bluuebunny/crossref_metadata_2025_split huggingface dataset:
1840. Implementation of a daptomycin dosing nomogram and assessment of clinical outcomes across a large health system
Authors: Terravecchia Ariana , Gopinathan Vineet , Minor Sarah B 
Published: December 2022

Abstract

Background
Daptomycin (DAP) is frequently used for a gram-positive infections with conflicting guidance on optimal dosing, especially dosing weight in obese patients. With newer commercially available vial sizes and limited supporting evidence pointing to an optimal dosing strategy and dosing weight (e.g., actual, ideal, adjusted), we seek to explore the impact of a standardized DAP nomogram (Figure 1) on both clinical and safety outcomes across a large health system. Figure 1.Standardized Daptomycin Dosing Nomogram

Methods
This retrospective cohort study evaluated patients receiving DAP across 7 campuses within AdventHealth between Sep 1, 2020 to Dec 31, 2020 (pre-implementation with standard mg/kg dosing) and Dec 1, 2021 to Jan 31, 2022 (post-implementation with nomogram dosing). Inclusion criteria: age ≥18, invasive infection (e.g., bone/joint, bacteremia, complicated cellulitis, endocarditis), hospital admission, and duration of DAP ≥72hr. Exclusion: DAP in ambulatory setting, duration of DAP &lt; 72hr, and non-invasive infection, defined as uncomplicated cellulitis not requiring surgical intervention. Primary outcome was clinical success, defined as improvement in signs/symptoms at end of therapy or discharge and absence of repeat positive cultures. Secondary outcomes included mean length of therapy (LOT), adherence to nomogram-guided DAP dosing, and occurrence of adverse events.

Results
100 patients were included in each group. Average age was 58 years and most were male (54%). Most common indication for DAP was bacteremia (46%) and S. aureus was isolated in 28% of all cultures. Thirty-four percent of patients in each group were on concomitant statin therapy and average BMI was similar between groups (31.4 kg/m2 vs. 31.9 kg.m2). Clinical success (Figure 2) occurred in 74% of patients in the post-implementation group compared to 70% in the pre-implementation group (p=0.529). Average LOT was similar (10.9 days vs. 9.15 days, p=0.191). Pharmacist adherence to the nomogram was high at 91%. Rates of adverse events were similar between groups, with CPK elevations &gt; 200 units/L occurring in 12% of patients in the pre-implementation group compared to 14% of patients in the post-implementation group (p=0.674).

Conclusion
A standardized DAP nomogram led to a safe and effective process for treating invasive gram-positive infections.

Disclosures
All Authors: No reported disclosures.
1855. Risk factors for early mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia
Authors: Lee Chan Mi , Kim Chung-Jong , Kim Seong Eun , Park Kyung-Hwa , Bae Ji Yun , Choi Hee Jung , Jung YoungHee , Lee Seung Soon , Choe Pyoeng Gyun , Park Wan Beom , Suk Kim Eu , Song Je Eun , Kwak Yee Gyung , Hee Lee Sun , Lee Shinwon , Cheon Shinhye , Kim Yeon Sook , Kang Yu Min , Bang Ji Hwan , Jung Sook-In , Song Kyoung-Ho , Bin Kim Hong 
Published: December 2022

Abstract

Background
Although many deaths due to carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia occur within a few days after the onset of bacteremia, risk factors for early mortality (EM) have not been deeply investigated. We aimed to determine the risk factors for EM and the difference between risk factors associated with EM and late mortality (LM) in CRAB bacteremia.

Methods
All patients with CRAB bacteremia in 10 hospitals during a 1-year study period were identified. We prospectively collected patients’ clinical data, including microbiological and demographic data, underlying comorbidities, origin of bacteremia, severity of illness, antibiotic therapy, and mortality. Among the cases with mortality within 30 days, EM and LM were defined as death within 3 and more than 5 calendar days from the first positive blood culture, respectively.

Results
A total of 212 CRAB bacteremia cases were included in the analysis. Of 122 (57.5%) patients with 30-day mortality, EM was observed in 75 (61.5%) patients and LM in 39 (32.0%) patients. The proportion of severe sepsis or septic shock, Pitt score, and Sequential Organ Failure Assessment (SOFA) score were significantly higher in 30-day deaths than 30-day survivors. These factors of clinical severity were also significantly higher in patients with EM than those with LM. While urinary tract infection as the factor of site of infection and the severity of illness were independent predictors of LM, only factors representing the severity of illness were independent risk factors for EM. Appropriate empirical antibiotic therapy was associated with reduced risk of EM.

