Background Use DAA has resulted in widespread eradication of Hepatitis C virus (HCV) infection in patients with advanced liver disease (ALD) compared with interferon (IFN)-based treatment era therapy. Recent reports have indicated an increased risk of hepatocellular carcinoma (HCC) associated with HCV treatment with DAA and/or after achieving sustained virologic response (SVR). Decreasing incidence of HCC has been reported for patients treated with IFN-based therapy who achieve SVR. Widespread HCV treatment with IFN-based therapy was started in 2006 at a single center. An interest exist whether there was an increase in HCC incidence after introduction of DAA therapy.Methods A single-center retrospective analysis of HCC incidence from 2009 to 2016 was conducted. Patients with HCC due to non-HCV-related diseases were included as unmatched controls. HCC cases were reviewed for HCV diagnosis, liver disease stage and evidence of prior HCV treatment. HCC rate was calculated using number of at risk patients with ALD who received HCV treatment each calendar year. Descriptive statistics were utilized for trend analysis. A total of 143 cases of HCC was identified between 2009 and 2016 with 110 cases of HCC in HCV patients. 727 at risk patients with ALD received treatment with antiviral therapy.ResultsThere was a progressive decrease in the number of incident HCC in HCV patients. The incidence rate of HCC in HCV patients declined from 23.1% in 2009 to 1.79% in 2016 in at risk patients receiving antiviral therapy. The HCC incidence rates in 2009, 2010, 2011, 2012, 2013, 2014, 2015, and 2016 was 23.1%, 14.3%, 60.0%, 22.2%, 6.25%, 1.48%, 1.11%, and 1.79% respectively. The number of HCC cases in non-HCV patients remain unchanged during the same period. One year HCC survival ranged from 75% to 90% in HCV patients and 38 to 100% in non-HCV patients with no trends in survival identified.Conclusion The incidence of HCC decreased in at risk HCV patients with ALD who received antiviral therapy with the largest decline occurring in patients who received DAA therapy. One year survival did not appear to change during the study period.Disclosures All authors: No reported disclosures.
Background Bacteremia is associated with significant morbidity and mortality, with each hour of delay initiating antibiotics associated with a 7.6% decrease in survival rate. At the Salisbury Veterans Affairs Health Care System (VA HCS), FilmArray® Blood Culture Identification (BCID) is used along with TheraDoc® to assist with selection of antimicrobial regimens as an antimicrobial stewardship practice at the site. The purpose of this study is to evaluate the time to appropriate antibiotic therapy based on positive BCID results. Methods This study is a retrospective, quality assurance project conducted at a 284-bed VA medical center from May 2018 through December 2020 of Veterans with positive BCID results identified on TheraDoc®. The primary endpoint is to identify the mean time for initiation of appropriate antimicrobial therapy defined as at least 80% susceptibility on local antibiogram to the resulting BCID organism for Veterans not on antibiotics or on inappropriate therapy from the time of BCID positivity. Secondary endpoints include comparing time to appropriate therapy with or without Infectious Diseases (ID) and Antimicrobial Stewardship Program (ASP) coverage, time to de-escalation, and contributors to time delays. Results A total of 168 Veterans were included in the study with 138 Veterans (82%) receiving appropriate antibiotic therapy at the time of BCID results and 30 Veterans (18%) on inappropriate or no empiric antibiotics. The mean time to appropriate therapy of the 30 Veterans on inappropriate or no antibiotics at the time of BCID positivity was 13 hours and 54 minutes with provider order entry being the largest factor in time delays. Of these 30 Veterans, BCID positivity occurred in 6 Veterans during business hours with onsite availability to ID and ASP to which the mean time to appropriate therapy was 3 hours and 29 minutes compared to 16 hours and 30 minutes for the 24 Veterans with results outside of business hours. For the 138 Veterans on appropriate therapy, the average time to de-escalation was about 43 hours and 52 minutes. Percentage of ID and/or ASP involvement. This pie chart shows the percentages of Veterans with ID and/or ASP involvement. Time to de-escalation. This graph demonstrates the time to de-escalation for Veterans on appropriate therapy at the time of BCID positivity. Inappropriate Therapy Group. This graph compares time to appropriate therapy between results occurring during business hours or outside of business hours for Veterans on no initial antibiotics or inappropriate therapy. Conclusion BCID and TheraDoc® are helpful antimicrobial stewardship tools to assist with reducing time to appropriate therapy when consistently monitored. Additional resources and education may be of benefit to providers covering outside of business hours. Example of BCID Algorithm Creation of a local BCID algorithm has been started as a result of this study. The goal of this resource is to be a tool for providers to help guide therapeutic decisions when ID and/or ASP are not readily available. Disclosures All Authors: No reported disclosures.
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