bluuebunny/crossref_metadata_2025_split huggingface dataset:
1426. Empiric Antimicrobial Prescribing for Urinary Tract Infections in Patients Discharged from the Emergency Department
Authors: Rech Megan A , Faine Brett , Vakkalanka Priyanka , Talan David A 
Published: December 2021

Abstract

Background
Urinary tract infections (UTIs) are commonly treated infections in the emergency department (ED), accounting for 3 million visits annually and 15% of outpatient antibiotic prescriptions. The purpose of this study was to characterize empiric and definitive antimicrobial therapy for treatment of UTIs in a nationally representative sample of ED patients.

Methods
This was a multicenter, retrospective cohort study utilizing the Emergency Medicine PHARMacy Research NETwork (EMPHARM-NET), a network of 15 geographically diverse EDs. Patients ≥18 years presenting to and discharged home from the ED with primary diagnosis code of cystitis, pyelonephritis, or UTI from 2018-2020 were included. We describe empiric intravenous (IV) and oral antibiotics used for the treatment of UTI in patients seen and discharged from the ED.

Results
Of the 3779 ED patients treated for UTI, most were discharged from the ED (n=2483, 66%). Most patients were female (76.3%) and common comorbidities were hypertension (47.8%) and diabetes (26.5%). Most patients had uncomplicated (39.4%) or complicated (40.9%) cystitis. 1134 (45.6%) had a positive urine culture, most commonly E. coli (63%) and K. pneumoniae (13%). The most common antibiotics administered in the ED were ceftriaxone (19.7%), nitrofurantoin (6.2%), cephalexin (5.8%), and sulfamethoxazole/trimethoprim (SMX/TMP, 4.8%). The most common antibiotics prescribed at discharge where cephalexin (33.9%), nitrofurantoin (20.6%), SMX/TMP (12%), ciprofloxacin (8.2%), and cefdinir (8%). The mean length of treatment was 7.1 days (standard deviation 2.5 days). Overall, 454 patients returned to the ED within 30 days. The odds of returning to the ED within 30 days was higher in those that did not have appropriate empiric antibiotics based on susceptibilities (OR 1.37, 95% confidence interval 1.06, 1.78).

Conclusion
This multicenter, retrospective cohort study describes ED patients discharged from the ED after UTI diagnosis. Patients presented most commonly for cystitis. Nearly half of discharged patients were culture positive. Antimicrobial selection varied; IV ceftriaxone and oral cephalexin were most commonly empirically utilized to treated patients with UTI. Inappropriate antimicrobial selection increased odds of a return ED visit within 30 days.

Disclosures
Megan A. Rech, PharmD, MS, BCCCP, FCCM, Spero (Research Grant or Support) Brett Faine, PharmD, Spero Therapeutics (Research Grant or Support) David A. Talan, MD, AbbVie (Consultant)GSK (Consultant)SPERO Therapeutics (Grant/Research Support)
1441. Significant Decrease in the Incidence Rate of Common Outpatient Upper Respiratory Tract Infection Diagnoses per Clinic Visit in the First Respiratory Season of October 2020 to March 2021 During the Covid-19 Pandemic. A Report From an Outpatient Antimicrobial Stewardship Program at a community hospital in Brooklyn
Authors: Shah Jilan M , Badem Olga , Thet Zeyar , Wai Thinzar , Seetharam Karthik , Akande Olawale , Pathickal Sherin , Orris Maxine , Kanu Ngozi , Ward Laurie , Mir Tanveer 
Published: December 2021

Abstract

Background
As part of our outpatient Antimicrobial Stewardship Program, we do surveillance of diagnoses and antibiotic use for common upper respiratory tract infections such as acute upper respiratory tract infection, acute bronchitis, sinusitis, and pharyngitis. We sought to evaluate the impact of the Covid-19 pandemic on the incidence rate of upper respiratory tract infection diagnoses per clinic visit during October 2020 to March 2021 season compared to the three prior respiratory seasons. We also sought to reflect of impact of increase in televisits and overlapping symptoms of COVID 19 and upper respiratory tract infections.

Methods
Our cohort study extending from October 2017 to March 2021. We collected number of diagnoses of upper respiratory infections and number of unique clinic visits during four consecutive respiratory seasons at our primary care sites via electronic health records.

