bluuebunny/crossref_metadata_2025_split huggingface dataset:
1815. Assessment of Therapy Duration for Non-Staphylococcal Gram-Positive Bloodstream Infections
Authors: Gould Alyssa P , Crawford Robert L 
Published: December 2022

Abstract

Background
The optimal duration of antimicrobial therapy for non-staphylococcal Gram-positive (GP) bloodstream infections (BSIs) remains unknown. The purpose of this study was to evaluate clinical outcomes in patients with short (6-10 days) vs. long (11-21 days) duration of therapy (DOT) for non-staphylococcal GP BSIs.

Methods
Adult patients with BSI due to Streptococcus or Enterococcus spp. admitted to a community health system from January 2016 to December 2021 were included in this retrospective chart review. Patients were excluded for polymicrobial BSI, positive culture deemed contamination, infectious source requiring prolonged treatment, DOT &lt; 6 or &gt; 21 days, or transfer, hospice, or death prior to therapy completion. The primary endpoint was 90-day all-cause mortality. Descriptive statistics, chi-square or Fisher’s exact test, and the student t-test were used for data analysis.

Results
Of 3,544 patients identified, 384 were screened and 86 included. There were 71 patients in the long DOT group and 15 patients in the short DOT group. All included patients were on active therapy for the entire DOT. Baseline characteristics were similar except patients in the long DOT group were more likely to have an infectious diseases consultation and a non-pulmonary source of infection (Table 1). All-cause mortality at 90 days was similar between short vs. long DOT groups (0% vs. 3%, p=0.51) (Table 2). The secondary endpoints of 30-day all-cause mortality, 30-day and 90-day BSI recurrence due to the same organism, 30-day readmission, and hospital length of stay were not statistically different between groups (Table 2). The most common pathogen identified in the short DOT group was Streptococcus pneumoniae (n=8), and the most common identified pathogens identified in the long DOT group was Streptococcus agalactiae (n=22), Enterococcus faecalis (n=14), and S. pneumoniae (n=13) (Table 3).

Conclusion
In this retrospective review of non-staphylococcal GP BSIs, there was no statistical difference in clinical outcomes between the short and long DOT arms. Additional research is needed to identify the optimal duration of antimicrobial therapy for non-staphylococcal GP BSIs.

Disclosures
All Authors: No reported disclosures.
1818. Characteristics Associated with Mortality in Patients with Gram-negative Bacteremia in Intensive Care Units
Authors: Shukdinas Alaina , Werzen Alissa , Ali Shereef N , Vyas Nikunj M 
Published: December 2022

Abstract

Background
Gram negative rod (GNR) bloodstream infections in patients requiring ICU level of care are associated with high risk of mortality. Very limited data is available on specific risk factors that are associated with this high mortality. The purpose of this study was to identify characteristics associated with mortality in ICU patients who were diagnosed with GNR bacteremia.

Methods
This was an IRB approved retrospective chart review that was conducted during November 2019 to November 2021 at a three hospital health system in NJ. Patients were included if they required ICU level of care, age ≥ 18 years old and had documented gram negative bacteremia. Patients were excluded if they had metastatic cancer, left against medical advice, or the blood culture was determined to be a contaminant. The primary endpoint of the study was to evaluate the association of characteristics and risk factors with all-cause inpatient mortality (ACIM) in patients with GNR bacteremia requiring ICU level of care. Secondary endpoints included impact of time to appropriate therapy and time to microbiologic cure on ACIM.

Results
There was a total of 79 patients who met inclusion criteria. The median age of patients was 69 years, 44% of the patients were female, and 81% of patients were in septic shock upon presentation to the ICU. The most common source of GNR bacteremia was urinary tract, followed by lower respiratory tract. The most common causative organism of bacteremia was E.coli, causing 25% of the cases. When evaluating primary endpoint, higher CCI (OR = 1.79, 95% CI [1.09-2.94]), and Pitt Bacteremia (OR = 2.1, 95% CI [1.32-3.35]) scores were independently associated with an increased risk of mortality in patients with gram-negative bacteremia in the ICU setting. Microbiologic cure was associated with a lower risk of mortality (OR=0.02, 95% CI [0.002-0.2]). Longer time to appropriate therapy and microbiologic cure were not associated with increased ACIM.
Results

Enterobacterales Breakdown

Conclusion
Patients admitted with GNR bacteremia requiring ICU level of care with higher CCI and Pitt Bacteremia scores have higher likelihood of suffering from ACIM. Microbiologic cure was independently associated with lower risk of ACIM. In a subset of patients, longer time to appropriate therapy and microbiologic cure was not associated with increased ACIM.

