bluuebunny/crossref_metadata_2025_split huggingface dataset:
2277. Variability in Changes in Physician Outpatient Antibiotic Prescribing from 2019 to 2021 during the COVID-19 Pandemic in Ontario, Canada
Authors: Tandon Pranav , Brown Kevin , Daneman Nick , Langford Bradley J , Leung Valerie , Friedman Lindsay , Schwartz Kevin 
Published: November 2023

Abstract

Background
Outpatient antibiotic prescribing decreased during the COVID-19 pandemic. Understanding how antibiotic prescribing habits changed differentially based on physician and practice characteristics presents an opportunity to inform antibiotic stewardship. Our objective was to evaluate inter-physician variability and predictors of changes in antibiotic prescribing before (2019) and during (2020/2021) the COVID-19 pandemic.

Methods
We conducted a retrospective cohort analysis of physicians in Ontario, Canada prescribing oral antibiotics in the outpatient setting between 1 January 2019 and 31 December 2021 using the IQVIA Xponent dataset. The primary outcome was the change in the number of antibiotic prescriptions between the pre-pandemic and pandemic period. Secondary outcomes were changes in the selection of broad-spectrum agents and long-duration ( &gt;7 days) antibiotic use. We used multivariable linear regression models to evaluate physician- and practice-level predictors of change.

Results
There were 17,288 physicians included in the study with substantial inter-physician variability in changes in antibiotic prescribing (median change of -43.5 antibiotics per physician, IQR -136.5 to -5.0). In the multivariable model, later career stage (adjusted mean difference [aMD] -45.3, 95% confidence interval [CI] -52.9 to -37.8, p&lt; .001), family medicine (aMD -46.0, 95% CI -62.5 to -29.4, p&lt; .001), male patient sex (aMD -52.4, 95% CI -71.1 to -33.7, p&lt; .001), low patient comorbidity (aMD -42.5, 95% CI -50.3 to -34.8, p&lt; .001), and high prescribing to new patients (aMD -216.5, 95% CI -223.5 to -209.5, p&lt; .001) were associated with decreases in antibiotic initiation. Family medicine and high prescribing to new patients were associated with significant decreases in selection of broad-spectrum agents and prolonged antibiotic use.

Conclusion
Antibiotic prescribing changed throughout the COVID-19 pandemic with overall decreases in antibiotic initiation, broad-spectrum agents, and prolonged antibiotic courses with inter-physician variability. These findings present opportunities for targeted community antibiotic stewardship interventions.

Disclosures
All Authors: No reported disclosures
2951. Nursing home clinician characteristics associated with simulated urinary tract infection treatment decision-making
Authors: Taylor Lindsay , Wilson Brigid , Jolles Sally , Bej Taissa A , Kowal Corinne , Hicks Oteshia , Jump Robin , Crnich Christopher J 
Published: November 2023

Abstract

Background
Antibiotic overuse and misuse are common in nursing homes (NHs). Urinary tract infection (UTI) is the most common indication for antibiotics in NHs. We conducted a clinical vignette experiment to identify clinician-level characteristics associated with suboptimal UTI treatment decision-making among a sample of NH clinicians.

Methods
Six clinical vignettes, two designed to assess clinicians’ treatment threshold and four designed to assess antibiotic choice decision-making, were created through an iterative process. NH clinicians were recruited nationally via professional organizations from December 2021 to April 2022. Clinical vignettes were shared using a web-based survey tool (Qualtrics) during which participants were asked if they would initiate antibiotics and which one. Participants provided demographic information, including degree, specialty training and NH experience. A multivariable logistic regression model with the decision to initiate antibiotic therapy (Yes/No) as the dependent variable and a multivariable ordinal regression model with number of vignettes for which a fluoroquinolone (FQ) was empirically chosen as the dependent variable were constructed in R.

Results
A total of 298 NH clinicians, whose characteristics are detailed in Table 1, responded to the survey. Despite national guidelines not recommending treatment for asymptomatic bacteriuiria (ASB), 10.4% of participants chose to initiate antibiotics when presented with the ASB vignette. Physicians (vs. APPs) and clinicians with ≥ 10 years NH experience were less likely to initiate antibiotics for ASB (Table 2). Empiric treatment was withheld for simple cystitis by 38.9% of clinicians, with APPs more likely to withhold antibiotics than physicians (Table 2). Across the four cases assessing empiric antibiotic choice, 38.3% of clinicians chose a FQ in at least one clinical case (Table 1). Clinicians with more years of NH-practice experience were more likely to prescribe a FQ (aOR 2.41, 95% CI 1.47-3.95, p&lt; 0.01, Table 2).
Respondent Characteristics
Abbreviations: Advanced Practice Provider (APP); Asymptomatic bacteriuria (ASB); Fluoroquinolone (FQ), Nursing Home (NH).
Effect of clinician credentials, training, and experience on antibiotic prescribing for urinary tract infection
Abbreviations: * reference; Adjusted odds ratio (aOR); Confidence interval (CI); Asymptomatic bacteriuria (ASB); Advanced practitioner (APP)

