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  • 1
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    669. Rapid Molecular Testing of Sputum for Identification of Pulmonary Tuberculosis: Impact on Duration of Respiratory Isolation
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. Supplement_1 ( 2020-12-31), p. S389-S390
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S389-S390
    Abstract: Current guidelines recommend molecular testing directly on sputum of patients with suspected pulmonary tuberculosis (TB) to facilitate discontinuation of airborne infection isolation (AII). Henry Ford Hospital (HFH), a tertiary care center in Detroit, MI serves a population at high-risk for TB. Molecular testing of sputum using GeneXpert/MTB RIF (Xpert; Cepheid) (GXTB) was implemented at HFH on March 2019. Providers were permitted to remove patients from AII using 3 negative acid-fast bacillus smears (AFB) or 2 negative GXTB results. We evaluated the impact of GXTB on duration of AII over a 2-year period: Pre-implementation (January 2018 to February 2019) and post-implementation (March 2019 to February 2020). Methods Retrospective data was abstracted for all patients placed in AII during the study period. Demographic data, TB risk factors, duration of AII, length of hospital stay (LOS), accuracy and turn-around-times (TAT) of AFB and GXTB were compared in the pre- and post-implementation periods. Categorical variables were studied using chi-square testing, and continuous variables were studied using T-test or Mann Whitney U test as appropriate. Results During the study period, 269 patients with suspected TB were placed in AII: 137 pre-implementation and 132 post-implementation. Clinical characteristics and TB risk factors were generally comparable in both groups (Table 1). Abnormal chest X-ray was more frequent in patients in the post-implementation phase. All cases of culture positive TB were detected by AFB and GXTB. TAT of AFB results before and after implementation were similar and ranged from 20-24 hours (Table 2). In the post-implementation period, TAT of GXTB compared to AFB was 6.35 vs 21.28 hours (p & lt; 0.0001). Duration of AII was shortened by almost 24 hours (70.2 vs 93.7 hours, p=0.031) (Table 3). Time from first sample collection to final results of all samples was 19.2 vs 52.6 hours, p & lt; 0.0001. There was no difference in total LOS pre and post-implementation. Table 1. Clinical Characteristics of Patients with Suspected Pulmonary Tuberculosis Table 2. Turnaround times (TAT) of AFB and GeneXpert/MTB (Xpert) RIF before and after implementation Table 3. Duration of Airborne Isolation, Total Turn-Around Times, and Hospital Length of Stay in the Pre- and Post-implementation Period Conclusion Implementation of rapid direct molecular testing reduced the duration of respiratory isolation for patients with suspected pulmonary TB. Further provider education regarding the reliability of GXTB in excluding TB may be necessary to reduce overall hospital LOS. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa439.862
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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  • 2
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    386. Long-term Complications Associated with COVID-19 Infection
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. Supplement_1 ( 2020-12-31), p. S261-S262
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S261-S262
    Abstract: In Michigan, 44,964 (68%) of the 66,269 COVID-19 patients have recovered. However, there is concern that COVID-19 infection may lead to long-term sequelae, including pulmonary defects, cardiac complications, blood clots, and neurocognitive impairment. This study describes the 30-day outcomes of patients who had recovered. Methods From 3/16/2020 to 5/19/2020, a follow-up was attempted for patients who were discharged alive from Henry Ford Hospital in Detroit and had recovered. Recovery was defined as being alive 30 days post symptom-onset. A telephone survey was conducted 30 days post-index admission and recorded in electronic medical records. Oxygen (O2) requirements, symptoms, readmissions and the need for antibiotics for secondary bacterial infections were evaluated. Results 585 patients met inclusion criteria and were contacted by phone; 303 answered their phone (Table 1), but only 266 (45%) completed a full telephone encounter and were included in the final analysis (Table 2). The majority were female (53%), black (80%), and discharged to home (84%). The clinical characteristics of those who completed the survey were as follows: 11% presented with O2 saturation & lt; 90%, 16% had underlying lung pathology, and 57% had a BMI above 30. Patients’ average age was 61 ± 14.3 years. At 30 days post-index admission, 49% were still symptomatic. Of the symptomatic patients, 86% had dyspnea on exertion and 15% required O2 supplementation. 