Background Complementary feeding (CF) is the period when exclusive breastfeeding ends and the introduction of a wide range of foods while breastfeeding should continue until the child is at least 24 months of age. Sub-optimal complementary feeding practices of infants and young children persist due to different factors, which include knowledge, attitude, and self-efficacy of index mothers. Therefore, this study aimed to assess determinants of knowledge, attitude, and self-efficacy towards complementary feeding among rural mothers with index child in rural Ethiopia. Methods A community-based, cross-sectional study was conducted using multistage sampling techniques followed by systematic random sampling techniques. A structured interviewer-administered questionnaire was used. The Chi-square and Fisher’s exact probability tests were used to assess the baseline differences in the CF knowledge, attitude, self-efficacy and socio-demographic characteristics of the intervention and control groups. An independent sample t-test was used to determine the mean differences. Multiple linear regression models were fitted to assess the predictors of complementary feeding knowledge, attitude, and self-efficacy. All tests were two-tailed, and a statistically significant association was considered at a p -value ≤ 0.05. Results Overall, 516 mothers were interviewed. 52.5% of the mothers had high complementary feeding (CF) knowledge, whereas only 47.7% and 38.9% had favorable attitude and high self-efficacy, respectively. The socio-demographic characteristics of the intervention and control groups were overall similar. However, there was a significant difference in the child’s sex (p = 0.021) and age (p = 0.002). Independent t-tests found no significant difference between the two groups in terms of the mean score of CF knowledge, attitude, and self-efficacy at baseline. Maternal educational status (p = 0.0001), number of ANC visits (p = 0.025), and CF information received (p = 0.011) were significant predictors of CF knowledge. Child sex (p = 0.021) and the number of ANC visits (p = 0.01) were significant predictors of CF attitude. Family size (p = 0.008) and household food security status (p = 0.005) were significant predictors of maternal CF self-efficacy. Conclusion Overall, half of the mothers had high knowledge. Whereas maternal attitudes and self-efficacy toward CF were low. Maternal educational status, the number of ANC visits, and the CF information received were predictors of CF knowledge. Likewise, child sex and the number of ANC visits were predictors of CF attitude. Family size and household food security status were predictors of CF self-efficacy. These findings imply that nutrition intervention strategies are mandatory, particularly to enhance maternal knowledge, attitude, and self-efficacy towards optimum complementary feeding.
Designing iteratively, evaluating early, and continuing to refine a design are solid tenets of formative design. As designers and design researchers, we continuously apply an ongoing formative lens to our design process and the design courses we teach. In this chapter, we take you on our formative design journey where we engaged in implicit and explicit reflection to iteratively design, evaluate and refine our courses, in an effort to improve our instruction, while cultivating our designer professional identity. As a result of our formative journey, three immediate design improvements are described as well as additional improvements to be implemented in future courses.
Background Outpatient Parenteral Antimicrobial Therapy (OPAT) is challenging to implement safely and difficult for infectious diseases (ID) physicians to monitor in centers without a dedicated OPAT staff. We utilized a 6-Sigma framework to evaluate our OPAT process and define opportunities for improvement. Methods In a retrospective cohort study, we screened 5 months of ID consult data for patients who left on OPAT from an urban hospital system (Fig 1). Primary outcome was incidence of adverse event (AE), a composite of either emergency department (ED) visit or all-cause 30-day readmission. Clinical characteristics and completeness of ID documentation were compared between patients with and without an AE. Complete documentation included antibiotic dose, duration, stop date, and a scheduled ID appointment. We simultaneously conducted a 6-sigma analysis involving stakeholders (physicians, case managers, nurses) in focus groups, to generate a process map, Ishikawa diagram, 5-Why’s analysis, and identify heterogeneity in our OPAT process (Fig 2). Results Fifty of 441 patients (11.3%) were discharged on OPAT and incidence AE was 30%. Neither type of infection (Fig 3), nor demographics, clinical characteristics, or discharge location differed between groups (Table 1). Only half (50%) of the patients had complete documentation. Median time from discharge to clinic was 21 days, however, AE’s occurred in a median time of 12 days. Patients without an AE were more likely to have been seen in the clinic post-discharge (51% versus 20%, p=0.039). ID clinic appointments were made for 60% of patients, with a show rate of 63%. (Fig 4). Two additional unscheduled patients initiated their own visit (Fig 4). The 6-Sigma analysis identified process heterogeneity at discharge location and over-reliance on human memory for complete documentation. Interestingly, focus groups revealed numerous assumptions not supported by the objective data (Fig 5 in conclusion). Conclusion Almost 1 in 3 patients leaving on OPAT experienced an adverse event. A 6 Sigma analysis identified heterogeneity in our process and incorrect assumptions among stakeholders (Fig 5). Next steps should focus on improving ID documentation and ensuring all patients leaving on OPAT have an ID clinic visit scheduled within 14 days after discharge. Disclosures All Authors: No reported disclosures
