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  • 11
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    558. Implementation and Outcomes of a COVID-19 Monoclonal Antibody Treatment Program in an Urban Safety-net Community Hospital
    Oxford University Press (OUP) ; 2021
    In:  Open Forum Infectious Diseases Vol. 8, No. Supplement_1 ( 2021-12-04), p. S381-S381
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 8, No. Supplement_1 ( 2021-12-04), p. S381-S381
    Abstract: Neutralizing monoclonal antibodies (mAbs) bind to the receptor binding domain of the spike protein of SARS-CoV-2. In November 2020, several mAbs were issued an EUA by the FDA as single-dose intravenous (IV) infusions for treatment of mild to moderate COVID-19. mABs were allocated to local health facilities capable of administering infusions and managing side effects. Creating an outpatient infusion program during the COVID-19 winter surge can be logistically difficult. Our goal was to implement a mAb outpatient infusion program at an urban safety-net community hospital designed to serve communities most heavily impacted by COVID-19. Methods The emergency department (ED) fast-track was repurposed for the mAb program with protocols from the infectious diseases physician and antimicrobial stewardship. Education materials with indications for mAbs were distributed in surrounding clinics serving our community. The program was available to all patients meeting criteria outlined in the protocol, 24/7, including but not limited to current ED patients and referrals from facilities in the vicinity. Results Between December 1, 2020 and March 1, 2021, a total of 37 patients were treated: 51% male, 57% Hispanic or Latinx, 27% Black, and 95% (35) represented ZIP codes with high COVID-19 burden (Figure 1). Bamlanivimab was used for each instance and all infusions met criteria. Patient indications for mAb infusion are listed in Figure 2. Parenteral antibiotics were given to 10.8% and 35% received oral antibiotics upon discharge. At 30 days post-infusion, 8% (3) required hospitalization and there were no deaths. Zip codes with high COVID-19 disease burden served by our mAB infusion program Distribution of patients who received mAB infusions by indication Conclusion A mAb outpatient infusion program was successfully deployed in a safety-net community hospital. We believe strengths of the program included the flexible infusion hours and convenient referral site for patients and providers. Of importance, this program was able to provide services to minorities from ZIP codes most heavily impacted by COVID-19. Unfortunately, antibacterial use was common and may reflect broader unnecessary use in COVID-19 patients. Whilst mAb treatment was deemed appropriate in all instances via protocol inclusion criteria, antibacterial stewardship programs may need to expand to ED settings for COVID-19 management. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofab466.756
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 12
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    931. All Hands on Deck: Incorporation of Infectious Diseases Pharmacy Trainees in a Community Hospital Antimicrobial Stewardship Program
    Oxford University Press (OUP) ; 2022
    In:  Open Forum Infectious Diseases Vol. 9, No. Supplement_2 ( 2022-12-15)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 9, No. Supplement_2 ( 2022-12-15)
    Abstract: Community hospitals may have challenges implementing core elements of antimicrobial stewardship (ASP) due to lack of ID trained pharmacists (PharmD). The COVID-19 pandemic compounded these challenges with constrained resources and staffing. The pandemic also saw a rise in antimicrobial use (AU) and brought forth novel therapeutics, thus increasing the need for robust ASP. We established a community ASP rotation for ID PharmD fellows during the COVID-19 pandemic. Methods A community ASP rotation was established at a 151-bed community hospital. ID PharmD trainees rotated with the ID clinician and were responsible for daily prospective audit and feedback (PAF) under close supervision of the ID clinician. Fellows were involved in pandemic response, including protocol development and restrictions for COVID-19 therapeutics. Results A community ASP rotation was successfully implemented (Figure 1). For PAF activities, the most common indications were CAP (19%), HAP (3%), IAI (24%), SSTI (22%) and UTI (19%). Average DOT/1000 was 340.4 per quarter with increases each COVID-19 surge (Figure 2). Empiric AU was protocol adherent 77% of the time and 23% required ASP changes. ASP Interventions included change to protocol (23%), bug drug mismatch (2%), de-escalation (15%), duration change (25%), IV to PO (16%), discontinuation (19%). Fellows successfully developed protocols and managed restrictions for remdesivir, baricitinib, and anti-SARS-CoV-2 monoclonal antibodies in coordination with the ID clinician and assisted in mass vaccination campaign protocols. Conclusion A community ASP rotation was successfully established and sustained during COVID-19. Fellows received hands on experience and performed PAF under close supervision. The program enhanced ID clinician capabilities while leveraging PharmD expertise at a time when staffing and resources were stretched thin. The rotation provided firsthand experience in pandemic preparedness and response. This educational opportunity assisted in maintaining a strong ASP in a community hospital setting while preparing trainees with experiences to assist them throughout their future careers. Disclosures All Authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofac492.776
