bluuebunny/crossref_metadata_2025_split huggingface dataset:
2603. Acceptance of Pharmacist-Led Stewardship Recommendations for Patients with Community-Acquired Pneumonia
Authors: Walker Ramara E , Pallotta Andrea , Schulte Rebecca , Tereshchenko Larisa , Criswell Victoria A , Deshpande Abhishek , Rothberg Michael 
Published: November 2023

Abstract

Background
Community-acquired pneumonia (CAP) is a leading cause of hospitalizations and mortality in the US. Overuse of extended spectrum antibiotics (ESA) for CAP contributes to antimicrobial resistance. The 2019 Infectious Diseases Society of America/American Thoracic Society guidelines emphasize de-escalation of ESA following negative cultures, early switch to oral (PO) antibiotics and limited duration of therapy (DOT). This study describes physician acceptance of pharmacist-led stewardship recommendations in hospitalized CAP patients.

Methods
This intervention is part of an ongoing, large, pragmatic, 2×2 factorial, cluster-randomized, controlled trial across 12 Cleveland Clinic hospitals evaluating the independent and combined effects of pharmacist-led de-escalation and rapid diagnostic testing versus usual care in adults with CAP. The pharmacist developed and delivered the following interventions: ESA de-escalation, DOT, intravenous (IV) to PO transition, and antimicrobial discontinuation. Descriptive statistics were used to describe acceptance rates by prescribers for each pharmacist intervention types.

Results
From November 1, 2022 to March 16, 2023, the pharmacist recommended 317 interventions for 212/1533 CAP patients (14%). Of the recommended interventions, 57.5% were for patients receiving an ESA during their hospitalization, and 16% were for patients classified as having severe CAP. ESA de-escalation, DOT, IV to PO transition, antimicrobial discontinuation, and other interventions made up 22%, 45%, 18%, 11%, and 4% of the total recommended interventions, respectively. Providers accepted 238 recommendations (75%); they were most likely to accept recommendations for ESA de-escalation (60/69, 87%) and IV to PO transition (48/56, 86%), followed by antimicrobial discontinuation (26/35, 74%), and other (10/13, 77%). Recommendations to limit DOT were least likely to be accepted (94/144, 65%). CAP recommendations were made to the following prescribers: physicians (83%) and advanced practice providers (17%) with equal acceptance rate (75%).
Summary of CAP-targeted intervention acceptance rates by intervention category

Conclusion
Approximately 1 in 7 patients garnered a CAP recommendation. While most recommendations were accepted, prescribers were most receptive to de-escalating ESA and least receptive to limiting DOT.

Disclosures
Abhishek Deshpande, MD; PhD, Merck: Advisor/Consultant|Seres Therapeutics: Grant/Research Support Michael Rothberg, MD, MPH, Blue Cross Blue Shield: Advisor/Consultant
150. Nasal Staphylococcus aureus polymerase chain reaction (NSAP): A pediatric antibiotic stewardship tool
Authors: Marisol Fernandez , Swindle Michael , Downey Rachel 
Published: November 2023

Abstract

Background
In recent years, literature has flourished analyzing nasal Staphylococcus aureus polymerase chain reaction (NSAP) diagnostic performance in patients with pneumonia. Fewer data are available for other diagnoses or in pediatrics.
This study aims to determine the baseline use of NSAP results in discontinuation of anti- methicillin resistant S. aureus (MRSA) coverage in pediatric patients with bone/joint infection, complicated pneumonia, and skin and soft tissue infection (SSTI). The second aim is to calculate sensitivity and specificity of this test to help determine its utility as a tool to de-escalate antibiotic coverage.Figure 1.Inclusion and exclusionFigure 2.Anti-MRSA antibiotic use before and after negative NSAP testing

Methods
This is a single center, retrospective chart review study of patients with NSAP performed from March 2016 to September 2021. Figure 1 describes case inclusion and exclusion. Empiric antibiotic data were collected and cases were categorized according to antibiotic use with or without MRSA coverage before and directly after NSAP testing. Changes to antibiotics with regard to MRSA coverage were assumed to be related to NSAP results. NSAP results were compared to blood and other site cultures and molecular testing (if done) to determine sensitivity and specificity.

Results
Among the 135 cases included in the analysis, NSAP testing was negative for MRSA in 129 cases. Figure 2 describes MRSA coverage before and after negative NSAP results. False negative rate was &lt; 1% (1/129).
Six cases were positive for MRSA by NSAP (4%). Empiric antibiotics for 4/6 cases provided MRSA coverage. Following positive NSAP results, MRSA coverage was initiated in 1 additional case. Cultures were congruently positive in 4/6 (67%) of these cases.

