558. Implementation and Outcomes of a COVID-19 Monoclonal Antibody Treatment Program in an Urban Safety-net Community Hospital

Abstract Background 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

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Selection and Duration of Therapy as a Target for Antimicrobial Stewardship during COVID-19: Levees for a Hundred-Year Flood

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.31 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s17-s17

Author(s):

Alfredo Mena Lora ◽

Rodrigo Burgos ◽

Ella Li ◽

Nichelle Simpkins ◽

Fischer Herald ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Community Hospital ◽

Average Duration ◽

Safety Net ◽

Audit And Feedback ◽

Antimicrobial Use ◽

Multimodal Approach ◽

Duration Of Therapy ◽

Urban Safety ◽

Bacterial Coinfection

Background: The disease caused by SARS-CoV-2, COVID-19, has caused a pandemic leading to strained healthcare systems worldwide and an unprecedented public health crisis. The hallmark of severe COVID-19 is lower respiratory tract infection (LRTI) and hypoxia requiring hospitalization. A paucity of data on bacterial coinfection and a lack of therapeutic options for COVID-19 during the first surge of cases has increased pressure on antimicrobial use and has challenged antimicrobial stewardship programs (ASPs). We implemented a multimodal approach to antimicrobial stewardship in an urban safety-net community hospital targeting selection and duration of therapy. Methods: Retrospective review of cases during the first wave of COVID-19 in a 151-bed urban safety-net community hospital from March to June 2020. EMR order sets (Figure 1) and prospective audit and feedback by ASPs targeting empiric antimicrobial selection and duration were implemented as part of the COVID-19 response. Hospitalized patients with COVID-19 were reviewed retrospectively. Demographic information was collected. Data on antimicrobial use were tabulated, including selection and duration of antimicrobials (Figure 1). Results: In total, 302 patients were reviewed, of whom 221 (73%) received empiric antimicrobials. The most commonly used antimicrobials were ceftriaxone and azithromycin (Figure 2). Days of therapy per 1,000 patient days (DOT/1,000 PD) for ceftriaxone increased from 71 in the quarter prior to 113 during the study period. Average duration of therapy was 6 days. In the ICU, average duration was 8 days compared to 5 days in non-ICU settings. Average durations of parenteral therapy were 5.54 days in the ICU and 3.36 days in non-ICU settings. Procalcitonin was obtained in 37 cases (17%) and ranged from 0.09 to 12.57 ng/mL, with an average of 1.21 ng/mL. No cases had documented bacterial coinfection (Figure 1). Conclusions: Antimicrobials were commonly prescribed during the first wave of COVID-19 in a safety-net community hospital. Procalcitonin did not guide therapy nor did lack of documented coinfection change physician behavior. With limited resources, ASP successfully guided clinicians toward IDSA guideline recommendations for selection and duration, as evidenced by antimicrobial use. During this unprecedented surge of LRTIs, a multimodal approach to antimicrobial stewardship was used and guided toward early transition to oral agents and shorter durations.Funding: NoDisclosures: None

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Impact of COVID-19 on Antimicrobial Use and Resistance in an Urban Safety-Net Community Hospital

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.32 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s17-s18

Author(s):

Alfredo Mena Lora ◽

Ella Li ◽

Fischer Herald ◽

Nichelle Simpkins ◽

Candice Krill ◽

...

Keyword(s):

Community Hospital ◽

Safety Net ◽

Antimicrobial Use ◽

Health Crisis ◽

Carbapenem Resistant ◽

Days Of Therapy ◽

Urban Safety ◽

Precious Resource ◽

Tract Infections ◽

The Impact

Background: The disease caused by SARS-CoV-2, COVID-19, has caused a pandemic leading to strained healthcare systems worldwide and an unprecedented public health crisis. Lower respiratory tract infections (LRTIs) and hypoxia caused by COVID-19 has led to an increase in hospitalizations. We sought to define the impact of COVID-19 on antimicrobial use and antimicrobial resistance (AMR) in an urban safety-net community hospital. Methods: Retrospective review of antimicrobial use and AMR in a 151-bed urban community hospital. Antimicrobial use was calculated in days of therapy per 1,000 patient days (DOT/1,000 PD) for ceftriaxone, piperacillin-tazobactam and meropenem during 2019 and 2020. Ceftriaxone, piperacillin-tazobactam and meropenem were reviewed for calendar year 2019 and 2020. AMR was assessed by comparing the carbapenem resistant Enterobacteriaceae (CRE) infection incidence rate per 1,000 patient days between 2019 and 2020. Results: The average quarterly DOT/1,000 PD increased from 359.5 in 2019 to 394.25 in 2020, with the highest increase in the second and fourth quarters of 2020, which temporarily correspond to the first and second waves of COVID-19. Ceftriaxone and meropenem use increased during the first and second waves of COVID-19. Piperacillin-tazobactam use increased during the first wave and declined thereafter (Figure 1). Rates of CRE increased from a quarterly average of 0.57 to 0.68 (Figure 2). Conclusions: Antimicrobial pressure increased during the first and second waves of COVID-19. Ceftriaxone was the most commonly used antimicrobial, reflecting internal guidelines and ASP interventions. CRE rates increased during COVID-19. This finding may be due to an overall increase in antimicrobial pressure in the community and in critically ill patients. Antibiotics are a precious resource, and antimicrobial stewardship remains important during the COVID-19 pandemic. Appropriate use of antimicrobials is critical to preventing AMR.Funding: NoDisclosures: None

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Orphan designation: Humanised anti-IL-6 receptor monoclonal antibody, Treatment of neuromyelitis optica spectrum disorders

