bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shaping a Climate of Arrival: National and Local Media Representations of Refugees’ Arrival Infrastructures in the Netherlands
Authors: Kox Mieke , van Liempt Ilse , Smits Anna 
Published: December 2022

AbstractNegative media representations such as framing refugees as criminals may increase concerns among the general audience about the arrival of asylum seekers. At the same time, these media representations may also create anxiety among the refugees themselves and negatively impact on their sense of belonging. In this article, we explicitly focus on media representations of arrival infrastructures for refugees and how these representations shape their climate of arrival. We zoom in on the regulatory-administrative dimension consisting of all formal structures involved in the arrival of refugees, the everyday practical dimension that refers to infrastructuring practices outside the regulatory-administrative framework related to refugees, as well as the normative-discursive dimension that consists of ideas and debates around arrival and arrival infrastructures. By taking arrival infrastructures as our centre of attention, we move beyond a refugee-centred approach. This allows us to uncover the different layers of the climate of arrival brought to light by national and local media representations as well as to nuance the rather uniform and dominant image of refugees in the media. Our findings show the responsibility of media to represent a more diverse image of refugees as well as the need for migration and media scholars to move beyond a sole focus on how refugees are represented in the media.
738. Outcomes of Ceftriaxone Versus Antistaphylococcal Penicillins or Cefazolin for Definitive Therapy of Methicillin-susceptible Staphylococcus aureus Bacteremia
Authors: Khodadadi Ryan B , Yetmar Zachary A , Go John R , Chesdachai Supavit , Razi Samrah , Abu Saleh Omar M 
Published: December 2022

Abstract

Background
Methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia requires weeks of IV antimicrobial therapy for treatment with antistaphylococcal penicillins (ASP) and first-generation cephalosporins being mainstays of therapy. While effective, use of these agents in the outpatient setting requires frequent dosing along with close toxicity monitoring through the duration of therapy. Ceftriaxone is an appealing alternative given daily dosing and tolerability, but efficacy in this setting remains uncertain. We sought to review outcomes of patients who received ceftriaxone versus an ASP and first-generation cephalosporins for definitive therapy of MSSA bacteremia.

Methods
Following IRB approval, we reviewed medical records of a retrospective adult cohort diagnosed with MSSA bacteremia treated with ceftriaxone, cefazolin, or an ASP between January 2018 and December 2019 at Mayo Clinic campuses. Treatment was defined as the antibiotic used in the outpatient setting. The primary outcome was 90-day treatment failure, defined as a composite of mortality and microbiologic relapse. Secondary outcomes were 30-day treatment failure and individual components of treatment failure. Multivariable Cox regression analysis was performed to analyze for an association between ceftriaxone use and the primary outcome after adjusting for factors that may also impact outcomes. Kaplan-Meier curves were compared utilizing a log-rank test for survival between groups.

Results
A total of 223 patients with the accompanying characteristics met study criteria (Table 1). Thirty-seven received ceftriaxone (16.5%) and 186 (83.4%) were treated with cefazolin or an ASP. Ninety and 30-day treatment failure were higher in those treated with ceftriaxone (27%, 8.1%) compared to cefazolin or an ASP (8.6%, 3.8%). Multivariable analysis for risk of 90-day treatment failure revealed a hazard ratio of 2.91 for ceftriaxone (Table 2) and a significant difference in event-free survival for those treated with ceftriaxone compared to cefazolin or an ASP (Figure 1).

Conclusion
Patients receiving definitive therapy with ceftriaxone for MSSA bacteremia experienced a higher rate of 90 and 30-day treatment failure and a lower rate of event-free survival as compared to those treated with cefazolin or an ASP.

Disclosures
All Authors: No reported disclosures.
751. Decoding a Decade: Temporal Trends of MIC Distribution of Antifungals Against Cryptococcus species From a Reference Laboratory
Authors: Ordaya Eloy E , Abu Saleh Omar M , Vergidis Paschalis , Deml Sharon , Wengenack Nancy , Fida Madiha 
Published: December 2022

Abstract

Background
There are not established clinical breakpoints (CBP) for antifungals against Cryptococcus species; However, the analysis of their MICs using epidemiological cut-off values (ECVs) can help to distinguish wild-type (WT) isolates from non-WT strains that may harbor intrinsic or acquired resistance to antifungals. Herein, we analyze the MIC distribution of antifungals against Cryptococcus spp. isolated over the last decade at our reference laboratory.

