bluuebunny/crossref_metadata_2025_split huggingface dataset:
1024. Transitions of Care Quality Metrics in Patients Discharged on Parenteral Antimicrobial Therapy in a Large Urban Hospital that Lacks a Formal Outpatient Parenteral Antimicrobial Therapy Program
Authors: Schultz Sara K , Minuk Jeffrey , Rodriguez Leah 
Published: December 2022

Abstract

Background
With the evidence demonstrating the need for antimicrobial stewardship in the transition from inpatient to outpatient intravenous (IV) antibiotic therapy, it is imperative to have effective communication and coordination in a multidisciplinary team. Studies have demonstrated the utility of initiating a formal Outpatient Parenteral Antimicrobial Therapy (OPAT) program. The goal of this study is to assess quality metrics in a sample of patients discharged on IV antibiotics prior to initiation of a pilot OPAT program.

Methods
This is a retrospective, multicenter chart review of patients admitted to Temple University Health System from 10/1/2020 - 10/31/2021 who were discharged on IV antibiotics. There were no exclusion criteria. Patients with multiple admissions were documented as separate occurrences. Qualitative data were collected on the appropriateness of OPAT indication, pathogens targeted, antibiotics used, performance of infectious diseases (ID) consult, line selected, outcomes, and demographics. The primary endpoint is the percentage of global IV antibiotic prescribing errors (antibiotic, dose, route, frequency, duration, parenteral access device).

Results
There were 748 total discharges on IV antimicrobials in 705 unique patients. We chose a random sample of 109 discharges. Twenty (18%) had an oral antimicrobial available as an option. Antibiotic selection, dosing, duration, and access were correct 92%, 82%, 64% and 65% respectively (Table 2). ID recommended laboratory monitoring for 44 (40%) patients, of which 8 (18%) were sent to ID clinic; all had abnormal findings. Of the 25 patients who required ID follow-up, 11 had a scheduled ID appointment of which 8 attended. There was no mortality within 30 days from the 8 patients, but 2 were readmitted within 30 days. Overall, 39% patients readmitted within 30 days, 6% had mortality within 30 days and 50% were known to have completed therapy.

Conclusion
Our study captured a 65% rate of prescribing errors in a sample of 109 patients receiving IV antibiotics at discharge. The findings demonstrate an urgent need for an OPAT program to help with antimicrobial, parenteral access selection, monitoring, and follow-up with ID. By implementing this program, we hope to improve our ID follow-up, lab monitoring, and readmission metrics.

Disclosures
All Authors: No reported disclosures.
1046. Assessing School-Based COVID-19 Transmission in Middle and High Schools in an Underserved Population through Qualitative Interviews
Authors: Yuan Grace , Hayes Samantha , Malone Sara , Akuse Sewuese , Watterson Tremayne , Reyes Summer M , Reyes Sydney A , Evans Christina , Bonty Brittany , Prater Jasmine , Shelley Jamee T , Liu Jingxia , Fritz Stephanie A , Newland Jason 
Published: December 2022

Abstract

Background
Case and contact investigation is a mitigation strategy to understand transmission of diseases. The goal of this study is to assess COVID-19 transmission in schools that employ contact tracing.

Methods
Five middle and high schools provided a list of ongoing student and staff cases and their school contacts for the 2021-22 school year. Cases were eligible for interview if they had a known positive test or were a “presumed positive” by a practitioner. Contacts were eligible if they were identified as a close contact to a case within their school. Contacts who later became a case were eligible for a separate case interview. Trained interviewers contacted eligible individuals to offer COVID-19 resources and determine interests in participating in the study. Interested cases and contacts underwent a semi-structured interview with standardized questions.

Results
From 5/2021-4/2022, 360 cases (45% during Omicron surge) and their 412 contacts were identified (Fig 1). Among the 111 cases interviewed, 75% were students, half were in grades 6-8 (Fig 2). 61% of the cases were vaccinated with their primary series. 92% were symptomatic and fatigue, cough, and headaches were the most common symptoms. Transmission from school occurred in 29% (Fig 3) and most commonly occurred in the classroom. Among the 68 contacts interviewed, 96% were students. The two most reported activities contacts participated in were band (n=9) and sports (n=22), 10 from playing basketball. Three contacts reported exposure to COVID-19 within the household and five contacts reported exposure outside the home or school.

Conclusion
Case and contact investigation can be a valuable tool to assess COVID-19 transmission in schools. Almost one-third of cases reported school exposures, a greater school transmission rate than previous reported likely do to the increased transmissibility of Omicron. Assessing transmission events with this strategy alone may be limited by its reliance on self-reports. Case investigations can help schools identify potential areas to improve in limiting school-based COVID-19 transmission.

