bluuebunny/crossref_metadata_2025_split huggingface dataset:
1933. Characteristics of Community-Associated Extended-Spectrum β-Lactamase Producing Enterobacterales Infections in Monroe County, NY, 2020-2021
Authors: Tellerman Julia , Russ Savanah , Che Looi Hsioa , Tsay Rebecca , Myers christopher J , Dumyati Ghinwa 
Published: November 2023

Abstract

Background
Extended-spectrum β-lactamase–producing Enterobacterales (ESBL) have emerged as a serious multidrug resistant threat to the community. Epidemiologic data for community-associated (CA) ESBL infections are limited compared to that for healthcare-associated (HA) infections. We examined characteristics of CA ESBL cases over a two-year period and compared them to those of HA cases to guide prevention.

Methods
CA ESBL cases from 1/2020-12/2021 were identified via laboratory and population-based surveillance in Monroe County as part of the CDC Emerging Infections Program. Cases were defined as the first instance of positive culture in a county resident from a normally sterile site or urine of Escherichia coli, Klebsiella pneumoniae, or K. oxytoca resistant to ≥ 1 3rd-generation cephalosporin and nonresistant to carbapenems. Epidemiologic data were collected through medical record abstraction. Cases were classified as HA if they had prior healthcare exposures (e.g. hospitalization, surgery, chronic dialysis, indwelling devices, or external catheters) and CA if they did not. Case addresses were geocoded to the census tract level to obtain Social Vulnerability Index (SVI) percentiles. Chi-square analyses were conducted to quantify the difference in distribution of these characteristics between CA and HA cases.

Results
From 2020-2021, 1729 incident cases were identified; 854 (49%) were classified as CA. Compared to HA cases, CA cases were younger (median 59 vs. 70 years), more likely to be female (89.8% vs 65.3%), less likely to have a urinary tract abnormality (27.0% vs 56.8%) or underlying comorbidities (73.2 % vs 95.8%), and less likely to have received prior antibiotics (24.0% vs 55.1%). Interestingly, CA cases were more widely spread across SVI quartiles compared to HA cases; a higher proportion of HA cases resided in census tracts in the 3rd or 4th SVI quartiles (Table 1).

Conclusion
Patient-specific risk factors classically associated with HA ESBL are less commonly associated with CA ESBL in Monroe County. Community-based preventions may need to target different populations than hospital-based strategies. As ESBL incidence increases, continued surveillance to identify at-risk groups and explore the association of specific social determinants of health is necessary.

Disclosures
Rebecca Tsay, MPH, CDC: Grant/Research Support Ghinwa Dumyati, MD, Pfizer: Grant/Research Support
1943. RSV Prophylaxis for 29-34 Gestational Preemies. Are Current Guidelines Justified? Lessons from an Israeli Multicenter Off-seasonal Study
Authors: Armoni Domany Keren , Mandelberg Avigdor , Burrack Nitzan , Tripto Golan Inbal , Masarweh Kamal , Rochman Mika , Prais Dario , Mor Meirav , Weinberger Opek Moran , Nasrallah Elias , Megged Orli , Shatzman Steuerman Rachel , Stein Michal , Steinberg Zohar , Shehadeh Shereen , Tasher Diana 
Published: November 2023

Abstract

Background
Respiratory syncytial virus (RSV) prophylaxis provided during the winter to infants born at 29–34-week gestational age (wGA) is controversial. We utilized the unprecedented opportunity of high load off-season RSV admissions with no prophylaxis given during the summer of 2021, to assess the impact of withholding palivizumab on the relative burden of hospitalized 29-34 wGA infants.

Methods
This was a national multi-center observational retrospective study in 11 medical centers in Israel. We included infants under 1 year-old, who were hospitalized with RSV between November 2017 and August 2021. Demographics and clinical data were extracted from the medical records. We categorized our cohort into a seasonal admissions group (November- March) when palivizumab was indicated, and an off-season admissions group (April-October) when palivizumab was not indicated. The primary outcome was the proportion of 29-34 wGA hospitalizations in each group. Secondary outcomes included clinical severity parameters.

