test of 49% to mean post-test 79%). Table 1 displays the question topics and pre/post test change in percentage correct. The most difficult pre-test topics were ‘Recognition of AmpC-Expressing Organisms’ and ‘Antibiotics with activity against Pseudomonas aeruginosa,’ which improved, from 31% to 81% correct (p=0.03) and 50% to 100% correct (p=0.01), respectively.

Figure 1. Mean score of interns on pre-rotation vs post-rotation antimicrobial stewardship quiz from March 2020 to May 2021 (n=16; p=0.01).
Table 1. Question topics and change in percentage correct on pre-rotation and post-rotation quizzes.

Conclusion
A required one-week ID consult rotation for IM interns improved antimicrobial stewardship knowledge. Our experience may serve as a model for other institutions interested in increasing IM housestaff exposure to ID and antimicrobial stewardship.

Disclosures
Kristen Marks, MD, Gilead Sciences (Grant/Research Support)
964. Impact of the COVID-19 Pandemic on Bedside Medical Education: A Mixed-Methods Study
Authors: Clark Eva , Freytag Jennifer , Hysong Sylvia J , Dang Bich , Giordano Thomas P , Kulkarni Prathit A 
Published: December 2021

Abstract

Background
The COVID-19 pandemic obligated academic medical programs to substantially alter the traditional Internal Medicine (IM) rounding model to decrease risk of inpatient nosocomial viral transmission. Our study aimed to describe how IM rounding practices changed during the COVID-19 pandemic and to understand the impacts of these changes on medical education.

Methods
We conducted a two-phase, mixed-methods study of inpatient IM rounding team practices at a large academic hospital in Houston, TX. In the first phase (January-February 2021), we organized and audio-recorded 4 virtual (Zoom) focus groups. Each included 5-6 rounding team members, divided by: attendings; senior residents; interns; and medical and physician assistant students. In the second phase (March-May 2021), we performed 6 direct observations of IM teams during rounds. Two observers systematically recorded variables such as time spent on non-bedside versus bedside rounds, number of each team member type entering patient rooms for bedside teaching, and types of personal protective equipment (PPE) worn.

Results
Topics discussed during focus groups included comparisons of rounding team size, rounding duration, physical distancing and PPE use, bedside education, communication methods, and patient safety before and after March 2020. Perceptions of changes in each topic were generally consistent across groups (Table 1). Direct observation data showed that team rounding styles remained diverse in the proportion of rounding time spent in an office versus on the wards, and in the number and types of team members entering patient rooms. IM team members uniformly wore respiratory PPE when entering all patient rooms; use of eye protection varied. Teams spent more total time discussing patients with or suspected to have COVID-19 compared to patients without COVID-19 (median 24 min versus 13 min, p&lt; 0.0001).

Conclusion
Our results suggest that the COVID-19 pandemic adversely impacted bedside medical education, even into Spring of 2021. Conclusions from this study can be used to 1) address educational gaps related to COVID-19 pandemic-associated rounding changes and 2) create innovative methods of providing high-quality clinical education that will be minimally impacted by future respiratory virus pandemics.

Disclosures
Prathit A. Kulkarni, M.D., Vessel Health, Inc. (Grant/Research Support)
967. Interprofessional Education of Medical Students in a Comprehensive HIV Care Coordination Elective
Authors: Goebel Melanie , Rodriguez Natalia , Robinson Felicia , Patel Shital 
Published: December 2021

Abstract

Background
Interprofessional education (IPE) is critical in undergraduate medical student curriculum to promote teamwork, increase effective communication, and improve patient-centered care especially in medically underserved populations, including those living with HIV.

Methods
Medical students participated in 2-week elective rotations at a freestanding, multidisciplinary HIV clinic providing comprehensive HIV care for more than 6,000 people in an urban, ethnically diverse, resource-limited population. The interprofessional faculty included physicians, pharmacists, case managers, social workers, service-linkage workers, substance use counselors, and medication access specialists. Students interviewed patients, rotated with at least four multidisciplinary health professionals at the clinic, and rounded with the HIV inpatient consult team and service linkage worker in the hospital. Each student completed a reflection paper on the barriers and facilitators of HIV care engagement. Student feedback was collected through course evaluations and debriefing sessions with course directors. Knowledge and ability to perform HIV-related services were assessed through student assessments at baseline and within 2 weeks of completing the rotation.
IPE competencies

Results
From January 20, 2020 to May 21, 2021, 17 medical students completed the 2-week elective (5 second-year students, 10 third-years, and 2 fourth-years). Student reflection papers demonstrated understanding of barriers to care, social determinants of health, and potential solutions to improve health outcomes. Open-ended feedback was positive, with many commenting on the benefits of learning from diverse healthcare professionals in HIV care. At follow up, 80% of students rated their knowledge of ideal functioning of interprofessional teams as very good or excellent. Students reported increased ability to deliver team-based care, provide services to culturally diverse people, and coordinate care for non-medical needs.

Conclusion
Interprofessional education enhanced students’ knowledge of care coordination, interprofessional communication skills, competency in teamwork, and understanding of socioeconomic barriers to care in an underserved population with HIV.

