bluuebunny/crossref_metadata_2025_split huggingface dataset:
310. Yogurt Intake and Colorectal Cancer Incidence Subclassified by Bifidobacterium Status in Tumor
Authors: Ugai Satoko , Ugai Tomotaka , Ogino Shuji 
Published: November 2023

Abstract

Background
Although epidemiological evidence is limited, experimental data indicated a tumor-suppressive effect of yogurt containing Bifidobacterium. We hypothesized that the association between yogurt intake and colorectal cancer incidence differed by Bifidobacterium status in tumor tissue.

Methods
We utilized data from two prospective cohort studies: the Nurses’ Health Study and the Health Professionals Follow-up Study. Inverse probability weighted multivariable Cox proportional hazards regression was used to assess differential associations of yogurt intake with the incidence of colorectal carcinomas subclassified by tumor Bifidobacterium status.

Results
During follow-up of 132,056 individuals, we documented 2,950 incident colorectal cancer cases, including 1,191 with available Bifidobacterium data. The association between yogurt intake and colorectal cancer incidence differed by Bifidobacterium status (Pheterogeneity = 0.03). This differential association became stronger in a subgroup analysis of proximal colon cancer (Pheterogeneity = 0.003). Multivariable hazard ratios in individuals who consumed ≥ 2 servings/week (vs. &lt; 1 serving/month) of yogurt were 0.43 [95% confidence interval (CI), 0.22-0.85] for Bifidobacterium-positive proximal colon cancer, and 1.40 (95% CI, 0.95-2.05) for Bifidobacterium-negative proximal colon cancer.

Conclusion
Yogurt intake was inversely associated with the incidence of Bifidobacterium-positive (but not Bifidobacterium-negative) proximal colon cancer, suggesting an interactive influence of yogurt intake and intestinal microbiota on tumor development.

Disclosures
All Authors: No reported disclosures
339. OPAT Outcomes in Patients with Immunocompromise
Authors: Mahoney Monica V , Swords Kyleen , Le Mahajan Audrey , Alonso Carolyn D , Larnard Jeffrey 
Published: November 2023

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) allows patients to complete intravenous (IV) or high risk oral medications outside the acute inpatient setting. Data regarding OPAT in patients with immunocompromise (PWIC) are sparse. PWIC represent a vulnerable population due to underlying comorbidities. This study evaluated OPAT clinical outcomes in PWIC at an academic medical center.

Methods
This was a retrospective chart review of adult PWIC enrolled in our OPAT program between 1/2015-3/2023. Immunocompromising conditions included HIV/AIDS, stem cell or solid organ transplant, hematologic malignancy, solid tumor, or receipt of immunosuppressing medications. All patients were under the care of an immunocompromised ID specialist. Data collected included patient demographics, infection information, and OPAT outcomes including completion rates, readmission rates, OPAT failure, and death. OPAT failure was defined as death, 30-day infection-related readmission or 30-day OPAT-related complication. This study was exempt by the Institutional Review Board.

Results
50 patients were included. Demographics are in Table 1. Most (68%) patients completed OPAT therapy in the home, with 82% of courses being IV-only. Most (72%) patients received 1 antimicrobial agent, but 20% received 2 and 8% received 3 agents. The most common agents were daptomycin, ertapenem, and vancomycin.
Infection information is in Table 2. Bloodstream infections and osteomyelitis were the most common. Most (82%) patients had an organism identified: 51% were Gram positive, with Staphylococci the most prevalent. Cytomegalovirus was the reason for OPAT in 4 patients.
OPAT outcomes are in Table 3. OPAT failure occurred in 9 patients, including 1 death and 8 OPAT-related readmissions. Most (68%) patients completed the OPAT course within the specified time. Hospital readmissions were common: 46% had at least 1 readmission, though most readmissions were unrelated to OPAT. Vascular device issues and adverse drug reactions occurred in 12% and 20%, respectively.

Conclusion
OPAT can be safely performed in PWIC with completion and complication rates comparable to non-immunocompromised cohorts. We observed high hospital readmission rates (46%) though a minority of readmissions were due to OPAT related issues.