Disclosures
Sara Malone, PhD, LCSW, AHRQ: Grant/Research Support|NIH: Grant/Research Support Jason Newland, MD, AHRQ: Grant/Research Support|Merck: Grant/Research Support|NIH: Grant/Research Support|PEW Charitable Trust: Grant/Research Support|Pfizer: Grant/Research Support.
1053. Comorbidities Associated with All-Cause Readmission to the Same Hospital after Index COVID-19 Hospitalization: A Retrospective Cohort Study of 232155 Patients in the United States
Authors: Nadimpalli Gita , O’Hara Lyndsay M , Magder Lawrence , Kristie Johnson J , Haririan Abdolreza , Pineles Lisa , Goodman Katherine E , Baghdadi Jonathan , Pineles Beth , Harris Anthony 
Published: December 2022

Abstract

Background
Understanding comorbidities that drive all-cause readmission in patients hospitalized with Coronavirus disease 2019 (COVID-19) can inform healthcare system capacity planning and improve post-discharge care.

Methods
This was a retrospective cohort study of patients hospitalized for COVID-19 between April 2020-December 2020 (index cohort) across 760 hospitals in the Premier Healthcare Database. Patients who died or left against medical advice were excluded from the index cohort. Surviving patients in the index cohort were followed until May 2021. First readmission to the same hospital as the COVID-19 index admission was considered all-cause readmission. The all-cause 14-month risk (95% confidence interval) of readmission was calculated using the Kaplan-Meier approach. A multivariable Cox proportional hazards model adjusted for demographic variables, hospital characteristics, co-existing comorbidities, and COVID-19 severity was built to study the association between Elixhauser comorbidities and readmission.

Results
Among 232155 unique patients in the index cohort, 36680 were readmitted to the same hospital at least once, followed through May 2021. The 14-month risk of readmission was 16.2% (95% CI:16.1% - 16.4%). The most frequent primary diagnosis on readmission was infectious disease (14240, 38.8%), of which 8754 (24%) were for COVID-19. With each additional comorbidity, the readmission hazard increased by 19% (HR, 1.19; 95% CI:1.18 - 1.19). In the multivariable Cox proportional hazards model, many comorbidity categories were associated with an increased risk of readmission. Metastatic cancer (HR, 1.74; 95% CI:1.60 –1.89), lymphoma (HR, 1.61; 95% CI:1.47 – 1.77), drug abuse (HR, 1.51; 95% CI:1.41 – 1.62), congestive heart failure (HR, 1.47; 95% CI:1.44– 1.51), and alcohol abuse (HR, 1.46; 95% CI:1.36– 1.56) were associated with the highest hazard for readmission.

Conclusion
COVID-19 patients have a high risk of all-cause readmission and are frequently readmitted for COVID-19. With the continued emergence of COVID-19 variants, this study provides valuable insights into developing more informed discharge plans and improving post-discharge care for COVID-19 patients with existing comorbidities to prevent readmission.

Disclosures
Lyndsay M. O'Hara, PhD, MPH, PDI: Grant/Research Support.
1055. Comparison of Scoring systems in Predicting Clinical Outcomes in Patients Hospitalized with COVID 19
Authors: Huang Anderson , Dieckhaus Kevin , Chirch Lisa M , Bath Roopjeet K , Abrantes-Figueiredo Jessica , Onwochei Jennifer , Holtzman Assaf , Tailor Neelam , Kuo Chia-Ling 
Published: December 2022

Abstract

Background
Previous scoring systems have been proposed to predict COVID19 outcomes, however none have been universally adopted. Two scoring systems of interest are Monoclonal Antibody Screening Score (MASS) and Oral Antiviral and Monoclonal Antibody Screening Score (OMASS). MASS prioritized patients for outpatient monoclonal antibody treatment based on risk of hospitalization, and OMASS was a modified version of MASS used to prioritize outpatient oral antivirals. We created a modified scoring system (UCH2021) incorporating vaccination status. These scores (table 1) have not been used to predict in-hospital clinical outcomes. We investigate these systems’ abilities to predict mortality and oxygen requirements in hospitalized COVID19 patients. They do not require blood tests and allow for more rapid triage. Table 1:MASS, OMASS, UCH2021 Scoring Criteria

Methods
A retrospective chart review was performed on 133 patients in two tertiary care centers between March and Sept. 2020 with RT-PCR confirmed SARS CoV2. Baseline risk factors were collected and MASS, OMASS, and UCH2021 were calculated. Primary outcomes included mortality, need for intubation, and need for supplemental oxygen &gt;6L during hospitalization. Secondary analysis assessed if any individual risk factors were associated with those outcomes. These systems were evaluated via area under the curve calculations. Two groups based on an outcome were compared using two-sample t-tests for continuous variables and Fisher’s exact tests for categorical variables.

