bluuebunny/crossref_metadata_2025_split huggingface dataset:
49. Effects of Maternal SARS-CoV-2 Infection on Neonatal Discharge Planning and Care: Exacerbation of Racial and Ethnic Healthcare Disparities
Authors: Jubulis Jennifer , Goddard Amanda , Dibrigida Sarah , McCarthy Carol A 
Published: December 2021

Abstract

Background
SARS-CoV-2 has exacerbated healthcare disparities. Maine’s population of 1.3 million is comprised of only 6% Black, Indigenous, People of Color (BIPOC); however, statewide 18% of SARS-CoV-2 infections have occurred in this group. This study examines newborn care inequities for infants born to mothers with SARS-CoV-2.

Methods
This study was conducted at Maine Medical Center in Portland, the largest hospital in Maine. Maternal SARS-CoV-2 infections from March 15, 2020 through April 1, 2021 were identified by PCR near time of delivery. Cases were matched to uninfected women by date of delivery. Chart review was conducted assessing demographic and clinical characteristics, comparing SARS-CoV-2 exposed and unexposed infants. The subset of SARS-CoV-2 exposed infants was further analyzed for trends in care by race. Protocol was exempt by MaineHealth IRB.

Results
Twenty four women and their infants were identified with maternal positive SARS-CoV-2 PCR just prior to delivery. An additional 24 unexposed infants were enrolled. When compared to unexposed infants, SARS-CoV-2 exposed were more likely to be racial minorities (63% vs 21%, p = 0.003), to have foreign-born mothers (58% vs 0.4%, p&lt; 0.05) or to receive health care in a language other than English (29% vs 0.4%, p =0.02). For infants born to SARS-CoV-2 infected mothers, only 29% had initial follow up visit in person with their primary care provider (13% of BIPOC infants vs 56% of non-BIPOC infants, p = 0.03). Time to in-person follow up for exposed infants varied by race, with median time of 21 days (range 2-53 days) for racial minorities and 7.5 days (range 2-30 days) for non minorities. All families were discharged with a thermometer and scale for home management. No infants required re-admission during the month after discharge. One exposed infant tested positive for SARS-CoV-2.

Conclusion
The American Academy of Pediatrics recommends evaluation of newborns 3-5 days after discharge to identify maternal and child health factors affecting newborn well-being. The SARS-CoV-2 pandemic has made this challenging for patients, particularly for racial minorities. BIPOC pediatric patients were disproportionately affected by the pandemic in Maine, and were disproportionately affected by care discrepancies even when the infant was uninfected.

Disclosures
All Authors: No reported disclosures
53. Sex and Race Disparities in Premature Mortality among People with HIV: A 21-Year Observational Cohort Study
Authors: Pellegrino Rachael , Rebeiro Peter F , Turner Megan , Davidson Amber , Best Noelle , Shaffernocker Chandler , Sterling Timothy , Castilho Jessica L 
Published: December 2021

Abstract

Background
Since the availability of antiretroviral therapy, mortality rates among people with HIV (PWH) have decreased; however, this trend may fail to quantify premature deaths among PWH. We assessed trends and disparities in all-cause and premature mortality by sex, HIV risk factor, and race, among PWH receiving care at the Vanderbilt Comprehensive Care Clinic from January 1998 – December 2018.

Methods
We examined mortality trends across calendar eras using person-time from clinic entry to date of death or December 31, 2018. We compared mortality rates by demographic and clinical factors and calculated adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) using multivariable Poisson regression. For individuals who died, years of potential life lost (YPLL) were obtained from the expected years of life remaining by referencing US sex-specific period life tables at age and year of death; age-adjusted YPLL (aYPLL) rates were also calculated. We examined patient factors associated with YPLL using multivariable linear regression.

