bluuebunny/crossref_metadata_2025_split huggingface dataset:
2597. Postoperative Pneumonia Characteristics following Pulmonary Thromboendarterectomy (PTE)
Authors: Rathod Shardul N , Ropski Pamela , Glowala Jakub , Quinn Charles M , Stamper Alyssa , Bolon Maureen K , Schimmel Daniel , Malaisrie S Chris C , Mylvaganam Ruben , Cuttica Mike J 
Published: November 2023

Abstract

Background
Pulmonary thromboendarterectomy (PTE) surgery, the gold standard for treatment of chronic thromboembolic pulmonary hypertension (CTEPH), is complicated by reperfusion lung injury (RPLI) in anywhere from 10-40% of cases. Postoperative pneumonia (PNA) following PTE is not well described, but its rates of 17-35% may be higher than expected compared to other cardiothoracic surgeries (5-6%, STS ACSD). Unique features of this highly specialized surgery may predispose patients to increased risk of postoperative PNA. This study aims to describe the incidence of suspected/confirmed post-PTE PNA and assess diagnostic/clinical characteristics and outcomes.

Methods
All patients (n=75) were treated at a single-center CTEPH referral center and underwent PTE between 2016 and 2022. A retrospective chart review was conducted to assess clinical symptoms and signs of RPLI and/or PNA within 7 days of PTE. Microbiologic data was collected via bronchoalveolar lavage (BAL) within 7 days of PTE. Cohorts with microbiologic evidence of PNA and those with RPLI were compared.

Results
Demographics are listed in Table 1. Of the 75 patients who underwent PTE, 28% were documented to have RPLI (mean of 2 days post-PTE) and 21% with PNA (mean of 4 days post-PTE). Of those with RPLI, 43% underwent bronchoscopy with 56% positivity 4 days post-PTE on average (Table 2). Patients with post-PTE PNA were treated with antibiotics for a mean of 6.2 days with Staphylococcus aureus (40%) and Pseudomonas aeruginosa (40%) being the most commonly isolated causative organisms. Patients with post-PTE PNA had longer intensive care unit (ICU) length of stay (LOS) (16.4 vs. 5.6 days, p=0.044) and duration of mechanical ventilation (MV) (7.4 days vs. 1.5 days, p=0.033) along with higher white blood cell counts on postoperative day one (18.3 vs. 14.8 x103µL, p=0.035) (Figure 1).

Conclusion
The cohort demonstrated 28% of patients with RPLI and 21% of patients with PNA. Of those with RPLI who underwent bronchoscopy, over half the patients had positive cultures. Given that PNA is correlated with prolonged ICU LOS and duration of MV, clinicians may consider more systemic evaluation for PNA when considering RPLI, possibly warranting a change in management in these critically ill patients.

Disclosures
Daniel Schimmel, MD, Inari: Advisor/Consultant|Inari: Grant/Research Support|Inari: Honoraria|Penumbra: Advisor/Consultant|Penumbra: Honoraria Mike J. Cuttica, MD, MS, Bayer: Advisor/Consultant|Bayer: Grant/Research Support|Bayer: Honoraria
2600. Incidence of Non-COVID Pneumonia Before and After Mask Mandate at a Midwestern Hospital: An Analytical Cross-Sectional Study
Authors: Szabadi Stephen B , Koenig Katelyn , Gauss Chester , Sila Zachary , Reddy Adithya , Huffman Cuyler , Dewey John , Liu Gordon , Olken Melissa H 
Published: November 2023

Abstract

Background
The introduction of universal masking policies at many American healthcare institutions during the COVID-19 pandemic represented a major shift in infection prevention protocol. However, despite their widespread use, previous data on face masks as a tool for preventing respiratory infections before COVID have been mixed, frequently showing no benefit. This study examines the impact of a universal face mask policy on rates of hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), community-acquired pneumonia (CAP), and other non-COVID pneumonias of indeterminate etiology at Ascension Borgess Hospital in Kalamazoo, Michigan.

Methods
An analytical cross-sectional study was performed comparing patient data from March through September 2019 with the same period in 2020 for any patient admitted with any ICD-10 code for pneumonia. Chi-square analysis was employed to determine pneumonia frequency by subtype, pre and post-mandate. A significance level of p &lt; 0.05 was used for all tests.

