Positive Laboratory Test Research Articles

176. Antibiotic Resistance Patterns, Seasonality, and Correlation with the Influenza Season in the United States: A Multicenter Evaluation Reveals Surprising Association Between Influenza Season and Gram Negative Pathogens

BackgroundInfluenza infection may affect bacterial transmission dynamics and seasonality of antimicrobial resistance (AMR). There is a paucity of data on the association of influenza season and AMR rates. We aimed to describe trends of AMR and their correlation with the influenza season in ambulatory and inpatient settings in the United States (US). MethodsWe used the BD Insights Research Database (Franklin Lakes, NJ USA) to identify 30 day non-duplicate isolates collected from patients >17 years old with susceptibility profile of Gram-negative (GN) (Enterobacterales (ENT), P. aeruginosa (PSA), A. baumannii spp. (ACB), and S. maltophilia (Sm)) and Gram-positive (GP) pathogens (S. aureus (SA), and S. pneumoniae (Sp)) in up to 257 US healthcare institutions from 2011-19. We defined the outcomes as rates per 100 admissions and % of non-susceptibility (NS), stratified by community and inpatient settings, resistance type (resistance to carbapenem (Carb-NS), quinolone (FQ-NS), macrolide (Macr NS), penicillin (PCN NS), and extended spectrum cephalosporin (ESC NS)) and isolate origin (respiratory and non-respiratory). Influenza data were presented as the % of positive laboratory tests. We used descriptive statistics and generalized estimating equations models to evaluate the monthly trends of AMR outcomes and correlation with the influenza season.ResultsWe identified 16 576 274 confirmed non-duplicate pathogens, of which 154 841 were GN Carb-NS, 1 502 796 GN FQ-NS, 498 012 methicillin resistant SA (MRSA), and 44 131 Macr-NS, PCN-NS, and ESC-NS Sp. Among the Carb-NS pathogens, Influenza rate was correlated with % ACB-NS [β= 0.205, p< .001]. In the FQ-NS group, influenza was associated with overall % ENT-NS [β= 0.041 p< .001] and % PSA-NS [β= 0.039, p = .015]. For the GP pathogens, all Sp. rates were correlated with increased influenza positivity % (See Table). Only MRSA rates of respiratory source were associated with influenza [β= .066, p=.028].Summary of Multivariate regressions of AMR and % Flu by Source and Setting (controlling for hospital level factors): 2011-2019 Data in each cell is presented as the coefficient and p-value is in parentheses. ^adjusted for region, teaching, urban, bed size, and season. + p<.10 *p <.05 **p <.01 ***p <.001ConclusionOur study revealed surprising association between influenza epidemics and GN resistance and corroborated the evidence of correlation between respiratory GP and influenza infections. These insights may help inform targeted antimicrobial stewardship initiatives during influenza season.Disclosures Amine Amiche, PhD, Sanofi (Employee, Shareholder) Heidi Kabler, MD, Sanofi Pasteur (Employee) Janet Weeks, PhD, Becton, Dickinson and Company (Employee) Kalvin Yu, MD, BD (Employee) Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder)

Missing diagnoses of congenital cytomegalovirus infection in electronic health records for infants with laboratory-confirmed infection

Congenital cytomegalovirus (CMV) is a leading cause of non-genetic sensorineural hearing loss and neurodevelopmental disabilities among US children. Studies using administrative healthcare databases have identified infants with congenital CMV using diagnostic codes from the International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification. Using Cerner Health Facts deidentified electronic health records, we assessed the sensitivity of CMV diagnostic codes among infants with laboratory confirmed congenital CMV infection (i.e. a positive CMV laboratory test – polymerase chain reaction, direct fluorescent antibody, or culture from urine, saliva, respiratory secretion or blood samples, or IgM serology – within 21 days of life). During 2010–2017, 668 congenital CMV cases were identified among 7,517,207 infants with encounters within 21 days of life, or 0.89 cases per 10,000 infants. The sensitivity of CMV diagnostic codes assigned within 21 and 90 days of life was 10.3% (95% CI: 8.2–12.9) and 11.1% (95% CI: 8.9–13.7), respectively.

