bluuebunny/crossref_metadata_2025_split huggingface dataset:
2237. Outcomes of Metronidazole Dosed Every 12 Hours Versus Every 8 Hours
Authors: Box Maggie , Duong Kelly , Molina Kyle 
Published: November 2023

Abstract

Background
Metronidazole (MTZ) is a mainstay treatment for anaerobic infections. Due to its pharmacokinetic and phamacodynamic properties, it can be dosed at 8 -, 12-, or 24-hour intervals. MTZ’s adverse effects depend on the cumulative dose, permitting less frequent administration. Less frequent dosing intervals may save nursing and pharmacy resources and improve patient compliance. Further, drug shortages of IV MTZ have prompted efforts to reduce utilization to preserve the availability of therapy. The objective of this study was to compare clinical outcomes of patients who received MTZ every 8 hours to every 12 hours.

Methods
This multicenter, retrospective study was conducted at Scripps Health from 1/1/2022 - 12/31/2022. Hospitalized adult patients who received MTZ, dosed at 500 mg every 8 hours or every 12 hours, for &gt; 5 days for a pulmonary, intra-abdominal, or skin source were included. Patients were excluded if they received anaerobic antibiotics for &gt; 72 hours prior to MTZ or concurrent to MTZ, or were pregnant, transitioned to hospice, or received MTZ for &lt; 75% of the total therapy duration. The primary outcome was clinical cure and all-cause mortality within 30 days. Secondary outcomes were escalation of therapy, 30-day readmission, and duration of therapy.

Results
A total of 107 patients were included with similar baseline characteristics per group. The predominant infection source was intra-abdominal (55.1%), followed by skin (29.1%) and pneumonia (12.1%). An anaerobic organism was isolated in 16.8%, and source control was performed in 47.7%. All patients received concurrent antibiotics. Comparing every 8-hour (n = 52) versus every 12-hour (n = 55) MTZ, there was no difference in clinical cure (94.2% vs. 100.0%, p = 0.071) or all-cause mortality (1.9% vs. 0.0%, p = 0.301), respectively. For secondary outcomes, there was no difference in escalation of therapy (3.8% vs. 1.8%, p = 0.525) or 30-day readmission (28.8% vs. 25.5%, p = 0.693) between every 8 hours and every 12 hours. Total duration of antibiotics was similar between groups (14.2 vs 13.0 days, p = 0.541).

Conclusion
There was no difference in clinical cure, 30-day all-cause mortality, 30-day readmission, or escalation of therapy among patients receiving every 8 versus every 12-hour MTZ therapy.

Disclosures
All Authors: No reported disclosures
2249. Piperacillin-tazobactam-targeted provider education to improve utilization in a small community hospital
Authors: Gilmore Robert , Elgin Jennifer , Warren Cirle A 
Published: November 2023

Abstract

Background
Piperacillin-tazobactam is a broad-spectrum antibiotic commonly used for the treatment of Pseudomonas aeruginosa and other susceptible Gram negative and anaerobic infections. Piperacillin-tazobactam utilization is markedly elevated in our institution compared with regional and national rates.Thus, interventions to promote optimal use of this antibiotic to reduce utilization rates and negative consequences are needed.

Methods
Healthcare providers were provided with guidelines on piperacillin-tazobactam alternative treatments for various infections. Guideline handouts were disseminated and complemented by in-person presentations and one-on-one case discussions, as needed. Data on piperacillin-tazobactam utilization was gathered using BD Medmined’s medication analytics.

Results
Total antibiotic utilization at our institution is higher compared to national and regional rates. In the 2nd quarter (Q2) of 2021, piperacillin-tazobactam utilization was 44% and 26% above national and regional comparative rates, respectively. In Q2 2022, piperacillin-tazobactam was 59% and 45% higher, respectively. Immediately post-initiation of intervention (Q3 2022), utilization rates dropped to 34% and 22%, respectively and utilization dropped further in the succeeding quarters attaining comparable rates to national and regional comparator hospitals.

Conclusion
Providing healthcare providers with antibiotic-targeted education on alternative treatments can significantly reduce the utilization of piperacillin-tazobactam. Further studies are warranted to evaluate the long-term impact of this intervention on antibiotic stewardship in small community hospitals.

