bluuebunny/crossref_metadata_2025_split huggingface dataset:
602. Clinical Outcomes of Ertapenem in Patients with Hypoalbuminemia
Authors: Gavaghan Victoria , Luu Tyler , Adams Jenna , Santarossa Maressa , Albarillo Fritzie S , Rech Megan A 
Published: December 2022

Abstract

Background
Infections caused by extended-spectrum ß-lactamase (ESBL) producing organisms pose a unique challenge for infection control. The preferred agents for treatment of infections due to ESBL-producing bacteria are carbapenems. Data from prior studies suggest that hypoalbuminemia may have a profound effect on the pharmacodynamic properties of ertapenem. Our hypothesis is that ertapenem usage in patients with hypoalbuminemia will lead to negative clinical outcomes such as infection recurrence, hospital readmission, and mortality when compared to subjects with higher albumin levels.

Methods
This was a retrospective, observational, single-centered, cohort study of hospitalized patients at Loyola University Medical Center between January 2010 and August 2020. Patients were divided into 2 groups to include those who received ertapenem with serum albumin &gt;2.5 g/dL and those who received ertapenem with serum albumin &lt; 2.5 g/dL. The primary outcome of interest was 30-day all-cause mortality. Baseline characteristics that were collected included age, sex, nutrition status, patient comorbidities. Data regarding predictors of mortality within 24 hours of initiation of ertapenem including the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Charlson Comorbidity Index (CCI) was also collected.
Study Criteria

Results
Of the 146 subjects that were included, 73 patients had serum albumin levels of &lt; 2.5 g/dL during treatment with ertapenem. 30 day all-cause mortality was 19.7% for subjects with low albumin and 9.6% for subjects with normal albumin levels (p=0.09). Our study found that although not statistically significant, there is potentially a clinical significance between hypoalbuminemia and our primary endpoint, 30-day all-cause mortality, with higher rates of mortality in the low albumin group and a 9.6% between group difference. This data suggests that in subjects with hypoalbuminemia, treatment with once-daily ertapenem may lead to suboptimal outcomes regarding patient mortality.

Outcome Data

Conclusion
The present study data suggests that in subjects with hypoalbuminemia, treatment with ertapenem dosed as a once-daily intravenous infusion may be associated with suboptimal clinical outcomes that may include an increased mortality, hospital readmission, and length of stay.

Disclosures
All Authors: No reported disclosures.
659. In Vitro Activity of Ceftazidime-Avibactam and Comparator Agents against Enterobacterales Collected from Patients with Bloodstream Infections (BSI) as Part of the ATLAS (India) Surveillance Program, 2019-2020
Authors: Routray Abhisek , Mane Akshata 
Published: December 2022

Abstract

Background
Ceftazidime-avibactam (CAZ-AVI) is indicated for patients with bacteremia that occurs in association complicated intra-abdominal infection (cIAI), complicated urinary tract infection (cUTI) and hospital-acquired pneumonia (HAP). The present report evaluated the in vitro activity of CAZ-AVI and comparators against Enterobacterales clinical isolates collected from BSI as part of the ATLAS (The Antimicrobial Testing Leadership and Surveillance) surveillance program in 2019-2020 from India.

Methods
A total of 2126 Enterobacterales (493 from blood samples) non-duplicate clinically significant isolates, were collected from 2019-2020. In vitro activity of Ceftazidime-avibactam and its comparators were assessed against Enterobacterales blood isolates.

Results
Overall susceptibility to the β -lactam/β -lactamase inhibitor (BL-BLI) was 60 -76% for Enterobacterales. with highest susceptibility to Ceftazidime-avibactam. Overall highest susceptibility (97%) was noted for Tigecycline for Enterobacterales(n=476).The susceptibility to colistin was lower(83%) in Enterobacterales (n=409). Among 168 CR-Enterobacterales (CRE), Ceftazidime avibactam showed 29% susceptibility (n=49) while susceptibility to Tigecycline was 96%(n=161) followed by Colistin at 84%(n=141). Molecular analysis for CRE isolates showed 55 % (n=93) to be OXA-48 like producers (with or without NDM) ,68%(n=114)to be NDM producers (with or without OXA- 48) and 30%(n=51) to be co producers of OXA-48 like & NDM.
In vitro activity of commonly used antibiotics against Enterobacterales, blood isolates (2019-2020)

Conclusion
Caz-Avi showed overall good susceptibility against the blood isolates tested hence it may be a valuable therapeutic option for treating BSI caused by MBL-negative Enterobacterales. Tigecycline followed by Colistin showed the highest susceptibilities. Tigecycline attains very low plasma concentrations and is not licensed for use in blood stream infections, while the use of colistin may be limited by the lack of CLSI susceptibility breakpoints and safety concerns.