Impact of COVID-19 in Pregnant Women and Their Newborns

Impact of COVID-19 in Pregnant Women and Their Newborns

EVALUATION OF C - REACTIVE PROTEIN AS A PROGNOSTICATOR OF THE COURSE OF COVID 19 DISEASE

Diagnosis of COVID 19 is based on clinical manifestations, history of exposure, positive CT scan findings and laboratory tests. Inflammation plays a key role in pathogenesis of COVID 19. CRP is an acute phase protein in the serum and is also a surrogate marker for the pro inflammatory cytokine IL 6. Significant rise in CRP indicates clinically relevant inflammation. Aim and Objectives: To analyse the CRP levels in COVID 19 infected patients and to validate CRP as an indicator of the severity of SARS CoV 2 infection. Materials and Methods: This retrospective study was carried out at Chettinad Hospital and Research Institute, a tertiary care hospital situated on the outskirts of Chennai, India, for a period of 4 months. A total of 10263 patients were tested for COVID-19 by RT PCR. Viral RNA Extraction was automated and SARS CoV2 RTPCR performed with ROTOR GENE Q(QIAGEN) using SD Biosensor Real Time PCR kit. The CRP levels were measured using QDx Instacheck Fluorescence immunoassay system, Indianapolis, IN. Results: Among 10263 patients, 2694 (26.2%) patients tested SARS CoV-2 positive. CRP levels were measured for 1472 SARS CoV 2 patients (including both OP and IP). Among them 745 (50.6%) patients were found to be CRP reactive. Of the CRP reactive patients, 7 patients (0.9%) were &lt;18 years, 190 patients (25.5%) were between 18 - 45 years and 548 patients (73.5%) were &gt;45 years. Of the 592 patients with elevated CRP levels, 167 patients were from ICU and 425 patients were from non-ICU. Highly elevated CRP levels of &gt;100mg/L were found in 65% (n=109) of the COVID positive ICU patients and 23% (n=101) of the non-ICU patients. Increased CRP levels were noted in SARS CoV- 2 infected individuals. Elevated CRP was common among elder patients aged &gt;45 years and in males. Conclusion This study concludes that the significant rise of CRP levels was noted in hospitalized SARS CoV 2 positive patients aged &gt; 45 years. Thus, estimating the early rise of serum CRP levels in SARS CoV-2 patients is a well affordable and less invasive parameter to guide the clinicians that is readily available in all the health care centers.

A case of ocular neurosyphilis in a patient with HIV

A case of ocular neurosyphilis in a patient with HIV

Impact of Clostridioides difficile infection on patient-reported quality of life.

We investigated the quality of life (QoL) of patients hospitalized with C. difficile infection (CDI). Prospective survey study. US tertiary-care referral center, acute-care setting. Adults hospitalized with a diagnosis of CDI, defined as ≥3 episodes of unformed stool in 24 hours and a positive laboratory test for C. difficile. We surveyed patients from July 2019 to March 2020 using the disease-specific Cdiff32 questionnaire and the generic PROMIS GH survey. We compared differences in Cdiff32 scores among demographic and clinical subgroups (including CDI severity, CDI recurrence, and various comorbidities) using 2-sample t tests. We compared PROMIS GH scores to the general population T score of 50 using 1-sample t tests. We performed multivariable linear regression to identify predictors of Cdiff32 scores. In total, 100 inpatients (mean age, 58.6 ±17.1 years; 53.0% male; 87.0% white) diagnosed with CDI completed QoL surveys. PROMIS GH physical health summary scores (T = 37.3; P < .001) and mental health summary scores (T = 43.4; P < .001) were significantly lower than those of the general population. In bivariate analysis, recurrent CDI, severe CDI, and number of stools were associated with lower Cdiff32 scores. In multivariable linear regression, recurrent CDI, severe CDI, and each additional stool in the previous 24 hours were associated with significantly decreased Cdiff32 scores. Patients hospitalized with CDI reported low scores on the Cdiff32 and PROMIS GH, demonstrating a negative impact of CDI on QoL in multiple health domains. The Cdiff32 questionnaire is particularly sensitive to QoL changes in patients with recurrent or severe disease.