Background Post-COVID conditions (PCC) are common, and risk factors include older age and female sex. While high interleukin (IL)-6 and C-reactive protein are associated with more severe disease, it is unclear whether other cytokines are associated with PCC. This study was performed to identify factors associated with PCC development. Methods The Convalescent Plasma to Limit SARS-CoV-2 Associated Complications (CSSC-004) trial was a double-blind, multi-center, randomized, controlled trial comparing the use of COVID-19 convalescent plasma (CCP) to control plasma for the prevention of hospitalization among COVID-19 outpatients. Among 882 individuals participating in the trial with available biospecimens and symptom data, the association between early COVID-19 treatment, cytokine levels and PCC was evaluated. Cytokine and chemokine levels were assessed at baseline, day 14 and day 90 using a multiplexed sandwich immuosassay. Presence of any PCC symptom was assessed at day 90. Associations between COVID-19 treatment, cytokine levels and PCC were examined using multivariate logistic regression models. Results Baseline characteristics were similar by trial treatment group (Figure 1). At day 90, 292 (33.1%) participants had PCC. The most common symptoms were fatigue (14.5%), anosmia (14.5%), and ageusia (10.0%). Levels of most cytokines decreased over time (Figure 2). Six pro-inflammatory cytokines especially IL-6 were elevated at baseline among those with PCC (Figure 3). In multivariable analysis, female sex (adjusted odds ratio [AOR]=2.70[1.93-3.81]), age 50 or greater (AOR=1.32[1.17-1.50]), and elevated baseline IL-6 (AOR=1.59[1.02-2.47]) were associated with development of PCC, whereas race, obesity, vaccine status and diabetes were not. Those who received early CCP treatment (<5 days after symptom onset) compared to late CCP treatment had statistically significant lower odds of PCC (AOR=0.60 [0.38-0.95]). Conclusion This study showed high prevalence of PCC symptoms at day 90, particularly among those with higher baseline levels of IL-6 or who did not receive early CCP treatment. The potential utility of IL-6 modulation as a therapeutic intervention among individuals as higher risk for PCC should be studied. Disclosures Kelly Gebo, MD, MPH, Pfizer: Advisor/Consultant|Spark HealthCare: Advisor/Consultant Sonya L. Heath, MD, Pfizer: Data Monitoring Committee/DSMB Shmuel Shoham, MD, adagio: Advisor/Consultant|Adamis: Advisor/Consultant|ansun: Grant/Research Support|Avir Pharma: Honoraria|cidara: Grant/Research Support|F2G: Grant/Research Support|Immunome: Advisor/Consultant|Karius: Honoraria|Scynexis: Advisor/Consultant|zeteo: Grant/Research Support Judith S. Currier, M.D., MSc, Merck and Company: Advisor/Consultant|Merck and Company: Honoraria Moises A. Huaman, MD, MSc, AN2 Therapeutics Inc: Grant/Research Support|Gilead Sciences Inc: Grant/Research Support|Insmed Inc: Grant/Research Support Jay S. Raval, MD, Sanofi Genzyme: Advisor/Consultant Arturo Casadevall, MD, PhD, Ortho Diagnostics: Speakers Bureau|Sabtherapeutics: Advisor/Consultant
Background The COVID-19 pandemic, resulting from the rapidly evolving SARS-CoV-2 virus, has drastically impacted health systems and economies worldwide. Genomic sequencing is critical for the surveillance of SARS-CoV-2 to monitor the rapidly evolving virus and identify new strains. Methods 583 isolates from Henry Ford Health were retrospectively profiled across 3 years (117 isolates in 2020; 39 in 2021; 427 in 2022). DNA was extracted using Kingfisher viral isolation kit; RT-PCR screening was used to identify isolates with cycle threshold < 32 for whole genome sequencing (WGS). Libraries were generated using QIAseq DIRECT SARS-CoV-2 Kit, followed by Illumina sequencing (MiSeq or NovaSeq 6000; 300 cycles). Lineage analysis of the SARS-CoV-2 consensus genome sequences generated from samtools variant analysis pipeline was determined using Nextclade and Pangolin software. Results Sequences were classified into 11 unique clades across 108 lineages by Nextclade and Pangolin, respectively. Almost three-fourths of the sequenced isolates were from 2022. 117 (20%) genomes were from the early pandemic (2020) and were clustered into 8 clades: 19A, 19B, 20A, 20B, 20C, 21 J (Delta) and 21L (Omicron). Most of the 2022 genomes (72%) were in clade 20C from lineage B.1, identified during the outbreak in Europe. 