University of Texas Southwestern Medical Center
Recent publications
The impact of COVID-19 on surgeons practicing in low- and middle-income countries is not well understood. However, it is necessary to consider the pandemic’s global impact as future collaborations and trips are designed. We undertook a qualitative study exploring the personal and professional experiences of Indonesian reconstructive surgeons. We conducted qualitative interviews with 16 surgeons from July 2020 to February 2021. Interviews were done via the Zoom platform. Inductive thematic analysis was performed by the study team in an iterative process. Practice settings ranged from city centers to remote islands. All participating surgeons described personal and professional challenges during the COVID-19 pandemic. Planned advanced training abroad was cancelled, and time zone differences limited participation in live virtual conferences. However, the themes emerged of strong sense of purpose and prioritization of patient needs, especially given persistent trauma volume and the inability to travel within the country to assist colleagues or patients. Despite this, participants described persistence and innovation. The pandemic has impacted Indonesian reconstructive surgeons in and out of the operating room. Though some of these challenges are shared globally, others require considering geography and resources. Partnering with international surgical colleagues to coordinate virtual surgical conferences and education should be prioritized. When international global surgery trips resume, we must consider pandemic-related delays for pediatric and adult reconstructive cases.
Background Optimal management of COVID-19 in children requires risk stratification based on comorbidities and demographic factors that can predispose to severe disease. The Pediatric Infectious Diseases Society (PIDS) Pediatric COVID-19 Therapies Task Force, comprised of pediatric infectious diseases physicians, intensivists, and pharmacists from 29 US hospitals, develops clinical guidance for pediatric COVID-19 management. In support of these efforts, a systematic review of peer-reviewed literature was conducted to synthesize the evidence for risk factors for severe pediatric COVID-19. Methods Medline, EMBASE, and CDC databases were searched to identify all relevant publications before July 1, 2022. Titles and abstracts were reviewed to identify studies that assessed for potential predictors of severe COVID-19 disease in children < 21 years. Severe disease was defined by intensive care unit admission, invasive mechanical ventilation, multiorgan dysfunction, or death. A team of reviewers appraised eligible studies, extracted relevant data, and assessed the quality of evidence. Comorbidities and demographic factors were classified as definite, probable, or unlikely risk factors based on the certainty of association with severe COVID-19. Results Sixteen potential risk factors were evaluated based on evidence from 50 studies: 13 reviews/meta-analyses, 23 multi-center, and 14 single-center studies (Figure 1). Severe immunocompromise, obesity, diabetes, prematurity, and neurologic, cardiovascular, and chronic lung disease were classified as definite risk factors. Evidence was less consistent in support of sickle cell disease, mild/moderate immunocompromise, neurodevelopmental, and chronic liver disorders as risk factors. Most studies found asthma, sex, mental health, chronic kidney disease, and inflammatory bowel disease to be unlikely risk factors. Many studies demonstrated that the magnitude of risk for comorbidities was modified by prior immunization, age, and medical complexity (i.e., multiple or poorly controlled comorbidities) (Figure 2).Figure 1.Evidence Review: Comorbidities and Severe COVID-19 in Children Obesity - BMI ≥95th percentile for age and sex per CDC growth curves. Severe immunocompromise - Any of the following: Receipt in the 3 months before COVID-19 diagnosis of chemotherapy for a solid tumor or hematologic malignancy, high-dose corticosteroids (e.g., prednisone >20mg/day for ≥14 days), or other systemic B- or T-cell-depleting immunosuppressive agents; hematopoietic stem cell transplant, CAR T cell therapy, or solid organ transplant within 100 days of COVID-19 diagnosis; human immunodeficiency virus infection and CD4 count <200; combined primary immunodeficiency disorders. Moderate immunocompromise - Routine receipt of non-lymphocyte-depleting immunosuppressive or immunomodulatory medications or prednisone <20 mg/day for inflammatory/immune-mediated disease.Figure 2.Risk Factors and Risk Modifiers for Severe Pediatric COVID-19*Children who are less likely to gain protection from previous infections or vaccines. Definite risk factor - Evidence for increased risk for severe COVID-19, supported by large multicenter studies, meta-analyses, or systematic reviews. Probable risk factor - Evidence for increased risk, supported by small or single-center studies; this category also includes factors inconsistently associated with severe COVID-19, suggesting substantial uncertainty. Unlikely risk factor - Evidence against increased risk for severe COVID-19, supported by large multicenter studies, meta-analyses, or systematic reviews. Conclusion This study highlights key comorbidities and effect modifiers associated with severe COVID-19 in children. These findings can be used to facilitate risk stratification and inform management decisions. Disclosures Zachary I. Willis, MD, MPH, Merck Sharp & Dohme Corp: Grant/Research Support|Pfizer Inc: Grant/Research Support Gabriela Maron, MD, Astellas Inc: Grant/Research Support|SymBio Pharma: Grant/Research Support Paul K. Sue, MDCM, Allovir, Inc: Participant in Industry Sponsored Trial|Gilead Sciences, Inc: Participant in Industry Sponsored Trial|Merck & Co.: Participant in Industry Sponsored Trial Scott H. James, MD, Bayer: Advisor/Consultant|Evrys: Grant/Research Support|Gilead: Grant/Research Support Mari M. Nakamura, MD, MPH, Gilead Sciences, Inc.: Grant/Research Support Joshua Wolf, MBBS, PhD, Karius Inc.: Grant/Research Support|Merck Inc.: Participation in industry-sponsored research
