bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1889. Penicillin Allergy and Its Impact on Clinical Outcomes in OPAT Patients: A Retrospective Cohort Study
Authors: Jafar Maher , McSweeney Kristen , Liu Fang-yu , Erdil Rachel , Vindenes Tine , Doron Shira , Foong Kap Sum 
Published: January 2025

Abstract

Background
10% of the U.S. population is labeled as allergic to penicillin, with higher rates among women and older adults. These individuals often experience worse clinical outcomes. Despite the extensive use of Outpatient Parenteral Antimicrobial Therapy (OPAT), data on the prevalence of penicillin allergy in this population and its impact on clinical outcomes are scarce. Our study aims to address this knowledge gap by assessing rates of penicillin allergy in OPAT patients and its associations with OPAT-related clinical outcomes.
Table 1
Comparison of characteristics and complications among OPAT patients considering penicillin allergy status

Methods
We conducted a retrospective cohort study at Tufts Medical Center, including all patients aged ≥18 years discharged on OPAT between April 2022 and October 2022. Data on demographics, penicillin allergy status, complications, and outcomes were extracted through chart reviews. The primary outcomes were: (1) rates of penicillin allergy, and (2) association between penicillin allergy and OPAT complication rate (line- or antibiotic-related), OPAT extension, 30-day ED visits, and readmission rates. We used a multivariable logistic regression model to examine these associations, adjusting for age, sex, race, ethnicity, and Charlson comorbidity index. Two-sided p values were considered statistically significant at .05.
Table 2
Association of documented penicillin allergy and complications related to OPAT

Results
A total of 231 patients received OPAT; 39 (17.9%) had documented penicillin allergy. Females and white patients had higher rates of penicillin allergy compared to their counterparts; 24.4% vs 12.4% and 19.1% vs 9.4%, respectively (Table 1). In the final multivariable logistic regression model, penicillin allergy status was not associated with OPAT extension (adjusted odds ratios[aOR] 0.83; 95% confidence interval[CI] 0.36-1.89), OPAT-related complications (aOR 1.04; 95%CI 0.42-2.57), 30-day ED visits (aOR 0.38, 95%CI 0.05-3.13), and 30-day readmissions (aOR 0.24; 95%CI 0.03-1.87) (Table 2).

Conclusion
Our findings suggest that the rates of PCN allergy were higher than in hospital settings (∼15%), but these do not significantly influence the OPAT clinical outcomes. However, neither group met the required 248 subjects to reliably detect a 10% increase in complication rates, limiting the significance of the findings. Further research with a larger sample size is needed to validate these findings.

Disclosures
Shira Doron, MD, Medtronic: Expert Testimony|Sunovion: Advisor/Consultant|Vertex: Speaker
P-1890. Implementation and outcomes of a fully remote tele-ID and tele-OPAT program at a regional medical center
Authors: Davis Matthew R , Shah Neel , Maurer Stephen M , Neils Megan Gray , Khan Nazia 
Published: January 2025

Abstract

Background
Infectious diseases (ID) consult services and outpatient parenteral antimicrobial therapy (OPAT) programs have traditionally been restricted to well-equipped academic medical centers. However, the integration of telehealth technologies into ID specialty care now allows for the expansion of ID expertise to underserved medical communities, including non-academic medical centers, and community and rural hospitals. Our initiative pioneered a comprehensive tele-ID service, encompassing both inpatient consultations and a tele-OPAT service for post-discharge management. Herein, we describe the program structure and outcomes from the first year of our integrated tele-ID and tele-OPAT program, implemented at a 144-bed community hospital in Vermont.

Methods
The program featured an inpatient tele-ID consult service supported by local nurse tele-presenters who would facilitate physical exams for a remote ID physician using videoconferencing technology. Patients deemed appropriate for OPAT were referred to the remote tele-OPAT team which consisted of a nurse coordinator, an ID pharmacist, and the current ID physician attending the inpatient service. The nurse coordinator's responsibilities included communicating with the local case management team, home health, and post-discharge facilities to ensure orders were placed, and communications were triaged for the tele-OPAT team. The ID pharmacist reviewed OPAT regimens for appropriateness and monitored outpatient labs for safety and dose adjustments. Tele-OPAT patients were seen locally by the ID physician in a pre-existing clinic with the assistance of a nurse tele-presenter.