15 (13%) genomes had clade 19A (lineage B) and 1 had 19B (lineage A.3), identified early in the pandemic in Wuhan, China. Of the 39 (7%) genomes from 2021, the majority (82%) clustered into clade Delta 21J that originated in India. Only 2 (5%) of the genomes from 2021 had Alpha variant of concern (21I) from the lineage B1.1.7, which were suspected to be more transmissible. Of the 427 (73%) genomes from 2022, 393 (92%) had variants within Omicron variant of concern (21L), with 79 different lineages; 1 was Omicron variant 21K from the lineage BA1.1. Other clades observed in the 2022 batch were 19A (6%), 20A (0.2%), 20B (0.2%), 20C (0.2%) and 21M (1%). Conclusion Our genomic surveillance data suggest that SARS-CoV-2 infections at the local level mirrored global outbreaks. This underscores the importance of robust genomic surveillance efforts to inform public health planning and practice. Disclosures Marcus Zervos, MD, Contrafect: Advisor/Consultant|GSK: Grant/Research Support|Johnson and Johnson: Grant/Research Support|Pfizer: Grant/Research Support
Background C. difficile infection (CDI) is a common health care-associated infection and quality measure for hospitals. The use of diagnostic stewardship interventions have been shown to decrease the rates of CDI by guiding appropriate testing using nucleic acid amplification tests (NAAT), which are highly sensitive but cannot differentiate between colonization and infection (i.e. lack clinical specificity). Cell culture cytotoxic assay (the “gold standard” test) has limited use in real time diagnosis, however may play a role in validating and augment the impact of diagnostic stewardship reductions in CDI. Methods This single center, retrospective review evaluated the utilization of a cytotoxic assay on clinical patient stool samples that met the criteria for diagnostic testing using NAAT as part of a diagnostic stewardship intervention for appropriate C. difficile testing. Samples that were positive for NAAT from 9/11/2018 to 4/11/2023 were concurrently sent for cell culture cytotoxic assay to verify the clinical suspicion of infection from C. difficile and the results reviewed by the multidisciplinary care and quality team for clinical correlation. Results Of the thirty-seven specimens that tested positive for CDI by NAAT, twenty-eight tested positive on the cytotoxic assay (a total 75.7% of specimen with positive NAAT had concordance with the cytotoxic assay). After clinical adjudication, a decrease of 13 days of therapy (DOT) for vancomycin, 3 DOT for fidaxomicin, and total cost saving of $739.50 was noted after adjustments to therapy. Average turnaround time for the cytotoxic assay was 7.1 days (SD = 3.8). Conclusion While limited as a real-time diagnostic assay for CDI, use of the cell culture cytotoxic assay validates the impact of diagnostic stewardship interventions and improves the specificity of testing when utilized in a sequential testing algorithm with NAAT. Disclosures All Authors: No reported disclosures
Background BK virus hemorrhagic cystitis (BKV-HC) is a complication after allogeneic hematopoietic stem cell transplant (AlloHCT) for which optimal management is uncertain. Intravenous (IV) and intravesicular (IVES) cidofovir have been used with varying degrees of success in small case series of six to 33 patients. While some series have investigated side effects, none have examined medication errors (Fig 1). Methods A retrospective single-center case series of AlloHCT patients with BKV-HC given IV or IVES cidofovir (CDV) from 2018 to 2022 at an urban cancer center in Detroit, MI. Our primary objective was to determine the incidence of CDV related medication errors (ME) and perform a root cause analysis (RCA) to determine factors contributing to such events. Secondary objectives were to describe the effectiveness of CDV for BKV-HC following AlloHCT. Results Six AlloHCT patients were treated with CDV. Patient characteristics are shown in Table 1. Median age was 48 years (range 32-63), with most being high risk for cytomegalovirus (R+) and experiencing acute graft versus host disease. CDV and BKV-HC characteristics are shown in Table 2. BKV-HC occurred a median of 53 days post Allo-HCT (range 27-179). Four patients received IV CDV only and two received it both IV and IVES. Median number of doses was 2 (range 1-10). Median BKV-HC severity grade was 2.5, and three of six patients had BK viremia (Table 2). Five of six patients had microscopic resolution of hematuria (median time to resolution 30 days, range 1-116). However, 4 of 6 had died and 1 of 6 had recurrence of BKV-HC within 90 days. The most common CDV side effects were bladder pain/spasms (n=5) and acute kidney injury (n=4). There were 2 MEs; one near miss where CDV was incorrectly ordered IV but changed to IVES by a pharmacist, and one major safety event where an IVES dose was administered IV. RCA analysis revealed multiple contributing factors including similarity in appearance of doses and an overly simplified pump library without an option for IVES administration (Fig 2). Conclusion In this first case series to describe medication errors in patients treated with CDV for BKV-HC, one in three patients experienced an ME. Clinicians caring for AlloHCT patients should have a high predisposition for error when cidofovir is being prescribed. Disclosures All Authors: No reported disclosures