Background Norovirus (NoV) results in potentially severe, relapsing, remitting diarrhea in immunocompromised hosts (ICH). A number of interventions, including nitazoxanide (NTZ), have been tried with unclear success in managing cases of NoV in ICH. Methods We conducted a NIH-sponsored multi-center, prospective, randomized, double-blind study of NTZ for the treatment of Norovirus in adult HSCT and SOT recipients between 2018 and 2021. Subjects with a positive Norovirus test within 14 days of enrollment and active GI symptoms were randomly assigned (1:1) to NTZ 500 mg twice daily or placebo (P) for 56 consecutives doses and were followed for 6 months, including patient reported outcomes (PRO) diary assessments. Primary endpoint was to determine the clinical efficacy, assessed as the time from randomization until symptoms resolution for at least 48 hours. Secondary endpoints included virologic efficacy assessed as the time from randomization to first negative viral load and safety through frequency of adverse events. Results 31 subjects (16 NTZ, 15 P) were enrolled and had balanced demographics (See Table 1). Early withdrawal was documented in 5 subjects from each group. Thirty (30) had received solid organ transplants. Most had chronic ( > 14 days) symptoms (77%). In the mITT population, the median time to initial clinical resolution was 19.0 days (95% CI: 1.0, 31.0) for the Nitazoxanide group and 11.0 days (95% CI: 2.0, 14.0) for the placebo group (p-value=0.459). The difference between time to first negative viral load for the Norovirus GII genotype was not significant (p-value=0.873). Patients appear to have clinical improvement based on PRO results while on active therapy. No serious adverse event related to the study treatment was documented. One severe unsolicited adverse event, abdominal pain, was reported on the day of first dose NTZ. Hospitalization and non-serious or laboratory adverse events were not significantly different between the two arms. Analysis of PK and viral genetics is ongoing and will be reported at the meeting. Conclusion NTZ did not shorten time to clinical resolution or viral shedding duration but may have resulted in transient symptom improvement. Although NTZ appears safe, its role is likely limited in the setting of chronic NoV among ICHs. Disclosures Daniel Kaul, MD, Medscape: Honoraria|Nobelpharma: Grant/Research Support|Takeda: Grant/Research Support Robin K. Avery, MD, Aicuris: Grant/Research Support|Astellas: Grant/Research Support|Astra-Zeneca: Grant/Research Support|Chimerix: Grant/Research Support|Merck: Grant/Research Support|Oxford Immunotec: Grant/Research Support|Qiagen: Grant/Research Support|Regeneron: Grant/Research Support|Takeda: Grant/Research Support Ajit Limaye, Professor/MD, MedPace: DSMB member|merck: Advisor/Consultant|merck: Grant/Research Support|moderna: Advisor/Consultant|moderna: site investigator|syneos: DSMB member Steven A. Pergam, MD, MPH, Cidara: Investigator in clinical trials|F2G: Investigator in clinical trials|Global Life Technologies: Grant/Research Support|Symbio: Investigator in clinical trials Michael D. Green, MD, MPH, ADMA: Advisor/Consultant|Allovir: Advisor/Consultant|Bristol Myers Squibb: Advisor/Consultant|ITB-MED: Advisor/Consultant Marian G. Michaels, MD, MPH, Merck: Grant/Research Support|Viracor: Grant/Research Support Lara A. Danziger-Isakov, MD, MPH, Aicuris: Contracted Clinical Research|Ansun Biopharma: Contracted Clinical Research|Astellas: Contracted Clinical Research|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Contracted Clinical Research|Pfizer: Contracted Clinical Research|Roche Diagnostics: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: Contracted Clinical Research Michael P. Angarone, DO, Abbvie Pharmeciuticals: Advisor/Consultant|DKBMed Inc: Advisor/Consultant|DKBMed Inc: Honoraria
Background Dalbavancin is a long-acting lipoglycopeptide used off-label in the treatment of deep-seated infections. An emerging potential niche for dalbavancin is chronic suppressive therapy in patients with retained sources. Limited data exists describing the use of DST. The purpose of this study is to evaluate the long-term safety, effectiveness, and optimal dosage regimens of dalbavancin suppression therapy (DST). Methods This was a multicenter, multinational, retrospective observational cohort study among adult patients who received as least 1 dose of suppressive dalbavancin between January 1, 2018 and March 31, 2023. The primary endpoint was the proportion of patients on DST who experienced treatment-emergent adverse events (TEAEs). Additional endpoints included assessment of clinical failure defined as hospitalization or microbiological recurrence due to index organism a and a detailed assessment of dosing regimens used. Results A total of 46 patients who received DST were assessed. Therapy was continued for an average of 6.8 months. The majority of patients (83%) had a retained prosthesis or device. Staphylococcal spp. was the most prevalent pathogen (47%) and the majority were monomicrobial. TEAEs were observed in 18 (39%) patients. Nephrotoxicity was the most common TEAE with 15 (33%) patients experiencing an AKI during DST. Only 1 TEAE (2.2%) was considered related to dalbavancin therapy TEAEs that led to the discontinuation or dosing modification of DST occurred in 1 (2.2%) patient. The most frequently used dosage scheme was 1500 mg IV every 2 weeks, followed by 1000 mg IV every 4 weeks. Eight patients (17%) were hospitalized or had microbiological recurrence due to the index organism, occurring an average of 7 months after starting DST. Conclusion DST was utilized for a variety of infections, most of which involved prostheses. Though TEAEs were observed in nearly 40% of patients, those resulting in discontinuation or dose modification were rare despite long-term follow-up. Majority of patients experienced clinical success at an average 7-month follow-up. Future prospective studies should assess pharmacokinetics of DST to determine the optimal dosage regimen. Disclosures Julie Ann Justo, PharmD, MS, FIDSA, BCPS, Gilead Sciences: Advisor/Consultant|Shionogi: Advisor/Consultant|Vaxart: Stocks/Bonds Wesley D. Kufel, Pharm.D., BCPS, BCIDP, AAHIVP, Merck & Co.: Grant/Research Support Tamara Krekel, PharmD, BCPS, BCIDP, AbbVie: Honoraria|Merck: Honoraria|Shionogi: Honoraria Ricardo M. La Hoz, MD, Takeda: Advisor/Consultant
Background OPAT decreases length of stay/inpatient costs while benefiting patients. However, OPAT costs incurred in the ambulatory setting are poorly quantified. We evaluated unaccounted costs and potential savings from OPAT delivered via patient self-administration (S-OPAT), home care agencies/hemodialysis centers (HH-OPAT), and skilled nursing facilities (SNF-OPAT). Methods The electronic health record (EHR) for all adult patients discharged on OPAT from Parkland Hospital (PH), a 900-bed safety-net hospital, during April - June 2021 and January - March 2022 was reviewed for the number and duration of antibiotics administered and post-discharge non-billable encounters (defined as an encounter on any day without a corresponding billable visit). Encounters on the day of a billable visit were excluded. Inpatient days avoided were defined as days post-discharge on which the patient received OPAT. An average daily hospital adjusted expense per inpatient day of $3,764 for Texas state hospitals and wholesale acquisition cost data from the Texas Department of State Health Services were used to estimate cost savings from OPAT. 340B pricing was used to calculate the cost of drugs provided to S-OPAT patients by PH. Antibiotics with different formulations were converted to equivalent daily doses and costs were averaged to estimate a daily antibiotic cost. The institutional IRB approved this study. Results Of 340 patients, 84 (25%) received SNF-OPAT, 115 (34%) HH-OPAT, and 141 (41%) S-OPAT. There were 255 non-billable encounters in the S-OPAT group, 242 in the HH-OPAT, and 220 in the SNF-OPAT group, with the highest rate per 100 person-days in SNF-OPAT recipients (Table 1), nearly twice that of S-OPAT. Antibiotic costs avoided by discharging patients on OPAT were $383,240 for HH-OPAT patients and $505,588 for SNF-OPAT patients (Table 2). For S-OPAT patients, costs incurred by PH based on 340B pricing were $33,785. Conclusion All OPAT care models saved costs compared to hospitalization. Our study likely underestimates the unaccounted costs associated with OPAT; however, costs incurred may be significant and differ between care models. Personnel time and non-billable work should additionally be considered in determining true OPAT cost. Disclosures All Authors: No reported disclosures