Results
Ninety patients were enrolled in the tele-OPAT program in the first twelve months. Of these, 62 (68.9%) completed therapy without adverse event (AE) or 30-day readmission. 30-day readmission occurred in 14 patients (15.6%) and 20 patients (22.2%) had a documented AE during therapy, with 10 patients (11.1%) experiencing line-related issues.

Conclusion
Our telehealth initiative successfully expanded ID expertise to an underserved community hospital, with a majority of patients completing therapy without AEs or readmissions, demonstrating the efficacy and safety of remote ID consultations and tele-OPAT services.

Disclosures
All Authors: No reported disclosures
P-1897. Quality Improvement Initiative: Quantifying and Reducing Anti-infective Pharmaceutical Waste at a Tertiary Care Pediatric Hospital
Authors: Doshi Shreya M , Esadah Esther , Yoko-Uzomah Johnny , Howard Erica , Shapiro Craig A , Dassner Aimee 
Published: January 2025

Abstract

Background
Pediatric hospitals have reported thousands of doses and dollars’ worth of waste from anti-infective drugs (anti-microbial, anti-fungal, anti-viral) every year. This has an environmental impact due to pharmaceutical waste incineration resulting in greenhouse gas emissions and contributes to drug shortages. Anti-infective drugs are prepared in advance for routine administration. When an order is modified or cancelled it cannot be used for another patient and gets discarded. The goal of this study was to calculate the anti-infective waste at our tertiary care pediatric hospital, to understand the key drivers and design education and QI interventions to reduce wasted doses.Figure 1:Fish bone diagram highlighting the reasons for waste

Methods
Pharmacy data for waste reviewed (06/2022-03/2024). The reasons for wasted doses determined by point prevalence review of 75 charts on a single hospital day. PDSA 1 included creation of additional batch processing timings. PDSA 2 included education of providers on teams with high amounts of wasted orders held in 02/2024. Pharmacy leaders reminded teams daily on rounds about stop dates.Figure 2:Key driver diagram

Results
Total waste - 79,525 doses at a cost of $407,072 were wasted due to order changes in 2023. Top wasted anti-infectives include ampicillin-sulbactam, cefepime, cefazolin, ceftriaxone, vancomycin, and piperacillin-tazobactam.
PDSA 1 (Addition of batches for batch processing timing) & PDSA 2 (Provider education and awareness) showed significant reduction in waste per 1,000 doses as highlighted in figure 4.Figure 3:Reasons for waste on chart review of 75 patients

Conclusion
Education around medication waste was created through this QI Initiative and was well received. Using the data collected, IT and pharmacy workflow interventions are being developed and will be evaluated including standardized dosing, 48 hour hard-stops for sepsis rule outs.A key intervention we are currently working on (PDSA 3) is to reduce the time gap between discharge of the patient and when the orders are discontinued on the EMR (identified during chart review). For our hospital this time gap was found to be 6.5 hours which results in large amounts of waste. Calculating environmental impact & Green House Gas emissions from the pharmaceutical waste (by measuring weight in kg) is another impact assessment metric we are working on.Figure 4:Run-chart of baseline waste data with the two PDSA cyclesA decrease in the center line was observed following PDSA 1 that was sustained for greater than 6 months

Disclosures
All Authors: No reported disclosures
P-1912. Characteristics and Outcomes of Matched Vaccinated and Unvaccinated Patients Hospitalized for Covid-19 in 27 Hospitals During Brazil's Delta and Omicon Waves
Authors: Moraes Eduardo V , Pires Magda Carvalho , Costa Amanda A A , Tupinambás Unaí , Marcolino Milena S 
Published: January 2025

Abstract

Background
Brazil faced significant challenges during the COVID-19 pandemic, emerging as one of the most affected countries globally in the number of cases and deaths. In January 2021, the country began the national vaccination campaign against COVID-19. Currently, about 80.2% of Brazilians over six months of age are fully vaccinated.
Few population-based studies have compared clinical characteristics and outcomes among patients hospitalized for COVID-19 concerning vaccination status. This knowledge gap was even greater when an attempt was made to match vaccinated versus unvaccinated individuals to control for confounders. Therefore, this study aimed to compare the clinical characteristics and outcomes of matched vaccinated and unvaccinated COVID-19 in hospital patients.
Flowchart of COVID-19 patients included in the study.