18% of patients were readmitted within 30 days, and 9% developed a secondary infection prior to the phone encounter. No statistically significant differences in demographics or comorbidities were found between symptomatic and asymptomatic cohorts (Tables 1, 2). Conclusion In our study, almost half of the discharged patients remained symptomatic after 30 days with a substantial proportion experiencing pulmonary symptoms. A better understanding of the long-term pulmonary sequelae following COVID-19 infection is needed to design interventions to reduce post-infectious morbidity. Disclosures Indira Brar, MD, Gilead (Speaker’s Bureau)janssen (Speaker’s Bureau)ViiV (Speaker’s Bureau)
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa439.581
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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  • 3
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    1755. Assessment of Vaccine Rates in Solid-Organ Transplant Recipients and Identification of factors Associated with Completion of Vaccination
    Oxford University Press (OUP) ; 2019
    In:  Open Forum Infectious Diseases Vol. 6, No. Supplement_2 ( 2019-10-23), p. S644-S645
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 6, No. Supplement_2 ( 2019-10-23), p. S644-S645
    Abstract: Vaccine administration is an essential component of pre and post-transplant care. Although Society guidelines for vaccination of solid-organ transplant recipients (SOT) are published, rates of vaccination remain low and potential factors influencing these rates are not well identified. Methods A retrospective review of electronic medical records (EMR) was done for all adult SOT patients who underwent transplantation from January 2015 to December 2016 at Henry Ford Hospital, Detroit, MI. Sociodemographic data, comorbidities, and vaccination status at 1-year post-SOT for influenza, pneumococcus, hepatitis A and B, Tdap, and Td vaccines were assessed from EMR and the Michigan Care Improvement Registry. Data were analyzed using SAS 9.4 software, univariate analysis was done with Chi-square test, t-test, and multivariate analysis with logistic regression. Results 530 patients underwent SOT during the study period. Characteristics of the study population are shown (Table 1). The median age was 59, mean Charlson Comorbidity Index was 5.25, 58.3% had smoking history. At 1-year post SOT, 88.7% had received ≥1 vaccine(s), whereas 11.3% received no vaccines. Most patients received vaccines before SOT. Influenza (69.4%) and pneumococcal (69.3%) vaccines were the most administered (Table 2). On univariate analysis, pre-SOT visits with a primary care provider (PCP), transplant team or PCP based at our institution were significantly associated with vaccination (Table 3). On multivariate analysis, PCP based at our institution (odds ratio [OR] , 2.03 [95% confidence interval {CI}, [1.06–3.88], P = 0.033) and pre-SOT PCP visits (OR 1.47, [95% CI 1.11–1.96] , P = 0.008) were significantly associated with vaccine uptake. Smoking history negatively impacted vaccine uptake (Table 4). Patients who had received the influenza vaccine(s) were significantly associated with increased uptake of other vaccines (P 〈 0.0001). Conclusion Despite guidelines, vaccination rates in SOT patients remain low at our institution. Factors associated with improved vaccination were institution-based PCP, pre-SOT PCP visits and receipt of influenza vaccines. A multidisciplinary approach is required for the optimization of vaccination rates in the SOT population. Disclosures All authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofz360.1618
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
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  • 4
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    592. Antimicrobial Utilization in Solid Organ Transplant Recipients 12-Months Post-Transplantation
    Oxford University Press (OUP) ; 2021
