bluuebunny/crossref_metadata_2025_split huggingface dataset:
1572. Impact of a Multicenter Fluoroquinolone Stewardship Collaboration on Prescribing Trends over Five Years
Authors: Olson Kelsey , Blackburn Laura , Feltman Judy 
Published: December 2022

Abstract

Background
Fluoroquinolone (FQ) use is generally discouraged in uncomplicated infections when alternative therapies exist. Antimicrobial stewardship programs use diverse strategies to encourage appropriate prescribing of antibiotics, and FQ stewardship is often a priority due to the known toxicity risks. This study aimed to evaluate how the coordinated implementation of several stewardship strategies impacted FQ prescribing at eight community hospitals.

Methods
This retrospective, observational study includes data from January 2017 to January 2022. In 2018, the facility clinical pharmacy programs established formal clinical metrics to be tracked and reported on a regular basis. One such metric tracked FQ prescribing in urinary tract infections (UTI), and this metric has remained active since 2018. In early 2019, the health-system implemented a clinical decision support alert in the electronic health record, which requires acknowledgement of a risk/benefit assessment upon FQ order entry. In late 2019, some facilities began suppressing automated susceptibility results for FQ on cultures, due to technological limitations with new minimum inhibitory concentration breakpoints. Using a clinical surveillance system, a report was generated to assess the year-over-year changes in FQ days of therapy (DOT) per 1000 patient days at each facility.

Results
An 83% reduction in FQ use was observed over five years (737 DOT/1000 patient days vs. 125 DOT/1000 patient days), with facility-level reductions ranging from 62% to 96%. The smallest decrease in FQ use (18%) occurred from 2017–2018, before any system-wide FQ stewardship initiatives were adopted. A larger decrease in FQ use (33%) was seen from 2018–2019, after introducing the formal FQ UTI metric. The biggest decrease in FQ use (50%) occurred from 2019–2020, when the FQ alert and susceptibility suppression strategies were implemented alongside the existing UTI metric. An additional 39% decrease in FQ use was seen from 2020–2022, when no additional FQ interventions were implemented.

Conclusion
Substantial decreases in FQ prescribing were observed when multiple FQ stewardship strategies were utilized. The decreases were sustained over several years across multiple hospitals.

Disclosures
All Authors: No reported disclosures.
1185. Taking care of migrants: The approach to eosinophilia
Authors: Kladias Michael , Berto Moreano Cesar G , Mahmood Sumaita , Friedman Lianna , Coyle Christina 
Published: December 2022

Abstract

Background
Eosinophilia in immigrant patients is a common finding in the outpatient setting. While screening guidelines for refugee populations exist, there are no guidelines to the approach to eosinophilia in immigrants. Etiologic diagnosis and laboratory investigation in migrant patients requires attention to the epidemiological risk factors. Serodiagnosis is an important tool in the diagnosis of chronic parasitic diseases affecting migrant patients.

Methods
We describe the demographic, laboratory and diagnosis characteristics of migrant patients with eosinophilia (absolute eosinophil count ≥ 500 cells/mm3) who were referred to the Tropical Medicine clinic of Jacobi Medical Center, New York.

Results
A total of 104 cases of eosinophilia were seen. Most individuals were female (54.8%) and born in The Caribbean (27.9%), followed by Asia (23.1%) and Central America (15.4%). The mean age of the patients was 50.7 ± 14.4 years and the median time from migration was 18 years [IQR 6-28 years]. The mean of the peak of eosinophils in the past 3 months was 1300 ± 600 cel/mm3. Serology for Strongyloides was positive in 24 patients (23.1%). The proportion of seroprevalence for Strongyloides by country was higher in Central America (7 patients; 43.8%), Africa (3 patients; 37.5%) and The Caribbean (8 patients; 27.6%). Patients with bathroom and plumbing outdoors were more likely to be seropositive for Strongyloides (p=0.04). Chagas serology was positive in 6 out of 10 patients tested and Schistosoma antibodies were positive in 3 out of 8 patients tested. Of note, both results were only tested in patients with epidemiological risk factors.

Conclusion
Strongyloidiasis was common in our migrant population. Individuals without water supply and bathroom inside the house were more likely to have a positive serology. Many of these patients can develop disseminated infection if receiving corticosteroids. Screening in at-risk asymptomatic patients allows to identify and treat this latent disease and avoid potential morbidity and mortality. Patients were also screened for other latent parasitic infections based on epidemiology risk factors that do not result in eosinophilia such as Chagas disease and schistosomiasis. Further studies are needed to help inform guidelines on screening immigrant populations.