Disclosures
All Authors: No reported disclosures.
1842. Intravenous to Oral Antibiotic Stepdown for Uncomplicated Streptococcal Bacteremia
Authors: Salam Madison E , Lew Alison K , Nguyen Cynthia T , Pettit Natasha N , Pisano Jennifer 
Published: December 2022

Abstract

Background
Historically, intravenous (IV) antibiotics have been the standard of care for the treatment of bloodstream infections (BSIs). IV antibiotic use predisposes patients to line-related complications and is associated with increased length of stay (LOS) and treatment costs as compared to oral (PO) antibiotics. The purpose of this study was to compare the efficacy and safety of IV therapy versus PO stepdown for uncomplicated Streptococcal BSIs.

Methods
This single-center, retrospective, non-inferiority study included adults who had Streptoccoccus spp. in blood cultures with susceptibilities reported, &lt; 48 hours of positive blood cultures, and were treated for the BSI. Patients were excluded if they had polymicrobial bacteremia, mortality prior to treatment completion, unattainable source control, or a complicated infection. The primary outcome was clinical success, defined as absence of infection recurrence, infection-related readmission, and infection-related mortality at 90 days. Secondary outcomes included individual components of composite endpoint, microbiological success, LOS, IV-line associated complications, and antibiotic-associated adverse events.

Results
Of 79 patients included, 36 patients (45.6%) received IV for the full course of therapy and 43 (54.4%) received PO stepdown. Baseline characteristics were similar between groups. The most common sources were skin and soft tissue (34.6%) and oropharyngeal (13.6%). The median duration of IV therapy in PO stepdown patients was 4.4 days (IQR 2.7 – 6.9). Amoxicillin/clavulanate (44%) and cefdinir (24%) were the most common PO agents. Clinical success occurred in 94% of IV only patients and 91% of PO stepdown patients (p = 0.573). No infection-related deaths or recurrences occurred. Line complications were more frequent in patients receiving IV compared to PO stepdown therapy (14% vs. 0%, p = 0.015). LOS was lower in the PO stepdown group (11 vs. 6 days, p &lt; 0.001).

Conclusion
This study strengthens the hypothesis that PO stepdown therapy may be non-inferior to IV therapy for clinical success with a trend towards decreased LOS and line complications. However, this study was not powered to meet statistical significance. We are collaborating with several other centers to determine the true impact of this intervention.

Disclosures
All Authors: No reported disclosures.
1867. Characteristics and Outcomes of Patients with SARS-CoV-2 Reinfections Requiring Treatment in a COVID-19 Ambulatory Treatment Program
Authors: Cowman Kelsie , Golia Austin , Guo Yi , McSweeney Terrence D , Chang Mei H , Bao Hongkai , Nori Priya 
Published: December 2022

Abstract

Background
Montefiore Medical Center (MMC), Bronx, NY, established an ambulatory program to offer COVID-19 treatments (monoclonal antibodies [mAB] and oral antivirals) to patients with mild-moderate illness according to emergency use authorization criteria. Given multiple pandemic waves in the area, several patients have been reinfected and were treated twice. The objective of this analysis is to identify clinical characteristics and outcomes in patients with repeated COVID-19 infections and treatments.

Methods
Electronic health records were reviewed to identify patients between December 1, 2020 and April 28, 2022 who received COVID-19 treatment on more than one occasion at MMC. Data collected included demographics, risk factors for progression to severe illness, name and date of COVID-19 treatments received, vaccination status, and clinical outcomes of 30-day emergency department (ED) presentation or hospital admission following each treatment.

