bluuebunny/crossref_metadata_2025_split huggingface dataset:
906. Impact of Accelerate Rapid Diagnostic Technology on Time to Optimal Antimicrobial Therapy in Gram Negative Bloodstream Infection
Authors: Jung Hye Lim , Jozefczyk Caroline , Faulkner-Fennell Carmen M , Shirley Rhett , Schrank John 
Published: December 2022

Abstract

Background
Previous studies at our institution evaluating rapid diagnostic testing (RDT) for blood culture identification (BCID) did not show significant differences in time to optimal antimicrobial therapy for Gram negative bloodstream infections (GNBSI). Recent studies of Accelerate Pheno® system (Accelerate-PS) for blood culture identification and susceptibility have shown significant reduction in time to optimal antimicrobial therapy. This study evaluated the impact of Accelerate-PS compared to BCID RDT on time to optimal antimicrobial therapy for GNBSI.

Methods
A single center, retrospective, cohort study included adult patients with GNBSI from February 2017 to January 2018 (pre-implementation) and February 2020 to January 2021 (post-implementation). The primary outcome was time to optimal antimicrobial therapy for GNBSI, defined as time from positive blood cultures to time patient received optimal antimicrobial therapy. Secondary outcomes include duration of therapy, rate of antimicrobial-related adverse effects, hospital length of stay, in-hospital mortality, and infection-related readmission.

Results
The final cohort included 190 patients in pre-implementation group and 179 patients in post-implementation group. Escherichia coli and Klebsiella species were the most common pathogens and urinary tract was the most common source of bacteremia in both groups. More patients in the pre-implementation group had congestive heart failure while more patients in the post-implementation group had peripheral vascular disease. Patients in the post-implementation group had higher Pitt bacteremia scores (1.05 vs. 1.37, P=0.017). Patients in the post-implementation group had significantly shorter time to optimal therapy (mean 60.62 hours vs. 20.17 hours, P&lt; 0.001) and shorter duration of therapy (mean 366.56 vs 310.24 hours, P &lt; 0.001) than in the pre-implementation group. There were no differences in mortality or readmission at 30-days.

Conclusion
The results of this study indicate that incorporation of Accelerate-PS into microbiology lab workflow significantly reduces time to optimal antimicrobial therapy for GNBSI. Rapid diagnostic testing is a vital component of a robust antimicrobial stewardship program.

Disclosures
John Schrank, MD, Gilead: Speaker's Bureau.
964. Physicians' acceptable treatment failure rates and interpretation of antibiogram for Gram-negative infections: A pilot survey study of infectious diseases specialists
Authors: Hasegawa Shinya , Perencevich Eli N , Dukes Kimberly , Goto Michihiko 
Published: December 2022

Abstract

Background
The recommendations of many clinical guidelines include an antibiogram as a key component when making empiric therapy decisions. However, little is known about how clinicians interpret antibiograms. We aim to characterize the threshold of the acceptable risk of selecting inappropriate antibiotics among clinicians through clinical case-based questionnaires.

Methods
We conducted an online survey of infectious diseases (ID) specialists at the University of Iowa, as an internal pilot study. We created realistic clinical case scenarios and asked clinicians to provide the desired minimum percentage of susceptible isolates on an antibiogram for them to feel comfortable with selecting that agent for empiric therapy. We included four scenarios in the questionnaire: i) a patient with urinary tract infection (UTI) in an outpatient setting, ii) a patient with UTI in an inpatient setting, iii) a patient with Gram-negative rod bloodstream infection (GNR-BSI) in an intensive care unit (ICU) setting, iv) a patient with GNR-BSI in a non-ICU setting.

Results
Of the 16 of 26 providers (62%) who responded, 15 were considered effective responses. ID Physicians reported wide ranges in thresholds of minimum percentage to feel comfortable with prescribing a hypothetical antibiotic and higher thresholds for patients with more severe illnesses (outpatient with UTI: 85% [range: 75-100%]; inpatient with UTI: 95% [range: 50-99%]; inpatient with GNR-BSI in non-ICU settings: 90% [range: 80-95%]; inpatient with GNR-BSI in ICU: 95% [range: 88-100%]) (Figure 1). Figure 1.The distribution of physicians’ acceptable likelihood of susceptibility in four realistic clinical case-scenarios.
Abbreviations: GNR-BSI, Gram-negative rod bloodstream infection; ICU, intensive care unit; UTI, urinary tract infection.

