bluuebunny/crossref_metadata_2025_split huggingface dataset:
2270. Dealing with an old foe –Assessment of Knowledge, Attitude, and Practices: A survey on management of Staphylococcus aureus bacteraemia among Indian Physicians
Authors: Ravindra Akshatha , Kumar Deepak , Meena Durga Shankar , Naguthevar Santhanam , Bohra Gopal Krishana 
Published: November 2023

Abstract

Background
Staphylococcus aureus bacteraemia (SAB) is associated with high morbidity, mortality, and healthcare costs. Effective management of SAB significantly improves outcome. There is significant gap in the guidelines and clinical practice. This survey was conducted with aim to assess opinions and practice patterns in management of SAB among Indian clinicians.

Methods
We conducted a cross-sectional respondent-driven survey, using a 45-item, anonymous, voluntary, multiple-choice google form questionnaire among clinicians in India, after obtaining ethical approval from the institute. We distributed survey via social media, WhatsApp, and E-mail. Survey responses were analysed using SPSS, Version 25.0.

Results
The total of 125 practicing clinicians responded to this survey. Questions where systematically divided into treatment of choice for MSSA, MRSA, additional investigations, persistent bacteraemia, and adjunctive anti-toxin therapy. Around 57% of the respondents have 1-10 episodes of SAB every month. For suspected SAB, most respondents (74%) preferred vancomycin as empiric therapy. If MSSA was identified, 66.7% initiated on Anti staphylococcal penicillin, while in MRSA vancomycin was selected by majority (80%) (Figure 1 & 2). Most clinicians (74%) perceived 1st generation cephalosporins non-inferior to ASPs. Infectious diseases referral for SAB was undertaken in only in about 56% of the cases, with 25% respondents citing non-availability of ID specialist in the institute. Repeat blood cultures and echocardiography was performed by most respondents. Lack of consensus was apparent in diagnosis and management of persistent bacteraemia and oral switch of therapy (Figure 1 & 2).Most respondents managed SAB with at least 14 days of parenteral antibiotics in several scenarios. But, in patients with complicated SAB there was significant practice variation (Figure 3).
Figure - 1
Drug of choice in MSSA, MRSA and management of persistent bacteraemia according to the respondents
Figure 2
Persistent bacteraemia definition according to the respondents along with the additional tests performed

Conclusion
There were some areas of consensus, but this survey highlights considerable practice variation among clinicians. Although the value of ID consultation in SAB management has been established by multiple studies, this survey demonstrates that there remains ample opportunity to further define best practices and optimize management of this complex disease.

Disclosures
All Authors: No reported disclosures
2273. Azithromycin Use Before and During COVID- 19 and Impact of Implementing Evidence-based Guidelines
Authors: Shams Sherin , Nafady-Hego Hanaa , Thomas Anil G , Saleem Samah , Hanana Fathima , Malik Aimon , Kaleeckal Anvar Hassan , Latif Ali Nizar , Umar Aftab Mohammad , Alkhal Abdullatif , Almaslamani Muna , Abou-Samra Abdul-Badi , Butt Adeel A 
Published: November 2023

Abstract

Background
Early in the COVID-19 pandemic, results from small uncontrolled studies led to azithromycin being proposed as an effective treatment in patients with COVID-19. Numerous subsequent randomized controlled trials and observational studies have failed to demonstrate azithromycin’s effectiveness in COVID-19. The magnitude of azithromycin overuse, particularly for COVID-19 remains undocumented. We sought to quantify the use of azithromycin before and during the COVID-19 pandemic in a national healthcare system where specific evidence-based guidelines were rapidly implemented for judicious use of various suggested COVID-19 treatments.

Methods
The study was conducted at Hamad Medical Corporation in Qatar, which was the single provider of inpatient care for COVID-19 in Qatar. Evidence-based guidelines were implemented in Qatar for use of azithromycin in June 2020. For our study, all azithromycin prescriptions between 2019-2022 were retrieved from the electronic medical records. Number of azithromycin courses prescribed, and rate/100,000 population were calculated and compared over time. A course was defined as any azithromycin prescription with no gap of &gt; 10 days. A course was deemed related to COVID-19 if written within -3 to +10 days of a positive SARS-CoV-2 PCR. A one-way repeated measured analysis of variance was conducted to evaluate the null hypothesis that there was no change in azithromycin use before and during COVID-19.