Results
Out of 3,042 total treated patients, 13 (0.4%) received multiple treatments with either mAB or oral antivirals for COVID-19 reinfection during the study period. Median age of reinfected patients requiring treatment was 50 years. Median days between first and second treatments was 298 days (range 91-468 days). The most common risk factor for progression to severe disease were cardiovascular disease (54%) and immunocompromised status (62%) (Table 1). Ten patients had received at least two doses of vaccine (77%) with Pfizer (54%) or Moderna (23%) vaccines prior to reinfection. No patients reported any adverse reactions to either treatment. Four patients presented to the ED or were hospitalized following treatment of reinfection, three of which were for COVID-related symptoms. Of these, two had two risk factors for progression and the third had been hospitalized previously for initial COVID-19 infection.

Conclusion
Though COVID-19 reinfection has been described, especially during Omicron surges, there were relatively few reinfected patients requiring treatment in our cohort. Patients with risk factors for disease progression may also be at increased risk for reinfection, especially the immunocompromised.

Disclosures
Kelsie Cowman, MPH, Merck: Grant/Research Support Yi Guo, PharmD, BCIDP, Merck: Grant/Research Support.
2322. Effectiveness of Recombinant Influenza Vaccine vs. Standard Dose Inactivated Influenza Vaccines Against Hospitalized Influenza-Related Outcomes in Adults: A Cluster Randomized Trial
Authors: Hsiao Amber , Yee Arnold , Fireman Bruce , Hansen John R , Lewis Ned , Klein Nicola P 
Published: December 2022

Abstract

Background
More effective influenza vaccines are needed to prevent influenza and its complications. Recombinant influenza vaccines may offer better protection than traditional egg-based vaccines. Using a cluster randomized design to estimate the relative vaccine effectiveness (rVE) of Flublok Quadrivalent recombinant influenza vaccine (RIV4) vs. standard dose inactivated influenza vaccine (SD-IIV4), we separately reported that RIV4 provided significantly better protection against primary outcome of confirmed influenza in adults 50–64 yrs in the 2018–20 moderately severe influenza seasons. Here we report the rVE against the secondary and exploratory outcomes of hospitalized influenza-related outcomes.

Methods
We randomized 66 facilities within Kaiser Permanente Northern California (KPNC) to routinely administer RIV4 or SD-IIV4 to adults, alternating vaccine formulations weekly by facility during the influenza season (ClinicalTrials.gov NCT03694392). Hospitalized cases of PCR-confirmed influenza, community-acquired pneumonia, and cardio-respiratory events were prespecified as secondary in 50–64 yrs and exploratory in 18–49 yrs. We estimated the relative hazard ratio (rHR) using Cox regression on a calendar timeline, adjusting for age, sex, and race, using facility-specific stabilized propensity scores. We calculated rVE as (1–rHR) x 100%.

Results
During the 2018–19 and 2019–20 seasons, the study consisted of 1,630,328 vaccinees 18–64 yrs (RIV4=632,962; SD-IIV4=997,366), and included 95 hospitalized influenza cases after RIV4 and 153 after SD-IIV4 among 50–64 yrs (Table 1). RIV4 vs. SD-IIV4 was not significantly more protective against hospitalized influenza-related outcomes in adults 50–64 yrs or 18–49 yrs.

Conclusion
While this large cluster randomized study found that RIV4 vs. SD-IIV4 reduced the risk of lab-confirmed influenza in adults 50–64 yrs across 2 influenza seasons, RIV4 and SD-IIV4 performed similarly against hospitalized influenza-related outcomes. Evaluating influenza-related hospitalizations during influenza seasons when more hospital outcomes occur may help to better understand the relative effectiveness of recombinant versus standard inactivated influenza vaccines against severe disease.

Disclosures
All Authors: No reported disclosures.
1915. Divided on dividers: Real-world assessment of the efficacy of barriers for prevention of aerosol exposure
Authors: Cadnum Jennifer , Jencson Annette , Memic Samir , Donskey Curtis 
Published: December 2022

Abstract

Background
Barriers are commonly installed in workplace situations where physical distancing cannot be maintained to reduce the risk for transmission of respiratory viruses. Although some types of barriers have been shown to reduce exposure to aerosols in laboratory-based testing, limited information is available on the efficacy of barriers in real-world settings.

