1328. Risk Factors for Severe Influenza Outcomes Among Infants Born Between 2011 and 2019

Abstract Background Influenza in infancy can cause significant morbidity and mortality. This study aimed to characterize influenza outcomes in infants < ορ = 12 months and identify risk factors for severe infection. Methods A retrospective cohort of infants ≤ 12 months born between 2011-2019 who received longitudinal ambulatory and inpatient care within a multi-facility hospital system and had laboratory-confirmed influenza were included. Perinatal, medical and illness characteristics were described. Risk factors for severe influenza (hospitalization, intensive-care unit (ICU) admission, secondary bacterial infections) were analyzed using Chi-square analysis and multivariate logistic regression. Results Among 421 infants with influenza, 134 (32%) were < 6 months (m), 28 (6.5%) were born prematurely (< 35 weeks gestational age), and 41(10%) had chronic medical conditions (CMC). 62 (15%) required hospital admission, 13 (21%) of which required ICU care. No deaths were reported. Secondary bacterial infections were diagnosed in 101 (24%) including acute otitis media (84%), pneumonia (15%) and sinusitis (3%). Prematurity (OR 3.6, 95%CI:1.5-8.3), age < 6m (OR 3.4, 95%CI:1.9-5.9), and CMC (OR 7.6, 95%CI 3.8-15.3) were significantly associated with hospitalization. Prematurity, age < 6m, and CMC were also associated with ICU admission. Infants > 6m (OR 2, 95%CI:1.2-3.5) were more likely to be diagnosed with a secondary bacterial infection than younger infants. Among infants > 6m, complete influenza vaccination (2 doses) was associated with lower rates of antibiotic use (OR 0.5, 95% CI:0.3-0.9) compared to partial or no vaccination, but did not significantly affect hospitalization, ICU admission, or frequency of secondary bacterial infections. Adjusting for prematurity, age < 6m remained associated with hospitalization (aOR 4, 95%CI: 2.1-7.3) as did presence of CMC (aOR 7.3, 95%CI 3.3- 15.7). For ICU admission, age < 6m (aOR 6.3, 95%CI:1.6-24.1) and CMC (aOR 19.7,95%CI:4.9-79.5) were also independent risk factors. Conclusion Younger age and chronic medical conditions were independent risk factors for severe influenza infection. Complete influenza vaccination in eligible age groups was associated with decreased antibiotic use. Disclosures John V. Williams, MD, GlaxoSmithKline (Advisor or Review Panel member, Independent Data Monitoring Committee)Quidel (Advisor or Review Panel member, Scientific Advisory Board) Judith M. Martin, MD, Merck Sharp and Dohme (Consultant)

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936. Risk Factors and Clinical Outcomes for Extended-Spectrum Beta-Lactamase Producing Enterobacterales Blood Stream Infections in Patients with Hematologic Malignancies

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1131 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S560-S560

Author(s):

Amanda Lefemine ◽

Jacqueline Meredith ◽

Katie Hammer ◽

Ekaterina Kachur ◽

Jiaxian He ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Clinical Outcomes ◽

Panel Member ◽

Antibiotic Use ◽

Hematologic Malignancies ◽

Blood Stream ◽

Review Panel ◽

Blood Stream Infections ◽

Optimal Therapy

Abstract Background Hematologic malignancy patients have high rates of antibiotic exposure, and increasing resistance is a major concern, particularly with extended-spectrum beta lactamases (ESBL) in Enterobacterales blood stream infections (BSIs). Identifying risk factors for ESBL-producing Enterobacterales (ESBL-E) BSIs may facilitate faster appropriate antibiotic use and decrease mortality. Methods This was a retrospective study of patients with hematologic malignancies and Escherichia coli or Klebsiella spp. bacteremia admitted to Carolinas Medical Center in Charlotte, NC from January 2010 through September 2020. The primary objective was to compare 30-day mortality rates for patients with ESBL-E BSIs to those with non-ESBL-E BSIs. Fisher’s exact or Mann-Whitney U tests were used for primary and secondary clinical outcomes as appropriate. Risk factors associated with 30-day mortality and ESBL production were assessed as secondary objectives using logistic regression models. Results A total of 28 patients with ESBL-E BSIs and 60 patients with non-ESBL-E BSIs were included. The 30-day mortality rate with ESBL-E BSIs was 25% compared to 15% with non-ESBL-E BSIs (P = .373). In-hospital mortality, 30-day infection recurrence, intensive care unit (ICU) admission, and length of stay after culture were not significantly different. However, time to optimal therapy was longer in the ESBL-E group (median 42.3 vs 1.9 hr; P < .001). Multivariate logistic regression analysis showed an association of 30-day mortality with ICU admission (OR 16.7; 95% CI, 3.56-78.4; P < .001) and longer time to optimal therapy (OR 1.03; 95% CI, 1.0-1.05; P = .026). Prior ESBL-positive culture was associated with ESBL-E BSI in the univariate logistic regression (OR 9.83; 95% CI, 1.05-92.56; P = .046). Additionally, prolonged neutropenia (OR 3.05; 95% CI, 1.01-9.23; P = .049) and prior intravenous antibiotic use (OR 2.96; 95% CI, 0.96-9.09; P = .059) were associated with ESBL-E BSI in the multivariate analysis. Conclusion Significantly longer time to optimal therapy was seen in ESBL-E BSIs and was associated with mortality in patients with hematologic malignancies. The identified ESBL risk factors create an opportunity to decrease delay in optimal therapy through risk stratification during initial antibiotic selection. Disclosures Ekaterina Kachur, PharmD, BCOP, Bristol Myers Squibb (Advisor or Review Panel member)Genentech (Employee)Glaxosmithkline (Advisor or Review Panel member)Kyowa Kirin (Advisor or Review Panel member)