Results
1187 patient records were collected, 28 were excluded for incompleteness, and 1159 were included in our analysis. The study population was 81.80% White and 53.66% male. 670 patients (57.81%) were pre-mask mandate and 487 (42.19%) were post-mandate. Pre-mandate, 107 patients had HAP, 575 had all-cause pneumonia (non-COVID pneumonia of any etiology), and 0 had VAP. Post-mandate, 84 patients had HAP, 2 had VAP, and 376 had all-cause pneumonia. A significant difference was observed in the number of all-cause pneumonia cases between pre and post-mandate (χ2 = 13.3058, p &lt; 0.0001), but not in HAP cases (χ2 = 0.2996, p = 0.5841). There were only two instances of VAP; therefore, inferential statistics were not obtained.A significant difference was observed in all-cause pneumonia cases between pre and post-mask mandate implementation (χ2 = 13.3058, p &lt;0.0001), but not in HAP cases (χ2 = 0.2996, p = 0.5841).

Conclusion
Among hospitalized patients, a significant difference in HAP pre and post-mandate was not observed. However, the incidence of non-COVID pneumonia of any etiology was significantly lower during the mask mandate (p &lt; 0.0001). Wether this difference is attributable to universal masking or other mandated or non-mandated precautionary behaviors in the hospital or community cannot be determined. These results suggest that mask mandates as currently implemented do not prevent HAP, but may play a role in decreasing total pneumonia prevalence in the community.

Disclosures
All Authors: No reported disclosures
149. Stewardship Efforts during the COVID-19 Pandemic: Impact on Antibiotic Prescribing Practices of Ambulatory Care Providers for Common (non-COVID-19) Viral Respiratory Syndromes
Authors: Mackey Melinda , Cosimi Reese , Daragjati Florian , Rice Erin , Miller Collin , Shoemaker Aaron , Fakih Mohamad G 
Published: November 2023

Abstract

Background
An estimated one third of antibiotics prescribed in the outpatient setting is considered unnecessary. We evaluated ambulatory antimicrobial use for a single system before and during the COVID-19 pandemic and assessed the impact of a system-based stewardship intervention on overall antibiotic selection and prescribing rates for indications with typically viral etiologies.
Comparison of Antibiotic Use for Common Viral Respiratory Syndromes Prepandemic and Pandemic Periods
Change in Antibiotic Use and Spectrum for Prepandemic and Pandemic Periods

Methods
This retrospective, quasi-experimental pre-post design evaluated rates of antibiotic prescribing for ambulatory setting in all ages across a large, multi-state healthcare system with encounters coded for common viral respiratory syndromes. Stewardship interventions were implemented starting July 2021 and included mandatory training on common upper respiratory infections for all Primary Care and Urgent Care clinicians, coupled with feedback on prescribing practices for targeted viral syndromes at quarterly intervals. Encounter volumes for ambulatory care clinicians were stratified by time period and common viral respiratory syndrome diagnosis (excluding COVID-19). Data on systemic antibiotic prescriptions collected from outpatient electronic health records (EHRs) was obtained during a prepandemic year (January 2019 - December 2019) and a pandemic year (January 2022 - December 2022). We compared the use of antibiotics for common viral respiratory syndromes between the two periods in the ambulatory setting and further evaluated for any changes in antibiotic selection.

Results
Ambulatory antibiotic utilization for common viral respiratory syndromes decreased from 54.3% (prepandemic) to 47.1% (pandemic), resulting in an absolute 7.2% reduction (p&lt; 0.001). After adjusting for the decreased volume of common viral syndromes diagnosed during 2022, approximately 28,578 fewer antibiotics were prescribed during the COVID period.

Conclusion
Associated with an intervention to optimize antimicrobial use, we witnessed an improvement in overall use and choice of antimicrobials during the pandemic in a single system.

Disclosures
Melinda Mackey, MSN, RN, CPHQ, CCM, Pfizer, Inc: Advisor/Consultant Reese Cosimi, PharmD, Allergen: Advisor/Consultant
2607. The impact of portable high efficiency Hepa Filters on the incidence of invasive fungal infection in Covid 19 inpatients in a tertiary care hospital: a retrospective analysis from Pakistan
Authors: AHMED A N E E R A , JAMIL B U S H R A , SULTAN A I M A N , LUXMI S H O B A 
Published: November 2023

Abstract

Background
Objective: To identify impact of air filtration on incidence of Invasive fungal infections in COVID-19 patients after restructuring of COVID-19 wards.