Results
All three systems demonstrated some discriminative power for mortality (table 2), but not for oxygen and intubation requirements. There was statistically significant difference in age between survivors and deceased (table 3), and BMI for oxygen requirements (table 4). Other risk factors were not predictive of mortality or oxygen requirement. Table 2:MASS, OMASS, UCH2021 Scores and Mortality in Hospitalized COVID19 PatientsTable 3:Age and Mortality in Hospitalized COVID19 PatientsTable 4:BMI and Oxygen Requirements in Hospitalized COVID19 Patients

Conclusion
The MASS, OMASS, and UCH2021 score all had predictive power in determining in-hospital mortality, with moderate accuracy, however none were predictive of oxygen requirements. Age and BMI were also good predictors of mortality and oxygen requirements respectively. This study was completed prior to vaccine distribution in the US. Further studies would be helpful to assess if UCH2021 score has greater discriminative power in samples with vaccinated patients.

Disclosures
All Authors: No reported disclosures.
1058. Development of a Steroid Stewardship Bundle to tackle the Glucocorticoid-Induced Hyperglycemia in COVID-19 patients: Results of SUPER Diabetes Study.
Authors: Issac Aleena , Kochuparambil Jose J 
Published: December 2022

Abstract

Background
Glucocorticoid therapy in COVID-19 patients poses a greater risk of hyperglycemia, leading to an unexpected detrimental effect on treatment outcomes. The Steroid Use in Patients Exhibiting Risk (SUPER) to Diabetes -SUPER Diabetes- study aimed to implement a steroid stewardship bundle to encounter the incidence of Glucocorticoid-Induced Hyperglycemia (GCIH) in COVID-19 patients and to evaluate the effectiveness of the Steroid Stewardship Program.

Methods
This interventional study included 600 COVID-19 confirmed patients admitted between April 2021and March 2022 in a secondary care hospital in India (stewardship cohort). A six-item Steroid Appropriate Index (SAI) assessed the need for steroid therapy using the parameters like the severity of disease, the onset of symptoms, weight of the patient, CT Thorax score, the preferred route of administration, and the comorbid disorders. This created a steroid stewardship bundle with the following parameters: (1) appropriate selection of the corticosteroid; (2) repeat blood sugar monitoring every 8 hours until discharge from hospital; (3) appropriate duration of therapy (4) proper de-escalation of dose/intravenous to oral switch. The patients were followed until discharge/death to track the incidence of hyperglycemia. The analysis of the effectiveness of SAI and the stewardship bundle was done by comparing this with the clinical outcomes among 300 COVID-19 confirmed patients admitted before implementing the scale (retrospective cohort).

Results
The majority of the patients included in the stewardship cohort were males (367; 61.1%), and the mean age was 47.3± 17.1 years. The incidence of new-onset of hyperglycemia or a worsened glycemic profile, i.e., Glucocorticoid-Induced Hyperglycemia (GCIH), was more among the retrospective cohort when compared with the stewardship cohort (32.1% vs 6.3%), p&lt; 0.001). The study also revealed that history of diabetes (p&lt; 0.001), age (p=0.002), number of medicines used for treatment (p&lt; 0.001), and the frequency of monitoring of diabetes (p&lt; 0.001) are significantly associated with GCIH.

Conclusion
Implementing the steroid stewardship bundle significantly improved the appropriate selection and use of corticosteroids, decreasing the incidence of associated adverse events.

Disclosures
All Authors: No reported disclosures.
1073. SARS-CoV-2 Vaccine-Induced Immunogenicity among Hematopoietic Stem Cell Transplant Recipients (HSCT)
Authors: Kokogho Afoke , Aleissa Muneerah M , Chang Jun Bai Park , Walsh Stephen R , Crowell Trevor A , Baden Lindsey R , Sherman Amy C 
Published: December 2022

Abstract

Background
SARS-CoV-2 vaccination reduces the risk and severity of coronavirus disease 2019 (COVID-19), but immunogenicity may be reduced in patients undergoing hematopoietic stem cell transplantation (HSCT). The variables that impact the humoral response, such as age, gender, disease and transplant type, prior treatments, and vaccine type, have not been comprehensively described.