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1104. Risk Factors and Outcomes of Refractory and/or Resistant Cytomegalovirus (CMV) Infection after Allogeneic Hematopoietic Stem Cell Transplantation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1290 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S582-S583

Author(s):

Eleni Karantoni ◽

Yiqi Su ◽

Anat Stern ◽

Phaedon D Zavras ◽

Sergio Giralt ◽

...

Keyword(s):

Risk Factors ◽

Overall Survival ◽

T Cell ◽

Panel Member ◽

Multivariable Model ◽

Research Support ◽

Review Panel ◽

Material Support ◽

Advisory Boards ◽

Research Grant

Abstract Background The epidemiology of CMV end-organ disease (EOD) after Hematopoietic Cell Transplant (HCT) in the era of preemptive therapy (PET) is defined. In contrast, less data exists on refractory and/or resistant (R/R) CMV. We report on 1) the incidence; 2) risk factors and outcomes of R/R CMV by 1-year post HCT. Methods Retrospective review of 167 CMV seropositive (R+) recipients of first marrow or peripheral blood HCT from 1/2014 - 12/2017 managed by PET. Refractory CMV was defined as failure to achieve >1 log10 decrease in CMV viral load (VL) and having VL >1,000 IU/mL after ≥14 day of PET. Resistant CMV required genotypic confirmation of resistance mutation(s) in UL54 and/or UL97 genes. End organ disease (EOD) was defined by standard criteria. Patients (pts) were followed through 1-year post HCT and were categorized in two mutually exclusive groups as R/R and no R/R. Demographics, clinical characteristics and outcomes were extracted from medical records and hospital databases. Univariable and multivariable logistic models were used to identify risk factors for R/R CMV. Results Of 167 PET recipients, 91 (54.5%) received ex vivo T cell depleted (TCD) HCT; 40 (24.0%) had mismatched donor; and 26 (15.6%) had multiple myeloma. 66/167 (39.5%) pts developed refractory CMV (6 pts also had resistant CMV). Time from HCT to CMV viremia was shorter in R/R group: median (IQR) 21.5 (17.2-27.8) days compared to no R/R group: 26 (19-32) days (p=0.031). Maximum VL was higher for R/R compared to no R/R: median (IQR) 9,118 (2,849-18,456) and 868 (474-1,908), respectively (p< 0.001). In multivariable model, risk factors for R/R included TCD HCT (p< 0.0001) and higher VL at PET initiation (p=0.0002). In contrast, CMV seropositive donor (p=0.035) was protective (Figure 1). CMV EOD developed in 28.2% of R/R and 16.2% of no R/R groups (p=0.085) (Figure 2). Overall survival at 1 year was 59.1% for R/R compared to 83.1% for no R/R group (p=0.00027) (Figure 3). Figure 1. Adjusted odds ratio (OR) and 95% confidence interval (CI) from multivariable model evaluating risk factors of refractory/resistant (R/R) CMV. Figure 2. Cumulative incidence curves of CMV end-organ disease (EOD) at 1-year post HCT Figure 3. Kaplan-Meier survival curves of overall survival (OS) at 1-year post HCT Conclusion 1) Refractory and/or resistant CMV occurred in 39,5% of PET recipients. 2) T-cell depletion and higher CMV VL at PET initiation were risk factors for R/R CMV in multivariable models. 3) R/R CMV was associated with more EOD and worse overall survival. Disclosures Sergio Giralt, MD, Amgen (Advisor or Review Panel member, Research Grant or Support, Served an advisory board for Amgen, Actinuum, Celgene, Johnson & Johnson, JAZZ pharmaceutical, Takeda, Novartis, KITE, and Spectrum pharma and has received research support from Amgen, Actinuum, Celgene, Johnson & Johnson, and Miltenyi, Takeda.) Miguel-Angel Perales, MD, Abbvie (Other Financial or Material Support, Honoraria from Abbvie, Bellicum, Celgene, Bristol-Myers Squibb, Incyte, Merck, Novartis, Nektar Therapeutics, Omeros, and Takeda.)ASTCT (Other Financial or Material Support, Volunteer member of the Board of Directors of American Society for Transplantation and Cellular Therapy (ASTCT), Be The Match (National Marrow Donor Program, NMDP), and the CIBMTR Cellular Immunotherapy Data Resource (CIDR) Committee)Cidara Therapeutics (Advisor or Review Panel member, Other Financial or Material Support, Serve on DSMBs for Cidara Therapeutics, Servier and Medigene, and the scientific advisory boards of MolMed and NexImmune.)Kite/Gilead (Research Grant or Support, Other Financial or Material Support, Received research support for clinical trials from Incyte, Kite/Gilead and Miltenyi Biotec.) Genovefa Papanicolaou, MD, Chimerix (Research Grant or Support)Merck&Co (Research Grant or Support, Investigator and received funding and consulting fees from Merck, Chimerix, Shire and Astellas)