Disclosures
All Authors: No reported disclosures.
1191. Comparison of High Touch Surface Bioburden Associated with the Use of Disinfectants With and Without Continuously Active Disinfection Properties in Ambulatory Care Settings
Authors: Torres Heidi M , Marino Jamie , Simon Matthew , Singh Harjot K , Westblade Lars , Calfee David P 
Published: December 2022

Abstract

Background
Microbial contamination of high-touch surfaces (HTS) in health care settings contributes to pathogen transmission. HTS quickly become re-contaminated after disinfection. A quaternary ammonium (QA) and isopropyl alcohol (IPA)-based disinfectant (Sani-24®) with reported continuously active disinfection (CAD) properties for up to 24 hours has been associated with reduced microbial buildup on HTS over time in in vitro studies and inpatient healthcare settings. The performance of this product in ambulatory care settings has not been reported.

Methods
HTS bioburden associated with use of QA-IPA with CAD (Sani-24®) was compared to that of a QA-IPA disinfectant without CAD (Super Sani-Cloth®) in an urgent care center (UCC) and outpatient clinic (OPC). Surfaces/rooms were assigned 1:1 to the disinfectants. Study team used pre-saturated wipes to disinfect designated HTS (stretcher/exam table, stretcher rail, armrest, doorknob, counter, light switch) at the beginning of each sampling period. In the UCC, unit staff performed subsequent disinfection per routine protocols. In the OPC, unit staff used the study-assigned disinfectant for disinfection between patients. HTS were sampled at 0, 4-6, 8-12, and 24 hours using Eswabs soaked in neutralizing broth. Microbial burden was quantified after 48 hours of incubation. Average CFU/cm² were compared using T-tests and proportion of samples with &lt; 2.5 CFU/cm², a microbiologic standard for environmental surfaces, were compared by chi-square test.

Results
66 UCC HTS (33 per disinfectant) and 70 OPC HTS (35 per disinfectant) were included. There were no statistically significant differences in average CFU/cm² on individual HTS (Figure 1) or average CFU/cm² on all HTS combined between the disinfectants. There were also no significant differences in the proportion of surfaces with &lt; 2.5 CFU/cm² (Figure 2) between the disinfectants.

Conclusion
No differences were observed in the HTS bioburden in ambulatory settings over 24 hours following disinfection using products with and without CAD. These findings differ from those of studies in other settings, perhaps due to frequent disinfection, less extensive recontamination, or Hawthorne effect in these ambulatory settings. Further study in other ambulatory care settings is warranted.

Disclosures
Harjot K. Singh, MD, clinical care options: Advisor/Consultant|MJSciences/HCP Live: Advisor/Consultant|NYC Health and Hospitals: Advisor/Consultant Lars Westblade, PhD, Accelerate Diagnostics, Inc.: Grant/Research Support|BioFire Diagnostics, LLC: Grant/Research Support|Hardy Diagnostics: Grant/Research Support|Roche Molecular Systems, Inc.: Advisor/Consultant|Roche Molecular Systems, Inc.: Grant/Research Support|Shionogi, Inc.: Advisor/Consultant|Talis Biomedical: Advisor/Consultant.
1208. Polymorphic Locus SerMT1 for Sequence-based Typing of Serratia marcescens
Authors: Edlind Tom 
Published: December 2022

Abstract

Background
Outbreaks of pathogenic agents within healthcare facilities may have sporadic or nosocomial sources. Effective intervention requires distinguishing between these sources, which in turn requires epidemiological investigation in conjunction with typing of pathogen isolates. For the latter, established methods range from ribotyping and pulse-field gel electrophoresis to multilocus sequence typing and whole genome sequencing. Due to technical complexities and costs associated with these methods, however, typing is rarely pursued. Polymorphic locus sequence typing (PLST) addresses these issue by employing conventional PCR and Sanger sequencing; the key to PLST is its focus on a tandem repeat-containing locus exhibiting maximal variation due to combinations of single nucleotide polymorphisms and insertions/deletions. Serratia marcescens has been implicated in numerous nosocomial outbreaks, and relatedly has the ability to colonize the hospital environment (e.g., sinks), although few studies have definitively established an outbreak-environment link.