Results
Among the 6,531 individuals (51% non-Hispanic [NH] White race, 40% NH Black race, 21% female) included, 956 (14.6%) died. Mortality rates dramatically decreased during the study period (Figure). After adjusting for calendar era, age, injection drug use, hepatitis C virus (HCV), year of HIV diagnosis, history of AIDS-defining illness, CD4 cell count, and HIV RNA at clinic entry, only female sex (aIRR=1.32, 95% CI: 1.13–1.55 vs. males) but not NH Black race (aIRR=1.02, 95% CI: 0.88–1.17 vs. NH White race) was associated with increased mortality. In contrast, aYPLL per 1,000-person years was significantly higher for both female and NH Black PWH (Table 1). In adjusted models including CD4 cell count, HIV RNA, HCV, and year of clinic entry, higher YPLL remained associated with NH Black race, female sex regardless of HIV risk factor, and younger age at HIV diagnosis (Table 2).

Conclusion
Despite marked improvement over time, sex disparities in mortality as well as sex and race disparities in YPLL remained among PWH in care in this cohort. YPLL is a useful measure for examining persistent gaps in longevity and premature mortality among PWH.

Disclosures
Peter F. Rebeiro, PhD, MHS, Gilead (Other Financial or Material Support, Single Honorarium for an Expert Panel)
58. Cost-Effectiveness of Emerging Antibiotic Strategies for the Treatment of Drug-Use Associated Infective Endocarditis
Authors: Adams Joella W , Savinkina Alexandra , Gai Mam Jarra , Hill Allison , Hudspeth James , Jawa Raagini , Kimmel Simeon D , Marks Laura , Linas Benjamin P , Barocas Joshua 
Published: December 2021

Abstract

Background
Drug use-associated infective endocarditis (DUA-IE) is typically treated with 4-6 weeks of in hospital intravenous antibiotics (IVA). Outpatient parenteral antimicrobial therapy (OPAT) and partial oral antibiotics (PO) may be as effective as IVA, though long-term outcomes and costs remain unknown. We evaluated the clinical outcomes and cost-effectiveness of four antibiotic treatment strategies for DUA-IE.

Methods
We used a validated microsimulation model to compare: 1) 4-6 weeks of inpatient IVA along with opioid detoxification, status quo (SQ); 2) 4-6 weeks of inpatient IVA along with inpatient addiction care services (ACS) which offers medications for opioid use disorder (SQ with ACS); 3) 3 weeks of inpatient IVA with ACS followed by OPAT (OPAT); and 4) 3 weeks of IVA with ACS followed by PO antibiotics (PO). We derived model inputs from clinical trials and observational cohorts. All patients were eligible for either in-home or post-acute care OPAT. Outcomes included life years (LYs), discounted costs, incremental cost-effectiveness ratios (ICERs), proportion of DUA-IE cured, and mortality attributable to DUA-IE. Costs (&US) were annually discounted at 3%. We performed probabilistic sensitivity analyses (PSA) to address uncertainty.

Results
The SQ scenario resulted in 18.64 LY at a cost of &416,800/person with 77.4% hospitalized DUA-IE patients cured and 5% of deaths in the population were attributable to DUA-IE. Life expectancy was extended by each strategy: 0.017y in SQ with ACS, 0.011 in OPAT, and 0.024 in PO. The PO strategy provided the highest cure rate (80.2%), compared to 77.9% in SQ with ACS and 78.5% in OPAT and X in SQ. OPAT was the least expensive strategy at &412,300/person, Compared to OPAT, PO had an ICER of &141,500/LY. Both SQ strategies provided worse clinical outcomes for money invested than either OPAT or PO (dominated). All scenarios decreased deaths attributable to DUA-IE compared to SQ. Findings were robust in PSA.
Table 1

Selected cost and clinical outcomes comparing treatment strategies for drug-use associated infective endocarditis including the status quo, status quo with addiction care services, outpatient parenteral antimicrobial therapy, and partial oral antibiotics.