    In:  Open Forum Infectious Diseases Vol. 8, No. Supplement_1 ( 2021-12-04), p. S399-S400
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 8, No. Supplement_1 ( 2021-12-04), p. S399-S400
    Abstract: Antimicrobials are widely used in solid organ transplant recipients (SOTr). Yet, antimicrobial utilization in the transplant (TP) population is not well characterized. National Healthcare Safety Network antimicrobial use (NHSN-AU) does not provide data specific to SOTr. This study sought to describe inpatient antibiotic use among SOTr up to 1-year post-TP. Methods A cross-sectional study was performed of all SOTr who received a TP between January 2015 to December 2016. Demographics, TP type, antibiotic use variables, hospital days, and Clostridioides difficile infection (CDI) are described. Inpatient antibiotic administration was measured for 365 days starting from date of TP surgery. Automated data generated for NHSN-AU reporting was utilized, and SOTr data was abstracted by cross-matching with the transplant database. Transplant-patient days was used as the denominator for metrics. Variables included duration of therapy (DOT), DOT/1000 patient days, antimicrobial free days (inpatient days no antimicrobials were administered), and NHSN-AU reporting targets of anti-methicillin resistant S. aureus (MRSA), broad spectrum, and high-risk CDI agents. Data was analyzed using descriptive statistics via Microsoft Excel®. Results A total of 530 SOTr were analyzed. Baseline characteristics are shown in Table 1. Median age was 61, male gender 64%, median Charlson Comorbidity Index was 5. Kidney TP (43%), liver TP (32%), lung (9%) and heart (8%) were most common TP types. Among these four TP types: Lung TP had the highest median DOT (13 days), DOT/1000 patient days (6.6) and ratio of DOT/total patient (1.9) (Table 2). Liver TP had the most antimicrobial free days (34%). Proportionally, anti-MRSA agents use was highest in thoracic TP (lung/heart), broad-spectrum agent use was common in all but kidney TPs, and high-risk CDI agents use was highest among kidney TP (Table 3). A total of 34 SOTr had CDI, 76% in kidney/liver TPs. Table 1. Antimicrobial usage and SOT - ID Week 2021 Table 2. Antimicrobial usage and SOT - ID Week 2021 Table 3. Antimicrobial usage and SOT - ID Week 2021 Conclusion Our study provides preliminary and important data of inpatient antibiotic utilization specifically in SOTr, generated using automated NHSN-AU data cross-matched to transplant database. These metrics can be utilized to promote antimicrobial stewardship efforts directed to specific TP types. Disclosures Rachel Kenney, PharmD, Medtronic, Inc. (Other Financial or Material Support, spouse is an employee and shareholder)
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofab466.790
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 5
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    2511. Characterization of Patient Pill Preferences from a Prospective Placebo vs. Placebo Ease of Swallowability Study
    Oxford University Press (OUP) ; 2019
    In:  Open Forum Infectious Diseases Vol. 6, No. Supplement_2 ( 2019-10-23), p. S871-S872
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 6, No. Supplement_2 ( 2019-10-23), p. S871-S872
    Abstract: HIV therapy has been moving toward smaller size, once a day regimens in hopes of improved adherence. Surprisingly, few publications characterize HIV patient’s pill preferences. To evaluate HIV-negative or treatment-naïve pill preference, we conducted a prospective randomized study at the Infectious Diseases Clinic at Henry Ford Hospital in Detroit, MI. Methods Fifty patients were recruited, receiving questionnaires regarding factors influencing the ease of swallowability, medication habits, pill preferences and adherence while being randomized to receive placebo pills representing currently FDA approved combination antiretrovirals DTG/ABC/3TC and BIC/FTC/TAF. Statistical analyses presented are descriptive. Results Patients preferred pills or tablets (84%) as their preferred form of medication. Patient’s ideal pill length size was reported between 4–9 millimeters (96%), with no responses 〉 13 mm. The most important factors for ease of swallowability were stated as size (40%) and smoothness (38%). Interestingly, 80% of participants then reported that size and shape of the pills was only “some or less” important to them for their pills; however, 32% of