bluuebunny/crossref_metadata_2025_split huggingface dataset:
2571. Posaconazole DRT in Children; Time to Bring Out the Pill Crusher?
Authors: Weerdenburg Heather L , Gwee Amanda , Haeusler Gabrielle , Osowicki Joshua , Boast Alison 
Published: November 2023

Abstract

Background
Posaconazole, a broad-spectrum triazole antifungal, is licenced for prophylaxis and treatment of invasive fungal infections (IFI). Young children who are unable to swallow tablets or those with enteral tubes are routinely prescribed oral suspension. However, this formulation has poor bioavailability and despite appropriate dosing, often results in subtherapeutic concentrations. In contrast, the delayed release tablet (DRT) has excellent bioavailability irrespective of gastric pH resulting in reliable absorption and attainment of therapeutic exposure. Several adult case series have reported the achievement of therapeutic posaconazole concentrations by crushing DRT. We investigated the attainment of therapeutic posaconazole concentrations with crushed DRT.

Methods
Case series of children receiving posaconazole DRT via enteral tube between September 2022 to April 2023. Each 100mg DRT was crushed in ∼10ml of sterile water followed by a flush of ∼10ml - 20mL to avoid blocking the tube. Tablets were not given with food. Therapeutic trough serum concentrations were defined as ≥ 0.7mg/L (prophylaxis) and ≥ 1mg/L (treatment).

Results
Four children, aged 4 to 14 years, received crushed posaconazole DRT (treatment; n=3, prophylaxis; n=1). The median initial dose was 10 mg/kg/d (range 5 -11). All children achieved target concentrations, however, two children receiving posaconazole for treatment of IFI required a dose increase prior to achieving therapeutic concentrations. No toxicities were reported. The switch to posaconazole DRT facilitated earlier hospital discharge for 2 patients.
Posaconazole Trough Levels For IFI Treatment

Conclusion
Our case series demonstrates that therapeutic concentrations can be achieved when crushed poscaonzole DRT is administered via enteral tube. This formulation allowed the discontinuation of IV formulations, facilitating earlier patient discharge.

Disclosures
All Authors: No reported disclosures
2572. Adherence to Evidence-based Guidelines for the Management of Pneumonia in a Tertiary Teaching Hospital in Saudi Arabia
Authors: Alhifany Abdullah A 
Published: November 2023

Abstract

Background
Abstract:
Background
Adherence to therapeutic guidelines is crucial when treating pneumonia, as it reduces mortality rate, length of hospital stay and duration of antibiotic therapy. However, the high non-adherence rate to treatment guidelines, in general, and Infectious Disease Society of America (IDSA) guidelines, are still reported globally. According to our knowledge, no existing data is available regarding the rate of physicians' adherence to the IDSA guidelines for managing pneumonia in Saudi Arabia. Therefore, we aim to assess the adherence rate and the clinical outcomes among patients treated according to the IDSA guidelines, in a tertiary care center in Riyadh.

Methods
Methods
A single-centered, retrospective observational study was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia. All data were extracted from the hospital's electronic information system, known as Esihi. Adult patients (≥18 years old) who have been diagnosed and treated in the hospital for community-acquired pneumonia, hospital-acquired pneumonia, or ventilator-associated pneumonia from Nov 2019 to Nov 2021 were included.

Results
A total of 148 patients were included in this study, with an average age of 65 ± 20 years. Demographics and baseline characteristics of the included patients are shown in Table 1. The data showed that only 74 (50%) were treated according to the guidelines' recommendations, while the other 74 (50%) were not. The former group had a statistically higher cure rate and lower mortality compared to the latter (95% vs. 84%; p = 0.034) and (5% vs. 14%; p = 0.022), respectively (Figure 1). Nevertheless, patients who were treated according to the guidelines had a higher CURB-64 score for pneumonia severity and Average Calculated Charlson comorbidity index than patients who were treated irrespectively of the guidelines (1.86 vs 1.39) and (4.62 vs 3.28), respectively, yet, no statistically significant difference was observed (Table 1 and 2).
Demographics and Clinical outcomes of included patients n=148

Conclusion
Conclusion
Non-adherence to the evidence-based guidelines has been observed in 50% of patients treated for pneumonia. In addition, higher clinically cure rate, shorter length of stay and lower mortality rate have been observed in patients who were treated based on the evidence-based guidelines.