Conclusion
Our results indicate that specific clinician characteristics are associated with suboptimal antibiotic prescribing. This suggests that tailoring stewardship interventions to clinician-specific factors may augment ongoing efforts to improve antibiotic use in NHs.

Disclosures
Lindsay Taylor, MD, MS, Merck: Grant/Research Support Robin Jump, MD, PhD, Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support
2287. Goal! Goal! Goal! Detection of SARS-CoV-2 Variants in Travelers During the FIFA World Cup, Qatar 2022 — CDC Traveler-Based Genomic Surveillance Program, November 2022–January 2023
Authors: Byrd Katrina M , Bart Stephen , Smith Teresa C , Loh Samantha M , Guagliardo Sarah Anne J , Rome Benjamin , Aichele Thomas , Ernst Ezra T , Morfino Robert C , Cetron Martin S , Friedman Cindy R , Walker Allison T 
Published: November 2023

Abstract

Background
Over 1 million people traveled to Qatar and surrounding countries during the World Cup 2022 soccer tournament, a mass gathering that could enhance transmission of SARS-CoV-2 variants. Minimal information about circulating variants in World Health Organization (WHO) Eastern-Mediterranean region (EMRO) which includes Qatar, United Arab Emirates, and Saudi Arabia were available from global data bases (GISAID). The Traveler-based Genomic Surveillance (TGS) program samples arriving international travelers to detect new variants and fill surveillance gaps. Monitoring of flights from EMRO was increased during the tournament.

Methods
Travelers at six US airports volunteered to provide nasal swabs that were pooled by flight origin and sent to laboratories for SARS-CoV-2 reverse transcription polymerase chain reaction. Positives underwent whole genome sequencing. Pool positivity and variant frequencies were compared for travelers from EMRO vs. other regions. Chi-square tests were used to determine statistical significance.

Results
During November 20, 2022–January 2, 2023, 2050 sample pools from 16,595 travelers were collected. Of these, 100 pools (703 travelers) were from EMRO and 1950 pools (15,892 travelers) were from other regions. Pool positivity from EMRO was 28% (28/100) vs. 25% (489/1950) in other regions (p=0.51). Regionally detected variant proportions were: EMRO (n=25) XBB (40%), BQ.1 (20%), BQ.1.1 (20%); Europe (n=166) BQ.1.1 (48%), BQ.1 (20%), XBB (9%); Western Pacific (n=51) BA.5 (24%), BN.1 (22%), XBB (18%); South-East Asia (n=21) BQ.1.1 (33%), XBB (29%), BA.2 (10%), BA.5 (10%), XBB.1.5 (10%); and Africa (n=15) BQ.1.1 (53%), BA.5 (27%), XBB (20%). The proportion of XBB in EMRO was significantly higher than Europe and Western Pacific regions (p&lt; 0.05).

Conclusion
During World Cup 2022, SARS-CoV-2 positivity was similar for travelers from EMRO compared to all other regions. Variant proportions differed among regions, with EMRO having the highest proportion of XBB, a recombinant lineage associated with higher transmissibility. TGS fills gaps in SARS-CoV-2 surveillance and can be surged during mass gathering events.

Disclosures
Benjamin Rome, MBA, Ginkgo Bioworks, Inc.: Employee|Ginkgo Bioworks, Inc.: Stocks/Bonds Robert C. Morfino, MBA, Ginkgo Bioworks Inc.: I am an employee|Ginkgo Bioworks Inc.: Stocks/Bonds
2952. Impacts of an evidence-based, pre-populated order panel on antimicrobial prescribing trends in ambulatory patients with community-acquired pneumonia
Authors: Stevens Ryan W W , Arensman Hannan Kellie , Schanz Caitlin C , Vergidis Paschalis , Anderson Benjamin , Dierkhising Ross , Kooda Kirstin , Virk Abinash , Jensen Kelsey L 
Published: November 2023

Abstract

Background
Optimizing antimicrobial regimens for outpatients with community-acquired pneumonia (CAP) represents an area of opportunity for ambulatory antimicrobial stewardship programs. A pre-populated, antibiotic order panel for outpatient respiratory syndromes was implemented in the Mayo Clinic Enterprise on 1/4/2021. For CAP, it provides national guideline adherent regimens (i.e., selection, dosing, and durations) by patient comorbidity and beta-lactam allergy status. We aimed to assess impacts of panel use on antibiotic prescribing in outpatients with CAP.

