bluuebunny/crossref_metadata_2025_split huggingface dataset:
796. Burden of Healthcare-associated (HA) Respiratory Syncytial Virus (RSV) in Hospitalized Adults
Authors: Hill-Ricciuti Alexandra C , Walsh Edward E , Greendyke William G , Barrett Angela , Alba Luis , Branche Angela , Falsey Ann , Phillips Matthew R , Choi Yoonyoung , Finelli Lyn , Saiman Lisa 
Published: December 2021

Abstract

Background
Little is known about the burden of HA-RSV in hospitalized adults. We assessed risk factors and clinical outcomes in hospitalized adults diagnosed with HA-RSV.

Methods
A retrospective case-control study was performed from 2017-2020 in two academic hospital systems. HA-RSV cases were &gt;18 years of age, hospitalized &gt;4 days, and developed new or worsening respiratory signs and symptoms that prompted clinicians to test for respiratory pathogens; cases were RSV-positive by PCR assays. Two community-onset (CO) RSV-positive controls (admitted with &gt;2 acute respiratory symptoms), were matched to each HA-RSV case by age, sex, and RSV season. We compared risk factors and outcomes in cases vs. controls. We assessed escalation of respiratory support in HA-RSV cases, defined as new or increased respiratory support from Day -2 to Day +4 of their RSV-positive test. Exact conditional logistic regression compared outcomes of HA-RSV vs. CO-RSV subjects, adjusting for demographic and clinical characteristics.

Results
84 cases and 160 controls (both median 64 years) were included; 87% had ≥1 comorbidity. HA-RSV cases were hospitalized for a median of 10 (IQR: 5-17) days prior to their RSV-positive test. CO-RSV controls were more likely to have pulmonary comorbidities than HA-RSV cases (46% vs. 31%, p=0.02). 38% of HA-RSV vs. 15% of CO-RSV subjects were hospitalized ≥15 days after their RSV-positive test (p=0.047). 14% of HA-RSV and 6% of CO-RSV subjects died (p=0.25). Among patients who survived, HA-RSV cases were more likely discharged to a skilled nursing or rehabilitation facility than CO-RSV controls (46% vs. 17%, p=0.04). Of the 44 HA-RSV cases assessed thus far, 25% required escalation of respiratory support; none required initiation of mechanical ventilation.

Conclusion
HA-RSV was associated with increased morbidity and increased health care resource use during and after hospitalization. RSV vaccines could prevent CO- and HA-RSV infections in adults.

Disclosures
Edward E. Walsh, MD, GSK (Advisor or Review Panel member)Janssen (Grant/Research Support)Merck (Grant/Research Support)Merck (Grant/Research Support) William G. Greendyke, MD, Merck (Grant/Research Support) Angela Branche, MD, Merck Dohme and Sharpe (Grant/Research Support) Ann Falsey, MD, BioFire Diagnostics (Grant/Research Support)Janssen (Grant/Research Support)Merck (Grant/Research Support)Novavax (Other Financial or Material Support, DSMB member)Pfizer (Grant/Research Support) Matthew R. Phillips, MPH, Merck & Co., Inc. (Employee, Shareholder) Yoonyoung Choi, PhD, MS, RPh, Merck (Employee) Lyn Finelli, DrPH, MS, Merck (Employee) Lisa Saiman, MD, MPH, Merck (Grant/Research Support, Research Grant or Support)Merk Co., Inc (Grant/Research Support, Advisor or Review Panel member)
798. Incomplete Contact Investigation and Risk of Developing Tuberculosis Among Healthcare Professionals After Tuberculosis Exposure
Authors: Khawcharoenporn Thana , Noisang Kongporn 
Published: December 2021

Abstract

Background
Tuberculosis (TB) contact investigation is recommended for healthcare professionals (HCPs) after TB exposure. However, association between no participation in or incomplete contact investigation and subsequent TB development has not been well-described. This study aims to determine TB incidences and factors associated with TB development among HCPs requiring contact investigations.

Methods
We conducted a prospective cohort study among Thai HCPs with TB exposure from January 2013 to December 2017. Contact investigations, including baseline TB and latent tuberculosis infection (LTBI) screening and follow-up at 3 months after TB exposure, were recommended to all HCPs. The two-step tuberculin skin test (TST) was used for LTBI testing. All HCPs were followed for 2 years for TB development.