Results
During the study period, a total of 203,806 azithromycin courses were prescribed for 166,062 individuals. Overall number of courses increased in the first 2 quarters of 2020 (average 12,857/quarter in 2019 to average of 19,297 in Q1-Q2 of 2020) and then dropped precipitously to 9,881/quarter over the next 6 quarters. COVID-19 related azithromycin courses peaked in 2020-Q2 (13,691) and dropped subsequently to 2,836 for 2020-Q3, 1,410 for 2020-Q4; 5,465 for 2021-Q1, and 4,288 for 2021-Q2. Stringent evidence-based guidelines implemented in June 2020 for use of various COVID-19 therapeutics coincided with the rapid drop in azithromycin use for COVID-19.

Conclusion
While azithromycin prescriptions increased immediately after the COVID-19 pandemic, a rapid decline was observed immediately after implementing evidence-based guidelines

Disclosures
Adeel A. Butt, MBBS, MS, Gilead Sciences: Grant/Research Support|Merck and Company: Grant/Research Support
2274. Trends in Empiric Antibiotic Utilization for Patients Hospitalized with Community-Onset SARS-CoV-2 Infections and Viral Sepsis During the COVID-19 Pandemic
Authors: Shappell Claire N , Klompas Michael , Kanjilal Sanjat , Chan Christina , McKenna Caroline S , Rhee Chanu 
Published: November 2023

Abstract

Background
Empiric antibiotic use in patients hospitalized with COVID-19 was common early in the pandemic despite low rates of bacterial co-infection. Little is known, however, about trends in antibiotic prescribing for patients with COVID-19 with and without viral sepsis.

Methods
We retrospectively identified all adults admitted to 5 Massachusetts hospitals from March 2020 to November 2022 with community-onset COVID, defined by positive SARS-CoV-2 PCR prior to hospital day (HD) 3. Community-onset COVID sepsis was defined as a positive PCR and ≥1 acute organ dysfunction (advanced oxygen support, vasopressors, elevated lactate, or changes in baseline creatinine, bilirubin, or platelets) before HD 3. We calculated quarterly rates of initial (before HD 3) and prolonged (≥4 days/first week) empiric broad-spectrum antibiotics in COVID patients with and without sepsis and estimated quarterly odds for receipt of prolonged antibiotics relative to the first pandemic quarter using logistic regression to adjust for age, comorbidities, and positive blood or sputum cultures before HD 3.

Results
Of 431,017 total hospitalizations, 21,563 (5.0%) had community-onset COVID, of whom 3,829 (17.8%) had COVID sepsis. COVID patients with sepsis had a positive blood or sputum culture before HD 3 in 8.8% of encounters versus 1.8% of those without sepsis. Initial antibiotics were given to 69.0% of COVID patients with sepsis vs 34.3% of those without sepsis and were continued for ≥4 days in 49.5% and 18.6% respectively. Crude quarterly rates of prolonged antibiotic use decreased from 66.9% to 47.6% for COVID patients with sepsis (IRR 0.96/quarter, 95% CI 0.95-0.97) and from 31.0% to 16.4% for COVID without sepsis (IRR 0.95/quarter, 95% CI 0.94-0.96) (Figure). Trends in prolonged antibiotic use were similar after risk adjustment (quarterly aOR 0.92 for COVID with sepsis, 95% CI 0.90-0.94 and aOR 0.91 for COVID without sepsis, 95%CI 0.90-0.92).
Trends in Prolonged Antibiotics Prescribing for Hospitalized Patients with SARS-CoV-2 with and without Viral Sepsis

Conclusion
During the first 2.5 years of the pandemic, empiric antibiotics were given to 2/3 of COVID patients with community-onset sepsis and 1/3 of COVID patients without sepsis, usually for at least 4 days, despite low rates of documented bacterial co-infection. Antibiotic use in both groups, however, significantly declined over time.

Disclosures
Michael Klompas, MD, MPH, UpToDate, Inc.: Royalties for chapters on pneumonia Sanjat Kanjilal, MD, MPH, GSK: Advisor/Consultant|Pattern biosciences: Advisor/Consultant|Roche: Honoraria|Uptodate: Royalties Chanu Rhee, MD, MPH, Cytovale: Advisor/Consultant|Pfizer: Advisor/Consultant|UpToDate, Inc.: Honoraria
2282. Characterizing Antibacterial Regimen Modification, Patient Characteristics, and Outcomes for Patients with Complicated Gram-Negative Bacterial Infections
Authors: Yamaki Jason , Yucel Emre , Watanabe Alexandre H 
Published: November 2023

Abstract

Background
There are few studies describing the rationale or frequency of empiric or directed therapy treatment modification behaviors among patients with complicated Gram-negative bacterial infections (GNBI). We sought to characterize patient and treatment characteristics, details of regimen modification, and patient outcomes.