Background Respiratory syncytial virus (RSV), commonly a virus of the fall and winter months, can be particularly serious in children under one year of age and in older adults or people with other comorbidities. Because of the precautions taken during the COVID-19 pandemic, recent RSV infections have deviated from the usual seasonal trend. The purpose of this study was to assess the overall morbidity and mortality in patients with RSV. Methods We conducted a multicenter historical cohort study of adult patients hospitalized for laboratory-confirmed RSV-related diseases in Ascension hospitals in southeast Michigan between January 2017 and December 2021. Hospitalized patients were identified using ICD 10 codes for RSV-related diseases. Electronic medical records were reviewed. Data were analyzed using the chi squared test, Student’s t test, and the Mann-Whitney U test using SPSS v. 29.0. Results Of 360 patients, the mean (sd) age of the cohort was 69.9 + 14.7 years, 228 (63.5%) were female and 227 (63%) were white. The mean body mass index (BMI) was 30.6 + 9.7 kg/m2 and 56.1% were smokers. The most common comorbidities were hypertension (66.7%), chronic lung diseases (57.2%), obesity (33.6%), diabetes mellitus (31.1%) and congestive heart failure (26.1%). The mean Charlson weighted index of comorbidity was 2.2 ± 1.9. Cough (79.2%) and shortness of breath (72.8%) was most common symptoms. Admission chest x-rays were abnormal in 44.7% of cases. RSV upper and lower respiratory tract infections (RTI) were present in 58.4% and 41.6% of patients, respectively. Antibiotics were given in 56.9% of patients. Mechanical ventilation was required in 11% and intensive care in 14.2 % of patients. Other complications were acute kidney injury in 23.3%, encephalopathy in 11.4%, and liver injury in 3.6 %; 13 (3.6%) patients died and 21 (5.8%) were readmitted within 30 days to an Ascension hospital. Conclusion Our study finds elderly patients hospitalized with RSV had substantial comorbidities. While overall mortality was low, the hospital course and complications suggest a disease that was costly both in human and financial suffering. Our study supports a need for RSV preventable initiatives and immunizations for this susceptible adult population. Disclosures All Authors: No reported disclosures
Background People experiencing homelessness (PEH) face inequitable social determinants of health that impact primary care prevention, complications related to infectious diseases (ID), and hospitalizations. The purpose of Street Medicine Organizations is to provide accessible medical care to PEH where they reside. We describe a uniquely developed hospital consult service (HCS) targeted for PEH. Methods This HCS took place in an 877-bed quaternary care hospital in Detroit, MI and occurred from 07/2022 – 03/2023. Inclusion criteria were PEH (defined as living unsheltered, sheltered, or with unstable housing). Figure 1a describes HCS timeline and objectives and aims of the HCS are shown in Figure 1b. The HCS template is shown in Figure 2. Healthcare screening (HS) recommendations were provided to the primary team, and discharge support including harm reduction education and community resources were provided to the patient. The outcomes evaluated included HS and vaccine orders and follow-up success on street medicine runs. Consult note template Results 60 patients were evaluated with the HCS from 09/2022 – 03/2023. Of those, 43 consults were completed prior to patient discharge. Patient characteristics are shown in Table 1. Median population age was 50 years, 44 (73.3%) were men and 46 (76.7%) were Black. Majority of patients seen (48.8%) were unsheltered. 31 patients (76.7%) had last seen a primary care provider > 12 months ago. Patient were more inclined to receive the influenza (30.2%) and pneumococcal (30.2%) vaccine compared to the COVID-19 vaccine (7%). 25 patients (58.1%) admitted to polysubstance use. There were recommendations placed for 23 (53.4%) of patients in which 11 (47.8%) were executed successfully prior to discharge. 17 (39.5%) patients had a scheduled follow up visit at a specific location and time on the street. Conclusion We describe the implementation of a unique HCS with a targeted needs assessment for PEH in hospital. Challenges regarding the HCS included frequent reeducation of HCS members to provide recommendations and sign-out. One major patient barrier included lack of phone for follow-up. However, specific gaps for this population within ID expertise have been identified. HCS future goals are to focus on harm reduction education, STI prevention, and addressing vaccine hesitancy in PEH. Disclosures Marcus Zervos, MD, Contrafect: Advisor/Consultant|GSK: Grant/Research Support|Johnson and Johnson: Grant/Research Support|Pfizer: Grant/Research Support