Results
Of the 342 HCPs with TB exposure included in the study, 311 (91%) participated in the contact investigations and 252 (74%) completed baseline TB and LTBI screening. Among the 210 HCPs with negative baseline TST, 45 (21%) completed the follow-up tests. The overall incidence of TB was 2.92/100 person-years. HCPs who did not complete follow-up TST had significantly higher TB incidence than those completed baseline and follow-up TST (3.55 vs. 0/100 person-years; P=0.01). No participation in the contact investigation and no chest radiograph performed at baseline were the independent factors associated with TB development among the HCPs [adjusted odds ratio (aOR) 6.69; P&lt; 0.001 and aOR 8.85; P=0.01, respectively]. Contact with an index patient with concomitant TB at extrapulmonary sites (aOR 49.76, 10.03-246.99; P&lt; 0.001) and with negative sputum AFB but positive sputum GeneXpert MTB/RIF (aOR 3.18, 1.35-7.50; P=0.008) were independently associated with no participation in the contact investigation.

Conclusion
The findings indicate the risk of TB development among the HCPs who did not undergo or complete contact investigations and underscore the need for interventions to improve contact investigation participation and completeness.

Disclosures
All Authors: No reported disclosures
799. A Pseudo-Outbreak of Pseudomonas fluorescens Infections
Authors: Jaber Tariq , Saini Vikram , Morris Laura , Como James D , Bhanot Nitin , Min Zaw 
Published: December 2021

Abstract

Background
Pseudomonas fluorescens is a water-borne pathogen that has been associated with outbreaks from transfusion of contaminated blood products or medical equipment. Our institution had a cluster of cultures that grew an uncommonly encountered microbe P. fluorescens within a period of one week. This prompted an internal investigation. We summarize the investigational process that led to the resolution of this pseudo-outbreak.

Methods
We conducted a retrospective chart review of surgical and non-surgical patients with cultures positive for P. fluorescens from July 2nd to July 8th 2020. Baseline patient characteristics, clinical course, laboratory data, use of blood-associated products, and microbiology cultures were analyzed.

Results
Eight patients were identified with positive tissue cultures for P. fluorescens. Among those, 5 specimens (62.5%) were from osteoarticular sites (1 prosthetic hip, 1 prosthetic knee, 1 right foot, 1 sternum, and 1 vertebral source). One culture (12.5%) was obtained from a sacral soft tissue wound. Two tissue specimens (25%) were collected from respiratory sites (1 lung tissue and 1 bronchoalveolar lavage). No association with specific surgical personnel or operating room was identified. During routine specimen processing, a small amount of sterile normal saline is added to the conical grinder prior to culture preparation. It was discovered that a non-sterile normal saline had been inadvertently utilized during that step. These eight tissue specimens were subsequently reprocessed with sterile solution; P. fluorescens was not re-isolated. Specimen processing protocols were reinforced. Adjustment of antimicrobial therapy was made accordingly without reported subsequent adverse clinical outcomes.

Conclusion
A multi-faceted team approach in collaboration with Infection Prevention, Infectious Diseases, Surgery, operating room personnel, and Microbiology identified an unintended breakdown in sterile laboratory protocols which resulted in a cluster of falsely positive cultures. An increased incidence of infection with an uncommon pathogen initiated a prompt investigation that resulted in the identification of a pseudo-outbreak event.

Disclosures
All Authors: No reported disclosures
800. Needle Stick And Sharps Injuries Among Health Care Workers – The Experience of a Tertiary Hospital in Jamaica
Authors: Martin Sue-Ann , Thompson Tamara , Ferguson Trevor 
Published: December 2021

Abstract

Background
Despite advances in occupational safety protocols in healthcare facilities, needle stick and sharps injuries (NSSIs) continue to be a concerning occurrence among healthcare workers (HCWs). Such exposures lead to the risk of blood borne infections as well as emotional and financial consequences which may be difficult to measure. Few studies on NSSIs among Jamaican HCWs have been published in the last decade. We evaluated adherence to established NSSIs management protocols and investigated the demographic and work-related characteristics of HCWs sustaining NSSIs. The proportion of HCWs affected and frequency and direct costs associated with these injuries were estimated.

Methods
This retrospective case-series reviewed HCWs employed or contracted to an urban tertiary teaching hospital in Jamaica, who reported NSSIs in the emergency room during the period January 1, 2015 and December 31, 2018. Archived incident reporting forms for these HCWs were reviewed. Data were analyzed using STATA 14 statistical software.