Methods
This retrospective review included Mayo Clinic outpatient encounters from Minnesota in 2021 and 2022. Eligible encounters used a CAP-related primary ICD-10 code, conveyed intention to treat CAP in encounter notes, and were performed by primary care, emergency department, or urgent care clinicians who managed ≥1 CAP patient with the panel and ≥1 without the panel during the study period. Encounters were excluded if patients were already receiving antibiotics at the time of encounter. The primary outcome was adherence (drug and duration) to guideline recommendations. Secondary outcomes included utilization rate by agent and therapy duration. Outcomes were analyzed with Kruskal-Wallis rank sum and Pearson’s chi-squared tests (α level = 0.05).

Results
352 encounters (134 panel vs. 218 non-panel) were included. Prescribing was guideline adherent in 61.9% and 29.4% (p&lt; 0.01) of panel and non-panel encounters, respectively. The most common reason for guideline non-adherence during panel use was inappropriate drug selection (n = 45/51, 88.2%). This was predominantly driven by use of the incorrect section of the treatment panel based on patient comorbidity status (n = 30/45, 66.7%). Individual antibiotic utilization rates differed between panel and non-panel cohorts (Table 1), with higher rates of amoxicillin and amoxicillin/clavulanate use and lower rates of azithromycin and doxycycline use in the panel cohort. Durations &gt;5 days were more common in the non-panel as compared to the panel cohort (34.4% vs. 7.5%, p &lt; 0.01).

Conclusion
Use of a pre-populated antimicrobial order panel in outpatients with CAP resulted in greater adherence to national guideline recommendations.

Disclosures
Paschalis Vergidis, MD, MSc, AbbVie: Advisor/Consultant|Ansun: Grant/Research Support|Cidara: Grant/Research Support|Scynexis: Grant/Research Support
2288. Short and Longer-Term All-Cause Mortality among SARS CoV-2-Infected Persons and the Pull-Forward Phenomenon in Qatar
Authors: Chemaitelly Hiam , Faust Jeremy Samuel , Krumholz Harlan M , Ayoub Houssein H , Abu-Raddad Laith J 
Published: November 2023

Abstract

Background
Risk of short- and long-term all-cause mortality after a primary SARS-CoV-2 infection is inadequately understood.

Methods
A national, matched, retrospective cohort study was conducted in Qatar to assess the risk of all-cause mortality in the national cohort of people infected with SARS-CoV-2 compared with a reference national control cohort of uninfected persons. Associations were estimated using Cox proportional-hazards regression models.

Results
Among unvaccinated persons, within 90 days after primary infection, adjusted hazard ratio (aHR) comparing incidence of death in the primary-infection cohort with the infection-naïve cohort was 1.19 (95% CI: 1.02-1.39). The aHR was 1.34 (95% CI: 1.11-1.63) in persons more clinically vulnerable to severe COVID-19 and 0.94 (95% CI: 0.72-1.24) in those less clinically vulnerable to severe COVID-19. In subsequent follow-up, the aHR was 0.50 (95% CI: 0.37-0.68). The aHR was 0.41 (95% CI: 0.28-0.58) in months 3-7 after the primary infection and 0.76 (95% CI: 0.46-1.26) in subsequent months. The aHR was 0.37 (95% CI: 0.25-0.54) in persons more clinically vulnerable to severe COVID-19 and 0.77 (95% CI: 0.48-1.24) in those less clinically vulnerable to severe COVID-19. Among vaccinated persons, no evidence was found for differences in incidence of death in the primary-infection versus infection-naïve cohorts, even among persons more clinically vulnerable to severe COVID-19.

Conclusion
COVID-19 mortality in Qatar appears primarily driven by forward displacement of deaths of individuals with relatively short life expectancy and more clinically vulnerable to severe COVID-19. Vaccination negated the mortality displacement by preventing early deaths.

Disclosures
All Authors: No reported disclosures
2289. Accuracy of the National Early Warning Score 2 (NEWS2) in predicting Mortality and ICU Admission among COVID-19 patients in the Emergency Department of a Tertiary Private Hospital in the Philippines
Authors: Cruz Bernice Ong-dela , Cledera Darlene Mae E 
Published: November 2023

Abstract

Background
The objective of this study is to evaluate the prognostic value of NEWS2, assessed upon arrival at the emergency department, for predicting in-hospital mortality and ICU admission in COVID-19 patients.