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Risk factors for mortality, ICU admission and bacteremia in patients suspected of sepsis at the Emergency department. A prospective cohort study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa594 ◽

2020 ◽

Author(s):

Valentino D’Onofrio ◽

Agnes Meersman ◽

Sara Vijgen ◽

Reinoud Cartuyvels ◽

Peter Messiaen ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Regression Models ◽

Serum Lactate ◽

Suspected Sepsis ◽

Logistic Regression Models ◽

Icu Admission ◽

Observational Cohort ◽

Independent Risk Factors ◽

Prediction Of Prognosis

Abstract Background There is a clear need for a better assessment of independent risk factors for in-hospital mortality, ICU admission, and bacteremia in patients presenting with suspected sepsis at the ED. Methods A prospective observational cohort study including 1690 patients was performed. Two multivariable logistic regression models were used to identify independent risk factors. Results SOFA score of ≥2 and serum lactate of ≥2mmol/L were associated with all outcomes. Other independent risk factors were individual SOFA variables and SIRS variables but varied per outcome. MAP<70 mmHg negatively impacted all outcomes. Conclusion These readily available measurements can help with early risk stratification and prediction of prognosis.

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1334. Outcomes Among Influenza and SARS-CoV-2 Infection in Hospitalized Adults Age ≥ 50 Years and with Underlying Chronic Obstructive Pulmonary Disease (COPD) or Congestive Heart Failure (CHF)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1526 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S755-S755

Author(s):

Megan Taylor ◽

Ashley Tippett ◽

Laila Hussaini ◽

Luis Salazar ◽

Caroline Ciric ◽

...

Keyword(s):