Conclusion
Institutional use of NSAP testing can result in a decrease of unnecessary anti-MRSA antibiotics. NSAP testing allowed for de-escalation of antibiotics in 40% of cases with negative results. In this sample, the false negative rate was low at &lt; 1%, which, along with similar studies, could give precedence for a system-wide approach for deescalating antibiotics using NSAP. MRSA NSAP screening had sensitivity of 80% and specificity of 98% when compared to conventional tests.

Disclosures
All Authors: No reported disclosures
2622. Recent or concurrent rhino/enterovirus infection with respiratory syncytial virus associated with decreased symptoms and medical care use in healthy children, PREVAIL, 2017–2020
Authors: Leon Maria Deza , Gailani Adam E , Conrey Shannon C , Washington Dorcas , Burrell Allison , Teoh Zheyi , McMorrow Meredith L , Payne Daniel C , Morrow Ardythe L , Staat Mary A 
Published: November 2023

Abstract

Background
Respiratory syncytial virus (RSV) infections are common in children, resulting in thousands of hospitalizations each year. Viral coinfections are frequently detected during RSV infection, but the effect of these coinfections is poorly understood, and most studies only include hospitalized children. We examined the effect of the most frequently identified co-infection, rhinovirus/enterovirus (RE), on symptoms status and medical care use in a birth cohort of healthy children with RSV.

Methods
PREVAIL is a CDC-funded, 2-year birth cohort (2017–2020) in Cincinnati, OH of healthy, full-term infants. Weekly, mid-turbinate nasal swabs were tested using the Luminex Respiratory Pathogen Panel. RSV infection was defined as a swab positive for RSV (A or B). C Concurrent coinfection was defined as detection of RE at the time of RSV infection, prior RE infection was defined as a swab positive for RE up to 14 days prior to RSV infection. Symptomatic infection was defined as presence of cough or fever reported by the mother via text survey or abstracted from the child’s medical record and medical care use was defined as receiving medical care or not. Odds of symptomatic infection or medical care use with RSV were calculated using a generalized estimating equation adjusted for the child’s age at infection, type of insurance, coinfection with RE and sex.

Results
Overall, 128 RSV infections were identified in 101/245 (41%) children; 89 (69%) were symptomatic, 59 (46%) were medically attended, 4 (3%) were hospitalized. Concurrent co-infection with RE occurred in 20% (n=26) and 31% (n=40) had a RE coinfection between 0-14 days prior to the RSV episode. Coinfection with RE, whether concurrent (aOR 0.29, 95%CI 0.10-0.82) or prior (aOR 0.18, 95%CI 0.07-0.45) was associated with decreased odds of symptomatic disease. Concurrent (aOR 0.19 95%CI 0.06-0.60) or prior (aOR 0.25, 95%CI 0.11, 0.55) RE coinfection was also associated with decreased odds of medical care use.

Conclusion
RSV infections were common in the PREVAIL cohort, most infections were symptomatic with nearly half medically attended. Coinfection with RE 0-14 days prior to RSV infection was associated with decreased odds of both symptoms and medical care use.

Disclosures
Mary A. Staat, MD, MPH, CDC: Grant/Research Support|Cepheid: Grant/Research Support|Merck: Grant/Research Support|NIH: Grant/Research Support|Pfizer: Grant/Research Support|Up-To-Date: Honoraria
152. Impact of BioFire FilmArray Blood Culture Identification Panel 2 (BCID2) and Antimicrobial Stewardship Interventions on Time to Optimal Antimicrobial Therapy in Patients with Positive Blood Cultures
Authors: Nichols Isaac , Kunapuli Anjly 
Published: November 2023

Abstract

Background
Delayed treatment of bloodstream infections is associated with increased morbidity and mortality. Conventional methods for organism identification and susceptibility data from blood cultures can take about 2-5 days. Technological advancements in gene-based polymerase chain reaction tests amplify DNA targets from positive blood cultures and can shorten the identification time of certain organisms and resistance genes, aiding in earlier optimization of antimicrobial therapy.

Methods
This pre/post quasi-experimental, single center study was conducted 6 months prior to and 6 months after implementation of the BCID2 panel. Patients with at least 1 positive blood culture with an organism on the BCID2 panel were included in the study. One hundred twenty-five patients were included in the pre-BCID2 arm and 114 patients in the BCID2 arm. In the BCID2 panel group, real-time alerts were received by the antimicrobial stewardship team (AST) and recommendations were made to providers. The primary outcomes were time to pathogen identification, effective therapy, and optimal therapy.

