bluuebunny/crossref_metadata_2025_split huggingface dataset:
1384. Practice Variations in Pre-Hematopoietic Stem Cell Transplantation Infectious Disease Evaluation
Authors: Conway-Pearson Liam S , Pisano Jennifer , Sica Roberto A , McCort Margaret E 
Published: December 2021

Abstract

Background
Hematopoietic stem cell transplantation (HCT), and other forms of cellular therapies such as chimeric antigen receptor T cell therapy (CAR-T), while of critical therapeutic value, confers significant, long-term risk of infectious complications. Recipients would benefit from evaluation by infectious disease (ID) specialists. However, amidst many existing guidelines from ID and oncology societies, pre-transplant ID evaluation and management practices vary across US institutions. To better understand these variations and identify targets for standardization, we conducted a survey of ID and oncology providers at transplant centers in the US.

Methods
A 38-question, anonymous, voluntary, online survey was distributed via Google Forms to a professional organization e-mail list of ID providers as well as to followers of relevant Twitter accounts. Responses were collected and analyzed.

Results
A total of 51 responses were received, the majority of which (68.6%) came from ID providers. 60.8% of respondents worked at healthcare facilities with over 500 beds. 43 respondents (84.3%) reported that their center performed autologous and allogeneic HCT as well as CAR-T. 56.8% of CAR-T centers use a standardized template, compared to 70.8% of those providing HCT. For allogeneic HCT centers, 8% reported that no ID evaluation is offered; 34% reported that it is offered “sometimes.” Practices varied for treatment of latent tuberculosis infection prior to HCT: 26.5% treat “All the time;” 10.2% treat “Very rarely.” In assessing risk factors, only 63% and 54% identified HIV infection and healthcare occupation, respectively, as epidemiologic risk factors for tuberculosis infection. 59.2% answered that &lt; 10% of patients are screened for Strongyloides. Only 5 respondents reported universal Strongyloides screening prior to transplant. COVID-19 vaccination for family is recommended “Always” by 95.5% of respondents. 25% have offered influenza vaccination to family through the transplant clinic.
Table 1

Differences in ID evaluation practices by type of cellular therapy candidate.
Table 2

Characteristics of survey respondents.

Conclusion
Practices around pre-HCT infectious disease evaluation and management are heterogenous among the centers surveyed. The adoption of standardized screening for and management of infectious diseases in this patient population would likely be beneficial.

Disclosures
All Authors: No reported disclosures
1386. Seroprevalence of Strongyloidiasis in Liver Transplant Candidates at a Tertiary-Level Hospital in Newark, NJ
Authors: Robledo Jorge , O’Shaughnessy Michael , Varughese Tilly , Finkel Diana 
Published: December 2021

Abstract

Background
The liver transplant center at University Hospital (Newark, NJ) is one of the busiest in northern NJ. Current guidelines for Strongyloides stercoralis (Ss) screening in solid transplant recipients recommend targeted testing. We propose a high seroprevalence of this infection in our facility given its significant percentage of foreign-born patients from Ss endemic areas such as Latin America, the Caribbean, and Africa.

Methods
Descriptive study from secondary data. We obtained the total number of Strongyloides antibody tests performed at University Hospital in the last two years (08/2018-10/2020). Subsequently, medical charts were reviewed to obtain epidemiological and clinical data.

Results
A total of 388 patients underwent screening for Strongyloides antibody, of whom 71 (18%) were positive. The test was mainly performed in male (58%) and foreign-born (55%) patients. More than half (55%) of the US-born individuals had history of travel overseas. The main reasons for testing were transplant evaluation (65%), immunosuppression (14%) and eosinophilia (9%). There was no association between transplant evaluation and seropositivity (81% vs 81%, p = 0.994). Being foreign-born was not associated with a positive test (19% vs 20%, p = 0.834), but for US-born patients, having a history of travel was associated with a positive test (33% vs 14%, p = 0.039). For the Ss positive patients, 34% had a HTLV-I/II test, 48% had at least one stool test, and 76% were given treatment.

Conclusion
There is a significant seroprevalence of Ss in our transplant candidate population, both non-foreign and foreign-born, prompting the indication for universal screening at our facility.