Disclosures
All Authors: No reported disclosures
978. Disease Associations and Outcomes in Hospitalized Patients with Non-Cutaneous Mucormycosis: Data from the National Inpatient Sample
Authors: White Mark 
Published: December 2021

Abstract

Background
Data regarding comorbidities and hospital outcomes among patients with non-cutaneous mucormycosis is primarily derived from case reports and single institution series. This study was undertaken to define the prevalence of this condition among adult inpatients in the United States and to measure the frequency of comorbid illnesses and outcomes of inpatients with mucormycosis.

Methods
The 2016 National Inpatient Sample was used to identify a cohort of patients with a hospital diagnosis of non-cutaneous mucormycosis. Patients with mucormycosis and comorbid medical illnesses were identified by ICD-10 codes. The impact of disease site and comorbid illness on inpatient mortality was measured.

Results
A cohort of 95 adults with non-cutaneous mucormycosis was identified and included patients with pulmonary (n=53), rhinocerbral (n=25), disseminated (n=17), and gastrointestinal (n=4) mucormycosis. The prevalence of non-cutaneous mucormycosis was 15.7 cases per million admissions. Frequently associated medical conditions included diabetes mellitus (45.3%), hematologic malignancy (34.7%), hematopoietic stem cell transplant (6.3%), long term use of systemic steroids (6.3%), myelodysplastic syndrome (6.3%), solid organ transplant (5.3%), non-hematologic malignancy (4.2%), and iron overload disorders (2.1%). The median age of adults hospitalized with non-cutaneous mucormycosis was 53.2 years (range 18-83); patients were predominantly male (78.9%) and Caucasian (51.8%). The median length of stay for this cohort was 20 days (range 1-190) with a median total hospital cost of &323, 470 (range &2,401-&1,958,259) and an in-hospital mortality rate of 20%. The inpatient mortality rate was increased with underlying myelodysplastic syndrome (p=0.003) but not by other associated medical conditions or by site of disease.

Conclusion
Non-cutaneous mucormycosis is associated with a high in-hospital mortality rate and should be considered in patients with suggestive clinical presentations and underlying diabetes or conditions associated immunosuppression. Prompt recognition and tissue confirmation of this diagnosis leading to early surgical intervention and systemic antifungal therapy may improve outcomes.

Disclosures
All Authors: No reported disclosures
985. Fusarium Infections in Patients with Hematological Malignancies
Authors: Krishnan Gayathri , Pande Anupam 
Published: December 2021

Abstract

Background
Fusarium is a ubiquitous mold that can cause invasive and disseminated fusariosis in immunosuppressed patients, especially those with hematological malignancies. The risk factors associated with mortality of patients with Fusarium infections have not been adequately assessed in literature. In this study, we sought to explore the characteristics, clinical outcomes, and risk factors for mortality in Fusarium infections in patients with hematological malignancies.

Methods
This is a retrospective study of adult hematological malignancy patients admitted to surgical/medical wards or critical units at an academic medical center from January 2010 to January 2021 and diagnosed with proven invasive Fusarium infections through positive microbiological culture data from a biopsy, surgical specimen or sterile site. Primary end point was 30-day mortality. Statistical analysis was done using Fischer’s exact test and Mann-Whitney U test.

Results
31 patients with hematological malignancies were identified with proven Fusarium infections during the 10-year period (13,390 total unique patients with diagnosis of hematologic malignancies). Two were excluded due to incomplete data. Demographic characteristics, type and status of hematological malignancy, chemotherapy, exposure to steroids, neutropenia, lymphopenia, antifungal prophylaxis, and other factors were analyzed. Mean age at diagnosis was 52.6 years. 16/29 (55.2%) had undergone stem cell transplant prior to infection with median duration of 150.5 days (range 12 to 1503) prior to infection. The most common pathologies were invasive sinusitis and disseminated cutaneous infection in 13/29 (44.8%) patients. Blood culture was positive in 5/29 (17.2%). Overall mortality was 86.2% with 30-day mortality of 44.8% and 1-year mortality of 83%. Death was attributed to fusariosis in 12/25 (48%). Median duration to death was 56 days (range 2 to 1627 days). Risk factors for 30-day mortality were assessed (table 1).

The table describes risk factors for 30-day mortaity for fusarium infections in patients with hematological malignancies. statistical analysis done using fischer’s exact test

Conclusion
Fusarium infections result in morbidity and mortality in patients with hematological malignancies. A variety of host and disease factors dictate eventual outcome of Fusarium infections in these patients. Lack of neutrophil recovery is a significant risk factor for 30-day mortality in this population.