Conclusion
There were wide ranges in thresholds for interpretation of antibiogram among frontline clinicians, especially for less severe infections. Understanding physicians’ antibiogram usage can be helpful to determine how and if antibiogram guides clinicians toward more appropriate empiric therapy decisions. As this was a preliminary study, we plan to conduct a study with a larger sample size to better characterize the use of antibiogram among clinicians from diverse practice settings.

Disclosures
Michihiko Goto, MD MSCI, Merck & Co.: Grant/Research Support.
985. Practice Patterns of Antimicrobial Suppression Therapy in Total Knee Arthroplasty Infections
Authors: Lastinger Allison , Scribner Jacob 
Published: December 2022

Abstract

Background
There are no current established guidelines for the role of antimicrobial suppression therapy in management of prosthetic joint infection (PJI). In 2013, the IDSA provided initial treatment guidelines for PJI but did not address suppressive therapy. The guidelines do not address suppressive therapy beyond the initial 4-6 weeks for non-staphylococcal infections nor do they address suppressive therapy after 3-6 months of treatment for Staphylococcal infections. Practitioners must delicately balance the risk of PJI recurrence and the negative effects of continued antibiotic therapy including toxicity and resistance. In this study, we surveyed Infectious Disease providers to better understand their antimicrobial suppression practice patterns in different clinical scenarios.

Methods
We surveyed Infectious Disease providers across the United States from April 2022 to May 2022. We received 78 unique response from 31 different states. Basic demographic data was obtained. Providers presented six multiple choice clinical scenarios and were asked if they would start suppressive therapy and the duration of suppressive therapy.

Results
The preliminary data revealed that practice patterns vary greatly amongst providers in the management of antibiotic suppressive therapy in PJI. Of the 6 scenarios, only half had greater than 50% consensus (50.6%, 51.3% and 70.1%). Scenario 1 involved a patient who underwent a single stage revision. It was of particular interest as 51.3% of providers indicated they would stop antimicrobial therapy and 48.7% indicated they would extend antimicrobial therapy with 25.6% electing for lifelong suppressive therapy.

Conclusion
Practice patterns for antimicrobial suppression therapy in knee PJI varies significantly among providers. Even with IDSA guidelines addressing Staphylococcal PJI, the practice patterns among infectious diseases providers still varied greatly especially with regards to single stage revisions. Additional randomized controlled trials examining the best way to manage antimicrobial suppression in PJI would be helpful, and would allow for development of evidence-based guidelines. We also plan to survey orthopedic surgeons using the same clinical scenarios to see if there is a difference in management styles.

Disclosures
All Authors: No reported disclosures.
998. Clinical Outcomes and Cost Savings of Dalbavancin Use in OPAT: Focus on Complicated Staphylococcus aureus Infections
Authors: Alexander Bryan T , Miller Molly M , LeMaster Melissa , Bergman Scott J , Van Schooneveld Trevor C , Cortes-Penfield Nicolas W 
Published: December 2022

Abstract

Background
The practical and financial benefits of long-acting glycopeptides are increasingly recognized, and their efficacy is becoming better established for a variety of indications. Dalbavancin use as primary therapy for complicated Staphylococcus aureus (cSA) infections, however, has only been described in small case series to this point.

Methods
This retrospective review identified patients prescribed dalbavancin for any indication and followed by the Nebraska Medicine OPAT team since program implementation (4/1/19 - 4/30/22). Patients in the cSA infection subgroup were defined by need for &gt;2 weeks of treatment for a Staphylococcus aureus infection involving bacteremia. Dalbavancin as primary therapy for cSA was defined as initiation of dalbavancin within the first 10 days of antibiotic therapy and continued through the end of treatment. The primary clinical outcome was 30-day readmission rate (both infection-related and not infection-related).

Results
A total of 66 patients were prescribed dalbavancin for treatment of any infection (Table 1), with an all-cause 30-day readmission rate of 13.6% (9 of 66); only two of these were infection-related (3%). Updating a prior institutional analysis, use of dalbavancin led to the avoidance of 506 planned inpatient days per year on average and $1,113,000 in yearly inpatient costs. Dalbavancin was utilized for primary therapy of cSA in 16 patients, of whom only one (6.3%) had a 30-day readmission, due to progression of cSA vertebral osteomyelitis-discitis. Table 1:Characteristics of the Dalbavancin Cohort

Conclusion
In both overall and cSA subgroup analysis, OPAT use of dalbavancin was associated with low readmission rates. This study is the largest to date suggesting favorable clinical outcomes with dalbavancin as primary therapy for cSA infections; others have reported few of these patients or utilized dalbavancin exclusively as consolidation therapy following significant lead-in with other antimicrobials. The enrolling Dalbavancin as an Option for Treatment of Staphylococcus aureus Bacteremia study (DOTS; NCT04775953) is anticipated to provide randomized controlled data evaluating this approach. Discharge facilitation utilizing dalbavancin contributed significantly to OPAT program cost justification and resources to support team expansion.