Disclosures
All Authors: No reported disclosures
159. Improving Antibiotic Use for Sinusitis and Upper Respiratory Tract Infections: A Virtual Visit Antibiotic Stewardship Initiative
Authors: Wasylyshyn Anastasia , Kaye Keith S , Chen Julia , Haddad Haley , Nagel Jerod , Petrie Joshua G , Gandhi Tejal N , Petty Lindsay A 
Published: December 2021

Abstract

Background
Asynchronous virtual patient care is growing in popularity; however, the effectiveness of virtually delivering guideline-concordant care in conjunction with antibiotic stewardship initiatives remains uncertain. We developed a bundled stewardship intervention aimed at improving antibiotic use in E-visits for upper respiratory tract infections (URTIs).

Methods
In this pre-post study, adult patients who completed an E-visit for “cough,” “flu,” or “sinus symptoms” at Michigan Medicine between 1/1/2018 and 9/30/2020 were included. Patient demographics, diagnoses, and antibiotic details were collected. The multi-faceted intervention occurred over 6 months (Figure 1).
We performed segmented linear regression to estimate the effect of the intervention on the level and trend of appropriate antibiotic use for URTI diagnosis (defined as no antibiotic prescribed) and sinusitis (defined as guideline-concordant antibiotic selection and duration). Regression lines were fit to data before (March 2019) and after (May 2019) the physician championing period.

Results
Among 5151 E-visits, the mean age was 46 years old, and most patients were female (71.3%, N=3674). 3405/5151 E-visits were for URTI. Inappropriate antibiotic use for URTI was stable in trend prior to the audit and feedback intervention (Figure 2), followed by a 12% (P-value = 0.01) decrease in inappropriate antibiotic use post-intervention. The trend in inappropriate antibiotic use continued to decrease after the intervention by 1.1%/month (P-value = 0.02) (Figure 2a).
Of 2493/5151 E-visits specifically for sinus symptoms, guideline-concordant antibiotic use was low (intercept = 8%) pre-intervention (Figure 2b). Post-intervention, there was an estimated 47% increase (P-value &lt; 0.001) in patients receiving guideline-concordant antibiotics.

Solid line represents time of the webinar, dashed line represents time of modified questionnaire roll out and electronic medical record “nudges”, and shaded area is time of physician champion intervention. Guideline-concordant antibiotic prescribing for sinusitis included amoxicillin/clavulanate or doxycycline prescribed for a duration of 5-7 days

Conclusion
A multifaceted stewardship bundle for E-visits improved guideline-concordant antibiotic use for URTIs. Changes implemented in the EMR are most beneficial after a period of audit and feedback. This approach can aid stewardship efforts in the ambulatory care setting particularly with regards to telemedicine.

Disclosures
Tejal N. Gandhi, MD, Blue Cross Blue Shield of Michigan (Individual(s) Involved: Self): Grant/Research Support Lindsay A. Petty, MD, Nothing to disclose
1400. Pretomanid in the Treatment of Patients with Tuberculosis in the United States: the Bedaquiline, Pretomanid and Linezolid (BPaL) Accelerated Monitoring (BAM) Project
Authors: Goswami Neela , Peddareddy Lakshmi Praveena , Jereb John , Semidey Angel Colon , Darnall Elaine , Macias Patricia , Jasuja Supriya , Landers Karen , Dasgupta Shom , Oxtoby Margaret , Spitters Christopher , Dov Lana , Narita Masa , DaSilva Malini , Cropper Tracina , Gullickson Cricket , Ashkin David , Haley Connie 
Published: December 2021

Abstract

Background
In August 2019 the U.S. FDA approved pretomanid as part of a 6-month all-oral BPaL (bedaquiline, pretomanid, and linezolid) regimen for treating pulmonary extensively drug-resistant (XDR) or treatment-intolerant or nonresponsive multidrug-resistant (MDR) tuberculosis (TB). In the study supporting approval, 89% of patients had a favorable outcome, and all reported ≥ 1 adverse event. We describe the reported use of BPaL in the United States.

Methods
Using the 2020 CDC Report of a Verified Case of Tuberculosis (RVCT) MDR TB supplemental form, TB programs and providers submitted data for patients who began taking BPaL between Aug 1, 2019 and May 1, 2020, for retrospective descriptive analysis.