Results
During the recent October 2020 to March 2021 respiratory season which coincided with the second NYC Covid-19 wave, we had 11569 unique clinic visits and 39 diagnoses of an upper respiratory tract infection - incident rate of 1.29. In the three prior respiratory seasons combined, we had 40939 unique clinic visits and 833 diagnoses of an upper respiratory tract infection – incident rate of 1.49. The incident rates showed a dramatic decline using the test based method and the chi square-statistic p&lt; 0.0001 with an incident rate ratio using a poisson exact method of 6.0359. Statistical comparisons of the current season to each prior individual season yielded similar results. The percentage of Tele-visits during the current season was 19% compared to 0% in the 3 prior seasons.

Conclusion
During the first respiratory season from October 2020 to March 2021 in midst of the Covid-19 pandemic which also coincided with the second Covid-19 wave in New York, we saw a statistically significant decrease in incidence of common upper respiratory tract infection diagnoses per clinic visit compared to the three prior respiratory seasons. Overlapping signs and symptoms of upper respiratory tract infections and Covid-19 with the added percentage in Tele-visits did not cause an increase in incidence rates of upper respiratory tract infection diagnoses. Covid-19 related mitigation efforts may have played a role.

Disclosures
All Authors: No reported disclosures
167. Efficacy of Investigational Microbiota-Based Live Biotherapeutic RBX2660 in Individuals with Recurrent Clostridioides difficile Infection: Data from Five Prospective Clinical Studies
Authors: Bancke Lindy , Su Xin 
Published: December 2021

Abstract

Background
Microbiota-based treatments have shown promise to reduce recurrence, morbidity, and mortality for recurrent Clostridioides difficile infections (rCDI), but consistent and reliable clinical efficacy data are needed to support regulatory approvals that broaden patient access. Here we provide cumulative data from 5 prospective clinical studies evaluating RBX2660—a standardized, microbiota-based investigational live biotherapeutic—for reducing rCDI recurrence.

Methods
This analysis included three phase 2 (PUNCH CD, PUNCH CD2, PUNCH CD Open Label) and two phase 3 trials (PUNCH CD3, PUNCH CD3-OLS ad hoc analysis). All participants were ≥18 years old with documented rCDI who completed standard-of-care (SOC) oral antibiotic therapy prior to treatment with RBX2660. Depending on the trial, assigned study treatment was 1 or 2 doses of RBX2660 or placebo, with Treatment Success (TS) defined as remaining recurrence-free for 8 weeks after treatment. Treatment responders were monitored for additional recurrence through at least 6 months after receiving the last RBX2660 dose. Treatment non-responders were administered SOC antibiotic treatment and/or additional RBX2660 treatment and monitored for recurrence for 8 weeks after the last received RBX2660 treatment.

Results
Among the 5 trials with a total of 629 participants, RBX2660 consistently reduced the recurrence of rCDI, with TS rates ranging from 50 to 78.9% (Figure 1). Among primary non-responders, additional RBX2660 treatments further reduced recurrence and overall rates of TS ranged from 75.0% to 84.4% (Figure 2). Among CD, CD3, and CD3-OLS, a majority of primary responders remained CDI-free to 6 and up to 24 months with success rates ranging from 74.4% to 92.1%.

Conclusion
Among 5 trials with consistent investigational product and clinical endpoints, RBX2660 consistently reduced rCDI recurrence, with a majority of treatment responders remaining CDI-free for at least 6 and up to 24 months. Further, initial lack of response to RBX2660 did not preclude clinical benefit of additional RBX2660 treatment. Collectively, these data demonstrate consistency and reliability of the potential benefit of RBX2660 across an entire clinical program.

Disclosures
Lindy Bancke, PharmD, Rebiotix, a Ferring Company (Employee) Xin Su, MD, Rebiotix/Ferring (Employee)
179. Identification and Whole Genome Sequencing Analysis of an Oxacillinase (OXA)-48-like-producing Acinetobacter baumannii Outbreak in California, January-May 2021
Authors: Holden Diana , Sylvester Matthew , Crandall John , Xu Fengfeng , Schneider Emily C , Watson Hillary Berman , Zhang Peng , Bacud Jaclyn , Mejia Rafael , Epson Erin , Berrada Zenda , Mitsunaga Tisha , Mukhopadhyay Rituparna 
Published: December 2021

Abstract

Background
In January 2021, a California acute care hospital (ACH A), a sentinel site for Acinetobacter baumannii (AB) surveillance, identified OXA-48-like-carbapenemase producing (CP) AB in a patient admitted from a ventilator-equipped skilled nursing facility (vSNF A); OXA-48-like AB had not been previously reported in the United States.

