bluuebunny/crossref_metadata_2025_split huggingface dataset:
2188. A Quality Improvement Initiative for Influenza Diagnosis and Treatment within Health Systems Serving American Indian/Alaskan Native Patients
Authors: Mera Jorge , Montgomery Roger , Stephens David , Leston Jessica , Carter Jeffrey D , Douglas Bonnie , Simone Laura , Molloy Leah 
Published: December 2022

Abstract

Background
This project aimed to identify practices, knowledge and confidence in diagnosing and treating influenza in health systems serving American Indian/Alaskan Native communities and to provide education to support alignment with IDSA guidelines.

Methods
Anonymous baseline surveys were completed electronically by healthcare professionals (HCPs) from Cherokee Nation Health Services (CNHS) and the Northwest Portland Area Indian Health Board’s teleECHO program. Responses informed a 2-part series of live virtual educational trainings featuring pre- and post-program surveys and team-based action planning.

Results
Baseline surveys were completed by 247 HCPs. 149 attended the 1st meeting, and 90 attended the 2nd. For outpatient influenza diagnosis, 72% of baseline survey respondents reported primarily using rapid antigen testing, and 11% reported using molecular testing. Similarly, 15% of learners in the live meetings correctly identified rapid molecular assay as the guideline-recommended test, which improved to 72% afterwards. All 9 CNHS outpatient health centers switched from rapid antigen to molecular testing for influenza diagnosis after the training. Influenza treatment decision-making was assessed using a case vignette. For a patient at high risk for complications with flu-like symptoms but stable for outpatient care, 23% of learners in the live meetings correctly chose to start antiviral treatment immediately, which improved to 54% after the program, and more learners felt confident applying diagnostic test results to treatment, from 31% before to 68% after the training. Learner confidence also improved from 19% feeling confident in selecting antiviral treatment and 33% feeling confident in identifying high risk patients before the program to 60% and 70% afterwards, respectively. Action plans prioritized by the HCPs included: patient engagement (61%), reviewing guidelines and data (57%), improving patient adherence to treatment (50%), and developing criteria for immediate antiviral treatment (50%).

Conclusion
Knowledge and confidence in influenza management improved after the training, as did system-wide alignment with IDSA-recommended diagnostic testing. Studies evaluating the clinical impact of this activity is warranted.

Disclosures
Jorge Mera, MD, FACP, Abbvie: Grant/Research Support|Gilead Sciences: Grant/Research Support|Gilead Sciences: Received one time honorarium for participating as a panelist in a COVID-19 Webinar|Merck: Grant/Research Support.
2191. Children with severe human rhinovirus lower respiratory tract infection
Authors: Kim Doo Ri , Kim Kyung-Ran , Park Hwanhee , Cho Joongbum , Huh Hee Jae , Lee Nam Yong , Kim Yae-Jean 
Published: December 2022

Abstract

Background
Human rhinovirus (HRV) infection can also cause lower respiratory tract infections (LRTIs). We aimed to investigate the proportion and characteristics of severe HRV infection among children under 5 years who were hospitalized due to HRV LRTI.

Methods
The medical records were reviewed retrospectively in patients hospitalized caused by HRV LRTI from January 1, 2016 to December 31, 2020, at Samsung Medical Center, Seoul, Korea. Patients who were older than 90 days and younger than 5 years old were included. Patients with co-infection of other respiratory viruses or bacteria were excluded. Patients with cancer were excluded.
Severe HRV LRTI was defined as the following: need for high flow oxygenation, mechanical ventilation, or intensive care unit (ICU) admission.

Results
A total of 116 cases were identified. The median age was 17 months (range, 3-56 months), and their median hospital days were four days (range, 2-31 days). Of 116 cases, 18 cases (15.5%) showed a severe course. The median age was younger in severe group compared to non-severe group (9.5 months vs. 19.5 months, p=0.001). In 18 patients with severe HRV LRTI, 11 (11/18, 61%) had underlying diseases; bronchopulmonary dysplasia and bronchiolitis obliterans accounted for the largest proportion (7/11, 63.6%). Six patients (6/18, 33.3%) required mechanical ventilation. Of note, there were seven previously healthy children (7/18, 38.9%) were diagnosed with severe HRV LRTI. Of those seven, three were diagnosed with asthma later during follow-up.
When 116 cases were divided into previously healthy (n=61) and underlying disease (n=55) groups, severe course of HRV LRTI was observed in 11% and 20%, respectively (p=0.205).
There was no fatal case.

