bluuebunny/crossref_metadata_2025_split huggingface dataset:
316. Leveraging the Electronic Health Record to Improve OPAT Discharges at University of Colorado Hospital
Authors: Allen Lorna , Montague Brian T , Koehler Sandra , Hallman Heather , Olsen Nicholas L , Pisney Larissa 
Published: November 2023

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) discharges at University of Colorado Hospital (UCH) are not standardized and require a highly coordinated, multidisciplinary approach. Discrepancies and omissions on the discharge medication list have led to near miss and patient harm events during transitions of care including missed doses, wrong doses, and inappropriate cessation of IV antimicrobials. The purpose of this project was to improve patient safety and provider efficiency through streamlining and standardizing the OPAT discharge process.

Methods
In September 2022 we implemented a two pronged intervention on the UCH Anschutz campus. A change in the workflow designated the Infectious Disease provider to place the antimicrobial on the discharge medication list. In addition, an OPAT navigator tool was developed in collaboration with an EPIC build team and launched in the electronic health record (EHR). The navigator utilizes discrete data entry into flow sheet rows to populate a standardized OPAT order that is automatically pulled onto the after visit summary.

Results
Baseline data collected from 10/2020 - 8/2022 showed that 48% (n = 131) of OPAT patients had either incorrect or omitted orders on the discharge medication list. Post intervention data collected from 10/2022 - 3/2023 showed a mean of 98% (n= 433) of OPAT patients had the correct IV antimicrobial on the discharge medication list. Four steps were eliminated from the previous discharge workflow.

Conclusion
Transitions in care are a vulnerable period for high risk OPAT patients. This project has been successful in achieving the primary aims of improved accuracy of IV antimicrobials on the discharge medication list. Continued efforts will be focused on sustainability as well as the potential for expansion to additional UCHealth sites.

Disclosures
Lorna Allen, FNP-C, MERCK: Grant/Research Support Brian T. Montague, DO MS MPH, Eli Lilly: Grant/Research Support|Regeneron: Grant/Research Support
332. Factors Associated with Readmission in Patients with End-Stage Renal Disease on Hemodialysis Discharged on Outpatient Parenteral Antimicrobial Therapy
Authors: Ismail Ghaleb , MacDonald Nancy , Kenney Rachel M , MULUGETA Surafel , Gendjar Suzette , Daifi Chantale 
Published: November 2023

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) is a popular option for patients who require extended treatment with antimicrobials. OPAT in patients with end stage renal disease (ESRD) on hemodialysis (HD) has unique considerations and regimens that facilitate vein preservation as a priority. This study aimed to characterize patients with ESRD on HD discharged on OPAT and identify factors associated with poor outcomes.

Methods
This was an IRB–approved retrospective cohort of patients ≥ 18 years with ESRD on HD who were discharged between 1/1/20 and 8/30/22 with at least one week of OPAT. Enrolled patients were divided into two equal groups depending on their 60-day readmission status. Patients were excluded if they were admitted on OPAT prior to admission or expired within 30 days of the initial OPAT discharge, incarcerated, or if the discharge was self-directed. To identify risk factors for readmission, patients who had an unplanned all-cause 30-day readmission were compared with those not readmitted. Other safety measures collected include transitions of care process measures, pharmacist collaboration with patient education and follow-up monitoring.

Results
162 patients (67 females, 95 males; median age 59 years) were included. The most common reason for OPAT was bloodstream infection (51%). Vancomycin was the most prescribed (50%). Nine patients in the readmitted group reported adverse events compared to 31 in the readmitted group (p = &lt; 0.001). Patients in the non-readmitted were statistically more likely to have a pharmacist infection treatment plan note prior to discharge (p = 0.036) and statistically more likely to attend infectious disease (ID) follow-up appointments (p = 0.001). A multivariable regression identified that being female, having diabetes mellitus, or congestive heart failure are associated with increased risk of unfavorable outcomes (Adjusted odd ratio = 3.352, 1.75, and 1.671 respectively).

Conclusion
This study suggests that OPAT optimization and patient education by a pharmacist, and attending follow-up ID appointments reduced the risk of readmission for patients with ESRD on HD.

