105. Fluoroquinolone Stewardship at a Community Health-System: A Decade in Review

Background Fluoroquinolone stewardship is a common target for antimicrobial stewardship programs seeking to maintain or improve fluoroquinolone susceptibility rates. Additional benefits include reducing C. difficile infection rates, drug toxicities, and resistance to other antimicrobials as fluoroquinolones can co-select for resistance. The Norton Healthcare antimicrobial stewardship program was founded in 2011 and provides services at 4 adult hospitals with ~1600 beds. Main fluoroquinolone stewardship activities have included provider education, prospective audit and feedback, and guideline and order-set development. The purpose of this study was to describe the resistance and usage rates of fluoroquinolones over time. Methods This was a descriptive study examining individual adult hospital antibiograms from 2010 to 2020. Levofloxacin susceptibility rates to E. coli and P. aeruginosa were collated from annual antibiograms between 2010 and 2020 for outpatients and each adult hospital. Adult hospital resistance rates were aggregated and weighted accordingly to number of isolates per hospital per year. Additionally, levofloxacin and ciprofloxacin inpatient days of therapy (DOT) was collected since 2016 when DOT was first readily retrievable and was normalized per 1000 patient days to compare between different time points. Results Outpatient levofloxacin likelihood of activity against P. aeruginosa improved from 81% to 91%. Outpatient levofloxacin likelihood of activity against E. coli remained stable between 84 – 86% (Figure 1). Adult inpatient fluoroquinolone usage decreased by approximately 75% from 83.5 to 21.37 DOT/1000 patient days since 2016 (Figure 2). Adult inpatient levofloxacin likelihood of activity against P. aeruginosa improved from 53% to 83%. Adult inpatient levofloxacin likelihood of activity against E. coli improved from 65% to 75% (Figure 3). Conclusion The Norton Healthcare antimicrobial stewardship program has been effective in reducing unnecessary fluoroquinolone usage and improving inpatient fluoroquinolone susceptibility rates. Future studies should examine opportunities to translate successes to the outpatient phase of care. Disclosures Ashley Wilde, PharmD, BCPS-AQ ID, Nothing to disclose Paul S. Schulz, MD, Gilead (Consultant, Speaker’s Bureau)Merck (Consultant, Speaker’s Bureau)

A Multicentre Retrospective Cohort Study on Covid-19-related Physical Interventions and Adult Hospital Admissions for ENT Infections

Objectives: To report changes in adult hospital admission rates for acute ENT infections following the introduction of Covid-19-related physical interventions such as hand washing, use of face mask and social distancing of 2-metres in the United Kingdom. Design: Retrospective cohort study comparing a one-year period after the introduction of Covid-related physical interventions (2020-21) with a one-year period before this (2019-20). Settings: 3 UK secondary care ENT departments Participants: Adult patients admitted with acute tonsillitis, peritonsillar abscess, epiglottitis, glandular fever, peri-orbital cellulitis, acute otitis media, acute mastoiditis, retropharyngeal abscess and parapharyngeal abscess. Main outcome measures: Number of adult hospital admissions Results: In total there were significantly fewer admissions for ENT infections (n=1073, 57.56%, p<0.001; RR 2.36, 95% CI [2.17, 2.56]) in the 2020-2021 period than in the 2019-2020 period. There were significant reductions in admissions for tonsillitis (64.4%; p<0.001), peritonsillar abscess (60.68%; p<0.001), epiglottitis (66.67%; p<0.001), glandular fever (38.79%; p=0.001), acute otitis media (26.85%; p=0.01) and retropharyngeal and/or parapharyngeal abscesses (45.45%; p=0.04) Conclusion: Our study demonstrates a sizeable reduction in adult admissions for ENT infections since the introduction of Covid-19-related physical interventions. There is evidence to support the use of physical interventions in the prevention of viral transmission of respiratory disease. Preventing ENT infections requiring admission through simple physical interventions could be of great benefit to the quality of life of patients and economical benefit to healthcare systems.

Estimating the burden of adult hospital admissions due to RSV and other respiratory pathogens in England

Respiratory Syncytial Virus (RSV) is a common seasonal respiratory virus and an important cause of illness among infants, but the burden of RSV disease is not well described among the older population. The objective of this study was to estimate the age-specific incidence of hospital admission among over 65s due to respiratory illnesses attributable to RSV in England to inform optimal vaccine and therapeutic interventions. We used linear multiple regression to examine the effect of changes in weekly counts of respiratory pathogens on the weekly counts of respiratory hospital admissions. The study population was all patients aged 65 years or over admitted to English hospitals between 2nd August 2010 and 30th July 2017. RSV was estimated to account for a seasonal annual average of 71 (95% CI 52-90) respiratory admissions per 100,000 in adults age 65-74 and 251 (95% CI 186-316) admissions per 100,000 adults age 75+. Pneumococcus was the pathogen responsible for highest annual average respiratory admission with 448 (95% CI 310-587) admissions per 100,000 adults age 65-74 and 1010 (95%CI 527-1493) admissions per 100,000 adults aged 75+. This study shows that RSV continues to exert a significant burden of disease among older adults in England. These findings will support development of policy for the use of RSV therapeutics and vaccines in this age group.

