Hospital Beds Research Articles

Comparison of demographics, mortality outcomes and resource utilization in early-onset versus later-onset pancreatic cancer: An analysis of the US National Inpatient Sample (NIS).

700 Background: Pancreatic cancer is associated with higher mortality, with 5-year relative survival of 12%. Early-onset pancreatic cancer (EOPC) is relatively uncommon and is seen in 5-12% of the cases. Recent studies indicate a rising trend in the incidence of EOPC. In this study, we categorized EOPC for ages less than 50 and later-onset pancreatic cancer (LOPC) for ages above or equal to 50 years. The aim of the study is to understand difference in demographics, mortality, and resource utilization between the two sub-categories of patients admitted to acute care hospitals in the United States. Methods: This is a retrospective cohort study of adult patients hospitalized with pancreatic cancer as the primary diagnosis at acute care hospitals across the United States in 2021, using the National Inpatient Sample (NIS) database. International Classification of Diseases, 10th Revision (ICD-10) codes were utilized to identify patients with a primary diagnosis of pancreatic cancer. The primary outcome is comparing demographics and in-hospital mortality between EOPC and LOPC. The secondary outcomes are length of stay (LOS) and total hospitalization charges. We performed multivariate logistic regression analysis to assess in-hospital mortality, LOS, and total hospitalization charges after adjusting for potential confounders such as sex, race, Charlson comorbidity index, hospital teaching status, and hospital region. Results: Our study included 38,654 patients with pancreatic cancer, of which 2,242 were EOPC and 36,412 were LOPC. The majority of the baseline characteristics were similar in both groups, except that EOPC has a higher Hispanic population (16.06% versus 8.77 %, p < 0.001), higher Medicaid as the payer source (28.28 % versus 7.32%, p < 0.001), and a more significant number of patients admitted to an urban teaching hospital (89.2 % versus 85.2%, p < 0.05) compared to LOPC subpopulation. No statistically significant difference in mortality was found between the two sub-categories (odds ratio 0.97, 95 % CI 0.60-1.5). Charlson index, hospital location, hospital bed size, and hospital region are independent predictors of mortality. There was no statistically significant difference between the two sub-categories for mean length of stay and total hospitalization charges. Conclusions: No significant difference was observed between EOPC and LOPC regarding in-hospital mortality, total length of stay, and total hospitalization charges. Our study highlights that EOPC disproportionately affects the Hispanic population and also a greater number of EOPC patients being admitted to urban teaching hospitals. Future research is needed to understand the disproportionate effect on the Hispanic population in the EOPC group and continued research in the domain, as the incidence of early-onset pancreatic cancer is expected to rise.

Fluoroquinolone consumption and resistance after an Antibiotic Stewardship Team intervention-an interventional study in a single hospital in southern Poland from 2018-2023.

Among the many classes of antibiotics, fluoroquinolones (FQ) are widely used in empiric treatment. Unfortunately, resistance to FQ is progressively rising. Using in hospital surveillance data and following the recommendations of the U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA), our Antibiotic Stewardship Team (AST) decided to pursue a restrictive policy for FQ utilization. The aim of this study was to evaluate the impact of an AST intervention restricting FQ use with pre-authorization to determine its effectiveness in decreasing FQ consumption and resistance. This study was conducted in a 650-bed hospital in southern Poland during 2018-2019 and 2022 (pre-intervention period, pre-IP) and 2023 (post-intervention period, post-IP). Antibiotic consumption (ABC) and antibiotic resistance (ABR) were compared in the pre-IP to the post-IP after an intervention restricting FQ use with pre-authorization was implemented. ABC was expressed as a DDD per 1000 pds (DDD/1000 pds) and ABR was expressed as a resistance rate (RR) parameter based on combined resistance to FQ in select Gram-negative bacilli. In the analyzed period, general ABC of all antibiotics varied significantly from 2,987.7 DDD/1000pds in 2018 to 3,741.1 DDD/1000pds in 2023. The urology ward showed a statistically significant decreasing FQ consumption from 358.9 DDD/1000pds in 2018 to 43.4 DDD/1000pds in 2023 (R= -0.952, p <0.001). A decrease in FQ consumption as a proportion of total ABC was observed during the study period (40.2 to 4.1%). A 25% reduction in the RR to FQ was observed, with the greatest difference between 2022 (69.9%) and 2023 (52.6%). This study demonstrates the effectiveness of FQ restriction and pre-authorization in a hospital without vast resources and it should encourage such interventions in other hospitals.

P-898. Reproducible profiling of eight Brazilian infectious diseases specialist training sites through open databases