Disclosures
All Authors: No reported disclosures
2573. The Use of MRSA PCR for De-escalation of Anti-MRSA therapy for CAP and HAP at a Community Hospital: a Quality Improvement Analysis for Antibiotic Stewardship
Authors: Browne Angelina M , Rasnake Mark , Ducas Stephanie 
Published: November 2023

Abstract

Background
The use of nasal MRSA PCR is beneficial in reducing the duration of anti-MRSA therapy, since it can rapidly be attained and has excellent negative predictive value. There is scarcity of literature regarding the potential impact of MRSA PCR on the length of stay and cost of care at a community hospital, when considering empiric treatment of CAP or HAP.

Methods
This retrospective analysis was conducted at Naples Community Hospital, a 588-bed facility. We assessed 134 patients that were admitted for treatment of pneumonia who received anti-MRSA therapy for CAP or HAP from March to April 2023. Our approach was to employ a pharmacy-driven protocol whereby adult patients who had received either vancomycin, linezolid, or both during their hospitalization were screened with MRSA nares PCR shortly after initiation of anti-MRSA therapy. The primary outcome was the duration of anti-MRSA treatment in hours. Secondary outcomes assessed included time from MRSA colonization status result to the discontinuation of anti-MRSA therapy, with subgroup analyses of the percentage of patients with vancomycin trough levels drawn in the vancomycin group, the incidence of acute kidney injury and hospital length of stay pre- and post-implementation.

Results
Our analysis showed a primary outcome with a statistically significant reduction in the hours of anti-MRSA therapy duration when comparing pre- and post-implementation of MRSA PCR (64 vs. 40 hours, P= 0.0008). A considerable improvement was noted in the total duration of anti-MRSA therapy (26 vs. 11 hours, P=0.0006). Our study showed a reduced in length of stay; however, was not statistically significant between the two groups (206 vs 142 hours, P=0.066). No statistical difference was noted in the incidence of AKI between groups.

Conclusion
Our study suggests that pharmacy-driven protocols employed in community hospitals can significantly aid in reduction of inappropriate use of anti-MRSA empiric therapy and reduce costs associated with unnecessary antibiotics. Our analysis showed a trend to shorter length of stay post-implementation, which shortened duration of anti-MRSA therapy. Further investigation with a larger sample size, may also show a significant reduction in length of stay.

Disclosures
All Authors: No reported disclosures
147. Opportunities for Improving Urine Culturing Practices in U.S. Acute Care Hospitals, 2017-2020
Authors: Asonganyi Nyawung , Kazakova Sophia V , Baggs James , Hatfield Kelly M , Reddy Sujan , Fridkin Scott , Lutgring Joseph D 
Published: November 2023

Abstract

Background
Inappropriate urine cultures (UCs) lead to misdiagnosis and unnecessary antibiotic use and can impact surveillance. The absence of pyuria on a urinalysis (UA) has a high negative predictive value for urinary tract infections (UTIs) in certain settings and can reduce unnecessary UCs. UCs performed without UA or with a negative UA indicate opportunities for diagnostic stewardship. Understanding facility variability and patient characteristics associated with inappropriate UCs can inform improvements in acute care hospitals (ACHs).

Methods
Using clinical microbiology data from 279 ACHs reporting UC and UA data to the PINC AI Healthcare Database, we assessed appropriateness of the first UC collected during adult hospitalizations, excluding pregnant and urologic procedure patients identified using ICD-10-CM diagnosis codes. Each UC was categorized as follows: (1) UC with at least 1 positive UA (WBC ≥10/HPF, presence of leukocyte esterase or nitrite) 24 hours before/after UC (UA+ UC), (2) UC with negative UA in 24 hours (UA- UC), and (3) UC without UA in 24 hours (no-UA UC). Overall percentages of UC categories were described by year and patient characteristics. Monthly facility-specific percentages of UCs were calculated, and facility-level variability was described by medians, quartiles 1 and 3 (Q1:Q3).

Results
1.2 million incident UCs were included. Of those, 65% were UA+, 21% UA-, and 14% no-UA UCs. From 2017 to 2020, UA+ UCs increased from 60.5% to 68.2%, no-UA UCs decreased from 19.3% to 10.5%, and UA- UCs stayed at 21%. UA- and no-UA UCs were more common among male, younger age, and Medicaid patients (Figure 1). No-UA UCs were more commonly obtained on day 4 or later. The median monthly facility-level percentages of UA+, UA-, no-UA UCs were 75 (Q1:Q3, 55.6-86.5), 15 (Q1:Q3, 6.5-28.6), and 5.3 (Q1:Q3, 2.1-10.5), respectively (Figure 2).