Methods
This retrospective multicenter cohort study included adult COVID-19 patients, with a laboratory-confirmed diagnosis, from 27 hospitals, admitted from March/2021 to August/2022. Clinical characteristics, vaccination status, and outcomes were collected from medical records. Vaccinated and unvaccinated patients were compared in a matched analysis, using the propensity score model that included age, sex, hospital, and comorbidities (hypertension, diabetes mellitus, obesity [body mass index &gt; 30kg/m2], heart failure, and chronic kidney disease).

Results
From 3,188 patients, 1,963 (61.6%) were unvaccinated and 1,225 (38.4%) fully vaccinated. Among these, we matched 771 vaccinated with 771 unvaccinated. Vaccinated had lower rates of mortality (17.6% vs. 29.7%), invasive mechanical ventilation (IMV-17.5% vs. 33.0%), non-invasive mechanical ventilation (NIMV- 10.0% vs. 20.2%), intensive care unit admission (ICU- 29.8% vs. 44.0%) vasoactive drugs use (20.5% vs. 30.9%), dialysis (8.0% vs. 13.7%), p &lt; 0.001 for all, and thrombosis (3.7% vs. 7.5% p=0.002).

Conclusion
This study suggests considerable benefits of vaccination for patients hospitalized with COVID-19. Fully vaccinated patients experienced lower mortality rates and lower severity disease with fewer ICU admissions, and shorter hospital lengths of stay. These findings confirm that prior vaccination reduces the risk of death and alters the disease trajectory in hospital settings.

Disclosures
All Authors: No reported disclosures
P-1922. Liver Function Test Abnormalities near Admission Predict Mortality for Patients with COVID-19: A Single-Center Study
Authors: Hirashima Lucia Cabrejos , Naiman Nicole , Jain Mamta K 
Published: January 2025

Abstract

Background
Early data from the COVID-19 pandemic shows patients commonly present with abnormal liver function tests (LFTs) upon admission. This phenomenon is multifactorial and is associated with increased in-hospital mortality and disease severity. There is limited data describing COVID-19 LFT derangements in the United States, and few comparisons of LFT derangements between variants.

Methods
This is a retrospective cohort study that includes non-pregnant adults admitted at Parkland Health and Hospital System from 03/01/2020 to 12/31/2021 with laboratory confirmed or ICD-10-documented COVID-19. We examine the association of LFT derangement (within 24 hours of admission) and mortality using multivariate logistic regression adjusting for baseline demographics, comorbidities, oxygen requirement, and lab values previously reported to be associated with COVID-19 mortality. We also examine this association after excluding patients with prior liver disease, viral hepatitis, and use of remdesivir prior to measuring LFTs. Finally, we compare LFT derangement patterns between variants (defined by date).Table 2.Multivariate logistic regression of liver function tests as predictors for mortality

Results
In our cohort of 3587 patients, over 93% had an available LFT. Abnormalities of aspartate aminotransferase (AST) and alkaline phosphatase (AP) are more prevalent in the deceased group (Table 1). Multivariate logistic regression shows that severely elevated AST and abnormal AP are consistently associated with mortality, while severely elevated alanine aminotransferase (ALT) is associated with mortality only in patients with no prior liver disease, viral hepatitis or remdesivir use (Table 2). Our analysis reveals significant differences in the frequency of AST and ALT abnormalities based on the variant, with the delta variant showing the highest occurrence of abnormalities. However, we do not find a significant difference in mortality between variants (Table 3).Table 3.Distribution of liver function tests and mortality rate by SARS-CoV-2 variant

Conclusion
This study highlights the consistent association between elevated LFTs at admission and mortality in COVID-19 patients, suggesting close monitoring by clinicians. It also demonstrates that COVID-19 is a systemic illness. Further studies are warranted to elucidate variant-specific differences in the association between LFT derangements and mortality.