Methods
In this retrospective cohort study, the medical records of patients with confirmed COVID-19 infection between June 2021 to November 2021 were reviewed. The study evaluated the predictive accuracy of NEWS2 for ICU admission and in-hospital mortality based on the patients' baseline scores at the emergency department. Sensitivity, specificity, and the area under the curve were calculated for NEWS2 score of ≥ 5.

Results
A total of 382 COVID-19 patients were analyzed. The median age was 63 years, of whom 59% were male. The overall mortality rate was 23.5%, and 28.5% of patients were admitted to the ICU. The median NEWS2 score was 7 with more than half of the patients considered high risk.The sensitivity and specificity of a NEWS2 score of 5 or higher in predicting ICU admission were 93.58% and 40.66%, respectively, with an area under the curve of 0.67 (95% CI: 0.63-0.71). The sensitivity and specificity of a NEWS2 score of 5 or higher in predicting mortality were 87.78% and 36.64%, respectively, with an area under the curve of 0.62 (95% CI: 0.58-0.67). Age, respiratory rate, oxygen saturation, hypertension, diabetes mellitus, and cardiac disease were found to be associated with an increased risk of ICU admission and mortality.

Conclusion
NEWS2 has good sensitivity and is a reliable predictor of ICU admission and in-hospital mortality in COVID-19 patients

Disclosures
All Authors: No reported disclosures
2301. Viral Kinetics of Sequential SARS-CoV-2 Infections
Authors: Kissler Stephen , Hay James , Fauver Joseph , Mack Christina , Tai Caroline , Anderson Deverick , Ho David D , Grubaugh Nathan , Grad Yonatan H 
Published: November 2023

Abstract

Background
An estimated 65% of the US population had at least two SARS-CoV-2 infections by November 2022, but the impact of prior infection on disease course in subsequent infections has been debated. Population-level studies can yield conflicting results due to biases that arise from differences in differences in infection history, vaccination status, and patient characteristics. Examining the dynamics of SARS-CoV-2 infections at the individual level can help adjust for these biases.

Methods
Using a convenience sample of 94,812 longitudinal RT-qPCR measurements from samples each taken from a combined anterior nares/oropharyngeal swab, we compared the SARS-CoV-2 viral kinetics of first vs. second infections, adjusting for viral variant, vaccination status, and age. We characterized the kinetics of these infections by fitting a hierarchical Bayesian piecewise linear model to the viral concentration measurements.

Results
Relative to first infections, second infections usually featured a faster clearance time (5.1 days, 95% CI (4.7, 5.7) vs. 8.8 days (7.8, 9.8) in first infections), especially in individuals who received a vaccine dose between their first and second infection. Furthermore, a person’s relative (rank-order) viral clearance time, compared to others infected with the same variant, was similar across first and second infections (Spearman correlation: 0.475, p &lt; 0.0001); that is, individuals who had a relatively fast clearance time in their first infection tended to also have a relatively fast clearance time in their second infection.

Conclusion
Like vaccination, immunity from a prior SARS-CoV-2 infection shortens the duration of subsequent acute SARS-CoV-2 infections principally by reducing viral clearance time. Additionally, there appears to be an inherent element of the immune response, or some other host factor, that shapes a person’s relative ability to clear SARS-CoV-2 infection that persists across sequential infections.

Disclosures
Stephen Kissler, PhD, ModernaTx: Advisor/Consultant Christina Mack, PhD, IQVIA: Full time employee of IQVIA which is in paid contractual relationship with bio pharma companies. Caroline Tai, PhD, Evidation Health: Stocks/Bonds|IQVIA: Employee Yonatan H. Grad, MD, PhD, Day Zero Diagnostics: Board Member|GSK: Advisor/Consultant
2315. Hidden in Plain Sight: Latent Class Analysis of Respiratory Infection Symptoms based on COVID-19 Testing and Vaccination History
Authors: Sun Xiaowu , Lupton Laura L , Henriette Coetzer , DeShazo Jonathan , Berk Alexandra , Anatale-Tardiff Laura 
Published: November 2023

Abstract

Background
During XBB variant dominance, there is still a lack of evidence describing phenotypes of acute respiratory infection (ARI) symptoms present at COVID testing and how clusters of symptoms are associated with COVID test positivity, COVID vaccination status, and vaccination timing.