Overall Percentages of Urine Cultures
Variability in Hospital Monthly Percentages of Urine Cultures (UC) in Each Category, 2017-2020, N hospital-months = 9,863
Hospital-level Variability

Conclusion
During the study period, urine culturing practices improved; however, 35% of incident UCs had no UA or negative UA. The high proportion of these UCs and facility-level variability of the monthly proportions call for diagnostic stewardship to identify and address causes of the potentially suboptimal UC practices. This will support the efforts to decrease UTI overdiagnosis and antibiotic overuse.

Disclosures
All Authors: No reported disclosures
2586. Comparison of Antimicrobial Regimens for Critically Ill Patients with Suspected or Confirmed Hospital-Acquired or Ventilator-Associated Pneumonia: A Retrospective, Cohort Study
Authors: Kosharek Abigail , Betthauser Kevin , Juang Paul , Micek Scott , Igles Dan , Kollef Marin 
Published: November 2023

Abstract

Background
Hospital-acquired and ventilator-associated pneumonia (HAP/VAP) remain significant causes of morbidity and mortality among patients admitted to a medical facility. Consensus guidelines for the treatment of HAP/VAP recommend patients with certain risk factors be empirically treated with an anti-methicillin resistant Staphylococcus aureus (MRSA) and anti-pseudomonal antibiotic. The most commonly utilized anti-pseudomonal agents at BJC hospitals include cefepime, followed by piperacillin/tazobactam and meropenem. The purpose of this study is to determine if there is a difference in clinical outcomes between cefepime and the other most commonly used anti-pseudomonal antibiotics, piperacillin/tazobactam or meropenem, at these institutions for the treatment of HAP/VAP.

Methods
This retrospective, multicenter cohort study included adult patients with HAP/VAP who received cefepime, meropenem, or piperacillin/tazobactam. Major exclusion criteria included patients that received antibiotics within 48 hours of hospital admission or less than 48 hours of empiric antibiotics. The primary outcome was in-hospital mortality. Secondary outcomes included change in initial antibiotic, mechanical ventilation-free days, ICU length of stay, hospital length of stay, hospital readmission, and new C. difficile infection.

Results
Of 1,117 included patients, 1,008 patients received cefepime and 109 received meropenem or piperacillin/tazobactam. Incidence of in-hospital mortality was not observed to be significantly different among empiric Gram-negative regimens (cefepime group 19.4% vs. meropenem or piperacillin/tazobactam 22%, p=0.521. Change in initial antibiotic, ICU length of stay, and hospital length of stay were observed to be significantly higher in the cefepime group.

Conclusion
We observed no difference in in-hospital mortality between cefepime and piperacillin/tazobactam or meropenem. However, there was a significantly higher incidence of change in initial antibiotic, ICU length of stay, and hospital length of stay observed in the cefepime group, though additional research is needed to corroborate these observations.

Disclosures
Kevin Betthauser, PharmD, La Jolla Pharmaceutical Company: Advisor/Consultant|La Jolla Pharmaceutical Company: Grant/Research Support Paul Juang, Pharm.D., Merck & Co: Grant/Research Support
2594. Rate of Methicillin-Resistant Staphylococcus aureus Infection Among Patients Hospitalized for Community-Acquired Pneumonia
Authors: Poole Rachel M , Lee Helen , Park Steven 
Published: November 2023

Abstract

Background
National clinical practice guidelines for community-acquired pneumonia (CAP) suggest empiric treatment for methicillin-resistant Staphylococcus aureus (MRSA) among hospitalized patients with risk factors including prior respiratory isolation of MRSA, recent hospitalization with receipt of IV antibiotics within 90 days, or based on a locally validated model. This study aims to assess the rate of MRSA infection among patients hospitalized with CAP to aid clinical decision-making regarding empiric treatment.

Methods
This is a retrospective, observational, population-based, descriptive study at an academic medical center. Patients will be included in the study if they were admitted between 1/01/2021 to 3/18/2023, are at least 18 years old, present with bacterial pneumonia, have a respiratory or blood culture obtained within 48 hours of admission, and complete an MRSA nasal screen, stratified by admission to an ICU vs. non-ICU ward. The primary outcome will be the rate of MRSA infection in patients hospitalized for CAP. The secondary outcome is to determine the negative predictive value (NPV) of MRSA nasal screening. Subgroup analyses will be performed for patients with respiratory MRSA isolation within 1 year of admission, mechanical ventilation within 24 hours of admission, and IV antibiotic use within 90 days of admission.