Conclusion
Treating DUA-IE with OPAT along with ACS increases the number of people completing treatment, decreases DUA-IE mortality, and is cost-saving compared to the status quo. The PO strategy also improves clinical outcomes, but may not be cost-effective at the willingness-to-pay threshold of &100,000.

Disclosures
Simeon D. Kimmel, MD, MA, Abt Associates for a Massachusetts Department of Public Health project to improve access to medications for opioid use disorder in nursing facilities (Consultant)
62. Follow-Up Blood Culture Practices for Gram-Negative Bloodstream Infections in Immunocompromised Hosts at a Large Academic Medical Center
Authors: Groft Lauren , Mease James , Bork Jacqueline , Bernhardi Ciera L , Kristie Johnson J , Claeys Kimberly C 
Published: December 2021

Abstract

Background
Routine follow-up blood cultures (FUBC) are strongly recommended for Staphylococcus aureus and Candida spp. bloodstream infections (BSI), but the role of FUBC in Gram-negative (GN) BSI remains controversial. Factors that may result in persistent GN BSI include critical illness, endovascular infection, lack of source control, multidrug resistant organisms (MDRO), end-stage renal disease, or immunocompromised status. As such, FUBC in patients with any of these factors may be warranted to improve clinical outcomes, but the true balance of benefit versus harm remains unknown. Our objective was to evaluate the role of FUBC in immunocompromised patients with GN BSI.

Methods
This was a retrospective observational cohort of adult, immunocompromised patients treated for confirmed GN BSI between January 2019 and December 2020 at University of Maryland Medical Center. Immunocompromise was defined as active hematologic or solid tumor malignancy at time of BSI diagnosis, history of hematopoietic stem cell transplantation (HSCT) or solid organ transplantation (SOT), or absolute neutrophil count (ANC) &lt; 1000 cells/mm3 at any time 30 days prior to BSI diagnosis. FUBC were defined as blood cultures drawn between 24 hours and 7 days from index blood culture, within the same hospital encounter. Positive FUBC was defined as a FUBC with same pathogenic GN organism identified. Comparison of patient and microbiologic characteristics was made between patients with and without FUBC.

Results
A total of 146 patients with GN BSI were included. Baseline characteristics are reported in Table 1. FUBC were collected in 129 (88.4%) patients. Neutropenia (49.6% vs. 19.4%, P=0.122), presence of central line (69.8% vs. 30.2%, P=0.061), and hospital-acquired origin of BSI (63.6% vs. 36.4%, P=0.395) resulted in increased frequency of FUBC. Patients with FUBC had a significantly longer post-BSI mean (SD) length of stay (17.3 [35.4] vs. 6.5 [6.0] days; P=0.005). Positive FUBC occurred in only 2 cases (1.4%) and both patients had persistent fevers at time of FUBC.
Table 1. Baseline Characteristics

Conclusion
Positive FUBC were uncommon in this immunocompromised cohort with GN BSI, which challenges the need for routine collection of FUBC in this patient population.

Disclosures
Ciera L. Bernhardi, PharmD, Servier Pharmaceuticals (Advisor or Review Panel member) J. Kristie Johnson, PhD, D(ABMM), GenMark (Speaker’s Bureau) Kimberly C. Claeys, PharmD, GenMark (Speaker’s Bureau)
66. Utilizing ceftazidime/avibactam therapeutic drug monitoring in the treatment of neurosurgical meningitis caused by Difficult-to-treat resistant (DTR)-Pseudomonas aeruginosa and KPC-producing Enterobacterales
Authors: Yasmin Mohamad , nutman Amir , Wang Lu , Marshall Steven , Yahav Dafna , Chen Ke , Wang Jiping , Li Jian , Bonomo Robert A 
Published: December 2021

Abstract

Background
Central nervous system (CNS) infections caused by carbapenem-resistant Enterobacterales (CRE) and Difficult-to-treat resistant (DTR)-Pseudomonas aeruginosa (PA) are a therapeutic challenge. Data demonstrating the pharmacokinetic/pharmacodynamic (PK/PD) properties of newer beta-lactamase inhibitors remains scarce. A clinical challenge lies in selecting an antimicrobial regimen that diffuses across the blood brain barrier and maintains concentrations to achieve PD targets associated with bacterial killing. These complexities compelled us to quantify the pharmacological properties of ceftazidime/avibactam (CZA). Utilizing therapeutic drug monitoring (TDM), we evaluated the adequacy of therapy and aimed to guide precise CNS dosing in the treatment of three patients with neurosurgical meningitis.

