bluuebunny/crossref_metadata_2025_split huggingface dataset:
2470. A Survey of the Collection of Denominator Data in the Korean National Healthcare-associated Infections Surveillance System (KONIS), Intensive Care Unit Module
Authors: Kwak Yee Gyung , Lee Mi Suk 
Published: November 2023

Abstract

Background
National surveillance data should be validated to identify data quality issues. While denominator data can have a significant effect on the healthcare-associated infection (HAI) rate, they are relatively overlooked compared to numerator data. The Korean National Healthcare-associated Infections Surveillance System (KONIS) has been conducting data validation, and this study analyzed the current status of, and problems with, collecting denominator data for the first time.

Methods
The web-based cross-sectional survey was conducted on January 6, 2023 on 183 infection control nurses from 127 hospitals, among a total of 275 participating hospitals in the KONIS ICU module. The questionnaire was delivered using the QR code method and answered online by participants via SurveyMonkey®. The survey examined denominator data collection methods, such as patient days and device days of central lines and urinary catheters. The knowledge of the types of central lines and urinary catheters for KONIS reporting and the responses to case questions about specific situations related to the calculation of device days, were also evaluated.

Results
The respective proportions of manual vs. electronic methods for counting denominator data were 10.4% vs. 81.4% for patient days, 22.4% vs. 67.8% for central line days, and 23.5% vs. 69.4% for urinary catheter days. About 27.3%, 29.5%, and 31.1% of respondents reported periodically checking the accuracy of patient days, central line days, and urinary catheter days data, respectively. Infection control nurses were responsible for collecting the majority (66.1%) of the denominator data and entering them into the Web-based Report and Analysis Program (88.0%). The survey results indicated that the rate of accurately understanding and responding to the case questions on device days for central lines ranged from 24.6% to 78.7%, while for urinary catheters, it ranged from 27.3% to 92.3%.

Conclusion
To maintain the reliability of the national HAI surveillance data, it is important to collect accurate denominator data, in addition to numerator data. This study has identified several areas where improvements in denominator data collection methods are needed. Continuing education on the definition of denominator data and accurate data collection methods is crucial.

Disclosures
All Authors: No reported disclosures
2491. The Association of Parkinson’s Disease with Hepatitis C Virus Infection and Its Treatment
Authors: Aslam Samia , Yan Peng , Butt Adeel A 
Published: November 2023

Abstract

Background
There are contradicting reports regarding the relationship between hepatitis C virus (HCV) infection and its treatment with idiopathic Parkinson’s Disease (PD). We sought to determine the association of HCV infection and its treatment with idiopathic PD.

Methods
We used the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES), as well characterized national cohort of HCV infected Veterans and uninfected controls to create a dataset of HCV infected individuals and propensity-score matched (PSM) uninfected controls, matched on age, race, sex, body mass index, using nearest neighbor matching with a caliper of 0.2 SD. We excluded individuals with prevalent PD diagnosis (any PD diagnosis before the first HCV positive test date and the match date for corresponding controls), HIV or hepatitis B virus coinfection from both groups, and those with missing or undetectable baseline HCV RNA values among the HCV infected group. PD was defined as presence of &gt; 1 inpatient or &gt; 2 outpatient ICD-10 CM codes. HCV treatment was defined as receipt of any FDA-approved treatment with combination directly acting antiviral agents for &gt; 30 consecutive days. Cox regression analysis was used to determine the probability of disease-free survival for HCV infected and uninfected, and among the HCV infected for those treated and untreated for HCV.

Results
We identified a total of 25,579 matched pairs. Incident idiopathic PD was diagnosed in 344 (1.34%) of HCV+ and 252 (0.99%) of HCV- individuals. Among the HCV+, 9,445 (36.9%) were treated and 91 (0.96%) were diagnosed with PD; while 16,134 were untreated and 161 (1.00%) were diagnosed with PD. Kaplan-Meier curves showed no difference in the probability of remaining PD-free between HCV+ and HCV- (log-rank p=0.5; see figure), while among the HCV+, those who were treated had a higher probability of remaining PD-free over median of 10.5 years (IQR 5.3-15.6; maximum 23.6 years) of follow-up (log-rank p &lt; 0.001; see figure).