Nursing Home ◽

Research Study ◽

Scientific Research ◽

Panel Member ◽

Research Support ◽

Review Panel ◽

Icu Admission ◽

Study Investigator ◽

Significant Burden ◽

Research Grant

Abstract Background A significant burden of disease exists for adults infected with influenza (flu) and SARS-CoV-2, which causes COVID-19. However, data are limited comparing outcomes between hospitalized adults infected with these viruses. Methods Over the course of 3 consecutive winter respiratory viral seasons, adults ≥ 50 years of age admitted with acute respiratory tract infections (ARI) and adults of any age with COPD or CHF-related admissions were enrolled from 2 Atlanta area hospitals. For the 2018-19 and 2019-20 seasons, participants were approached in the hospital. If the participant enrolled, nasopharyngeal (NP) and oropharyngeal (OP) swabs were collected and tested using BioFire® FilmArray® respiratory panel. Due to the COVID-19 pandemic in 2020-21 and limitations involving participant contact, only NP standard of care (SOC) swabs were collected. A comprehensive medical chart review was completed for each subject which encompassed data on their hospitalization, past medical history, and vaccination history. Co-infected patients were excluded from the analyses. Results Of the eligible participants, 118 were flu positive (three RSV-influenza co-infections were excluded) and 527 were COVID-19 positive. Median age was lower for the flu cohort at 62 (IQR 56-71) than those with COVID-19 (67, IQR 59-77) (p < 0.0001). Length of stay (LOS) was shorter in flu-infected patients (median 3 d, IQR 2-6), but was longer for COVID-19 patients (median 5 d, IQR 3-10). ICU admission occurred in 20% of those with flu, and among those admitted to the ICU mechanical ventilation (MV) occurred in 12.5%. ICU admission and MV was significantly higher for those with COVID-19, with 28% of patients admitted to the ICU and 47% of those requiring MV. Among patients with COVID-19, 8.9% died. This was significantly higher than that of flu (3.4%) (p=0.008). Hospital discharge occurred more frequently to a nursing home or LTCF with COVID-19 (10.3%) than with flu (0%) (p< 0.0001). Table 1. Breakdown of age, hospitalization course, and discharge disposition for participants diagnosed with influenza or COVID-19 during hospitalization. Conclusion COVID-19 resulted in a longer hospital admission, a greater chance of ICU admission and MV as compared to flu. Additionally, COVID-19 participants had a high rate of discharge to a nursing home/LTCF and a significantly higher risk of death. While the clinical course was not as severe as COVID-19, influenza contributed a significant burden. Disclosures David L. Swerdlow, MD, Pfizer Vaccines (Employee) Robin Hubler, MS, Pfizer Inc. (Employee) Christina A. Rostad, MD, BioFire Inc, GSK, MedImmune, Micron, Janssen, Merck, Moderna, Novavax, PaxVax, Pfizer, Regeneron, Sanofi-Pasteur. (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)Meissa Vaccines (Other Financial or Material Support, Co-inventor of patented RSV vaccine technology unrelated to this manuscript, which has been licensed to Meissa Vaccines, Inc.) Larry Anderson, MD, ADVI (Consultant)Bavarian Nordic (Consultant)Novavax (Consultant)Phizer (Grant/Research Support, Scientific Research Study Investigator)Sciogen (Research Grant or Support) Nadine Rouphael, MD, pfizer, sanofi, lily, quidel, merck (Grant/Research Support) Nadine Rouphael, MD, Lilly (Individual(s) Involved: Self): Emory Study PI, Grant/Research Support; Merck (Individual(s) Involved: Self): Emory study PI, Grant/Research Support; Pfizer: I conduct as co-PI the RSV PFIZER study at Emory, Research Grant; Pfizer (Individual(s) Involved: Self): Grant/Research Support, I conduct as co-PI the RSV PFIZER study at Emory; Quidel (Individual(s) Involved: Self): Emory Study PI, Grant/Research Support; Sanofi Pasteur (Individual(s) Involved: Self): Chair phase 3 COVID vaccine, Grant/Research Support Evan J. Anderson, MD, GSK (Scientific Research Study Investigator)Janssen (Consultant, Scientific Research Study Investigator, Advisor or Review Panel member)Kentucky Bioprocessing, Inc (Advisor or Review Panel member)MedImmune (Scientific Research Study Investigator)Medscape (Consultant)Merck (Scientific Research Study Investigator)Micron (Scientific Research Study Investigator)PaxVax (Scientific Research Study Investigator)Pfizer (Consultant, Grant/Research Support, Scientific Research Study Investigator)Regeneron (Scientific Research Study Investigator)Sanofi Pasteur (Consultant, Scientific Research Study Investigator)

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Blood Transfusion is Associated with Infection and Increased Resource Utilization in Combat Casualties

The American Surgeon ◽

10.1177/000313480607200709 ◽

2006 ◽

Vol 72 (7) ◽

pp. 619-626 ◽

Cited By ~ 14

Author(s):