The Role of Pneumococcal Pneumonia among Community-Acquired Pneumonia in Adult Turkish Population: TurkCAP Study.

To evaluate the rate of pneumococcal pneumonia (PP) among patients with community-acquired pneumonia (CAP) in Turkey and to investigate and compare features of PP and non-PP CAP patients. This multicenter, non-interventional, prospective, observational study included adult CAP patients (age ≥ 18 years). Diagnosis of PP was based on the presence of at least 1 positive laboratory test result for Streptococcus pneumoniae (blood culture or sputum culture or urinary antigen test [UAT]) in patients with radiographic findings of pneumonia. Four hundred sixty-five patients were diagnosed with CAP, of whom 59 (12.7%) had PP. The most common comorbidity was chronic obstructive pulmonary disease (30.1%). The mean age, smoking history, presence of chronic neurological disease, and CURB-65 score were significantly higher in PP patients, when compared to non-PP patients. In PP patients, 84.8% were diagnosed based ony on the UAT. The overall rate of PP patients among CAP was calculated as 22.8% considering the UAT sensitivity ratio of 63% (95% confidence interval: 45-81). The rate of intensive care treatment was higher in PP patients (P = .007). While no PP patients were vaccinated for pneumococcus, 3.8% of the non-PP patients were vaccinated (P = .235). Antibiotic use in the preceding 48 hours was higher in the non-PP group than in the PP group (31.8% vs. 11.1%, P = .002). The CURB-65 score and the rate of patients requiring inpatient treatment according to this score were higher in the PP group. The facts that PP patients were older and required intensive care treatment more frequently as compared to non-PP patients underline the burden of PP.

COVID-19 Infection During Pregnancy and Associated Perinatal Health Outcomes: A National Cohort Study of US Pregnancies

Background: Emerging evidence suggests that COVID-19 infection is more severe in pregnant individuals and may be associated with increased risk of adverse perinatal health outcomes. However, few large-scale, community-based comparative epidemiological studies have evaluated pregnancy outcomes following COVID-19 infection.Methods: We conducted a national cohort study using de-identified administrative claims and electronic health record data from the OptumLabs® Data Warehouse. Every pregnancy with a last menstrual period before 30 April 2020 and date of pregnancy end after 11 March 2020 was included. We identified maternal infections using ICD-10-CM diagnostic code of U07.1 or a positive laboratory testing record for SARS-CoV-2. We compared the risk of adverse pregnancy outcomes using Cox proportional hazard models treating COVID-19 infection as a time-varying exposure, which were adjusted for baseline covariates.Findings: Of the 78,283 pregnancies identified, 2,655 (3·4%) had a documented COVID-19 infection. Infection was more prevalent among Black and Hispanic pregnant individuals and those with pre-existing medical conditions; 3·4% of COVID-19 cases required admission to intensive care, invasive mechanical ventilation or ECMO treatment. COVID-19 during pregnancy was associated with higher risk of medical termination (adjusted hazard ratio [aHR] 2·60; 95% CI 1·17, 5·78), cesarean section (aHR 1·99; 95% CI 1·71, 2·31), clinician-initiated preterm birth (2·88; 95% CI 1·93, 4·30), spontaneous preterm birth (aHR 1·79; 95% CI 1·37, 2·34), and fetal growth restriction (aHR 2·04; 95% CI 1·72, 2·43). Similar associations were observed by trimester of COVID-19 infection.Interpretation: Data from this US pregnancy cohort show increased risk of adverse pregnancy outcomes associated with prenatal COVID-19 infection during any trimester of pregnancy. Prevention of COVID-19 through vaccination, social distancing and other measures could prevent COVID-19-associated adverse pregnancy outcomes. Funding Information: Access to study data was financially supported by OptumLabs® and University of California Los Angeles. The WHO Collaborating Centre for Reference and Research on Influenza is supported by the Australian Government Department of Health.Declaration of Interests: We declare no competing interests.Ethics Approval Statement: Because this study involved analysis of pre-existing, de-identified data, it was considered exempt from Institutional Review Board approval.