Results
57 cases of NSSIs were reported at an average rate of 1 per month and an annual incidence of 0.14 per 100 beds and 4.75 per 100 workers. 49 (86%) HCWs were female and 18 (14%) were male. 55% of HCWs were between the ages of 24-29 years old. Nurses (53%) and physicians (19%) made up most of the sample. 28 (58%) HCWs reported not wearing gloves during the incident. Improperly handling used sharps and re-capping needles were reported by 26 (46.5%) and 17 (30%) of HCWs respectively. HIV and viral Hepatitis screening of source patients were performed 85% and 55% of the time respectively. Only 25% of HCWs were prescribed HIV post exposure prophylaxis. Post-injury counselling occurred with 52 (91%) HCWs and follow up care arranged for 36% of cases. The mean direct cost associated with the initial management of the HCW was US &163.22 per NSSI.

Conclusion
The frequency of reported NSSIs by HCWs is low but the burden of direct costs is high. There is inadequate adherence to NSSIs management protocols and accurate monitoring systems are lacking. We recommend the need for safer needle disposal methods and devices, routine auditing of sharps practices and training in occupational hazard prevention and management. This may improve occupational risk perception among HCWs and workplace safety.

Disclosures
All Authors: No reported disclosures
801. Patient Reported Experience with Influenza Episode and Impact on Life and Work
Authors: Way Nate , Martin Ashley , Wallick Chris , Neuberger Edward , Corral Mitra 
Published: December 2021

Abstract

Background
Influenza is a highly prevalent seasonal disease that has a wide range of impact on patients, including experiencing symptoms, social isolation, missing work, and worrying about transmitting to others. The aim of this study was to better understand patients’ experience with influenza, areas of life that were most impacted and what matters most to patients.

Methods
Data for this study were obtained from two online quantitative surveys of influenza patients: A pool of respondents who previously completed the National Health and Wellness Survey (NHWS) (N=74,977) OR from Lightspeed M3 Global’s online “General Panel” (N=500,000+) in the US between January 2020 through May 2020. A total sample of 1,005 patients &gt;18 years of age and having a self-reported diagnosis of influenza by a healthcare professional within the last 90 days were included. Outcomes related to patient demographics, health-related characteristics, perspectives on the influenza episode and productivity impairment (measured by the Work Productivity and Activity Impairment questionnaire) were collected.

Results
Influenza patients reported greatest impact on physical activity, running errands and chores outside the home, and overall lifestyle. 64% were employed at the time they experienced influenza. They missed a mean 23 hours of work due to problems associated with their influenza and actually worked for 15 hours during the 7 days after first experiencing symptoms. Mean absenteeism (work time missed), presenteeism (impairment at work), overall work impairment, and activity impairment was 59%, 73%, 87% and 75%, respectively. For employed respondents, 60% missed work because of transmission worry; about 40% of patients had somebody else get flu shortly after them and about 68% of those people felt responsible for transmitting.

Conclusion
Influenza greatly reduced respondents’ ability to be productive at work and in their daily activities outside of work. Worry about transmitting an influenza infection to others was a highly influential motivator for missed work or other responsibilities.

Disclosures
Nate Way, PhD, Genentech, Inc. (Grant/Research Support)Kantar Health (Employee) Ashley Martin, PhD, Genentech, Inc. (Grant/Research Support)Kantar Health (Employee) Chris Wallick, PharmD, MS, Genentech, Inc. (Employee, Shareholder) Edward Neuberger, PharmD, MBA, MS, Genentech, Inc. (Employee, Shareholder) Mitra Corral, MS, MPH, Genentech, Inc. (Employee, Shareholder)
Variation in Severe Acute Respiratory Syndrome Coronavirus 2 Bioaerosol Production in Exhaled Breath
Authors: Verma Renu , Kim Eugene , Degner Nicholas , Walter Katharine S , Singh Upinder , Andrews Jason R 
Published: December 2021

Abstract
We developed a simple, noninvasive mask sampling method to quantify and sequence severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from exhaled breath. We found substantial variation between individuals in SARS-CoV-2 copies exhaled over a 15-minute period, which moderately correlated with nasal swab viral load. Talking was associated with a median of 2 log10 greater exhaled viral copies. Exposure varies substantially between individuals but may be risk stratified by nasal swab viral load and whether the exposure involved conversation.
A Real-World Clinical and Economic Analysis of Cell-Derived Quadrivalent Influenza Vaccine Compared to Standard Egg-Derived Quadrivalent Influenza Vaccines During the 2019–2020 Influenza Season in the United States
Authors: Divino Victoria , Ruthwik Anupindi Vamshi , DeKoven Mitch , Mould-Quevedo Joaquin , Pelton Stephen I , Postma Maarten J , Levin Myron J 
Published: December 2021

Abstract

Background
Cell-derived influenza vaccines are not subject to egg-adaptive mutations that have potential to decrease vaccine effectiveness. This retrospective analysis estimated the relative vaccine effectiveness (rVE) of cell-derived quadrivalent influenza vaccine (IIV4c) compared to standard egg-derived quadrivalent influenza vaccines (IIV4e) among recipients aged 4–64 years in the United States during the 2019–2020 influenza season.