Abstract Background Many factors influence the choice of a specialty and a residency training site after essential medical education, including hospital characteristics. We set out to explore characteristics of infectious diseases (ID) and pediatric ID training sites in one Brazilian state, aiming to provide a data-driven input into residency site choice. Number of hospitalizations and age and sex of patients (A) Absolute number of hospitalizations per institution in the 10-year period, and (B) proportion of hospitalizations in each institution along the years. (C) Violin plots of ages for each institution with the same maximum width, and inner boxplots with width proportional to hospitalization count. (D) Frequency plots of male and female patients hospitalized in each institution, with (E) corresponding area plots adding to 100% for every age. Methods We performed a retrospective, descriptive study of hospitalizations in institutions which offer ID and/or peds ID medical training, using Ministry of Health openly available hospitalization databases as sources. We used R software version 4.3.1 for analysis to ensure reproducibility. Procedures performed, length of hospital stay and intensive care unit costs per institution (A) Proportion of diagnostic, clinical, surgical and transplant procedures carried out in each hospital. (B) Proportion of specialty associated with hospital bed used for each hospitalization. (C) Violin plots of days of hospital stay for each institution. (D) Violin plots of total ICU costs (US dollars, log scale) in each hospitalization for each hospital; (E) the same plot, after removing COVID hospitalizations. Results Eight institutions from Rio de Janeiro (RJ) fit the criteria and had available data. From January 2013 to December 2022, they carried out 583,362 hospitalizations. Two hospitals (HGNI, HUPE) accounted for 56.6% of these. The hospitals with peds ID positions (IPPMG, IFF) have different age distributions because one also admits birthing mothers. Most admissions were due to clinical or surgical procedures, with a minority cataloged as diagnostic procedures or cell, tissue and organ transplants. Most patients were discharged within 7 days. HUCFF had the highest proportion of diagnostic and transplant procedures (1.88% and 2.12%, respectively). On average, university hospitals are paid 2∼3 times as much as other institutions per hospitalization. Overall disease burden was diverse, but INI stood out as a center for HIV care. Proportions of ICD-10 chapters or subchapters as leading causes of hospitalization Heatmaps with unsupervised clustering of ICD-10 chapter or subchapter frequency as leading cause of hospitalization, for all hospitalizations (A), for hospitalizations filed under “clinical treatment of infectious and parasitic diseases” or “clinical treatment of HIV/AIDS” (B), or for hospitalizations filed under ICD-10 chapters I or VI (C). Conclusion Hospitals in RJ with ID and peds ID residency spots have distinct workloads, patient profiles, disease burden and government-paid income. Residents from these programs might express similar views, but they do not necessarily reflect the widest picture, and might not be accessible to all interested candidates. Although subjectivity should not be discarded when choosing a training site, open data can inform more precise, transparent distinctions. For example, candidates interested in transplant ID could be more inclined to choose HUCFF, while candidates interested in less complex care could opt for HGNI. The framework we provide can also be employed to analyze other programs and hospitals, such as surgical residencies. Not all hospitals with residency positions feed these databases, thus limiting our analysis. Disclosures All Authors: No reported disclosures

P-364. Outbreak of bla-OXA-48 in the eastern part of Singapore

Abstract Background Changi General hospital (CGH) is a 1000 bed acute hospital that mainly serves the general population in the eastern region of Singapore and community. At the beginning of October 2023 till March 2024, we observed an increase in the number of the Carbapenemase producing Enterobacteriaceae (CP-CRE) bla-OXA-48 cases from the routine long-stayer inpatient surveillance screening in several wards. Methods Standard outbreak protocols are executed, including enhanced environmental testing and disinfection, inpatient contact tracing, and Box-PCR typing of Klebsiella pneumoniae spp. isolates. Results 68% (n = 226) of the bla-OXA-48 are identified from the outbreak wards, of which 15% (n = 33) cases is likely due to the additional beds added in the outbreak wards, reported an OR of 3.6 times (p-value: 0.007, 95%CI: 1.3 – 9.0) of being colonized by bla-OXA-48 CP-CRE compared to the non-outbreak wards. Patients from the outbreak wards have 2.7 times higher odds of requiring significantly more nursing care compared to the non-outbreak wards (p-value: 0.009, 95%CI: 1.3 – 5.7). The limited space to manoeuvre during nursing care, especially during diaper changing for the bed bound patients which is 61% (n = 139) of bla-OXA-48 CP-CRE cases in the outbreak wards. Among the bedbound patients, the odds of being colonized with bla-OXA-48 CP-CRE is 5.6 times (p-value: 0.008, 95%CI: 1.3 – 24.7) in the outbreak wards compared to the non-outbreak wards due to possible surface contamination when the curtains are drawn during the diaper changing or through accidental contact with the adjacent beds by the healthcare workers. The microbiological typing suggests 2 common types are circulating between patients in the outbreak wards in 79% (n = 58) of the samples tested. 3% (n = 194) of the environmental samples are positive for bla-OXA-48 detected in the toilet and drains, used only by ambulating patients during their hospitalization. No incidences (n = 75) of community onset of bla-OXA-48 CP-CRE is reported form a point prevalence survey (PPS). Conclusion Hence, bla-OXA-48 CP-CRE transmission is more likely from healthcare worker transmission. Ensuring adequate spacing between hospital beds is crucial to facilitate the work of healthcare staff, allowing them to move freely and efficiently while providing care. Disclosures All Authors: No reported disclosures

P-1323. Forecasting the incidence of acute respiratory infections in Uzbekistan, 2022-2023

Abstract Background Acute respiratory infections (ARIs) are a significant cause of morbidity and mortality worldwide, and this is particularly evident in regions such as Uzbekistan within Central Asia. Forecasting ARIs allows public health authorities to anticipate and prepare for surges in cases. This includes ensuring that healthcare facilities have adequate resources, such as hospital beds, ventilators, medicines, and personal protective equipment (PPE). Therefore, we aimed to predict the incidence of ARIs in Uzbekistan and respond to public health threats in a timely and appropriate manner.Figure 1.Short-term prediction of incidence acute respiratory infections in Uzbekistan, 2022-2023 Methods We conducted a retrospective study using weekly data on the incidence of ARIs reported in Uzbekistan between January 2022 and November 2023. Two models were selected to predict the number of ARIs cases. The first model, based on prediction using the EpiNow2 package, was used for short-term prediction for 2 weeks, and the second model, from the nnetar package, based on neural networks for prediction of univariate time series, was used for prediction for the next 12 weeks. Data analysis was performed in R version 4.3.2.Figure 2.Long term prediction of incidence acute respiratory infections in Uzbekistan, 2022-2023 Results The short-term forecast for the following 2 weeks showed a possible increase in case numbers (rate of growth = 0.011 (95% CI 0.004 - 0.028)). The model predicts 2,310 (767 - 2,939) new cases by infection date. At the end of the forecast period, the model predicted 5,711 (2,486 - 39,623) new cases of ARIs per week . The long-term model predicted 217,469 (176,261 - 247,929) new infections over the next 12 weeks. At the same time, the peak incidence was predicted to occur in December 2023. In that month, the model predicted 19,817 (17,340 - 22,303) new infections per week. When evaluating the accuracy of the model, we found that the predicted values were lower than the actual number of cases (mean absolute percentage error (MAPE) of the first model = 0.68, MAPE of the second model = 0.39). Conclusion The selected models of forecasting make it possible to determine the possible number of cases, although they underestimate values of these cases. The country needs to collect data on risk factors to better predict the incidence of ARIs. However, short- and long-term forecasting models can help to adjust public health response. Disclosures All Authors: No reported disclosures