Results
A total of 1,053 patients met inclusion criteria for the study. The overall rate of MRSA infection was 3.3% (16/490) for ICU patients and 1.1% (6/563) for non-ICU patients. In patients with prior respiratory MRSA isolation, prevalence was 0% (0/7) and 28.6% (2/7) for the ICU and non-ICU groups, respectively. Among mechanically ventilated patients, prevalence was 2% (9/457). For prior IV antibiotic recipients, prevalence was 2.8% (3/109) and 0.5% (1/189) for the ICU and non-ICU groups, respectively. The combined NPV of MRSA nasal screening was 99%.

Conclusion
Overall prevalence of MRSA infection was low among patients hospitalized for CAP, without excluding patients based on underlying comorbid conditions or admission from a skilled nursing facility. MRSA nasal screening was associated with an overall high NPV. Empiric use of vancomycin is unlikely to be warranted for most patients admitted for CAP at our institution.

Disclosures
All Authors: No reported disclosures
2608. Circulating Respiratory Syncytial Virus Genotypes in Hospitalized Children with Bronchiolitis in the United Arab Emirates
Authors: Alsamri Mohammed , Narchi Hassib , AlDhanhani Huda , George Junu , Collyns Timothy , Al Dhaheri Klaithem , Al-Hamad Sania , Alsuwaidi Ahmed R 
Published: November 2023

Abstract

Background
Respiratory syncytial virus (RSV) is a major cause of acute respiratory illness in young children and elderly people worldwide. It has a complex molecular epidemiology with multiple strains cocirculating during a single epidemic. Whole genome sequencing is a valuable tool for monitoring genetic diversity and providing genomic information essential for antiviral and vaccine development. In the United Arab Emirates (UAE), little is known about the RSV circulating genotypes, their evolution, and transmission dynamics. Using next-generation sequencing, this study aims to identify RSV genotypes circulating among young children with bronchiolitis in Al Ain City, UAE.

Methods
This cross-sectional study involved 100 children under two years of age who were hospitalized at a tertiary care facility between April and December 2021 with RSV-positive bronchiolitis. Nasopharyngeal samples were obtained, within 24 hours of hospitalization, for RSV genotyping. MinION nanopore sequencer was used to analyze the whole viral genome. We only sequenced samples with cycle threshold (Ct) &lt; 30 (n=70). After sequencing, 7 samples were not analyzed due to long gaps and small lengths. The remaining 63 samples included 59 RSV-A and 4 RSV-B isolates.

Results
The median age of the studied children was 4.3 months, interquartile range (2.1-10.4), with 56% below the age of 6 months. There was no significant difference in the clinical characteristics of children having RSV-A compared to those infected with RSV-B. Phylogenetic analysis showed that out of the 59 RSV-A sequences, 58 clustered with the NA1 genotype, and 1 sequence clustered with the GA1 genotype. All RSV-B sequences were classified as BA2 genotypes. The amino acid sequence alignment of the G gene revealed that all 58 NA1 genotypes had 24 amino acid duplication regions from 247 to 282 amino acid positions. We also found four substitutional changes at L248I, H258Q, L274P, and P276Q.

Conclusion
Phylogenetic analysis revealed that the subtype A NA1 genotype was the dominant strain among the studied children in Al Ain, UAE during the 2021 season. As vaccine development advances, further sequencing of RSV is needed to better understand viral origin, transmission, and genetic recombination, particularly in under-studied populations.

Disclosures
All Authors: No reported disclosures
2611. Risk Factors Associated with Longer Hospital Stay in Adult Patients with Respiratory Syncytial Virus Infections
Authors: Bhargava Ashish , Malik Ambreen , Szpunar Susan M , Johnson Leonard B , Sharma Mamta 
Published: November 2023

Abstract

Background
Respiratory Syncytial Virus (RSV) is known to cause severe disease in elderly individuals and patients with underlying cardiopulmonary or immunocompromised conditions. Little is known about the factors that are associated with the length of hospital stay (LOS).