Conclusion
The difference between risk factors for EM and LM was identified in this study. Our data suggest that a large proportion of CRAB bacteremia with high severity progress to a rapidly fatal course, regardless of the underlying diseases or source of infection. Further studies might be needed to investigate the microbiological factors associated with CRAB and pathogen-host interaction in patients with EM.

Disclosures
All Authors: No reported disclosures.
1856. Risk factors for mortality amongst hospitalised patients with Staphylococcus aureus bacteraemia – a prospective cohort study
Authors: Ngiam Jinghao Nicholas , Nasir Haziq , Mo Yin , Chai Louis Yi-Ann , Archuleta Sophia , Fisher Dale , Tambyah Paul Anantharajah 
Published: December 2022

Abstract

Background
Staphylococcus aureus bacteraemia (SAB) remains a common infection with significant mortality, ranging from 20 to 40%. Understanding the risk factors for adverse outcomes in this infection will better prognosticate and guide patient management and disposition.

Methods
We prospectively recruited and examined 634 consecutive patients with laboratory-confirmed SAB. They were characterised in terms of baseline demographics, clinical profile, and laboratory findings at the time of SAB diagnosis. Sensitivity testing was carried out to identify patients who had methicillin-resistant (MRSA) or methicillin-sensitive Staphylococcus aureus (MSSA) infection. All patients were followed up prospectively for clinical outcomes including in-hospital mortality, and sites of metastatic infection. Univariate and multivariable logistic regression was used to identify risk factors associated with mortality in hospitalised patients with SAB.

Results
The overall mortality was 5.8% (n=37). There were no significant differences in gender, but patients who died tended to be 11 years older on average (69.6±14.9 years vs 58.1±18.2 years, p&lt; 0.001). Diabetes mellitus, prior history of structural heart disease, haemodialysis and recent surgery had not been significantly associated with mortality in our cohort. Amongst the patients who died, MRSA infection was significantly more common (45.9% vs 24.8%, p=0.004). On multivariable logistic regression, older age (adjusted OR 1.05, 95%CI 1.02-1.07) and MRSA infection (adjusted OR 2.04, 95%CI 1.01 – 4.09) remained independently associated with mortality. We did not demonstrate an association with prolonged fever or bacteraemia and in-hospital mortality.

Conclusion
Amongst hospitalised patients with SAB, the mortality was low (5.8%). Older age and MRSA infection were the most important risk factors identified in association with mortality.

Disclosures
All Authors: No reported disclosures.
1859. Significance of Bacteremia in Left Ventricular Assist Device Infections due to Pseudomonas aeruginosa
Authors: Murugan Lalithaa Thirunavukarasu , Murugan Lalithaa Thirunavukarasu , Murugan Lalithaa Thirunavukarasu , Banzon Jona 
Published: December 2022

Abstract

Background
Infection is one of the most common complications of Left Ventricular Assist Devices (LVADs). Pseudomonas aeruginosa (PsA) LVAD infections in particular are challenging due to limited antibiotic options and tendency to form biofilm making eradication difficult. In this study we examined the implications of bacteremia in patients with PsA LVAD infections.

Methods
This was a retrospective study of patients treated at our institution between July 1, 2007 and February 1, 2021 who had proven or probable driveline infection (DLI), pump pocket, or pump/cannula infection due to PsA according to International Society for Heart & Lung Transplantation criteria.

Results
Of 717 patients with an LVAD, 51 patients had had proven or probable VAD-specific infections due to PsA.16/51 (31%) had Pseudomonas bloodstream infection associated with the VAD infection, with a median 400 days from initial diagnosis. Only 29% of those with DLI were bacteremic, vs. 66% of those with pump pocket infection, and 50% of those with mediastinitis (Fig 1). Patients who developed bacteremia had a median of 3 episodes (range, 1-5). All but 1 patient with bacteremia received surgery. Of the 16 patients who developed bacteremia, 11 (69%) died vs 9/35 (26%) in patients who were not bacteremic (Fig 2). 10/11 patients who were bacteremic and died had infections limited to driveline.
In 21/41 (51%) of episodes of bacteremia identified, patients were already on antibiotics for PsA with a median duration of 49 days (7-198) prior to onset of bacteremia.