P-805. Factors associated with mortality and morbidity of patients with methicillin-resistant Staphylococcus aureus bacteremia in a regional hospital

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is a critical health issue. This retrospective study aimed at identifying factors associated with adverse clinical outcomes in MRSA bacteremic patients admitted to Kwong Wah Hospital, an 800-bed regional hospital in Hong Kong, China. It was approved by the Kowloon Central/Kowloon East Cluster Research Ethics Committee, Hospital Authority (KC/KE-23-0107/ER-4). Methods Patients aged 18 years or above with MRSA bacteremia between 2020 and 2022 were identified. Their demographics and clinical background were summarized in Table 1. The primary and secondary outcomes were 30-day all-cause mortality and intensive care unit (ICU) admission, respectively. Results Of the 115 patients included, 112 (97.4%) received intravenous vancomycin as the first line antibiotic, 59 (51.3%) developed complicated bacteremia and 17 (14.8%) necessitated second line antibiotics (Figure 1). Thirty-six (31.3%) died within 30 days of positive blood culture for the first time and 14 (12.2%) needed ICU care. Among the 44 (38.3%) patients attended by an infectious disease (ID) doctor, there was a higher chance to receive echocardiogram (77.3% vs 56.3%), computed tomography (52.3% vs 8.45%), surgical removal of infective foci (43.2% vs 12.7%), and numerically lower deaths (20.5% vs 38.0%) compared to those who were not. ID consultation, along with younger age, lower Charlson comorbidity index, longer duration of antibiotics, and those without altered mental status or hypothermia, were noted to favor survival in univariate analysis (Table 2). By multivariate logistic regression, older age, higher C-reactive protein, altered mental states, and shorter antibiotic duration were significantly associated with mortality while ID consultation, vancomycin MIC &amp;gt;= 1 μg/mL, and congestive heart failure were associated with ICU admission (Table 3). Conclusion MRSA bacteremia resulted in high mortality. ID consultation might have contributed to a greater effort in searching for surgically removable infective foci and a numerically lower death rate. Its association with ICU admission might suggest that sicker patients require greater expertise from ID doctors. Disclosures All Authors: No reported disclosures

P-830. Comparison of Oral Antibiotic Use and Hospital Readmission Among People Who Use Drugs with Staphylococcus aureus Bacteremia and Before Medically Advised Discharge During Two Time Periods

Abstract Background Recent studies suggest the benefit to salvage oral (PO) antibiotics to support people who use drugs (PWUD) with serious bacterial infections who leave before medically advised (BMA) prior to completing antibiotics. We compared the use of PO antibiotics in PWUD with S. aureus bacteremia (SAB) discharged BMA before versus after the implementation of a multidisciplinary discharge planning conference for PWUD requiring long-term antibiotics and publication of recent literature suggesting the benefit of PO antibiotics for patients leaving BMA. Methods We performed a retrospective chart review of PWUD with SAB admitted to a 500-bed teaching hospital over two time periods: 1/1/16 to 12/31/17 (group A) and 7/1/21 to 7/31/23 (group B). We compared 30 and 90-day readmission, PO and IV antibiotic recommendations, prescriptions, and percent of prescriptions dispensed. Results There were 21 patients in group A and 20 in group B. Univariable analysis showed no significant difference in the groups (Table 1). The incidence of 30 and 90-day readmission was similar (48% vs 50%, p=0.65) and (57% vs 65%, p=0.85), respectively. Long-acting antibiotics were administered on BMA discharge in 1 patient in group A and 8 in group B. PO antibiotic/s were prescribed on BMA discharge for 33% in group A and 50% in group B. While no patients in Group A filled their prescriptions, 35% in Group B did. When incorporating PO treatment that was dispensed and long-acting antibiotics administered, only 5% (1/21) in group A received treatment on BMA discharge compared to 75% (15/20) in group B. Conclusion There was an improvement in providing recommendations and prescriptions for PO antibiotics as well as long-acting injectable antibiotics to provide treatment in situations of BMA discharge. These results suggest an impact of the publication of recent literature and our multidisciplinary discharge planning conference but still highlight room for improvement in recommending and prescribing PO antibiotics for PWUD with SAB who leave the hospital BMA. The lack of benefit in readmissions is likely due to the small sample size and limited duration of follow-up. Disclosures Monica K. Sikka, MD, F2G: Grant/Research Support

P-1596. Procalcitonin: A Promising Tool in Post COVID-19 Antibiotic Prescribing at a Community Teaching Hospital