participants stated that size, and shape (16%), could make them not want to take a pill daily. When offered the choice of regimens, patients preferred taking more, smaller pills (42%) vs. fewer larger pills (36%) or liquids (14%). Three most common factors indicated as making medication adherence difficult included taking multiple doses daily (38%), large pills (16%), and multiple pills per dose (14%). When given free response, pills having a smooth coating was reinforced by 10 of the 25 (40%) participants who commented. Conclusion Patient preferences for medications are varied and nuanced, but carry implications on patients self-reported likelihood to remain adherent to a regimen. Care should be taken in a clinical setting, such as HIV, to take pill characteristics into account when selecting antiretroviral regimens for patients. Disclosures All authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofz360.2189
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
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  • 6
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    593. Utility of Microbiologic Testing Obtained via Bronchoalveolar Lavage on Asymptomatic Lung Transplant Recipients: A Quality Improvement Study
    Oxford University Press (OUP) ; 2021
    In:  Open Forum Infectious Diseases Vol. 8, No. Supplement_1 ( 2021-12-04), p. S400-S400
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 8, No. Supplement_1 ( 2021-12-04), p. S400-S400
    Abstract: The utility of surveillance bronchoscopy (SB) in asymptomatic lung transplant recipients (LTR) is controversial. Guidelines regarding the timing of SB and diagnostic testing varies across centers. Studies evaluating the role of microbiologic testing are lacking. Our transplant institute currently performs SB at week 1, and months 1, 3, 6, 9, 12, and 24 post-transplant. We evaluated if routine microbiologic testing obtained during SB impacted clinical management. Methods This observational cohort study was performed at Henry Ford Hospital, Detroit, MI and included all LTR done from August 2014 to August 2019. Clinical and laboratory data was abstracted from the electronic medical record Pre/post-SB. Bronchoscopies performed for new or worsening respiratory symptoms, decline in forced expiratory volume at one second ≥10%, new radiographic abnormalities and follow up bronchoscopies to assess stents or recent acute rejection were excluded. Microbiologic tests assessed are shown in Table 2. Management change was defined as reduction in immunosuppression or prescription of antimicrobials. Rate of change in clinical management based on microbiologic test positivity was the primary outcome. Data were analyzed with descriptive statistics. Results 449 SB in 107 LTR were evaluated. Median age was 63 years, 68% were male. The average number of SB performed per patient was 4.2 (Table 1). The most common microbiologic tests performed were bacterial (435), mycobacterial (427), and fungal including Pneumocystis jirovecii (1022) (Table 2). The rate of test positivity and resultant change in management are shown in Table 3. The rate of test positivity was highest for bacterial (54%), fungal (27%) and viral tests (6%) with management changes in 12%, 2%, and 3% respectively. Table 1. Patient Demographics Table 2. Rate of Microbiologic Testing per Surveillance Bronchoscopy Table 3. Rate of Microbiologic Positivity and Management Change per Surveillance Bronchoscopy Conclusion This is the largest study to specifically evaluate the role of routine microbiologic tests during SB in LTR. Bacterial cultures may be appropriate due to higher rates of management changes. However, routine fungal, AFB, and viral studies are unnecessary due to low true positivity, and consequent low rate of management changes. This represents an important opportunity for diagnostic and antimicrobial stewardship. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofab466.791
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 7
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    Bridging the gap: An approach to reporting antimicrobial stewardship metrics specific to solid organ transplant recipients
    Wiley ; 2022
    In:  Transplant Infectious Disease Vol. 24, No. 5 ( 2022-10)
    Details
    In: Transplant Infectious Disease, Wiley, Vol. 24, No. 5 ( 2022-10)