Methods
The IQVIA PharMetrics Plus administrative claims database was utilized. Study outcomes were assessed postvaccination through the end of the study period (7 March 2020). Inverse probability of treatment weighting (IPTW) was implemented to adjust for covariate imbalance. Adjusted rVE against influenza-related hospitalizations/emergency room (ER) visits and other clinical outcomes was estimated through IPTW-weighted Poisson regression models for the IIV4c and IIV4e cohorts and for the subgroup with ≥1 high-risk condition. Sensitivity analyses modifying the outcome assessment period as well as a doubly-robust analysis were also conducted. IPTW-weighted generalized linear models were used to estimate predicted annualized all-cause costs.

Results
The final sample comprised 1 150 134 IIV4c and 3 924 819 IIV4e recipients following IPTW adjustment. IIV4c was more effective in preventing influenza-related hospitalizations/ER visits as well as respiratory-related hospitalizations/ER visits compared to IIV4e. IIV4c was also more effective for the high-risk subgroup and across the sensitivity analyses. IIV4c was also associated with significantly lower annualized all-cause total costs compared to IIV4e (–$467), driven by lower costs for outpatient medical services and inpatient hospitalizations.

Conclusions
IIV4c was significantly more effective in preventing influenza-related hospitalizations/ER visits compared to IIV4e and was associated with significantly lower all-cause costs.
Safety and Efficacy of Tocilizumab 4 or 8 mg/kg in Hospitalized Patients With Moderate to Severe Coronavirus Disease 2019 Pneumonia: A Randomized Clinical Trial
Authors: Kumar Princy N , Hernández-Sánchez Jules , Nagel Sandra , Feng Yuning , Cai Fang , Rabin Joseph , Morse Caryn G , Nadig Nandita R , Ashraf Obaid , Gotur Deepa B , McComsey Grace A , Gafoor Khalid , Perin Patrick , Thornton Sarah C , Stubbings William , Lin Celia J F , Tsai Larry 
Published: December 2021

Abstract

Background
Tocilizumab, an interleukin 6 receptor (IL-6R) antagonist monoclonal antibody, has shown efficacy in patients with coronavirus disease 2019 (COVID-19) pneumonia, but the optimal dose is unknown.

Methods
Patients hospitalized for moderate to severe COVID-19 pneumonia were randomized 1:1 to receive standard of care treatment and 1–2 doses of intravenous tocilizumab 4 mg/kg or 8 mg/kg (open-label). Primary pharmacokinetic and pharmacodynamic end points were serum concentrations of tocilizumab and soluble interleukin 6 receptor (sIL-6R), IL-6, ferritin, and C-reactive protein (CRP), from baseline to day 60. The secondary end point was safety. Key exploratory efficacy end points included clinical status, time to discharge, mortality rate, and incidence of mechanical ventilation.

Results
Of 100 patients randomized, 49 received tocilizumab 4 mg/kg and 48 received 8 mg/kg. In pharmacokinetic and sIL-6R assessments, dose-dependent differences were seen in patients who received 1 or 2 doses of 4 or 8 mg/kg. Serum concentrations of IL-6, ferritin, and CRP and safety outcomes were comparable between groups. Through day 60, serious adverse events were reported in 30.6% and 25.0% of patients in the 4- and 8-mg/kg groups, respectively. Eight patients (16.3%) in the 4-mg/kg group and 6 (12.5%) in the 8-mg/kg group died. Exploratory time-to-event outcomes favored 8 mg/kg within the first 2 weeks.

Conclusions
In patients with moderate to severe COVID-19 pneumonia who received tocilizumab 4 or 8 mg/kg, pharmacokinetic and sIL-6R assessments showed expected dose-dependent effects; pharmacodynamic assessments and safety were comparable, with no new safety signals. Further study is required before a lower dose of tocilizumab can be recommended in patients with COVID-19 pneumonia.