Abstract Background A rise in antibiotic use was universally observed during the COVID-19 pandemic. Use of procalcitonin (PCT) in understanding the bacterial burden of disease both in the context of COVID-19 and other infections continues to be associated with much debate. Our hospital saw a precipitous rise in antimicrobial use during COVID-19, despite ongoing efforts of antimicrobial stewardship. We looked to PCT to help curb antibiotic overprescribing following the COVID-19 pandemic. Hospital wide SAAR Methods This was a single-center, before and after study to evaluate the impact of PCT implementation at a 500-bed community teaching hospital on antimicrobial usage. Education was provided to all providers before and during PCT implementation. A lab order was added to the existing sepsis clinical pathway and a pocket card detailing the appropriate use of PCT for approved indications (lower respiratory tract infections and sepsis) was provided to clinicians. For the primary outcome, we evaluated the standardized antimicrobial administration ratio (SAAR) before and after PCT implementation. Secondary outcomes included antibiotic consumption as described by days of therapy (DOT) per 1000 days present (DP), change in antimicrobial cost, appropriateness of testing and adherence to the PCT prescribing algorithm included in the pocket guide. ICU SAAR Results Since becoming available at our hospital, PCT has been ordered on average 583 times per month. On average, monthly SAARs were 8.4% lower during post-PCT period (1.06 vs 0.98; p=0.0011) (Figure 1). A decline was observed in both intensive care units (ICU) as well as non-ICU inpatient wards (Figure 2, 3). Total antimicrobial utilization decreased by 8.5% (550 vs 503 DOT/1000 DP), which translated to a 19.3% reduction in antimicrobial spending. Appropriateness of the initial PCT testing was 74% and appropriate discontinuation of antibiotics based on PCT algorithm was 80% during 18-months of PCT use. Non-ICU SAAR Conclusion Our findings suggest that appropriate use of PCT added to antimicrobial stewardship can be a valuable tool in both ICU and non-ICU settings. Disclosures Elizabeth Nothdurft, PharmD, BCPS, BCIDP, Abbvie: Honoraria Nirmol Philip, MD, MPH, Nestle: Honoraria

P-802. The Predictive Accuracy of Clinical Covariates in Differentiating Staphylococcus aureus Bacteremia with and without Deep-Seated Foci of Infection via Application of Different Variable Selection Methodologies

Abstract Background Staphylococcus aureus bacteremia (SAB) is a common bloodstream infection with a mortality rate of 20-30%. SAB is frequently associated with deep-seated foci of infection (DSFI) for which IDSA/ESCMID draft guidelines propose using clinical features early in evaluation to risk stratify for DSFI. However, literature for using combinations of clinical features to identify DSFI is limited, and the best process of variable selection is not defined. We explored variable selection methods to identify a combination of clinical features with the best predictive accuracy for identifying SAB with DSFI. Methods 242 adults admitted to a 500-bed teaching hospital in Portland, Oregon with incident SAB between January 1, 2016 and December 31, 2017 were included. Patients who died, transitioned to comfort or discharged before medically advised within 7 days, or without an infectious disease consultation were excluded. Clinical information was abstracted from electronic medical records. We performed four variable selection methods: best subset, forward and backward stepwise regression, and the LASSO. Variables were selected using 5-fold cross-validation. We estimated the area under the receiver operating curve (AUC) and fit a multivariable logistic regression model to evaluate the expected performance of the predictor combinations. Results The cohort is described in Table 1 and 2. SAB with one or more DSFI was diagnosed in 65% (n=158). Predictors selected by the four methods are described in Table 3. The combination of bacteremia duration, hospital acquired SAB (haSAB), central venous catheter (CVC), skin and soft tissue infection (SSTI), and any cardiac device had the highest predictive accuracy with an AUC of 82%. The odds of DSFI is estimated to increase by 32% (95% CI; 15% to 53%) for every 1 day increase in bacteremia after adjusting for haSAB, CVC, SSTI and any cardiac device (Table 4). Conclusion Duration of bacteremia, haSAB, and CVC were included regardless of the variable selection method. Our model shows that combinations of clinical features are more predictive of DSFI than any single feature. Larger studies in different cohorts are needed to verify the predictive accuracy of these variables used in combinations to risk stratify for SAB with DSFI. Disclosures All Authors: No reported disclosures

639. A Decade-Long Analysis of Ventilator-Associated Pneumonia in the Intensive Care Unit of a Public Hospital in a Major Brazilian City: An Exploration of Trends, Challenges, and Opportunities