Introduction
Most COVID-19 patients present with mild or moderate disease; but patients with comorbidities may be predisposed to secondary and opportunistic infections. Aspergillus infections resulting from failure in air filtration systems have been reported. Our study aims to determine the impact of installation of such preventative measures in covid units on the frequency of invasive fungal disease as a complication of covid 19 illness

Methods
All COVID-19 patients &gt;18 years (non-severe, severe and/or critical) admitted at the tertiary care center were included. Even COVID-19 patients with suspected IPA, based on isolation of fungal species from one or more respiratory samples were included. Two time frames were used for inclusion of patients, one three months prior to and second three months after installation of HEPA filters in COVID wards. Patients with underlying respiratory disease, previous history of invasive pulmonary aspergillosis, on chronic steroid use ( &gt;3 months), on broad-spectrum antibiotics and with hematological malignancies were excluded. SPSS version 23.0 was used for data analysis.

Results
From 187 patients, 97 enrolled before installation of HEPA filters while 90 after installation of HEPA filters. Overall the mean age of patients was 62.7 ± 14.6 years. A significant difference of p-0.04 was observed in terms of length of stay in-between before installation of HEPA filter group (13.1 ± 11.2 days) and in after installation of HEPA filter group (10.2 ± 8.2 days). Beta-D-Glucan test with HEPA filter was positive in 17 (17.5%) of patients while in 28 (31.1%) of patients without HEPA filter (p-0.03). Treatment with Azoles was found to have significant difference in-between both groups (p-0.002). Overall, treatment was successful in 16 (16.5%) patients in without HEPA filter group while in 38 (42.2%) of patients with HEPA filter (p&lt; 0.001)

Conclusion
Substantial decrease in incidence of invasive fungal infections among COVID-19 patients was reported in terms of age, length of stay, Beta-D-Glucan, treatment with azoles and overall treatment in favor of HEPA filters.

Disclosures
All Authors: No reported disclosures
2610. Home Administration of Intranasal Live Attenuated Influenza Vaccine: A Review of Current Evidence and Potential for Meeting Vaccination Targets
Authors: Jhaveri Ravi , Zahn Matt , Bandell Allyn R 
Published: November 2023

Abstract

Background
During the 2010–2021 influenza seasons, vaccination coverage was below the 70% target for the United States at 33.4–58.6% among children and 50.2% among adults.[1, 2] The live attenuated influenza vaccine (LAIV) is currently approved for healthcare professional administration (HCPA); however, self- and home-administered LAIVs may provide an additional, effective option for vaccine administration, which could expand seasonal influenza vaccine accessibility. LAIV is a quadrivalent influenza vaccine administered intranasally, with comparable effectiveness to the inactivated influenza vaccine.[3] Broadening vaccine availability to multiple vaccination sites has been shown to increase vaccination rates by up to 22%.[4]
Here we summarize the current evidence on self- and home-administered LAIV efficacy and safety, and potential applications for increasing community influenza vaccination accessibility.

Methods
Publications evaluating the efficacy, safety, and practicality of self- and home-administered LAIV were identified from a literature search with the following search string: (live attenuated influenza vaccine OR LAIV) AND (home administration OR self administration OR self immuni*).

Results
In three studies comparing LAIV self- and home administration to HCPA (Table), home administration was preferred by 64, 74, and 96% of participants. Sample sizes ranged from 41 children to 4561 patients receiving LAIV, with participants aged between 2.6 and 64 years old. A trial of 4561 patients comparing LAIV self- and home administration to HCPA groups found similar effectiveness against influenza-like illness, immunogenicity, and adverse events post-vaccination.

Conclusion
Evidence suggests that self- and home-administered LAIV could be safely and effectively offered, and may be preferable for a subset of the population, which could expand seasonal influenza vaccine accessibility.
References
[1] Centers for Disease Control and Prevention. Flu vaccination coverage, United States, 2020–21 influenza season.
[2] Gates DM et al. Vaccine. 2022;40(44):6337-6343.
[3] Bandell A et al. Open Forum Infect Dis. 2020;7(Suppl 1):S709.
[4] Ipsos. Expanding flu vaccine access.