28-Year-Old Man With Recurrent Vertigo, Syncope, and Progressive Memory Impairment

28-Year-Old Man With Recurrent Vertigo, Syncope, and Progressive Memory Impairment

Clinical characteristics of COVID-19 infection in polyhandicapped persons in France

AimLittle is known about the clinical profile of COVID-19 infection in polyhandicapped persons. This study aimed to describe the characteristics of this infection among individuals with polyhandicap. MethodThis was a retrospective observational study. Polyhandicap was defined by the combination of motor deficiency, profound mental retardation, and age at onset of cerebral lesion younger than 6 years. A positive COVID-19 status was considered for patients with a positive COVID-19 laboratory test result, or patients presenting with compatible symptoms and living in an institution or at home with other patients or relatives who had laboratory-confirmed COVID-19 infection. Data collection included sociodemographic data, clinical and paraclinical characteristics, as well as the management and treatment for COVID-19 infection. ResultsWe collected 98 cases, with a sex ratio of 0.98 and a mean age of 38.5 years (3 months to 73 years). COVID-19 infection was paucisymptomatic in 46% of patients, 20.6% of patients presented with dyspnea, while the most frequent extra-respiratory symptoms were digestive (26.5%) and neurological changes (24.5%); 18 patients required hospital admission, four adults died. The mean duration of infection was longer for adults than for children, and the proportion of taste and smell disorders was higher in older patients. ConclusionThese findings suggest that PLH persons often develop paucisymptomatic forms of COVID-19 infection, although they may also experience severe outcomes, including death. Clinicians should be aware that COVID-19 symptoms in PLH persons are often extra-respiratory signs, mostly digestive and neurologic, which may help in the earlier identification of COVID-19 infection in this particular population of patients.

Phenotyping coronavirus disease 2019 during a global health pandemic: Lessons learned from the characterization of an early cohort

From the start of the coronavirus disease 2019 (COVID-19) pandemic, researchers have looked to electronic health record (EHR) data as a way to study possible risk factors and outcomes. To ensure the validity and accuracy of research using these data, investigators need to be confident that the phenotypes they construct are reliable and accurate, reflecting the healthcare settings from which they are ascertained. We developed a COVID-19 registry at a single academic medical center and used data from March 1 to June 5, 2020 to assess differences in population-level characteristics in pandemic and non-pandemic years respectively. Median EHR length, previously shown to impact phenotype performance in type 2 diabetes, was significantly shorter in the SARS-CoV-2 positive group relative to a 2019 influenza tested group (median 3.1 years vs 8.7; Wilcoxon rank sum P = 1.3e-52). Using three phenotyping methods of increasing complexity (billing codes alone and domain-specific algorithms provided by an EHR vendor and clinical experts), common medical comorbidities were abstracted from COVID-19 EHRs, defined by the presence of a positive laboratory test (positive predictive value 100%, recall 93%). After combining performance data across phenotyping methods, we observed significantly lower false negative rates for those records billed for a comprehensive care visit (p = 4e-11) and those with complete demographics data recorded (p = 7e-5). In an early COVID-19 cohort, we found that phenotyping performance of nine common comorbidities was influenced by median EHR length, consistent with previous studies, as well as by data density, which can be measured using portable metrics including CPT codes. Here we present those challenges and potential solutions to creating deeply phenotyped, acute COVID-19 cohorts.