Abstract Background Ventilator-associated pneumonia (VAP) remains a critical issue in ICUs. This study investigates VAP dynamics over the past decade by examining trends in its incidence, shifts in etiological agents and their antimicrobial sensitivities, and factors affecting patient mortality.Figure 1Ten-Year Trend of Ventilator-Associated Pneumonia Incidence in the ICU of a Major Brazilian Public Hospital: Initial Reduction Reversed in 2020 Due to the COVID-19 Pandemic; Current Levels (2021-2023) Show a 23% Decrease Compared to the Start of the Series (2014-2016). Ten-Year Trend of Ventilator-Associated Pneumonia Incidence in the ICU of a Major Brazilian Public Hospital: Initial Reduction Reversed in 2020 Due to the COVID-19 Pandemic; Current Levels (2021-2023) Show a 23% Decrease Compared to the Start of the Series (2014-2016). Methods Surveillance of ICU patients on mechanical ventilation in a 300-bed public hospital in Belo Horizonte, Brazil (Jan/2014-Dec/2023) followed the National Healthcare Safety Network protocol. Logistic regression analyzed VAP mortality risks. Microorganism clusters were identified using dynamic programming to determine edit distances between pseudoDNA strings, which were formed from concatenated antimicrobial sensitivity results (S, R, I) for each strain.Figure 2Ten-Year Trends in VAP Etiology in the ICU of a Major Brazilian Public Hospital: Despite Variations in Predominant Agents, the Same Bacteria (e.g., Acinetobacter, Staphylococcus aureus, Pseudomonas, Klebsiella, Serratia) Have Consistently Caused VAP Throughout the Decade. Ten-Year Trends in VAP Etiology in the ICU of a Major Brazilian Public Hospital: Despite Variations in Predominant Agents, the Same Bacteria (e.g., Acinetobacter, Staphylococcus aureus, Pseudomonas, Klebsiella, Serratia) Have Consistently Caused VAP Throughout the Decade. Results From 2014 to 2023, there were 1,166 VAP cases (20.9 cases per 1,000 ventilator-days). Initially, the incidence of VAP decreased significantly until 2019, but a rising trend began in 2020 and persisted through 2022 (Fig. 1). The predominant etiological agents, Acinetobacter, Staphylococcus aureus, Pseudomonas, and Klebsiella, accounted for 70%-80% of cases (Fig. 2). Antimicrobial sensitivity remained relatively stable over the decade, with a notable decline only in 2023 (Fig. 3). PseudoDNA analysis for Acinetobacter baumannii revealed two clusters: a small multisensible cluster (4% of strains) and a larger multiresistant cluster present throughout the decade (Fig. 4). The same pattern was observed for the other predominant microorganisms. A logistic regression model predicting mortality in VAP patients identified four significant predictors (area under the ROC curve = 0.68): patient age, time from hospitalization to pneumonia diagnosis, secondary sepsis (Odds Ratio = 2.6), and number of prior hospitalizations at the same hospital.Figure 3Ten-Year Trends in Antimicrobial Sensitivity of Acinetobacter, Pseudomonas, Klebsiella and Staphylococcus aureus Causing VAP in the ICU of a Major Brazilian Public Hospital: Increased Resistance Observed in 2023. Ten-Year Trends in Antimicrobial Sensitivity of Acinetobacter, Pseudomonas, Klebsiella and Staphylococcus aureus Causing VAP in the ICU of a Major Brazilian Public Hospital: Increased Resistance Observed in 2023. Conclusion We addressed three key questions on VAP: 1) Despite a temporary increase in 2020, we achieved a 23% overall reduction in VAP incidence, though it remains above benchmark levels. 2) The etiology of VAP has been consistent over the decade, but antimicrobial sensitivity has deteriorated. 3) Age, time from hospitalization to pneumonia diagnosis, prior admissions, and notably, secondary sepsis, are significant risk factors for VAP mortality.Figure 4PseudoDNA Cluster Analysis of Acinetobacter baumannii Showing Two Distinct Groups: A Small Multisensible Cluster (4% of Strains) and a Predominant Multiresistant Cluster Persistent Over the Decade PseudoDNA Cluster Analysis of Acinetobacter baumannii Showing Two Distinct Groups: A Small Multisensible Cluster (4% of Strains) and a Predominant Multiresistant Cluster Persistent Over the Decade Disclosures All Authors: No reported disclosures

P-699. The Impact of Low Influenza Immunization rates on U.S. Hospital System Resources. A Dynamic Model estimation

Abstract Background Increasing influenza vaccination rates can significantly reduce the onset of severe symptoms and reduce the risk of complications. This helps alleviate the burden during flu seasons when hospitals may be overwhelmed with patients. Nevertheless, the overall vaccine uptake has been decreasing in the United States which is expected to have an important effect by increasing the burden of disease. The aim of this study was to estimate the impact of low influenza vaccination rates on disease burden and U.S. hospital system resources. Methods The impact of the reduced flu immunization rate was estimated using a dynamic age-stratified transmission model. Two U.S. flu seasons (2011-2012 for low incidence and 2017-2018 for high incidence) were used in the analysis to simulate the variation of flu epidemic. This study assessed four different flu vaccination rates: 25%, 30%, 35% and 40%. Outcome measures include number of infections, outpatient visits, hospitalizations, intense care unit (ICU) stays and deaths. The flu vaccine effectiveness (VE) rate was taken from CDC reports to estimate an average VE for all ages for the last 10 seasons (42%). Vaccination rates by age group were estimated using CDC reports and this model assumed immunization with quadrivalent flu vaccines for all ages. Total number of acute hospital and ICU hospital beds available for influenza were assumed in the U.S. at 300,000 and 30,000, respectively. Results Using U.S. flu immunization rate from season 2023-2024 (≈35%), in case of a high flu incidence season, the total number of symptomatic infections is expected to result in 71M, office visits in 29M, hospitalizations in 0.94M and deaths in 133,670. Any scenarios with an immunization rate below 45% will generate significant pressure on the US hospital system and would saturate the number of ICU hospital beds in high incidence seasons. Only increasing the flu immunization rate up to 50% or higher may prevent any saturation of acute hospital or ICU hospital beds regardless on the incidence of the flu season. Conclusion The U.S. analyses shows the critical need to increase the U.S. flu immunization rates to at least 50%, to improve health outcomes and avoid saturation of hospital system resources, especially those associated to ICU hospital beds. Disclosures Van Nguyen, PhD, CSL Seqirus USA: Advisor/Consultant Joaquin F. Mould-Quevedo, PhD, CSL Seqirus USA: Stocks/Bonds (Private Company)

P-1129. Exploring Cost Savings through Reduced Sedation for Magnetic Resonance Imaging in Pediatric Osteomyelitis Diagnosis