Methods
This retrospective chart review included patients, admitted from 1/1/2019-12/31/2020 to Hoag Memorial Hospital, with a complicated GNBI due to an extended spectrum cephalosporin resistant pathogen. Patient charts were reviewed for demographics, antibiotic (ABX) modifications, rationale and timing of modifications, and patient outcomes. ABX modifications were defined as GNB ABX switched, added, or removed.

Results
The study cohort included 400 patients (median age 74.5 years; 61% male). The predominant sources were lung (34%) and bloodstream (26%) for single cultures and bloodstream (33%) and urine (26%) for multiple cultures. The most common pathogens were ESBL organisms (36% overall with E. coli accounting for 81% of cases), and Pseudomonas spp. (40%). Inpatient initial empiric therapies included piperacillin-tazobactam (32%), cefepime (24%), meropenem (15%), and ceftriaxone (17%). ABX regimens were modified up to 6 times in 72% of patients. Median [IQR] time to first modification was 41 [21, 70] hours. For initial modifications, 70% were escalations, and most empiric modifications were based on preliminary culture results (56%) and lack of patient response or decompensation (25%). No difference in mortality and readmission was observed based on presence of ABX modifications.

Conclusion
Many patients experienced modification to GNB empiric and targeted antibacterial regimens. In almost all cases, rationale for change was documented. No difference in patient outcomes was observed. Despite changes to ABX regimens, patient outcomes are not improved possibly due to shortcoming of existing antibiotic portfolio. Furthermore, the numerous changes in therapy observed may reflect the lack in identifying patients with resistant GNB organisms early in admission. This highlights the needs of more effective and novel antibiotics and importance of identifying patients at risk for resistant GNBI.

Disclosures
Jason Yamaki, PharmD, PhD, Merck & Co., Inc.: Grant/Research Support Emre Yucel, PhD, MERCK: I am a full time Merck Employee and own stocks in the retirement plan provided by Merck.|MERCK: Stocks/Bonds Alexandre H. Watanabe, PharmD, Merck & Co., Inc.: Employee
2299. Genomic Epidemiology of SARS-CoV-2 in Metropolitan Detroit
Authors: Kaur Jagjeet , Gurdziel Katherine , Wasinski Benjamin , Vakeesan Nivisa , Raza Sayed Hassan , Liu Wanqing , Zervos Marcus , Suleyman Geehan 
Published: November 2023

Abstract

Background
The COVID-19 pandemic, resulting from the rapidly evolving SARS-CoV-2 virus, has drastically impacted health systems and economies worldwide. Genomic sequencing is critical for the surveillance of SARS-CoV-2 to monitor the rapidly evolving virus and identify new strains.

Methods
583 isolates from Henry Ford Health were retrospectively profiled across 3 years (117 isolates in 2020; 39 in 2021; 427 in 2022). DNA was extracted using Kingfisher viral isolation kit; RT-PCR screening was used to identify isolates with cycle threshold &lt; 32 for whole genome sequencing (WGS). Libraries were generated using QIAseq DIRECT SARS-CoV-2 Kit, followed by Illumina sequencing (MiSeq or NovaSeq 6000; 300 cycles). Lineage analysis of the SARS-CoV-2 consensus genome sequences generated from samtools variant analysis pipeline was determined using Nextclade and Pangolin software.

Results
Sequences were classified into 11 unique clades across 108 lineages by Nextclade and Pangolin, respectively. Almost three-fourths of the sequenced isolates were from 2022. 117 (20%) genomes were from the early pandemic (2020) and were clustered into 8 clades: 19A, 19B, 20A, 20B, 20C, 21 J (Delta) and 21L (Omicron). Most of the 2022 genomes (72%) were in clade 20C from lineage B.1, identified during the outbreak in Europe. 15 (13%) genomes had clade 19A (lineage B) and 1 had 19B (lineage A.3), identified early in the pandemic in Wuhan, China. Of the 39 (7%) genomes from 2021, the majority (82%) clustered into clade Delta 21J that originated in India. Only 2 (5%) of the genomes from 2021 had Alpha variant of concern (21I) from the lineage B1.1.7, which were suspected to be more transmissible. Of the 427 (73%) genomes from 2022, 393 (92%) had variants within Omicron variant of concern (21L), with 79 different lineages; 1 was Omicron variant 21K from the lineage BA1.1. Other clades observed in the 2022 batch were 19A (6%), 20A (0.2%), 20B (0.2%), 20C (0.2%) and 21M (1%).