Methods
A multicenter historical cohort study was conducted on adult patients hospitalized for laboratory-confirmed RSV-related diseases in Ascension hospitals in Southeast Michigan between January 2017 and December 2021. Hospitalized patients were identified using ICD 10 codes for RSV-related diseases. Electronic medical records were reviewed after IRB approval. LOS was categorized as below the mean LOS or at the mean or above. Data were analyzed using Student’s t-test, the chi-squared test, the Mann-Whitney U test and logistic regression using SPSS v. 29.0.

Results
Of 360 patients, the mean (sd) age of the cohort was 69.9 + 14.7 years, 228 (63.5%) were female and 227 (63%) were white. The mean body mass index (BMI) was 30.6 + 9.7 kg/m2 . The mean Charlson Weighted Index of Comorbidity (CWIC) score was 2.2 + 1.9. The mean hospital LOS was 7.1 + 5.4 days. Factors associated with longer hospital LOS (&lt; =7) in univariable analysis were older age on admission, smoking status, CWIC score, home oxygen, encephalopathy, oxygen requirement during hospitalization, qSOFA score, lower respiratory tract infection, abnormal chest imaging, acute kidney injury, liver injury and respiratory failure requiring intubation. The multivariable logistic regression revealed that predictors for prolonged hospital LOS were age on admission (odds ratios [OR], 1.034; 95% CI 1.01-1.06), smoking status (OR, 2.2; 95% CI 1.2-3.9), CWIC (OR, 1.1; 95% CI 0.99-1.30), liver injury (OR, 4.7; 95% CI 1.16-19.33), oxygen requirement during hospitalization (OR, 2.9; 95% CI 3.02-7.72). and respiratory failure requiring intubation (OR, 9.9; 95% CI 3.02-39.20).

Conclusion
Our study finds that age on admission, patient’s smoking status, their CWIC, liver injury, oxygen requirement during hospitalization and respiratory failure requiring intubation were significantly associated with prolonged hospital LOS among adult patients with RSV infection. Every one unit increase in age and CWIC increased the risk for prolonged hospital LOS by 3.4% and 13.9% respectively.

Disclosures
All Authors: No reported disclosures
2615. Effect of Early NSAID and Aspirin Use on Clinical Outcomes in Patients Hospitalized with Influenza: A Retrospective Study
Authors: Chan-Colenbrander Suk Yin , Wang Qi 
Published: November 2023

Abstract

Background
Seasonal influenza infection causes significant morbidity and mortality worldwide. This study evaluates the effect of early nonsteroidal anti-inflammatory drug (NSAID) and aspirin use in patients hospitalized with influenza.

Methods
We performed a retrospective chart review of patients (age 18 years and older) admitted between January 1, 2016, and December 31, 2019, to the University of Minnesota Medical Center, who were tested positive for influenza. Data were summarized using median and interquartile range (IQR) for continuous variables, frequency and percentage for categorical variables. Groups were compared using two-sample Wilcoxon test for continuous variables and Chi-square test (or Fisher's exact test for sparse data) for categorical variables.

Results
Out of 320 patients tested positive for influenza, 180 were vaccinated against influenza. The median age of those tested positive and vaccinated was 64 (IQR 49-74) and those unvaccinated, 58 (IQR 35-71), p=0.0074. 97.8% of the vaccinated and 94.3% of the unvaccinated, received oseltamivir. More unvaccinated patients were admitted to the intensive care unit (ICU) (p=0.0029) and required ventilatory support (p=0.0097) compared to those vaccinated.
Among the vaccinated, early NSAID use was associated with fewer cardiovascular complications, but this was not significant (p=0.0758). NSAID use was also associated with a higher chance of survival at 1 year (p=0.0004) and 3 years (p&lt; 0.0001) post hospitalization. Among the unvaccinated, NSAID use led to fewer ICU admissions (p=0.0401), fewer cardiovascular complications (p=0.0156) and fewer renal complications (p=0.0006).
Those who were vaccinated and not on aspirin, had a better chance of surviving the hospital stay compared to those on aspirin (p=0.0452). Those who were unvaccinated and not on aspirin, had a higher chance of survival at 3 years post hospitalization than those on aspirin (p=0.0131). No significant difference was observed with aspirin use between these 2 groups in cardiovascular, respiratory or renal complications, ICU admission, 30 days readmission or survival at 1 year post hospitalization.

Conclusion
Our findings show better outcomes with early NSAID use but worse outcomes with aspirin in patients hospitalized with influenza

Disclosures
All Authors: No reported disclosures