James R. Dunne ◽

Mark S Riddle ◽

Janine Danko ◽

Rich Hayden ◽

Kyle Petersen

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Blood Transfusion ◽

Resource Utilization ◽

Independent Risk Factor ◽

Study Cohort ◽

Icu Admission ◽

Independent Risk Factors ◽

Combat Casualties ◽

Injured Patients

Combat casualty care has made significant advances in recent years, including administration of blood products in far-forward locations. However, recent studies have shown blood transfusion to be a significant risk factor for infection and increased resource utilization in critically injured patients. We therefore sought to investigate the incidence of blood transfusion and its association with infection and resource utilization in combat casualties. Prospective data were collected and retrospectively reviewed on 210 critically injured patients admitted to the USNS Comfort over a 7-week period during the 2003 assault phase of Operation Iraqi Freedom. Patients were stratified by age, gender, and injury severity score (ISS). Multivariate regression analyses were used to assess blood transfusion and hematocrit (HCT) as independent risk factors for infection and intensive care unit (ICU) admission controlling for age, gender, and ISS. The study cohort had a mean age of 30 ± 2 years, a mean ISS of 14 ± 3, 84 per cent were male, and 88 per cent sustained penetrating trauma. Blood transfusion was required in 44 per cent (n = 93) of the study cohort. Transfused patients had a higher ISS (18 ± 4 vs. 10 ± 3, P < 0.01), a higher pulse rate (105 ± 4 vs. 93 ± 3, P < 0.0001), and a lower admission HCT (27 ± 1 vs. 33 ± 2, P < 0.0001) compared with patients not transfused. Patients receiving blood transfusion had an increased infection rate (69% vs. 18%, P < 0.0001), ICU admission rate (52% vs. 21%, P < 0.0001), and ICU length of stay (6.7 ± 2.1 days vs. 1.4 ± 0.5 days, P < 0.0001) compared with nontransfused patients. However, there was no significant difference in mortality between transfused and nontransfused patients. Multivariate binomial regression analysis identified blood transfusion and HCT as independent risk factors for infection (P < 0.01) and blood transfusion as an independent risk factor for ICU admission (P < 0.05). Combat casualties have a high incidence of blood transfusion. Blood transfusion is an independent risk factor for infection and increased resource utilization. Therefore, consideration should be given to the use of alternative blood substitutes and recombinant human erythropoietin in the treatment and management of combat casualties.

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Clinical Features and Risk Factors of ICU Admission for COVID-19 Patients with Diabetes

Journal of Diabetes Research ◽

10.1155/2020/5237840 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Ming Lei ◽

Kashuai Lin ◽

Yaoqiu Pi ◽

Xiaomei Huang ◽

Lixin Fan ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Rate ◽

Early Stage ◽

Binary Logistic Regression ◽

C Reactive Protein ◽

Radiographic Findings ◽

Icu Admission ◽

Reactive Protein ◽

Patients With Diabetes ◽

Independent Risk Factors

Introduction. Previous studies of coronavirus disease 2019 (COVID-19) have focused on the general population. However, diabetes (DM) as one of the most common comorbidities is rarely studied in detail. This study is aimed at describing clinical characteristics and determining risk factors of ICU admission for COVID-19 patients with DM. Methods. Data were extracted from 288 adult patients with laboratory-confirmed COVID-19 from Guangzhou Eighth People’s Hospital. Demographic characteristics, laboratory results, radiographic findings, complications, and treatments were collected and compared between DM and non-DM groups. Binary logistic regression was used to identify the risk factors associated with ICU admission for COVID-19 patients with DM or non-DM. Results. COVID-19 patients with DM showed as older ages, higher levels of C-reactive protein (CRP), myoglobin, alanine transaminase (ALT), and aspartate transaminase (AST). They were also more prone to transfer to the intensive care unit (ICU) for treatment. Multiple regression analysis showed that the following were the independent risk factors for COVID-19 patients with DM that received ICU admission: each 1-year increase in age (odds ratio (OR), 1.07; 95% CI, 1.02-1.13; P = 0.007 ), respiratory rate over 24 times per minute (OR, 5.22; 95% CI, 2.26-16.58; P = 0.016 ), HbA1c greater than 7% (OR, 4.58; 95% CI, 1.82-10.55; P = 0.012 ), and AST higher than 40 U/L (OR, 2.96; 95% CI, 1.58-8.85; P = 0.022 ). In addition, each 1-year increase in age (OR, 1.05; 95% CI, 1.01-1.10; P = 0.006 ), diarrhea (OR, 4.62; 95% CI, 2.01-9.36; P = 0.022 ), respiratory rate over 24 times per minute (OR, 5.13; 95% CI, 1.18-16.82; P = 0.035 ), CRP greater than 10 mg/L (OR, 5.19; 95% CI, 1.37-13.25, P = 0.009 ), and TnI higher than 0.03 μg/L (OR, 6.48; 95% CI, 1.17-21.38; P = 0.036 ) were risk factors for ICU admission of COVID-19 patients with non-DM. Conclusions. The older age, respiratory rate over 24 times per minute, HbA1c greater than 7%, and AST higher than 40 U/L were risk factors of ICU admission for COVID-19 patients with diabetes. Investigating and monitoring these factors could assist in the risk stratification of COVID-19 patients with DM at an early stage.