Methods
We conducted a retrospective evaluation of antifungals MICs for Cryptococcus neoformans and Cryptococcus gattii complex isolates from various sources that were processed at the Mayo Clinic Laboratory from November 18, 2011 to June 7, 2021. Antifungal susceptibility testing was performed by the Clinical & Laboratory Standards Institute (CLSI) standards (CLSI M59-ED3:2020). We used recommended ECVs to define if the isolates were WT or non-WT, and described the change in the percentage of WT isolates over time.

Results
During the study period, C. neoformans was isolated from 632 samples collected from 533 patients. Sample sources included cultures from blood (n=301), cerebrospinal fluid (n=230), respiratory (n=71), and other sources (n=30). The overall percentage of WT isolates for amphotericin B (AMB), 5-flucytosine, and fluconazole were 77%, 98% and 91% respectively with no significant difference based on various sources (Table). We noticed an overall increase in MICs for AMB, with 100% WT isolates in 2011 compared to 79% in 2021. No such increase was seen for fluconazole or 5-Flucytosine (Figure). Irrespective of the source or the year of isolation, WT strains for itraconazole, voriconazole, and posaconazole were consistently &gt; 93%. C. gattii was isolated from 16 samples, and 94% were WT strains for AMB and 100% for the other antifungals.
CLSI, Clinical and Laboratory Standard Institute; CSF, cerebrospinal fluid; ECVs, epidemiologic cut-off values.
AMB, amphotericin B; FLU, fluconazole; 5FC, 5-flucytosine.

Conclusion
In the last decade, we have observed an overall increase in MICs of AMB for C. neoformans. The number of WT strains for other antifungals was high and not significantly changed during the study frame. Further studies are needed to identify the clinical implications of these findings.

Disclosures
Paschalis Vergidis, MD, AbbVie: DSMB|Cidara: Grant/Research Support|Scynexis: Grant/Research Support.
755. Predictors of Mortality in Invasive Mold Infections Among Patients with Hematologic Malignancies and Hematopoietic Stem Cell Transplant Recipients
Authors: Gupta Aanchal , Ranganath Nischal , Mendoza Maria A , Diseases Infectious , Deml Sharon , Wengenack Nancy , Vergidis Paschalis 
Published: December 2022

Abstract

Background
Invasive Mold Infections (IMI) cause significant morbidity and mortality, particularly in patients with hematologic malignancies (HM) and hematopoietic stem cell transplant (HSCT) recipients. Although the risk has significantly decreased with the use of triazole agents as primary prophylaxis, breakthrough infections still occur. Risk factors for IMI have been well-described. Limited data exist on factors predicting mortality.

Methods
We identified cases using the Cancer registry and Microbiology data at Mayo Clinic Minnesota from 11/19/2011–8/6/2021 and Mayo Clinic Arizona and Florida from 09/13/2017–11/19/2021. We conducted a retrospective review to identify cases of proven/probable IMI per EORTC/MSG criteria. Patients who received at least 7 days of anti-mold prophylaxis were considered having breakthrough infection (Br-IMI). Survival function was estimated using the Kaplan-Meier method. We evaluated predictors of mortality using Cox regression analysis.

Results
401 cases of IMI were included (80.2% aspergillosis, 10.2% fusariosis, 8.4% mucormycosis, 1.2% scedosporiosis). 189 patients had proven/probable and 212 had possible disease. 12-week mortality for the entire cohort was 33%. There were 87 cases of Br-IMI (21.6%) on mold-active prophylaxis (posaconazole n=54, voriconazole n=26, isavuconazole n=5, itraconazole n=1, liposomal amphotericin B n=1).
A comparison between patients not receiving prophylaxis and those with Br-IMI is shown in Table 1. Higher proportion of patients with Br-IMI had prolonged neutropenia/lymphopenia and graft-versus-host disease involving the gastrointestinal tract or lungs. Positive Aspergillus galactomannan (index ≥ 1.0) was seen more in patients who were not on mold-active prophylaxis. Mortality was 31.5% in patients not receiving prophylaxis and 41.3% with Br-IMI (Figure 1). In multivariate analysis, age, prolonged neutropenia, active HM, Br-IMI and HSCT were associated with increased mortality (Table 2).

Conclusion
In this cohort, the rate of Br-IMI was significant despite the use of primary prophylaxis (mainly posaconazole). Mortality was higher in patients with Br-IMI compared to those not receiving mold-active prophylaxis. Therefore, clinicians should remain alert to the possibility of Br-IMI.