Disclosures
Mamta K. Jain, MD, MPH, Abbvie: Grant/Research Support|Gilead Sciences: Grant/Research Support|Laurent: Grant/Research Support
P-1926. Once Is Enough, Two Is Too Much: Unraveling Predictors of COVID-19 Readmission among Previously Hospitalized Patients
Authors: Colaneri Marta , Canuti Marta , Torrigiani Ginevra , Dall’Olio Lucia , Bobbio Chiara , Baldi Sante Leandro , Nobili Alessandro , Puoti Massimo , Marchetti Giulia , Latronico Nicola , Plebani Pierluigi , Raviglione Mario , Gori Andrea , Ojeda Fernandez Maria Luisa , Baviera Marta , Tettamanti Mauro , Leoni Olivia , Fortino Ida , Bandera Alessandra 
Published: January 2025

Abstract

Background
While risk factors for COVID-19 hospitalization are well characterized, only a few studies investigated those associated with hospital re-admission after SARS-CoV-2 re-infections, since most are focused-on re-admission because of all-causes. Our aim was to identify co-morbidities and other risk factors associated with a second COVID-19 hospitalization.
Study flowchart and timeline

Methods
Administrative database from the Lombardy Welfare Directorate was used to detect patients hospitalized for COVID-19 for a first time between 1st Feb 2020 to 31st Aug 2021. Information on demographic variables, hospital records and drug prescriptions were collected. The population comprised the re-hospitalized individuals, who were readmitted for COVID-19 at least 3 months after their initial hospital admission, likely because of a different SARS-CoV-2 infection and the non-re-hospitalized subjects. Follow-up observation lasted until the re-hospitalization, death or the end of study period. Adjusted hazard ratio (CI, 95%) was performed to assess the association between risk factors and re-hospitalization with a competing risk analysis.
Multivariable analysis with competing risk, where death after 3 months is the competing risk for re-hospitalization due to COVID-19.

Results
From a total of 98,369 patients hospitalized for COVID-19, 25,776 (26.2%) died within three months and 610 (0.6%) were re-hospitalized for a likely new SARS-CoV-2 infection (Figure 1). Re-hospitalized patients were mostly male (61.3%) and were 72.2 years on average.
The strongest risks for re-hospitalization in patients with a new episode of COVID-19 were kidney and liver diseases. However, a significant association for this risk was also observed for age, males, immune suppression, cerebro-vascular and cardio-vascular diseases, lung disease, diabetes, and some medications (Table 1).

Conclusion
We demonstrated that vulnerability due to multimorbidity and chronic conditions, such as kidney and liver disfunction, may diminish the ability to withstand physiological challenges, elevating the risk of re-hospitalization. The fact that the elderly, immune suppressed individuals, or those with chronic conditions may survive an initial hospitalization does not safeguard them from further admissions. We emphasized the importance of targeted interventions and heightened clinical vigilance for these high-risk patient populations.

Disclosures
All Authors: No reported disclosures
P-1929. Impact of the COVID-19 Pandemic on the Risk Factors and Outcomes Associated with Candidemia
Authors: Endashaw Melat , Dykes Austin , Clark Rachael , Warrayat Laila , Deng Shiyuan , Chen Xianyan , Henao Martínez Andrés F , Chastain Daniel B 
Published: January 2025

Abstract

Background
Cases of candidemia surged during the COVID-19 pandemic, possibly due to the intensive treatments used in critically ill patients. This study aims to explore the impact of the pandemic on risk factors and clinical outcomes associated with candidemia.

Methods
We retrospectively analyzed patients ≥ 18 years diagnosed with candidemia at a single facility in Albany, Georgia, between January 2017 and May 2023. Patients were categorized into three groups based on their COVID-19 status and admission date (January 21, 2020, marking the first US case): 1) pre-pandemic (before January 21, 2020), 2) pandemic with COVID-19 (after January 21, 2020), and 3) pandemic without COVID-19 (after January 21, 2020). We compared risk factors for candidemia and in-hospital mortality across these groups.