Methods
Bacterial identification and susceptibility testing were performed using MicroScan. TDM of CZA was implemented using a dose of 2.5 g infused intravenously over 2-hours, every 8 hours. The concentrations of ceftazidime and avibactam were determined by liquid chromatography/mass spectrometry. For patients 2 and 3, four unique CSF and plasma samples spanning the dosing interval were obtained; including trough values. (See table)

Results
Bacterial identification and CZA MICs for patients 1, 2, and 3 revealed blaKPCKp (0.25μg/mL), DTR PA (4 μg/mL), and blaKPCE. cloacae (0.25 μg/mL), respectively. Measured plasma and CSF concentrations of avibactam (AVI) and ceftazidime (CAZ) are shown in Table 1.
Table 1a. Therapeutic Drug Monitoring of CAZ-AVI depicting dosing, time of samples, and measured concentrations in CSF and Human Plasma (HP)

Table 1b. Therapeutic Drug Monitoring of CAZ-AVI concentrations in CSF and Human Plasma (HP) pertaining to patient 2 and 3

Conclusion
Measuring CZA concentration levels in CSF was achieved in 3 patients with complicated CNS infections. Post-infusion concentrations indicated that adequate CAZ and AVI exposures were attained in the CSF. Notably, avibactam was shown to achieve concentrations ≥1 µg/ml in the CSF throughout the dosing interval. For avibactam and ceftazidime, the PK/PD target correlated with bacterial killing is ~50% fT &gt;MIC. In 2 out of 3 patients, concentrations were determined to be above the respective MICs throughout the entire dosing interval in the CSF. All patients attained clinical and microbiological cure. A novel CZA TDM method was successfully employed to establish that CZA maintains therapeutic CSF concentrations that exceed the MIC throughout the dosing interval.

Disclosures
Robert A. Bonomo, MD, entasis (Research Grant or Support)Merck (Grant/Research Support)NIH (Grant/Research Support)VA Merit Award (Grant/Research Support)VenatoRx (Grant/Research Support)
68. Comparison of Cardiovascular Risk Assessment Calculators in the US Military HIV Natural History Study
Authors: Wyatt Andrew C , Xu Xiaohe , Daniels Colton , Sunil Thankam , Grance Melissa , Bohidar Niraja , Batzlaff Caitlin G , Ganesan Anuradha , Agan Brian , Larson Derek , Okulicz Jason , Markelz Ana E 
Published: December 2021

Abstract

Background
People living with HIV (PLHIV) have increased risk of cardiovascular disease (CVD), however CVD risk assessment can be challenging as HIV-related factors are not included in most calculators. We compared CVD risk calculators in US Military HIV Natural History Study (NHS) participants.

Methods
The NHS database was screened for participants enrolled between 2009-2019 who were ≥ 40 years of age with no previous history of CVD or statin use. Of the 399 participants meeting criteria, 385 (96.5%) had available data to assess 3 CVD risk calculators: Atherosclerotic CVD risk calculator (ASCVD), Framingham Risk Calculator (FRC), and the Data Collection on Adverse Eﬀects of Anti-HIV Drugs Study (DAD) risk calculator. Risk calculators were applied cross-sectionally at the first available time point at or after age 40 years and calculators were compared using a Wilcoxon signed rank test. Demographic and HIV-related characteristics were analyzed as independent variables.