Results
We included 4,340 children in our study; 57% were males, 61% were Jewish, and the median age at admission was 2.9 months (IQR 1.4-6.4). A total of 3,296 infants were admitted during the RSV season, and 1,044 were admitted off-season. The proportion of 29-34 wGA preemies was significantly higher in the off-season admissions group compared to the in season patients (7% vs 2.1%, p&lt; 0.001). We found a significantly higher prevalence of Jewish (77% vs 57%, p=0.001) and higher socioeconomic status (55% vs 45%, p&lt; 0.001) children in the group admitted off-season compared to those in season. Logistic regression analysis revealed that the relative-odds of 29-34 wGA preemies to be hospitalized off-season was 2.67 (95% CI: 1.8-3.9, p&lt; 0.001) fold higher than in season, independent of ethnicity, socioeconomic-status, gender, age, or institution. Clinical severity parameters did not differ significantly between the groups.
Flow chart of study participants
The proportion of 29-34 wGA preterm infants out of total admissions categorized into seasonal and out of season RSV infections
Clinical severity in the subgroup of 29-34 wGA preterm infants

Conclusion
Our results reveal a significant higher proportion of 29-34 wGA preemies among the children hospitalized during off-season periods, when RSV immunoprophylaxis was not indicated. These findings may support the current broad Israeli policy of administration.

Disclosures
All Authors: No reported disclosures
1160. Comparative Effectiveness of Pneumococcal Vaccination Strategies to Prevent Invasive Pneumococcal Disease: A Cohort Study at the Veterans Health Administration
Authors: Goto Michihiko , Kakiuchi Satoshi , Perencevich Eli N , Hasegawa Shinya , Jones Michael 
Published: November 2023

Abstract

Background
The direct impact of a combined vaccination strategy pneumococcal 13-valent conjugate vaccine (PCV13) and 23-valent polysaccharide vaccine (PPSV23) for adults in preventing pneumococcal infections has yet to be thoroughly investigated. We aimed to estimate the comparative effectiveness of preventing the most severe form of pneumococcal infections, invasive pneumococcal disease (IPD), by comparing the risk of IPD stratified by the use of PCV13, PPSV23, and their combinations.

Methods
We included all patients who were 65 years or older, had established primary care within the Veterans Health Administration (VHA) between 2005 and 2021, and had not received any prior pneumococcal vaccination. We measured time-to-event from cohort enrollment to the onset of culture-proven IPD, considering death a competing risk event, and constructed a Cox regression model to estimate cause-specific hazards. PCV13 only, PPSV23 only, and PCV13 + PPSV23 were incorporated into the model as a time-dependent exposure variable, and we estimated hazard ratios (HRs) associated with them. We also considered a waning effect by incorporating time-by-vaccine interaction terms in the model to estimate continuously changing time-dependent hazards.

Results
5,069,917 patients were enrolled in the cohort (male: 96.5%; median age: 72 [IQR: 65-79]). 1,217,349 patients received at least one dose of pneumococcal vaccine during the study period. The overall incidence rate of IPD was 9.1 per 100,000 patient-years. In crude analysis, all pneumococcal vaccines were associated with lower HRs for IPD, and there was an additive benefit of PCV13 and PPSV23 (Tables 1 and 2). In multivariate analysis, associations between PCV13 alone and PPSV23 alone were no longer statistically significant after adjusting for age and comorbidities, but PCV13 + PPSV23 was significantly associated with lower HR for IPD. No time-by-vaccine interaction term was significant.

Conclusion
In this large cohort study at the VHA, neither vaccine by itself appeared to lower the risk of IPD, but the combination of PCV13 and PPSV23 was associated with a significantly lower risk. In addition, we did not observe evidence of a waning effect to prevent IPD. Further studies are needed to evaluate the effect of newer pneumococcal vaccines.

Disclosures
Michihiko Goto, MD MSCI, Merck & Co.: Grant/Research Support
1161. Effectiveness of the Influenza Vaccine for Preventing Laboratory-Confirmed Influenza Infections in Outpatient Immunocompromised Adults, 2017-2018
Authors: Kramer Kailey Hughes , Zimmerman Richard K , Nowalk MaryPatricia , Silveira Fernanda P , Balasubramani G K , Chung Jessie R , Belongia Edward , Martin Emily T , Gaglani Manjusha , Haggerty Catherine L , Phillips C Hallie 
Published: November 2023

Abstract

Background
While the number of immunocompromised (IC) individuals continues to rise, the existing literature on influenza vaccine effectiveness (VE) in IC populations is limited. IC individuals have a higher risk of severe influenza and influenza-related hospitalizations, and understanding the VE of the seasonal influenza vaccines in IC populations remains paramount.

Methods
Using 2017-2018 US Flu VE Network (US Flu VE) data, we examined the VE of the 2017-2018 seasonal influenza vaccine against symptomatic influenza in outpatient settings among IC adults. Patients were enrolled from outpatient sites in five states. IC status was determined by ICD-10 codes. We used logistic regression and adjusted for enrollment site, race, self-reported general health status, age, and onset date of symptoms. Separate models were used to calculate and compare the VE for non-IC and IC among outpatient adults &gt;18 years.