Disclosures
Cirle A. Warren, MD, Ser-109 Coactuate: Advisor/Consultant|Ser-109 Coactuate: Honoraria
2250. Fluoroquinolone Stewardship at a Veterans Affairs Facility: A Six Year Review
Authors: Glicksberg Jessica , Froehlich Morgan , Creed Mary , Psevdos George 
Published: November 2023

Abstract

Background
Increased utilization of antibiotics leads to decreased antimicrobial susceptibility, a well-established phenomenon. Antimicrobial stewardship programs (ASP) promote appropriate prescribing of antibiotics by decreasing inappropriate use, aiming to improve patient outcomes and reducing antimicrobial resistance. Fluroquinolones (FQ) are among the most prescribed antibiotics. We describe out institutional FQ use since inception of our ASP and followed the trend for susceptibility of Enterobacteriaceae and Pseudomonas

Methods
Northport Veterans Affairs Medical Center (VAMC) provides care for over 30000 Veterans in Long Island, New York, with emergency room, acute care hospital, nursing homes and outpatient clinics A Retrospective review investigated FQ use by total refills per year and by days of therapy per 1000 patient days at Northport VAMC from 2012 to 2022, along with review of local annual antibiograms focusing on ciprofloxacin susceptibility to E. coli, K. pneumoniae, P. mirabilis and P. aeruginosa. An ASP in our facility was initiated in 2016. FQs are restricted antibiotics and require approval by the infectious diseases team (attendings, fellows, pharmacist)

Results
Figure 1 provides the outpatient total fills per year for Ciprofloxacin, Levofloxacin, Moxifloxacin. Inpatient FQ use during the ASP years was low: Figure 2 shows the FQ inpatient use (days of therapy/1000days) from 2019 to 2022. Comparing years 2012-2016 vs 2017-2022 there was a decrease in fills of ciprofloxacin (median 604 vs. 308 fills, P: 0.009), levofloxacin (276 vs. 116, P: 0.032), and moxifloxacin (116 vs. 14, P: 0.015). By same period comparison (see figure 3), Ciprofloxacin susceptibility for E. coli ranged median 66.5% to 61.5%, P: 0.126, K. pneumoniae 67% vs. 75.5% P: 0.086, P. mirabilis 45% vs. 47.5% P: 0.451, and P. aeruginosa 63% vs. 68.5% P: 0.308
Figure 2
inpatient FQ use 2019 to 2022
Figure 3
Ciprofloxacin susceptibility trend over time

Conclusion
There was a statistically significant decrease in the use of FQ in the outpatient setting after ASP was initiated in our facility. Although there was a trend in improvement in ciprofloxacin susceptibilities for Klebsiella, Proteus, and Pseudomonas, it was not statistically significant. Nevertheless, our results show that reducing FQ consumption can prevent worsening susceptibility trends for enteric gram negatives and Pseudomonas.

Disclosures
All Authors: No reported disclosures
2257. Cost-Benefit Analysis of Fidaxomicin (FDX) as First Line Treatment for Initial Episode of Clostridioides difficile Infection (CDI) during the COVID-19 Pandemic: A Quality Control/Improvement (QC/QI) Project at a Tertiary Care Veterans Affairs Medical Center (VAMC) over a 4-year period
Authors: Khaja Sumaiya F , Kuhn Ryan , Ali Sajjad , Natesan Suganthini Krishnan 
Published: November 2023

Abstract

Background
In 2021, Clostridioides difficile infection treatment guidelines were updated to recommend fidaxomicin over oral vancomycin as first-line therapy for initial and recurrent episodes of CDI. The aim of this analysis is to evaluate the cost benefit advantage of using fidaxomicin as first line therapy for the first episode of CDI.

Methods
A retrospective review of outpatient oral vancomycin and fidaxomicin use at the VAMC in Detroit, Michigan was conducted by evaluating total prescription fills per 1000 unique patients from 2019 to 2022. This study was done during the COVID-19 pandemic when there was an increased use of antibiotics for respiratory infections, and after the updated IDSA guidelines recommending fidaxomicin as first line therapy for initial and first recurrence of CDI. Diagnosis of CDI was based on clinical presentation and a positive stool C diff PCR test. Despite substantial cost of FDX, the expectation was that there would be a significant reduction in recurrent CDI, hospitalizations, length of stay, all of which would offer a cost-benefit advantage.

Results
There was a 5-fold increase in the use of fidaxomicin in 2021-2022 compared to 2018-2019. Its use was directly proportional to the increased use of respiratory quinolones and Beta lactam antibiotics for respiratory infections during the COVID-19 pandemic in 2020. Insurance co-pays were high and the FDX company support programs failed to cover veterans with Medicaid/Medicare coverage. Veterans were unable to complete the 10-day course of FDX as it was unaffordable. They had to be transitioned to oral vancomycin to complete the 10-day course for CDI.