Background To achieve HIV care continuum goals, novel modes of HIV care are needed. In 2017, the Wayne State University Home Care Program (HCP) was launched in Detroit, Michigan. The primary purpose of this program is to re-engage people with HIV (PWH) who have been unable to attend regular clinic visits through an intensive, in-home model of HIV care. This study evaluates the outcomes of the first 5 years of this program. Methods We conducted a retrospective cohort analysis of the 81 patients enrolled in the HCP from inception in 2017 to December, 2022. We evaluated duration of participation, reason for discharge from the program, and effect of a full year of program participation on viral suppression (viral load ≤ 20 copies/mL) and CD4 count (above or below 200 cells/mm3). Patients who did not have at least 1 year of participation were excluded from analysis of change in VL and CD4 count. McNemar test of significance was used, p value of < 0.05 was considered significant. Results Most of the patients enrolled in the HCP were African American (95.1%) and male (65.4%). Common primary barriers to clinic visits were transportation (27.2%) and stigma (25.9%). The median duration spent in the HCP was 924 days (approximately 2.5 years). At entry, 15.3% of patients had a suppressed viral load, and after the first year of enrollment, 52.5% of patients achieved viral load suppression (p< 0.001). Similarly, 72.9% of patients achieved a CD4 ≥ 200 cells/mm3 after a year when compared to 57.6% of patients at entry with CD4 ≥ 200 cells/mm3 (p=0.012). Of the 81 patients enrolled during the study period, 28 patients (50%) returned to clinic-based care, out of which 21 patients (91.3%) were retained in care and 2 (8.7%) were lost to follow-up. Total of 11 patients (19.6%) died during the study period.Table 2:Home Care Program Outcomes Conclusion The Wayne State University Home Care Program is an innovative model to re-engage and maintain PWH who are unable to receive care in traditional settings. By removing physical and stigma-related barriers, the HCP was able to improve viral load suppression and CD4 count among an ill and “hard to reach” cohort. Additionally, the HCP empowered patients to successfully return to clinic-based care. Disclosures All Authors: No reported disclosures
Background Chimeric Antigen Receptor (CAR) T-cell therapy is an emerging therapeutic modality for relapsing and refractory haematological malignancies. We describe the infectious complications following CAR T-cell therapy. Methods This is a retrospective analysis of data on patients who received CAR-T cell therapy between April 2018 and December 2022 at Karmanos Cancer Institute, Detroit, Michigan. Patients’ data were collected up to their last known clinic or inpatient follow-up visit. An infectious episode was defined as any microbiologically proven or documented infection. Statistical analysis was performed using SPSS software version 28.0. Results Seventy-six patients received therapy with FDA-approved CAR-T cell products. Thirty-three patients (43.4%) had at least one infection with a range of 1 to 4 infectious episodes per patient. There were 61 infectious episodes during a median follow-up of 184 (96-340) days. The median duration for the onset of infection was 59 (22-209) days. Bacterial and viral infections occurred in 42.6% and 41% of the infectious episodes respectively. COVID-19 was the most common infectious complication (14.8%). Time-to-event analysis showed that most of the infections occurred within the first 100 days (Figure 2). Empirical antibiotic use in Cytokine Release Syndrome (CRS)/ Immune effector Cell-Associated Neurotoxicity Syndrome (ICANS) in the absence of documented infection was reported in 85.7% of patients. Clostridioides difficile (C.difficile) accounted for 11.5% of all infections. Out of 6 patients with C.difficile infection 5 patients had CRS and antibiotic use. There were four documented deaths during the study period. Two deaths occurred in patients who had an infection. Conclusion The mortality rate among patients who had an infection was 6.5%. Most of the infections occurred within the first 100 days. COVID-19 and C. difficile infection were the most common infections following CAR-T cell therapy. The rate of C. difficile infection was high in patients with CRS receiving empiric antibiotics in the absence of any documented infection, thus providing an opportunity for antibiotic stewardship in this population. Disclosures All Authors: No reported disclosures
Background Microbiology wet labs have been eliminated in many medical schools and infectious diseases (ID) fellows are training in a post-COVID era where hands-on experience is lacking. The IDSA recommends 120 hours of microbiology experience for fellows, but feasibility is limited in centers struggling to retain adequate staff, and technicians are limited in their ability to integrate clinical skills. We aimed to overcome these struggles by implementing a microbiology and mycology curriculum for ID fellows using a case-based approach within the microbiology lab (Fig1). Methods In a quasi-experimental study, eight ID fellows from Wayne State University were taught in interactive, 1-hour sessions delivered monthly in the lab over 11 months using existing samples. Planning included a needs assessment, review of in training scores to identify weak spots, and pre-tests to assess baseline knowledge (Fig 1). Sessions topics are shown in Table 1. All sessions were delivered by an ID faculty to ensure homogeneity. Prior to each session, specimens were procured and objectives were outlined and linked to core content areas. An example of the objectives and core content for the hyaline mold session is shown in Table 2. A post-test occurred after session 9. Primary outcome was comparison of de-identified pre and post test