Background Incidence of deep and organ space surgical site infections (SSI) after abdominal hysterectomy ranges from 1.1% - 5.7%, with higher rates for women without private insurance. Parkland Hospital is one of the largest safety net hospitals in the United States, serving mostly uninsured and Medicaid-enrolled patients. In 2021, our deep and organ space SSI rate for abdominal hysterectomies was 1.39%, with a standardized infection ratio (SIR) of 1.456. We studied SSI risk factors and report performance improvement (PI) initiative that decreased SSI incidence. Methods This retrospective case-control study randomly matched 37 patients with deep and organ space abdominal hysterectomy SSI from 2019 to 2021 with controls undergoing the same procedure during the same calendar month. We evaluated 18 variables as potential risk factors (Tables 1&2). We conducted a multidisciplinary PI intervention focusing on a modifiable risk factor identified during our investigation to reduce SSI post-hysterectomy. Evaluation showed vaginal and enteric organisms causing SSI leading to observations indicating improper vaginal preparation even though it was being performed.Table 1.Risk factors for SSI after Abdominal Hysterectomy (Univariate Analysis) Results Univariate analysis found one variable to be associated with lower risk and eight variables to be associated with higher risk (Table 1). Diabetes (OR, 3.89; 95% CI,1.25-12.08; p=0.0188) was found to be a risk factor in multivariate analysis while being Hispanic seems to be protective (OR, 0.31; 95% CI,0.12-0.80; p=0.0160). After the intervention of educating nursing staff on the right way of doing vaginal preparation, and weekly OR observations, our deep and organ space SIR in 2022 decreased to 0.63. Vaginal preparation was found to be a risk factor in our univariate analysis, but the coefficient was not estimable in multivariate analysis.Table 2.Independent Risk Factors for SSI After Abdominal Hysterectomy (Multivariate Logistic Regression) Conclusion Multidisciplinary intervention significantly decreased deep and organ space SSI rates. Ensuring standardized pre-operative vaginal preparation also enhanced SSI risk reduction. We suspect that our intervention improved SSI rates by improving the accuracy of vaginal preparation. Performance of vaginal preparation was a risk factor in univariate analysis but was not significant on multivariate analysis. Disclosures All Authors: No reported disclosures
Background Pseudomonas aeruginosa (PA) causes significant morbidity and mortality in immunocompromised hosts and those with cystic fibrosis. Peptide-conjugated phosphorodiamidate morpholino oligomers (PPMOs) are antisense compounds designed to target specific genes and prevent translation. PPMOs with L-isomer peptides (L-PPMOs) were previously shown to have in vitro and in vivo activity. However, L-PPMOs are vulnerable to degradation by host proteases. We hypothesize that PPMOs with a D-isomer peptide (D-PPMOs) may be a more stable and potent alternative. We aimed to characterize the activity of L- and D-isomers in PA strains using planktonic and biofilm assays as well as an infected mouse model. Methods All L- and D-PPMOs were synthesized by Sarepta Therapeutics, Inc. We tested L- and D-isomers of the (RXR)4XB (X for 6-aminohexanoic acid and B for β-Ala) and R6G peptide [(Arg)6-Gly]. PMOs for rpsJ (ribosomal protein) and acpP (fatty acid synthesis protein) were conjugated to the 3’ end of each peptide. Minimum inhibitory concentration (MIC) assays were performed in unique lab and clinical (including MDR) isolates using MOPS medium. Strain PAO1 biofilms were grown in MBEC plates for 24 hours, with PPMOs then dosed every 8 hours for 24 hours, followed by colony enumeration. For in vivo studies, mice were infected with strain PA103 intratracheally and given intranasal PPMO at 6 hours post-infection. Lung burden was determined at 24 hours post-infection. Results MIC values of D-R6G-RpsJ and D-R6G-AcpP were comparable to their L-isomers, but D-RXR-RpsJ showed an improved MIC90 of 0.5 μM compared to the L-RXR-RpsJ MIC90 of 16 μM (Table 1). Both isomers demonstrated reduction of 48-hour biofilm to various degrees. D-PPMO biofilm reduction ranged from 1.5 logs to > 3 logs (D-R6G-AcpP and D-RXR-RpsJ, respectively). L-PPMO biofilm reduction ranged from 2 logs to > 4 logs. D-PPMOs were superior to their L-PPMO counterparts in our delayed in vivo acute pneumonia model, with most D-PPMOs resulting in an additional 50% decrease in lung burden. Conclusion D-PPMOs show similar or improved activity in vitro and in vivo when compared to L-PPMOs at the same dosage. Future studies will investigate the pharmacology of D-PPMOs, as they may represent a more biologically robust alternative to L-PPMOs for PA infections. Disclosures David E. Greenberg, MD, University of Texas Southwestern Medical Center: Dr. Greenberg has numerous patents on PPMOs
Background Antimicrobial stewardship programs (ASP) were created to improve antimicrobial use without compromising patient outcomes. Nationwide, Pediatric ASPs have shown a very rapid growth during the past decade. Inpatient stewardship can present some challenges, particularly with special patient populations like newborns and premature infants. Methods A new Pediatric Antimicrobial Stewardship committee was established in April 2022 at Ochsner LSU Health Shreveport- St. Mary’s Hospital. The first process measurement was a medication usage evaluation (MUE) report of piperacillin-tazobactam from January 31st, 2020, to September 7th, 2021, in the Neonatal Intensive Care Unit (NICU) for early and late onset sepsis. Neonatologists received education about the recommended antibiotics for these indications. The stewardship committee obtained a report one year later to evaluate the impact of the intervention. Slicer dicer, a data extraction tool from EPIC Electronic Health Record (EHR) system was used to determine how many NICU patients received piperacillin-tazobactam. Results From January 31st, 2020, to September 7th, 2021, the charts of 64 neonatal patients, who were prescribed piperacillin-tazobactam, were reviewed. Out of