Disclosures
Abhisek Routray, PhD, Pfizer India Limited: Advisor/Consultant Akshata Mane, MD, Pfizer India Limited: Advisor/Consultant|Pfizer India Limited: Stocks/Bonds.
669. Real World Use of Ceftazidime/Avibactam for the Treatment of Multidrug Resistant Gram Negative Bacilli Infections: A Real World Experience from Two Centers in Mexico
Authors: Molina-Jaimes Aaron , Olmedo-Reneaum Alejandro , Sanabria-Trujillo Giovanni 
Published: December 2022

Abstract

Background
Ceftazidime-avibactam (C-A) is effective against many carbapenem resistant Enterobacteriaceae (CRE) and some carbapenem resistant Pseudomonas aeruginosa (CRPsa), indicated in complicated urinary tract infections (cUTI), complicated intra-abdominal infections (cIAI), and hospital-acquired pneumonia. To our knowledge, in Mexico, there is no data regarding the clinical efficacy (clinical cure) of its use in the treatment of cIAI, cUTI, hospital-acquired pneumonia, and the treatment of CRE and CRPsa.

Methods
this is a descriptive, observational, retrospective study, including infections in which ceftazidime avibactam was the definitive therapy for CRE and CRPsa, and empiric treatment of cUTI, cIAI, Hospital-acquired pneumonia. The study includes patients from 2 centers, between April 2019 and february 2020. Demographic, clinical and microbiological data were obtained. Clinical cure was defined as the absence of fever, leukocytosis, tachycardia, systolic pressure &lt; 90mmHg or use of vasopressors, and lowering of C-reactive protein by at least 60% after 5 days of treatment.

Results
Seventy patients in which C-A was the definitive antimicrobial treatment were evaluated. UTI accounts for 24 cases (34.2%), followed by primary and secondary peritonitis (28.5%), soft tissue infection (12.8%), bacteremia (12.8%) and hospital-acquired pneumonia (11.4%). Of all infections 39.9% were secondary to CRPsa, and 60.1% were due to CRE (30.3% Klebsiella pneumoniae, 21.2% Escherichia coli and 6% for Klebsiella oxytoca, Enterobacter cloacae and Proteus mirabilis). Clinical cure was achieved in 64 patients (91.4%). Six patients died, but only one was associated to CRPsa infection.

Conclusion
To the best of our knowledge, this is the first study of Mexican experience with C-A. Our study brings relevant information on the treatment of carbapenem resistant GNB infections with C-A in our population. More studies, specifically RCTs are needed to prove the antibiotic efficacy in our media.

Disclosures
All Authors: No reported disclosures.
965. Prevalence and Drivers of Burnout Among Antimicrobial Stewardship Personnel in the United States: A Cross-Sectional Study
Authors: Szymczak Julia E , Elle Saine M , Chiotos Kathleen , Keller Sara C , Newland Jason , Lautenbach Ebbing , Heil Emily L 
Published: December 2022

Abstract

Background
Although antimicrobial stewardship (AS) personnel are faced with occupational stressors that may contribute to burnout, little is known about the degree to which they experience this work-related syndrome. Our objective was to characterize the prevalence of, and identify factors associated with, burnout among AS personnel practicing in United States (US) hospitals.

Methods
We conducted a cross-sectional survey in October-December 2021. AS personnel (physicians and pharmacists) were approached via email through four US-based professional organizations. Respondents self-administered a questionnaire measuring demographics, AS program structure, resources, and organizational climate. Burnout was measured using the Maslach Burnout Inventory, a 22-item validated instrument with three subscales. Burnout was defined as a dichotomous outcome based on the presence of high scores on the emotional exhaustion subscale along with either a high depersonalization score or low professional accomplishment score. Descriptive statistics and logistic regression analyses were performed.