scores by Wilcoxon signed-rank test for paired non-parametric data. Fellows experience and feedback for improvement were also collected. Results Sessions were performed as described and included hands on activities and a summary handout (Fig 2). Pre versus post test scores showed significant median improvement (65% to 82.5%. p=0.048, table 3). Feedback on the sessions was overwhelmingly positive, with suggestions for encore sessions and request to make a similar parasitology curriculum (Table 4). Sessions became so popular that pharmacists and other trainees began attending. Although not an intended outcome, it was noted that after posting handouts to twitter, fellowship following increased by 250%. Conclusion A monthly longitudinal microbiology and mycology curriculum was well received by ID fellows and objectively increased their knowledge. This is the first study attempting to objectively quantify knowledge gained using a hands-on microbiology lab curriculum to teach ID fellows. Disclosures All Authors: No reported disclosures
Background The persistence of Acinetobacter on different surfaces and the continuous exposure of bacteria to disinfectants such as quaternary ammonium compounds (QACs) in the healthcare environment have led to microbicide tolerance. Acinetobacter baumannii have also rapidly acquired carbapenem resistance. Here we determined the prevalence of microbicide resistance genes in carbapenem susceptible and resistant clinical isolates of Acinetobacter. Methods All clinical isolates were collected from two separate hospitals in Detroit between 2017-2021. Following DNA isolation using Qiagen kit, Nextera Flex kit was used for library preparation of Acinetobacter clinical isolates. Whole genome sequencing (WGS) was performed via Illumina NextSeq 550 using the prepared DNA library. The FASTQ files from the sequencing run were then subjected to bioinformatic analysis with Bionumerics software v7.6. ResFinder was used for determination of presence or absence of QAC resistant genes and results were tabulated by Carbapenem-Resistant Acinetobacter baumannii (CRAb) or Carbapenem-Susceptible Acinetobacter baumannii (CSAb) with or without the QAC resistant genes. Results Out of the 139 Acinetobacter patient isolates, 70/139 (50.4%) were CRAb containing carbapenemase blaOXA-23 and 69/139 (49.6%) belonged to CSAb (Table 1). Figure 1. shows the prevalence of antimicrobial resistance (AMR) genes in CRAb and CSAb isolates with qacE genes. For CRAb isolates, 56% had qacE genes while 39% of CSAb had qacE genes. About 42% of CRAb isolates were multi-drug resistant (MDR), indicating a prevalence of qacE genes among the MDR isolates. Table 2 shows the presence of qacE genes by sequence type (ST). In the ST2 (Pasteur) and ST406 (Pasteur) strains, qacE gene was mainly present. Interestingly, most of the Acinetobacter isolates that belong to ST2 (ST195 and ST281, Oxford) are CRAb with qacE gene.Figure 1:Different AMR genes and qacE in both CRAb and CSAb isolates Conclusion Clinical isolates in our study had an even distribution of both CRAb and CSAb. The presence of qacE gene was more prevalent in the CRAb isolates compared to the CSAb isolates. While different STs harbored the qacE gene, the prevalence of qacE gene was highest in ST2 among all isolates. Future studies are needed to determine the reduced susceptibility to other commonly used hospital disinfectants. Disclosures Keith S. Kaye, MD, MPH, Abbvie: Advisor/Consultant|Abbvie: Honoraria|Entasis: Advisor/Consultant|Entasis: Honoraria|GSK: Advisor/Consultant|GSK: Honoraria|Merck: Advisor/Consultant|Merck: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria|VenatoRx: Advisor/Consultant|VenatoRx: Honoraria
Background The first reported Candida auris (C. auris) cases in United States, were associated with global travel. It has emerged as a nosocomial pathogen among critically ill patients with prolong hospital stay, patients in long-term-acute hospitals, and skilled nursing facilities. Given the increase in cases (59% in 2019 to 95% in 2021) and C. auris being multidrug-resistant, Centers for Disease Control and Prevention has declared it to be a pathogen of urgent public health threat. The purpose of this study is to describe the epidemiology of C. auris among patients in a tertiary care center in greater Detroit area. Methods A retrospective cohort study was conducted among patients who tested positive for C. auris between January 2021 to January 2023. See Figure 1 flow chart of screening and culture method used to identify C. auris. Patients were defined as infected or colonized based on review of medical documentation. Data on demographics, length of stay, source of admission, treatment and susceptibility report were collected. Results One hundred and eight patients tested positive for C. Auris with 10 infections and 98 colonizations. 90% of infected patients were in intensive care unit, 80% required a ventilator, 50% had fungemia and 40% died within 30 days of C. auris infection (Table1). Among the 4 patient that died, median age was 67.5, one patient had persistent C. auris fungemia due to endocarditis, one patient had decompensated cirrhosis with concomitant bacteremia and urinary tract infection with C. auris, one patient had C. auris mediastinitis with severe cardiac comorbidities, and one patient had abdominal aortic aneurysm repair developed ventilator associated pneumonia with C. auris and Aspergillus Niger complicated by severe acute respiratory distress syndrome. 80% of patients were treated with micafungin and one patient was treated with micafungin and amphotericin B given C. auris endocarditis (Table 1). Voriconazole was used for treatment in one patient due to concomitant Aspergillus infection (Table 1). See Table 2 for minimum inhibitory concentration for 8 of 10 isolates. Conclusion C. auris is an emerging pathogen that can colonize the skin and has a potential of causing invasive infections leading to high morbidity and mortality. Disclosures All Authors: No reported disclosures