Results
Participants were predominantly male (91.1%), mostly White (49.6%) or Black/African American (44.7%), and commonly had a history of tobacco use (38.9%). The mean age at HIV diagnosis and at CVD risk calculation was 33 and 41.8 years, respectively (Table 1). Overall, there was significant variability between calculators with mean scores of 3.66%, 2.50% and 1.38% for ASCVD, FRC, and DAD, respectively for all pairwise comparisons (p&lt; 0.001; Table 2). When assessing those with CVD risk ≥ 7.5%, a clinically relevant threshold, the proportion of individuals with risk ≥ 7.5% varied for the ASCVD (10.4%), FRC (7.5%), and DAD (&lt; 0.8%) calculators. Associations or trends toward higher CVD risk was observed among the various calculators for race/ethnicity and both age &lt; 30 years and CD4 ≤ 350 cells/uL at HIV diagnosis (Table 2).

Conclusion
Since significant variability among CVD risk calculators was observed in the NHS cohort, it may be challenging to apply overall CVD risk calculators in a clinically relevant manner. HIV-related factors, such as duration of HIV infection and CD4 nadir, are not accounted for in CVD calculators and may be indicators of increased CVD risk. Future studies are warranted in order to determine the optimal clinical use of CVD risk calculators for PLHIV.

Disclosures
All Authors: No reported disclosures
70. Changes in Invasive Pneumococcal Disease among Adults Living with HIV Following Introduction of 13-Valent Pneumococcal Conjugate Vaccine, 2008–2018
Authors: Matanock Almea , Li Jianmin , Adih William , Xing Wei , Schaffner William , Alden Nisha B , Harrison Lee , Petit Susan , Baumbach Joan , Reingold Arthur , Almendares Olivia , Gierke Ryan , Holtzman Corinne , Farley Monica M , Thomas Ann , Pilishvili Tamara , Kobayashi Miwako 
Published: December 2021

Abstract

Background
People living with HIV (PLHIV) are at increased risk of invasive pneumococcal disease (IPD). The 13-valent pneumococcal conjugate vaccine (PCV13) was recommended for children in 2010, and for immunocompromised adults (including PLHIV) in series with 23-valent polysaccharide vaccine (PPSV23) in 2012. We evaluated changes in IPD incidence in adults ≥19 years old by HIV status after PCV13 introduction and proportion of remaining IPD due to serotypes included in the 15- (PCV15) and 20-valent (PCV20) conjugate vaccines expected to be licensed in 2021.

Methods
IPD cases were identified through CDC’s Active Bacterial Core surveillance (ABCs). HIV status was obtained from medical records. Isolates were serotyped by Quellung reaction, or whole-genome sequencing and grouped into PCV13-types, PPV11-types (unique to PPSV23), or non-vaccine types. We estimated IPD incidence (cases per 100,000 people) using national projections of ABCs cases as numerators and national case-based HIV surveillance (PLHIV) or US census data (non-PLHIV) as denominators. We compared IPD incidence in 2011–12 and 2017–18 to pre-PCV13 baseline (2008–09) by serotype groups. We assessed the proportion of IPD due to serotypes included in PCV15 and PCV20.

Results
Overall IPD incidence at baseline was 306.7 for PLHIV and 15.2 for non-PLHIV. From baseline to 2017–18, IPD incidence declined in PLHIV (-40.3%; 95% CI: -47.7, -32.3%) and non-PLHIV (-28.2%; 95% CI: -30.9, -25.5%). The largest reductions were in PCV13-type IPD during both periods (-44.2% for PLHIV and -42.2% for non-PLHIV in 2011–12; -72.5% for PLHIV and -62.2% for non-PLHIV in 2017–18) compared to baseline (Figures 1, 2). In 2017–2018, overall IPD and PCV13-type rates were 16.8 (95% CI: 15.1, 18.5) and 12.6 (95% CI: 9.9, 15.3) times as high in PLHIV vs non-PLHIV, respectively; PCV13, PCV15/non-PCV13, and PCV20/non-PCV15 serotypes comprised 21.5%, 11.2% and 16.5% of IPD in PLHIV.
IPD incidence rates among adults aged ≥19 years old by serotype group in PLHIV, 2008–2018