Results
A total of 259 AS personnel completed the questionnaire. The majority of respondents were pharmacists (n=201; 78.2%), female (n=166; 64.3%) and worked in a teaching hospital (n=212, 84.1%). The median age was 36 (IQR, 32-41). Thirty-six percent (n=94 of 259) of respondents met the definition for burnout. There were no significant differences in burnout by respondent demographics or professional role. Significant drivers of burnout (P&lt; 0.05) identified in univariable regression modeling included feeling as if AS is not an institutional priority, that hospital leadership is unsupportive of AS, prescriber resistance to AS recommendations is common, having unsupportive infectious diseases or pharmacy colleagues, the AS team does not work well together, and AS work is not intellectually stimulating.

Conclusion
Over one third of AS personnel in our sample met predefined standardized criteria for burnout. Contextual aspects of the work environment, including leadership, unsupportive peer climate and conflict were associated with burnout. There is a need to address factors that contribute to burnout in AS personnel to ensure an engaged workforce and to minimize turnover.

Disclosures
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.
1033. Management of Disseminated Nocardiosis in an Immunocompromised Patient Using Multi-Drug Therapy
Authors: Khan Abrar , Perwez Talha , Farooq Junaid , Gutierrez Ramiro , Zeineddine Nabil , Mahapatra Rahul 
Published: December 2022

Abstract

Background
Nocardiosis may cause fatal infections in immunocompromised and immunocompetent patients. While there are many different species, Nocardia farcinica, has been a clinically important cause but less frequently identified species. We present a case of an immunocompromised patient successfully treated with a multi-drug regimen for disseminated nocardiosis due to Nocardia farcinica.

Methods
The patient is a 65-year-old male with a history of Autoimmune Hemolytic Anemia (AIHA) who presented with fevers, chills, symptomatic anemia, and new left lower extremity weakness associated with spasms over several days prior to arrival.

Results
6 months prior, he had received treatment for AIHA with rituximab, cyclophosphamide, and high dose corticosteroids. Head CT revealed a 1.5cm right posterior frontal lobe mass with surrounding edema. CT thorax revealed innumerable spiculated pulmonary nodules and masses bilaterally. Lung biopsy as well as blood culture were positive for Nocardia farcinica, specimen was sent to reference laboratory for susceptibility testing. He was initially treated with imipenem and IV Bactrim. Subsequently, clinical exam findings were unchanged and repeat MRI brain showed enlarging frontal mass. Linezolid and IV amikacin were added to the regimen based on susceptibility results. Patient was discharged home but returned to hospital shortly after discharge with severe hemolytic anemia, suspected to be due to Bactrim administration. The patient was later discharged home on Imipenem, IV amikacin, oral Linezolid, and oral Moxifloxacin in stable condition without surgical intervention and with improved left lower extremity weakness.

Conclusion
Disseminated Nocardiosis is known to cause fatal pulmonary and CNS infections in immunocompromised patients and requires aggressive therapy usually with multiple antibiotics. Nocardia farcinica infections are particularly clinically complex given the organism’s multiple inherent resistance mechanisms, interpretation of in vitro susceptibility testing, and possible adverse effect profile of treatment regimen.

Disclosures
All Authors: No reported disclosures.
1118. COVID-19 Therapeutics: Real-World Experience in Flint, Michigan (MI)
Authors: Younas Mariam , Osterholzer Danielle , Rios-Bedoya Carlos , Flues Brandon R , Bachuwa Ghassan , Bachuwa Ghassan 
Published: December 2022

Abstract

Background
Data on the real-world effectiveness of Remdesivir (RDV) has yielded conflicting results. US Food and Drug Administration granted full approval for RDV on 10/22/20. On 11/20/20, the World Health Organization issued a conditional recommendation against its routine administration in hospitalized patients, regardless of disease severity. We aimed to examine the association between COVID-19 therapeutics and survival among the recipients.

Methods
Hurley Medical Center, is a 443-bed teaching hospital in Flint, MI. We retrospectively collected basic demographics, treatment data, and outcomes on adults (≥ 18 years of age) with confirmed SARS-CoV-2 infection, hospitalized at our facility from 03/2020 through 02/2022. Mortality predictors were identified using logistic regression.