Conclusion
HRV can cause severe LRTI in certain pediatric patient, especially with underlying diseases and young-aged children. One out of ten hospitalized children even without previously diagnosed underlying diseases, showed severe course of HRV LRTI.

Disclosures
Doo Ri Kim, MD, Korean Society of Pediatric Infectious Diseases: Grant/Research Support Yae-Jean Kim, MD, PhD, Janssen: Grant/Research Support|Korean Society of Pediatric Infectious Diseases: Grant/Research Support|Ministry of Trade, Industry and Energy: Grant/Research Support|MSD: Grant/Research Support.
2203. Involvement of Respiratory Viruses in Community-Acquired Alveolar Pneumonia (CAAP) in Children &lt; 5 Years in Southern Israel, Before and During the COVID-19 Pandemic
Authors: Danino Dana , van der Beek Bert Adriaan , Ben-Shimol Shalom , Avni Yonat Shemer , Greenberg David , Dagan Ron 
Published: December 2022

Abstract

Background
Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) and to a lesser extent, parainfluenza and influenza viruses have been associated with pneumonia in young children. In contrast, adenovirus (AdV) and rhinovirus (RhV) are usually not associated with pneumonia. We aimed to evaluate the involvement of the four pneumonia associated viruses (grouped as PAV) in pediatric CAAP, before and during the COVID-19 pandemic.

Methods
CAAP incidence and viral activity surveillance in southern Israel in children &lt; 5y and virological detection methods were described previously (Danino. CID 2022, https://doi.org/10.1093/cid/ciab1014). We reviewed the period of Jan 2016 - Mar 2022. Most cases of COVID-19 in children &lt; 5y occurred during Dec 2021 - Mar 2022 (Figure 1); Over 95% of children admitted for respiratory disease were tested for COVID-19 (PCR). Since AdV and RhV activity was previously not associated with CAAP and tended to be equally involved in mixed and single infections, the current analysis was done for the four PAV only.

Results
CAAP incidence dynamics closely resembled the four PAV (grouped) activity dynamics (Figure 2A, 2B) with very low activity during the expected peak in winter 2020-2021, but with an off-season resurgence from spring 2021. Even though most CAAP episodes during the pandemic coincided with peak COVID-19 rates, only 9 CAAP episodes were COVID-19 positive (7 in 2022, of which 5 were RSV positive). Out of 3,430 CAAP episodes 55% were tested for PAV, of which 61% were positive, with similar rates before and during the pandemic. RSV was the most common involved virus, followed by hMPV. The virus distribution in CAAP during the entire period reflected their activity in the community (Figure 2C). Unlike pre-pandemic years where all four PAV appeared almost simultaneously, in 2021 PAV resurged sequentially, resulting in successive involvement in CAAP episodes, suggesting a causative association.

Conclusion
1. SARS-CoV-2 was only rarely involved in CAAP in young children. 2. PAV were involved in 61% of CAAP episodes in children &lt; 5y with predominance of RSV and hMPV. 3. The atypical dynamics imposed by the COVID-19 pandemic suggests a causative association between PAV and CAAP.

Disclosures
All Authors: No reported disclosures.
2213. Increased Early Syphilis Detection and Treatment in an Urban Emergency Department During the COVID-19 Pandemic
Authors: Lipps Ashley , Malvestutto Carlos , Koletar Susan L , Dick Michael , Lindsey Sommer E , Bazan Jose A 
Published: December 2022

Abstract

Background
Many people at risk for sexually transmitted infections (STIs) utilize the emergency department (ED) for evaluation and treatment of STI-related complaints. Syphilis testing rates in the ED have historically been low. Following the implementation of a joint ED and Infectious Disease (ID) multidisciplinary quality improvement initiative designed to increase syphilis testing in this setting, we sought to evaluate the demographics and clinical outcomes for patients diagnosed with early syphilis in the ED.

Methods
A retrospective chart review of patients with positive syphilis test results from ED encounters at the Ohio State University Wexner Medical Center East Hospital between 1 January 2019 and 31 December 2021 was performed. Demographic and clinical information was obtained for patients diagnosed with early syphilis (primary, secondary or early latent syphilis).