Conclusion
Reduction of recurrent CDI may not offset the higher up-front cost of fidaxomicin ($2,400/10 days), compared to oral vancomycin ($30/10 days). This QC/QI analysis over a 4-year period revealed that increased use of fidaxomicin as first-line treatment for CDI did not translate into a cost advantage through decreases in CDI recurrence, given the high cost of fidaxomicin. Reduction in cost of fidaxomicin to &lt; $1,200 may be needed to achieve the expected cost benefit. Based on our data, starting November 2022, FDX has been restricted in our institution. Prescription for FDX requires ID approval, and is reserved for recurrent CDI and not for the first episode of CDI.

Disclosures
All Authors: No reported disclosures
2285. Using Genomic Sequencing to Describe SARS-CoV-2 Transmission Dynamics in U.S. Major League Soccer Clubs
Authors: Velasquez-Reyes Joseline , Carmola Ludy R , Turcinovic Jacquelyn , Schneider Isaac , Putukian Margot , Sherry Kyle , Akula Natalie , Rischmann Owen , Silvers-Granelli Holly , Connor Bradley A , Angelo Kristina , Kozarsky Phyllis E , Libman Michael , Huits Ralph , Hamer Davidson H , Bourque Daniel , Fairley Jessica K , Piantadosi Anne , Connor John 
Published: November 2023

Abstract

Background
In 2020–2022, U.S. Major League Soccer (MLS) used SARS-CoV-2 mitigation protocols that included masking, social distancing, avoiding contact with others outside of training and games, testing, quarantine, and isolation. In addition to isolation for those who tested positive, a SARS-CoV-2 genomic sequencing strategy was developed to identify whether infections were associated with intra-league transmission.

Methods
Nasopharyngeal swabs were collected by MLS club medical staff from players and staff from February 2021 through September 2022. During this time, surveillance testing changed from daily to weekly to testing only symptomatic players and staff.
SARS-CoV-2 positive samples were analyzed using amplicon-based whole genome sequencing. A phylogenetic tree was constructed using Nextstrain to visualize genomes from infected players and staff in the context of genomes available on GISAID circulating in the United States during corresponding time periods. To identify transmission links, all genomes were compared in a pairwise fashion. Genomes that were 0–2 nucleotides different were considered part of direct transmission clusters.

Results
Of 250 samples that were rtPCR positive for SARS-CoV-2, 215 (86%) were sequenced. Phylogenetic analysis showed a broad diversity of lineages, including some predominant overseas (e.g., AY.98.1). Pairwise comparison revealed SARS-CoV-2 sequences from 7 individuals appeared to be linked. These individuals were on 2 different MLS teams; there was an off-field exposure (dinner). Five (71%) had identical SARS-CoV-2 sequences; 2 had sequences that were 1 nucleotide different at the consensus level. Subconsensus genome analysis revealed that differences of 1 nucleotide were due to subconsensus mutations fluctuating below and above 50%, suggesting all 7 individuals were part of a transmission cluster. Phylogenetic analysis revealed that the sequences from the cluster were distinct from reference sequences and were likely a unique transmission chain.

Conclusion
SARS-CoV-2 transmission may occur within, and even between, professional sports teams. Pairwise comparison of individual genomes can provide improved granularity to identify clusters and understand SARS-CoV-2 transmission.

Disclosures
Davidson H. Hamer, MD, Kephera Diagnostics: Grant/Research Support|Takeda: Advisor/Consultant|Takeda: Grant/Research Support|Trinity Biotech, LLC: Advisor/Consultant|Valneva: Advisor/Consultant|Valneva: Grant/Research Support Daniel Bourque, MD, Kephera Diagnostics: Grant/Research Support
2286. A comparison of SARS-CoV-2 wastewater-based surveillance in a sentinel community versus a large metropolitan sewershed in Massachusetts, 2020-2023
Authors: Brown Tyler , Rao Sowmya R , Begemann Daniel , Amaya Flor , Keppard Barry , Mohareb Amir , Bates Samantha , Alonso Cristina , Jia Katherine M , Levison Julie H , Ryan Edward T , LaRocque Regina C 
Published: November 2023

Abstract

Background
Many wastewater-based surveillance (WBS) programs for COVID-19 sample from distal endpoints of sewage treatment systems (for example, sewage treatment plants). SARS-CoV-2 RNA measurements from these endpoints represent highly aggregated cross-sections from entire sewage systems, and are inherently unable to capture local variation in COVID-19 disease activity. Importantly, using highly aggregated samples from sewage system endpoints may limit the utility of SARS-CoV-2 RNA measurements as a leading indicator for forecasting applications. Geographically-focused, hyperlocal sampling in communities with more intense and/or earlier COVID-19 epidemic activity is a promising strategy for enhancing the public health value of WBS.
Chelsea versus Boston-wide SARS-CoV-2 wastewater RNA concentration over time