Disclosures
Ravi Jhaveri, MD, AbbVie: Grant/Research Support|AliOS: Grant/Research Support|AstraZeneca: Advisor/Consultant|Gilead: Grant/Research Support|MedImmune: Advisor/Consultant|Merck: Grant/Research Support|Saol Therapeutics: Advisor/Consultant|Seqirus: Advisor/Consultant Allyn R. Bandell, PharmD, AstraZeneca: employee|AstraZeneca: Stocks/Bonds
2640. Estimated Additional Burden Averted from Use of Cell-Based Influenza Vaccines Compared to Egg-Based Influenza Vaccines Among People 0-64 Years of Age in the United States: 2017-2020 Seasons
Authors: McGovern Ian , Taylor Alexandra , Sardesai Aditya , Toro-Diaz Hector , Haag Mendel 
Published: November 2023

Abstract

Background
Influenza vaccines have traditionally been produced in eggs, which can introduce egg-adaptive mutations. Cell-based influenza vaccines avoid egg-adaptive mutations, potentially improving match to circulating influenza viruses and therefore vaccine effectiveness. This study modeled the public health impact if all vaccinated people 0-64 years of age in the United States received cell-propagated inactivated quadrivalent influenza vaccine (IIV4c) compared to egg-propagated inactivated quadrivalent influenza vaccine (IIV4) across the 2017-2018 through 2019-2020 Influenza Seasons.

Methods
The modeling method used by the US Centers for Disease Control and Prevention (CDC) for estimating overall burden averted due to influenza vaccination was extended to a relative vaccine effectiveness (rVE) context. The model utilized CDC data on influenza vaccine uptake, influenza incidence, influenza-related healthcare resource use and deaths. CDC estimates of absolute vaccine effectiveness (aVE) (any vaccine) were used as the aVE of IIV4. Based on previously published rVE estimates generated from the same real-world database, the rVE of IIV4c vs IIV4 was assumed to be 19.3% (95% Confidence interval: 9.5 to 28) in 2017-2018, 7.6% (6.5 to 8.6) in 2018-2019, and 17.2% (15.8 to 18.6) in 2019-2020. Base-case results were validated with deterministic (DSA) and probabilistic (PSA) sensitivity analyses.

Results
Figure 1 shows the anticipated number influenza-related cases and complications that would be averted if all vaccinated people 0-64 years of age received IIV4c or IIV4. Across the 3 influenza seasons, use of IIV4c would result in prevention of an additional 12,706,837 symptomatic illnesses, 6,222,820 outpatient visits, 80,390 hospitalizations, and 2,765 deaths. DSA results showed that the rVE estimate was associated with the most variability while the burden estimates were most influential in the other two seasons. Mean PSA results were all within a 0.5% difference of base-case results.Figure 1.Number of Outcomes Prevented from Use of IIV4c Compared to IIV4 Among People 0-64 Years of Age: 2017-2018 Through 2019-2020 Seasons

Conclusion
Use of IIV4c instead of IIV4 during the 2017-2020 influenza seasons in the US would have had a substantial public health impact due to a 28.5% to 49.1% increase in influenza cases prevented.

Disclosures
Ian McGovern, MPH, CSL Seqirus: Employment|CSL Seqirus: Stocks/Bonds Alexandra Taylor, MSc, CSL Seqirus: Advisor/Consultant Aditya Sardesai, MSc, CSL Seqirus: Advisor/Consultant|Merck & Co. Inc: Grant/Research Support|Merck & Co. Inc: Grant/Research Support Hector Toro-Diaz, PhD, CSL Seqirus: Advisor/Consultant Mendel Haag, PhD, PharmD, CSL Seqirus: Stocks/Bonds
153. Sensitivity of MRSA Nasal Screening in Patients with Staphylococcus aureus Pneumonia: Impact of a More Sensitive Comparator
Authors: Papamanolis Irene-Constantina , Decano Arnold , Zacharioudakis ioannis , Dubrovskaya Yanina , Siegfried Justin , Marsh Kassandra , Mazo Dana , Inglima Kenneth 
Published: November 2023