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22. International Multicenter Study Comparing Cancer to Non-Cancer Patients with COVID-19: Impact of Risk Factors and Treatment Modalities on Outcome

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.022 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S15-S15

Author(s):

Ray Y Hachem ◽

Anne-Marie Chaftari ◽

Nigo Masayuki ◽

Nelson Hamerschlak ◽

Hiba Dagher ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cancer Patients ◽

Independent Risk Factor ◽

Panel Member ◽

Low Flow ◽

Treatment Modalities ◽

Research Support ◽

Review Panel ◽

All Cause Mortality

Abstract Background Given the limited collaborative international studies that evaluated COVID-19 in patients with cancer in comparison to patients without cancer, we aimed to determine the independent risk factors associated with increased 30-day mortality and the impact of novel treatment modalities in a large group of cancer and non-cancer patients with COVID-19 from multiple countries. Methods We retrospectively collected de-identified data on cancer and non-cancer patients diagnosed with COVID-19 between January and November 2020, at 16 centers in Asia, Australia, Europe, North America, and South America. A logistic regression model was used to identify independent predictors of all-cause mortality within 30 days after COVID-19 diagnosis. Results Of the total 4015 COVID-19 confirmed patients entered, we analyzed 3966 patients, 1115 cancer and 2851 non-cancer patients. Cancer patients were older than non-cancer patients (median age, 61 vs 50 years; p< 0.0001); more likely to be pancytopenic , had pulmonary disorders, hypertension, diabetes mellitus. In addition, they were more likely to present with higher inflammatory biomarkers (D-dimer, ferritin and procalcitonin), but were less likely to present with clinical symptoms. By multivariable logistic regression analysis, cancer was an independent risk factor for 30-day mortality (OR 1.46; 95% CI 1.03 to 2.07; p=0.035). Older age (≥65 years) was the strongest predictor of 30-day mortality in all patients (OR 4.55; 95% CI 3.34 to 6.20; p< 0.0001). Remdesivir was the only therapeutic agent independently associated with decreased 30-day mortality (OR 0.58; CI 0.39-0.88; p=0.009). Among patients on low-flow oxygen at admission, patients who received remdesivir had a lower 30-day mortality rate than those who were on high flow oxygen (5.9% vs 17.6%; p=0.03). Patients transfused with convalescent plasma within 1 day of diagnosis had a lower 30-day mortality rate than those transfused later (1% vs 7%, p=0.04). Conclusion Cancer is an independent risk factor for increased 30-day all-cause mortality from COVID-19. Remdesivir, particularly in patients receiving low-flow oxygen, can reduce 30-day all-cause mortality, as well as convalescent plasma given early after COVID-19 diagnosis. Disclosures Roy F. Chemaly, MD, MPH, FACP, FIDSA, AiCuris (Grant/Research Support)Ansun Biopharma (Consultant, Grant/Research Support)Chimerix (Consultant, Grant/Research Support)Clinigen (Consultant)Genentech (Consultant, Grant/Research Support)Janssen (Consultant, Grant/Research Support)Karius (Grant/Research Support)Merck (Consultant, Grant/Research Support)Molecular Partners (Consultant, Advisor or Review Panel member)Novartis (Grant/Research Support)Oxford Immunotec (Consultant, Grant/Research Support)Partner Therapeutics (Consultant)Pulmotec (Consultant, Grant/Research Support)Shire/Takeda (Consultant, Grant/Research Support)Viracor (Grant/Research Support)Xenex (Grant/Research Support) Fareed Khawaja, MBBS, Eurofins Viracor (Research Grant or Support) Monica Slavin, MBBS,MD, F2G (Advisor or Review Panel member)Merck (Advisor or Review Panel member)Pfizer (Advisor or Review Panel member) Dimitrios P. Kontoyiannis, MD, Astellas (Consultant)Cidara Therapeutics (Advisor or Review Panel member)Gilead Sciences (Consultant, Grant/Research Support, Other Financial or Material Support, Honoraria)

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132. Standardized Antimicrobial Administration Ratios to Guide Antimicrobial Stewardship in the Neonatal Intensive Care Unit: a Single Center Experience

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.334 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S178-S179

Author(s):

Steven Smoke ◽

Uzma Hasan ◽

Eileen Steffen ◽

Kamtorn Vangvanichyakorn

Keyword(s):