Results
Programs and providers reported 17 TB patients aged a mean of 41 years (range 23–76) who received BPaL: 11 (65%) were male; 15 (88%) were non-U.S. born; 15 (88%) had pulmonary TB disease only; two (12%) had both pulmonary and extrapulmonary disease. Of all patients, 16 had Mycobacterium tuberculosis isolated from sputum and 7 (44%) had cavitary disease. The preliminary drug susceptibilities were 8 MDR patterns, 8 pre-XDR, and 1 unreported. Three patients received BPaL as their only treatment; six first received treatment for drug-susceptible TB, and eight received other regimens for MDR TB before BPaL. Eleven (65%) patients had ≥ 1 side effect reported during any TB treatment, including peripheral neuropathy (n=5), depression (n=4), vestibular dysfunction (n=3), and vision changes (n=3). Timing related to specific TB drug use was not reported. Sixteen (94%) patients received less than the approved initial dose of 1200 mg linezolid daily, and 15 (88%) patients underwent monitoring of linezolid exposure. All 16 patients with M. tuberculosis in initial sputa converted to negative culture results within 6 months of starting treatment. At 12 months after BPaL initiation, all patients had completed treatment, without TB recurrences or deaths reported.

Conclusion
In the early period after FDA approval, most U.S. patients received BPaL off-label with an initial linezolid dose lower than the approved 1200mg yet still achieved good outcomes. Most reported patients underwent some monitoring of linezolid exposure. Monitoring of BPaL use is important and should continue.

Disclosures
All Authors: No reported disclosures
1403. Tuberculous sacroiliitis: Clinical and Imaging Characteristics
Authors: Hammami Fatma , Koubaa Makram , Chakroun Amal , Marrakchi Chakib , Smaoui Fatma , Jemaa Mounir Ben 
Published: December 2021

Abstract

Background
Osteoarticular tuberculosis remains a common disease among which the spine is the most affected site. Less frequently, sacroiliac joint is involved. Its diagnosis is often delayed due to misleading and varied symptoms. The aim of this work was to study the clinical features and the contribution of imaging results in the diagnosis of tuberculous sacroiliitis.

Methods
We conducted a retrospective study including all patients hospitalized in the infectious disease department for tuberculous sacroiliitis. The diagnosis was based on clinical, laboratory and radiological features.

Results
In total, we encountered 12 women with a median age of 51 [39-63] years. Three patients had a family history of tuberculosis (25%). The median diagnostic delay was 155 [48-331] days. The revealing symptoms were lower back pain (75%) and hip pain (25%) associated with fever (83.3%) and weight loss (75%). Reduced mobility was noted in 3 cases (25%). Pulmonary tuberculosis and tuberculous spondylodiscitis were associated with tuberculous sacroiliitis in 5 cases (41.7%) and 4 cases (33.3%), respectively. Tuberculin skin test was positive in 6 cases (50%). Laboratory investigations revealed elevated C-reactive protein levels in 11 cases (91.6%) and accelerated erythrocyte sedimentation rates in 9 cases (75%). Needle biopsy of the sacroiliac joint (41.7%) and soft tissues abscess puncture (16.6%) were performed. Computed tomography scan revealed joint space widening (83.3%), peripheral joint erosions (83.3%) and osteolysis (58.3%). Soft tissue abscesses were noted in 66.7% of the cases. Magnetic resonance imaging was performed in 4 cases (33.3%). Sacroiliac joint was hypointense in T1-weighted images (75%), hyperintense in T2 weighted images (50%) and in STIR images (50%). Bone scintigraphy, performed in 5 cases, revealed hyperfixation of the sacroiliac area (100%). All patients received antitubercular therapy. Percutaneous abscess drainage was indicated in 4 cases (33.3%).

Conclusion
Because of its deep localization, the diagnosis of tuberculous sacroiliitis is mainly based on imaging results associated with epidemiological, clinical and laboratory features. Antitubercular therapy initiated promptly leads to recovery.

Disclosures
All Authors: No reported disclosures
1407. The Latent Tuberculosis Infection Cascade of Care during the COVID-19 Pandemic Response in a Mid-Sized US City
Authors: Stantliff Trevor M , Houshel Lauren , Goswami Rinki , Millow Serenity , Cook Gabrielle , Knapmeyer Robin , Easton Christa , Mooney Jennifer , Huaman Moises A 
Published: December 2021

Abstract

Background
The COVID-19 pandemic response may unintendedly disrupt multiple public health services, including tuberculosis control programs. We aimed to assess the cascade of care of latent tuberculosis infection (LTBI) in an urban US city during the COVID-19 pandemic response.