Results
Since 2019, we have observed a significant increase early syphilis cases identified in our ED despite stable rates of testing (Figure 1). There were 55 cases of early syphilis, 3 with neurosyphilis (NS) at the time of diagnosis (Figure 2). Most cases were men (38/55; 69%), Black/African American (44/55; 80%), and symptomatic (48/55; 87%). Nine of 55 patients (16%) had HIV co-infection, 2 were new diagnoses at time of syphilis diagnosis. Most patients (44/55; 80%) completed appropriate treatment. Of the symptomatic patients, 17/45 (37%) received presumptive treatment in the ED (3 cases of NS excluded). Of those who received treatment after discharge from the ED, the median time to treatment completion was 3 days (range 0-30), with 11/24 (46%) returning to the ED for treatment. Figure 1.Figure 2.

Conclusion
As a result of a collaborative ED/ID STI testing initiative established at our institution, we have observed a significant increase in the number of symptomatic early syphilis cases identified in our ED between 2019 and 2021, with most patients completing treatment in a timely manner. This data show that the ED is an important and feasible setting for syphilis diagnosis and treatment when appropriate support systems are in place, including established communications with ID colleagues.

Disclosures
Carlos Malvestutto, MD MPH, Gilead Sciences: Advisor/Consultant|Viiv Healthcare: Advisor/Consultant Susan L. Koletar, MD, Gilead Sciences: Grant/Research Support.
2219. Syphilis Diagnosis and Treatment Practices in the Ambulatory Setting of a Large Vertically Integrated Healthcare Organization: An Opportunity for Infectious Diseases Physician Engagement
Authors: Gwiazdon Matthew , Matheu Michelle M , Seibert Allan M , Stanfield Valoree K , Kumar Naresh , Stenehjem Edward A 
Published: December 2022

Abstract

Background
Sexually transmitted infections (STIs) continue to increase in the United States. Syphilis management may challenge busy outpatient clinicians and diagnostic delays have been described. To better understand syphilis treatment practices and identify targets for improvement in our organization, we characterized outpatient encounters associated with a positive syphilis test.

Methods
Intermountain Healthcare (IH) is an integrated healthcare system with 23 emergency departments (ED), 34 urgent care (UC), and &gt;100 primary care (PC) clinics. Protocols favor treponemal testing as the initial screening test. All positive treponemal tests associated with a positive non-treponemal test in the ambulatory setting were routed to an electronic inbox within the electronic health record (EHR) and reviewed by a team of Infectious Disease (ID) clinicians from May 1st 2021 – January 31st, 2022. Positive results originating from ID or HIV-trained primary care clinicians were excluded. Each encounter was assessed for staging and treatment plans based on CDC guidelines as well as HIV pre-exposure prophylaxis (PrEP) and HIV treatment eligibility.

Results
119 encounters were reviewed. Patients 30-44 years old were most likely to have a positive test (50, 42.0%). PC (63, 52.9%) and UC (24, 20.2%) accounted for the most positive tests. 102 (85.7%) positive tests were from white patients, consistent with racial demographics of Utah. Only 40 (33.6%) encounters could be clinically staged after chart review by an ID clinician. Of these, 17 (42.5%) were determined to be staged and treated inappropriately by the treating provider. 54 (45.4%) encounters could not be staged and required further testing or more clinical history to determine the significance of positive test. 18 (15.1%) patients could possibly have benefitted from PrEP evaluation and one new HIV diagnosis was referred to ID clinic.

Conclusion
Our exploratory analysis revealed many syphilis cases unable to be staged on chart review and opportunities to improve care. Strategies such as prospective audit and feedback or eConsults may be insufficient and clinical evaluation may be necessary to stage syphilis infection. Syphilis care improvements in our system may be a future target for ID physician engagement and novel stewardship strategies.

Disclosures
All Authors: No reported disclosures.
2220. Trends in Follow-up Testing among Patients Positive for Chlamydia and Gonorrhea in the Veterans Health Administration (VHA), 2013-2019
Authors: Schirmer Patricia , Sharma Aditya , Lucero-Obusan Cynthia A , Oda Gina , Holodniy Mark 
Published: December 2022

Abstract

Background
Chlamydia (CT) and gonorrhea (GC) infections are an ongoing public health issue. CDC recommends testing patients with CT/GC for other sexually transmitted illnesses (STIs) and repeating CT/GC testing 3-12 months later. We described repeat testing and testing for other STIs among GC/CT cases in VHA.