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 13
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    281. Not the sharpest of tools: Procalcitonin and bacterial co-infections in patients admitted with COVID-19
    Oxford University Press (OUP) ; 2022
    In:  Open Forum Infectious Diseases Vol. 9, No. Supplement_2 ( 2022-12-15)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 9, No. Supplement_2 ( 2022-12-15)
    Abstract: The COVID-19 pandemic has caused record breaking hospitalizations due to respiratory failure. A major challenge in the management of COVID-19 is the difficulty distinguishing COVID-19 from other causes of lower respiratory tract infections (LRTIs) that may require antimicrobial use (AU). Procalcitonin (PCT) has been used to differentiate viral from bacterial causes of LRTIs and clinicians have relied on PCT to use or withhold antimicrobials. However, the utility of PCT in the setting of COVID-19 remains unclear. We seek to define the role of PCT in patients admitted with COVID-19. Methods Retrospective cohort study of COVID-19 inpatients with PCT ordered at a 151-bed urban community hospital from March 2020-March 2022. Ranges of PCT were categorized as high ( & gt;5 µg/L), medium (0.25-5 µg/L), and low ( & lt; 0.25 µg/L) risk of infection. Co-infection was defined as presence of clinical and microbiological evidence of infection in blood (BSI) or in sputum within 7 days of admission. Late infections were excluded Results Of a total 262 cases, 154 (58%) were low-risk, 43 (16%) medium-risk, and 63 (24%) high-risk (Figure 1). AU in the low-risk category was 29% (45), followed by 29% in the moderate and 36% in high-risk categories. 1 BSI caused by Klebsiella pneumoniae in the low-risk category and 1 LRTI caused by Streptococcus pneumoniae in the high-risk category were found, representing 0.6% and 1.5% of samples in those categories. Total documented infection was 0.7% for all cases. Figure 1.Procalcitonin levels and co-infections in patients admitted with COVID-19 pneumonia. Conclusion PCT has limited utility in COVID-19. Co-infection rates on admission are exceedingly rare, representing & lt; 1% of our cohort. Only 2 documented infections were found, 1 of which was in the low-risk category. Thus, PCT was commonly elevated without documented infection. Though rare, a co-infection can occur without elevation of PCT. As described in the 2019 IDSA Community Acquired Pneumonia Guidelines, the use of PCT is of limited utility and may confound providers towards using or deferring antimicrobials inappropriately. This remains true in COVID-19. Antimicrobial stewardship programs should advise against its routine use. Disclosures All Authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofac492.359
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 14
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    1109. Rise and Fall of COVID-19 Therapies Throughout Different Waves of the Pandemic: Results of a Nationwide Survey
    Oxford University Press (OUP) ; 2022
    In:  Open Forum Infectious Diseases Vol. 9, No. Supplement_2 ( 2022-12-15)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 9, No. Supplement_2 ( 2022-12-15)
    Abstract: The COVID-19 pandemic has caused a major public health crisis and is now a leading cause of death. At the start of the COVID-19 pandemic, treatment was limited to supportive care and off-label use of a variety of agents as we awaited the results of randomized controlled trials (RCTs). Our understanding of the disease has evolved and multiple evidence-based (EBM) treatment strategies supported by RCTs are now approved for use. Interpreting emerging data while responding to the pandemic can been challenging. We seek to understand the use of common medications during the COVID-19 pandemic. Methods A survey was developed and disseminated through Infectious Diseases Society of America (IDSA) IDea network, IDSA Antimicrobial Stewardship Centers for Excellence and the Society for Healthcare Epidemiology messaging boards. Data collected included city, therapeutic options including convalescent plasma (CP), hydroxychloroquine (HCQ), baricitinib and tocilizumab during each COVID-19 wave. Results A total of 78 responses were collected, representing wide geographic reach in the US (Figure 1). Use of HCQ declined by 96% and use of CP declined by 85% (Figure 2). The decline in CP was gradual each wave despite RCTs showing lack of benefit. Tocilizumab was used in 71% and 76% of hospitals during the first wave, prior to RCT data supporting its use. Baricitinib was used in 42% of hospitals prior to RCT data supporting its use. There was a 90% increase in baricitinib use after RCT data emerged. Figure 1Geographic distribution of hospitals represented in the survey Figure 2 Use of Hydroxychloroquine, Convalescent Plasma, Tocilizumab and Baricitinib Throughout