Methods
To extend PLST to S. marcescens, tandem repeats were bioinformatically identified in the genome sequence of strain WW4 (accession CP003959) and used with flanking sequences as queries in BLASTN searches of the GenBank nr/nt Serratia genome database including 97 S. marcescens strains. One locus designated SerMT1 (bp 243212-244195) was present in all strains and exhibited high variability associated with 6-16 copies of a PVVEPE-encoding repeat within signal recognition particle receptor gene ftsY.

Results
SerMT1 was downloaded from all 97 strains, aligned using Clustal Omega, and phylogenetically analyzed using DNA parsimony. This analysis resolved 91 total alleles and yielded an impressively high Simpson’s Diversity Index of 0.998. Six clusters of 2 to 4 strains shared SerMT1 sequence; their epidemiologic relatedness was supported by their GenBank annotations (e.g., UMH-10 and UMH-11 isolated the same month at the same facility).

Conclusion
SerMT1 PLST provides an affordable, user-friendly new tool for epidemiologic investigation of S. marcescens outbreaks.

Disclosures
Tom Edlind, PhD, MicrobiType LLC: Ownership Interest.
1211. Assessing the Applicability of Enhanced Barrier Precautions among Adult Hospitalized Patients
Authors: Makhija Jinal , Lin Michael Y 
Published: December 2022

Abstract

Background
In nursing homes, the CDC has endorsed an interim approach for containment of multidrug-resistant organisms called Enhanced Barrier Precautions (EBP). With an EBP approach, residents with either indwelling medical devices or chronic wounds are considered at risk for multidrug-resistant organisms; therefore, healthcare personnel are to use gown and gloves for care activities that are considered high risk for organism transmission (e.g., dressing or bathing a patient), while lower risk activities are excluded. EBP guidance currently does not apply to acute care hospitals; we aimed to assess what proportion of hospitalized patients would qualify for an EBP prevention approach.

Methods
We performed rolling single day point prevalence surveys for all adult inpatient units at Rush University Medical Center, Chicago, IL in March-April 2022. Using electronic chart review, we recorded patient unit location, multidrug-resistant organism colonization status, Contact Precautions status, presence of indwelling medical devices, and presence of wounds (pressure ulcer of stage ≥2, or open surgical wound). Patients with any indwelling device or wound qualified for EBP. We also assessed alternate definitions of EBP (device-only or wound-only). Prevalence differences were analyzed using the Chi-squared test.

Results
We assessed 353 hospitalized patients (characteristics, Table 1). Among all patients, 18% (n = 65) were in Contact Precautions, primarily for the indication of multidrug-resistant organism or C. difficile control. Under an EBP approach, a higher proportion (52%, n = 184, P = .005) would qualify. Under alternate EBP definitions, 49% (n = 172) would qualify under a device-only criterion, and 9% (n = 32) would under a wound-only criterion. Comparing intensive care unit (ICU) vs non-ICU patients, Contact Precautions rates were similar, but EBP rates would be higher in ICU patients than non-ICU patients, driven by device use (Table 2).

Conclusion
An EBP infection control approach would impact a substantially larger proportion of hospitalized patients, compared to traditional indications for Contact Precautions. To improve feasibility of an EBP approach among hospitalized patients, further refinements to the qualifying criteria are likely needed.

Disclosures
All Authors: No reported disclosures.
1234. Analysis of an Automated Letter HCV Screening Program within a Veterans Affairs Health System: Implications for Universal HCV Screening
Authors: Harjono Lucas , Motwani Yash , Mohtashemi Neaka , Chen Phillip , Tamkus Greta , Dong Tien , Benhammou Jihane , Goetz Matthew B , Kawamoto Jenna , Patel Arpan , Bhattacharya Debika 
Published: December 2022

Abstract

Background
Although universal Hepatitis C Virus (HCV) Screening in the US was recommended in 2020, the optimal implementation method is unknown. We characterized the efficacy of an automated letter HCV screening program at the Veteran’s Affairs (VA) Greater Los Angeles Healthcare System (VAGLAHS) and evaluated associations with linkage to care.