Disclosures
Monica V. Mahoney, PharmD, BCPS, BCIDP, FCCP, FIDSA, FIDP, BD Biosciences: Advisor/Consultant|Cidara Therapeutics: Advisor/Consultant|GSK: Advisor/Consultant|Merck: Grant/Research Support|Open Forum Infectious Diseases: Board Member|Open Forum Infectious Diseases: Associate Editor|Pfizer: 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
340. Infections in The Unhoused: A Descriptive Review of Unhoused People Presenting to The Emergency Room with Fever
Authors: McFarland Jessica M , Rawal Ruchi , Yan Yueqi , Sivasubramanian Geetha 
Published: November 2023

Abstract

Background
Homelessness has been increasing in several cities in California. The US Department of Housing and Urban Development and the Fresno Madera Point in Time Homeless Count, estimates that 4,216 people were experiencing homelessness during the year 2022 alone in Fresno County (Fig 1). People who are homeless often lack adequate health insurance, access to medical care, and have low healthcare literacy. They are subjected to poor sanitation and overcrowded living conditions putting them at risk for communicable diseases. Comprehensive studies of febrile illnesses in unhoused patients are sparse. We retrospectively studied unhoused individuals who presented to our center with fever. We aimed to quantify and understand their underlying presenting infections.
Areas shown in red represent increase in homeless counts between 2019 and 2020

Methods
The Fresno Information Gateway (FIG) is an IRB (Institutional Review Board) approved database which has data captured on patients seen in our center. We used ICD 10 codes for unhoused, fever and subset of infections to obtain data between 2015-2019 (Fig 2). Crosstabulation and chi-square or Fisher’s exact test were performed to examine the frequency and percentage of individuals with each type of disease. T-test was used to compare the average age between samples with vs. without each disease. Logistic regression was performed to examine the association of factors with each disease, while controlling for other factors.

Results
A total of 4792 unhoused patients were seen in the study period. Of these, 2177 patients presented with a fever (Table 1). Unhoused females had higher odds of presenting with blood stream and urinary tract infections (Table 2). Substance abusers had higher odds of soft tissue, cardiac and respiratory infections. Unhoused Asians or Pacific Islanders had higher odds of coccidioidomycosis, compared with their White counterparts.

Conclusion
A large number of unhoused patients presented to our center in Central California with febrile illness due to various infections. Unhoused females, substance users and HIV positive individuals in our study-set had higher odds of presenting with certain infections. Further studies are warranted to examine these associations, which may help us develop disease specific healthcare delivery models in unhoused patients.

Disclosures
All Authors: No reported disclosures
351. Factors Predicting Readmission within 90 days in Patients Receiving Outpatient Parenteral Antibiotic Therapy
Authors: Smola Kyle , Silliman Julia , Ho Minh , Mercurio Amanda 
Published: November 2023

Abstract

Background
Outpatient Parenteral Antibiotic Therapy (OPAT) involves administering antibiotics outside hospitals via non-oral routes. Success depends on well-reasoned selection of patients for this treatment modality and proper antibiotic stewardship to avoid serious complications.

Methods
We created a de-identified dataset (n=295) from a retrospective chart review of veterans receiving OPAT at the Orlando VA Medical Center (ORL-VAMC) in 2020. We included patients aged 18 or older who underwent OPAT therapy at ORL-VAMC with at least one antibiotic administration between January 1 and December 31, 2020. Inclusion also required compliance with follow-up and laboratory monitoring for at least 90 days after starting outpatient antibiotics. Of 364 patients receiving OPAT during 2020, 295 met the full criteria, with loss to follow-up and absent labs as common reasons for exclusion. We examined patient demographics, medical history, diagnosis, and elements of treatment for associations with unplanned hospital visits within 90-days of OPAT initiation using Binary Logistic Regression modeling.

Results
The average age within the dataset was 67.37 (SD=±11.38) years. Common treatment indications included Osteomyelitis (80/295, 27.12%) and Bacteremia (64/295, 21.69%). 40.96% (119/295) of patients had an unplanned hospital visit within 90 days, primarily due to unresolved symptoms. Our regression model identified Pyelonephritis/UTI (OR 2.26; 95% CI 1.02-5.41), Intra-Abdominal Infection (OR 3.81, 95% CI 1.15-17.45), Cephalosporin Antibiotics (OR 2.57, 1.39-4.91), Liver Disease (OR 2.26, 95% CI 1.02-5.41), and psychiatric illness (OR 1.74, 95% CI 1.06-2.87) as being significantly associated with unplanned hospital visits within 90 days.

Conclusion
A majority (177/295, 60%) of patients did not need further care in the hospital setting after starting OPAT. Our study supports OPAT as an effective option for delivering IV antibiotic therapy when indicated. This study's external validity is limited by the overrepresentation of males in the sample. Nevertheless, these findings can help physicians better anticipate successful outcomes and select suitable patients for OPAT. Further research aimed at understanding the associations identified may offer improved clinical utility.