Neonatal Intensive Care ◽

Antibacterial Agents ◽

Panel Member ◽

Antibiotic Use ◽

Third Generation ◽

Review Panel ◽

Implementation Period ◽

Third Generation Cephalosporins ◽

Neonatal Population ◽

Antimicrobial Administration

Abstract Background Antimicrobial stewardship (AMS) is particularly challenging in the neonatal population. Both under- and overuse can negatively impact outcomes. There are limited reports of strategies to improve AMS in the neonatal population. Standardized Antimicrobial Administration Ratios (SAARs) are novel metrics of antimicrobial use, recently introduced for neonatal populations by the National Healthcare Safety Network (NHSN). We describe our experience using SAARs to guide AMS in the neonatal intensive care unit (NICU). Methods This was a retrospective study conducted from January 2020 to April 2021. A team consisting of AMS and NICU department staff identified and implemented AMS strategies. Based on a review of NICU SAAR data, a goal was set to reduce third generation cephalosporin use by encouraging aminoglycoside use when appropriate. The pre-implementation period was January 2020 to May 2020 and the post-implementation period was July 2020 to April 2021. Antibiotic use was measured as SAARs and compared between study periods. The primary outcome was the neonatal SAAR for third generation cephalosporins. Secondary outcomes included SAARs for aminoglycosides and all neonatal antibacterial agents. SAARs were compared using the NHSN Statistics Calculator. Results For third generation cephalosporins, there were 385 observed antimicrobial days (OAD) and 115 expected antimicrobial days (EAD) in the pre-implementation period compared to 597 OAD and 228 EAD in the post implementation period. This resulted in a SAAR of 3.34 and 2.62, respectively; a reduction of 22% (p < 0.001). For aminoglycosides, there were 713 OAD and 584 EAD compared to 1617 OAD and 1155 EAD. This resulted in a SAAR of 1.22 and 1.4; an increase of 15% (p = 0.002). For all neonatal antibacterial agents, there were 2716 OAD and 1739 EAD compared to 5321 OAD and 3438 EAD. This resulted in a SAAR of 1.56 and 1.55; indicating no change in use (p = 0.70). See Table 1 for results. Table 1. Antibiotic Use Conclusion While this initiative resulted in decreased use of third generation cephalosporins, this was not associated with a decrease in antibiotic use overall. Use of SAARs in the NICU may be helpful in both identifying opportunities to improve antibiotic use and monitoring antibiotic use over time. Disclosures Steven Smoke, PharmD, Karius (Advisor or Review Panel member) Shionogi (Scientific Research Study Investigator, Advisor or Review Panel member)

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1050. Phase 3 Trial to Evaluate the Safety, Tolerability, and Immunogenicity of V114 Followed by 23valent Pneumococcal Polysaccharide Vaccine 6 Months Later in At-risk Adults Aged 18–49 Years (PNEU-DAY): A Subgroup Analysis by Baseline Risk Factors

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1244 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S616-S617

Author(s):

Laura Hammitt ◽

Dean Quinn ◽

Ewa Janczewska ◽

Francisco J Pasquel ◽

Richard Tytus ◽

...

Keyword(s):