Disclosures
Bryan T. Alexander, PharmD, BCIDP, AAHIVP, Astellas Pharma: Advisor/Consultant Scott J. Bergman, PharmD, BCIDP, FCCP, FIDSA, Merck & Co., Inc: Advisor/Consultant|Merck & Co., Inc: Grant/Research Support|Merck & Co., Inc: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria Trevor C. Van Schooneveld, MD, bioMerieux: Advisor/Consultant|bioMerieux: Grant/Research Support|Insmed: Grant/Research Support|Merck: Grant/Research Support|Thermo-Fischer: Advisor/Consultant.
1020. The Impact of COVID-19 on Outpatient Intravenous Antimicrobial Therapy (OPAT) at an Academic Medical Center
Authors: Goteti Ravitej , Monday Lea M , Weinmann Allison J 
Published: December 2022

Abstract

Background
The coronavirus disease 2019 (COVID-19) pandemic dramatically affected the delivery of healthcare. Patients discharged on outpatient parenteral antibiotic therapy (OPAT) require clinic follow-up and laboratory monitoring which is a logistical challenge to standardize across discharge locations. We sought to investigate how COVID-19 impacted patients discharged with OPAT at an academic medical center. Primary objectives included 30-day readmission rates and ID clinic follow-up before and during COVID-19. Secondary outcomes included whether suspected infection type, antimicrobial selection and discharge location differed between the two cohorts.

Baseline Patient Characteristics & Outcomes between pre-COVID-19 and COVID-19 cohorts

Methods
Patients discharged on OPAT were evaluated in two 3-month cohorts from Oct-Dec 2019 (pre-COVID-19) and compared to Oct-Dec 2020 (COVID)-19. Demographics, infection type, discharge location, therapy characteristics, and outcomes were compared retrospectively (Fig 1). Statistical analysis was performed using Chi-square and Wilcoxon rank-Sum test with p&lt; 0.05 considered statistically significant.
Suspected Infectious Source among the two cohorts

Results
A total of 316 pre-COVID patients were discharged with OPAT compared to 263 COVID-19 patients. Table 1 shows the comparison of OPAT characteristics between 2019 and 2020. There were significantly more patients discharged home and fewer patients discharged to facilities in COVID-19 group(p=0.001 and p=0.011, respectively). LOS, ID clinic follow-up, and 30-day readmission did not differ between groups. Reasons for readmission were similar (Fig 1). Antimicrobial prescribing was generally similar except for more vancomycin prescribed in the COVID-19 group (12.5% versus 7.3%, p=0.033). Suspected source of infection did not differ between groups (Fig 2), nor did isolation of pseudomonas, MRSA, or drug resistant organisms (Table 2).

Conclusion
Sources of infection and antimicrobial classes were generally similar despite decrease in elective procedures during a COVID-19 related winter surge. Rates of readmission and clinic follow did not differ, however, patients discharged with OPAT post-COVID were more likely to go home versus a facility. Further analysis of this difference may help determine best practices to facilitate improved monitoring and clinic follow-up among OPAT patients.

Disclosures
All Authors: No reported disclosures.
1022. The Role of Baseline Body Temperature in Neutropenic Fever
Authors: Corsi Anthony J , Searles Madison , Lupone Christina , Geneva Ivayla I 
Published: December 2022

Abstract

Background
The management of neutropenic fever patients is challenging – from identification to diagnosis to treatment. We hypothesize that patients’ individual baseline body temperature provides diagnostic and prognostic value.

Methods
This is an analysis of 92 adult patients admitted for neutropenic fever to a tertiary medical center over 1 year period. We modelled the length of stay and the ability to find a definitive diagnosis using the change in body temperature from each patient’s outpatient baseline, the neutropenia level and overall patient acuity on admission, persistence of fever over 48-72 hours, and age. All temperatures were standardized to oral. Refer to Table 1 for the inclusion and exclusion criteria and statistical methods. Table 1.Inclusion and exclusion criteria and statistical methods.