Conclusion
Our genomic surveillance data suggest that SARS-CoV-2 infections at the local level mirrored global outbreaks. This underscores the importance of robust genomic surveillance efforts to inform public health planning and practice.

Disclosures
Marcus Zervos, MD, Contrafect: Advisor/Consultant|GSK: Grant/Research Support|Johnson and Johnson: Grant/Research Support|Pfizer: Grant/Research Support
2300. Incidence of COVID-19 in Irish Healthcare Workers: Preliminary Results from PRECISE-5
Authors: Kenny Claire , McGrath Jonathan , Kelly Gavin , Walsh Shane , Moran Conor , Flynn Lee , Byrne David , Flynn-Dowling Irene , Allen Niamh , Rooney Peadar , Martin Greg , Doherty Lorraine , Fleming Catherine , Bergin Colm 
Published: November 2023

Abstract

Background
Healthcare workers (HCW) are the ideal population to track the evolving epidemiology of SARS-CoV-2. Surges in breakthrough SARS-CoV-2 infection and quarantine regulations leads to staff absence at a time when hospital resources are already burdened.

Methods
All HCWs in 2 large teaching hospitals were invited to participate in this prospective longitudinal cohort study in November 2022. Information on demographics, SARS-CoV-2 infection history and COVID-19 vaccination dates/brands was collected. Baseline serology for anti-Nucleocapsid (N) and anti-Spike (S) antibodies was performed. Cohort seroprevalence was compared to a prior study phase (November 2021). Monthly follow-up e-surveys collected information relating to incident SARS-CoV-2 infections, symptom duration and work days missed.

Results
1261 participants enrolled (Table 1). 25/1261 (0.08%) were unvaccinated. 1103/1261 (87.5%) had received a primary vaccine series and at least one booster.
1260/1261 (99.9%) of participants were anti-S seropositive. 1008/1261 (79.9%) participants were anti-N seropositive. In comparison, serology performed in November 2021 showed anti-N antibody seropositivity in 23.4% (p&lt; 0.0001). 377/1261 (29.9%) participants denied having a prior SARS-CoV-2 infection; of these, 178/377 (47.21%) were anti-N seropositive suggestive of previously undiagnosed infection.
Response rate to monthly surveys over the first 14 weeks of the study (Weeks 45-52 of 2022 and Weeks 01-06 of 2023) was 54.3%. 121/1261 (9.6%) of participants reported a positive SARS-CoV-2 test (PCR or Antigen). Incident infections peaked at Weeks 50-52 of 2022 (Fig. 1), reflective of the national trend. 41/121 (33.8%) reported a symptomatic infection, with median symptom duration 7.5 days. Over 14 weeks, total number of work days missed secondary to SARS-CoV-2 infection was 589 days (median 5 days missed per HCW).

Conclusion
In this interim analysis, 9.6% of participants reported an incident SARS-CoV-2 infection over 14 weeks. This was in the context of high baseline seropositivity for anti-N antibody and vaccination uptake. This suggests that SARS-CoV-2 continues to circulate widely. While morbidity and mortality is low, there are significant consequences including rostered working days lost in healthcare settings.

Disclosures
All Authors: No reported disclosures
2306. A serosurvey of healthcare workers caring for, or handling specimens from, individuals exposed to, or diagnosed with, SARS-CoV-2 infection (COVID-HEROES)
Authors: Pradhan Alyssa , Dwyer Dominic E , Hueston Linda , Asquith Will , Dotel Ravindra , Nanan Ralph , Wood Nicholas , Howard-Jones Annaleise , O’Kane Gabrielle M , Stuart Rhonda , Whyler Naomi , Chua Kyra , Gilbey Timothy , Bemand Timothy , Weatherall Chris , Hammoud Mohamed , Martinello Marianne , Rai Neela Joshi , O’Sullivan Matthew 
Published: November 2023

Abstract

Background
COVID-HEROES is a multicentre study of Australian healthcare workers (HCW) assessing 1) incidence of and risk factors for SARS-CoV-2 infection and 2) serological response to SARS-CoV-2 vaccination and infection.Figure 1:Cases of SARS-CoV-2 over time by diagnostic method

Methods
We conducted a multi-centre, prospective observational cohort study of Australian HCWs from January 2020 – January 2023, evaluating incidence of, and risk factors for, SARS-CoV-2 infection. HCWs underwent monthly surveys to assess SARS-CoV-2 occupational exposure, vaccination status and infection and serology testing to detect antibody response to vaccination (measured by IgG immunofluorescent antibody titre) or infection (development of SARS-CoV-2 nucleoprotein (NP) IgG antibodies measured by ELISA). Factors associated with infection were identified using logistic regression models.