Disclosures
Paschalis Vergidis, MD, AbbVie: DSMB|Cidara: Grant/Research Support|Scynexis: Grant/Research Support.
783. Lung Transplantation for COVID-19-Associated Lung Injury (CALI): An International Registry
Authors: Alamri Maha M , Osborn Rebecca , Girgis Reda , Marschalk Nicholas , Rivosecchi Ryan , Ison Michael G , Weder Max , Aslam Saima 
Published: December 2022

Abstract

Background
SARS-CoV-2 can result in a range of infections from asymptomatic disease to progressive COVID-19 and death. In some pts with CALI, lung transplantation (LTx) may be lifesaving. Up to 10% of LTx in the US is currently for pts with CALI. Understanding the characteristics and outcomes of these pts is critical.

Methods
A open-access electronic registry was established to collect de-identified data from pts who have undergone LTx for CALI from centers globally. The study was IRB approved at Northwestern with a wavier for consent (no PHI is collected sites could submit data about pre-Tx, peri-Tx and post-Tx course). Follow-up for 1-yr post-LTx was collected.

Results
To date, 89 pts with complete day 30 post-LTx data have been entered into the registry. Pt demographics and pre-Tx status are shown in Table 1. 3 pts required oxygen prior to COVID-19. Most sites required neg PCR tests prior to listing (11 (12.4%) required no - PCRs, 11 (12.4%) required 1 and 61 (68.5%) required 2). LTx occurred 137 days post-infection and none developed COVID-19 in the first 30 d; 4 were given monoclonal antibodies post-tx. Post-tx ICU LOS averaged 24.5 d with total post-tx hospitalization of 37.6 d (See Table 2). Most experienced infectious and non-infectious morbidity. Most (47.8%) required an additional 30 days of rehab. 2 pts died within 30 days due to sepsis and anoxia. 5 died between day 30 and 90 and an additional 12 died between day 90 and 365.

Conclusion
The contribution of cases to this international registry is ongoing. While outcomes of LTx for CALI are generally good, patients experience prolonged post-transplant hospitalization, rehabilitation and significant morbidity and infections are common.

Disclosures
Michael G. Ison, MD MS, GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support Saima Aslam, MD, Armata: Grant/Research Support|BioMx: Advisor/Consultant|Contrafect: Grant/Research Support|Gilead: Honoraria|Merck: Honoraria|Phico: Advisor/Consultant.
787. Predictors of Co-infection with Multidrug Resistant Organisms among Hospitalized Patients with COVID-19: An Exploratory Analysis
Authors: Zhang Yue , Li Haojia , Jones Barbara E , Rubin Michael , Haroldsen Candace , Willson Tina M , Effiong Atim , Cole Jessica , Khader Karim 
Published: December 2022

Abstract

Background
Bacterial co-infection has been reported with COVID-19, but risk factors for bacterial co-infection remain unclear due to limited large scale studies. We seek to identify predictive factors associated with risk of co-infection with multidrug-resistant organisms for patients hospitalized at Veterans Affairs (VA) hospitals with COVID-19.

Methods
This retrospective cohort study included Veterans admitted to VA hospitals from March 1, 2020 through May 31, 2022 with a confirmed positive COVID-19 test within the previous 14 days and up to 2 days after admission. Outcomes of interest were hospital-onset co-infection (HOI, &gt; 2 calendar days after admission) and community-onset co-infection (COI, within 2 calendar days of admission). Potential risk factors included both patient- (e.g. vital sign, medication use) and facility-level covariates (e.g. bed size, antibiotic use rate). We compared the covariate distributions for patients with and without HOI and COI. Our analytical approaches included variance inflation factors to detect the presence of multicollinearity among these factors, and Least Absolute Shrinkage and Selection Operator to identify the subset of factors associated with HOI and COI. We conducted a two-stage analysis, first performing feature selection among the individual-level risk factors followed by identification of facility-level risk factors. Optimal models were identified using 10-fold cross validation.

Results
By July 2021, 33,383 patients were admitted to VA with positive COVID-19 test. We found that medications for ventilator induction (OR with 95% CI: 2.9 (2.2, 3.9)), norepinephrine (OR with 95% CI: 1.6 (1.2, 2.2)) and antimicrobial therapies for gram-positive infections (OR with 95% CI: 4.5 (3.6, 5.6)) [Table 1] were associated with the increased risk of HOI and patients in facilities with high C difficile infection rates were more likely to have COI detected (OR with 95% CI: 1.14 (1.11, 1.18)) [Table 2]. Homeless Veterans had higher risk of developing an HOI (OR with 95% CI: 1.5 (1.1, 2.0)), but not a COI.