VARIATION IN TREATMENT APPROACHES TO ADOLESCENT MIDSHAFT CLAVICLE FRACTURES IN PEDIATRIC VERSUS ADULT HOSPITALS

Background: Optimal treatment of midshaft clavicle fractures in adolescents remains a topic of controversy. While adolescent midshaft clavicle fractures have historically been treated nonoperatively, recent randomized controlled trials of displaced midshaft clavicle fractures in the adult literature have raised the question of decreased symptomatic nonunion and malunion and improved functional outcomes with surgery. Consequently, the rates of surgical treatment of adolescent midshaft clavicle fractures, particularly in the older adolescent age group, has increased, despite a paucity of high-level evidence to justify this trend. Hypothesis/Purpose: To identify differences in treatment approach for isolated, displaced midshaft clavicle fractures in ‘older’ adolescent patients at adult versus pediatric hospitals. The secondary objective was to identify factors associated with surgery. Methods: Adolescents aged 15 to 18 years with isolated, displaced midshaft clavicle fractures treated at one of two adult tertiary care hospitals or one pediatric tertiary care hospital. Exclusion criteria included open fractures, skin tenting, nondisplaced fractures, medial third or distal third clavicle fractures, non-isolated injuries, and delay from injury to presentation of more than 2 weeks. Bivariate analysis and multivariable logistic regression analysis were used to identify factors associated with surgical treatment. Results: Two hundred and fourteen patients (median age: 16 years, mean BMI: 22.5, 85% male) were included. The cohort from the pediatric hospital was significantly younger, had lower BMI, had fewer comminuted fractures, and a higher proportion of angulated fractures (Table 1). One hundred six (50%) patients underwent surgical treatment. Bivariate analysis showed that older age (p = 0.004), higher BMI (p = 0.002), dominant upper extremity injury (p = 0.001), and treatment at an adult hospital (p < 0.0001) were associated with surgery. The fracture characteristics of comminution (p < 0.0001), greater displacement (p < 0.0001), and greater shortening (p < 0.0001) were associated with surgery. Multivariable logistic regression analysis showed superior-inferior fracture displacement (OR 1.13, 95% CI 1.06 to 1.20), dominant upper extremity injury (OR 2.60, 95% CI 1.19 to 5.67), and treatment at an adult hospital (OR 5.28, 95% CI 2.28 to 12.2) to be independently associated with surgery. Conclusions: After controlling for relevant demographic and fracture characteristics, adolescent patients treated at adult hospitals for displaced midshaft clavicle fractures have more than 5 times the odds of surgical treatment than those treated at a pediatric hospital. Significant practice variation across institutions reflects ongoing controversy in surgical indications and underscores the need for high quality prospective outcomes studies. [Table: see text]

Ophthalmological masks of a new coronovirus infection

Goal. To present a clinical and statistical analysis of the somatic status and ophthalmological manifestations of the new coronavirus infection in patients treated in a round-the-clock ophthalmological hospital. Materials and methods. The clinical, laboratory and instrumental data of 12 patients with a new coronavirus infection treated in the ophthalmology department of the adult hospital of the Regional Clinical Hospital No. 2 from February 2020 to May 2021 were analyzed. Results. The structure of nosologies is represented by the following diseases: corneal ulcer – 33.3% (4/12), of which men – 25% (3/12), women – 8.3% (1/12); phlegmon of the orbit – 8.3% (1/12); combined corneal and vascular lesions (keratouveitis) – 16.6% (2/12); nerve tissue damage (optic neuritis, neuroretinovasculitis) – 16.6% (2/12); vascular lesions are represented by chronic iridocyclitis OD in the acute stage and panuveitis of fungal etiology – 16.6% (2/12); the lesion of the central retinal vein (CVC) is represented by partial thrombosis of its upper-temporal branch – 8.3% (1/12). The development of the disease is associated with the presence of systemic atherosclerosis and hypertension, or trauma to the visual organ. Conclusions. Ophthalmic masks of a new coronavirus infection are more common in men. The trigger factors include systemic atherosclerosis, arterial hypertension, or trauma to the eyeball, blood pathology, chronic diseases of the gastrointestinal tract, diabetes mellitus.

Racial Disparities in 7-Day Readmissions from an Adult Hospital Medicine Service

Background Health systems have targeted hospital readmissions to promote health equity as there may be racial and ethnic disparities across different patient groups. However, 7-day readmissions have been understudied in adult hospital medicine. Design This is a retrospective study. We performed multivariable logistic regression between patient race/ethnicity and 7-day readmission. Mediation analysis was performed for limited English proficiency (LEP) status. Subgroup analyses were performed for patients with initial admissions for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and cancer. Patients We identified all adults discharged from the adult hospital medicine service at UCSF Medical Center between July 2016 and June 2019. Main Measures The primary outcome was 7-day all-cause readmission back to the discharging hospital. Results There were 18,808 patients in our dataset who were discharged between July 2016 and June 2019. A total of 1,297 (6.9%) patients were readmitted within 7 days. Following multivariable regression, patients who identified as Black (OR 1.35, 95% CI 1.15–1.58, p <0.001) and patients who identified as Asian (OR 1.26, 95% CI 1.06–1.50, p = 0.008) had higher odds of readmission compared to white patients. Multivariable regression at the subgroup level for CHF, COPD, and cancer readmissions did not demonstrate significant differences between the racial and ethnic groups. Conclusions Black patients and Asian patients experienced higher rates of 7-day readmission than patients who identified as white, confirmed on adjusted analysis.