Disclosures
All Authors: No reported disclosures
357. High Rate of Adverse Events in Patients Receiving Oral Antimicrobials Under a COpAT Monitoring Protocol
Authors: Sawey Ciara , Burgoyne Colleen , Winbush Angelina , Temple Craig , Qualls Brandon W , Munsiff Sonal , Yamshchikov Alexandra 
Published: November 2023

Abstract

Background
Oral linezolid (LZD), trimethoprim sulfamethoxazole (SXT), voriconazole (VRC), and itraconazole (ITC) are used often for prolonged durations and are associated with an array of adverse events (AEs). Establishing specific protocols for monitoring such courses of Complex Outpatient Antibiotic Therapy (COpAT) regimens as parenteral alternatives is a priority.

Methods
Patients receiving LZD, SXT, VRC, ITC between January 1st, 2019 and December 31st, 2022 with monitoring by our Outpatient Parenteral Antimicrobial Therapy (OPAT) program staff were identified for retrospective review of electronic health records. Weekly labs were highly encouraged in the first month of therapy, and at least monthly thereafter. All patients were reviewed during weekly OPAT rounds. An AE grading tool was derived using Common Terminology Criteria for Adverse Events (CTCAE 2017) to capture common AEs associated with study drugs. Primary study endpoint was occurrence of up to three AEs of any severity during antibiotic therapy. Secondary analyses evaluated risk factors and treatment outcomes associated with AE occurrence using chi-square statistic (MedCalc Software Ltd.).

Results
A total of 133 adverse events were identified in 70 (56.5%) of 124 patients receiving COpAT with LZD, SXT, VRC, ITC. Most common infections were pulmonary, bone/joint, and bacteremia/endocarditis (Figure 1). Median length of therapy ranged 21 days (LZD) to 102 days (ITC). Median time to AE onset ranged 8 days (SXT) to 14 days (VRC). Most AEs (88.3%) were &lt; Grade 2 in severity, but 44 (62.9%) of 70 patients incurred &gt; 2 AEs per treatment course. Although VRC incurred highest proportion of AEs, rates were &gt; 50% for all agents (Figure 2), and gastrointestinal AEs were most common (Figure 3). Occurrence of AE of any severity was significantly associated with modification of drug regimen and change in treatment duration.Figure 1.Infectious Disease Diagnoses Represented Under COpAT. Pulmonary, bone/joint, and endovascular infectious were most commonly represented.Figure 2.Proportion of Study Patients with Adverse Events by Medication. Adverse events were incurred in half or more of all treatment courses represented in this studyFigure 3.Adverse Event Categories by Medication.
Gastrointestinal toxicity was most frequently represented, followed by derangements in electrolyte or renal function.

Conclusion
High rates of multiple low- grade AEs per patient treated were associated with use of oral LZD, SXT, VRC, and ITC for severe infections, and frequently required modifications in regimen or duration of therapy. Evidence based protocols are needed to help guide monitoring and clinical management for patients receiving COpAT with these important agents.

Disclosures
All Authors: No reported disclosures
358. Differences in antibiotic usage patterns in Korean hospitals according to the appropriateness of surgical prophylactic antibiotic use: a Nationwide study
Authors: Yoon Choseok , Shin Jihye , Kim Dong-Sook , Chae Jungmi , Yoon Sang-Heon , Kim Yeseul , Jang wooyoung , Kim Jinnam , Kim Bongyoung 
Published: November 2023

Abstract

Background
Since 2007, the Health Insurance Review and Assessment Service (HIRA) has been conducting an appropriateness evaluation of prophylactic surgical antibiotic use for all hospitals in Korea. Each of the hospitals were divided into 5 grades based on their evaluation results. The purpose of this study is to analyze the differences in antibiotic usage patterns in Korean hospitals based on the appropriateness of surgical prophylactic antibiotic use.

Methods
We analyzed all antibiotics prescribed from hospitals included in the 9th appropriateness evaluation of surgical prophylactic antibiotic use from January 2020 to December 2021, using National Health Insurance claims data submitted to the HIRA. Antibiotic usage was calculated as Days of Therapy (DOT) and then adjusted to 1,000 patient-days. We compared antibiotic usage patterns with a surgical prophylactic antibiotic usage evaluation grade 1 or 2 hospitals and those with other grades hospitals. In addition, we analyzed the factors associated with grade 1 using logistic regression analysis.