Results
5671 participants were included in the adult analytic dataset, and 455 (8%) were IC. The VE among non-IC was 31% (95% CI: 22, 39) and among IC participants was -4 % (95% CI: -66, 35). P-value for interaction by IC status was 0.100.

Conclusion
We observed lower VE against symptomatic influenza among non-hospitalized patients with immunocompromising conditions though the difference was not statistically significant. This study demonstrates the capacity to study a large IC population using an existing influenza VE network and contributes to the literature to support large, multicenter VE studies for IC populations.

Disclosures
Richard K. Zimmerman, MA; MD; MPH; MS, Sanofi Pasteur: Grant/Research Support MaryPatricia Nowalk, PhD, RDN, Merck & Co.: Grant/Research Support|Merck & Co.: Honoraria|Sanofi: Grant/Research Support Fernanda P. Silveira, MD, Ansun: Grant/Research Support|Eurofins Viracor: Advisor/Consultant|Janssen: Advisor/Consultant|Merck: Grant/Research Support|Regeneron: Grant/Research Support|Takeda: Advisor/Consultant Emily T. Martin, PhD, MPH, Merck: Grant/Research Support
1162. Influenza Vaccination Among Pregnant People in the Vaccine Safety Datalink, 2016-17 through 2022-23 Influenza Seasons
Authors: Irving Stephanie , Crane Bradley , Weintraub Eric , Kauffman Tia L , Brooks Neon , Patel Suchita A , Razzaghi Hilda , Belongia Edward , Daley Matthew F , Getahun Darios , Glenn Sungching C , Hambidge Simon , Jackson Lisa , Kharbanda Elyse , Klein Nicola P , Zerbo Ousseny , Naleway Allison L 
Published: November 2023

Abstract

Background
Estimates of influenza vaccination coverage during pregnancy vary, but studies in the US prior to the 2020-21 influenza season show increasing coverage over time. However, there are limited data on influenza vaccination coverage among pregnant people during the COVID-19 pandemic.

Methods
Within the Vaccine Safety Datalink, we examined influenza vaccination coverage among people ages 18-49 years identified as pregnant with a live birth using a validated algorithm. For primary analyses covering the 2016-17 through 2021-22 influenza seasons, we captured all influenza vaccination between July 1 and March 31 of each season, irrespective of the timing of administration relative to pregnancy (i.e., prior to, during, or after pregnancy), and assessed crude coverage; demographic and clinical characteristics associated with vaccination; and vaccination patterns by calendar month of pregnancy start. Secondary analyses included crude coverage estimates for the 2022-23 season, using data through January 2023, stratified by race and ethnicity.

Results
In primary analyses, among cohorts of pregnant people ranging from 128,267 to 139,927 each season, crude annual influenza vaccination coverage ranged from a high of 71% (2019-20) to a low of 56% (2021-22). In each of the six seasons, coverage was lowest among 18-24-year-olds (Figure) and among non-Hispanic Black pregnant people. The 2021-22 season had the lowest coverage estimates across all age and race and ethnicity groups. Coverage differed based on the calendar month of pregnancy onset, with the lowest coverage observed among pregnancies starting in January-March during each influenza season. In secondary analyses, overall coverage as of January 2023 was 47.9%, a decrease of 7.7 percentage points from January 2022 estimates.

Conclusion
Influenza vaccination coverage among all pregnant people increased from the 2016-17 influenza season through the 2019-20 influenza season, then decreased to the lowest level in the 2021-22 season. Interim estimates for the 2022-23 season declined further. The decreases seen in recent seasons, likely due in part to the COVID-19 pandemic, were consistent across all characteristics examined, and highlight the need for continued efforts to improve influenza vaccination coverage in pregnant people.

Disclosures
Edward Belongia, MD, Seqirus: Grant/Research Support Lisa Jackson, MD, MPH, Pfizer: Grant/Research Support Nicola P. Klein, MD, PhD, GlaxoSmithKline: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi Pasteur: Grant/Research Support
1167. The Value of Influenza Vaccination in the Older Adult Population. A Stochastic Model Estimation of the benefit of vaccination to prevent the Severe Outcomes in the U.S.
Authors: Pelton Stephen I , Nguyen Van , Mould-Quevedo Joaquin F 
Published: November 2023

Abstract

Background
Influenza is associated with substantial morbidity and mortality in the United States. Increasing influenza vaccination rates among all persons extends the benefits of immunization programs on reducing illnesses, especially those accrued to the older adult population who has the highest risk of severe outcomes. This research assesses the value of influenza vaccination by estimating the number of severe outcomes such as, respiratory and cardiovascular hospitalizations and deaths averted through immunization in the U.S. older adult population.