Different COVID-19 Waves Conclusion The use of therapies before proven benefit was common through the pandemic. Similarly, the use of therapies after benefit was in question continued. Hydroxychloroquine was widely used in the first wave and then halted by the majority of hospitals in subsequent COVID-19 surges. IL-6 and JAK-2 inhibitors were commonly used prior to evidence of benefit and were more widely adopted once evidence emerged. Convalescent plasma use was common despite lack of evidence and its use continued despite multiple negative RCTs. Overall, our survey shows a gap between evidence and practice. Communicating evidence-based treatment strategies is a vital priority for major professional societies. Translating evidence into practice remains challenging during public health emergencies like the COVID-19 pandemic. Disclosures All Authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofac492.948
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 15
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    1887. Hyperglycemia and COVID-19: An independent risk factor for disease severity and death in the Dominican Republic
    Oxford University Press (OUP) ; 2022
    In:  Open Forum Infectious Diseases Vol. 9, No. Supplement_2 ( 2022-12-15)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 9, No. Supplement_2 ( 2022-12-15)
    Abstract: The COVID-19 pandemic has caused an unprecedented global public health emergency. Vaccine uptake in low and middle income countries (LMICs) lags developing nations and immunity from vector-based vaccines commonly used in LMICs may be inferior to mRNA vaccines. Thus, defining clinical characteristics that can help identify and triage cases and allocate resources in LMICs of priority. Hyperglycemia has been associated with higher morbidity and mortality in numerous diseases and in critical illness. We seek to understand the relationship between COVID-19 and hyperglycemia. Methods This is a single center retrospective review of cases with COVID-19 between January 2021 and June 2021. Adult patients & gt;18 years of age were reviewed and those with a molecular-based laboratory confirmed SARS-CoV-2 infection were included in our study. Patients with known diabetes, elevated A1C or prior steroid use within 2 weeks of admission were excluded. Clinical characteristics, demographics, glucose levels, C-reactive protein (CRP) and ferritin were reviewed. Results A total of 120 patients were reviewed, of which 60.8% were male. Hyperglycemia ( & gt;140mg/dL) was present in 57.5%. Hyperglycemia was associated with elevation of inflammatory markers including CRP and Ferritin (p=0.12) (Table 1). Hyperglycemia was more common in patients requiring supplemental low flow oxygen (table 2) and was more common in patients who did not survive (Figure 1). The mortality rate was higher in the hyperglycemia group with 61.5%, a statistically significant finding. Association between hyperglycemia and inflammatory markers. Supplemental oxygen needs and hyperglycemia. Survival and hyperglycemia. Conclusion Hyperglycemia on admission was an independent risk factor for disease progression and death. Inflammatory markers were also higher in patients with hyperglycemia. These patients had no prior steroid use or diabetes. Thus, it is possible that it reflects inflammation, stress, or endocrine end-organ damage due to SARS-CoV-2. If validated in larger studies, this simple test can help clinicians identify patients at risk of decompensation and allocate resources and therapeutics accordingly. Disclosures All Authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofac492.1514
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 16
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    The great impostor: Lues maligna in an HIV-infected male
    SAGE Publications ; 2017
    In:  SAGE Open Medical Case Reports Vol. 5 ( 2017-01-01), p. 2050313X1773105-
    Details
    In: SAGE Open Medical Case Reports, SAGE Publications, Vol. 5 ( 2017-01-01), p. 2050313X1773105-
    Abstract: Lues maligna is a rare severe cutaneous manifestation of secondary syphilis. It is also known as malignant syphilis and ulceronodular syphilis. We report a case of a 58-year-old HIV-infected male who presented with diffuse, pruritic, non-tender, maculo-papular skin lesions, ulcerated nodules and plaques surrounded by an erythematous base. The disseminated skin lesions were at various stages and were located on his back, chest, arms and testicles. Patient had been receiving antiretroviral therapy. Laboratory studies had demonstrated CD4 lymphocyte count of 463 cells/mm 3 and an undetectable HIV viral load. Workup revealed a rapid plasma reagin of 1:256 dilutions and the skin biopsy findings were compatible with syphilis. The skin lesions resolved with intramuscular penicillin. We herein describe a rare case of lues maligna in an HIV-infected patient with a preserved immune function and viral suppression. Such skin lesions can mimic fungal or mycobacterial infections and can pose a diagnostic challenge. Even in the modern era, syphilis remains the great impostor. Clinicians must be able to recognize this condition based on clinical characteristics and risk factors to diagnose and treat this condition promptly.