Conclusion
Risk factors for HOI and COI in COVID-19 were distinct, with specific classes of medications and antibiotics as well as patient factors resulting in increased risk for HOI. Further work is needed to better understand the risk factors for COI.

Disclosures
Karim Khader, PhD, BioFire Diagnostics: Grant/Research Support.
873. Comparison of Antibiotic and Antiviral Use before and after Deployment of Rapid Influenza Testing in the Emergency Department
Authors: Wesolowski Alec , Clifton Jennifer D , Miller Jessica , Shields Maureen 
Published: December 2022

Abstract

Background
Influenza shares common symptoms with bacterial pneumonia, resulting in inappropriate prescribing of antibiotics that may lead to increased risk of adverse reactions, antimicrobial resistance, and healthcare costs. Rapid influenza polymerase chain reaction (PCR) tests have reduced turnaround times compared to multiplex PCR respiratory panels allowing for earlier diagnosis, which may improve antimicrobial stewardship outcomes in the emergency department (ED). This study aims to compare antibiotic and antiviral use before and after deployment of a rapid influenza PCR in the ED.

Methods
This single-center, retrospective, cohort study included pediatric and adult patients discharged from the ED with a positive influenza test with either the multiplex PCR respiratory panel (January 2017 – July 2019) or rapid PCR (July 2019 – February 2020). The primary endpoint was antibiotic use pre- and post-implementation of the rapid influenza PCR in the ED. Secondary endpoints included antiviral use, duration of antimicrobial therapy, test turnaround time, ED length of stay, 30-day readmission, and adverse events. A multivariable regression model evaluated patient factors associated with antimicrobial prescribing.

Results
A total of 620 positive influenza results were identified with 280 patients (multiplex PCR = 33; rapid PCR = 247) meeting inclusion criteria. Patients were less likely to be prescribed antibiotics (39.4% vs 8.9%, OR 0.15, 95% CI 0.067–0.34) and more likely to be prescribed antivirals (24.2% vs 61.1%, OR 4.92, 95% CI 2.13–11.34) with the rapid influenza PCR. Rapid influenza PCR significantly reduced ED length of stay (4.9 vs 3.4 hours, p &lt; 0.01) and test turnaround time (27 hours vs 3.5 hours, p &lt; 0.01). Patients at high risk for complications associated with influenza were more likely to be prescribed antiviral therapy (25% vs 77.7%, OR 5.27, 95% CI 3.02–9.17). Based on the regression analysis conducted, asthma, (OR 3.5, 95% CI 1.48–8.26), immunosuppression (OR 9.6, 95% CI 1.18–78.2), and age less than 5 years old (OR 3.1, 95% CI 1.80–5.45) are predictors of antiviral prescribing.

Conclusion
Implementation of a rapid influenza PCR in the ED reduced antibiotic use and optimized antiviral therapy for patients at higher risk of influenza with complications.

Disclosures
All Authors: No reported disclosures.
879. Intravenous to Oral Antibiotic Switch in Patients Hospitalized with Community-Acquired Pneumonia
Authors: Deshpande Abhishek , Guo Ning , Imrey Peter B , Rothberg Michael 
Published: December 2022

Abstract

Background
Community-acquired pneumonia (CAP) is a leading cause of hospital admissions and antimicrobial use worldwide. The ATS/IDSA guidelines recommend switching antimicrobials to per-oral once patients are clinically stable. Using a large national inpatient database, we assessed switch therapy practices across hospitals and their associations with outcomes in patients hospitalized with CAP.

Methods
We included adult patients admitted with CAP and initially treated with intravenous (IV) antibiotics at 642 US hospitals from 2010–2015. Switching was defined as discontinuation of IV antibiotics and starting oral antibiotics without delay. Patients switched on or before hospital day 3 were considered early switchers. We conducted subgroup analysis restricted to patients initially treated with either 3rd generation cephalosporin/macrolide or quinolone monotherapy, indicating non-severe inpatient CAP. In a propensity-adjusted analysis, we compared length-of-stay (LOS), in-hospital 14-day mortality, late deterioration (ICU transfer), hospital costs, total antibiotic days, and C.difficile infection between early switchers and others. We also compared adjusted outcomes across hospital switching rate quartiles.