Results
During the study period, overall crude 90-day mortality rate was 16% (269/1668). Supplemental oxygen was required by 1,213 patients and 378 needed ventilatory support. Early in the pandemic, 159/1668 patients received Hydroxychloroquine (HCQ). Based on institutional protocol, 51% (858/1668) of the patient received RDV (Figure 1, 2). After adjusting for age, gender, race and Body Mass Index, HCQ was associated with increased risk of mortality (Odds ratio (OR) 1.72, 95% Confidence Interval (CI) 1.14 – 2.59, p-value 0.010). Mortality in the RDV group was also noted to be higher (162/269) (adjusted OR for mortality 1.37, 95% CI 1.03 – 1.83, p-value 0.032). Supplemental oxygen use was associated with mortality regardless of RDV use (adjusted OR 3.39, 95% CI 2.15 – 5.36, p-value &lt; 0.001). RDV showed no mortality benefit in the group requiring mechanical ventilation (MV) (adjusted OR 0.77, 95% CI 0.55 – 1.09, p-value 0.152) (adjusted OR for mortality with MV 18.62, 95% CI 13.02 – 26.63, p-value &lt; 0.001). Figure 1:Institutional protocolFigure 2:Institutional protocol

Conclusion
This study adds to the growing evidence that more efficacious treatments against COVID-19 respiratory failure are needed once a patient is hospitalized and that antiviral therapies at this late stage may not have the desired effect. This study has several limitations including its retrospective nature and that the RDV group was likely sicker with higher disease severity. We also did not assess the effect of combination therapy such as RDV and steroids on mortality. A need for further studies remains.

Disclosures
All Authors: No reported disclosures.
1153. Safety and Potential Efficacy of Exosomes Overexpressing CD24 (EXO-CD24) for the Prevention of Clinical Deterioration in Patients with Moderate or Severe COVID-19: A Phase II, Randomized, Single-blinded Study.
Authors: Grigoropoulos Ioannis , Tsioulos Georgios , Kastrissianakis Artemis , Shapira Shiran , Arber Nadir , Poulakou Garyfallia , Syrigos Konstantinos , Rapti Vasiliki , Xynogalas Ioannis , Leontis Konstantinos , Ntousopoulos Vasileios , Sakka Vissaria , Gaga Mina , Sardelis Zafeiris , Fotiadis Andreas , Vlassi Lamprini , Kontogianni Chrysoula , Levounets Anastasia , Tsakona Maria , Savva Athina , Kavatha Dimitra , Boumpas Dimitrios , Antoniadou Anastasia , Tsiodras Sotirios 
Published: December 2022

Abstract

Background
EXO-CD24 is a novel inhaled drug of exosomes displaying CD24, a protein with anti-inflammatory properties. We evaluated the safety and potential efficacy of EXO-CD24, in a phase II, randomized, single-blinded clinical trial of EXO-CD24 in hospitalized patients with moderate or severe COVID-19, following the preliminary safety and efficacy results of a phase 1 study (ClinicalTrials.gov: NCT04747574).

Methods
Two tertiary care hospitals in Athens, Greece participated. Patients received either 109 or 1010 exosome particles per dose, once per day for 5 days and were followed for 28 days. Safety and efficacy measures (including respiratory rate &lt; 23 b/min and pulse oximetry SpO2≥ 94% on room air, oxygen need and levels of inflammatory biomarkers i.e. CRP, LDH, ferritin, fibrinogen and d-dimers) were compared between groups at days 3, 5 and 7. A separate analysis was conducted comparing the clinical course of treated patients with that of a control cohort (n=70 patients) matched by propensity scoring out of a similar period hospitalized cohort (n=202) that did not participate in the study.

Results
Between June 9th and August 3rd 2021, 91 patients underwent randomization: 45 in group A and 46 in group B (109vs. 1010 exosome particles per dose). Mean age was 49.4 (± 13.2) years and 74.4% were male. Mean time from symptom onset to randomization was 8 days. Improvement in respiratory rate and pulse oximetry was noted in 72 out of 86 (83.7%) and 55 out of 86 (64%) analyzed patients. Day 7 inflammatory indices levels dropped at least 50% from baseline admission values in 72 out of 86 (82.8%) analyzed patients (p&lt; 0.001). No treatment-related adverse events were reported. Comparison with the propensity score matched group showed statistically significant differences in the same parameters (p≤ 0.01 for all comparisons).

Conclusion
Our results suggest safety and potential efficacy of EXO-CD24 on clinical and laboratory parameters of moderate or severe COVID-19, that deserve further investigation in a phase 3 study. (Funded by Athens Medical Society. ClinicalTrials.gov: NCT04902183, EU Clinical Trials Register EudraCT Number 2021-002184-22).