Methods
Severe hospitalizations and deaths prevented were estimated through a decision-tree model using a stochastic approach. Model’s incidence rate as well as complications probabilities were calibrated to reflect the reported U.S. CDC data. This analysis compares no vaccination of older adult population against influenza immunization with either a standard-dose quadrivalent vaccine (QIVe) or an enhanced quadrivalent vaccine recommended by ACIP. Absolute vaccine effectiveness and relative vaccine effectiveness of enhanced quadrivalent vaccine vs QIVe for hospitalizations averted were obtained from a targeted literature review. Median value and 95% CI were estimated from a 1000 stochastic simulation.

Results
In comparison to no vaccination, the number of respiratory and cardiovascular hospitalizations prevented with QIVe was 49,323 (19,584-91,620) and 93,950 (41,537-186,224), respectively. In addition, the number of respiratory and cardiovascular deaths prevented with QIVe vs no vaccination was 4,481 (1,517-9,701) and 8,277 (3,124-19,548), respectively. In the case, older adults were vaccinated with an enhanced vaccine, such as aQIV, then the number of respiratory and cardiovascular hospitalizations prevented against no vaccination was 52,428 (21,354-96,922) and 99,948 (44,400-197,284), respectively. Lastly, 4,742 (1,612-10,202) and 8,787 (3,314-20,910) were the estimated deaths prevented due respiratory and cardiovascular hospitalizations, respectively.

Conclusion
Influenza vaccination in older adult population reduces almost by 50% severe complications. The use of an enhanced vaccine such as the adjuvanted formulation increases further the clinical benefits.

Disclosures
Stephen I. Pelton, MD, CSL Seqirus Inc.: Advisor/Consultant|CSL Seqirus Inc.: Honoraria Van Nguyen, PhD, CSL Seqirus Inc.: Advisor/Consultant|CSL Seqirus Inc.: Advisor/Consultant|CSL Seqirus Inc.: Honoraria Joaquin F. Mould-Quevedo, PhD, CSL Seqirus Inc.: Employee|CSL Seqirus Inc.: Employee|CSL Seqirus Inc.: Stocks/Bonds|CSL Seqirus Inc.: Stocks/Bonds
1172. Compliance with Human Papillomavirus Vaccination At The HIV Outpatient Program in New Orleans, Louisiana
Authors: Yau Tat , Frontini Maria , Hagensee Michael 
Published: November 2023

Abstract

Background
Guidelines recommend the human papillomavirus (HPV) vaccine for all adults through age 26, shared clinical decision-making for those aged 27 through 45 years who are inadequately vaccinated, and for all people with HIV up to age 45 years. The intent of this study is to evaluate HPV vaccination rates at the HIV Outpatient Program (HOP) at University Medical Center in New Orleans.

Methods
Immunization records from patients aged 18 through 45 years attending a physician visit in the LSU Infectious Diseases fellows’ HIV primary care clinic at HOP in 2022 were reviewed. The purpose of this project was to assess compliance with HPV vaccination recommendations among the infectious diseases fellows.

Results
Among patients under age 27, 15 of 21 visits (71%) had completed HPV vaccines series. 4 visits (19%) had incomplete status and 2 visits (10%) did not have any HPV vaccines record. Among patients aged 27 through 45 years, 73 of 194 visits (38%) had completed HPV vaccines series. 34 visits (18%) had partial vaccination records and 87 visits (45%) had no records.

Conclusion
Vaccination compliance among the LSU ID fellows was less than ideal, only 71% of visits for patient aged up to 27 years attending LSU ID fellows’ clinic had completed HPV vaccine series, compared to the Health People 2020 recommendation of 80%. Only 38% of visits for patients aged 27 through 45 years are fully vaccinated with HPV vaccines. Patients in this age group are often labeled “aged out” for HPV vaccines by health maintenance reminders however, due to having HIV, they are still eligible and should be vaccinated. These results led to the institution of quality improvement project to address HPV vaccinations. This intervention will focus on educating all HOP providers about the vaccination recommendations and updating the health maintenance care gaps reminder in the electronic medical record.