Methods
Molecular laboratory testing for CT/GC during 1/1/2013-12/31/2020 was retrieved from VHA data sources. Patients were evaluated for syphilis, HIV, and repeat CT/GC testing within one year after a positive GC or CT test. Differences in characteristics of CT/GC positive patients associated with receiving recommended testing were assessed using the chi-squared test.

Results
41,630 of 1,005,762 (4.1%) CT results (36,138 unique patients) and 17,649 of 1,013,198 (1.7%) GC results (14,598 unique patients) were positive; mean age of positive CT/GC patients were 31.5 and 40yo respectively with the largest percentage of cases in the 25-34yo group. Repeat testing within 91-365 days after a positive result were 32.6% and 34.5% for CT and GC, respectively (Table 1-2). Of CT/GC positives receiving repeat testing, 9% of CT and 15% of GC were again positive. HIV testing was performed for 72.4% and 65.5% CT and GC first positives, respectively, while syphilis testing was completed for 66.5% and 60.5% CT and GC, respectively (Table 3-4). In CT and GC patients tested for other STIs, HIV was positive in 2.1% and 5.9%, and syphilis was positive in 4.1% and 11.3%, respectively. Compared to 25-34yo patients with CT or GC, those &lt; 25 had higher odds of inappropriate repeat testing (i.e., retested &lt; 91 days, or not retested within 365 days after positive) but had lower odds of not being tested for HIV and syphilis. CT/GC positive females had lower odds of not being tested for HIV and syphilis.

Conclusion
In VHA, nearly 2/3rds CT/GC patients had inappropriate repeat testing, nearly 1/3rd were not tested for HIV/syphilis and up to 15% remained positive for CT/GC, suggesting testing practices and treatment could be improved to better align with current CDC recommendations. STIs not identified and treated appropriately can have serious individual and public health consequences. VHA providers may benefit from additional education on CDC recommended STI guidelines.

Disclosures
All Authors: No reported disclosures.
2244. Prescribing Patterns of Urinary Tract Infections in Patients Discharged from the Emergency Department
Authors: Tan Jorden , Kue Kenneth , Kale-Pradhan Pramodini , Delgado George , Giuliano Christopher , Johnson Leonard B 
Published: December 2022

Abstract

Background
Urinary tract infections (UTIs) are one of the most common infections in the emergency department (ED). The risk of treatment failure and readmissions to the ED may be increased with inappropriate antibiotic regimens. The purpose of this project is to determine the proportion of patients receiving guideline-based therapy (GBT) for UTI discharged from the ED.

Methods
Single-center, retrospective cohort study of adult patients diagnosed with an UTI or pyelonephritis from July 1-December 31, 2020. The primary outcome was to describe the proportion of patients discharged from the ED who received GBT for UTI. Secondary outcomes were to define the proportion of patients readmitted within 30 days, describe the reason for readmission, and compare 30-day readmission rates in patients who received GBT versus non-GBT.

Results
Of 370 patients screened, 68 were excluded primarily for inpatient admission. Of the 302 patients included, 172 (57%) received GBT and 130 (43%) received non-GBT with no significant difference in Charlson Comorbidity Index (p= 0.48) between groups. Fifty two of 302 patients (17.2%) were readmitted within 30 days; 31 (60%) from GBT and 21 (40%) from non-GBT (p=0.632). Of the 52 readmissions, 14 (26.9%) were related to the UTI and returned for either persistent symptoms (11 patients) or development of sepsis (3 patients).
Readmissions related to persistence of UTI and development of sepsis were not significantly different between GBT and non-GBT, 9 patients and 5 patients respectively (p=0.92).

Conclusion
The majority of prescribed antibiotic therapy did conform to GBT for UTI. However, 30-day readmission rates were not significantly different between groups.

Disclosures
All Authors: No reported disclosures.
2245. Urinary tract infections in the elderly population in Japan; long hospital stay, high medical costs, and decline in the activities of daily living scores
Authors: Akiyama Yutaro , Saito Sho , Tsuzuki Shinya , Mezaki Kazuhisa , Ohmagari Norio 
Published: December 2022

Abstract

Background
Japan has one of the most aging societies in the world. Urinary tract infection (UTI) is a common disease in the elderly, and the incidence of hospitalization owing to UTI is increasing with the aging population. Here, we examined the length of hospital stay, differences in the Barthel index (BI), activities of daily living score (ADLs) at admission and discharge, and medical costs of UTI in elderly patients.