Methods
We conducted a retrospective cohort study of adult patients who presented for LTBI evaluation at the Hamilton County Public Health Tuberculosis Clinic in Ohio between 2019 and 2020. We defined 01/2019 to 02/2020 as the pre-COVID-19 response period, and 04/2020 to 12/2020 as the COVID-19 pandemic response period. We reviewed electronic medical records and extracted sociodemographic information, medical history, and follow-up and treatment data to define steps within the LTBI cascade of care. Logistic regressions were used to assess factors associated with LTBI treatment acceptance and completion, adjusted by potential confounders and COVID-19 period.

Results
Data from 312 patients were included. There was a significant decrease in the number of monthly LTBI referrals (median, 18 vs. 8, p=0.02) and LTBI evaluations (median, 17.5 vs. 7, p&lt; 0.01) during COVID-19. There was a decrease in the proportion of immigrants as indication for LTBI testing (30% vs. 9%; p&lt; 0.01), and an increase in LTBI diagnoses based on interferon-gamma release assay (IGRA; 30% vs. 49%; p&lt; 0.01) during COVID-19. The proportion of people who were recommended LTBI treatment was similar before and during COVID-19 (76% vs. 81%, p=0.41), as well as the LTBI treatment acceptance rates (56% vs. 64%, p=0.28), and LTBI treatment completion rates (65% vs. 63%, p=0.85). In multivariate analysis, LTBI treatment acceptance was associated with Hispanic ethnicity, younger age, male sex, IGRA use, no comorbidities, and non-healthcare occupation, independent of COVID-19 period. LTBI treatment completion was associated with taking a rifamycin-containing regimen, independent of COVID-19 period.

Conclusion
We observed a significant decline in the number of monthly LTBI referrals and evaluations during COVID-19. Our findings indicate an unintended negative impact of the COVID-19 response in LTBI screening efforts in our region. LTBI treatment acceptance and completion rates were not affected during COVID-19.

Disclosures
All Authors: No reported disclosures
160. Evaluation of an Intervention to Promote Guideline-Concordant Durations of Antibiotic Therapy in Two Urgent Care Centers
Authors: Shihadeh Katherine C , Vazquez Deida Axel A , Hussain Cory , Knepper Bryan C , Fish Lindsey , Breyer Michael , Zwakenberg Melody , Quinones Amy , Torok Bradley , Jenkins Timothy C 
Published: December 2021

Abstract

Background
Antibiotic overuse in urgent cares is common. Despite institutional guidance that recommends ≤ 5 days of therapy for most infections, a prior review found prescribed durations were often longer. This study evaluates the impact of an intervention on guideline-concordant durations of therapy.

Methods
This quasi-experimental study involved two urgent care centers (UC1 and UC2) in an integrated health care system. Prescriptions were included from January 2017 to May 2021 for patients ≥ 18 years of age for one of the following infections identified by ICD10 code: acute bacterial sinusitis, acute otitis media, cellulitis or skin abscess, COPD exacerbation, lower urinary tract infection, or pneumonia. The intervention was implemented in both urgent cares in January 2020 and included sharing baseline duration of therapy data with site directors and staff, providing in-person education on recommended durations of therapy, engaging peer champions, and posting educational flyers. An institutional smart phone application (app) with treatment recommendations for common infections was in place for the entirety of the study. The primary outcome was the proportion of antibiotic durations that were guideline-concordant during the app only and intervention periods in aggregate and by interrupted time-series analysis.

Results
On average, 1583 and 3850 antibiotic prescriptions were prescribed per year in UC1 and UC2, respectively. There was a significant increase in the proportion of guideline-concordant antibiotic prescriptions at the two sites by an absolute value of 20% (p&lt; 0.0001) (Table). By interrupted time-series, the change in slope after the intervention was not statistically significant for UC1 (p= 0.11), UC2 (p= 0.73), or combined (p= 0.61); however, there was a significant increase in prescriptions for ≤ 5 days immediately after the intervention in UC1 (p= &lt; 0.001) (Figure).

Conclusion
This intervention to promote institutional guideline-concordant durations of therapy resulted in a significant increase in the proportion of antibiotic prescriptions for ≤ 5 days. Preventing prolonged durations of therapy is a potentially effective strategy to reduce antibiotic overuse in urgent cares.

Disclosures
All Authors: No reported disclosures
1417. Fosfomycin Use in the Treatment of Complicated Urinary Tract Infections at a Veterans Affairs Medical Center
Authors: Lee Ryan , Tran Thuong , Tan Susanna 
Published: December 2021

Abstract

Background
The prevalence of multidrug resistant gram-negative urinary tract infections (UTIs) is increasing, often requiring intravenous antimicrobial therapy. Oral fosfomycin is a recommended alternative agent for the treatment of cystitis caused by extended spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli). The primary objective of this study is to evaluate the efficacy of fosfomycin in the treatment of UTIs at the Veterans Affairs Long Beach Healthcare System. The secondary objective is to assess the incidence of adverse drug reactions associated with fosfomycin.