IPD incidence rates among adults aged ≥19 years old by serotype group in non-PLHIV, 2008–2018

Conclusion
IPD rates declined significantly in both PLHIV and non-PLHIV during the study period due to reductions in PCV13-type IPD; however, IPD rates remained 17-fold higher in PLHIV compared to non-PLHIV, mainly due to non-PCV13 types. Higher-valent pneumococcal conjugate vaccines provide opportunities to reduce some of the remaining IPD burden in PLHIV.

Disclosures
William Schaffner, MD, VBI Vaccines (Consultant) Lee Harrison, MD, GSK, Merck, Pfizer, Sanofi Pasteur (Consultant)
88. Review of nursing home antibiotic stewardship citation deficiencies to identify opportunities to improve antibiotic stewardship implementation, 2018-2019
Authors: Gouin Katryna A , Cool Andrea J , Stone Nimalie D , Hicks Lauri , Jacobs Slifka Kara M , Almendinger Katherine , Harmon Holly , Gifford David , Truscott Pamela , Kabbani Sarah 
Published: December 2021

Abstract

Background
Centers for Medicare & Medicaid Services (CMS) set standards for nursing homes (NH) and conduct inspections to assess adherence to regulatory requirements, including antibiotic stewardship implementation. NHs not meeting requirements are issued a citation. We reviewed text summaries for citations related to antibiotic stewardship to assess implementation in NHs.

Methods
We obtained publicly available antibiotic stewardship deficiency citations issued to NHs from 9/2018—7/2019 and NH characteristics data from CMS Nursing Home Compare. We used the χ2 test to compare characteristics of NHs with and without citations.
We did a qualitative review of a randomly selected subset (318/635) of antibiotic stewardship citations and classified citations into one or more of four categories based on Centers for Disease Control and Prevention’s Core Elements of Antibiotic Stewardship: 1) Leadership & Accountability, 2) Action, 3) Tracking & Reporting, 4) Education (Fig 1). We developed subcategories based on our iterative review process to further describe the citations. Each citation was reviewed by two reviewers and yielded 95% agreement in categorization. Discordant citations were reviewed by a third reviewer, and core element categories with agreement by ≥2/3 reviewers were assigned, resulting in 99% agreement.
Antibiotic Stewardship Citation Deficiency Category Common Themes and Examples from Citation Text from Qualitative Review of Antibiotic Stewardship Citation Deficiencies.

Results
There were 635 NH stewardship citation deficiencies across 44 states from 9/2018—7/2019. NHs with a citation were more likely to have &lt; 100 beds (60% vs. 50%) and for-profit ownership (75% vs. 70%) (Table 1).
Of the 318 reviewed citations, Action was cited in 67% of NHs; 115/213 had missing or incomplete criteria documented for antibiotic initiation. Tracking & Reporting was cited in 40% of NHs; 117/126 had missing or incomplete antibiotic or infection tracking logs. Leadership & Accountability was cited in 23% of NHs; 41/72 NHs had no stewardship policy available. Education was cited in 13% of NHs (Fig 2).
Table 1. Characteristics of US Nursing Homes With and Without an Antibiotic Stewardship Citation Deficiency from 9/2018-7/2019.

Figure 2. Types of Antibiotic Stewardship Citation Deficiencies in US Nursing Homes, 2018-2019, N=318.

Conclusion
The most common opportunities for improvement fell under appropriate assessment and documentation of criteria for antibiotic initiation at the resident and facility-level. Training NH staff to use available resources for antibiotic stewardship activities may improve implementation. Further evaluation to identify barriers to implementation is needed.

Disclosures
David Gifford, MD, MPH, American Healthcare Association (Employee)