Disclosures
All Authors: No reported disclosures
352. Post-Discharge Microbiology Review by Infectious Diseases Pharmacists is Impactful
Authors: Van Abel Amy , Pertzborn Margaret , Lane Trudi , Schreier Diana , Teaford Hiliary R , Virk Abinash , Willis Courtney , Rivera (O'Connor) Christina G 
Published: November 2023

Abstract

Background
Post-discharge culture and susceptibility review has been described in emergency department and urgent care settings, but there is a lack of published literature describing culture review after acute care hospitalizations. Awaiting microbiology results can impede timely patient discharge. However, discharging patients while microbiology results are pending may result in suboptimal therapy or lost opportunity for additional testing/follow up. We implemented an antimicrobial stewardship effort to identify microbiology tests that result post-discharge utilizing a custom report in the electronic medical record (EMR).
Methods. This retrospective descriptive study included adult patients ( &gt;18 years of age) at 4 sites within Mayo Clinic from 1/1/2019 to 2/28/2023. Eligible patients had a hospitalization with an ID consult and an abnormal culture that was reviewed by an antimicrobial stewardship pharmacist after discharge. Urine cultures were excluded. The details of pharmacist-initiated antimicrobial stewardship interventions based on the culture review were identified by an EMR based research report.

Results
A total of 6803 patient encounters with at least 1 microbiology result reviewed post-discharge were identified. Patients were 40% female with a median age of 62 years. Patient race was 89.8% white, 4% black/African American, 1.5% Asian, and &lt; 1% other. Of these patients, 1983 (29%) had at least one pharmacist intervention. A total of 169 (2.5%) of these patients had multiple interventions. Interventions included modification of antimicrobial therapy, addition of susceptibility testing, or additional follow up (labs, imaging, or patient visits). Median time from culture update to pharmacist review was 27.2 hours. Median length of hospital stay was 5 days and discharge disposition was home with self care (65%), home with home health or hospice (22.7%), or discharge to another acute care or skilled nursing facility (12.3%).

Conclusion
Outpatient review of post-discharge culture updates utilizing EMR reporting led to substantial interventions impacting antimicrobial treatments.

Disclosures
Christina G. Rivera (O'Connor), Pharm.D, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Board Member|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria
389. PediCoViral: Clinical Outcomes of COVID-related Co-viral infections in Children
Authors: Anosike Brenda I , Sharma Shiv M , Sarill Kiera , Alrikaby Jassour , Duong Tim Q , Herold Betsy 
Published: November 2023

Abstract

Background
During the earlier phase of the COVID-19 pandemic, published reports demonstrated low rates of COVID co-viral infections. Upon relaxing public health measures, the epidemiology of known respiratory viral pathogens had dramatically shifted as the pandemic evolved. Little is known about the clinical impact of co-viral infections in children post-Omicron wave. This study investigates the clinical outcomes among children, adolescents, and young adults who test positive for SARS-CoV-2 [COVID] alone compared to those with COVID co-viral infection with either RSV or Influenza [Flu] A/B [denoted as COVID+]

Methods
We conducted a retrospective study of subjects ≤ 21 years of age who tested positive for SAR-CoV-2 presenting to the Children’s Hospital at Montefiore, Bronx, NY from 12/1/2021 to 1/15/2023. Laboratory confirmation was established using a multi-target PCR assay for influenza A/B, RSV, and SARS-CoV-2. The primary outcomes were hospitalization, need for invasive mechanical ventilation (IMV), and mortality. Demographic and patient outcomes were extracted using ATLAS database.

Results
Among 8307 subjects who tested positive for COVID alone, 8.5% (708) were hospitalized with a mean age of 8.7 years (SD=7.8) while mean age of those with COVID+ was 5.0 years (SD=4.4). Hospitalization rates for COVID alone, COVID+Flu, and COVID+RSV were 6.4%, 32.2%, and 57.7%, respectively (p&lt; 0.001). COVID positive children ≤ 5 years of age with or without a second virus were more likely to be hospitalized than other age group (p&lt; 0.001). When comparing COVID+Flu vs. Flu alone (32.2% vs. 4.3%, p&lt; 0.001) or COVID+RSV vs. RSV alone (57.7% vs. 15.8%, p&lt; 0.001), hospitalization rates were higher for those with COVID co-viral infections. No increase in mortality was observed.Figure 1.Patient Flow ChartTable 1.Patient Demographics and Characteristics*unadjustedTable 2.Clinical outcomes of pediatric patients

Conclusion
This single center retrospective study demonstrates that SARS-CoV-2 coinfection with RSV or Influenza is associated with increased risk for hospitalization compared to SARS-CoV-2, RSV or influenza alone. Hospitalization rates were higher in younger children. Further studies are needed to identify the mechanisms driving the increased morbidity associated with these coinfections.