Results
Refer to Tables 2 and 3 for demographics and descriptive statistics of temperature readings, to Table 4 for advanced statistical analyses. Importantly, the average baseline body temperature was at 36.7C; the average fever on admission was at 38.1C; based on the ≥ 38C cutoff, only 24% of patients had persistent fever over 48-72 hours but based on personalized cutoffs at &gt; 2 standard deviations (SDs) or &gt; 3 SDs above their outpatient baseline, 54% and 34% had persistent fever, respectively; the etiology of fever was identified in 48% of patients, all of which constituted infections; our multiple regression model demonstrated that a longer length of stay (LOS) of ≥ 4 days was predicted by larger deviation from baseline body temperature at admission and independently by fever persistence, after correcting for age, neutropenia level, and need for ICU level of care on admission. A similar model could not predict the ability to identify a fever-explaining diagnosis.

Conclusion
Given the average outpatient baseline body temperature of 36.7 +/- 0.3C, at 2 standard deviations (SDs) above this baseline, only 3% of patients would be at the 38C cutoff for fever, at 3 SDs, it would be 20%, thus rendering the standard 38C cutoff too high to be useful in identifying many neutropenic fever cases and supporting the use of personalized cutoffs based on patient’s baseline temperature. Further, consideration of the specific deviation from patients’ baseline body temperature could serve as a predictor for hospital LOS in patients admitted with neutropenic fever.

Disclosures
All Authors: No reported disclosures.
1027. Cerebrospinal Fluid Findings of Solid Organ Transplant Recipients with West Nile Virus Infections
Authors: Abbas Anum , Sikyta Adia , Florescu Diana F 
Published: December 2022

Abstract

Background
In the solid organ transplant (SOT) population, West Nile virus (WNV) neuroinvasive disease can have significant morbidity and mortality. We evaluated cerebrospinal fluid (CSF) findings in neuroinvasive WNv infections among SOT recipients.

Methods
We retrospectively reviewed medical records of all SOT recipients at our institution with WNv neuroinvasive disease (meningitis, encephalitis, meningo-encephalitis) from 2010 to 2018. Descriptive statistics were examined on key variables.

Results
Eight transplant patients with mean age 54.47 years (12.79) were included: 5 kidney transplants, 1 in each kidney-pancreas, liver and lung transplants. Median time from transplant to infection was 49.8 months (2.7-175.4) and mean time-to-diagnosis 2 days (1.31) . On admission, mean total CSF WBC count was 134.57 cells/mm3 (150.82), mean lymphocyte count 56.29 cells/mm3 (32.32), mean neutrophil count 27.14 cells/mm3 (34.34), and mean CSF protein 95.4 mg/dL (40.52mg/dL). West Nile virus CSF IgG at the time of diagnosis was negative in 7 patients, and not performed on 1 patient. WNv diagnosis is depicted below.
Serum and CSF WNV Antibodies in Neuroinvasive Disease in SOT Recipients
WNV CSF and serum IgG was negative at the time of diagnosis in 7/8 patients. Initial CSF IgM was positive in 3 out of 7 patients.

Conclusion
WNv infection produces a CSF pleocytosis with neutrophilic predominance, though we noted more lymphocytic predominance among SOT recipients. CSF IgM and IgG are important diagnostics in neuroinvasive WNv.

Disclosures
Diana F. Florescu, MD, AlloVir: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|NobelPharma: Grant/Research Support|Novavax: Grant/Research Support|Regeneron: Grant/Research Support|SymBio: Grant/Research Support|Takeda: Advisor/Consultant|Takeda: Grant/Research Support.
1087. COVID-19 in Solid Organ Transplant Recipients: A Single Transplant Center Experience
Authors: Sabunwala Suhel A , Cornelius Tuhina , Aslam Sadaf , Alrabaa Sally 
Published: December 2022

Abstract

Background
COVID-19 disease became a global health care crisis and was declared pandemic by WHO in March 2020. Some studies have indicated that Solid Organ Transplant (SOT) patients may have increased morbidity and mortality while others showed no difference. Our study aims to investigate patients’ characteristics, disease course, management of COVID-19 and outcomes in our SOT patient population.