Percutaneous Dilational Tracheostomy for Coronavirus Disease 2019 Patients Requiring Mechanical Ventilation.

To assess the impact of percutaneous dilational tracheostomy in coronavirus disease 2019 patients requiring mechanical ventilation and the risk for healthcare providers. Prospective cohort study; patients were enrolled between March 11, and April 29, 2020. The date of final follow-up was July 30, 2020. We used a propensity score matching approach to compare outcomes. Study outcomes were formulated before data collection and analysis. Critical care units at two large metropolitan hospitals in New York City. Five-hundred forty-one patients with confirmed severe coronavirus disease 2019 respiratory failure requiring mechanical ventilation. Bedside percutaneous dilational tracheostomy with modified visualization and ventilation. Required time for discontinuation off mechanical ventilation, total length of hospitalization, and overall patient survival. Of the 541 patients, 394 patients were eligible for a tracheostomy. One-hundred sixteen were early percutaneous dilational tracheostomies with median time of 9 days after initiation of mechanical ventilation (interquartile range, 7-12 d), whereas 89 were late percutaneous dilational tracheostomies with a median time of 19 days after initiation of mechanical ventilation (interquartile range, 16-24 d). Compared with patients with no tracheostomy, patients with an early percutaneous dilational tracheostomy had a higher probability of discontinuation from mechanical ventilation (absolute difference, 30%; p < 0.001; hazard ratio for successful discontinuation, 2.8; 95% CI, 1.34-5.84; p = 0.006) and a lower mortality (absolute difference, 34%, p < 0.001; hazard ratio for death, 0.11; 95% CI, 0.06-0.22; p < 0.001). Compared with patients with late percutaneous dilational tracheostomy, patients with early percutaneous dilational tracheostomy had higher discontinuation rates from mechanical ventilation (absolute difference 7%; p < 0.35; hazard ratio for successful discontinuation, 1.53; 95% CI, 1.01-2.3; p = 0.04) and had a shorter median duration of mechanical ventilation in survivors (absolute difference, -15 d; p < 0.001). None of the healthcare providers who performed all the percutaneous dilational tracheostomies procedures had clinical symptoms or any positive laboratory test for severe acute respiratory syndrome coronavirus 2 infection. In coronavirus disease 2019 patients on mechanical ventilation, an early modified percutaneous dilational tracheostomy was safe for patients and healthcare providers and associated with improved clinical outcomes.

Return of Positive Test Results to Participants in Sexually Transmitted Infection Prevalence Studies: Research Ethics and Responsibilities.

In prevalence studies of sexually transmitted infections (STIs), investigators often provide syndromic management for symptomatic participants but may not provide specific treatment for asymptomatic individuals with positive laboratory test results because of the delays between sample collection and availability of results as well as logistical constraints in recontacting study participants. To characterize the extent of this issue, 80 prevalence studies from the World Health Organization's Report on Global Sexually Transmitted Infection Surveillance, 2018, were reviewed. Studies were classified as to whether clinically relevant positive results were returned or if this was not specified. More than half (56%) of the cited studies did not specify if participants were notified of clinically relevant positive STI test results. The percentages were similar for low- and middle-income country populations (57%) and high-income country populations (53%). The absence of documentation of the provision of test results raises the possibility that in some instances, results may not have been communicated, with potential negative effects for participants, their sexual partners, and newborns. From an ethical perspective, clinically relevant results should be returned to study participants and treating clinicians in a timely fashion to ensure appropriate management of identified infections. Study authors should document if they returned test results to study participants and report on numbers lost to follow-up.