Results
Of 378,041 CAP patients, 116,118 (31%) were switched to oral antibiotics before discharge, and 21,784 (6%) were switched early. Hospital rates of early switching ranged from 3%-47%. Figure 1 summarizes the estimated effects of early switching among patients initially treated with cephalosporins/macrolide or quinolone monotherapy. Figure 2 shows the switch rate for patients within each hospital quartile, stratified by predicted mortality. Within each quartile, patients at higher predicted risk for mortality were less likely to be switched.

Conclusion
In this large multihospital cohort, most patients were not switched to oral antibiotics before discharge and &lt; 6% were switched early. Early switching was not associated with worse outcomes and was positively associated with shorter LOS and total days on antibiotics. Patients at hospitals in the top quartile of early switch rates did not suffer worse outcomes and had shorter LOS and total antibiotic duration. Our findings suggest clinicians could switch more patients early without compromising outcomes.

Disclosures
Abhishek Deshpande, MD, PhD, Clorox: Grant/Research Support|Merck & Co., Inc., Kenilworth, NJ, USA: Advisor/Consultant|Merck & Co., Inc., Kenilworth, NJ, USA: Stocks/Bonds|Seres Therapeutics: Grant/Research Support.
1520. Mind the Clap: Reported Disseminated Gonococcal Infections in the United States, 2020–2022
Authors: Quilter Laura A , Tang Eric C , Johnson Kelly A , Jacobson Kathleen , Ridpath Alison , Cohen Stephanie , Rajagopalan Shobita , Munoz Monica D , Holderman Justin L , Kent James B , Bachmann Laura H , Bernstein Kyle 
Published: December 2022

Abstract

Background
Disseminated gonococcal infections (DGI) are estimated to occur in 0.5% to 3% of untreated Neisseria gonorrhoeae (GC) infections; however, surveillance and population-based studies to estimate DGI burden and describe recent DGI epidemiology and clinical manifestations are limited. In response to increased reports of DGI cases and clusters in the U.S., the Centers for Disease Control and Prevention (CDC) developed a surveillance system in 2020. We analyzed data captured by the initial two years of surveillance.

Methods
During 1/1/2020–3/31/2022, U.S. state/local health jurisdictions reported DGI cases to CDC utilizing a standardized case report form that collects demographic, sociobehavioral, and clinical information. A confirmed case was defined as isolation or detection of GC from a disseminated site of infection by culture or nucleic acid amplification test (NAAT); a probable case was defined as clinical manifestations of DGI and isolation or detection of GC from a mucosal site by culture or NAAT.

Results
In total, 274 DGI cases were reported to CDC from 13 U.S. states (65.7% from California): 215 (78.5%) confirmed cases and 59 (21.5%) probable cases. Among DGI cases, 51.1% were cisgender male, 33.2% were ≥ 45 years old, and 26.6% reported methamphetamine use in the past 12 months. Most patients (87.6%) did not have documented underlying immunosuppression or predisposing medical conditions. Among patients with DGI, 85.8% were hospitalized, 41.2% underwent related surgeries, and 2.2% died. Among confirmed cases, the most common disseminated sites of infection were synovial fluid (50.2%) and blood (45.1%). Among 184 (67.2%) patients with DGI who were tested for GC at a mucosal site, 115 (62.5%) were diagnosed with a mucosal GC infection (69.6% urogenital, 27.0% pharyngeal, 12.2% rectal); however, 85.5% of those not diagnosed with mucosal GC were only tested at urogenital sites. Only 89 patients (32.5%) reported mucosal symptoms present at the time of or within the month prior to DGI presentation.

Conclusion
Health care providers should maintain a high degree of suspicion for patients presenting with DGI symptoms given the potential for significant associated morbidity and the low proportion of patients who present with concurrent GC mucosal symptoms.

Disclosures
Alison Ridpath, MD, MPH, 3M company: Stocks/Bonds|Abbott Laboratories: Stocks/Bonds|Abbvie Inc.: Stocks/Bonds|Allogene Theraputics: Stocks/Bonds|Amarin Corperation PLC: Stocks/Bonds|infinity Pharmaceutical Companies: Stocks/Bonds|IQVIA Holdings Inc: Stocks/Bonds|Johnson and Johnson: Stocks/Bonds|Medtronic: Stocks/Bonds|pfizer: Stocks/Bonds|Thermo Fisher Scientific: Stocks/Bonds.