these 64 patients, 46 (72%) were 4-28 days old when the antibiotic was received, 33 (72%) received piperacillin-tazobactam and vancomycin and 13 received additional antibiotics. Indications for the 46 patients included: Possible sepsis (15%), confirmed sepsis (6.5%), possible necrotizing enterocolitis (NEC) (2.2%) and confirmed NEC (10.9%). The report demonstrated a possible overuse of piperacillin-tazobactam for early and late onset sepsis, without the diagnosis of NEC. We reported this antibiotic’s usage in NICU patients during the years 2020, 2021 and 2022 (Figure 1).Figure 1:Piperacillin-tazobactam usage in newborns and infants admitted to the Neonatal intensive care unit (NICU). Piperacillin-tazobactam was administered to a total of 27 patients admitted to the NICU in 2020, 46 patients in 2021, and only 15 patients in 2022. The medication usage evaluation (MUE) was presented by the Pediatric Antimicrobial Stewardship committee in April 2022. Conclusion Neonates and premature infants can represent a challenging patient population for Pediatric ASPs’ interventions. Before the introduction of this committee, there was no tracking of the use of broad-spectrum antibiotics in patients admitted to the NICU. We reported a possible overuse of piperacillin tazobactam for early and late onset sepsis, as well as NEC. Our interventions caused a dramatic reduction in the administration of this broad-spectrum antibiotic in the NICU. Disclosures All Authors: No reported disclosures
Background Lung transplant (LT) recipients with high risk cytomegalovirus (CMV) mismatched donors (recipient negative, donor positive or R-/D+) have been found to have worse early and late outcomes. In our institution, high risk CMV mismatch patients are managed in a protocolized manner consisting of proactive utilization of antiviral agents (ganciclovir/valganciclovir) and immune augmentation with CMV immune globulin. Methods We reviewed our institutional LT database. The study group consistent of all patients who underwent single or bilateral lung transplant between January 2012 to December 2016 (n=319). The CMV serostatus of both recipients and donors was reviewed and patients were classified into two groups: High risk CMV mismatch (R-/D+): n=82 (25.7%) and non-high risk CMV mismatch (n=237). We compared patient demographics, co-morbidities, pre and port-transplant variables among the two groups. Three-year survival was analyzed as the primary outcome variable. With three-year survival as the dependent variable, we analyzed the association of CMV status with survival using multivariate logistic regression analysis. Results There was no difference in the baseline and post-transplant characteristics of LT recipients with and without CMV mismatch donors. Overall one-year and three-year survival was 89.96% and 72.7% respectively. Recipients transplanted with CMV mismatch status and managed with a proactive CMV prophylaxis protocol experienced similar one one-year (92.7% vs 89%, p=0.4) and three-year survival (73.2% vs 72.6%, p=1.0) as the non-CMV mismatch recipients. After adjustment for demographics, comorbidities and post-transplant course, CMV mismatch was not associated with three-year survival. Post-LT development of AKI the only independent variable to be independently associated with three-year survival (adjusted OR: 2.1, 1.13-3.87; p=0.019). Kaplan Meier analysis (see Fig) showed very similar survival curves for recipients with and without CMV mismatched donors. Conclusion Use of a proactive multimodality CMV prophylactic regimen consistent of antiviral agents (ganciclovir/valganciclovir) and immune augmentation with CMV immune globulin may improve outcomes among high risk CMV mismatch LT recipients. Disclosures All Authors: No reported disclosures
Background Metagenomic next generation sequencing (mNGS) is a novel, unbiased approach to identify clinically relevant microorganisms. While an increasing body of lliterature suggests the potential positive impact of mNGS testing, best–use cases remain unclear, with rates of clinically significant outcomes as low as 10%. We implemented a restrictive testing model requiring pre-approval for mNGS testing via an ad-hoc committee of infectious disease specialists and pathologists, to optimize utilization of mNGS testing and aid in interpretation of results. We hypothesized that implementation of this diagnostic stewardship model would lead to higher rates of clinically actionable results. Methods We performed a retrospective review of mNGS requests at our institution from August 1, 2018 – April 30, 2021. Cases were evaluated by the mNGS committee within 24 hours, and following committee-provider discussion, either approved, denied as inappropriate, or denied in favor of additional conventional evaluation. Charts were subsequently reviewed and mNGS testing adjudicated as having either positive, negative, or no impact . Results 12 mNGS requests were adjudicated, with 9 subjects approved for testing. Median age of participants was 8 years, with a large proportion (67%) of immunocompromised individuals. The most common indication for mNGS testing was persistent fever (58%). All samples were collected within 24 hours of request, with a median result time of 4 days. Among the 9 approved tests, seven (67%) were deemed to be clinically significant and directly impacted care, while three (33%) resulted in no impact. In total, mNGS testing led to 7 changes in management, 3 clinically relevant organisms identified, and 2 invasive procedures avoided. No adverse outcomes were observed among the denied requests. . Conclusion Plasma cell-free DNA mNGS is a promising albeit limited diagnostic tool for clinically relevant infectious diseases, and in the absence of diagnostic stewardship, may lead to unnecessary treatment and excess costs. Implementation of committee-based pre-approval and testing restriction led to high rates of clinically actionable results, and may improve the utility of mNGS testing, while neither delaying care nor negatively impacting outcomes. Disclosures Paul K. Sue, MDCM, Allovir, Inc: Participant in Industry Sponsored Trial|Gilead Sciences, Inc: Participant in Industry Sponsored Trial|Merck & Co.: Participant in Industry Sponsored Trial Laura Filkins, PhD, Avsana Labs: Board Member|Avsana Labs: Stocks/Bonds|Biofire Diagnostics: Grant/Research Support