Conclusion
A significant number of patients with PsA LVAD infections develop bacteremia, especially in those with involvement of central LVAD components. The presence of bacteremia should prompt evaluation for ascending infection. Most of the patients who developed bacteremia died, even when infection appeared limited to driveline, and it is possible that endoluminal infections were present in these cases. A substantial proportion of patients with bacteremia were on antibiotics at the time of bacteremia, which suggests that suppressive antibiotics alone may not be effective in controlling PsA LVAD infections.

Disclosures
All Authors: No reported disclosures.
1860. Streptococcus mitis/oralis sepsis in patients with neutropenia after chemotherapy
Authors: Lee Na Yoon , Kang Hyun Mi , Jeong Dae Chul , Kim Seong Koo , Lee Jae Wook , Chung Nack-Gyun , Cho Bin 
Published: December 2022

Abstract

Background
Streptococci are the dominant species in the human oral cavity and upper respiratory tract. Oral mucositis affects 30–40% of the patients receiving chemotherapy and 80% undergoing HSCT. During episode of oral mucositis, patients are at a risk for invasive infections caused by opportunistic pathogens in the oral cavity. The purpose of this study was to investigate the clinical characteristics of S. mitis/oralis invasive infection, and find patients at high risk for with S. mitis/oralis infection in order to prevention of S. mitis/oralis bacteremia.

Methods
Patients receiving chemotherapy or stem cell transplant for malignancies and primary immunodeficiencies at the pediatric bone marrow transplant center of Seoul St. Mary's hospital admitted during January 2017 to December 2020 for blood stream infections were included in this study. Chart review of the patients were done retrospectively.

Results
During the four year study period, there were 4,647 admissions, and 2,358 (50.7%) experienced at least 1 episode of fever. Overall, the incidence of bacteremia was 10.9% of all febrile children. The most common pathogen causing bacteremia was S. mitis/oralis (24%), followed by E. coli (14.3%), Klebsiella spp. (10.5%), and S. epidermidis (7.4%). Candida sepsis occurred in 3.5% of the children. By year, the proportion of bacteremia caused by S. mitis/oralis was 19% in 2017, 21% in 2018, 41% in 2019, and 25% in 2020. 51% of S. mitis/oralis bacteremia occurred 8-14 days after day 0 of chemotherapy. A multivariate analyses on risk factors for S. mitis/oralis bacteremia was the underlying disease AML (OR, 4.6; 95% CI, 2.4-8.7; P&lt; 0.001), and the use of cytarabine (OR, 4.5; 95% CI, 2.4-8.5; P&lt; 0.001). Compared to ALL, AML has a HR 3.7 (95% CI 1.9-7.2) of bacteremia with S. mitis/oralis. Prolonged duration of fever ( &gt;7 days) was observed in 13.4% of the patients, and a fever duration &gt;14 days was observed in 2 patients. Complications such as septic shock, n=4 (6.0%), ARDS, n=1 (1.5%), infective endocarditis, n=2 (3.0%) were observed.

Conclusion
S. mitis/oralis sepsis causes significant morbidity in patients undergoing treatment for malignancies. Patients with AML are at the highest risk, especially after induction or consolidation chemotherapy including cytarabine.

Disclosures
All Authors: No reported disclosures.
1872. Clusters of SARS-CoV-2 infection across six schools for children with intellectual and developmental disabilities
Authors: Gemmell Michael P , Walsh Tyler , Imbeah Adwoa , Bono Kelly , Baldenweck Megan , Sherby Michael R , Newland Jason , Gurnett Christina 
Published: December 2022

Abstract

Background
In-person learning is important for children with intellectual and developmental disabilities (IDD) because of the additional health, vocational, and functional services for students at these schools. It may be difficult to reduce SARS-CoV-2 transmission in IDD schools because students require assistance with activities of daily living such as eating, during which social distancing and masking cannot occur. Surveillance testing and cluster tracking in schools for children with IDD, which may be considered high-risk environments for transmissions, could have benefits for mitigating transmission and keeping students in schools. The objective of this study was to identify SARS-CoV-2 clusters in IDD specific schools to compare viral transmission in delta and BA.1 variant waves.