    Type of Medium: Online Resource
    ISSN: 2050-313X , 2050-313X
    URL: Article
    DOI: 10.1177/2050313X17731050
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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  • 17
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    Impact of a culturally sensitive multilingual community outreach model on coronavirus disease 2019 (COVID-19) vaccinations at an urban safety-net community hospital
    Cambridge University Press (CUP) ; 2023
    In:  Infection Control & Hospital Epidemiology Vol. 44, No. 9 ( 2023-09), p. 1526-1528
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 44, No. 9 ( 2023-09), p. 1526-1528
    Abstract: We assessed the efficacy of a culturally competent outreach model with promotoras in raising the coronavirus disease 2019 (COVID-19) first-dose vaccination rates in Chicago’s at-risk ZIP codes from February through May 2021. Utilizing community members from within target communities may reduce barriers, increase vaccination rates, and enhance COVID-19 prevention.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1017/ice.2023.1
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2023
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  • 18
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    Development and Evaluation of a Structured Tool to Assess the Preventability of Hospital-Onset Bacteremia and Fungemia
    Cambridge University Press (CUP) ; 2020
    In:  Infection Control & Hospital Epidemiology Vol. 41, No. S1 ( 2020-10), p. s31-s32
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 41, No. S1 ( 2020-10), p. s31-s32
    Abstract: Background: Hospital-onset bacteremia and fungemia (HOB) may be a preventable hospital-acquired condition and a potential healthcare quality measure. We developed and evaluated a tool to assess the preventability of HOB and compared it to a more traditional consensus panel approach. Methods: A 10-member healthcare epidemiology expert panel independently rated the preventability of 82 hypothetical HOB case scenarios using a 6-point Likert scale (range, 1= “Definitively or Almost Certainly Preventable” to 6= “Definitely or Almost Certainly Not Preventable”). Ratings on the 6-point scale were collapsed into 3 categories: Preventable (1–2), Uncertain (3–4), or Not preventable (5–6). Consensus was defined as concurrence on the same category among ≥70% expert raters. Cases without consensus were deliberated via teleconference, web-based discussion, and a second round of rating. The proportion meeting consensus, overall and by predefined HOB source attribution, was calculated. A structured HOB preventability rating tool was developed to explicitly account for patient intrinsic and extrinsic healthcare-related risks (Fig. 1). Two additional physician reviewers independently applied this tool to adjudicate the same 82 case scenarios. The tool was iteratively revised based on reviewer feedback followed by repeat independent tool-based adjudication. Interrater reliability was evaluated using the Kappa statistic. Proportion of cases where tool-based preventability category matched expert consensus was calculated. Results: After expert panel round 1, consensus criteria were met for 29 cases (35%), which increased to 52 (63%) after round 2. Expert consensus was achieved more frequently for respiratory or surgical site infections than urinary tract and central-line–associated bloodstream infections (Fig. 2a). Most likely to be rated preventable were vascular catheter infections (64%) and contaminants (100%). For tool-based adjudication, following 2 rounds of rating with interim tool revisions, agreement between the 2 reviewers was 84% for cases overall (κ, 0.76; 95% CI, 0.64–0.88]), and 87% for the 52 cases with expert consensus (κ, 0.79; 95% CI, 0.65–0.94). Among c ases with expert consensus, tool-based rating matched expert consensus in 40 of 52 (77%) and 39 of 52 (75%) cases for reviewer 1 and reviewer 2, respectively. The proportion of cases rated “uncertain“ was lower among tool-based adjudicated cases with reviewer agreement (15 of 69) than among cases with expert consensus (23 of 52) (Fig. 2b). Conclusions: Healthcare epidemiology experts hold varying perspectives on HOB preventability. Structured tool-based preventability rating had high interreviewer reliability, matched expert consensus in most cases, and rated fewer cases with uncertain preventability compared to expert consensus. This tool is a step toward standardized assessment of preventability in future HOB evaluations. Funding: None Disclosures: None
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1017/ice.2020.509
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2020
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  • 19
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    Impact of a Daily Hospital-wide Huddle on Urinary Catheter Device Utilization nd Catheter Associated Urinary Tract Infection Rates
    Elsevier BV ; 2020
    In:  American Journal of Infection Control Vol. 48, No. 8 ( 2020-08), p. S44-
    Details
    In: American Journal of Infection Control, Elsevier BV, Vol. 48, No. 8 ( 2020-08), p. S44-
    Type of Medium: Online Resource
    ISSN: 0196-6553
    URL: Article
    DOI: 10.1016/j.ajic.2020.06.048
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2011724-3
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  • 20
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    Recovery of Cryptococcus gattii from an Infected Ventriculo-Peritoneal Shunt, Illinois, USA
    Centers for Disease Control and Prevention (CDC) ; 2018
    In:  Emerging Infectious Diseases Vol. 24, No. 7 ( 2018-07), p. 1382-1383
    Details
    In: Emerging Infectious Diseases, Centers for Disease Control and Prevention (CDC), Vol. 24, No. 7 ( 2018-07), p. 1382-1383
    Type of Medium: Online Resource
    ISSN: 1080-6040 , 1080-6059
    URL: Article
    DOI: 10.3201/eid2407.171754
    Language: English
    Publisher: Centers for Disease Control and Prevention (CDC)
    Publication Date: 2018
    detail.hit.zdb_id: 2004375-2
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