Methods
We retrospectively included hospitalized UTI patients in our center between January 1, 2013 and March 31, 2019. The inclusion criteria were as follows: (1) urine culture positive for Escherichia coli (over 104 colony forming units/mL) within 48 h of admission, and (2) the presence of at least one of the following: fever ≥ 38°C, costovertebral angle tenderness, suprapubic tenderness, and dysuria at the time of admission. We classified the enrolled patients into four groups according to age: young adults (20–64 years), pre-old (65–74 years), old (75–84 years), and super-old (≥ 85 years). Patient characteristics were compared across groups using the Mann–Whitney U test, Fisher’s exact test, and Kruskal-Wallis test. The Bonferroni corrected P &lt; 0.05 was considered statistically significant.

Results
This study enrolled 393 cases, including 112 (28.4%) young adults, 72 (18.3%) pre-old, 130 (33.2%) old, and 79 (20.1%) super-old. The lengths of hospital stay were 10.8, 17.9, 17.2, and 21.6 days in young adults, pre-old, old, and super-old, respectively (P &lt; 0.05). Differences in the BI were 1.2, 4.2, 5.2, and 5.2 in young adults, pre-old, old, and super-old, respectively (P &lt; 0.05). However, no significant differences in these values were noted among the pre-old, old, and super-old groups. The medical costs were 6,054, 8,310, 10,129, and 12,577-USD (1USD = 128 yen) in young adults, pre-old, old, and super-old, respectively (P &lt; 0.05). Nevertheless, a comparison of the medical costs per day showed no significant differences among the groups.

Conclusion
UTI in elderly patients were associated with ADLs decline, longer hospital stays, and higher medical costs than those in younger patients; however, no significant differences were found among those aged ≥ 65 years.

Disclosures
Sho Saito, MD, PhD, DAIICHI SANKYO: Grant/Research Support|EVEC: Grant/Research Support|EVEC: Patents obtained through collaborative research|SHIONOGI: Grant/Research Support|Takeda: Advisor/Consultant.
109. Seroprevalence of Protective Antibodies against Varicella, Hepatitis-A and Dengue among Indian Children, Adolescents and Adults
Authors: Verma Sanjay , Baig Mirza Zubair , Rawat Ankita , Kapoor Rajesh , Rawat Amit , Suri Vikas , Suri Vanita 
Published: December 2022

Abstract

Background
Varicella, Hepatitis-A and Dengue cause significant disease burden in our country. Estimation of age-wise seroprevalence of antibodies against these diseases not only help us in understanding age-specific incidence rates and susceptibility, but also help policy makers in deciding need and timing of vaccination. None of these vaccines are part of current national immunization program in India, yet.

Methods
In this observational cross-sectional study, apparently healthy children (9-12 years), adolescents (15-18 years) and adults (25-30 years) attending OPD of a tertiary care hospital in Northern India over two-year period (July 17- June 19) were enrolled after taking informed written consent, and their 3-ml venous blood sample was collected. Ethical clearance was obtained from Institute Ethics committee, before enrolling subjects. Serum was tested for IgG antibodies using specific commercial ELISA kits. Those who received received Hepatitis-A or Varicella vaccination in past were excluded from enrollment.

Results
Out of total 240 subjects (M:F=117:123) enrolled, 75 were children, 75 adolescents and 90 adults in specified age groups. Mean age in these three groups were 11.04, 16.52 and 26.53 years respectively.
In our study, antibodies (IgG) against Varicella were &gt;12 U/ml (seroprotective) in 36% (27/75), 74.6% (56/75), 64.5% (58/90) in children, adolescent and adults in specified age groups, respectively. Similarly, the antibodies (IgG) against Hepatitis-A were &gt;10 U/ml (seroprotective) in above three groups were 68% (51/75), 85.3% (64/75), 95.5% (86/90). For dengue IgG antibodies also, seropositivity rates in above three groups were 37.3% (28/75), 62.7% (47/75), 53.3% (48/90).

Conclusion
Large proportion of children, adolescents and adults remain susceptible to Varicella and Hepatitis-A infection in India. Early childhood vaccination with Varicella and Hepatitis-A vaccines should be a part of National Immunization Programme in India, as a part of preventive strategy.
Our study also showed a large proportion of children, adolescents and adults remain seronegative for Dengue antibodies in various age groups. Therefore, if currently available dengue vaccine (Dengvaxia) has to be used in our population, it can only be used after individual screening.

Disclosures
All Authors: No reported disclosures.