Disclosures
All Authors: No reported disclosures
399. Recent COVID-19 infection is associated with high risk of mortality among patients with Staphylococcus aureus bacteremia
Authors: Eichenberger Emily , Pall Allison , Thomas Stepy , Ray Susan M 
Published: November 2023

Abstract

Background
Staphylococcus aureus bacteremia (SAB) is associated with significant mortality. Recent reports indicate that the incidence of invasive S. aureus infections has increased since the start of the COVID-19 pandemic. The impact of recent COVID-19 infection on clinical outcomes of patients with SAB is unknown.

Methods
We performed a retrospective study investigating outcomes associated with SAB in patients with recent COVID-19 infection (SAB-C) versus patients with SAB without a recent positive COVID-19 test (SAB-N). We used data collected by the Georgia Emerging Infections Program (EIP), a CDC- funded invasive S. aureus surveillance study in the 8-county Atlanta metro area to identify all patients with SAB between 2020-2021. SAB cases were linked to COVID-19 test results from the Georgia Notifiable Disease Reporting data to collect patient COVID-19 test results within 90-days of the initial positive blood culture. For subjects experiencing &gt; 1 episode of SAB, only the first episode was evaluated to ensure independence of observations. Comparisons were made using Kruskal-Wallis test and Fisher’s exact test as appropriate. Statistical significance was set at P=0.05.

Results
Between 2020 -2021 there were a total of 3705 unique patients with SAB. Among them, N=486 (13.1%) had a positive COVID-19 test &lt;90 days prior to SAB (SAB-C), and N=3219 (86.9%) did not (SAB-N) (Table 1). Median time from positive COVID-19 test to first positive blood culture was 7 days. SAB-C had a greater proportion of methicillin resistant S. aureus (MRSA) and hospital onset infection than SAB-N (41.8% vs 36.1%, p=0.0189, and 45.7% vs 17.3%, p&lt; 0.0001 respectively). 7-day mortality and in-hospital mortality were significantly higher among SAB-C vs SAB-N (25.7% vs 9.0%, p&lt; 0.0001, and 43.6% vs 15.3%, p&lt; 0.0001, respectively). Among SAB-C, hospital onset of SAB was significantly associated with mortality (29.6% survivors vs 66.5% non-survivors, p&lt; 0.0001, Table 2).

Conclusion
SAB-C is associated with high mortality. Further research is needed to understand additional factors contributing to this high mortality rate including source of infection, infecting strain, and underlying host immune factors.

Disclosures
All Authors: No reported disclosures
444. The disruptive effects of COVID-19 on the incidence of hospital acquired staphylococcus aureus bacteremia (HA-SAB) and its associated factors with mortality in a tertiary teaching hospital in an upper-middle income country
Authors: Ponnampalavanar Sasheela Sri La Sri , Goh Sheron Sir Loon , Rajandra Arulvani , Suhaimi Nur Alwani , Zainon Siti Norintan , Basri Sazali , Ng Rong Xiang , Yeow Yong Yaw , Kukreja Anjanna 
Published: November 2023

Abstract

Background
Hospital acquired bacteremia is predominantly caused by Staphylococcus aureus. Given its virulence, patients may experience serious complications that can be difficult to diagnose at the time of the infection leading to increased morbidity and mortality. The objective of this study is to evaluate the incidence of hospital-acquired Staphylococcus aureus bacteremia (HA-SAB) and its risk factors associated with mortality among hospitalized patients in Universiti Malaya Medical Centre (UMMC), a tertiary teaching hospital in Malaysia

Methods
This is a retrospective analysis of patients with HA-SAB admitted to UMMC over three time periods (P) in relation to the COVID-19 pandemic; P1 beginning of the pandemic (July 2020-May 2021), P2 during the peak of pandemic (June 2021-June 2022) and P3 recovery phase (July 2022-March 2023). We included patients ≥18 years old who fulfilled the criteria for HA-SAB. HA-SAB was defined as the first positive blood culture performed ≥48 hours after admission in patients with no evidence of infection at the time of admission. HA-SAB rates per 100 days admission and its risk factors associated with mortality were analyzed.

Results
A total of 287 cases of HA-SAB were identified (P1=80, P2=151 and P3=56) and the overall mortality rate was 31%. The HA-SAB rate increased by 42% from 0.19 (P1) to 0.33 (P2) per 100 admission days and decreased to 0.15 per 100 admission days (P3). On multivariate analysis, risk factors associated with mortality among patients with HA-SAB were older age (OR: 1.04, 95% Cl: 1.02-1.06), use of arterial lines (OR: 4.30, 95% Cl:1.57-11.5) and secondary bloodstream infection (BSI) (OR: 0.39, 95% Cl: 0.22 - 0.70).