Disclosures
All Authors: No reported disclosures
1176. Assessing the Impact of Collaborative Antimicrobial Stewardship Guidelines on the Use of Antibiotics in Hospitalized Veterans with COVID-19 from Five Veterans Health Administration (VHA) Hospitals
Authors: Thomas-Gosain Neena , Davis Kelly W , Hendrickson Sage , Hulgan Todd , Parvaz Parmida , Powers Caroline , Read John H , Staub Milner , Bennett Jessica G 
Published: November 2023

Abstract

Background
Limited data and resources drove collaboration among healthcare providers treating COVID-19. In July 2021 a multi-disciplinary committee representing all facilities in Veterans Integrated Service Network (VISN) 9 developed COVID-19 guidelines for bacterial co-infection in hospitalized COVID-19 patients. We assessed the impact of these guidelines on appropriate antibiotic utilization (AU) in admissions for COVID-19.

Methods
AU in COVID-19 admissions to VISN 9 facilities from 08/01/20 to 08/31/21 (pre-guidelines) were reviewed and compared to 11/01/21 to 11/30/22 (post-guidelines). COVID-19 positivity, hospitalization, and AU data were pulled from the Corporate Data Warehouse. COVID-19-specific antibiotic stewardship (AS) interventions and guideline distribution plans were collected for each facility. A weighted random sample of patients from each facility who received antibiotics was chart reviewed for appropriateness of AU. AU for non-respiratory indications were excluded from analysis (Table 1). AU was considered appropriate if at least one guideline criteria was met (Table 2). Antibiotic appropriateness was compared before and after guideline distribution for each site using t-test. The odds of appropriate antibiotic prescribing in the VISN after guidance distribution was determined by logistic regression adjusted for site.

Results
Initial rates of antibiotic use varied among facilities both pre and post guideline distribution (Table 1). Facility-specific interventions and guideline distribution also varied (Table 3). There was no significant change in the frequency of appropriateness for any individual site. Similarly, the odds of AU appropriateness for the VISN was not significantly changed in the post-guideline period (p=0.7) (Table 4).

Conclusion
AU appropriateness did not change significantly after guidance distribution, likely due to a myriad of reasons. Reprioritization of AS programs’ focus in the post-guidance period may have shifted resources away from initiatives targeting AU in COVID-19 patients. Additionally, guidance was distributed mid-2021 potentially missing the window for largest impact. Collaboration can fill in gaps for many ASPs; but the success of any intervention is multifactorial.

Disclosures
Milner Staub, MD, MPH, Gilead: Stocks/Bonds|Johnson & Johnson: Stocks/Bonds
1177. Clinical Pharmacist-Lead Amoxicillin Oral Challenges in Low-Risk Penicillin Allergy Patients
Authors: Caturano Breana , Bjork Lauren , Temino Viviana 
Published: November 2023

Abstract

Background
Amoxicillin direct oral challenge (DOC) without preceding skin testing in patients with low-risk penicillin (PCN) allergy histories has been shown to be a safe and effective method to delabel PCN allergies. The implementation of robust DOC programs is dependent on Allergy/Immunology oversight. Prior to this initiative, our institution primarily offered PCN skin testing to outpatients and DOC was limited. To expand upon our services, a clinical pharmacist was trained to independently interview, risk-stratify, and perform DOC in patients with low-risk PCN allergy histories.

Methods
Adult inpatients with a documented PCN allergy were evaluated by a clinical pharmacist based on the local algorithm created by Allergy (Figure 1). Patients who met criteria were offered amoxicillin 500 mg PO and observed for 60 minutes. Epinephrine and diphenhydramine were available in case of adverse reaction. If no reaction resulted, the PCN allergy label was removed.Figure 1.Penicillin Allergy History Evaluation Algorithm
Adult inpatients with a documented PCN allergy were evaluated by a clinical pharmacist based on the local algorithm created by Allergy Service.

Results
A total of 136 patients were screened from October 2021-March 2023 with a mean age of 67 and 89% were male (Table 1). The most common reaction was unknown (Table 2). Of the patients screened, 20% did not qualify for DOC and 15% were delabeled based on evaluation. During the study period, 65% of patients screened were qualified for DOC with 26% that received DOC. None of the DOC patients had an immediate adverse reaction, although one patient experienced a delayed reaction. Limitations included 34 clinically unstable patients and 22 DOC patients deferred and lost to follow-up outpatient (Figure 2).

Conclusion
Expanding the scope of practice of a clinical pharmacist to perform evaluations, risk assessments, and DOC on inpatients is a safe and effective method for those with low-risk PCN allergy histories. Institutions with adult patients may consider implementation of clinical pharmacist-led allergy delabeling program to expand upon current practices.

Disclosures
All Authors: No reported disclosures