Results
A total of 89 patients were included, with 44% pre-pandemic and 56% during the pandemic (half with COVID-19) (Table 1). Baseline characteristics were similar, except for a higher median number of comorbidities in the pre-pandemic group (p=0.008). Notably, the COVID-19 group had a significantly higher proportion of patients with no comorbidities (12%) compared to the pre-pandemic (0%) and pandemic without COVID-19 (4%) groups (p=0.01). Patients with COVID-19 were predominantly diagnosed with candidemia in the ICU (92%) compared to pre-pandemic (49%) and pandemic without COVID-19 (44%) groups (p&lt; 0.001). Additionally, mechanical ventilation and vascular catheters were more frequent in the COVID-19 group (88% and 96%, respectively) compared to the pre-pandemic (31% and 62%) and pandemic without COVID-19 (40% and 68%) groups (p&lt; 0.001 for both) (Table 2). While immunosuppressive medications were uncommon, glucocorticoid use was significantly higher in the COVID-19 group (76%) compared to the pre-pandemic (18%) and pandemic without COVID-19 (24%) groups (p=0.008). In-hospital mortality was highest among patients with COVID-19 (76%) compared to patients before the pandemic (44%) and those without COVID-19 during the pandemic (32%) (p&lt; 0.005).

Conclusion
Patients with COVID-19 displayed a higher prevalence of candidemia risk factors and significantly worse clinical outcomes, including higher in-hospital mortality, compared to the other groups.

Disclosures
All Authors: No reported disclosures
P-1944. The Natural History of SARS-CoV-2 Infection in Infants and the Role of Subsequent Infections on Protection: A Prospective Cohort in Mexico City
Authors: Molina-Sanchez Alejandra , Rodriguez-Dorantes Laura Angelica , Rajme-López Sandra , Ramos-Cervantes Pilar , Cline Allison R , Staat Mary A , Ruiz-Palacios Guillermo Miguel 
Published: January 2025

Abstract

Background
Limited information exists regarding the natural history of SARS-CoV-2 infection in infants, including the proportion of asymptomatic disease. Moreover, the impact of repeated infections on immunity and clinical presentation is unknown. The possibility of non-severe symptoms related to viral variants has not been explored.
Incidence rate of SARS-CoV-2 first and subsequent infections.

Methods
This meticulous prospective cohort study, conducted from January 1st 2022 to March 30th 2024, followed healthy newborns with weekly rtPCR. Upon respiratory symptoms or a positive rtPCR, subjects were evaluated and a daily symptomatic record was kept for 14 days. Positive samples were sequenced. Incidence rates were calculated for infection and reinfection. Symptoms were grouped according to organ and system involvement. Descriptive and logistic regression analyses were performed in R 4.3.3.

Results
Of 1181 eligible newborns, 796 were included and followed for 10,774 child-months. Nasal swab yield was 76%. Fifty two percent were male, 67% were exclusively breastfed, and none were vaccinated against SARS-CoV-2. A total of 559 SARS-CoV-2 infections were detected (423 first, 109 second, 23 third, and 4 fourth infections). The incidence rate was 5.1 cases per 100 child-months (Figure 1). One subject had severe COVID-19.
The most common symptoms for first infection were rhinorrhea (51%), cough (49%), irritability (39%), and fever (36%). Asymptomatic infection was more common in reinfections than first infections (44 vs 25%, p=0.001) (Table 1). The frequency of asymptomatic infection progressively increased from 25% to 35% and 78% for the first, second, and third infections (p 0.02; X2 for trend).
Subjects with throat, eyes, and skin symptoms were more likely to be infected with the BA.1/BA.2 variants. Those with systemic disease were more likely to be infected by the BA.4/BA.5. Asymptomatic infection tended to be more common in infections by the XBB/EG variants (Table 2). The odds of having an asymptomatic infection increased in subjects with ≥ 2 infections. (Table 3).

Conclusion
SARS-CoV-2 infection is common in infants, though predominantly non-severe. Asymptomatic infections are frequent. Subsequent infections conferred protection against symptomatic infection. The clinical characteristics of COVID-19 differ according to the viral variant.

Disclosures
Mary A. Staat, MD, MPH, Cepheid: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Up-To-Date: Honoraria