Methods
We examined SARS-CoV-2 RNA data in Chelsea, Massachusetts, a Boston-area community that has experienced disproportionately high COVID-19 disease burden across all phases of the epidemic thus far. Between November 2020 and April 2023, we collected biweekly samples from four local sewershed locations in Chelsea, which were analyzed for SARS-CoV-2 RNA concentration by BioBot Analytics. We compared these local measurements to those for identically analyzed samples collected at a distal sewer system endpoint (Massachusetts Water Resource Authority Deer Island Treatment Plant), for the same time points over the same collection period.

Results
Local sewershed SARS-CoV-2 RNA concentrations in Chelsea were consistently higher across all three major epidemic phases (pre-Delta, Delta, and Omicron) analyzed in our dataset. During the onset of the Delta wave, SARS-CoV-2 RNA concentrations in Chelsea increased earlier than Boston-wide levels measured at the sewer system endpoint.

Conclusion
Local wastewater sampling can facilitate pre-emptive and tailored public health responses to more effectively counter the burden of SARS-CoV-2 in disproportionately affected communities. Sampling in these “sentinel” communities may improve the utility of SARS-CoV-2 wastewater RNA concentrations as a leading indicator for COVID-19 forecasting applications.

Disclosures
Julie H. Levison, MD, MPhil, MPH, eMED, LLC.: Advisor/Consultant
2295. Documented SARS-CoV-2 Transmission Events Between Patients and Hospital Staff
Authors: Han Alison , Bailin Heike , Kwan Jennifer , Bell Michael , Decker Brooke K , Palmore Tara 
Published: November 2023

Abstract

Background
Non-Pharmaceutical Interventions (NPIs) were critical for the protection of healthcare personnel (HCP) from SARS-CoV-2 infection throughout the pandemic. Our review of several instances of patient-to-HCP, HCP-to-patient, and HCP-to-HCP spread showed that transmission events were primarily associated with not wearing masks.

Methods
Risk of transmission was assessed from tracing interviews. Possible or probable workplace-acquired COVID-19 was assessed in cases with high-risk exposures to infectious patients or staff and prolonged contact and plausible exposure timeline. HCP with dual masking between case and contact (both wearing a tight-fitting medical mask) were considered at no or low risk for exposure. Whole genome sequencing information was available for suitable samples in a subset of case studies.

Results
From March 3, 2020-March 31, 2023, there were 3,513 SARS-CoV-2 infections among healthcare workers. Of the total known HCP infections, 249 cases were possibly or probably associated with the workplace. An additional 25 cases with suspected workplace transmission were found to have low-risk contacts at work, but competing high-risk exposures outside of work. Stratifying by transmission vector dynamic, 146 (58.6%) had a documented epidemiologic link to another HCP within the workplace. Five (2.0%) HCP cases had a documented epidemiologic link to a patient and 1 (0.4%) had a documented epidemiologic link to another HCP and a patient. In 2 instances HCP were epidemiologically linked to a subsequent patient infection. Whole viral genome sequencing of suitable samples refuted workplace transmission in some cases and substantiated the linkage from tracing data in others.

Conclusion
After accounting for reported exposure sources, workplace transmission rates were extremely low in instances where NPIs were applied. Suspected transmission events were associated with instances where masking was relaxed between co-workers or in patient care instances where masking was not feasible by the patient.

Disclosures
Tara Palmore, MD, Abbvie: Grant/Research Support|Gilead: Grant/Research Support|Rigel: Grant/Research Support
2297. Trends in Respiratory Pathogens Detected by Using a Multiplex PCR Panel during the Different COVID-19 Pandemic Phases in Taiwan
Authors: Hsu Yu-Lung , Low Yan-Yi , Hsiao Chiung-Tzu , Chang Yu-Chang , Shih Hong-Mo , Lin Hsiao-Chuan , Hwang Kao-Pin , Hsueh Po-Ren 
Published: November 2023

Abstract

Background
The COVID-19 pandemic has greatly affected other respiratory infectious diseases. Taiwan's government implemented strict control measures initially, followed by relaxing measures, which may have impacted the incidence and distribution of other respiratory pathogens. This study aims to investigate the epidemiology of respiratory pathogens in Taiwan during different COVID-19 pandemic phases.