Conclusion
While we did not find a difference incidence of idiopathic PD among HCV+ vs. HCV- individuals, HCV+ individuals who received anti-HCV treatment were less likely to develop incident idiopathic PD over a median of 10.5 years of follow up.

Disclosures
Adeel A. Butt, MBBS, MS, Gilead Sciences: Grant/Research Support|Merck and Company: Grant/Research Support
2499. What Are We Waiting for? Chronic Hepatitis C Treatment Initiation During Inpatient Admission
Authors: Ham YoungYoon , Ryu HaYoung , Williams Carissa , Babiarz Jane , Varley Cara D , Streifel Amber C , Maier Marissa , Conte Michael , Govindan Sujeet 
Published: November 2023

Abstract

Background
Chronic hepatitis C virus (HCV) infection is highly prevalent among people who inject drugs. This vulnerable population experiences many barriers to engaging with the healthcare system. Evaluating and treating HCV during a hospital stay can be an opportunity to cure and prevent adverse HCV complications in a population that can be difficult to reach in an outpatient setting.

Methods
This was a retrospective review of treatment outcomes of patients who started on treatment for HCV infection with direct acting antivirals (DAAs) while hospitalized at an academic medical center between January 2022 and January 2023. DAAs were dispensed by outpatient pharmacies and brought into the hospital for patient use. Various teams were involved in the treatment of these patients and level of support varied between groups, ranging from full social services and pharmacy support to follow-up clinic visits only. Data collected included demographics, insurance type, injection drug use, housing status, DAA agents used, treatment duration and completion status, and sustained virological response (SVR) 12 or more weeks post-treatment.

Results
A total of 17 patients began treatment with DAAs while hospitalized. Sixteen (94%) were treated with glecaprevir-pibrentasvir for 8 weeks, while 1 (6%) received sofosbuvir-velpatasvir for 12 weeks. Sixteen (94%) reported using injection drugs and 12 (71%) reported unstable housing. All patients had government-managed health insurance, with 16 having Medicaid. Twelve (71%) patients completed treatment: 9 of 12 patients who completed treatment attained SVR12 and 3 were lost to follow up after treatment completion. Of the 5 patients who did not finish treatment, 2 attained SVR12 despite incomplete therapy, 1 is not yet due for SVR12, and 2 were lost to follow up.

Conclusion
In a vulnerable population with barriers to outpatient care, in-hospital evaluation and DAA initiation is a valuable opportunity to cure. Further evaluation is needed to optimize and implement strategies for inpatient HCV treatment initiation.

Disclosures
All Authors: No reported disclosures
2510. Adapting the CDC HCV viral clearance cascade methodology for persons with HIV (PWH) and HCV co-infection in 5 Health Department Jurisdictions in the US
Authors: Wegener Maximilian D , Brooks Ralph P , Nichols Lisa G , Villanueva Merceditas 
Published: November 2023

Abstract

Background
Cascades of care have been used by health departments to evaluate outcomes and gaps in HIV care and until recently, no standard existed for HCV cascades. The CDC guidance for HCV viral clearance cascades allows standardized use of HCV surveillance data. We adapted this approach for persons with HIV/HCV coinfection for 5 health jurisdictions in the US.

Methods
Lists of coinfected persons were generated by matching HCV surveillance data to prevalent HIV surveillance (eHARS) as of 12/31/2019. Dispositions based on HCV test results were created for viral clearance cascade steps: ever infected, viral testing, initial infection, cleared, and persistent infection. We collected aggregate data from each jurisdiction’s prevalent HIV, HCV, and coinfected populations. Quarterly updated data were submitted and analyzed from 12/31/2019-12/31/2021.

Results
Overall, jurisdictional coinfected populations were White (61%), Male [sex at birth] (75%), over 45 (76%) with IDU as HIV transmission risk factor (44%). As of most recent submission: virally tested was 73% (jurisdictional range 65-88%) of ever-infected; initial infection 83% (81-89%) of virally tested; cleared 44% (21-63%) of initial infection. Those more likely to receive viral testing include persons over 45, IDU, and those with more recent HCV and HIV lab tests; less likely were MSM (HIV transmission) along with Asian and Native American persons. Those more likely to achieve HCV clearance include those over 45, those with more recent HCV and HIV lab tests, and persons with undetectable HIV viral loads; less likely were Transgender persons.