Case Medical Research ◽

10.31525/cmr-973984 ◽

2019 ◽

Author(s):

Keyword(s):

Monoclonal Antibody ◽

Neuromyelitis Optica ◽

Neuromyelitis Optica Spectrum Disorders ◽

Antibody Treatment ◽

Orphan Designation ◽

Monoclonal Antibody Treatment ◽

Spectrum Disorders ◽

Receptor Monoclonal Antibody

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COVID-19 Pandemic and the Cholecystitis Experience at a Major Urban Safety-Net Hospital

Journal of Surgical Research ◽

10.1016/j.jss.2021.02.037 ◽

2021 ◽

Vol 264 ◽

pp. 117-123

Author(s):

Katherine F Vallès ◽

Miriam Y Neufeld ◽

Elisa Caron ◽

Sabrina E Sanchez ◽

Tejal S Brahmbhatt

Keyword(s):

Safety Net ◽

Safety Net Hospital ◽

Urban Safety

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Effectiveness of proprotein convertase subtilisin/kexin‐9 monoclonal antibody treatment on plasma lipoprotein(a) concentrations in patients with elevated lipoprotein(a) attending a clinic

Clinical Cardiology ◽

10.1002/clc.23607 ◽

2021 ◽

Author(s):

Anindita Chakraborty ◽

Jing Pang ◽

Dick C. Chan ◽

Wendy Barnett ◽

Ann Marie Woodward ◽

...

Keyword(s):

Monoclonal Antibody ◽

Plasma Lipoprotein ◽

Proprotein Convertase ◽

Antibody Treatment ◽

Lipoprotein A ◽

Monoclonal Antibody Treatment

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SARS-CoV-2 Sequence Characteristics of COVID-19 Persistence and Reinfection

Clinical Infectious Diseases ◽

10.1093/cid/ciab380 ◽

2021 ◽

Author(s):

Manish C Choudhary ◽

Charles R Crain ◽

Xueting Qiu ◽

William Hanage ◽

Jonathan Z Li

Keyword(s):

Persistent Infection ◽

Viral Evolution ◽

Phylogenetic Reconstruction ◽

Geographic Region ◽

Antibody Treatment ◽

Viral Genomes ◽

Monoclonal Antibody Treatment ◽

Viral Sequences ◽

Sequence Characteristics ◽

Baseline Health

Abstract Background Both SARS-CoV-2 reinfection and persistent infection have been reported, but sequence characteristics in these scenarios have not been described. We assessed published cases of SARS-CoV-2 reinfection and persistence, characterizing the hallmarks of reinfecting sequences and the rate of viral evolution in persistent infection. Methods A systematic review of PubMed was conducted to identify cases of SARS-CoV-2 reinfection and persistence with available sequences. Nucleotide and amino acid changes in the reinfecting sequence were compared to both the initial and contemporaneous community variants. Time-measured phylogenetic reconstruction was performed to compare intra-host viral evolution in persistent SARS-CoV-2 to community-driven evolution. Results Twenty reinfection and nine persistent infection cases were identified. Reports of reinfection cases spanned a broad distribution of ages, baseline health status, reinfection severity, and occurred as early as 1.5 months or >8 months after the initial infection. The reinfecting viral sequences had a median of 17.5 nucleotide changes with enrichment in the ORF8 and N genes. The number of changes did not differ by the severity of reinfection and reinfecting variants were similar to the contemporaneous sequences circulating in the community. Patients with persistent COVID-19 demonstrated more rapid accumulation of sequence changes than seen with community-driven evolution with continued evolution during convalescent plasma or monoclonal antibody treatment. Conclusions Reinfecting SARS-CoV-2 viral genomes largely mirror contemporaneous circulating sequences in that geographic region, while persistent COVID-19 has been largely described in immunosuppressed individuals and is associated with accelerated viral evolution.

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Association between season of vaccination and antibody levels against infectious diseases

Epidemiology and Infection ◽

10.1017/s0950268820002691 ◽

2020 ◽

Vol 148 ◽

Author(s):

T. C. Abreu ◽

H. Boshuizen ◽

L. Mollema ◽

G. A. M. Berbers ◽

H. Korthals Altes

Keyword(s):

Disease Burden ◽

Seasonal Cycles ◽

Inclusion Criteria ◽

Cross Sectional ◽

Vaccine Preventable Diseases ◽

Multivariable Regression ◽

Immunological Protection ◽

Antibody Levels ◽

Induced Immunity ◽

Tetanus Antibodies

Abstract Vaccination has reduced the disease burden of vaccine-preventable diseases. However, the extent to which seasonal cycles of immunity could influence vaccine-induced immunity is not well understood. A national cross-sectional serosurveillance study performed in the Netherlands (Pienter-2) yielded data to investigate whether season of vaccination was associated with antibody responses induced by DT-IPV (diphtheria, tetanus and poliomyelitis), MMR (measles, mumps and rubella) and meningococcus C (MenC) vaccines in children. In total, 434 children met the inclusion criteria to study DT-IPV immunity, 811 for MMR and 311 for MenC. Differences in log(antibody levels) by season of vaccination were investigated with linear multivariable regression analyses. Seroconversion rates varied according to season of vaccination for rubella (90% of autumn-vaccinated children vs. 99% of winter-vaccinated had concentrations above cut-off levels). Summer-vaccinated boys showed a slower decline of tetanus antibodies (6% per month), in comparison with winter-vaccinated boys. In conclusion, season of vaccination showed little association with immunological protection. However, a number of associations were seen with a P-value of about 0.03; and adding data from a just-completed nationwide serological study might add more power to the current study. Further immunological and longitudinal investigations could help understand the mechanisms of seasonal influence in vaccine-induced responses.

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