Methods
This retrospective study enrolled patients who visited China Medical University Hospital and China Medical University Children's Hospital in Taiwan between January 2020 and December 2022 during the COVID-19 pandemic. The respiratory tract specimens of these patients were detected using a commercial multiplex PCR-based panel assay that could identify 19 respiratory viruses and 4 bacterial pathogens. The study analyzed and compared the distribution patterns of respiratory pathogens among patients across three phases of the COVID-19 pandemic in Taiwan. These phases were divided into the transmission-blocking phase (period 1: January 2020 - December 2020), the transitional phase (period 2: January 2021 - December 2021), and the coexistence phase (period 3: January 2022 - December 2022).

Results
A total of 5,820 patients were included in the study. Of which,1,780 (30.6%) were positive for at least one respiratory pathogen. The most commonly detected virus was human rhinovirus/enterovirus (939/2492, 37.7%), followed by RSV (406/2492,16.3%), parainfluenza 3 (402/2492,16.1%), and adenovirus (261/2492,10.5%). Co-detection of multiple respiratory pathogens was observed in 9.5% of patients. Human rhinovirus/enterovirus was mainly detected throughout the three periods, peaking in the summer and winter. Human metapneumovirus and adenovirus were predominant during period 2, peaking in the summer, while parainfluenza 3 and RSV were predominant during period 3, peaking in the winter.Figure 1.Monthly respiratory pathogen distribution during three years of COVID-19 pandemicFigure 2.Monthly distribution of sample and detection rate during three years of COVID-19 pandemic

Conclusion
This study showed significant changes in the detection rates of non-SARS-CoV-2 respiratory pathogens during different phases of the COVID-19 pandemic in Taiwan. These findings highlight the importance of continued surveillance of respiratory pathogens beyond COVID-19 to better understand their epidemiology and inform public health interventions.

Disclosures
All Authors: No reported disclosures
2318. Utility of Routine Asymptomatic Post-Admission SARS-CoV-2 Screening in a Rehabilitation Facility
Authors: Williams Victoria R , Robinson Larry , Eisenberg Morty , Kozak Robert , Virdi Kuldeep , Candon Heather , Leis Jerome A 
Published: November 2023

Abstract

Background
SARS-CoV-2 testing is recommended for symptomatic patients, and asymptomatic testing following known exposure or on admission during periods of high community incidence. The role of post-admission asymptomatic screening is less clear. We evaluated the impact of routine weekly asymptomatic testing in a 178 bed rehabilitation setting that was experiencing frequent COVID-19 outbreaks following the emergence of the Omicron variant.

Methods
At baseline (April 1, 2021 to March 31, 2022), all patients were tested for SARS-CoV-2 in 4 situations: 1) routinely on admission (≤5 days); 2) in response to the development of new symptoms consistent with COVID-19 infection; 3) following exposure to a patient with COVID-19; and 4) as part of unit wide prevalence testing during suspected or confirmed outbreak. Routine weekly unit wide asymptomatic prevalence screening was introduced April 1, 2022 to March 31, 2023. An uncontrolled before-after study was performed assessing yield of these testing strategies and the incidence of healthcare associated-COVID-19 (HA-COVID). A case was defined as a patient testing positive for SARS-CoV-2 who had not been previously infected with COVID-19 within the preceding 90 days. Patients deemed to be recovered positive based on prospective assessment were excluded.

Results
The intervention was associated with nearly double the number of SARS-CoV-2 tests (8857 vs. 4672), of which 8513 (96.1%) and 4582 (98.1%) were eligible for inclusion during intervention and baseline, respectively. The before-after comparison of testing positivity was similar for overall, admission, and suspect/confirmed outbreaks with yield of 1.4%/0.5%/3.2% versus 2.6%/1.8%/4.9%, respectively. The addition of routine weekly testing had extremely low yield of 0.2% (8/4022). The incidence of HA-COVID increased during the intervention period (3.4 vs. 1.1 per 1000 patient-days; p&lt; 0.001).

Conclusion
In a rehabilitation setting, the addition of routine weekly asymptomatic prevalence testing of patients was of low yield when added to surveillance in place on admission, and for symptomatic or exposed patients. Despite the increased risk of HA-COVID associated with the emergence of the Omicron variant, these findings do not support routine weekly post-admission testing.

Disclosures
Jerome A. Leis, MD MSc FRCPC, Ontario Hospital Association, Ministry of Attorney General of Ontario, Seneca College: Expert Testimony