Methods
This observational cohort included 88,147 adult symptomatic individuals presenting for COVID testing at CVS Pharmacy® locations across the US during March and April of 2023. Individuals self-reported ARI symptoms, comorbid conditions, vaccination status, vaccination timing, and demographics when making an appointment for COVID testing. Latent class analysis (LCA) is a statistically robust method of cluster analysis and was adopted to examine patterns of ARI symptoms. COVID testing positivity was tabulated for each pattern by time from last dose of vaccine.

Results
Patients were 43.3 (SD: 16.6) years old on average and 37% male. The cohort was composed of 43% White or Caucasian, 21% Hispanic, 16% Black, 11% Asian, and 9% other race and/or ethnicities. About 20% of patients self-reported at least one comorbid condition. PCR and antigen tests were chosen by 79% and 21% of patients, respectively. Overall, 33% of patients tested positive for COVID. Of 87% vaccinated, 4% had been vaccinated within three months of testing, 21% within 4-6 months, 17% within 7-12 months, and 45% had been vaccinated over one year prior to testing.
The number of months since vaccination was associated with an increased number of reported symptoms, presenting a marked uptick of symptoms at 6-months following the last vaccination dose (Figure 1). LCA identified four distinct phenotype groups of ARI symptoms described with prevalence (%) (Figure 2). Phenotype group positivity rates were also associated with time since last dose of vaccines, and yet unlike individual symptoms, appeared to stabilize six months post-vaccination.

Conclusion
Four ARI symptom phenotypes having distinct responses to vaccine and COVID positivity were identified. Some phenotypes (such as P3 and P4) may present with symptom patterns consistent with seasonal influenza or RSV. More research is needed to validate these findings and understand the implications of possible COVID phenotypes.

Disclosures
Xiaowu Sun, PhD, CVS Health: Employee|CVS Health: Stocks/Bonds Laura L. Lupton, MD, MHSA, CVS Health: employee|CVS Health: Stocks/Bonds Coetzer Henriette, MD, Astra Zeneca: Stocks/Bonds|CVS Health: Employee|GSK: Stocks/Bonds Alexandra Berk, PhD, CVS Health: employee|CVS Health: Stocks/Bonds Laura Anatale-Tardiff, MPH, CVS Health: employee|CVS Health: Stocks/Bonds
2955. The Impact of the Healthcare Environment on the Nasal Microbiome in Children with Cancer
Authors: McNeil Jonathon C , Sommer Lauren M , Joseph Marritta , Runge Jessica , Murugesan Marudhu , Brackett Julienne , Mitchell Amya , Wilber Matthew , Ann Luna Ruth 
Published: November 2023

Abstract

Background
Children with cancer are at risk for healthcare associated infections (HAIs) given their immunosuppression as well as frequent hospitalizations and antibiotic and antiseptic exposure. The degree to which the healthcare environment impacts the flora of children with cancer and its subsequent role in infection is uncertain. We prospectively evaluated the nasal microbiome in children with malignancy relative to healthy children.

Methods
Subjects were enrolled into two cohorts. The high risk cohort included children with a new diagnosis of malignancy recruited from the Texas Children’s Hospital Cancer Center. Children in the low risk cohort were otherwise healthy and enrolled from two Houston area general pediatrics clinics. Subjects had anterior nares swab samples obtained at 3-month intervals for one year. Genomic material was extracted from samples and the 16S rRNA V4 region was amplified and sequenced. Microbiome analysis was performed using QIIME 2, and comparisons in both bacterial diversity (alpha diversity via Shannon index) and composition (genus-level) were made based on cohort and time point. We present early data from the time of subject enrollment and first follow-up.

Results
272 subjects were enrolled. Cohorts were similar in terms of demographics. No subjects were neutropenic at time of sample collection. High-risk subjects were significantly more likely to have received antibiotics (96.4% vs. 17.5%, p&lt; 0.01) and/or chlorhexidine gluconate containing products (91.6% vs. 0%, p&lt; 0.01) in the 90 days prior to enrollment. Within the high-risk cohort, 98.8% had received antineoplastic chemotherapy. Alpha diversity (Shannon index) was lower in the high risk cohort compared to the low risk cohort. In the high-risk cohort, the genera Staphylococcus and Corynebacterium were disproportionately represented relative to the low-risk cohort in which Moraxella predominated (Figure 1). Nasal microbiota were similar across cancer diagnoses.

Conclusion
There are significant changes in the nasal microbiota of children with cancer relative to healthy children. These findings suggest a high impact of healthcare exposure and specifically antibiotics and antiseptics on colonizing flora. Further work is needed to understand how these microbiome perturbations modify risk for HAI.

Disclosures
Jonathon C. McNeil, MD, Allergan: Grant/Research Support|Nabriva Therapeutics: Grant/Research Support