Conclusion
Diverse health jurisdictions successfully developed data strategies including enhancing HCV surveillance databases to implement the CDC HCV viral clearance cascade adapted for persons with HIV/HCV co-infection. Jurisdictions are now able to not only assess HCV cure rates of their co-infected population but testing and treatment gaps as well. The viral clearance cascades can provide key implementation strategy data for HCV microelimination through the development of innovative engagement strategies focused on the identified gaps.

Disclosures
Ralph P. Brooks, MS, Merck: Stocks/Bonds
2528. Cefepime Induced Neurotoxicity in Patients With or Without a History of Seizures
Authors: Baalbaki Nadeem , Hoge Christopher , Dar Aleena , Mohsen Mahinaz , Sackey Joachim , Salim Tanzila 
Published: November 2023

Abstract

Background
Cefepime is a commonly utilized antimicrobial for the treatment of nosocomial infections and serves as a carbapenem sparing agent for the treatment of ampC inducible bacteria. Although generally tolerated, cefepime induced neurotoxicity (CIN) is a well-documented adverse effect that has been observed most significantly in patients with renal dysfunction and elevated serum troughs. Data describing the incidence of CIN in patients with a history of seizures is currently limited.

Methods
This was a retrospective matched cohort study of patients admitted to University Hospital from May 2020 to May 2022 who were treated with cefepime for &gt; 48 hours with or without a baseline history of seizures. Patients with seizures were identified using ICD-10 codes. Patients were matched at a rate of 1:1 by age (+/- 5), sex at birth, and month of admission (+/- 1). The primary outcome was the rate of CIN in patients with a history of seizures versus patients without a history of seizures. The secondary outcome was identification of risk factors associated with CIN.

Results
A total of 102 patients were included in this study (51 in each group). There was no statistically significant difference in the rate of CIN in patients with a history of seizures versus patients without a history of seizures (11.8% vs 5.9%, P = 0.487). In a univariate analysis, patients with acute kidney injury (OR, 13.1 [95% CI, 2.3-74.8]) and an intensive care unit (ICU) stay (OR, 5.3 [95% CI, 1.04-36.4]) were associated with an increased risk of CIN. In a multivariate analysis, duration of cefepime administration was the only risk factor associated with CIN that was statistically significant (OR, 1.94 [95% CI 1-3.8]).

Conclusion
There was no statistically significant difference in the rate of CIN in patients with a history of seizures compared to patients without a history of seizures, although there were twice as many patients with CIN in the seizure group. Patients with acute kidney injury and an ICU stay were more likely to experience CIN in a univariate analysis, however confidence intervals were wide requiring caution with interpretation. There was a 1.94 times increase in the odds of CIN with every additional day of cefepime administration. Further investigations with larger sample sizes are warranted to confirm these findings.

Disclosures
All Authors: No reported disclosures
2543. Multisite Analysis of Vancomycin Predictions in a Bayesian Software in Patients with and without Acute Kidney Injury in Adult and Pediatric Patients
Authors: Hughes Maria-Stephanie , Hughes Jasmine 
Published: November 2023

Abstract

Background
Inpatients that require vancomycin therapy often present with an acute kidney injury (AKI). Due to their unstable renal function, pharmacists hesitate to base dosing decisions on predictions provided by pharmacokinetic (PK) models within a Bayesian software. This study will therefore compare accuracy of predictions by various PK models in patients presenting with and without AKI.

Methods
Adult and pediatric patients receiving vancomycin therapy from 1/1/2022 - 12/31/22 that were dosed using a Bayesian software were retrospectively evaluated. Data on patient age, weight, height, serum creatinine (SCr), sex, and vancomycin doses and levels were recorded. Baseline SCr was defined as the median of SCrs before vancomycin was given. AKIs at start of therapy were defined as a baseline SCr or any SCr collected &lt; 12 hours into therapy that was &gt; 1.5 times higher than any subsequent SCrs. A priori accuracy was calculated by measuring root mean square error (RMSE) of 7 PK models for patients with and without AKIs at start of therapy. Statistical difference between RMSE values was determined by non-overlapping 95% confidence intervals.