Background Cases of beta-lactam (BL) induced thrombocytopenia (TCP) have been reported, but the evidence on whether BLs pose an increased risk for TCP remains inconclusive. This large-scale study examines the association of TCP with BLs when compared to alternative non-beta-lactams (nBL). Methods This retrospective study included adult inpatients who received at least one antibiotic administration at The University of Texas Southwestern Medical Center between 2008 and 2021. We excluded surgical patients, patients with baseline TCP, noncontinuous antibiotic therapy, no recorded platelet count value following antibiotic administration, and those who received more than one class of antibiotic therapy. Antibiotics were grouped into classes and subclasses (Table 1). BL as well as each BL subclass were compared to nBL. For each comparison group, propensity score matching was performed to control for age, sex, baseline PLT, days of antibiotic therapy, immunosuppression, exposure to other thrombocytopenic medications, hematologic cancer, and transplant status. The primary outcome was TCP defined as 1)< 150×109/L or 2) > 50% decrease from baseline in the 30 days following the first antibiotic administration. Secondary outcomes included TCP in 3 and 7 days, and clinically significant TCP(< 50×109/L). Results A total of 13,887 unique patients were included, with 6,127 received exclusively BL and 7,760 nBL (Figure 1). Covariate balance was achieved following matching for each comparison. After matching, 931/5047 patients in the BL group developed TCP compared to 875/ 5047 matched patients in the nBL group. There was no statistically significant difference in the odds of TCP between both groups (OR, 1.08; 95 CI%, 0.97-1.19). Of the BL subclasses, only 1st generation cephalosporins and extended combination penicillins were found to carry statistically significant greater odds of TCP compared to nBL (Table 2). However, these differences disappeared for clinically significant TCP levels. There was no statistically significant difference in time to TCP for BL compared to nBL (Figure 2).Figure 1.Cohort flow diagramFigure 2.Kaplan Meier curve for thrombocytopenia by antibiotic class Conclusion The study found no statistically significant increase in TCP risk for BL when compared to nBL. Therefore, the risks and benefits should be considered before switching off preferred BL therapy. Disclosures Alyssa Y. Chen, MD, MPH, Advanced Clinical: Medical Specialist
Background Staphylococcus aureus bacteremia is a serious infection with a high mortality rate. Substance use disorder has been identified as a risk factor and poses unique challenges for treatment and outpatient parenteral antibiotic therapy (OPAT) eligibility. Outcomes of in this patient population have not been well studied. To address this gap, we conducted a retrospective study to evaluate the outcomes of patients with substance use disorder admitted with S.aureus bacteremia. Methods We conducted a retrospective epidemiological study of adults with substance use within 1 year and admitted to Parkland Hospital from April 2020 to March 2021 with diagnosis of S. aureus bacteremia during admission. Clinical and epidemiological data was collected using the electronic medical records system. Results 68 patients met inclusion criteria. 35 patients (52.4 %) reported active Intravenous drug use (IV). Cocaine use was reported by 40 %, Opioid use by 65.7 %, and amphetamine use by 26.9% of patients. 46% of patients were homeless and 52% were uninsured. Initial sources of bacteremia included skin and soft tissue infections (34%), bone and joint infections (31%), and infective endocarditis (22%). Most patients (40%) were discharged to a facility, while 24% were discharged home and 24% left against medical advice. Readmission within 30 days was observed in 21% of patients. Mortality at 30 days was 4.5%, while mortality at 1 year was 12%, with 17 patients (25%) lost to follow-up. Infectious complications related to S. aureus bacteremia within 1 year were seen in 31% of patients, with SSTI being the most common complication (16.4%). Six patients (9%) were diagnosed with endocarditis in a subsequent encounter. Leaving against medical advice was associated with an increased risk of S. aureus related complications after discharge (OR 6.6, 1.69-25 P=0.006) Conclusion There is significant burden of S. aureus bacteremia in patients with substance use disorder. Findings also suggest that infectious complications related to S. aureus bacteremia after discharge are common and require close monitoring and timely intervention. There is need for continued research to better understand the outcomes of patients with substance use disorder and to identify strategies for improving care Disclosures All Authors: No reported disclosures
Background Solid organ transplantation (SOT) is lifesaving, but donor-derived infections can be associated with significant morbidity and mortality. Candida species are common colonizers in deceased donors managed in the intensive care environment, and transmission to the recipient through transplantation is a described phenomenon. We sought to characterize Candida transmission events in the US SOT population. Methods Cases referred to Organ Procurement and Transplantation Network (OPTN) Disease Transmission Advisory Committee (DTAC) between 2012 and 2022 as potential donor disease transmission events (PDDTE) were adjudicated by DTAC based on consensus definitions. We included all recipients from any donor in which ≥1 proven or probable (P/P) or possible transmission of Candida occurred. Results Forty deceased donors were identified (characteristics, Table 1). 124 SOT recipients received organs from these donors including 60 kidney, 27 liver, 15 heart, 14 lung, and 8 multivisceral or other. DTAC adjudications of recipients included 8 proven, 16 probable, 24 possible, 1 unlikely, 51 excluded, and 24 intervention without disease transmission (IWDT). Growth of Candida in culture occurred in 24 of 40 donors and 63 of 124 recipients. Recipients were frequently bacteremic and had Candida growth at site of explanted kidney (Table 2). Mycotic aneurysm, bleed or hematoma occurred in 22 SOT recipients, 10 of which were P/P. Allograft explant was performed in 14 recipients (13 kidney and 1 other), 7 of which were P/P. Within 45 days of PDDTE reports, death occurred in 17 SOT recipients (1 proven, 7 possible, 7 excluded, 1 unlikely, 1 unknown). Only 6 of the 17 recipients who died received antifungal therapy. Seven deaths occurred in the 49 mate recipients of the 24 P/P transmissions, though lack of culture results did not support escalating adjudications beyond possible. Conclusion Donor-derived Candida infections occur with significant associated morbidity, including graft loss, and mortality, especially in kidney recipients. Opportunity exists to further identify risks, improve communication across transplant centers, initiate appropriate antifungal therapy, and improve management of mycotic aneurysm due to candidiasis. Disclosures Jason D. Goldman, MD, MPH, Adaptive Biotechnologies: Collaborative services agreements|Eli Lilly: Advisor/Consultant|Eli Lilly: Grant/Research Support|Eli Lilly: Honoraria|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria|GSK: Advisor/Consultant|Karius, Inc.: Advisor/Consultant|Merck: Grant/Research Support|Monogram Biosciences / Labcorp: Collaborative services agreements|Regeneron: Grant/Research Support Anil J. Trindade, MD, CareDx, Inc.: Advisor/Consultant|CareDx, Inc.: Grant/Research Support|Veloxis Pharmaceuticals, Inc.: Grant/Research Support Ricardo M. La Hoz, MD, Takeda: Advisor/Consultant Lara A. Danziger-Isakov, MD, MPH, Aicuris: Contracted Clinical Research|Ansun Biopharma: Contracted Clinical Research|Astellas: Contracted Clinical Research|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Contracted Clinical Research|Pfizer: Contracted Clinical Research|Roche Diagnostics: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: Contracted Clinical Research