Clinical Trials Registration
NCT04363736.
Resolution of Cryptosporidiosis in Transplant Recipients: Review of the Literature and Presentation of a Renal Transplant Patient Treated With Nitazoxanide, Azithromycin, and Rifaximin
Authors: Tomczak Ewa , McDougal April N , White A Clinton 
Published: December 2021

Abstract

Background
Cryptosporidium is a major cause of diarrheal disease worldwide, including chronic disease in malnourished children and patients with acquired immune deficiency syndrome. There are increasing reports of cryptosporidiosis in transplant patients, especially from middle-income countries.

Methods
The literature on treatment of cryptosporidiosis in transplant patients was reviewed and included no controlled trials but only small case series. Nitazoxanide, azithromycin, spiramycin, and combination therapies have been used, but none are consistently efficacious.

Results
We present a case of chronic diarrhea from cryptosporidiosis in a renal transplant patient. His illness resolved with decreasing immunosuppression and treatment with the 3-drug combination of nitazoxanide, azithromycin, and rifaximin.

Conclusions
Although current therapies are not reliably effective in the absence of an effective cellular immune response, combination therapies hold promise for improved responses.
DNA metabarcoding reveals broadly overlapping diets in three sympatric North American hummingbirds
Authors: Spence Austin R , Wilson Rankin Erin E , Tingley Morgan W 
Published: December 2021

ABSTRACT
Hummingbirds, a highly diverse avian family, are specialized vertebrate pollinators that feed upon carbohydrate-rich nectar to fuel their fast metabolism while consuming invertebrates to obtain protein. Previous work has found that morphologically diverse hummingbird communities exhibit higher diet specialization on floral resources than morphologically similar hummingbird communities. Due to the difficulties of studying avian diets, we have little understanding whether hummingbirds show similar patterns with their invertebrate prey. Here, we use DNA metabarcoding to analyze floral and invertebrate diets of 3 species of sympatric North American hummingbirds. We collected fecal samples from 89 Anna’s (Calypte anna), 39 Black-chinned (Archilochus alexandri), and 29 Calliope (Selasphorus calliope) hummingbirds in urban and rural localities as well as across an elevational gradient from sea level to 2,500 meters above sea level in California, USA. We found hummingbirds showed high dietary overlap in both invertebrate and plant resources, with few invertebrate and plant families common to most individuals and many families found in only a few individuals. Chironomidae was the most common invertebrate family across all species, and Rosaceae and Orobanchaceae were the most common plant families. Anna’s Hummingbirds had significantly higher invertebrate diet diversity than Black-chinned Hummingbirds when found at the same sites, but we found no difference in plant diet diversity among any of the 3 species. Hummingbirds in urban sites had higher plant diet diversity than in rural sites, but we found no effect of elevation on dietary richness. Our study shows how DNA metabarcoding can be used to non-invasively investigate previously unknown life-histories of well-studied birds, lending insight to community structure, function, and evolution.
Evaluating the impacts of metabarcoding primer selection on DNA characterization of diet in an aerial insectivore, the Purple Martin
Authors: Forsman Anna M , Hoenig Brandon D , Gaspar Stephanie A , Fischer Jason D , Siegrist Joe , Fraser Kevin 
Published: December 2021

Abstract
DNA metabarcoding is a molecular technique frequently used to characterize diet composition of insectivorous birds. However, results are sensitive to methodological decisions made during sample processing, with primer selection being one of the most critical. The most frequently used DNA metabarcoding primer set for avian insectivores is ZBJ. However, recent studies have found that ZBJ produces significant biases in prey classification that likely influence our understanding of foraging ecology. A new primer set, ANML, has shown promise for characterizing insectivorous bat diets with fewer taxonomic biases than ZBJ, but ANML has not yet been used to study insectivorous birds. Here, we evaluate the ANML primer set for use in metabarcoding of avian insectivore diets through comparison with the more commonly used ZBJ primer set. Fecal samples were collected from both adult and nestling Purple Martins (Progne subis subis) at 2 sites in the USA and 1 site in Canada to maximize variation in diet composition and to determine if primer selection impacts our understanding of diet variation among sites. In total, we detected 71 arthropod prey species, 39 families, and 10 orders. Of these, 40 species were uniquely detected by ANML, whereas only 11 were uniquely detected by ZBJ. We were able to classify 54.8% of exact sequence variants from ANML libraries to species compared to 33.3% from ZBJ libraries. We found that ANML outperformed ZBJ for PCR efficacy, taxonomic coverage, and specificity of classification, but that using both primer sets together produced the most comprehensive characterizations of diet composition. Significant variation in both alpha- and beta-diversity between sites was found using each primer set separately and in combination. To our knowledge, this is the first published metabarcoding study using ANML primers to describe avian diet, and also the first to directly compare results returned by ANML and ZBJ primer sets.