Methods
From January 2017 to May 2020, 14,804 Veterans born between 1945-1965 who did not have an HCV antibody (Ab) test result within the last 10 years and who were within the VAGLAHS catchment area were identified. Veterans were mailed a letter recommending HCV screening via a centralized process. Veterans then used the letter to present to a VA laboratory for HCV Ab testing, which included reflex HCV viral load. Those who were HCV viremic were referred to Hepatology/Infectious Diseases clinics for initiation of HCV treatment. Baseline characteristics of those with subsequent HCV viremia were collected. To determine associations with the first HCV visit (linkage to care), we performed independent chi-squared tests.
Flowchart of Automated Letter HCV Screening for Veterans

Results
A total of 12,875 Veterans were identified, 4,011 (31%) Veterans presented for HCV Ab testing, 167/4011 were HCV Ab + (4.2%), and 69/167 (41.3%) had HCV viremia. Of those viremic, 94 % were male, 26% were African-American, 62% had stable housing, 24% lived &gt;90 miles from the nearest VA clinic, and 17% had cirrhosis. Fifty-five Veterans (80%) were evaluated in a viral hepatitis clinic and 84 % (46/55) initiated HCV treatment (Figure 1). Patients’ housing status (p = 0.02), cirrhosis (p&lt; 0.0001), and distance to clinic (p=0.063) were associated with non-linkage to an initial HCV appointment.

Conclusion
One third of Veterans approached via mail participated in HCV Ab testing. Overall HCV Ab positivity rates were 4% and nearly half had HCV viremia. The majority of Veterans were linked to care but housing status, cirrhosis, and distance to clinic were associated with non-linkage to care. Automated letter screening is a promising approach to HCV screening, including universal screening. Future research should include investigations of telehealth and e-consults for linkage to care, especially for those who have marginalized housing status and live far from clinic.

Disclosures
Debika Bhattacharya, MD, MSc, Gilead: Grant/Research Support|Regeneron: Grant/Research Support.
1245. Outpatient Hepatitis C Management in Patients with Substance Use Disorder Following Hospital Admission for Severe Bacterial Infection
Authors: Conte Michael , Streifel Amber C , Sikka Monica K , Varley Cara D 
Published: December 2022

Abstract

Background
Patients with substance used disorder (SUD) are at high risk of hepatitis c virus (HCV) infection. During admission for acute illness, patients with SUD are often screened for or known to have untreated chronic HCV with outpatient follow-up recommended. However, many barriers to HCV treatment exists including lack of insurance, no primary care provider (PCP), drug cost, and transportation. Therefore, we aimed to investigate HCV follow-up and treatment in patients with SUD post-hospitalization.

Methods
We performed a retrospective review of patients with SUD admitted for a severe bacterial infection between July 2015 and March 2020. A descriptive analysis was performed to evaluate patients with positive HCV testing instructed to follow-up outpatient for HCV treatment per discharge summary. We collected key information via chart review including location and attendance of follow-up as well as HCV testing and treatment status within two years of discharge.

Results
We identified 108 patients during the study period with chronic HCV in which 48 were recommended follow-up for outpatient HCV treatment (Table 1). 38 (79.2%) were recommended to follow-up with PCP and 10 (20.8%) with hepatology. 15 patients (31.2%) made their follow-up appointment. 30 patients (62.5%) had documented repeat HCV testing within two years of discharge. Of these, one (3.3%) was HCV antibody (Ab) only, 10 (33.3%) were HCV Ab plus viral load (VL), and 19 (63.3%) were HCV VL alone. 41 patients (85.4%) had no evidence of HCV treatment and 7 (14.6%) had documented clearance (4 confirmed treatment, 2 presumed treatment, and one documented treatment without confirmed testing). Of the 7 treated, 4 (57.1%) had a PCP prior to admission, whereas in the 41 untreated, 5 (12.2%) had a PCP. Table 1:HCV Follow-Up Outcomes

Conclusion
A low proportion of patients were confirmed to initiate and complete outpatient HCV therapy following hospital discharge. Many patients were lost to follow-up and had no repeat testing available. One-third of patients with repeat testing had repeat HCV Ab screen indicating an area for diagnostic stewardship. More pro-active approaches coordinating HCV therapy in patients with SUD requiring hospitalization for other infections are warranted in order to prevent unnecessary sequelae including HCV cirrhosis and carcinoma.

Disclosures
Monica K. Sikka, MD, F2G: Site research investigator.
1247. Primary Care Teams in Veterans Health Administration Have High Knowledge of Universal HCV Screening But Favor System-Level Interventions to Close Care Gaps
Authors: Patel Arpan , Mohtashemi Neaka , Motwani Yash , Tseng Chi-hong , Kawamoto Jenna , Chen Phillip , Celedon Manuel A , Benhammou Jihane , Dong Tien , May Folasade , Goetz Matthew B , Bhattacharya Debika 
Published: December 2022

Abstract

Background
In 2020, the United States Preventive Services Taskforce recommended one-time Hepatitis C virus (HCV) screening for all adults aged 18-79. As the largest provider of HCV treatment in the US the Veterans Health Administration (VA) is committed to implementing these recommendations; thus, understanding perspectives of primary care teams towards this is critical.

