Background:Minimal important differences (MIDs) for the Veterans RAND 12-Item Health Survey (VR-12) and the Single Assessment Numeric Evaluation (SANE) have not been reported in patients following treatment for rotator cuff tears (RCTs).Purpose:To determine the MIDs for the VR-12 and SANE among patients with RCT after treatment.Study Design:Cohort study (diagnosis); Level of evidence, 2.Method:A total of 222 patients diagnosed with RCT completed the VR-12 and SANE at baseline and then received surgical or nonsurgical treatment. After 64 weeks, 160 patients completed the VR-12, the SANE, and a global change questionnaire. We applied a distribution-based approach to estimate the MIDs for the SANE and for the physical component score (PCS) and mental component score (MCS) of the VR-12. We then used the global rating score as an anchor for 20 patients who perceived a minimal improvement, and we applied an anchor-based approach. One-half standard deviation of the baseline score was used in the distribution-based approach. Linear regression analyses and backward model selection were conducted to evaluate the associations between patients’ characteristics and the anchor-based MIDs.Results:The MIDs derived from distribution-based method estimates for the VR-12 PCS, MCS, and SANE scores were 4.94, 5.99, and 11.80, respectively. The MIDs estimated using the anchor-based method for the PCS, MCS, and SANE scores were 2.57 (90% CI, –1.62 to 6.76), 1.87 (90% CI, –2.07 to 5.80), and 27.25 (90% CI, 16.17 to 38.33), respectively. The final regression model for significant predictors of the MID on the PCS included baseline PCS (P < .001), body mass index (P = .014), symptom duration (P = .011), diabetes (P = .009), and surgery (P = .089). The final model for the MID on the MCS included baseline MCS (P < .001), patient sex (P = .027), and diabetes (P = .083). The final model for the MID on SANE included baseline SANE score (P = .059) and diabetes (P = .050).Conclusion:This is the first study to assess the MIDs for the VR-12 and SANE scores in patients with rotator cuff disease. The estimates of MID will facilitate the interpretation and application of these outcome measures in clinical practice and research.

Background Intestinal and multivisceral transplantations are treatment options for patients with intestinal failure. Transplantation is often complicated by abdominal and/or bloodstream infections in the post‐operative period. Methods A retrospective chart review of all adults who underwent intestinal or multivisceral transplantation at our institution from 2003 to 2015 was performed. Data were collected for 2 years post transplant. Results A total of 106 intestinal or multivisceral transplants were performed in 103 patients. The median age at the time of transplant was 44 (IQR: 34‐52) with 55% (n = 58) male and 45% (n = 48) female. There were 46 (43%) intra‐abdominal infections post transplant among the 103 patients, and six transplant recipients (13%) developed concurrent bloodstream infections. The median time to first intra‐abdominal infection was 23 days (IQR: 10‐48). For those with organisms isolated in culture, forty‐seven percent of the isolates were gram negative, 39% gram positive, 7% anaerobes, and 7% yeast. The most common isolates were enterococci at 28%, E. coli at 14%, and Klebsiella spp at 13%. Sixty‐three percent of the enterococci were vancomycin‐resistant enterococci (VRE), and 22% of the gram‐negative isolates were extended spectrum beta‐lactamases (ESBLs). Patients with intra‐abdominal infections had longer hospital post‐transplant length of stays at a median of 35 days (IQR: 25‐48) vs 23 days (IQR: 17‐33) for those without infections, P = .0012. There was no difference in all‐cause mortality in patients with or without intra‐abdominal infections, P = .654. Conclusions Intra‐abdominal infections are common in intestinal or multivisceral transplant recipients, but despite this complication, we found no increased risk of mortality. These transplant recipients are also at risk for infection with drug‐resistant organisms.