Methods
Our investigation included onsite infection control (IC) assessments, contact tracing, and point prevalence surveys (PPS) at vSNF A. The Antibiotic Resistance (AR) Laboratory Network performed carbapenemase testing on AB isolates (including those from ACH A) and PPS swabs. A case was defined as a patient with an OXA-48-like AB isolate, or an epidemiologically-linked patient with an OXA-48-like gene detected via screening. We performed whole genome sequencing (WGS) of OXA-48-like AB and other CP organisms on the Illumina MiSeq and Oxford Nanopore MinION for short and long read sequencing, respectively.

Results
Since January 2021, we have identified five OXA-48-like AB cases (including the index), six OXA-48-like cases (no organism recovered), and six patients with other CP organisms at ACH A and vSNF A. Since August 2019, vSNF A has concurrently been experiencing an OXA-109 AB outbreak. A second vSNF A patient, Patient 2, who overlapped with the index patient, had OXA-48-like Klebsiella pneumoniae (KP) (November 2019) and OXA-109 AB (May 2020) isolates. WGS of the index patient’s AB and Patient 2’s KP isolates identified a rare OXA-48-like gene located on the AB chromosome and a KP plasmid. The OXA-48-like AB was also carrying an OXA-109 gene, and hqSNP analysis indicated it varied by 9-44 single-nucleotide polymorphisms (SNPs) from 14 OXA-109 AB isolates linked to that outbreak, and 0-3 SNPs from the other OXA-48-like AB case isolates.
Figure 1. Phylogenetic Tree Comparison of OXA-109 AB and OXA-48-like AB Isolates

Figure 2. Epidemic Curve of OXA-109 AB, OXA-48-like AB, and Other CP Organism Cases, 2019-2021

Conclusion
The first reported case of OXA-48-like AB in the US was identified through public health sentinel laboratory surveillance, allowing prompt response to contain spread of a novel multidrug-resistant organism (MDRO). WGS detected a rare OXA-48-like gene in AB and KP and provides evidence for possible interspecies transfer of this gene from KP to AB through plasmid transfer followed by chromosomal integration.

Disclosures
All Authors: No reported disclosures
193. Impact of COVID-19 Pandemic on Pulmonary Tuberculosis Evaluations and Diagnosis at a Large Safety Net Hospital in Los Angeles, California
Authors: Jones Aditya J , Jones-Lopez Edward C , Bulter-Wu Susan , Wilson Melissa L , Rodman John , Voyageur Christian , Jones Brenda E 
Published: December 2021

Abstract

Background
There is significant global concern that the COVID-19 pandemic may negatively impact tuberculosis (TB) control. This is a descriptive analysis of TB evaluations and diagnosis during 2019 (pre COVID-19 period) and 2020 (COVID-19 period) at the largest safety net hospital in Los Angeles County (LAC+USC Medical Center).

Methods
The medical records of patients diagnosed with pulmonary TB from January 1, 2019 to December 31, 2020 were identified through laboratory and electronic medical records. We included all patients with ≥ 1 sputum positive result for Mycobacterium tuberculosis (MTB) culture and reviewed their Xpert MTB/RIF MTB PCR.

Results
Table 1 shows summary of results. During the COVID-19 period, the number of patients evaluated for pulmonary TB decreased by 64% compared to the previous year (Figure 1). The proportion of patients with culture-confirmed TB disease however, was nearly identical (P=0.913) (Table 1). Sputum acid-fast bacilli (AFB) smear positivity increased 52% to 64% during COVID-19 (P=0.324) and disease severity as measured by chest radiograph, was significantly higher during the COVID-19 period (P = 0.031) (Figure 2).

Trend of sputum AFB smear and culture samples collected from January 1, 2019 to December 31, 2020.

Summary of results of patients diagnosed with pulmonary TB from January 1, 2019 to December 31, 2020 at LAC+USC Medical Center.

Results of two-sample test for proportions of 2019 vs 2020 for cavitary lesions, extent of disease, and sputum positive AFB smear microscopy.

Conclusion
These preliminary results suggest that when compared to the previous year, the number of pulmonary TB evaluations decreased by 64% during the COVID period. Whereas the proportion of patients diagnosed with TB disease was similar, TB patients during the COVID-19 period had more advanced disease at diagnosis, as measured by sputum smear AFB microscopy and disease severity on chest radiograph (P=0.031). These data suggest potentially consequential interruptions and delays in pulmonary TB diagnosis during the COVID-19 period.