Abstract Background Magnetic resonance imaging (MRI) is essential for the diagnostic workup of pediatric osteoarticular infection. In the pediatric population, sedation is often required to mitigate motion artifact and improve imaging quality, which contributes to cost, resource utilization, and risk to the patient. In 2021, our hospital implemented an evidence-based update to the pediatric osteomyelitis guideline adjusting MRI imaging sequences, which reduced sedation age requirements from 8 years to 3 years of age. This change was initiated in September 2021. This study evaluates economic implications of sedation reduction strategies in pediatric osteomyelitis imaging. Figure 1. Pre vs Post Guideline Sedation Rates. Methods This is a retrospective chart review study of pediatric patients evaluated for bone and joint infection by MRI at a free standing 299 bed hospital in Central Texas. Cases were pulled by MRI indication according to the hospital’s osteomyelitis guideline inclusion criteria between January 1, 2020 and December 31, 2023. Previously healthy children age 6 months to 18 years with physical exam suggestive of acute hematogenous osteomyelitis or septic joint and less than 14 days of symptoms were included. Cases were compared by year pre-guideline (2020-2021) and post-guideline (2022-2023) and reviewed for age, sex, need for sedation, and diagnosis after MRI. Cost savings estimates were based on an average per case cost of sedation. The cost of sedation was determined by hospital charges. Figure 2. Pre &amp; Post Guideline Sedated vs Non-Sedated Patients. Results 279 patients were included, (98 pre guideline change; 181 post guideline change). 61.3% male, 38.7% female, median age 6, IQR 6.5. A statistically significant reduction in sedation usage was observed after guideline implementation (50%-33%, p=0.0087) (fig 1). Among patients 3-8 years of age, 21 of 34 patients (62%) pre-guideline and 15 of 78 patients (19%) post- guideline received sedation (p&amp;lt; 0.001) (fig 2). An average estimated cost savings of $270,215 per year was found. There was no increase in repeat MRI rates seen with the implementation of the age requirement change. Conclusion Lowering the required age for sedation allows for individualized assessment of sedation needs in the 3-8 age group. This leads to improved patient care through decreased patient risk, reduction in overall rate of sedation and results in cost savings. Disclosures Brian Kaufman, MD, Johnson &amp; Johnson: Advisor/Consultant

P-1885. Continuous Infectious Diseases Coverage by Merging with a Hospitalist Practice in a Small Community Hospital System

Abstract Background There is a severe shortage of infectious diseases (ID) physicians in the United States, with &amp;gt; 80% counties without an ID physician. Insufficient compensation is a contributing factor, with many internal medicine graduates practicing as hospitalists. Based on community needs, we merged the ID practice into the hospitalists group to create an ID-Hospitalist position. Methods Corewell Health South is based in Berrien County, which is in Southwest Michigan, population 152,261, and includes large rural populations and several federally funded clinics. The hospital includes 2 acute care facilities, including 220-bed and 76 bed hospitals. In 2002, the ID physicians began seeing patients as hospitalists at a Long-Term Acute Care Hospital. An ID physician assumed the role of Hospitalist Director in 2005 and second physician became co-director in 2008. At that time, the ID service adopted a 7 day on-7 day off schedule and included primary hospitalist patients. Results Since 2011, the ID-Hospitalist group has had continuous coverage with at least 3 Full time and 1 part-time ID-Hospitalists. Coverage (2.63/100,000) exceeds the national average of 1.79/100,000 by 84%. All service weeks are based on a 7 day on-7 day off schedule. In 2013, the outpatient ID clinic was resumed after a 5-year hiatus and is Ryan White Funded. A clinic day is built into the 7-day work week. Over the last 22 years, the group has included 6 ID physicians, which include 5 American graduates and 1 international graduate. In surveying the group, 83% expressed that pay was a factor in working as an ID/Hospitalist. 67% reported more free time and improved work-life balance. 67% preferred doing ID only, although the majority enjoyed hospitalist practice. Perceived weaknesses included overextension of responsibilities and a de-emphasis on the ID service in favor of hospitalist responsibilities. Another limitation included inconsistent coverage at the smaller hospital, increasing the reliance on telephone consultations. Conclusion Merging an ID practice into a hospitalist group has been effective in sustaining an ID service. Strengths included stable salary support and ability to perform other administrative or clinical tasks. Weakness included a multitasking of duties. This may serve as a model for resource limited settings. Disclosures All Authors: No reported disclosures

Impact of the infected population and nonlinear incidence rate on the dynamics of the SIR model

This study proposes a dynamical epidemic model SIR incorporating a nonlinear saturated incidence and nonlinear recovery rates. The model considers the influence of available resources, the ratio of the infected population, and the decrease of interventions on the spread of infectious diseases. The use of a nonlinear incident rate as a monoid-type equation improves the study compared to a constant-type incident rate because the spread of infection is now determined by the force of the illness and the number of infected individuals available to disseminate the infection. The consideration of recovery rate, which includes the minimum and maximum feasible recovery rates and the amount of resources available for treatment, makes the research more advantageous. The conditions for the existence of the equilibria have been established. Furthermore, stability analysis and bifurcation have been carried out using Lyapunov’s direct method, the Routh–Hurwitz criterion, and Dulac’s creation under each set of conditions. A numerical simulation was conducted using MATLAB. As the value of the preventive measure increases, the results indicate a considerable decrease in the infected compartment. In addition, the recovered population is growing as more resources, such as oxygen cylinders, hospital beds, and vaccination doses, become available.