Methods
This is a retrospective, single-center, cohort study. Patients who received fosfomycin between June 1st, 2015 – June 30th, 2020 were included. Data collection was completed by chart review through the Computerized Patient Record System (CPRS). Descriptive analysis was used to evaluate data. Treatment outcomes were analyzed using a composite of clinical and microbiological cure. Clinical cure was defined as resolution of UTI symptoms. Microbiological cure was defined as urine sterilization within 1 month after completing treatment course with fosfomycin.

Results
A total of 62 unique patients were evaluated in this study. The mean age was 71.9 years. 56 patients (90.3%) were male, 31 patients (50.0%) had an indwelling catheter present at the time of treatment, and 48 patients (77.4%) had the presence of genitourinary tract pathology that may increase the risk of developing UTIs. Majority of patients (50%) had a urine culture result positive for E. coli prior to treatment, of which 43.5% were ESBL-producing. 60 patients (96.8%) received more than 1 dose of Fosfomycin. Out of 29 patients who were eligible to be evaluated for clinical outcomes, 20 patients (68.9%) met a positive composite outcome of either microbiological cure, clinical cure, or both. 4 patients (6.5%) experienced an adverse drug reaction of diarrhea that was self-limited.

Conclusion
Fosfomycin is an effective and well-tolerated antimicrobial agent that may be considered for treatment of complicated UTIs without evidence of pyelonephritis or bacteremia caused by multi-drug resistant organisms in the veteran population.

Disclosures
All Authors: No reported disclosures
1424. Short-Course Antibiotic Therapy for Urinary Tract Infection (UTI) in the NICU: It’s Safe and Effective!
Authors: Magers Jacqueline , Prusakov Pavel , Speaks Sunday , Sanchez Pablo J 
Published: December 2021

Abstract

Background
Antibiotic overuse in the neonatal intensive care unit (NICU) has been associated with adverse patient outcomes such as necrotizing enterocolitis (NEC), late-onset sepsis, invasive candidiasis, bronchopulmonary dysplasia, neurodevelopmental impairment, and death. On 11/2020 at Nationwide Children’s Hospital, Columbus, OH, the Neonatal Antimicrobial Stewardship Program Committee recommended 5 days of antibiotic therapy with a subsequent antibiotic “timeout” for uncomplicated UTI without bacteremia as part of ongoing efforts to reduce antibiotic exposure among high risk infants in 7 Level 2/3/4 NICUs.

Methods
Retrospective review of all infants who received antimicrobial therapy for UTI after implementation of a UTI Diagnosis and Management Protocol. Twice weekly NEO-ASP meetings provided prospective audit and feedback to neonatologists on appropriate antibiotic therapy and duration. Pertinent clinical, laboratory, and outcome data were obtained from the infants’ electronic health record. Safety measure evaluated include recurrence of infection with the same previously identified pathogen in the fourteen days after discontinuation of antibiotic therapy and mortality.

Results
Since implementation of the UTI protocol, 28 infants (median gestational age, 28 wk [IQR, 26-30 wk; median birth weight, 1203 g [IQR, 731-1801 g]) received antimicrobial therapy for treatment of a UTI at a median age of 50 days (IQR, 28-69 days). The most frequent pathogens were E. coli (n=8), K. pneumoniae (n=5), and Enterobacter spp. (n=4). Median duration of antibiotic therapy was 6 calendar days (IQR, 5-6 days). Only 1 (4%) infant had antibiotic therapy restarted within 14 days of discontinuation of initial therapy; infant had fever but blood, urine, and CSF cultures were sterile and antibiotic therapy was discontinued after 48 hours. One (4%) infant (23 wk gestational age) died at 6 weeks of age from NEC totalis not related to the previous UTI. 22 (81%) infants have been discharged home while 6 remain in the NICU.

Conclusion
Our preliminary data suggests that short course antibiotic therapy (with a timeout) &lt; ![if !supportAnnotations] &gt;[SP1]&lt; ![endif] &gt; for uncomplicated UTIs in the NICU is an effective and safe therapy that ultimately may lead to less antibiotic exposure among high risk infants.

Disclosures
All Authors: No reported disclosures