Results
A total of 149,100 adult and 4,311 pediatric patient treatment courses were included (see Table 1). Higher RMSE, or lower accuracy, was seen in the AKI groups for all models evaluated, and all except one were statistically different (see Table 2). The RMSE in the group without an AKI at baseline ranged from 4.27 - 6.70 mg/L whereas in the AKI group it ranged from 4.58 - 7.31 mg/L. The absolute difference between groups for each model ranged from 0.03 - 2.05 mg/L and the percent difference ranged from 0.45-39%.

Conclusion
PK models had reduced accuracy in patients with an AKI at start of therapy compared to those that do not. However, differences were small and statistical differences were likely detected due to large sample sizes. For adults, the Colin and Thomson models showed small (&lt; 10%) reductions in accuracy in patients with an AKI, while for pediatric patients, the Kloprogge model showed equal accuracy in all patients regardless of AKI status. These findings may help pharmacists decide whether to use PK models to inform initial vancomycin dosing.

Disclosures
Maria-Stephanie Hughes, PharmD, InsightRX: Stocks/Bonds Jasmine Hughes, PhD, InsightRX: Employee
2579. Pneumonia Severity Index and CURB-65 scoring for the evaluation of community associated pneumonia in patients with cancer at a major cancer center
Authors: Gali Varshini , Lee Yeon Joo , Jani Krupa , Kaltsas Anna , Seo Susan K , Cintron Melvili 
Published: November 2023

Abstract

Background
Cancer patients with pneumonia (PNA) have 2 to 21 times higher mortality rate compared to the general population. The Pneumonia Severity Index (PSI) and CURB-65 scale have been used to predict mortality for patients with community acquired pneumonia (CAP). While these scales are well studied in the general population, there is a paucity of research on the utility of PSI and CURB-65 for predicting outcomes from CAP in patients with cancer. In this study, we assessed the relationship between PSI and CURB-65 score and 30-day mortality of CAP in cancer patients at Memorial Sloan Kettering Cancer Center (MSKCC).

Methods
A prospective study at MSKCC was conducted between 01/2023 and 06/2023 on patients who presented with clinical symptoms consistent with PNA and had a urine streptococcus antigen test sent for evaluation. PNA was defined as pulmonary infiltrates on chest X-ray or CT &lt; 48 hours of index event and ≥ 1 clinical symptoms (fever, cough, dyspnea, increased sputum production, hypoxemia). Descriptive statistics were performed to report participant outcomes based on PSI and CURB-65 score and to identify the factors associated with CAP in this population. PSI and CURB-65 scores were derived as described in the literature, based on patient comorbidities (including neoplasia), clinical signs and laboratory values. Higher score is associated with worsening 30-day mortality.

Results
For 86 participants with who presented with symptoms of PNA and had a urine antigen test sent, 43 (50%) were diagnosed with CAP (Figure 1). The median age was 70 (range: 29-88), 21 (49%) were male, and 16 (37%) had hematologic malignancies (Table 1). Etiologies of CAP were identified in 8 patients (bacteria in 4 patients, virus in 3 patients, fungus in 1 patient). Of the 28 patients with 30-day outcome data available, 5 (18%) died within 30 days of CAP diagnosis. All 5 deceased participants were categorized as PSI Class IV or V (moderate to high risk); however, these participants only scored 0-2 (low to moderate risk) on the CURB-65 scale (Table 2).

Conclusion
We observed a 30-day overall mortality (n=28) of 18%. For cancer patients who present with CAP, PSI class provides a better means to assess mortality risk than CURB-65 score. Further study is needed to validate our findings.

Disclosures
Yeon Joo Lee, MD, MPH, AiCuris: institutional research support for clinical trials|Karius: institutional research support for clinical trials|Merck: Grant/Research Support|Scynexis: institutional research support for clinical trials Susan K. Seo, MD, Merck: Grant/Research Support
2582. Real-World Analysis of the Outcomes of Patients Treated with Ceftazidime-Avibactam
Authors: Wazzi-Mkahal Rayyan , Mansour Reem , Hamade Mahdi , Ghoussaini Racha , Tashman Adeeb , Doumat George , Abou-Fayad Antoine , Matar Ghassan , Kanj Souha S , Kanafani Zeina 
Published: November 2023

Abstract

Background
Ceftazidime-avibactam (CAZAVI) is a novel β-lactam/β-lactamase inhibitor combination with activity against Pseudomonas aeruginosa and some carbapenem-resistant Enterobacterales. CAZAVI has been particularly useful as a carbapenem-sparing strategy to mitigate the selection pressure observed with carbapenems. We aim to perform a real-world analysis of patients treated with CAZAVI for various clinical indications at a tertiary care center in Lebanon.