Results
Demographic characteristics were similar in both groups. A higher percentage of patients with multiple risk factors for bacteremia were identified in the pre-BCID2 arm (36.8% vs 20.2%).
The mean time to pathogen identification (60 hrs vs 30 hrs; P &lt; 0.0001) and time to optimal therapy (61.4 hrs vs 44.6 hrs; P=0.001) were shorter in the BCID2 arm compared to the pre-BCID2 arm. Patients in the BCID2 arm had an overall trend toward decreased mean time to effective therapy compared with the pre-BCID2 arm (17.5 hours vs. 14 hours; P=0.18). Subgroup analysis of blood cultures with vancomycin-resistant Enterococcus spp., ESBL-producing organisms, and Candida glabrata met statistical significance in all three primary outcomes. The BCID2 arm had a 21.9 hr. reduction in time to pathogen ID (49.6 v. 27.7; P=0.02), 38.9 hr. reduction in time to effective therapy (66.9 vs. 28; P=0.013), and a 54.5 hr. reduction in time to optimal therapy (89.3 vs 34.8; P=0.046). Overall, 99% of recommendations from the AST were accepted by providers.
Primary Outcome Results
Time to pathogen ID, Time to Effective Therapy, Time to Optimal Therapy
Secondary Outcomes 1
Total length of stay, ICU length of stay, Microbiologic Cure
Secondary Outcomes 2
30 day Mortality and Recurrent bacteremia

Conclusion
Implementation of the BCID2 panel significantly decreased time to pathogen identification and optimal therapy in patients with bacteremia.

Disclosures
All Authors: No reported disclosures
2647. A Study of Risk Factors for Severe Influenza in South India
Authors: Prasad Nidhi , Muralidhar Dantuluru , Anitha J , Acharya Chandana , KE Vandana , Surya Vamsi A , Mukhopadhyay Chiranjay , Arun Kumar G 
Published: November 2023

Abstract

Background
Severe influenza infections are associated with high hospitalization and increased mortality. The risk factors for severe influenza A and B are not clearly studied in the Indian population. The aim of this study was to identify risk factors in severe influenza patients who had been admitted to a tertiary care referral hospital in South India.

Methods
This was a prospective observational single center study conducted in admitted patients aged above 18 years who were confirmed to have influenza A and B by RTPCR from September 2019 to August 2021. Risk factors contributing to severe influenza were recorded. Exposure to risk factors was assessed and risk ratio/relative risk was calculated to determine strength of association. Statistical analysis was done by chi square test.

Results
A total of 285 patients were diagnosed with influenza during the study period of which 129 (45%) had severe influenza. The distribution of types of influenza amongst severe influenza cases are shown in Figure 1.
Among all subtypes chronic kidney disease (CKD) (OR-4.98), Type 2 Diabetes (OR-3.14) had statistical significance with severe influenza. The risk factor analysis for severe influenza is shown in Table 1.
On analysis of the subtypes of influenza, it was found that, CKD and Type 2 Diabetes had significant association for severe H1N1. However chronic lung disease was identified as the only risk factor for severe H3N2 infection and Influenza B infection.
The Distribution of Types of Influenza Amongst Severe Influenza Cases
Risk Factor Analysis for Severe Influenza

Conclusion
CKD, Type 2 Diabetes and Chronic lung disease are major risk factors for severe influenza infections. Given the significance of these risk factors in the Indian population, early treatment and vaccination can significantly reduce mortality and morbidity.

Disclosures
All Authors: No reported disclosures
2661. Characterization of Mpox in Southeast Michigan
Authors: Alvi Rija B R , Mann Yasmeen , Brar Simran , Brar Indira , Suleyman Geehan 
Published: November 2023

Abstract

Background
More than 30,000 cases of mpox have been identified in the United States. Data suggest that about 40% of affected persons are co-infected with HIV. Although most cases are self-limiting, patients with low CD4 counts are at increased risk of developing severe clinical manifestations and dying.

Methods
Retrospective case-control study comparing mpox cases among people with HIV (PWH) and HIV-uninfected persons from July to Dec 2022, at Henry Ford Health in Southeast Michigan. Demographic data, clinical characteristics, treatment, and outcomes were evaluated.