Methods
In an acute care hospital, we tested the effectiveness of in-use plexiglass dividers in reducing exposure of staff to aerosolized particles. An aerosol sprayer was used to release 5% NaCl aerosol at 1 or 2 meters from staff members with and without the barrier positioned between the point of aerosol release and the hospital staff. Particle counts on the staff side of the barrier were measured using a 6-channel particle counter. A condensed moisture (fog) generating device was used to visualize the airflow patterns.

Results
Of 13 dividers tested, 6 (46%) significantly reduced peak aerosol particle counts detected behind the divider, 6 (46%) reduced peak particle counts only to modest non-significant degree, and 1 (8%) significantly increased particle counts behind the divider; the figure shows data for 3 dividers that illustrate the 3 types of results. For effective dividers, condensed moisture fog flowed around the divider toward outlet air vents positioned in the ceiling, whereas fog pooled immediately behind the divider that increased staff exposure before exiting in an outlet air vent positioned on the side wall.
Effective divider reducing staff aerosol exposure
Ineffective divider increasing staff aerosol exposure
Minimally effective divider

Conclusion
In real-world settings, plexiglass barriers vary widely in effectiveness in reducing staff exposure to aerosols, and some barriers may increase risk for exposure. Devices that visualize airflow patterns may be useful as simple tools to assess barriers.

Disclosures
All Authors: No reported disclosures.
1935. Cardiac Tamponade Following COVID-19 Vaccination
Authors: Murphy Christopher B , Kasule Sabirah N , Vikram Holenarasipur R 
Published: December 2022

Abstract

Background
While numerous, most described cases of myocarditis and pericarditis following COVID-19 vaccination are mild and self-limited. We present two cases of life-threatening cardiac tamponade following COVID-19 vaccination.

Methods
Two cases of cardiac tamponade in temporal association with COVID-19 vaccination were reviewed

Results
Case 1 : 75-year-old male with rheumatoid arthritis admitted with chest pressure and hypotension 2 days after his 1st dose of Pfizer-BioNTech COVID-19 vaccine. Pericardiocentesis removed 275 ml of exudative effusion with 14,140 nucleated cells/ml. Fluid bacterial and fungal cultures were negative; cytology was inconsistent with malignancy. He had no Epstein-Barr virus (EBV) or cytomegalovirus (CMV) viremia. Symptoms resolved on prednisone and colchicine. A week later, he had an uneventful second COVID-19 vaccine. He went on to have 3 recurrences of pericarditis starting two months after his first. One was within 48 hours of his COVID-19 booster. He is on long term prednisone. Case 2: 66-year-old male with non-Hodgkin’s lymphoma in remission. He developed chest pain a day after his 2nd dose of Pfizer-BioNTech COVID-19 vaccine. Admitted 4 days later with pericardial effusion and managed medically. Readmitted a week later with fever and chest pain. Echocardiogram now showed cardiac tamponade. Pericardiocentesis removed 400 ml of exudative fluid with 1,191 nucleated cells/mL. Cultures for bacteria, fungi, and mycobacteria were negative. Cytology didn't show malignancy. Serologies for CMV, EBV and parvovirus represented past infection. He was discharged with a pericardial drain, colchicine, and NSAIDs. He was later readmitted with fevers. Echocardiogram only showed small pericardial effusion, which did not require drainage. Figure 1Circumferential pericardial effusion seen on trans-thoracic echocardiography from patient in case 1.

Conclusion
Given the proximity to COVID-19 vaccination and lack of alternative explanations, we believe that tamponade was a direct result of post-vaccine inflammatory pericarditis. Neither patient had a prior history of pericardial effusion. Both tested negative for SARS-CoV-2 by nasopharyngeal swab excluding active infection. Healthcare providers should consider the possibility of pericardial effusion and tamponade in patients with chest pain, shortness of breath, or hypotension following COVID-19 vaccination.

Disclosures
All Authors: No reported disclosures.
2012. A Descriptive Study of Infections Complicating Extracorporeal Membrane Oxygenations in Trauma Patients
Authors: Schweickhardt Samantha K , Sams Valerie , Radowsky Jason , Marcus Joseph E , Sobieszczyk Michal J 
Published: December 2022

Abstract

Background
Extracorporeal Membrane Oxygenation (ECMO) is a growing modality for respiratory and circulatory support in patients with traumatic injuries. There is limited data on the pathogens complicating a trauma patient’s ECMO course and thus empiric antibiotic choices are difficult in this cohort. We report the incidence and infection type in trauma patients receiving ECMO to potentially guide future empiric antibiotic treatment and improve outcomes.