Background We have observed an unexpected increase in hepatitis C virus (HCV) testing in the inpatient setting since the beginning of the COVID-19 pandemic. We hypothesized that this increase was driven by abnormal liver function tests (LFTs) due to COVID-19. We undertook a large observational study to test this hypothesis and to better understand the predictors of inpatient HCV testing. Methods We obtained medical record data for inpatients at Parkland Health and Hospital System (PHHS) from either of two 18-month time periods, representing before (8/1/2018-1/31/2020) and during (3/1/2020-8/31/2021) the COVID-19 pandemic. We evaluated possible predictors of inpatient HCV testing, including LFTs and COVID-19. Results Among the 34940 patients examined (18170 pre-pandemic [PP] and 16770 during pandemic [DP]), those hospitalized DP were more likely to be Hispanic and to have charity coverage (Figure 1). DP, 14.8% of inpatients received an HCV antibody (Ab) test, as compared to 13.4% of inpatients PP (p< 0.001). This increase specifically occurred among patients with COVID-19, of whom 18.5% received an HCV Ab test (Figure 2). This finding correlated with a much higher occurrence of elevated initial LFTs among patients with COVID-19 (Figure 3). The positivity rate of inpatient HCV Ab tests decreased from 9.07% PP to 4.87% among patients with COVID-19 (p=0.002), but there was no difference between time periods for patients without COVID-19 (Figure 2). When considering the subset of patients with COVID-19 who had an abnormal LFT, the Ab positivity rate was 4.13% (95% CI = [2.15%, 6.12%]). Among these Ab-positive patients, the HCV RNA positivity rate was 31.3% (95% CI = [8.5%, 54.0%]). Conclusion Hepatic injury associated with COVID-19 inadvertently resulted in more HCV Ab testing among inpatients. The Ab positivity rate and RNA detection were lower among these patients. Compared to non-COVID-19 inpatients who have abnormal LFTs, those with COVID-19 represent a lower risk population for HCV. Nevertheless, HCV testing still led to detection of new cases. Although abnormal LFTs among those with COVID-19 likely reflect hepatic injury due to SARS-CoV-2, it should be considered as an opportunity to screen a population who may not otherwise receive routine healthcare. Disclosures Brendan J. Fitzgerald, Pfizer Inc.: Stocks/Bonds|Viatris Inc.: Stocks/Bonds Mamta K. Jain, MD, MPH, Gilead Sciences: Grant/Research Support|Laurent: Grant/Research Support
Background The Burkholderia cepacia complex (Bcc) is composed of highly related opportunistic species that establish pulmonary infections in immunodeficient hosts, such as those with cystic fibrosis and chronic granulomatous disease. Due to their innate antibiotic-resistant phenotypes and capacity to form biofilm, Bcc infections are difficult to eradicate with traditional antibiotics. Peptide-conjugated phosphorodiamidate morpholino oligomers (PPMOs) offer an alternative therapeutic approach. These nucleotide analogues penetrate the outer membrane, bind specific mRNA, and inhibit translation. Due to high affinity base-pairing dynamics, these molecules can be rapidly modified and deployed to precisely inactivate innumerable bacterial gene targets. Previously, we found PPMOs targeting an acyl carrier protein (AcpP) are bactericidal against planktonic Bcc. It remains unknown whether PPMOs could modulate biofilm formation in these pathogens. Proposed Mechanism of Action of PPMOs Inside a bacterial cell, peptide-conjugated phosphorodiamidate morpholino oligomers (PPMOs) targeting the acpP gene bind to mRNA near the Shine-Dalgarno sequence and AUG start site, sterically inhibiting translation. This inhibition disrupts the expression and essential functions of acyl carrier protein (ACP). Methods Minimum biofilm eradication concentration assays were used to test two AcpP PPMOs on 24 h biofilms formed on pegs. Viable cells were enumerated. This activity was further evaluated by microscopy and 7-day biofilm kinetic studies. Fluorescein-labeled AcpP PPMO added to B. cenocepacia K56-2 DsRed was imaged over time to evaluate colocalization. PPMO toxicity was assessed over 24 h in A549 cells by LDH release. Results Treatment (10-40 μM) with AcpP PPMOs demonstrated more than a 3-log reduction (p< 0.0001) in biofilm burden across five clinical isolates of Bcc tested and B. thailandensis E264. PPMO bactericidal activity was visualized with confocal and scanning electron microscopy. Fluorescently labeled AcpP PPMO associated with the membrane of B. cenocepacia K56-2 DsRed in a temporal fashion. Additionally, AcpP PPMOs exhibited low toxicity in human pneumocytes. Conclusion PPMOs are active and bactericidal in established Bcc biofilms; thus, the biofilm setting is not a deterrent against PPMO delivery. This is further supported by the observations that AcpP PPMOs and Bcc cells colocalize in biofilm, resulting in membrane destruction and biomass reduction. Together, these data provide evidence that PPMOs are active in the biofilm setting of Bcc and could be a promising therapeutic strategy for these infections. Disclosures David E. Greenberg, MD, University of Texas Southwestern Medical Center: Dr. Greenberg has numerous patents on PPMOs
Background In 2015, a Best Practice Alert (BPA) was implemented into our electronic health record that prompts ordering of Hepatitis C Virus (HCV) antibody (Ab) screens for unscreened patients born between 1945-1965 (baby boomers: BB). The BPA begins the first step of the three-step care cascade, after which follow-up is needed for RNA testing if Ab-positive and HCV clinic visit if RNA-positive (figure 1). Prior studies found a 3.5-fold increase in HCV Ab screening after BPA implementation. We sought to understand the BPA’s role in cascade navigation during the COVID-19 pandemic. Initial BPA is triggered, which leads to subsequent steps including HCV antibody testing, HCV RNA testing, and ending with a clinic visit for treatment initiation. Methods This retrospective study included BB receiving their first BPA between 7/1/18-12/31/19 (pre-pandemic: PP) and 1/1/20-7/1/21, (intra-pandemic: IP), excluding patients with a death date ≤ 180 days after their BPA. Patients were followed for 180 days for each step and were marked unsuccessful if it was not completed. Successful navigation (SN) was defined as completing all steps or testing negative at any step. Hazard ratios for completion of each step were calculated via Cox Proportional Model. Clinical and demographic predictors of SN were examined via multivariable logistic regression in each cohort. Results Overall, 14,236 