Results
54 patients were diagnosed with mpox. Overall, 42 (78%) were MSM or bisexual men, 36 (67%) Black, and 34 (63%) PWH; median age was 34.5 years (Table 1). The majority (63%) had prior sexually transmitted infections (STIs), which were more common in PWH (82% vs 30%, p&lt; 0.001). About one-third had multiple sexual partners; more than half engaged in insertive or receptive anal intercourse. 32 (94%) of PWH were on ART, 26 (76%) had CD4 counts &gt;200 and 19 (60%) had undetectable viral load; mean CD4 count was 602 and viral load 7942. Of the HIV-uninfected persons, 5 (25%) were on PrEP. Receipt of mpox vaccine was uncommon in either group. All patients presented with rash that was disseminated in 35%. Fever/chills, lymphadenopathy, headache, proctitis and pharyngitis were the most common manifestations and did not differ among the two groups. Concomitant STIs were present in 22 (48%) of 46 persons tested; syphilis co-infection was more prevalent among PWH (35% vs 25%, p&lt; 0.006). Hospitalization and receipt of tecovirimat were similar between the two groups; no patients died.
Demographics, Risk Factors, Clinical Manifestations and Outcomes of Mpox Patients

Conclusion
Overall, there were no significant differences in clinical manifestations or outcomes between PWH and HIV-uninfected persons with mpox except for syphilis co-infection. Most of our PWH cohort was on ART and virally suppressed with high CD4 count. Hence, efforts should focus on rapid treatment of PWH with effective ART to achieve virological suppression and immunological recovery to minimize clinical complications and severe outcomes associated with opportunistic pathogens. Vaccinating all high-risk individuals, early mpox recognition and testing, and screening for additional STIs should be prioritized.

Disclosures
Indira Brar, MD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Janssen: Grant/Research Support|Janssen: Honoraria|ViiV: Advisor/Consultant|ViiV: Grant/Research Support|ViiV: Honoraria
156. Prevalence of Carbapenem Resistance Among The Clinical Isolates From Patients With Cardio Vascular Diseases Using X-pert Carba -R Real Time Multiplex PCR Assay in a Tertiary Care Hospital In Tamilnadu
Authors: Rakesh Gerard J , rohit anusha , Kumar Dorairajan Suresh , prasanthi jaya 
Published: November 2023

Abstract

Background
In the Post Antibiotic era with the ongoing Silent pandemic of AMR, early detection of the resistant gene exhibited by the offending pathogen causing the ailment is of paramount importance. Early diagnosis and formulating the choice of antibiotics in treatment of Multi drug and Pan drug resistant bacteria helps in reducing the hospital stay and the overall outcome of the patients.
Carbapenems serve as the first line drugs for the treatment of drug resistant Gram-negative bacilli (GNB) infections.However, carbapenem resistance (CR) among GNB is quite common in India.CR can be due to carbapenemase production.The most common carbapenemases are
bla KPC, blaNDM, blaVIM, blaIMP-1, and blaOXA-4.The present study aims to find the prevalence of Carbapenem resistance thereby aiding in initiating the empirical therapy. By studying the resistance patterns we would be able to know whether the isolate expresses single carbapenemase or multiple carbapenemases which has direct influence in the choice of antimicrobials and patient outcomes.

Methods
A total of One hundred and seventy seven clinical isolates which were Carbapenem non-susceptible Enterobacteriales, Pseudomonas aeruginosa, Acinetobater baumanii and Stenotrophomonas maltophilia isolated during the period of Jan2022- April 2023 (15 months) were included in the study. Carbapenem resistance was confirmed by Vitek 2 automated AST system.These isolates were further subjected to X-pert Carba -R Real Time Multiplex PCR Assay to detect the type of carbapenamses expressed

Results
Out of one hundred and seventy seven clinical isolates, one hundred and eight isolates did not produce carbapenemases by X-pert Carba -R Real Time Multiplex PCR Assay. A total of sixty nine isolates(38%) were positve for carbapenemases. Among the sixty nine isolates, thirty isolates(43%) produced blaNDM, fourteen isolates(20%) produced blaOXA-4.One isolate produced blaIMP-1.Twenty four isolates produced both blaNDM and blaOXA-4.

Conclusion
In Madras Medical Mission , New Delhi Metallo-Betalactamase -1 is the most common carbapenemase produced by the clinical isolates from Cardio-Vascular patients.Second most common carbapenemase is OXA-48.

Disclosures
All Authors: No reported disclosures
2691. Does Janus Kinase Inhibitor Increase the Risk of Herpes Zoster in Rheumatoid Arthritis Patients in Saudi Arabia? A Multicenter Retrospective Cohort Study
Authors: Ahmed Fida , Kaki Reham , Abudaowd Ola , Attar Suzan , Almoallim Hani , Salama Gamal 
Published: November 2023

Abstract

Background
JAK inhibitors (JAKi) are targeted synthetic disease-modifying antirheumatic drugs. Current evidence showed they are effective in either post Conventional or Biologic disease-modifying anti-rheumatic drugs ( cDMARDs) (bDMARDs) in patients with moderate to severe rheumatoid arthritis (RA)
JAKi could impair the immune response to viral infection by interfering with interferon signaling through JAK/STAT pathway.
Emerging Data from phase II/III clinical trials, long-term follow-up, and observational studies suggested an increased risk of viral infections, especially herpes zoster (HZ) virus reactivation in patients treated with JAKi.
Our aim was to evaluate the risk of herpes zoster in rheumatoid arthritis patients receiving JAK inhibitors.