Methods
A saliva-based PCR test was offered to students and staff for weekly SARS-CoV-2 screening at six Special School District (SSD) schools dedicated to children with IDD. Clusters, which are considered 2 or more positives cases in the same classroom having an epidemiological link, were then recorded. All weekly testing took place between November 23, 2020 and May 27, 2022. Clusters were recorded from November 15, 2021 to January 28, 2022. A Fisher's exact test was used to compare categorical variables.

Results
545 (90%) and 113 (16%) students participated in weekly testing. 160 participants tested positive throughout the study, 23 (14%) during the delta variant wave and 115 (72%) during the BA.1 variant wave. There was no significant variation in age, race, ethnicity, gender, or vaccination status between positive cases recorded from alpha, delta, and BA.1 variant waves (Table 1). Notably, the vaccination rate of positive participants was lower than the vaccination rate of participants who did not test positive. 42 clusters were recorded, 3 (7%) during the delta variant wave and 39 (93%) during the BA.1 variant wave (Fig. 1). Table 1.Demographics and SARS-CoV-2 Vaccination Status of Positive Cases during Three Variant WavesFigure 1.Reported Counts of Positive Cases and Clusters per Week at SSD Schools

Conclusion
The highly transmissible BA.1 variant resulted in an increase in clusters observed in IDD specific schools. Mitigation strategies for less transmissible alpha and delta waves were not as effective in reducing transmission during the BA.1 wave.

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.
2319. Analysis of the potential impact of effectiveness and availability of mRNA influenza vaccine on hospitalization and mortality
Authors: Haghpanah Fardad , Hamilton Alisa , Klein Eili Y 
Published: December 2022

Abstract

Background
Influenza viruses constantly change because of antigenic drift. Due to the time currently needed to develop and distribute flu shots, vaccines are often ill-matched to circulating influenza strains. One silver lining of the COVID-19 pandemic was the acceleration of mRNA technology, which could significantly reduce the timeline between strain choice and deployment, potentially increasing vaccine efficacy. Significant private and public investments would be required to accommodate accelerated vaccine development and approval. Hence, it is important to understand the potential impact of mRNA technology on influenza hospitalizations and mortality.

Methods
We developed a compartmental model stratified by age group to evaluate the potential effect of increased vaccine effectiveness (defined as a two-level measure of protection against infection and hospitalization) on influenza hospitalizations and mortality in the United States. We assume that mRNA technology can only shorten the time from strain choice to distribution but not distribution and administration. Thus, later decisions on vaccine composition would increase effectiveness but reduce availability. To assess this tradeoff, we evaluated two scenarios where strain choice was delayed until summer resulting in a more effective vaccine: (1) available to all age groups in the fall, or (2) available by August but only for adults 65 years and older.

Results
Assuming current vaccine coverage rates, if not available until October, the vaccine would need a minimum of 80% effectiveness against infection to see a decrease in hospitalizations and deaths (Figures 1A and 1B). When delayed until November, even a 100% effective vaccine could not reduce hospitalizations or deaths (Figures 1C and 1D). For the elderly, a 50% effective vaccine against infection (Figures 1E and 1F) or a vaccine 40% effective against infection and 60% against hospitalization available in late summer was similar to an 80% effective vaccine available in October for all ages.
Age-stratified weekly number of influenza-associated hospitalization per 100,000 population and total number of deaths in the United States for an mRNA vaccine that would be available in either October (A and B), November (C and D), or by late summer but only for the 65+ age group (E and F). The Baseline represents the 10-year average weekly hospitalization rate and mortality during the Flu Season (October to May).

Conclusion
As the majority of influenza-associated hospitalizations and deaths are in adults 65 years and older, a combination policy targeting higher vaccine effectiveness for this age group in the short term would be the most efficacious.

Disclosures
All Authors: No reported disclosures.
1877. COVID-19-Associated Hospitalizations among Long-Term Care Facility Residents Ages ≥65 Years — COVID-NET, 14 U.S. States, March 2020–January 2022
Authors: Taylor Christopher , Whitaker Michael , Anglin Onika , Pham Huong , Patel Kadam , Milucky Jennifer , Reingold Arthur , Alden Nisha B , Meek James , Ward Katelyn , Teno Kenzie , Kohrman Alexander , Como-Sabetti Kathy , Eisenberg Nancy , Spina Nancy L , Bushey Sophrena , Billing Laurie M , Sutton Melissa , Talbot Keipp , Swain Ashley , Havers Fiona P 
Published: December 2022

Abstract

Background
Adults aged ≥65 years and those with underlying medical conditions, including residents of long-term care facilities (LTCF), are at increased risk for COVID-19-associated hospitalizations and other severe outcomes.