Results
Among a total of 338 hospitals, 198 (58.6%) of hospitals received grade 1 or 2. The total antibiotic usage (253.4 vs. 169.6, P &lt; 0.001) and the usage of antibiotics predominantly used for resistant gram-positive bacteria (11.0 vs. 8.2, P &lt; 0.001) were higher in grade 1-2 hospitals than in other hospitals, while the usage of broad-spectrum antibiotics mainly used for hospital-onset infections (32.1 vs. 40.3, P=0.043) and Narrow-spectrum beta-lactam antibiotics (135.8 vs. 165.4, P=0.002) were lower in grade 1-2 hospitals than in other hospitals. Logistic regression analysis showed that factors associated with grade 1 were the Charlson's comorbidity index of patients (OR 3.59, 95% CI 1.61-8.03), the proportion of cancer patients (OR 0.98, 95% CI 0.98-0.99), and the number of infectious disease specialists (OR 1.10, 95% CI 1.07-1.14).

Conclusion
The overall use of antibiotics and the use of antibiotics mainly used for resistant gram-positive bacteria were higher in grade 1-2 hospitals than in other hospitals; the use of broad-spectrum antibiotics commonly used for hospital-acquired infections and narrow-spectrum beta-lactam antibiotics were lower in grade 1-2 hospitals than in other hospitals.

Disclosures
All Authors: No reported disclosures
363. A Phase II Prospective Randomized Study to Assess Imipenem-Relebactam in the Management of Cancer Patients with Febrile Neutropenia
Authors: Chaftari Anne-Marie , Dagher Hiba , Hachem Ray Y , Jiang Ying , Lamie Peter , Dib Rita Wilson , John Teny , Haddad Andrea , Philip Ann , Ali Shahnoor , Mulanovich Patricia , Juan Ying , Chaftari Patrick , Raad Issam I 
Published: November 2023

Abstract

Background
The overuse of antibiotics has led to the emergence of antibiotic resistance that poses a significant threat particularly for the immunocompromised cancer patients. Hence, the empiric therapy with standard antibiotic could be suboptimal in these vulnerable patients who often receive antibiotic treatment. New antibiotics that cover potential resistant pathogens may be considered.
In this prospective study we wanted to evaluate the role of a new combination of β-lactam/β-lactamase inhibitor Imipenem-Relebactam (IR) in comparison to standard of care (SOC) antibiotics in the empiric treatment of cancer patient with febrile neutropenia.

Methods
We conducted a prospective, randomized, open-label study comparing the safety and efficacy of IR vs SOC antibiotics (cefepime, piperacillin/tazobactam or meropenem) used in combination with gram-positive antibacterial agents as empiric therapy in adult cancer patients with febrile neutropenia. Patients received at least 48 hours of intravenous (IV) antibiotics before any switch of antibiotic was allowed and were followed through end of intravenous (EOIV) therapy and for up to 42 days.

Results
A total of 80 patients were enrolled between October 2021 and April 2023 of whom 39 were randomized to IR and 41 to SOC. Age, gender, race, and underlying malignancies were similar in both groups. The rate of microbiological infection including bacteremia was similar in both groups (27% in IR vs. 31% in SOC; p=0.81). Favorable clinical response at EOIV was comparable in both groups (88% in IR vs. 72% in SOC; p=0.12). The microbiological eradication at EOIV was 100% in IR vs 75% in SOC; p=0.22. Study-drug related adverse events were similar in both groups (10% in IR vs. 18% in SOC; p=0.29). Although overall mortality at late follow up was higher in SOC arm (11% in SOC vs. 0 in IR; p=0.049), there was no study-drug related mortality.

Conclusion
The use of IR as empiric coverage of febrile neutropenia in cancer patient is efficacious and safe and could be associated with a lower overall mortality.

Disclosures
Issam I. Raad, Distinguished Professor, Novel Anti-Infective Technologies, LLC: Technology License
384. Factors Potentiating the Risk of Linezolid-induced Thrombocytopenia in Patients without Haemato-oncologic Diseases: A Case-control Study
Authors: Thabit Abrar K , Alghamdi Arwa A , Alsaeed Afnan K , Magbool Nesreen M , Mahrous Ahmad J , Alrowaili Alya , Alsowaida Yazed S , Albakistani Ziyad K , Albangali Basem O , Alghumuy Anas M , Youssef Sara A , Alodayli Reem M 
Published: November 2023

Abstract

Background
Thrombocytopenia is a major adverse effect of linezolid due to myelosuppression. Many studies assessed factors associated with this effect, but most included patients with haemato-oncologic diseases, which may confound the assessment of thrombocytopenia. Therefore, this study aimed to investigate risk factors for linezolid-induced thrombocytopenia in patients without haemato-oncologic diseases.