Conclusion
The COVID-19 pandemic was associated with substantial increase in HA-SAB rate. This was likely due to changes in infection control measures in general and line care prevention bundle specifically to cope with the pandemic such as extended use of personal protective equipment (PPE), and non-adherence to the 5-moments of hand hygiene especially changing gloves between patients. Older age, use of arterial lines and secondary BSI were significantly associated with mortality among patients with HA-SAB.

Disclosures
All Authors: No reported disclosures
450. Performance Evaluation of PMMV as an internal control for the wastewater surveillance of SARS-CoV-2
Authors: Choi Hosoon , Coppin John David , Chatterjee Piyali , Brackens Emma , Mayo Lynn , Hwang Munok , Bennett Morgan , Gamage Shantini D , Jinadatha Chetan 
Published: November 2023

Abstract

Background
SARS-CoV-2 RNA is shed into sewers by infected individuals via excreta and sputum. Detections of SARS-CoV-2 RNA in wastewater can correlate with local COVID-19 prevalence. Wastewater-based surveillance can be a valuable tool for supplementing clinical testing in controlling COVID-19 transmission. Pepper mild mottle virus (PMMV) RNA has been used as a normalization biomarker in wastewater, largely reported for community-level surveillance. Here, we report the abundance of PMMV in wastewater collected during a pilot project of building-level wastewater-based SARS-CoV-2 surveillance and we evaluated the use of PMMV RNA as an internal control.

Methods
Wastewater samples were collected (January 11, 2021, to July 2, 2021) at eight nursing homes located across the US and shipped overnight for processing. After the heat inactivation by incubating samples in a 65±1°C circulating water bath for 90 minutes, the virus in the wastewater was concentrated using InnovaPrep Concentrating Pipette Select, and RNA was isolated from the concentrate and subjected to reverse transcription quantitative PCR (RT-qPCR) and RT-digital PCR to detect SARS-CoV-2 and PMMV RNA.
Steps of building-level wastewater-based SARS-CoV-2 surveillance

Results
Mean copy number and level of variability of PMMV in wastewater were different among the nursing home sites (Figure 1). SARS-CoV-2 was detected in sites with both low and high mean PMMV and variability (Figure 1). The distribution of PMMV for negative, inconclusive, and positives were not different (Figure 2) and no correlation between RNA concertation of SARS-CoV-2 and PMMV in the wastewater was detected (Figure 3).Figure 1.Concentration of PMMV RNA in wastewater of each collection site.Figure 2.Concentration of PMMV RNA in wastewater samples with negative, inconclusive, or positive SARS-CoV-2 detection.Figure 3.Correlation between PMMV RNA and SARS-CoV-2 RNA in wastewater samples.

Conclusion
PMMV RNA has been used to control noise due to varying human waste input. The role of PMMV as an internal control was very limited for this building-level surveillance pilot project. This could be mainly due to very low SARS-CoV-2 viral load in the wastewater samples. In this wastewater surveillance project, the variation of PMMV RNA was too big to be used as normalization factor. Also, the clear cutoff level of PMMV for SARS-CoV-2 detection in the wastewater could not be defined. More controlled studies are needed to determine the usability of PMMV as normalization biomarkers in building level-wastewater SARS-CoV-2 surveillance.

Disclosures
All Authors: No reported disclosures
451. Pre- and Post-implementation Comparison of the Impact of Emergency Department (ED)-Based COVID-19 Point-of-Care Testing on ED Patient Metrics
Authors: Fenstermacher Katherine Z J , Klein Eili , Mumford Jeanne , Maliszewski Barbara , Cole Gai , Saheed Mustapha O , Rothman Richard E 
Published: November 2023

Abstract

Background
Use of Point of Care Testing (POCT) in Emergency Departments (EDs) may afford the opportunity to improve key ED operational metrics. We evaluated the impact of COVID-19 POCT on time to delivery of test results, rates of patients who left the ED with or without a COVID-19 diagnosis, and the amount of time COVID-19-negative patients spent in isolation.

Methods
Retrospective pre-POCT (7/1/2020 – 8/31/2020, N=4105) and post-POCT (1/1/2021 – 3/31/2021, N=4795) implementation analysis of patients presenting to the Johns Hopkins Hospital Adult ED who received symptomatic COVID-19 testing. Both pre- and post-implementation POCT was performed using the Cepheid GeneXpert SARS-CoV-2 or SARS-CoV-2/Flu A/B/RSV nucleic acid tests, which have a run time of 45 minutes; pre-POCT occurred in the hospital central lab and POCT occurred in a POC testing lab established in the ED.