Methods
Hospitalizations among LTCF residents aged ≥ 65 years from March 2020–January 2022 were described using data on a representative sample of hospitalizations from the CDC’s COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance network of &gt; 250 acute care hospitals in 99 counties across 14 states. A Poisson regression model adjusting for age, race/ethnicity, underlying medical conditions, vaccination status, month of admission, and do-not-resuscitate/intubate-or-provide comfort-measures-only (DNR/DNI/CMO) code status examined the relationship of LTCF residency to death during COVID-19-associated hospitalization.

Results
Of 11,901 hospitalizations among adults aged ≥ 65 years reported during the study period, 2,965 (24.9%) were LTCF residents; most resided in nursing homes (53.8%) or assisted living facilities (26.8%). LTCF residents hospitalized with COVID-19 were older and more likely to have cardiovascular disease, congestive heart failure, a neurologic condition, dementia, or ≥ 3 underlying medical conditions than non-residents (Figure). The proportion of LTCF residents vs non-residents who required intensive care unit admission or invasive mechanical ventilation were not statistically different (23.2% vs 23.5% and 10.7 vs 13.5%, respectively). The proportion of in-hospital death was higher among LTCF residents than non-residents (22.8% vs 14.4%, p &lt; 0.01). More LTCF residents have a DNR/DNI/CMO code status (48%) compared to non-residents (19%). The fully adjusted regression model found the risk ratio for death was 1.03 (95% CI, 1.01–1.05) among LTCF residents compared to non-residents.

Conclusion
Compared to non-residents, LTCF residents were older, had more underlying conditions, and had a higher risk of in-hospital death. After adjusting for multiple potential confounders, results suggest that LTCF residency is a weak but significant independent risk factor for death during COVID-19-associated hospitalization.

Disclosures
All Authors: No reported disclosures.
1889. Knowledge, beliefs and practices about COVID-19 infection and vaccination in healthcare personnel at non-acute care facilities
Authors: Mansoor Armaghan-e-Rehman , ONeil Caroline A , McDonald David , Fraser Victoria J , Babcock Hilary , Kwon Jennie H 
Published: December 2022

Abstract

Background
The objective of this study is to characterize the experiences, knowledge, beliefs, and perceptions of risk related to COVID-19, infection prevention practices, and COVID-19 vaccination among healthcare personnel (HCP) at three non-acute care facilities.

Methods
The study protocol was approved by the Washington University IRB. Between April-May 2021, anonymous surveys were distributed to HCP at three non-acute care facilities in St. Louis, MO. Data was collected on demographics, experience working in healthcare, COVID-19 exposures, knowledge and beliefs about infection prevention policies and procedures, PPE use, perception of risk of acquiring COVID-19, and COVID-19 vaccination status.

Results
There were 156 respondents; 78% were female, and 53% reported &gt;10 years of healthcare experience. The largest proportion (32%) were in direct patient care as nurses or nurses’ aides. A majority (97%) reported adequate knowledge of how to protect themselves from COVID-19 at work, and most (95%) reported access to adequate PPE supplies.
HCP (58.7%) reported that wearing a mask or face shield made communication difficult, 56% stated they had taken on additional responsibilities due to staff shortages, and 53% indicated that their job became more stressful because of COVID-19. More than a quarter (28%) had considered quitting their job due to COVID-19. HCPs were more concerned about acquiring COVID-19 in the community than at work (47 vs 33%).
When asked about the COVID-19 vaccine, 78% of respondents reported receiving at least one dose of vaccine and 72% had completed a primary vaccine series. The most common reasons given for deciding to get vaccinated were a desire to protect family and friends (84%) and wanting to help stop the spread of COVID-19 (82%). For unvaccinated respondents (29%), the most common reasons for not receiving vaccination were concern for side effects (53%) and belief that the vaccine was not tested well enough (50%).

Conclusion
A significant proportion of HCP reported stress and increased responsibilities at work due to COVID-19, and 1 in 4 considered leaving their job. A majority were vaccinated, with concerns about side effects or inadequate vaccine testing cited as the most common concerns by unvaccinated HCPs.

Disclosures
All Authors: No reported disclosures.