110 A Single Centre Study on the Thirty-Day Hospital Reattendance and Readmission of Older Patients During the SARS-CoV-2 Pandemic

IntroductionHospital and social care suffered major alterations during the SARS-CoV-2 pandemic in the UK. Older adults were disproportionally affected by routine care disruption. To our knowledge, no data has been published so far on the impact of service disruption on 30-day readmission.MethodsWe performed a retrospective observational study of all patients admitted to a single east London hospital with laboratory-confirmed or clinical diagnosis of COVID-19 between 16th March and 6th April 2020. Older patients were defined as aged 80 years and over. Readmission was captured within 30 days of discharge. Comparator defined as the same period in 2019. Descriptive statistics were used.ResultsThree hundred and ninety-three patients were included. The majority survived to discharge (69.7%). Positive laboratory testing was similar between older and younger patients (85.7% vs 84.7%, p = NS). Mortality was significantly higher for older patients on index presentation (60.2% vs 20.3%, p < 0.001). Length of stay was also significantly longer for these patients (median 9 vs 7 days, p = 0.00694). The readmission rate for the 274 individuals discharged after index admission was 11.3% (n = 31). Amongst older patients, readmission rate during the study period was slightly higher than the same period in 2019 (17.9% vs 14.8%, p = 0.36). The median time interval between discharge and re-attendance was 8 [1–29]days. All re-attending older patients were re-admitted, whereas 54.2% of younger patients were sent home directly from the emergency department. Only 1 of the 31 patients re-attended because of insufficient social care.ConclusionsOur data shows that readmission rates in the older population of East London during the SARS-CoV-2 pandemic were largely similar to non-pandemic periods. During this period, readmission rates appear to have been driven by clinical rather than social imperatives. This suggests that adapted social care services performed well and should be reinforced for future surges.

27337 Characterizing Temporal Patterns in Glucose Dysregulation Following SARS-CoV-2 Infection

ABSTRACT IMPACT: Understanding the longitudinal glucose changes following SARS-CoV-2 infection can inform point-of-care guidelines and elucidate the viral hypothesis of diabetes mellitus pathogenesis. OBJECTIVES/GOALS: Hyperglycemia has emerged as an important manifestation of SARS-CoV-2 infection in both diabetic and non-diabetic patients. Whether clinically-detectable glycemic changes persist following SARS-CoV-2 infection remain to be elucidated. This work aims to characterize temporal patterns in glucose dysregulation following SARS-CoV-2 infection. METHODS/STUDY POPULATION: Electronic health records of patients with a diagnosis of COVID-19, positive laboratory test for SARS-CoV-2, and negative history of Diabetes Mellitus prior to infection were extracted from the TriNetX database. 7,502 patients with at least one blood glucose value 2 years to 2 weeks before, 2 weeks before to 2 weeks after, and 2 weeks after to 1 year after COVID-19 diagnosis were used for analysis. Temporal patterns are characterized by training state-of-the-art clustering algorithms, including fuzzy short time-series clustering, k-means for longitudinal data, and spectral clustering. Clustering performance is evaluated using internal evaluation metrics of the Silhouette coefficient, Calinski-Harabasz score, and Davies Bouldin index. RESULTS/ANTICIPATED RESULTS: Based on the success of prior clustering methods with random blood glucose measurements, we anticipate that the proposed time-series clustering algorithms will appropriately characterize temporal patterns of glycemic dysregulation. The best performing algorithm based on interval evaluation metrics will be selected for further analysis. Associations between blood glucose values and cluster membership will be evaluated using Kruskal-Wallis one-way ANOVA and effect size will be calculated using unbiased Cohen’s d. Clinical phenotypes for each cluster will be characterized in terms of current diagnoses, prior medication use, pertinent laboratory tests, and vital signs. DISCUSSION/SIGNIFICANCE OF FINDINGS: A clearer understanding of the longitudinal glucose changes following SARS-CoV-2 infection can elucidate clinically-detectable patterns of glycemic dysregulation, identify sub-phenotypes of patients who are more susceptive to glycemic dysregulation, and inform appropriate point-of-care guidelines.