Methods
We disseminated a 24-item online survey to PCPs at the VA Greater Los Angeles Healthcare System (VAGLAHCS), serving 1.5 million Veterans within an area that spans five counties. Our sample included physicians, pharmacists, nurse practitioners, and physician assistants on primary care teams. Our survey contained questions on demographics, provider knowledge of HCV testing, practice patterns and beliefs, and preferences for new screening tools. Descriptive statistics were completed and we compared item responses across demographics. Hypothesis testing was performed using Wilcoxon rank sum test for continuous variables and Fisher’s exact or Chi-square tests for categorical variables.

Results
In total, 107 PCPs responded to the survey (107/385=28% response rate), with 100 complete responses. Most respondents were women (63%) with median age of 42 years, physicians (53%), Internal Medicine-trained (47%), and of Asian descent (45%). A majority (59%) were aware of new screening recommendations. Most PCPs reported confidence (71%), intent (77%), and commitment towards (82%) HCV screening. Only 38% reported remembering to screen Veterans regularly. Physicians were most aware of new recommendations (73%), compared to pharmacists (55%) and nurse practitioners (42%). The most strongly preferred strategies to enhance screening included automatic test orders during physician visits (71%), automatic electronic-consults (68%), clinician reminders for HCV screening (57%), and opt-out phlebotomy (48%).

Conclusion
In a sample of providers within a large and diverse VA, 3 in 5 PCPs were aware of new universal HCV screening recommendations. There is high motivation among PCPs to perform screening, but forgetting to screen is still common. Several strategies to augment universal HCV screening were acceptable towards PCPs.

Disclosures
Debika Bhattacharya, MD, MSc, Gilead: Grant/Research Support|Regeneron: Grant/Research Support.
1249. Rise in ALT after Hepatitis C Treatment is a Highly Sensitive Marker of Treatment Failure
Authors: Flower Barnaby F , Fellow Clinical Research , Day Jeremy , Cooke Graham 
Published: December 2022

Abstract

Background
Hepatitis C nucleic acid testing to confirm sustained virological response (SVR) after antiviral treatment is technical and expensive, hampering scale-up and decentralisation of care in resource-poor settings. Serial liver function testing may offer a cheaper means of screening for treatment failure.

Methods
In an HCV treatment shortening study in Vietnam (n=51), we analysed whether a change in ALT or AST from EOT to EOT+ 12 weeks (ΔALT; ΔAST) was a sensitive surrogate for HCV RNA in detecting treatment failure. We compared ΔALT and ΔAST between cures (38) and failures (13), and assessed sensitivity, specificity and area under receiver-operator curves (AUROC) vs gold standard HCV RNA. We validated our findings in a second, larger study population from a UK treatment shortening study (n=202). Both study populations had mild liver disease, and all participants were treated with 4-8 weeks direct acting antiviral therapy.

Results
In Vietnam, among 46 HCV genotype 1 or 6-infected individuals who supressed ALT on therapy, 11 failed to achieve SVR. Median ΔALT was -1 IU/L in cures vs +24 IU/L in treatment failures (p&lt; 0.001). Increase in ALT (ΔALT &gt; 0) after end-of-treatment was 100% (95% C.I. [66.4 – 100]) sensitive and 48% [26.8 – 69.4] specific vs HCV RNA in identifying failures (AUROC = 0.99). These results were validated among 193 genotype 1 or 4-infected individuals who supressed ALT on treatment in a UK study (in which 60 failed to achieve SVR). Median ΔALT was +1 IU/L in cures vs +45 IU/L in treatment failures (p&lt; 0.001). ΔALT &gt; 0 was 100% sensitive (95% C.I. [94.6 – 100]) and 47% [38.3-56.3] specific (AUC = 0.98). ΔAST performed similarly. Figure 1Change in ALT from EOT to EOT+12 in cures and from EOT to start of retreatment (EOT+6 to 24) in treatment failures in a) Vietnam study b) UK study

Conclusion
ΔALT from EOT to EOT+12 is a highly sensitive screen for identifying DAA treatment failures. Using this strategy, only around half of treated individuals require HCV RNA testing 12 weeks after end of treatment, offering substantial benefits in terms of cost reductions and decentralisation of care.

Disclosures
All Authors: No reported disclosures.