Background Carbapenem-resistant Enterobacterales (CRE) are a significant public health threat. Ceftazidime-avibactam (CZA) retains activity against most carbapenemase-producing CRE and demonstrates favorable health outcomes compared to historically best available therapy. While early initiation of effective therapy is critical in serious infections, the impact of time to CZA initiation on CRE infection-related outcomes has yet to be assessed. Aim: to evaluate clinical outcomes of patients with CRE infections receiving early vs. late CZA as the first active β-lactam. Methods Multicenter, retrospective cohort of hospitalized adult patients from 2019-2022 with culture-positive CRE and infectious symptoms receiving early vs. late CZA as the first active β-lactam. Early and late CZA were defined as CZA administration within or after 48 hours of index culture collection, respectively. Primary outcome was a composite of clinical success defined as i) the absence of all-cause mortality or microbiological recurrence requiring therapy within 30 days from the end of CZA therapy and ii) continued infectious symptoms during CZA therapy. Results In total, 174 patients were included (≤48 hours n=52, >48 hours n=122). Median (IQR) age was 61 (53, 73) years and 56.3% were male. ICU admission rates were similar between early vs. late CZA (73.1% vs. 72.1%; P=0.921). Most common infection sources were respiratory (59.8%) and skin and skin structure (9.2%). Klebsiella pneumoniae was the most common CRE isolated (66%). The overall median (IQR) of CZA MIC was 2 (1,4). and there was no difference in the receipt of package insert CZA doses in the first 48 hours of CZA therapy between the early vs. late groups, respectively (1.9% vs. 5.2%; P=0.311). In total, 40/52 (76.9%) early and 68/122 (55.7%) late CZA patients met the clinical endpoint of clinical success (P< 0.001). The early and late CZA groups demonstrated similar ICU length of stay (LOS) (26 [9, 46] vs. 22 [12, 40]; P=0.431, respectively). Table 1. Baseline and Clinical Characteristics Conclusion In hospitalized adult patients with CRE infections, CZA administration within 48 hours of culture collection was associated with a higher rate of clinical success compared to CZA administered after 48 hours. Further studies in a larger patient cohort are warranted to verify these results. Disclosures Wesley D. Kufel, Pharm.D., BCPS, BCIDP, AAHIVP, Merck: Grant/Research Support Bryan White, PharmD, BCPS, BCIDP, Gilead Sciences: Advisor/Consultant Michael J. Rybak, PharmD, PhD, MPH, Abbvie, Merck, Paratek, Shionogi, Entasis, La Jolla, T2 Biosystems: Advisor/Consultant
Background Dentists routinely review patient allergy histories and prescribe penicillin. Dental visits offer an opportunity to identify patient candidates for PCN allergy reassessment. Aim: to collect and evaluate clinician and patient feedback on a PCN Allergy Reassessment for Treatment Improvement (PARTI) tool created for patient-clinician communication about PCN allergy labels, and ultimately, to delabel patient EHR records, as appropriate. Methods A mixed methods pilot study was conducted January-March 2023. We administered a semi-quantitative questionnaire to interdisciplinary clinicians and performed semi-structured focus groups of patients with a PCN allergy label for tool feedback. The questionnaire and focus group guide were developed to focus on the three tool components: (1) steps for PCN allergy reassessment, (2) general patient-centered PCN allergy information, and (3) a follow-up checklist for updating EHR allergy records. Deductive thematic analysis was used for the focus group data. Results In total, 50 clinicians completed the questionnaire and 15 patients participated in focus groups. Both groups included individuals from 5/5 U.S. regions. Survey respondents included mostly pharmacists (30%) and dentists (20%). PARTI steps 1, 2, and 3 were rated as “very important” or “important” for 81%, 67% and 93% of clinicians, respectively. Inclusion of the patient information section was supported by 100% of clinicians and 94% thought the PARTI tool was at an appropriate literacy level. Stated barriers to using the PARTI tool included patient follow-through and provider comfort with evaluating PCN allergies. Regarding the PARTI tool itself, focus group participants indicated that the tool was a conversation starter, easy to understand, included helpful patient-centered allergy information, and that the follow-up checklist for EHR record updates was useful. Stated patient barriers to the PARTI tool included patient follow-through and clinician hesitancy to update allergy records. Conclusion Patients and clinicians were receptive to using the PARTI tool for PCN allergy reassessment. Data herein will be used to address clinician and patient feedback to further develop the PARTI tool in preparation for its use in a national, multidisciplinary pilot study. Disclosures All Authors: No reported disclosures