Methods
A descriptive chart review was performed on all trauma patients at Brooke Army Medical Center receiving ECMO between February 2013 and July 2021. Charts were reviewed to identify pathogens by culture site as well as time to infection following cannulation. This protocol was approved by the 59th Medical Wing Institutional Review Board.

Results
Twenty-one trauma patients underwent ECMO during the study period. The majority of patients were men (n=19, 90%) with a median age of 30 years [IQR 27-38] with a median ECMO run of 227 hours [IQR 93-338]. Motor vehicle crashes (17, 81%) accounted for the majority of injuries, with gunshot wounds (2, 10%), blast injuries (1, 5%) and falls (1, 5%) accounting for the remainder. 16 (76%) patients survived to discharge, and infection was not associated with mortality (p=0.11). Of the 24 infections, the majority were respiratory (13, 58/1000 ECMO days) followed by skin and soft tissue (6, 26/1000 ECMO days), blood stream (4, 18/1000 ECMO days), and urinary tract (1, 5/1000 ECMO days). Gram-negatives were the most commonly isolated organism from all sites (Table 1) and at all time periods after cannulation (Table 2). Multi-drug resistant organisms accounted for 32% (n=9) of infections and were independent of time from cannulation.

Conclusion
This is the first study to describe infections in trauma patients requiring ECMO support. We observed majority Gram-negative infections regardless of culture site or time after cannulation. Determining empiric antibiotics will require a larger study of patients to identify trends in pathogens and ultimately improve antimicrobial stewardship in this unique population.

Disclosures
All Authors: No reported disclosures.
2024. Human Factor Considerations in Support of a Flexible IV Connector Safeguard to Prevent Central Line Associated Blood Stream Infections (CLABSI)
Authors: Walterspiel Juan N 
Published: December 2022

Abstract

Background
One of the sources of central line infections is contaminated and poorly disinfected IV connectors(CON).
A recent study found 23% of IV-line CONs were contaminated with bacteria, despite strict infection control guidelines that include the use of alcohol-lined caps (ALC).
Contamination (CONT) occurs after protective ALC has been removed in preparation for an infusion, and nurses perform their multiple tasks. These include purging air bubbles from the IV line, setting pumps, verifying medications, and keeping an eye on the patient. It is not surprising that nurses admitted that sterilization of IV CONs was not prior to 3% - 4% of infusions.
Schielded IV connector

Methods
A flexible rounded shield extending above a standard needleless CON to protect it from CONT was designed and tested (Pat pend).
A total of 4, 2 ICU Medical Inc. needleless CONs, one shielded and one unshielded, and two Komashine Inc. CONs, also one shielded and one unshielded were disinfected with 70% alcohol and their lines taped to the abdomen of 2 volunteers wearing loose shirts over the connectors.
The CONs remained on the volunteers for 3 hours, in 2 sessions. All 16 CON ends were cultured on Columbia blood agar, and plates held 48 h. Readings were evaluated by statistical analysis of 16 predictions (coinflips).

Results
It was confirmed that the tested shielded CONs were easy to sterilize, connect to infusion lines and that there was ample space left to screw on and off alcohol caps.
Colonies were absent from the protected connector ends, whereas all the unshielded ends grew several colonies.
The probability of observing the projected efficacy results, 8 unshielded with subsequent bacterial growth, and eight shielded, remaining sterile, i.e. not growing bacteria is &lt; 0.00002.
The lack of contamination on the shielded ends proved that the air currents generated by the movements of the volunteers, between their skin and their skirts did not transport bacteria to the shielded connector ends.

Conclusion
A properly designed flexible contamination shield will prevent the proportion of line infections that are caused by human factors. Pls, submit severe adverse event reports (prolongation of hospitalization or death) caused by contemporary "defective" IV connectors to the FDA to change their faulty design.

Disclosures
All Authors: No reported disclosures.