    Abstract: This study seeks to describe inpatient antimicrobial use (AU) utilizing the National Healthcare Safety Network‐AU (NHSN‐AU) framework among solid organ transplant recipients (SOTr) within 12 months after transplant. Methods This cross‐sectional study included SOTr ≥ 18 years of age who underwent transplantation from January 2015 to December 2016 at a Midwestern US transplant center. Inpatient AU was followed for 12 months post‐transplant. Hospital days present up to 12 months post‐transplant, AU variables, and Clostridioides difficile infection (CDI) occurrences were analyzed. Results The cohort of 530 SOTr included 225 kidney (42.5%), 171 liver (32.3%), 45 lung (8.5%), 40 heart (7.5%), 39 multivisceral (7.4%), seven small bowel (1.3%), and three pancreas (0.6%) transplants. Total days of therapy (DOT) were 22 782 among the cohort, with a median of 5 days [interquartile range [IQR], 1–12] . Lung and liver transplants had the most total DOT (6571 vs. 5569 days), while lungs and small bowels had the highest median DOT (13 [IQR, 2–56] vs. 12 [IQR, 2–31] ). The facility‐wide DOT/1000 days were lowest in pancreas and highest in lung transplants (5.3 vs. 428.1). Small bowel transplants received the most resistant‐Gram‐positive infection and hospital‐onset infection agents for facility‐wide DOT/1000 days present. Pancreas and kidney transplants accounted for the most high‐risk CDI agents. CDI occurred in 34 patients, with kidney and liver transplants experiencing 13 each. Conclusion This study represents one of the first reports of AU in SOTr utilizing the NHSN‐AU framework. More studies are needed for further peer‐to‐peer comparison of AU in this complex patient population. image
    Type of Medium: Online Resource
    ISSN: 1398-2273 , 1399-3062
    URL: Issue
    URL: Article
    DOI: 10.1111/tid.v24.5
    DOI: 10.1111/tid.13944
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2010983-0
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  • 8
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    Pilot comparison of the ease of swallowing of single tablet antiretroviral regimens
    Informa UK Limited ; 2022
    In:  AIDS Care Vol. 34, No. 3 ( 2022-03-04), p. 404-407
    Details
    In: AIDS Care, Informa UK Limited, Vol. 34, No. 3 ( 2022-03-04), p. 404-407
    Type of Medium: Online Resource
    ISSN: 0954-0121 , 1360-0451
    URL: Article
    DOI: 10.1080/09540121.2021.1939258
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2022
    detail.hit.zdb_id: 2003080-0
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  • 9
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    Clinical characteristics and outcomes of COVID-19 in solid organ transplant recipients: A cohort study
    Elsevier BV ; 2020
    In:  American Journal of Transplantation Vol. 20, No. 11 ( 2020-11), p. 3051-3060
    Details
    In: American Journal of Transplantation, Elsevier BV, Vol. 20, No. 11 ( 2020-11), p. 3051-3060
    Type of Medium: Online Resource
    ISSN: 1600-6135
    URL: Article
    DOI: 10.1111/ajt.16188
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2045621-9
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  • 10
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    T2Candida for the Diagnosis and Management of Invasive Candida Infections
    MDPI AG ; 2021
    In:  Journal of Fungi Vol. 7, No. 3 ( 2021-03-03), p. 178-
    Details
    In: Journal of Fungi, MDPI AG, Vol. 7, No. 3 ( 2021-03-03), p. 178-
    Abstract: Invasive candidiasis is a common healthcare-associated infection with high mortality and is difficult to diagnose due to nonspecific symptoms and limitations of culture based diagnostic methods. T2Candida, based on T2 magnetic resonance technology, is FDA approved for the diagnosis of candidemia and can rapidly detect the five most commonly isolated Candida sp. in approximately 5 h directly from whole blood. We discuss the preclinical and clinical studies of T2Candida for the diagnosis of candidemia and review the current literature on its use in deep-seated candidiasis, its role in patient management and prognosis, clinical utility in unique populations and non-blood specimens, and as an antifungal stewardship tool. Lastly, we summarize the strengths and limitations of this promising nonculture-based diagnostic test.
    Type of Medium: Online Resource
    ISSN: 2309-608X
    URL: Article
    DOI: 10.3390/jof7030178
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2784229-0
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