unscreened BB had a BPA (8,090 PP, 6,146 IP) fire during the study periods. The cohorts were similar, except for an increase in share with county financial assistance and those cared for by advanced practice providers in the IP cohort (table 1). An increase in HCV Ab screening (aHR 1.31 [95% CI: 1.25, 1.38]) and decreases in HCV RNA testing (aHR 0.79 [0.65, 0.96]) and clinic visits (aHR 0.43 [0.28, 0.66]) were seen in the IP cohort (figures 2A, B, and C). Hispanic patients had increased odds (aOR: 1.25 [1.02, 1.54]) of SN in the IP cohort (figures 3A and B). Compared to family medicine, those cared for in geriatric clinics had lower odds (aOR 0.75 [0.62, 0.91]) of SN in the IP cohort. Lower odds were also seen for those with Charlson Index ≥ 2 (aOR 0.85 [0.74, 0.98]) compared to 0.Table 1.Cohort Demographics.Baseline demographic, comorbidity, and provider factors for the pre-pandemic and intra-pandemic cohorts. Figure 2. Survival-Time Analysis of the HCV Care Cascade. Kaplan-Meier curves with 95% confidence intervals depicting time to completion by day after step initiation in each cohort. Data for the HCV antibody screening (A), HCV RNA testing (B), and liver clinic visit (C) steps are each shown separately. Log-rank test p-values are shown. Figure 3. Logistic Regression Forest Plots Forest plots showing the adjusted odds ratios and 95% confidence intervals for successful cascade navigation in the pre-pandemic (A) and intra-pandemic (B) cohorts. Odds ratio less than 1 indicates lower odds of successful navigation during that period. Odds ratio greater than 1 indicates higher odds of successful navigation. Conclusion The BPA increased the durability of HCV Ab screening rates during the pandemic compared to other steps in the cascade. Disparities in completing all steps of the cascade persisted and likely worsened in some groups during the pandemic. Overall, electronic reminders lessen impacts of disruptions in healthcare services. Disclosures Mamta K. Jain, MD, MPH, Gilead Sciences: Grant/Research Support|Laurent: Grant/Research Support
Background P. aeruginosa (PA) causes severe infections in immunocompromised patients and is increasingly antibiotic resistant. In addition, the formation of biofilm by PA makes effective treatment difficult. Peptide-conjugated phosphorodiamidate morpholino oligomers (PPMOs) are novel antisense antimicrobials that are designed to target pathogens in a gene-specific way and prevent translation of protein. We have demonstrated in vitro and in vivo activity of lead PPMOs in PA; however, it remains unclear whether PPMOs remain active in the biofilm setting over time and if synergy can be achieved with traditional antibiotics. Methods P. aeruginosa (GFP-PAO1) was dosed with a rhodamine-labelled PPMO targeting acpP. Samples were fixed at different time intervals and imaged by fluorescent microscopy. A Pearson’s coefficient was recorded for each dose and time condition. Minimum biofilm eradication concentration plates were used to treat PA biofilm with acpP or rpsJ targeted PPMOs in daily dosing experiments. Fixed synergy assays were performed on mature biofilm via 24-hour Q8 dosing with PPMO, antibiotics or control. Biofilm burden was quantified by CFU enumeration. Results PPMOs co-localized with PA in a dose- and time-dependent fashion. Pearson coefficients increased from 0.0583 at the 30-minutes to 0.4118 and 0.4976 at the 3- and 5-hour time points respectively. In addition, biofilm reduction was dose-dependent. In daily dosing experiments, the 3’RXR4-AcpP PPMO resulted in a 5-log reduction in biofilm burden compared to control on day 7 [p< 0.0001]; the 5’RXR4-RpsJ PPMO resulted in a 5.5-log reduction in biofilm burden compared to no treatment control [p< 0.0001]. PPMOs incubated with tobramycin or aztreonam were found to have synergistic (FIC< 0.5) or antagonistic effects (FIC > 1) in biofilm and planktonic killing depending on the combination tested. Conclusion Lead PA PPMOs demonstrate dose and time-dependent biofilm eradication over multiple days of therapy. In addition, some PPMOs demonstrate synergy with other small molecule antibiotics that are used to treat certain patients with PA infections. PA PPMOs could be an innovative treatment modality for infection due to Pseudomonas. Disclosures David E. Greenberg, MD, University of Texas Southwestern Medical Center: Dr. Greenberg has numerous patents on PPMOs
Background Enterococcus species commonly cause bloodstream infections (BSIs) with E. faecium infections considered especially worrisome due to association with vancomycin resistance via expression of the vanA gene. However, it is unclear if there is an association with E. faecium’s drug resistance potential and increased morbidity or mortality. Here we aimed to assess the severity of disease and mortality of patients with E. faecalis versus E. faecium BSIs, including subgroup analysis of vancomycin resistant E. faecium (VRE). Methods We conducted a retrospective, observational cohort study at a large urban academic center. Adult patients admitted from January 2018 to October 2022 with either E. faecalis or E. faecium BSI were included. Variables collected, determined a priori, included history of previous antibiotic use, malignancy, transplant status, and bacteremia source. Outcome variables of interest were ICU stay, length of stay, and mortality. Results There was a total of 182 total cases of E. faecalis and E. faecium BSI, 123 and 65, respectively, including 6 cases with both species (Table 1). Patients with E. faecium had higher median Pitt bacteremia scores (2 [IQR 0-4] versus 1 [IQR 0-3], p = 0.02) and longer median length of stay (30 [IQR 12-51] versus 15 [IQR 8-27], p < 0.001). There was statistically higher all-cause mortality at time of data collection in the E. faecium (60% vs 41%, p = 0.01) and VRE cohorts compared with E. faecalis (63% vs. 41%, p = 0.02). Kaplan-Meier curve (Figure 1) demonstrates decreased survival in the E. faecium cohort compared to E. faecalis within the first 100 days after bacteremia (HR 1.84, p = 0.01). Of note, a difference in 90-day all cause mortality was only statistically different in the entire E. faecium cohort when compared to the E. faecalis cohort. (45% vs 29%, p = 0.04), in contrast to the VRE cohort (43% vs 29%, p = 0.12). E. faecalis vs E. faecium results Comparison of select variables E. faecalis vs vancomycin resistant E. faecium results Comparison of select variables Conclusion E. faecium BSIs appear associated with longer, more clinically severe hospital courses and significantly increased mortality, specifically 90-day mortality when compared to E. faecalis BSIs. Future inquiries should assess the extent to which E. faecium serves as an index versus driver of poor clinical outcomes and strategies to mitigate the associated mortality. Disclosures James Sanders, PhD, PharmD, Merck & Co., Inc.: Grant/Research Support|Shionogi Inc.: Grant/Research Support