Methods
This is a retrospective study conducted at the American University of Beirut Medical Center from 2019-21. We excluded patients who were less than 18 years old, received CAZAVI for less than 48 hours, had severe COVID-19 infection, received more than three courses of CAZAVI, and patients on palliative care before CAZAVI treatment. Data were collected from electronic medical records. The primary endpoint was unfavorable outcome defined as death or incomplete clinical response.

Results
A total of 301 patients were included contributing 373 infection episodes. The median age was 66 years, with 48% of patients being male, and 55% having a high Charlson Comorbidity Index (CCI) of ≥ 5. A large proportion of patients had been admitted to the intensive care unit and had received antibiotics for more than 48 hours during the preceding 30 days. The majority of infection episodes were hospital-acquired (66%). The most common indication for CAZAVI was respiratory infection (44%) followed by bacteremia (9%). Clinical cultures were positive in 44% of episodes distributed as Enterobacterales 64%, P. aeruginosa 10%, and polymicrobial 26%. Clinical success was 66% and microbiological success was 52%. Mortality was 32%, 65% of which was directly attributable to the infection. The primary endpoint was achieved in 38% of episodes. Multivariate analysis of independent predictors of unfavorable outcome is shown in the Table.
Independent Predictors of Unfavorable Outcomes in Patients Receiving CAZAVI

Conclusion
Results from this highly morbid patient population suggest a good overall response to CAZAVI therapy. The presence of multiple infection sites is an important predictor of unfavorable outcome.

Disclosures
Souha S Kanj, MD, Gilead: Advisor/Consultant|Menarini: Advisor/Consultant|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant
2595. Burden of Lower Respiratory Tract Infection in United States of America and its Trend from 1990-2019: A Benchmarking Analysis from the Global Burden of Disease Study
Authors: Raj Deepti , Rao Mallyala Sahithi , Chirumamilla Avinash , Gajjar Jay , Patel Sneh , Dekhne Anushka , Dineshbhai Desai Hardik 
Published: November 2023

Abstract

Background
Lower respiratory infections (LRIs) cause substantial mortality and morbidity in the United states of America (USA) accounting for 2.78% of all causes of deaths. However, there is a large statewide variation within the United States with regard to LRIs burden. Comparable and consistent state-level measures of total LRIs burden have not been produced previously.

Methods
We used Global Burden of Disease Methodology to estimate the burden of LRIs by Age-groups, year, sex, location across the USA.

Results
In 2019, there were 299,564(95% UI 281,732–317,390) prevalent cases of LRIs in the USA, with an age-standardized rate (ASR) of 85.2 (95% UI 78.8-91.9) per 100,000 population. The annual percentage change of total number incidence increased by 14% followed by deaths increased 13% from 1990-2019. Furthermore, Mississippi [20.49 (95% UI 17.4–23.9)] per 100,000 and Tennessee [19.1 (95% UI 16–22.5)]per 100,000 had the highest age-standardized mortality rate (ASMR) in 2019. In 2019, the incidence and DALY were highest in the 60-64 age group,75-79 age group respectively in both females and males.
Age-Standardized Incidence, Mortality and DALYs Lower Respiratory Tract Infection in United States, 2019
Trend of Lower Respiratory Tract Infection in USA from 1990-2019
A) All age-counts, Incidence, Death, DALY B) Age-standardized rate Incidence, Death, DALY
Sex-wise distribution of Lower Respiratory Tract Infection, Deaths, per 100,000 across the United States

Conclusion
LRIs continue to be a significant burden on the healthcare system in the United States, causing a significant economic impact and affecting vulnerable populations disproportionately. Preventive measures and prompt treatment can help reduce this burden and improve the overall health of the population.

Disclosures
All Authors: No reported disclosures