Influencing factors of hand, foot, and mouth disease based on structural equation modeling in Hubei, China

Hand, foot and mouth disease (HFMD) is a major public health issue in Hubei Province; however, research on the direct and indirect effects of factors affecting HFMD is limited. This study employed structural equation modeling (SEM) and geographically weighted regression (GWR) to investigate the various impacts and spatial variations in the factors influencing the HFMD epidemic in Hubei Province from 2016 to 2018. The results indicated that (1) with respect to the direct effects, the number of primary school students had the greatest positive direct effect on the number of HFMD cases, with a coefficient of 0.542. Socioeconomic factors strongly influence HFMD cases more directly than natural factors. (2) Concerning indirect effects, the minimum temperature, combined with the per capita disposable income of urban residents, had the greatest positive indirect effect on HFMD cases, with a coefficient of 0.022. Both natural and social factors had more substantial direct impacts on the HFMD epidemic than indirect impacts. (3) Regarding total effects, the number of primary school students, through various natural and social factors, had a total effect coefficient of 0.503 on HFMD incidence. (4) The number of primary school students, per capita GDP, and the number of hospital beds per thousand people had the most significant spatial impacts on HFMD cases. In underdeveloped regions, the HFMD epidemic is more heavily influenced by economic factors.

Genome drafting of nosocomial infection CRE Klebsiella pneumoniae confirming resistance to colistin and eravacycline, carrying blaNDM-1, mcr-1, and blaKPC-2, in neonatology from November to December 2023

BackgroundCarbapenem-resistant Klebsiella pneumoniae (CRKP) is a critical pathogen in healthcare settings, associated with high mortality due to its extensive antibiotic resistance. In this study, we report an outbreak of CRKP in a neonatal intensive care unit (NICU) within a 200-bed tertiary hospital. The main goal of this study was to characterize the phenotypic and genomic profiles of the CRKP isolates involved in the outbreak and to gain insights into their resistance mechanisms and transmission dynamics within the NICU.MethodsThe study was conducted between November and December 2023 in a 5-bed NICU. Monthly surveillance cultures were performed to monitor colonization and infection with multidrug-resistant organisms. CRKP isolates were obtained from blood and nasal swabs of affected neonates. Identification and antimicrobial susceptibility testing were initially conducted using the Vitek®2 system with an N-395 card and further confirmed by 16S rRNA sequencing. Whole-genome sequencing (WGS) and antimicrobial resistance (AMR) profiling were performed to identify resistance genes and virulence factors. For genetic analysis, both Illumina short-read and Nanopore long-read sequencing were used, followed by hybrid assembly for enhanced genome resolution. Plasmid and resistance gene profiles were determined using AMRFinder and PlasmidFinder databases.ResultsA total of three CRKP isolates (designated Kp1, Kp2, and Kp3) were identified. Kp1 and Kp2 belonged to sequence type (ST) ST23 and were genetically near-identical, differing by a single allele, while Kp3 was of a distinct sequence type, ST2096, with 245 allelic differences from Kp1 and Kp2. All isolates were resistant to colistin and carried resistance genes, including mcr-1 and blaNDM-1,blaKPC2 confirming carbapenem resistance. Efflux pump genes and aminoglycoside resistance genes were also detected, providing a multifaceted defence against antibiotics. Plasmid analysis identified several incompatibility groups (IncFI, IncHI, IncFIB, IncX), indicating the potential for horizontal gene transfer of resistance determinants.ConclusionThis study highlights the complexity of CRKP outbreaks in neonatal care, with isolates exhibiting resistance mechanisms that complicate treatment. The plasmid profiles suggest these strains are reservoirs for multidrug-resistant genes, emphasizing the need for strict infection control and ongoing genomic surveillance. For neonatal care, these resistance challenges increase the risk of treatment failures and mortality, underscoring the importance of enhanced infection prevention and novel therapeutic strategies.

Innovative telehospitalist model optimizes medical triage in collaboration with community emergency departments: A cross-sectional study.

Optimal hospital bed utilization requires innovative patient care models. We studied a novel hospitalist model utilizing telemedicine to facilitate collaboration with affiliated emergency departments (EDs) and support medical triage and care of ED patients with high likelihood of hospital admission. Telehospitalists based at a tertiary care facility collaborated with four community EDs in the same healthcare network between January 1, 2022, and April 30, 2023. Telehospitalists supported ED clinicians in medical care decisions and facilitated patient disposition. Emergency department length of stay (LOS) and disposition were evaluated, as were hospital LOS, 30-day readmission, and in-hospital mortality. For patients discharged from the ED, 7-day ED readmission and subsequent hospitalization were evaluated. Telehospitalists discussed 550 "admit-likely" patients with ED clinicians: 105 patients (19.1%) discharged from the ED and avoided admission; 322 patients (58.5%) were admitted to local or nearby community hospitals; 123 patients (22.4%) transferred to the tertiary care facility. Emergency department LOS differed significantly among disposition groups, including patients discharged home (10.2 h), admitted to local hospitals (12.6 h), and transferred to tertiary care hospitalist services (14.9 h; p < 0.001). Hospital LOS and in-hospital mortality were not significantly different among disposition groups. Patients admitted locally had lower 30-day readmission compared to those transferred to tertiary care facility (odds ratio = 0.59 [0.36, 0.99], p = 0.048). Telehospitalists as triage clinicians is an innovative approach to support local ED clinicians and patients. Telehospitalists optimized hospital bed utilization and healthcare system resources by facilitating safe discharges to home and expediting tertiary care transfers when necessary.