Disclosures
Susan Bulter-Wu, PhD , Cepheid (Consultant)
19. Delivery of Flu Immunizations to Healthcare Workers During COVID-19 Pandemic Using a Multidisciplinary Flu Team Approach in a Tertiary Center in the Middle East
Authors: Cardona Lyssette , Mohammed Shafii , Nour Samah , Alkhalaileh Mu’ed 
Published: December 2021

Abstract

Background
Compliance with influenza immunization in HCW remains a global challenge, uptake in the Middle East has been reported at 24.7% due to limited access and awareness (1). We aim to report a successful campaign by establishing a multidisciplinary Flu Team during ongoing COVID-19 pandemic.

Methods
A multidisciplinary Flu team taskforce was assembled representing all stakeholders to include: Occupational Health, Nursing, Operations, Infomatics, Pharmacists and Administrative staff in July 2020. A pivot was made to switch location from previous year visits to an established vaccine center (ballroom) to a mobile campaign. From July to November 1st, the team met on a regular basis with 90 stakeholders to launch and monitor the ongoing immunizations. Electronic medical record (EPIC) tools such as One Click and Express Lane facilitated nursing check-in, documentation and immunization at one stop and eliminated previously used registration by other staff. EPIC Clarity feature facilitated reporting of compliance for managers and leadership. Ongoing education and awareness of immunization were ongoing through various platforms of communication such as huddles, phone screens, elevators, lounges, virtual grand rounds and corporate intranet communication and website videos.

Results
Of the 3578 healthcare workers, 3,399 were immunized (95%) from September 2020 until the end of October 2020. There were 86 (2.4%) employees exempted during this period due to medical reasons or excused leaves ( e.g military, maternity), Figure 1. Compliance differed among functions, 95.86% physicians, 97.2% clinical and nursing, 92% academics, 94.96% finance, 91.15% human resources, 92.1% infomatics, 60% legal, 80.6% operations. Only 93 (2.6%) were non-compliant.
Employee Flu Immunization

Hospital Overall Compliance in 2020

Compliance by Function in 2020

Conclusion
Influenza illness adds an additional burden to the healthcare workforce during COVID-19. A multidisciplinary and collaborative team of teams approach delivered higher compliance for flu immunization than reported in the Middle East and enhanced by the use of state of the art technology. Convenience, educational awareness, free and safe access supported further the compliance with vaccination. To our knowledge, our 2020 flu campaign is the first successful experience reported in the Middle East during the current pandemic.

Disclosures
All Authors: No reported disclosures
21. Systematic Review and Meta-Analysis of Pneumococcal Vaccine Effectiveness against Invasive Pneumococcal Disease among Adults
Authors: Farrar Jennifer Loo , Kobayashi Miwako , Childs Lana , Pilishvili Tamara 
Published: December 2021

Abstract

Background
Two new pneumococcal conjugate vaccines (PCVs), PCV15 and PCV20, are anticipated to be licensed for use in U.S. adults in 2021. To help inform the U.S. Advisory Committee on Immunization Practices’ discussions on pneumococcal vaccine use among adults, we conducted a systematic review and meta-analysis. We specifically looked at efficacy or effectiveness of PCV13 and pneumococcal polysaccharide vaccine (PPSV23) against invasive pneumococcal disease (IPD) in adults.

Methods
We conducted a search of English literature published from 1998 – February 2021 on PCV13 and PPSV23 efficacy or effectiveness studies using eight major databases. Studies targeting adults with immunocompromising conditions were excluded. Title and abstract screening of identified studies and data abstraction were performed by two reviewers. Results were stratified by vaccine product, outcome evaluated (vaccine type (VT) or all IPD), study design, and effect measure. Random effects models were used to pool estimates by stratum.

Results
Of 3,422 citations reviewed, we identified 26 IPD studies; 4 on PCV13, 22 on PPSV23, 18 with all IPD, and 17 with VT-IPD (Table) as an outcome. Only one randomized-controlled trial (RCT) was identified for PCV13 with an efficacy of 52% (95% CI: 22%, 77%) against all IPD and 75% (95% CI: 41%, 91%) against VT-IPD. A pooled vaccine effectiveness (VE) estimate from three observational studies evaluating PCV13 was 56% (95% CI: 32%, 71%; I2 =12.8) against VT-IPD.
Two RCTs evaluating PPSV23 reported efficacies against all IPD ranging between 79-86%; an additional RCT reported no IPD cases during RCT. Vaccine effectiveness estimates from 14 observational studies evaluating PPSV23 ranged between 29-76% against all IPD. Pooled VE estimates from 12 observational studies showed PPSV23 effectiveness against VT-IPD was 38% (95% CI: 28% to 46%; I2 =40.8).
Table. Efficacy and effectiveness studies against vaccine-type invasive pneumococcal disease

Conclusion
Evidence suggests both pneumococcal vaccines are effective against VT-IPD in adults. Given that PCV15 and PCV20 are expected to be licensed based on immunogenicity data and no clinical efficacy data are available for these new vaccines, the findings from this review will help inform policy discussions on use of the new PCVs among adults.