Methods
This was a multicenter retrospective case-control study of adults treated with linezolid 600 mg twice daily for ≥ 3 days. Cases were the patients who developed thrombocytopenia while controls are those who didn't develop it. Exclusion criteria were haemato-oncologic diseases, active COVID-19, active dengue fever, baseline platelet count &lt; 100 × 103/mm3, concurrent therapy with trimethoprim/sulfamethoxazole or valproic acid, platelet transfusion within 7 days before linezolid therapy, and insufficient platelets data. Various factors were assessed for potential association with linezolid-induced thrombocytopenia (defined as drop in platelet count below 100 × 103/mm3).

Results
142 patients were included, 31 cases and 111 controls. Patients in both groups had a median age of 62 years and received linezolid for a median of 8 days. Platelet counts significantly dropped in the cases (Figure 1). Figure 2 shows the trend of change in platelet count (the white square indicates the median duration to thrombocytopenia, 8 days). In the univariate analysis, serum creatinine, creatinine clearance, baseline hemoglobin, baseline platelet count, and bacteremia were significantly associated with thrombocytopenia. However, after adjusting for confounders in the multivariate analysis, only low baseline hemoglobin and bacteremia were associated with thrombocytopenia (adjOR = 0.71; 95% CI 0.53-0.95; P = 0.022 and adjOR = 17.02; 95% CI 1.15-251-71; P = 0.039, respectively). Among the cases, those who had a baseline platelet count of &lt; 200 × 103/mm3 developed thrombocytopenia faster as early as 3 days (log-rank P = 0.002; figure 3).
Figure 1
Rate of change in platelet count between the cases (thrombocytopenia) and controls (no thrombocytopenia)
Figure 2
Trend of platelet counts over 14 days in the cases (thrombocytopenia) and controls (no thrombocytopenia)
Figure 3
Kaplan-Meier curve for the development of thrombocytopenia depending on baseline platelet count

Conclusion
Patients without haemato-oncologic diseases are at risk of linezolid-induced thrombocytopenia. especially those with bacteremia and low hemoglobin level. Patients with low baseline platelet count should be monitored closely early in therapy.

Disclosures
All Authors: No reported disclosures
405. Incidence and Potential Risk Factors of COVID-19 Associated Pulmonary Aspergillosis (CAPA)
Authors: Imoto Waki , Yamada Koichi , Kaneko Yukihiro , Kakeya Hiroshi 
Published: November 2023

Abstract

Background
Invasive pulmonary aspergillosis (IPA) that develops in coronavirus disease 2019 (COVID-19) patients is called COVID-19 Associated Pulmonary Aspergillosis, CAPA. The incidence of CAPA is reported as high as 1–40 % worldwide. However, the incidence of CAPA is highly variable among reports and it may vary among countries and medical facilities. Therefore, we investigated the incidence of CAPA in severe to critical severity COVID-19 using administrative claims data.

Methods
A retrospective cohort study was performed using administrative claims data called Diagnosis Procedure Combination (DPC) data from advanced treatment hospital in Japan to explore potential risk factors for CAPA using multivariable regression models. In addition, the contribution of CAPA to mortality in COVID-19 patients was examined.

Results
Data for 154,731 COVID-19 patients were included from DPC data. Of these, 33,136 were severe or critical COVID-19 and 14,720 were critical COVID-19. The incidence of CAPA were 0.4–1.3 % in severe or critical COVID-19, and 0.5–2.7 % in critical COVID-19. The risk factors for CAPA were steroids (hazard ratio [HR] = 4.753), immunosuppressants (HR = 2.592), intensive care unit admission (HR = 1.677), blood transfusion (HR = 6.206), and dialysis (HR = 2.185). The adjusted mortality HR for CAPA was 2.367 in severe or critical COVID-19, and 1.955 in critical COVID-19.

Conclusion
The incidence of CAPA in our study was lower than previously reported. It suggests the possibility that appropriate screening test is not being conducted in Japan due to insufficient attention to CAPA. Because CAPA is a significant contributor to mortality in COVID-19 patients, appropriate screening is required in at-risk patients.

Disclosures
Hiroshi Kakeya, MD, PhD, Asahi Kasei Pharma Corporation: Honoraria|Merck Sharp & Dohme: Honoraria|Sumitomo Pharma Co., Ltd.: Honoraria