Diagnosis and management of type 2 diabetes mellitus in patients with ischaemic heart disease and acute coronary syndromes - a review of evidence and recommendations

Type 2 diabetes mellitus (T2DM) represents a major healthcare condition of the 21st century. It is characterised by persistently elevated blood glucose occurring as a result of peripheral insulin resistance and reduced insulin production which may lead to multiple long-term health conditions such as retinopathy, neuropathy, and nephropathy. The estimated number of individuals suffering from diabetes mellitus (DM) is expected to rise to 591 million by the year 2035 with 4.4 million in the United Kingdom (UK) alone, 90% of which is attributed to T2DM. Moreover, a significant proportion of individuals may have undetected diabetes mellitus, especially among those presenting with symptoms of ischaemic heart disease (IHD). This is particularly important in those individuals presenting with acute coronary syndromes (ACS) who are at the highest risk of complications and sudden cardiac death. Identifying abnormal levels of common biochemical markers of diabetes, such as capillary blood glucose or glycated haemoglobin (HbA1c) in these patients is important for early diagnosis, which will then allow for timely intervention to improve outcomes. However, a significant proportion of individuals who meet the criteria for the diagnosis of diabetes remain undiagnosed, representing missed opportunities for early intervention. This may result in a prolonged period of untreated hyperglycaemia, which can result resulting in significant further microvascular and macrovascular complications. There is an increased risk of IHD, heart failure, cerebrovascular accidents (CVA), and peripheral artery disease (PVD). These account accounting for 50% of deaths in patients with T2DM. Cardiovascular diseases in the context of diabetes particular represent a significant cause of morbidity and mortality with a two to three times higher risk of cardiovascular disease in individuals with T2DM than in those without the condition normo-glycaemia. In the United Kingdom UK alone, around 120 amputations, 770 CVA, 590 heart attacks, and more than 2300 presentations with heart failure per week are attributed to diabetes DM. with One 1 in six 6 hospital beds and around 10% of the healthcare budget may be being spent on managing diabetes DM or its complications. Therefore, it represents a significant burden on our healthcare system.

P1215 Hospital utilisation for ulcerative colitis in Australia, 1993–2022: a review of observational separation data

Abstract Background The prevalence of ulcerative colitis (UC) is compounding in Western nations, including in the Australasia region1. Mortality has fallen over the last 7 decades since the introduction of intravenous corticosteroids, but despite newer therapies, colectomy rates have not improved2, 3. UC is a chronic, relapsing and remitting condition, and flares lead to hospitalisations and significant costs4. In the era of advanced IBD therapies, understanding trends in admissions will guide cost management strategies. We aimed to assess hospital utilisation trends for UC in Australia between 1993-94 and 2021-22. Methods We obtained resident population figures from the Australian Bureau of Statistics and hospital data for the financial years 1993-94 and 2021-22 from the Australian Institute of Health and Welfare’s National Hospital Morbidity Database. We calculated the rate of hospital separations due to UC (ICD-10 code K51) per 100,000 residents, mean length of stay, and bed utilisation rate for UC admissions. The advent of biologics between 1993-94 and 2021-22 led to an increase in hospital separations and bed days, as each visit to an infusion unit is treated as a separate same-day hospital separation with a uniform length of stay of 1 day. Therefore, we also assessed the separation rate, mean length of stay, and bed utilisation rate for non-same-day separations (i.e., overnight or multi-day stays) to better reflect trends in acute UC flares requiring emergency treatment. Results Total hospital separations for UC grew by 841.1%, from 5,148 in 1993-94, to 48,447 in 2021-22; total patient days increased by 286.1%, from 18,396 to 71,034. Same-day admissions rose 1160.7%, from 3,499 to 44,111. Non-same-day hospitalisations grew by 163.0%, from 1,649 to 4,336, and total days in hospital for these multi-day stays grew by 80.7%, from 14,897 to 26,923. The rate of non-same-day hospitalisation increased by 80.0%, from 9.3 to 16.7 per 100,000 people. Mean length of stay for non-same-day admissions decreased by 31.2%, from 9.0 days to 6.2 days per stay. The bed utilisation rate for UC non-same-day admissions per 100,000 increased by 23.7% from 83.7 to 103.5 per 100,000 people. Conclusion Infusion unit visits for new biologics have driven a massive rise in same-day hospital separations with a primary diagnosis of UC. Despite treatment advances, the rate of non-same-day hospitalisations for UC has also grown, though more modestly, and although mean length of stay has shortened, overall bed utilisation rates due to non-same-day UC admissions have increased. These trends appear to reflect the increasing prevalence of UC in Australia, and healthcare cost modelling must factor this in going forward.

Optimising efficiency and patient-centredness in general hospitals: insights from data envelopment and matrix analysis.

Medical institutions face management challenges from intense competition and an unclear link between patient-centredness and profitability. This study examined the association between efficiency and patient-centredness in general hospitals and identified management strategies to optimise both. Data from the 2021 patient experience evaluation by the Health Insurance Review and Assessment Service and financial statements from the Korea Health Industry Development Institute for general hospitals in South Korea were used. Efficiency scores and patient-centredness were determined for 256 general hospitals using data envelopment analysis (DEA), and their relationships were analysed through matrix analysis. The Kruskal-Wallis and Mann-Whitney tests assessed group differences identified through matrix analysis. Efficiency and patient-centredness can be improved concurrently. Hospitals in the highest efficiency group reported significantly higher average inpatient revenue per 100 beds (179.67) and net profit (158.84) than those in lower-performing groups (p<0.001). Optimal management of hospital beds and specialised diagnostic equipment per 100 beds was associated with higher efficiency scores, while a greater number of doctors and nurses positively influenced patient-centredness metrics. Therefore, general hospitals should invest in personnel and resources to enhance efficiency and patient-centredness, achieving optimal financial and operational outcomes. This study combines DEA and matrix analysis to explore the link between hospital efficiency and patient-centredness, using recent data on patient experience and financials from South Korean hospitals. It identifies strategies to enhance both dimensions.