Disclosures
All Authors: No reported disclosures
23. ZOE-50 and ZOE-70 Placebo Groups Data Shows that Burden of Pain Associated with Herpes Zoster Interferes with Activities of Daily Living
Authors: Cabrera Eliazar Sabater , Curran Desmond , Matthews Sean , Boutry Céline , Lecrenier Nicolas , Cunningham Anthony L 
Published: December 2021

Abstract

Background
Adults ≥ 50 years of age (YOA) are at increased risk of herpes zoster (HZ), a condition which can cause long-term pain and discomfort. In this analysis, we assessed the burden of pain associated with HZ and its interference with activities of daily living (ADL) in patients ≥ 50 YOA.

Methods
ZOE-50 (NCT01165177) and ZOE-70 (NCT01165229) were phase III, observer-blind, placebo-controlled, 1:1 randomized studies in adults ≥ 50 YOA (ZOE-50) and ≥ 70 YOA (ZOE-70) who received 2 doses of the adjuvanted recombinant zoster vaccine or placebo, 2 months apart. To correctly evaluate HZ pain, the analysis was performed only on the placebo groups data of ZOE-50 (≥ 50 YOA) and pooled ZOE-50/70 (≥ 70 YOA pooled data) in the modified total vaccinated cohort (mTVC, primary population for efficacy analysis) HZ-confirmed cases. HZ pain and interference with ADL was assessed by the Zoster Brief Pain Inventory (ZBPI) instrument completed daily by patients for the first 28 days and then weekly until resolution. Time to resolution of clinically significant pain was analyzed using Kaplan Meier methods. We estimated the cumulative area under curve (AUC) of the ZBPI worst pain score and the ZBPI ADL score up to 182 days post-HZ rash onset. A high AUC reflects a higher severity/longer duration of pain.

Results
Overall, 254 patients ≥ 50 YOA and 284 patients ≥ 70 YOA were included in the mTVC HZ-confirmed cases for the ZOE-50 and ZOE-70 pooled analysis, respectively. In HZ patients ≥ 50 YOA, 94.6% reported any pain (ZBPI pain score &gt; 0), 87.6% clinically significant pain (ZBPI pain score ≥ 3) and 65.1% severe pain (ZBPI pain score ≥ 7). Similarly, in HZ patients ≥ 70 YOA, 93.2% reported any pain, 90.9% clinically significant pain and 68.4% severe pain. It was estimated that 11.6% and 18.3% of patients aged ≥ 50 and ≥ 70 YOA, respectively, had clinically significant pain 3 months after the onset of HZ. The mean AUC at 182 days was 137.24 (≥ 50 YOA) and 190.68 (≥ 70 YOA), for the ZBPI worst pain score and 92.75 (≥ 50 YOA) and 130.89 (≥ 70 YOA), for the ZBPI ADL score.

Conclusion
Analysis of data provided by patients with confirmed HZ shows that the burden of HZ pain is high and is associated with interference on patients’ ADL.

Funding
GlaxoSmithKline Biologicals SA

Acknowledgment
M Maior/S Hulsmans provided medical writing/editorial support (Modis c/o GSK)

Disclosures
Eliazar Sabater Cabrera, MSc, GSK (Employee, Shareholder) Desmond Curran, PhD, The GSK group of companies (Employee, Shareholder) Sean Matthews, MSc, GSK (Independent Contractor) Céline Boutry, PhD, GSK (Employee) Nicolas Lecrenier, Ing, PhD, The GSK group of companies (Employee, Shareholder) Anthony L. Cunningham, F.A.H.M.S., MD, M.B.B.S., B. Med. Sci. (Hons), F.R.A.C.P., F.R.C.P.A., F.A.S.M., GSK group of companies (Grant/Research Support, Advisor or Review Panel member, Speaker’s Bureau)