Disclosures
All Authors: No reported disclosures.
Suicide and Self-Injury in Schools
Authors: Haag Granello Darcy , Granello Paul F. , Juhnke Gerald A. 
Published: December 2022

Abstract
Suicide and self-injury among students is a significant and growing concern. Students of all ages and grade levels are at risk, and the risk is disproportionately affecting certain students. Suicide rates are rising among Black students, for example, particularly among the very young. Other high-risk groups, such as transgender, LGBTQI+, and gender non-conforming students, Latinx, American Indian/Alaska Native, Asian/Pacific Islander students, and students with high ACEs scores are challenging our traditional perceptions about suicide risk. The pandemic, racism, social unrest, sleep disturbances, higher rates of substance use or mental illness, loneliness, bullying, and increased screen time all contribute to this increased risk. Schools must now use a whole school approach to suicide prevention where school mental health specialists develop and lead a comprehensive approach to creating a school-wide culture of care. In this approach, all staff, teachers, students, and parents have a role to play in saving lives, and suicide prevention truly becomes a shared responsibility. This book provides a research-informed, practical strategy for how schools can develop—and implement—a systemic and realistic school-wide approach. Readers will learn step-by-step approaches that will ultimately lead to the creation of Comprehensive School-Wide Suicide Prevention Program, grounded in 10 core components. Throughout the book, when a new concept, risk category, need, or application idea is presented, it is immediately followed by a concrete, practical strategy that can be implemented. There are more than 120 of these research-backed strategies, all of which have been tested in practice.
A Call to Action
Authors: Granello Darcy Haag , Granello Paul F. , Juhnke Gerald A. 
Published: December 2022

Abstract
Suicide is the third leading cause of death among young people ages 15–24, accounting for 17% of all deaths in this age group. Yet completed suicides are just the tip of the iceberg. More than 5,000 middle and high school students have a suicide attempt each day, and nearly one in five middle and high school students has seriously considered suicide in the past year. It is not fully understood how the pandemic has affected the long-term mental health and suicide rates of today’s young people, but all indications are that there will be multiple negative outcomes. It is within this context that readers are given information that underscores the importance of the topic and introduced to some of the key concepts and terminology regarding suicide.
Understanding Who Is at Risk
Authors: Granello Darcy Haag , Granello Paul F. , Juhnke Gerald A. 
Published: December 2022

Abstract
Understanding which students might be at elevated risk for suicide can help school personnel begin to create appropriate suicide prevention programming for their schools. Students in all demographic categories, of both sexes, as well as students who are transgender and gender fluid, of all sexual orientations, and of all races, ethnicities, and ages, can be at risk for suicide, although specific risk can vary. This chapter discusses these large-scale social and demographic risk categories. However, an important take-home message from this chapter is that school personnel must understand the students within their own schools and the risk factors for their specific school populations.
Understanding How the Online World and Social Media Affect Suicide Risk
Authors: Granello Darcy Haag , Granello Paul F. , Juhnke Gerald A. 
Published: December 2022

Abstract
Today’s students live in an online environment. Although the digital world, particularly social media, can seem overwhelming and frightening when it comes to suicide prevention, the reality is that this is the world in which students live. School-based mental health professionals must help students learn social media literacy. Students need help to make sense of what they see, hear, and participate in when they engage in these virtual relationships so that they are protected and safe. Ultimately, there is great potential in helping students use their engagement in these online platforms to help reduce mental health stigma, encourage help seeking, and lower suicidality. School-based mental health professionals can teach appropriate guidelines and then support and encourage students as they discover how to best, and safely, use these virtual platforms to help save lives.
Working With Suicidal Students in Schools
Authors: Granello Darcy Haag , Granello Paul F. , Juhnke Gerald A. 
Published: December 2022

Abstract
Schools are expected to help identify, perform the initial assessment of, contact parents of, help initiate the referral process for, and monitor students who have chronic suicidal thoughts; develop protocols for the re-entry of students who are returning after a suicide crisis; follow up with suicidal students; and document their efforts. Although most intervention work takes place with a community provider, school mental health professionals must work with parents, clinicians, and the suicidal student. Advanced training in suicide may be needed for staff to carry out these duties. Suicidal students fall into roughly three categories: chronically suicidal students, actively suicidal students, and students who return to school following a suicide crisis. Intervention for students who are suicidal generally follows a modified crisis counseling approach.