Bronchiectasis is one of the indicators of severe coronavirus disease 2019 pneumonia.

Bronchiectasis is one of the indicators of severe coronavirus disease 2019 pneumonia.

Clinical characteristics, treatment modalities and outcome of coronavirus disease 2019 patients treated at thisday dome isolation and treatment centre, federal capital territory Abuja, Nigeria.

Coronavirus disease 2019 (COVID-19), a highly transmissible viral infection has spread worldwide causing exponential increase in morbidity and mortality. But so far, there is limited information available to describe the presenting characteristics, outcomes and treatment modalities of COVID-19 patients in Nigeria. This study aimed to describe the demographic and clinical characteristics, underlying comorbidities, treatment modalities and outcomes of patients isolated and treated in a repurposed COVID-19 isolation and treatment centre in Abuja, Nigeria. A retrospective study which reviewed the medical records of 300 confirmed COVID-19 patients isolated and treated according to the World Health Organisation and Nigeria Centre for Disease Control guidelines between 22nd July and 26th October, 2020 in ThisDay Dome Isolation and Treatment Centre. Data collected from the medical records include demographics, clinical features, treatment measures and outcomes. Out of 300 patients studied, 61.0% were male. The mean age of the participants was 38.2 ± 14.7. Less than half of the patients (40.3%) had one or more underlying comorbidities with hypertension the most common co-morbidity. Majority (62%) of patients were mildly symptomatic, 33% were asymptomatic while only 2% were severely symptomatic. The most common presenting symptoms include cough 34.0%, fever 30.3%, anosmia 28.7% and dysgeusia 22.7%. Older age (P < 0.001), tertiary education and the presence of underlying comorbidity (P < 0.001) were significantly associated with symptomatic presentation of COVID-19. The median duration of time between positive laboratory testing and presentation for treatment was 5 days (0-29). All patients were treated with a combination of Ivermectin, Azithromycin, Zinc and Vitamin C with no recorded death. The median length of stay at facility was 9 days. Close attention should be given to patients with co-morbidities as an inefficient management of such co-morbidities could lead to mortalities which may not be directly attributable to COVID-19.

Исследование влияния депрессорных присадок на физико-химические свойства моторного масла

In this work, laboratory tests of M8G2k engine oil are carried out with the introduction of SAP 110 depressants by Shell Additives and Lz 6662 by Lubrizol and their impact on the properties of the lubricant in question are assessed separately. During the tests, the values of the following indicators of engine oils are obtained: kinematic viscosity at 100 °C, base number, flash point in an open crucible, pour point and content of active elements (calcium, zinc). With the help of the SI-010 bench installation, the values of anti-pitting properties are indicated, as well as experiments are carried out on the NAMI-1m and Petter W-1 installations, with their help the tendency to the formation of low- and high-temperature deposits in the internal combustion engine (ICE) and the assessment of anti-corrosion properties respectively. To analyze the detergent properties of the engine oil under consideration, a test procedure are carried out on a D-240 tractor engine. Positive laboratory test results give grounds to recommend using M8G2k engine oil containing SAP 110 or Lz 6662 additives for the D-240 engine manufactured by MMZ