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Background The CDC recommends testing for SARS-CoV-2 in patients who present with symptoms consistent with COVID-19 and to cohort hospitalized patients diagnosed with COVID-19. Up to 35% of persons infected with SARS-CoV-2 are asymptomatic; however, no recommendations exist for universal testing in hospitalized patients. We assessed the point prevalence of SARS-CoV-2 infection amongst hospitalized patients at a tertiary care center during a time when there was a regional surge of cases. Methods Nasopharyngeal SARS-CoV-2 PCR testing was performed on inpatients at Georgetown University Hospital on 4/27/20, excluding those who were SARS-CoV-2 positive, tested within 72 hours or admitted to pediatric, psychiatric, labor & delivery or ICUs. Patients within the hospital were not cohorted based on COVID-19 status. Patient demographics and comorbidities were obtained from the EMR and analyzed for significance based on SARS-CoV-2 status. Results Hospital census on the testing date was 297; 204/297(68.7%) met inclusion criteria; 78/297(26.3%) were known COVID-19 patients. Within the study group 78/204 (38.2%) had known COVID-19, 21/204 (10.3%) were PUIs (4 of whom tested positive), 31/204 (15.1%) tested negative for COVID-19 within 72 hours and 74/204 (36.3%) met criteria for testing. The median age was 62 years (IQR, 53 to 70), 59%(n=122) were male, 56%(n= 115) were Black, and 90%(n=185) had at least one co-morbidity. 0/74 of those tested on 4/27/20 were positive for SARS-CoV-2, and none were diagnosed with COVID-19 within 28 days. In adjusted analyses, patients who were hospitalized for COVID-19 were more likely to be Black(OR=10.53 95% CI 3.02, 36.68, p=0.0002); male(OR=3.27 95% CI 1.26, 8.47, p=0.0143); reside in group/nursing homes(OR= 11.78 95%CI 3.03, 45.76, p=0.0004); have a history of prior stroke(OR= 6.25 95%CI 1.49, 26.12, p=0.012); but less likely to smoke(OR=0.10 95%CI 0.02, 0.48, p=0.0039), or have active malignancy (OR= 0.11 95%CI 0.01, 0.73, p=0.0223). Conclusion The use of CDC testing criteria for PUIs were successful in identifying COVID-19 patients and limiting the need for routine testing in all hospitalized patients during a time when access to testing was limited. Nosocomial transmission did not occur in our institution despite a lack of cohorting. Disclosures Princy Kumar, MD, Gilead Sciences Inc. (Scientific Research Study Investigator)

BackgroundRespiratory viral infections (RVI) are becoming increasingly recognized as an important cause of pneumonia. There is limited data regarding the role of rapid PCR testing for RVI and its effect on antibiotic duration and length of stay (LOS).MethodsWe performed a single-center, retrospective chart review in adult patients who were admitted and underwent evaluation with the FilmArray Multiplex Respiratory Panel (RP) (Biomerieux™) using a random sample from July 1, 2016 through April 1, 2018. Patient clinical and virologic characteristics, LOS, antibiotic use, and duration of treatment were collected. A Student’s t-test was performed for all comparisons.ResultsWe identified 540 patients who were admitted and underwent RP testing. The mean age was 57.1 years (range 19–99), 50.2% were immunocompromised, 23.8% were transplant recipients, 70.4% had respiratory symptoms, and 35.7% had an admitting diagnosis of pneumonia. 55.6% required supplemental O2 and 24.6% had an ICU admission that required either noninvasive or mechanical ventilation. 22.6% (N = 122) of these patients were diagnosed with an RVI, of which 15 were co-infected with two or more respiratory viruses. There were 41 (34%) rhinovirus/enterovirus, 41 (34%) influenza (Types A/H1, A/H3, A/H1-2209, and B), 16 (13%) RSV, 15 (12%) coronavirus (Types NL63, OC43, 229E, and HKU1), 13 (11%) metapneumovirus, and 7 (5%) parainfluenza (Types 2, 3, and 4). 85.2% (104/122) of patients with an RVI received antibiotics. The mean LOS and antibiotic duration were 9.07 days and 7.31 days for patients with an RVI when compared with 11.5 days and 10.4 days for patients without an RVI (P = 0.098; P = 0.032), respectively. In patients with an RVI and negative bacterial cultures, the mean LOS was 8.4 days and mean antibiotic duration was 5.9 days when compared with 16.4 days and 15.5 days for all patients with positive bacterial cultures (P = 0.003; P < 0.0001), respectively. The mean time from available results of + RP to antibiotic discontinuation was 5.1 days in the setting of negative bacterial cultures.ConclusionAlthough antibiotic exposure and time to discontinuation still remained significant in patients diagnosed with an RVI, there was a marked reduction in LOS and antibiotic duration in the subset of patients with an RVI and negative bacterial cultures.Disclosures All authors: No reported disclosures.