Disclosures
All Authors: No reported disclosures
986. Incidence of Invasive Fungal Infections in Previously Untreated Patients with Acute Myeloid Leukemia Receiving Venetoclax and Azacitadine
Authors: Phupitakphol Tanit , Johnson Tanner M , Abbott Diana , Gutman Jonathan , Pollyea Daniel , Koullias Yiannis 
Published: December 2021

Abstract

Background
Acute myeloid leukemia (AML) is associated with poor prognosis, particularly in elderly patients with co-morbidities. Low-intensity therapies like azacitidine (aza) were the standard of care and were associated with low response rates and limited survival. Combining venetoclax (ven) with aza demonstrated significant improvements in responses and survival compared to aza alone, and represents the new standard of care for this population. However, as a myelosuppressive regimen, infectious complications, especially invasive fungal infections (IFI), are a potential concern. The incidence of IFI and the role for antifungal prophylaxis have not been well defined for newly-diagnosed AML patients receiving ven/aza.

Methods
We conducted a retrospective cohort review of AML patients treated with ven/aza at the University of Colorado Hospital from January 2014 to August 2020. Duration of therapy was defined as the time from initiation of treatment through one of the following endpoints (1) patient discontinuation, (2) progression of disease, (3) bone marrow transplantation, or (4) death. Four patients with a history of prior IFI were excluded. We assessed the impact of patient age, sex, duration of neutropenia, antifungal prophylaxis, and AML specific risk factors on the incidence of IFI as defined by the European Mycoses Study Group.

Results
One hundred forty-four AML patients were included in the study. Ten patients received antifungal prophylaxis and none developed IFI (p=0.21). Twenty-five (17%) patients developed IFI: 2 (8%) had proven IFI, 6 (24%) probable IFI, and 17 (68%) possible IFI. Invasive pulmonary aspergillosis represented all 25 cases of proven, probable, and possible IFI. There was a statistically significant association between prolonged neutropenia ( &gt;60 days) and IFI (p=0.007), whereas age, sex, and SWOG classification were not significantly associated with IFI.

Conclusion
The incidence of IFI in our AML cohorts treated with ven/aza was 17%, lower than that reported at other institutions. Neutropenia &gt; 60 days was significantly associated with IFI in our AML cohort treated with ven/aza. Although we were not powered to determine whether antifungal prophylaxis impacted IFI, there was no significant difference in IFI for patients who received prophylaxis.

Disclosures
All Authors: No reported disclosures
988. Is There Value of Infectious Diseases Consultation in Candidemia? A Single Center Retrospective Review From 2016-2019
Authors: Ryder Jonathan H , Van Schooneveld Trevor C , Van Schooneveld Trevor C , Stohs Erica J 
Published: December 2021

Abstract

Background
Candidemia is the second most common cause of healthcare-associated bloodstream infections in the US with mortality of approximately 25%. Studies demonstrate lower candidemia mortality with infectious diseases consultation (IDC). We evaluated effects of IDC on mortality and guideline-adherence at our institution to determine if mandatory IDC was warranted.

Methods
We retrospectively reviewed adults hospitalized with candidemia (≥ 1 blood culture positive for Candida) between 1/1/2016-12/31/2019. Exclusion criteria included age &lt; 19 years, polymicrobial blood culture, or death or hospice within 48 hours. Primary outcome was all-cause 30-day mortality. Secondary outcomes included guideline-adherence and treatment choice. Guideline-adherence was assessed with a modified EQUAL Candida score (Table 1). Descriptive statistics were performed.
Table 1. Original vs Modified EQUAL Candida Score

Abbreviations. CVC: central venous catheter, BCx: blood culture

Results
Of 187 patients reviewed, 92 episodes of candidemia with 94 species of Candida were included. Patient characteristics are shown in Table 2. Central venous catheters (CVCs) were present in 66 (71.7%) patients and were the most common infection source (N=38 [41.3%]) followed by intra-abdominal (N=23 [25%]). The most isolated species were Candida glabrata (40/94 [42.6%]) and C. albicans/dublienensis (35/94 [37.2%]). 30-day mortality was 21.7%. IDC was performed in 84 (91.3%) cases. Outcomes are in Table 3. Mortality was not different between IDC vs no IDC (18 [21.4%] vs 2 [25%]); other comparisons were numerically different but not significant: repeat blood culture (98.8% vs 87.5%), echocardiography (70.2% vs 50%), CVC removal (91.7% vs 83.3%), and initial treatment echinocandin (67.9% vs 50%). All patients received antifungal therapy. IDC resulted in more ophthalmology consultations (77.4% vs 12.5%, p&lt; 0.01). Mean modified EQUAL Candida score was higher with IDC (17.4 vs 13.9, p&lt; 0.01).
Table 2. Patient Characteristics

Abbreviations. TPN: total parenteral nutrition, ICU: intensive care unit, AIDS: acquired immunodeficiency syndrome
Table 3. Outcomes

Abbreviations. NS: non-significant, CVC: central venous catheter

Conclusion
IDC was common in candidemic patients and not associated with significant differences in outcomes. Current antimicrobial stewardship and consultation practices at our center do not warrant mandated IDC for candidemia.

Disclosures
Trevor C. Van Schooneveld, MD, FACP, BioFire (Individual(s) Involved: Self): Consultant, Scientific Research Study Investigator; Insmed (Individual(s) Involved: Self): Scientific Research Study Investigator; Merck (Individual(s) Involved: Self): Scientific Research Study Investigator; Rebiotix (Individual(s) Involved: Self): Scientific Research Study Investigator