1709. Influenza Surveillance in the U.S. Department of Veterans Affairs (VA): 2019-2020 Season

BackgroundVA conducts annual surveillance for seasonal influenza. VA’s large elderly population is at higher risk for influenza complications, including hospitalization and death. Herein we summarize VA’s 2019-20 national surveillance data for influenza activity and vaccinations.MethodsInfluenza telephone triage, influenza-like-illness (ILI) encounters and antiviral prescriptions plus outpatient visits, laboratory testing (antibody tests excluded), hospitalizations and deaths for influenza were obtained from VA data sources (9/29/19-5/16/20) and compared to prior seasons and national CDC FluView data. Influenza vaccinations were captured starting 8/1/2019. Vaccination rates were calculated based on VA users during the fiscal year.ResultsSurveillance metrics are presented (Table). ILI visits ranged from 0.9%-3.1% during the season. Influenza activity peaked during 2020 Weeks 6-7 and dropped rapidly beginning in Week 12, matching trends reported by CDC for influenza activity (Figure 1). Testing revealed 23,357 influenza positives out of 162,102 tests performed (14.4%). 17% of laboratory-confirmed influenza cases were hospitalized (compared to 23% during the prior season) with a median length of 3 days. Total influenza positives, telephone triage encounters, outpatient visits and antiviral use were higher than the prior season, whereas coded hospitalizations and deaths were fewer (Table, Figure 2).Table. VA Influenza Surveillance Measures, 2014-2015 through 2019-2020 Seasons. Figure 1. Comparison of select VA and CDC Influenza Indicators. Influenza positive laboratory tests and % positive (top) and influenza hospitalizations (bottom), by Season. Figure 2. Comparison of Key VA Influenza Indicators, by Season. ConclusionThe 2019-20 influenza season was of moderate severity when compared to prior seasons and continues to track well with national CDC data. Overall, vaccination levels have increased modestly and high-dose/adjuvanted vaccine administration increased from 6 to 26% of total vaccine given over the seasons evaluated. Influenza activity dropped precipitously after Week 12 even though testing for influenza remained high in the setting of COVID-19. This may have been influenced by widespread social distancing and masking measures adopted in response to COVID-19.Disclosures All Authors: No reported disclosures

785. Association between Prevalence of Laboratory-Identified Clostridioides difficile Infections (CDIs) and CDI Antibiotic Treatment in U.S. Acute Care Hospitals, 2018

Background Clostridioides difficile infections (CDIs) are an urgent public health threat, accounting for 223,900 infections and 12,800 deaths in hospitalized patients annually. In early 2018, the Infectious Disease Society of America (IDSA) recommended oral vancomycin or fidaxomicin as the first-line antibiotics for CDIs. To track the uptake of IDSA’s recommendations, we evaluated the association between CDI prevalence and use of first-line antibiotics in hospitals reporting to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN).MethodsWe matched 2018 hospital-level, NHSN data on laboratory-identified CDIs with NHSN antimicrobial use (AU) data for the same time period. Hospitals that submitted < 6 months of either data type in 2018 were excluded. The association between quarterly hospital-level CDI prevalence rates per 100 patient-admissions and use of CDI antibiotics (oral vancomycin plus fidaxomicin) per 1,000 days-present was evaluated using Pearson’s linear correlation coefficient and using Goodman and Kruskal’s gamma (G) on ordinal quartiles to assess rates of discordant pairs.ResultsAmong the 2735 hospital-level quarters based on 714 hospitals included in the study, CDI prevalence (median: 0.46 per 100 patient-admissions) and CDI antibiotic use (median: 8.85 antibiotic-days per 1,000 days-present) demonstrated only a moderately positive correlation (r = 0.48). Among hospitals in the highest quartile for CDI prevalence, 5.1% were in the lowest quartile for antibiotic use. Among hospitals in the highest quartile for antibiotic use, 5.3% were in the lowest quartile for CDI prevalence, and 54.2% were in the highest quartile for CDI prevalence (G = 0.60; 95% CI: 0.57–0.63).Correlation of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in U.S. acute care hospitals, 2018 Distribution of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in ordinal quartiles (Q1–Q4) to access rates of discordant pairs ConclusionThe moderate correlation and discordant rates suggest that vancomycin and fidaxomicin are less frequently used as primary antibiotics in some hospitals; whereas in others, CDI antibiotic use is occurring in the absence of positive laboratory tests for CDI. To further investigate this discordance, there is a need to assess hospitals’ prescribing and testing practices in an ongoing manner. These findings may be useful to serve as baseline for measuring progress of appropriateness of treatment and testing for CDIs.Disclosures All Authors: No reported disclosures