Background Numerous studies have reported that rates of nontuberculous mycobacteria (NTM) infections are increasing. However, data on the epidemiology of healthcare facility-associated (HCFA) NTM are sparse. We performed a multicenter longitudinal study to analyze the epidemiology of NTM at a network of U.S. academic hospitals. Methods We retrospectively analyzed data on positive cultures for NTM obtained from 2012-2020 at a network of 10 U.S. academic hospitals and associated clinics (Table). Variables analyzed included NTM species, specimen source, and hospital admission status. A unique NTM episode was defined as a patient’s first positive culture for a particular NTM species and specimen source category (pulmonary vs. extrapulmonary). Episodes linked to isolates obtained on day 3 or later of hospitalization were considered to represent hospital-onset (HO) NTM. Seven hospitals contributed at least 12 months of baseline data prior to January 2014, and within this closed cohort, trends of NTM incidence rates were estimated with log regression. Characteristics of a 10-hospital network that performed retrospective culture-based NTM surveillance from 2012-2020. Results Across the 10-hospital network, 24,376 total NTM isolates were identified during 19,248,137 patient-days of surveillance; 12,847 (53%) isolates represented unique NTM episodes. Of these episodes, 3,044 (24%) were HO-NTM, which were most commonly caused by M. avium complex (n=1,466, 48%), M. abscessus complex (n=397, 13%), and M. chelonae-M. immunogenum (n=348, 11%). For 595 (20%) HO episodes, specimen source was extrapulmonary. Individual hospital incidence rates of HO-NTM were highly variable with a median rate of 1.1 episodes per 10,000 patient-days (range, 0.4 – 5.5 episodes) (Table). For the 7-hospital closed cohort, the HO-NTM incidence rate decreased from 2.3 to 1.4 episodes per 10,000 patient-days from 2014 to 2020 (incidence rate ratio, 0.6; 95% CI, 0.5-0.7; P < .0001) (Figure 1). Trend analysis estimated that the rate of HO-NTM decreased by 10% per year (95% CI, 8-12%; P < .0001) (Figure 2). Incidence rates of NTM episodes observed from 2014-2020 at a 7-hospital cohort. Admitted epsiodes consisted of episodes that were hospital-onset (HO) or not HO. Log regression model of hospital-onset NTM incidence rates from 2014-2020 within a 7-hospital cohort. The fit plot displays predicted values with 95% confidence limits and observed rates. Conclusion Network HO-NTM incidence rates decreased from 2014-2020, but rates varied substantially at individual hospitals. These results provide comprehensive data on HCFA-NTM isolation, including rates that can serve as external benchmarks. Given hospital variability, NTM surveillance at the individual hospital level is paramount. Disclosures Arthur W. Baker, MD, MPH, Insmed: Grant/Research Support|Medincell: Advisor/Consultant Ricardo M. La Hoz, MD, Takeda: Advisor/Consultant Melissa B. Miller, PhD, BioFire: Advisor/Consultant|BioFire: Honoraria|Cantata Bio: Grant/Research Support|Luminex Molecular Diagnostics: Advisor/Consultant|Luminex Molecular Diagnostics: Honoraria|MiraVista Diagnostics: Advisor/Consultant|MiraVista Diagnostics: Honoraria|QIAGEN: Advisor/Consultant|QIAGEN: Grant/Research Support|QIAGEN: Honoraria David J. Weber, MD, MPH, BD: Advisor/Consultant|Germitic: Advisor/Consultant|GSK: DSMB|PDI: Advisor/Consultant|Pfizer: Advisor/Consultant|Wellair: Advisor/Consultant Barbara D. Alexander, MD, F2G Pharmaceuticals: Advisor/Consultant|HealthTrackRx: Advisor/Consultant|HealthTrackRx: Board Member|Leadiaint: Grant/Research Support|Merck: Advisor/Consultant|Scynexis: Grant/Research Support|Thermofisher: Advisor/Consultant Jason E. Stout, MD, MHS, AN2 pharmaceuticals: Grant/Research Support
Background Colorectal surgical site infection (SSIs) rates have been reported to be from 10%-30% and significantly contribute to patient morbidity, mortality, and healthcare costs. High safety-net burden has been shown to be associated with increased risk of SSI, but to our knowledge, modifiable risk factors for colorectal surgery (CRS) have not been investigated in this setting. Deep and organ space infection rate at Parkland Health, a safety-net hospital in Dallas County, was 3.7% in 2021 3.6% in 2022. We aim to identify modifiable risk factors for colorectal SSI at our safety net hospital. Methods This is a retrospective case-control study in which patients who had a deep or organ space SSI after CRS from 01/2018 to 05/2022 were randomly matched 1:3 by month. A total of 100 cases and 300 controls were studied. Data was extracted for 69 variables. All variables achieving p < 0.1 in univariate analysis were included in a multivariate logistic regression analysis.Table 1:Modifiable Risk Factors. Factors regarding demographic history, medical history, intraoperative management, pre-operative management, and post-operative management were extracted and analyzed. Results Univariate analysis was significant for: BMI18.5 - 24.9 (OR, 0.495; 95% CI, 0.274-0.895; p= 0.022) , age 40 to 49 (OR, 0.528; 95% CI, 0.287-0.970; p=0.039), early mobility (OR, 0.420; 95% CI, 0.236-0.747; p=0.003), immunosuppression (OR, 4.093; 95% CI, 1.642-10.202; p=0.003), NSQIP score of 2 (OR, 1.848; 95% CI, 1.147-2.977; p=0.016), serum glucose 200-250 (OR, 2.228; 95% CI, 1.130-4.393; p=0.032), and age 20 to 29 (OR, 2.306; 95% CI, 1.060-5.019; p=0.043). Early mobility was significant with multivariate logistic regression analysis (OR, 0.3; 95% CI, 0.14-0.66; p=0.0027).Figure 1.Univariate Significance Analysis of Extracted Variables The protective factors against developing an SSI were age between 40-49, BMI between 18.5-24.5, and early mobility. The risk factors that were associated with developing an SSI were age between 20 and 29, blood glucose level between 200 mg/dL and 250 mg/dL, NSQIP score of 2, immunosuppression.Table 2.Statistical Information about Significant Variables Seven variables were found to be significant after the completion of univariate analysis. Initial multivariate analysis indicates that early mobility may be significant with a p-value of 0.0027. Conclusion Early mobility in the form of out of bed to chair for all meals (3 times in a day) on post-operative day one is protective against SSI occurrence. While risk factors for SSIs post-colorectal surgery have been discussed in the literature, there has not been a study conducted in a large safety net hospital that already follows the National Surgical Quality Improvement Program recommended guidelines. We were able to assess the independent importance of different variables from practice guidelines as potential risk factors in a large, diverse, safety net hospital. We engaged our surgeons and OR nursing staff in a multidisciplinary effort to optimize early mobility to reduce SSI risk. Disclosures All Authors: No reported disclosures
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Alireza Eajazi
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  • Department of Surgery
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