Risk Factors ◽

Research Study ◽

Scientific Research ◽

Panel Member ◽

Baseline Risk ◽

Research Support ◽

Review Panel ◽

Post Vaccination ◽

Study Investigator ◽

Research Grant

Abstract Background Risk factors (RFs) for pneumococcal disease (PD) in immunocompetent individuals include comorbidities, behavioral habits, or living in a community with increased risk of PD transmission. RF stacking of comorbidities is associated with a higher incidence of PD, approaching that of immunocompromised individuals. Pneumococcal vaccination of certain adults is recommended with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) alone/sequentially with pneumococcal conjugate vaccine (PCV). V114, an investigational 15-valent PCV, contains 2 epidemiologically important serotypes (STs), 22F and 33F, in addition to the 13 STs in 13-valent PCV (PCV13). Methods PNEU-DAY was a Phase 3 study evaluating V114 or PCV13 administered on Day 1, and PPSV23 given 6 months later, in adults aged 18–49 years with or without RFs. This subgroup analysis assessed safety, tolerability, and immunogenicity of V114 and PCV13 based on the number of baseline PD RFs, which included chronic liver, lung, and heart disease, diabetes mellitus, tobacco use, and alcohol consumption. Adverse events (AEs; overall and solicited) were collected after each vaccination. Immunogenicity assessment was based on ST-specific opsonophagocytic activity (OPA) at 30 days after each vaccination. Subgroup analyses were conducted by RF group (0, 1, or ≥2 RFs for PD). Results Among the 1515 participants randomized to V114 (n=1135) or PCV13 (n=380), 25.2% had no RFs, 54.7% had 1 RF and 20.1% had ≥2 RFs for PD at baseline. The proportions of participants with solicited AEs following V114/PCV13 and PPSV23 were comparable across the 3 subgroups, with injection-site pain, myalgia, and fatigue being the most common. V114 and PCV13 were immunogenic in all subgroups based on OPA geometric mean titers (GMTs) at 30 days post-vaccination for the 13 shared STs (Figure); in addition, V114 induced a robust immune response to the 2 unique STs (22F, 33F) in all subgroups. PPSV23 following PCV was immunogenic for all 15 STs contained in V114 across all subgroups. Figure. Serotype-specific OPA GMTs at baseline and 30 days post-vaccination with V114 and PCV13 by number of baseline risk factors (per-protocol population) Conclusion V114 administered alone/sequentially with PPSV23 is well tolerated and immunogenic for all 15 vaccine STs, including those not contained in PCV13, in immunocompetent adults aged 18–49 years, regardless of the number of baseline RFs. Disclosures Laura Hammitt, MD, MedImmune (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)Merck & Co., Inc. (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)Novavax (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)Pfizer (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support) Francisco J. Pasquel, MD, MPH, Boehringer Ingelheim (Consultant)Dexcom (Grant/Research Support)Eli Lilly & Company (Consultant)Insulet (Grant/Research Support)Merck & Co., Inc. (Consultant, Grant/Research Support) K. Rajender Reddy, MD, BMS (Grant/Research Support)Deciphera (Advisor or Review Panel member)Gilead (Grant/Research Support)Grifols (Grant/Research Support)HCC-TARGET (Grant/Research Support)Intercept (Grant/Research Support)Mallinckrodt (Grant/Research Support, Advisor or Review Panel member)NASH-TARGET (Grant/Research Support)Pfizer (Advisor or Review Panel member)Sequana (Grant/Research Support) Ron Dagan, MD, Medimmune/AstraZeneca (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)MSD (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau)Pfizer (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau) Rachel Dawson, D.O. MPH, Merck & Co., Inc. (Employee, Shareholder) Jennifer McCauley, BSc, Merck & Co., Inc. (Employee) Kyeongmi Cheon, Ph.D., Merck & Co., Inc. (Employee, Shareholder) Alison Pedley, PhD, Merck & Co., Inc. (Employee) Tina Sterling, BS, Merck & Co., Inc. (Employee, Shareholder) Gretchen Tamms, B.S., Merck Sharp and Dohme (Employee, Shareholder) Luwy Musey, MD, Merck & Co., Inc. (Employee) Ulrike K. Buchwald, MD, MS, Merck & Co., Inc. (Employee)TB Alliance (Employee)

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Predictors of fever-related admissions to a paediatric assessment unit, ward and reattendances in a South London emergency department: the CABIN 2 study

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-310494 ◽

2016 ◽

Vol 102 (1) ◽

pp. 22-28 ◽

Cited By ~ 8

Author(s):

Amaya L Bustinduy ◽

Irina Chis Ster ◽

Rebecca Shaw ◽

Adam Irwin ◽

Jaiganesh Thiagarajan ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Bacterial Infections ◽

Tertiary Care ◽

Antibiotic Use ◽

Internal Validation ◽

Avoidable Admissions ◽

Large Tertiary Care ◽

Abnormal Chest ◽

Assessment Unit

ObjectiveTo explore the risk factors for ward and paediatric assessment unit (PAU) admissions from the emergency department (ED).DesignProspective observational study.Setting and patientsFebrile children attending a large tertiary care ED during the winter of 2014–2015.Main outcome measuresWard and PAU admissions, National Institute for Health and Care Excellence (NICE) guidelines classification, reattendance to the ED within 28 days and antibiotic use.ResultsA total of 1097 children attending the children's ED with fever were analysed. Risk factors for PAU admission were tachycardia (RR=1.1, 95% CI (1 to 1.1)), ill-appearance (RR=2.2, 95% CI (1.2 to 4.2)), abnormal chest findings (RR=2.1, 95% CI (1.2 to 4.3)), categorised as NICE amber (RR 1.7 95% CI (1.2 to 2.5)). There was a 30% discordance between NICE categorisation at triage and statistical internal validation. Predictors of ward admission were a systemic (RR=6.9, 95% CI (2.4 to 19.8)) or gastrointestinal illness (RR=3.8, 95% (1.4 to 10.4)) and categorised as NICE Red (RR=5.9, 95% CI (2.2 to 15.3)). Only 51 children had probable bacterial pneumonia (4.6%), 52 children had a proven urinary tract infection (4.2%), with just 2 (0.2%) positive blood cultures out of 485 (44%) children who received an antibiotic. 15% of all children reattended by 28 days and were more likely to have been categorised as Amber and had investigations on initial visit.ConclusionsRisk factors for PAU and ward admissions are different in this setting with high reattendance rates and very low proportion of confirmed/probable serious bacterial infections. Future studies need to focus on reducing avoidable admissions and antibiotic treatment.

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