Methods
We conducted a retrospective cohort study of all consecutive SOT recipients who were admitted to our transplant center from March 2020 to April 2021 with COVID-19 infection. Data was collected from the electronic medical records after receiving Institutional Review Board approval. Table 1Study Population Demographics
Figure 1 Age and Gender distribution of the study population

Results
A total of 135 patients met inclusion criteria. Average age at the time of COVID-19 diagnosis was 56.38±12.93 years. Majority of the patients (54%) were kidney transplant recipients. Out of the total, 28% of the patients required supplemental oxygen and 14% required intensive care unit (ICU) care. A total of 12 patients (9%) required intubation and mechanical ventilation. 21% of the patients were treated with Remdesivir and 30% met criteria for the use of corticosteroids. Unfortunately, 11 patients (8%) of the patients died from COVID-19 infection and its complications. Of those 11 patients 5 were treated with Remdesivir and 10 were treated Corticosteroids. None of the patients met the criteria for ECMO (Extra Corporeal Membrane Oxygenation). Figure 2Study Population Distribution of the Types of Transplants at time of COVID-19 infection
Figure 3 Outcomes - Admission to ICU and Mortality
Figure 4 COVID-19 Therapies and Outcomes in the SOT Recipients

Conclusion
Our study showed a higher mortality rate in SOT patients compared to general population. Treatment with Remdesivir and Corticosteroids improved the overall mortality rate but had no benefit in patients with critical illness requiring ICU level care. COVID vaccination significantly improved the outcome, and the major limitation of the study was COVID vaccination information was not included since the study was initiated prior to introduction of vaccines. More studies with larger sample size and vaccine data need to be conducted to accurately determine the outcome of COVID-19 infection in this patient population.

Disclosures
All Authors: No reported disclosures.
Reconsideration of Antinucleocapsid IgG Antibody as a Marker of SARS-CoV-2 Infection Postvaccination for Mild COVID-19 Patients
Authors: Dhakal Santosh , Yu Tong , Yin Anna , Pisanic Nora , Demko Zoe O , Antar Annukka A R , Cox Andrea L , Heaney Christopher D , Manabe Yukari C , Klein Sabra L 
Published: December 2022

Abstract
Antinucleocapsid (anti-N) immunoglobulin G antibody responses were lower in plasma and oral fluid after severe acute respiratory syndrome coronavirus 2 infection in vaccinated patients compared with patients infected before vaccination or infected without vaccination. This raises questions about the long-term use of anti-N antibodies as a marker for natural infection for surveillance.
Against Realism
Authors: Panaccio Claude 
Published: December 2022

Abstract
Chapter 2 first spells out Ockham’s main arguments against realism with respect to universals, that is, arguments from numerical unity, from ontological separability, from mereology (the theory of part-whole relations), and from the principle of the indiscernibility of identicals. Within these arguments, specific advantages and concerns are addressed, including the theological and philosophical aspects of separability and the adherence to Aristotelian notions of individual entities in opposition to Platonic notions of participation and Forms. It then presents Ockham’s critique of realism with respect to relations and his arguments from infinite regress and from the famous Razor principle. The chapter finally discusses Ockham’s critique of realism with respect to quantities, that is, extension and numbers.
Induction, Objects, and the Uniformity of Nature
Authors: Boyle Deborah 
Published: December 2022

Abstract
This chapter examines the final two points that Shepherd makes in her rebuttal of Humean causation: that nature is uniform and cannot change its course and that when we make causal inferences, reason rather than custom or habit is our guide. The chapter begins with an explanation of Shepherd’s account of objects and qualities, as well as of the way names and definitions apply to objects, and then examines how her account of effects as qualities that are necessarily connected with the objects that cause them grounds her claim that nature is uniform. The chapter also explores how Shepherd thinks we can make good causal inferences in ordinary life. It ends with discussions of Shepherd’s appeal to Locke (to show that Hume incorrectly appropriated Locke’s views to bolster his own position) and of her objections to views espoused by Scottish philosopher Thomas Brown.
Mind and Body
Authors: Boyle Deborah 
Published: December 2022

Abstract
This chapter examines Shepherd’s account of the connection between the mind—which she takes to be immaterial—and the material, external world and, more specifically, how she conceives of the relationship between mind and body in a human being. It explicates her terms ‘mind,’ ‘soul,’ and ‘self,’ arguing that Shepherd works with a narrower and a broader sense of all three terms. After exploring her argument for how each person knows that their own mind exists, the chapter considers her accounts of one’s knowledge of other minds, her claims about personal identity over time, how she might individuate minds, and how she accounts for the relationship of mind to the human body.