Background Odontogenic infections cause 2.2 million emergency department (ED) visits annually. Infectious diseases (ID) physicians are frequently consulted and recommend source control procedures by oral and maxillofacial surgery (OMFS). However, patients are often instructed to follow-up outpatient which may be difficult due to social determinants of health. Despite this common occurrence, almost no studies exist in the ID literature on follow-up rates or outcomes of these management strategies. We aim to identify and characterize patients with odontogenic infections, and determine whether definitive source control (SC) impacts outcomes. Methods An observational cohort study analyzing patients seen by OMFS for odontogenic infection over 14 months (1/2022-2/2023) at a safety net hospital system in Detroit, MI. Odontogenic infection was defined as that of the jaw, neck, or face originating from a tooth or its supporting structures. Non-infectious consults were excluded (Fig 1). Characteristics and outcomes were compared between patients with and without SC. Primary outcome was incidence of 30-day readmission. Mortality and microbiologic data were also collected. Results 78 patients were evaluated by OMFS; 44 (56%) were admitted and 34 (44%) were discharged from the ED. SC occurred in 60 patients, 50 of which had SC on the index admission or ED visit (29 of 44 admitted and 21 of 34 ED patients, respectively) (Fig 1). SC was deferred in 28 patients, 10 of whom did later receive it. Follow up rates for ED patients who SC deferred were high (8 of 13 patients). Only 2 of 15 deferred inpatients were seen (Fig 1). No documented SC occurred in 18 patients. Groups did not differ significantly in clinical characteristics, antibiotics, or rates of ID consultation (Table 1). There was a trend for SC patients to be male (p=0.057) and require intensive care unit support (p=0.081) (Table 1). Readmission rates were higher in those without source control (28% versus 3%, p=0.001). Common pathogens isolated included oral Streptococci and gram-positive rods (Fig 2). Conclusion Odontogenic infection patients without source control had high rates of readmission despite being less critically ill. The ID community should take a more active role in studying the optimal management strategy for this common occurrence. Disclosures All Authors: No reported disclosures
Background In December 2021, the FDA issued an emergency use authorization (EUA) for nirmatrelvir-ritonavir (Paxlovid). This was based on the randomized placebo-controlled trial data from the EPIC-HR study which showed that high-risk non-hospitalized patients given Paxlovid had an 88.9% reduction in the relative risk of progression to hospitalization or death by Day 28 in coronavirus disease 2019 (COVID-19). We aimed to study the risk factors for seeking medical care following Paxlovid treatment. Methods In this historical cohort study, we assessed risk factors for high-risk non-hospitalized patients treated with Paxlovid from January 1, 2022, to December 31, 2022, at outpatient facilities associated with Ascension St. John Hospital. Our outcome variable was the composite of subsequent evaluation in the Emergency Department (ED) or inpatient admission within four weeks of their Paxlovid treatment. Data were analyzed using SPSS v. 29.0. The study was approved by the IRB. Results Of 371 patients who received Paxlovid treatment, the mean (SD) age was 59.4 (±13.8) years; 63.9 % (237) were female, and 77.7% (282) white. The mean body mass index (BMI) of the cohort was 31.3 ± 7.8 kg/m2. The incidence of the composite event was 6.7% (25/371). The risk of the composite event was higher in patients with a history of myocardial infarction (MI) (28 % vs 9.3%), congestive heart failure (CHF) (12 % vs 2.3%), chronic lung diseases (CLD) (48 % vs 26.4%) and diabetes mellitus (DM) with complication (24% vs 4.1%), respectively. Alcohol users were less likely to seek medical care following Paxlovid (40 % vs 63.7%, respectively). There were no differences in BMI, tobacco use or vaccination rates between the groups. In multivariable logistic regression, factors associated with seeking medical care post-Paxlovid were female sex (OR 4.6; 95% CI 1.4-15.3; p= 0.013), alcohol use (OR 0.4; 95% CI 0.2-0.9; p= 0.039), MI (OR 4.0; 95% CI 1.4-11.8; p=0.011), DM with complications (OR 6.9; 95% CI 2.0-23.3; p= 0.002), CLD (OR=3.9, 95% CI 1.1-13.5; p=0.03), at the time of Paxlovid treatments. Conclusion Independent risk factors for seeking medical care following Paxlovid treatment for COVID-19 were MI, CHF, CLD, and DM with complications while alcohol users were less likely to seek medical care following the Paxlovid treatment. Disclosures All Authors: No reported disclosures
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