Results
575 participants completed 4882 surveys and 4325 serological tests over 36 months. Median enrolment duration was 8.4 (IQR 2.2-17.4) months. 160/575 (28%) of participants reported SARS-CoV-2 infection diagnosed by polymerase chain reaction (PCR) and/or rapid antigen test (RAT). 101/160 (64%) participants with known infection developed NP antibodies. A further 41 participants, without reported infection developed NP antibodies, indicating unrecognised infection (Figure 1).
153/160 (96%) known infections occurred after December 2021, corresponding to the Omicron wave, despite 25-50% of participants reporting occupational exposure to SARS-CoV-2 patients throughout the study period. 571/575 participants developed IgG response following two doses of SARS-CoV-2 vaccine, 6 of whom seroreverted. A logistic regression model of risk factors for HCWs contracting SARS-CoV-2 infection (Table 2) did not identify significant association between occupational exposure and infection (OR 1.49, CI 0.87- 2.57, p = 0.15).

Conclusion
In this 3-year prospective cohort, we report detailed occupational SARS-CoV-2 exposures to assess nosocomial acquisition risk, including symptomatic and unrecognised infection. We demonstrate low rates of infection until community prevalence increased, despite significant workplace exposure, indicating effective use of protective precautions in the Australian healthcare setting.

Disclosures
All Authors: No reported disclosures
2311. Predictive cut-off values for anti-N and anti-S antibodies for COVID-19 risk identification
Authors: Rebellón Sánchez David E , Llanos-Torres Julio , Tafurt Eric , Rosso Fernando 
Published: November 2023

Abstract

Background
The role of anti-N and anti-S antibody tests as a monitoring strategy for identifying patients at risk of developing COVID-19 is not clearly elucidated. Our study explored in a cohort of hospital workers whether the positivity of these antibodies linked to infection and/or vaccination was associated with a decrease in the risk of infections and sought to estimate a predictive cut-off point for the development of COVID-19 in the first 6 months of measurement.

Methods
A prospective observational study was conducted among hospital workers at a university hospital in Cali, Colombia. Measurements of COVID-19 antibodies were taken before the onset of the third, fourth, and fifth waves of COVID-19 cases. Anti-N and Anti-S total antibodies were measured using Elecsys® Anti-SARS-CoV-2 Immunoassay (Roche).

Results
We include 480 participants, 71.8% females and median age of 32 years (IQR: 27-39); 60.62% were healthcare workers involved in the care of COVID-19 patients. It was found that having a history of COVID-19 (aRR 0.49 (95% CI 0.34-0.70)), being vaccinated in the last 6 months (aRR 0.13 (95% CI 0.07-0.24)), having positive anti-N antibodies in the last 3 months (aRR 0.62 (95% CI 0.44-0.87)), and having positive anti-S antibodies in the last 3 months (aRR 0.55 (95% CI 0.31-0.97)) were associated with a lower risk of developing COVID-19. A cutoff point ≤ 150 COI for anti-N levels and ≤1,900 BAU/mL for anti-S levels was found to have a better predictive performance. The chosen cutoff point for anti-N achieved a sensitivity of 98.2%, with a specificity of 12.4%, a negative predictive value (NPV) of 98.5%, and a positive predictive value (PPV) of 10.2%, with an AUC of 0.55 for predicting COVID-19 in the next 6 months. Having anti-S antibodies ≤ 1900 BAU/mL was found to have a sensitivity of 58.1%, specificity of 55.5%, NPV of 85.3%, PPV of 22.9%, and an AUC of 0.63.

Conclusion
Our study suggests that having a positive anti-N or anti-S antibodies result may be associated with a lower risk of developing COVID-19. We also identified predictive cut-off points for anti-N and anti-S antibody levels that may be useful in identifying individuals at a higher risk of developing COVID-19 in the next 6 months. However, further studies are needed to confirm these findings and determine their generalizability to other populations.

Disclosures
All Authors: No reported disclosures