Methods
A retrospective review was conducted at a single-centre of HSCT recipients who received COVID-19 vaccinations between 2020 and 2021. Participants were included if &gt;18 years and had received at least a single dose of Pfizer, Moderna or Johnson & Johnson (J&J) vaccine. Anti-Spike (S) IgG titers were quantitatively measured at provider discretion during routine care using the Roche Elecsys Anti-SARS-CoV-2 spike immunoassay and categorized as Responders (&lt; 0.8U/mL) and Non-responder (&gt;0.8). Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for Responders vs Non-responders. Controlled risk factors included; Age, disease, treatments, and history of graft-versus-host disease (GVHD).

Results
Of 117 HSCT patients assessed, 59 (50.4%) were female, 106 (90.6%) were white, and the median age was 62.5 years (interquartile range [IQR, 49.9-67.8). Vaccinations were administered at a median of 179 days post-transplant (IQR 319 - 105) and antibody responses were measured at a median of 135.5 days post-vaccination (IQR 190-50). 106(90.6%) were responders with a mean titre of 1141.5U/mL (SD=1095.3). 35% had Low (&lt; 100U/mL) titres. Being Female (OR 0.02, 95%CI 0.003 - 0.6) was associated with a slightly higher odds of being a responder.

Conclusion
Hematopoietic stem cell transplant recipients demonstrated a high prevalence of anti-S IgG antibody positivity following COVID vaccination. However, neither patient characteristics nor treatment regimens were seen to be strongly associated with anti-S protein positivity among HSCT recipients. More studies are needed to further characterize patient and treatment characteristics that correlate with seroprotection among these patients.

Disclosures
Stephen R. Walsh, MD, Janssen Vaccines: Grant/Research Support|ModernaTX: Grant/Research Support|Sanofi Pasteur: Grant/Research Support.
1088. Evaluating the Effect of Donepezil on Mortality Among Alzheimer’s Disease Patients With and Without COVID-19 Infection
Authors: Bej Taissa A , Edmiston Elizabeth , Wilson Brigid , Phillips Joy , Jump Robin L 
Published: December 2022

Abstract

Background
Dementia has been identified as an independent risk factor for increased severity of COVID-19 infection. Donepezil, a cholinesterase inhibitor approved for Alzheimer’s disease (AD), has anti-inflammatory properties. Previous studies have found that donepezil reduced all-cause mortality for people living with AD. The anti-inflammatory effects of donepezil have not been studied in patients with COVID-19 and AD. Here, we compare mortality rates of patients with AD to assess the impact of donepezil on the severity of COVID-19 infections.
Survival following SARS-CoV2-2 test, stratified by result and Donepezil
Kaplan-Meier curves of all-cause mortality for Veterans with Alzheimer’s Disease taking donepezil (black) compared to those who were not taking donepezil (grey), further stratified by those with a positive SARS-CoV-2 PCR test (solid lines) or no evidence of a COVID-19 infection during the study period (dashed lines). While donepezil has a positive effect on survival, the adjusted survival odds ratio is not greater among those with vs. without a COVID-19 infection.

Methods
Using administrative data from the Veterans Healthcare Administration (VHA), we conducted a national retrospective cohort study of Veterans with AD who were tested for SARS-CoV-2 between March 1, 2020 and December 31, 2021 in the VHA. Among these patients, we assessed all-cause 30-day mortality stratified by COVID-19 infection and donepezil use and considered the interaction of these two factors. For Veterans with a positive test, the date of first positive test was used to assess mortality; for Veterans without a COVID-19 diagnosis or positive test, date of first negative test was used.

Results
During the study period, 582 Veterans with Alzheimer’s disease were positive for COVID-19 and 14430 had no test or diagnosis indicating COVID-19 infection. Among people with AD and COVID-19, all-cause 30-day mortality was 29% (47/163) for people taking donepezil compared to 38% (159/419) for those who were not. Among people with AD without COVID-19, all-cause 30-day mortality was 5% (189/4189) for people taking donepezil compared to 7% (712/10241) for those who were not. In a multivariable logistic regression, the decrease in mortality associated with donepezil did not differ between people with and without COVID-19 (OR (95% CI) = 0.71 (0.47, 1.07) vs. OR (95% CI) = 0.68 (0.57, 0.80), interaction P = 0.818).

Conclusion
While all-cause mortality was lower for patients taking donepezil compared to those not taking donepezil, the protective effect of donepezil was not increased in AD patients with COVID-19 over those without COVID-19. The population differences and inflammatory biomarkers of AD patients treated with and without donepezil merit further study.