Methods
A multicenter retrospective cohort study in Saudi Arabia. Rheumatoid arthritis patients aged 18 and above from the period of 2007-2022 were included.
Medical records were reviewed, and patients were phone interviewed to register an outcome of HZ infection.
Chi-square was used to assess the correlation between various risk factors and HZ infection.

Results
Of a total of 308 patients, 108 were on JAKi.
JAKi didn’t significantly increase the risk of HZ development (OR1.97, 95% CI 0.71- 4.67).
Patients on Etanercept had a higher risk of HZ (OR 2.88, 95% CI 1.65-2.83).
3 out of the 7 cases who developed HZ were on chronic corticosteroids. However, it wasn’t significantly associated with HZ devolvement.
Patients with Asian ethnicity were significantly more predisposed to HZ infection (OR 1.2, 95% CI 0.8-4.37).

Conclusion
In this multicenter study in Saudi Arabia, JAKi were not associated with the development of HZ among Rheumatoid Arthritis patients in real-world data.
As with any observational dataset cause and effect cannot be established with certainty as residual confounding may remain.
This finding would support the evaluation of zoster vaccination in RA patients.

Disclosures
All Authors: No reported disclosures
2694. Infectious Complications in CAR-T Cell Therapy Recipients: A Systematic Review and Meta-Analysis
Authors: Banegas Marcela , Bindal Poorva , Woodbine Maria Jose Hernandez , Aggarwal Pushan , Paredes Rodrigo , Arnason Jon , Alonso Carolyn D 
Published: November 2023

Abstract

Background
Chimeric antigen receptor (CAR) T-cell therapy is a rapidly evolving immunotherapy for hematological malignancies. With increasing access to this modality, there is an urgent need for a comprehensive understanding of infectious complications to optimize prophylaxis and improve clinical outcomes. We conducted a meta-analysis to assess the incidence and types of infectious complications in adult patients receiving CAR T-cell therapy.

Methods
The study was registered on PROSPERO and we searched 5 electronic databases from inception to 2022. Each author independently screened titles, reviewed full texts to identify eligible studies and extracted data from included studies using Covidence, a data extraction tool for conduction of standard systematic reviews. A random effects model was used, and proportions were used as a measure of outcome. We assessed heterogeneity using I^2 statistic. Risk of bias assessments were conducted using the RoB 2.0 for RCTs and ROBINS I tool for non-RCTs.

Results
Our search identified 12,441 studies of which 363 underwent full-text review. 33 studies were eligible for inclusion in the analysis and enrolled a total of 2866 patients. The pooled incidence of an infectious event in adult patients after CAR T-cell therapy was 38% (95%CI 0.31, 0.46; p&lt; 0.01; I2 = 98%]. No significant difference was noted in the incidence among studies with a longer follow up duration compared to studies with follow up of ≤ 30 days [40% (95% CI 0.30-0.50) vs 32% (95% CI 0.24-0.40), p=0.20 respectively]. BCMA-directed CAR T-cell therapies used for management of multiple myeloma had a significantly higher incidence of infectious complications compared to CD19 targeted agents, 64% (95% CI 0.53-0.74, I2 = 65%) versus 39% (95% CI 0.30-0.49; I2 = 98%; p &lt; 0.01) respectively, Figure 1. Clostridium difficile and Escherichia coli were the most common pathogens causing bacterial infections, while cytomegalovirus was the most commonly identified viral pathogen.
Figure 1.
Subgroup analysis of the pooled incidence of infectious events after CAR T-cell therapy among adult patients with hematologic malignancies

Conclusion
In this study, BCMA-directed CAR T-cell therapies were associated with a significantly higher risk of infectious complications. The results of this study can guide the development of strategies to prevent and manage infectious complications in this patient population.

Disclosures
Jon Arnason, MD, BMS: Advisor/Consultant|Regeneron: Advisor/Consultant Carolyn D. Alonso, MD, Academy for Continued Healthcare Learning: Honoraria|AiCuris: Advisor/Consultant|American Society of Healthcare Pharmacists: Honoraria|Cidara Therapeutics: Advisor/Consultant|Clinical Care Options: Honoraria|Merck: Advisor/Consultant|Merck: Grant/Research Support