Results
Post-implementation, the time from arrival to test result for all patients decreased by an average of 133.2 ± 3.3 minutes; the time to delivery of test result decreased by 177.4 ± 16.02 minutes for COVID+ patients. Reduction in time to test result was associated with a significant decrease in the percentage of patients who were discharged from the ED without their result being known prior to departure: pre-implementation, 8.7% of all tested patients left without a known result, with 21% of COVID+ patients leaving prior to receiving a diagnosis; post-implementation, only 0.92% of all tested patients and 0.68% of COVID+ patients left the ED without a final COVID diagnosis. The amount of time COVID-19 negative patients spent in isolation in the ED decreased by an average of 129.7 ± 3.3 minutes post-POCT implementation.

Conclusion
Use of ED POCT for COVID-19 in the ED resulted in more rapid time to test results and fewer patients leaving the ED who did not know their COVID-19 status, decreasing the likelihood that a COVID+ patient would unknowingly expose others in the community. Additionally, the improved time-to-test-result reduced the amount of time COVID-negative patients spent in isolation, enabling clinical staff to avoid unnecessary PPE usage and free up negative pressure beds.

Disclosures
Katherine ZJ Fenstermacher, PhD, Cepheid: Grant/Research Support Jeanne Mumford, MT, Cepheid Speaker Bureau: Advisor/Consultant|Cepheid Speaker Bureau: Honoraria Richard E. Rothman, MD, PhD, CEPHEID: Advisor/Consultant|Cepheid: Grant/Research Support|Danaher: Grant/Research Support
466. Immunogenicity of 2nd, 3rd, 4th SARS-CoV-2 Vaccines in Renal Patient Populations
Authors: Chen-Xu Michael , Cooper Daniel , Döffinger Rainer , Jones Rachel , Smith Rona M 
Published: November 2023

Abstract

Background
Dialysis, renal transplant (RTX) and autoimmune kidney disease (AKD) patients are at higher risk of COVD-19 and suboptimal humoral responses post primary SARS-CoV-2 vaccination. As such, these groups have been prioritised for further SARS-CoV-2 vaccine doses. Limited data are available on their immunogenicity.

Methods
Patients on dialysis or with a RTX or AKD who received primary SARS-CoV-2 vaccination were prospectively recruited from three UK sites. SARS-CoV-2 IgG spike antibody (anti-S IgG) and nucleocapsid titres were measured with a Luminex assay post 2nd, 3rd and 4th SARS-CoV-2 vaccines. Endpoints were median anti-S IgG titres and seroconversion (anti-S IgG titre &gt;1896 MFI).

Results
628 patients (58% male, median age 62 years) comprising 240 dialysis, 194 RTX, and 194 AKD patients were recruited, with seroconversion of 96%, 61% and 70% respectively post two vaccines, and median anti-S IgG titres (IQR) of 30604 (24393–31826), 5829 (455–28296) and 18711 (1233–30226). 400/627 (64%) had anti-S IgG titres post 3rd dose (82% BNT162b2, 7% mRNA-1273, 3% ChAdOx1, 8% unknown; median 191 days post 2nd dose), with 27/58 (47%) of RTX and 17/46 (37%) of AKD patient non-responders seroconverting. Seroconversion among RTX and AKD patients overall improved to 78% (114/146) and 79% (122/155) respectively (p&lt; 0.05), but not in dialysis patients post 3rd dose. 212/400 (53%) had serology post 4th dose (66% BNT162b2, 22% mRNA-1273, 12% unknown; median 104 days post 3rd dose), with 10/22 (46%) and 3/25 (12%) of RTX and AKD patient non-responders seroconverting. Anti-S IgG titre and seroconversion were similar within each group post 4th dose (Table 1, Figure 1).
Predictors of non-seroconversion post 3rd dose in a multivariable model were rituximab use within six months, mycophenolate, prednisolone, chronic kidney disease and AKD (all p&lt; 0.05), and post 4th dose, rituximab alone (p&lt; 0.001).

Conclusion
After primary SARS-CoV-2 vaccination, a 3rd but not 4th dose improved anti-S IgG titres and seroconversion in renal patients. Immunosuppressive use, particularly rituximab, was associated with reduced serologic responses (Tables 2, 3). Patients on immunosuppressives should therefore be prioritised for consideration of additional pre-exposure prophylactic agents.

Disclosures
Michael Chen-Xu, MBChB, MRCP, MPH, GSK: Grant/Research Support Rachel Jones, MD, GSK: Advisor/Consultant|GSK: Grant/Research Support|Roche: Grant/Research Support|Vifor Pharma: Advisor/Consultant Rona M. Smith, MD MRCP, GSK: Grant/Research Support|Union Therapeutics: Grant/Research Support