Abstract

Background
Staphylococcus aureus (S. aureus) pneumonia (PNA) is associated with significant morbidity and mortality. Methicillin-resistant Staphylococcus aureus (MRSA) nasal screening has been considered a valuable tool in guiding the de-escalation of antibiotics, particularly vancomycin, among patients with PNA by identifying patients with MRSA colonization in light of its high sensitivity and negative predictive value in earlier studies. However, the performance of MRSA/MSSA nasal screening has yet to be re-evaluated after more sensitive molecular methods for microbiologic diagnosis of PNA have become available. This study aims to determine the sensitivity of MRSA/MSSA nasal screening in patients diagnosed with S. aureus PNA based on the BIOFIRE® FILMARRAY® Pneumonia Panel results.

Methods
We conducted a retrospective cohort study involving 346 patients with a positive BIOFIRE® FILMARRAY® Pneumonia Panel for MRSA or MSSA. Inclusion criteria were age &gt;18 and use of MRSA/MSSA nasal screening by the culture within 48 hours of symptom onset. Exclusion criteria included polymicrobial PNA detected by the Pneumonia panel, infection(s) at other sites and known recurrent S. aureus infections.

Results
A total of 56 patients with S. aureus PNA met the inclusion criteria. Of the 56 patients, 22 had mecA/C or MREJ detected, indicating MRSA infection. Among these 22 patients with MRSA PNA, 11 (sensitivity 50%) were screened positive by nasal culture. Among the 34 patients with MSSA PNA, 16 screened positive by nasal culture (sensitivity of 47.1%).

Conclusion
The MRSA nasal screening culture demonstrated a sensitivity of 50% in patients with MRSA PNA, which is lower than what has been reported, including those using PCR. When using culture screening methods, risk factors for MRSA PNA and clinical and radiographic features will need to be considered for empiric antimicrobial therapy pending microbiologic test results. Future studies should focus on refining MRSA screening methodologies, evaluating their clinical utility in managing empiric antimicrobial therapy in patients with pneumonia, and studying the clinical outcomes in patients who received inappropriate therapy based on negative MRSA screening results.

Disclosures
All Authors: No reported disclosures
2648. Taming the Cytokine Storm: Baricitinib versus Tocilizumab for COVID-19 Hyperinflammation
Authors: Radziszewski Skyler , Swamy Siddharth , Jain Ruchi , Bicking Keri , Nyirenda Themba 
Published: November 2023

Abstract

Background
Baricitinib and tocilizumab are potent immunomodulators that can reduce mortality in severe and critical COVID-19. The objective of this study was to compare the outcomes of patients with COVID-19 who were treated with either baricitinib or tocilizumab.

Methods
This was a single-center, retrospective chart review. Patients were included if they were adults hospitalized with COVID-19 between January 2021 and October 2022 and received baricitinib or tocilizumab. Patients were excluded if they received both agents. Data collection included patient demographics and the predominant variant circulating at time of admission. The primary outcome was the percentage of patients with clinical improvement at day 14 after immunomodulator initiation. Clinical improvement was defined as a two point improvement on a six-point ordinal scale or hospital discharge. Secondary outcomes included clinical improvement at days 7 and 28 after immunomodulator initiation, progression to mechanical ventilation or ICU care, in-hospital mortality, and incidence of venous thromboembolism (VTE).

Results
Four hundred eleven patients were included, of whom 168 received baricitinib and 243 received tocilizumab. Due to availability, baricitinib was used when the Delta and Omicron variants were dominant, and tocilizumab was used throughout the entire study period. There was no significant difference in percentage of patients with clinical improvement at day 14 after immunomodulator initiation (35% versus 36%, p=0.82). Progression to mechanical ventilation (MV) or ICU care occurred significantly less frequently in baricitinib recipients compared to tocilizumab recipients (47% versus 57%, p=0.04). No significant differences were observed for in-hospital mortality, clinical improvement at days 7 and 28 after immunomodulator initiation, and incidence of VTE.

Conclusion
Baricitinib and tocilizumab appear to produce similar clinical outcomes in patients with severe or critical COVID-19. Baricitinib recipients had decreased progression to MV or ICU care, however, it remains unclear whether this outcome was influenced by changes in standard of care and circulating variants at different time points throughout the pandemic.

Disclosures
All Authors: No reported disclosures