Disclosures
Robin L. Jump, MD, PhD, Merck: Grant/Research Support|Pfizer: Advisor/Consultant.
1090. Factors effecting mortality among Covid-19 patients in Renal Transplant Recipients from a single center in Pakistan
Authors: Nasim Asma , Kumar Sunil 
Published: December 2022

Abstract

Background
Corona virus disease-19 (Covid-19) has significantly affected organ transplantation with concerns regarding severe infection and mortality. Data on Covid-19 in renal transplant recipients (RTRs) is scarce from Pakistan. The aim of this study is find out the factors effecting mortality among Covid-19 patients in renal transplant recipients from the largest transplant center of Pakistan.

Methods
All RTRs &gt;18 years, with positive severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction (PCR) and diagnosed as severe disease, between April to December 2020 were retrospectively reviewed. The severe disease was defined as O2 saturation &lt; 94% at room air on admission. Survivors and non- survivors were compared. Demographics, immunosuppression, comorbid conditions, clinical features, laboratory investigations and graft function were noted.

Results
A total of 95 RTRs had severe disease. There was no difference in mortality between age, gender and co-morbid conditions among survivors and non-survivors. Both groups received similar immunosuppressive regimen. Intensive care unit (ICU) admission [16.5% vs 68.8% p&lt; 0.001 OR 11.17 95% CI (3.3-37.6)] and high D-dimers &gt;1.5µg/ml (p=0.052) at the time of admission were significantly associated with mortality. There was no association of graft function with mortality. Treatment with methyl-prednisolone was found to be significantly associated with survival [83% vs 43% P=0.02 OR 0.15 95% CI (0.05-0.49)]. (Table 1) WHO grading of the disease is shown in figure 1, there was a 100% mortality among patients on mechanical ventilator. Figure 1:WHO clinical grading of severe diseaseTable 2:Comparison between survivors and non-survivors among patients with severe disease

Conclusion
ICU admission and high D-dimers at the time of admission are the significant risk factors for mortality in patients with Covid-19 infection. There was no association of graft dysfunction with mortality. Steroids use has significantly improved survival in renal transplant recipients with severe Covid-19 infection.

Disclosures
All Authors: No reported disclosures.
1096. Riding the Waves: Infection by SARS-CoV-2 Variants in Solid Organ Transplant Recipients at Texas Children’s Hospital
Authors: Buffaloe Leanne , Bocchini Claire , Moulton Elizabeth A , Ruderfer Daniel , Deray Kristen Valencia , Munoz Flor M 
Published: December 2022

Abstract

Background
Texas Children’s Hospital is the largest pediatric solid organ transplant (SOT) program in the US, performing heart, kidney, liver, and lung transplants. Limited data exist about SARS-CoV-2 infection (COVID-19) in the pediatric SOT population. We evaluated the impact of different SARS-CoV-2 variants in a cohort of PCR positive SOT recipients.

Methods
SOT recipients with a positive SARS-CoV-2 PCR test from 3/1/2020 to 2/28/2022 were included in the cohort. The study period was divided into 3 eras based on the predominant circulating variant of SARS-CoV-2: 3/20-6/21 original strain/Alpha, 7/21-11/21 Delta, and 12/21-2/22 Omicron variants. Retrospective medical record review was performed; Chi-squared and Fischer exact test were used to compare groups.

Results
A total of 269 of 1031 (26%) SOT recipients tested positive for SARS-CoV-2 during the study period. By organ, 87/335 (26%) heart, 57/224 (25%) kidney, 92/405 (23%) liver, and 25/67 (37%) lung recipients had COVID-19 infection. By era, there were 99 (37%) original strain/ Alpha, 65 (24%) Delta, and 105 (39%) Omicron. The patients’ median age was 12.72 years (IQR 6.6, 15.1) with a minority of recipients being female (42%). Common comorbidities included hypertension (50%), obesity (13%), diabetes (10%), and chronic kidney disease (10%); 34% had no comorbidities aside from chronic immunosuppression post-transplant. Overall, 80% of recipients were symptomatic (Figure 1), and 50 (19%) required hospitalization. Hospitalization rates were highest (29%) during Delta, compared with 18% for original/Alpha and 13% for Omicron (p=0.02) eras. Need for respiratory support, ICU admission, and all-cause mortality did not vary by era (Table 1). Three SOT recipients (2 original/Alpha and 1 Delta) were diagnosed with multi-inflammatory syndrome in children (MIS-C).

Conclusion
Our study suggests that pediatric SOT recipients have a high risk for hospitalization and short-term complications with COVID-19; Omicron appears to cause less severe disease, including MIS-C. Additional studies are needed to understand long-term complications of COVID-19 in SOT recipients.

Disclosures
Elizabeth A. Moulton, MD, PhD, Pfizer: Grant/Research Support Flor M. Munoz, MD, MSc, Gilead: Grant/Research Support|Moderna: DSMB|Pfizer: DSMB.