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Introduction: Pathogen inactivation (PI) utilizing amotosalen and UVA light (INTERCEPT® Blood System) is a well-established method for the production of safer platelet concentrates (PCs). While many studies describe clinical and logistical benefits of PI, the implications and potential challenges from a hospital management perspective have not yet been analyzed – health economic analyses considering reimbursement of PI are lacking. The objective of this analysis was to examine the real-life inpatient treatment costs from a hospital perspective and to assess the economic impact of PI-PC versus conventional PC (CONV-PC) administration in Germany. Methods: Real-life cost data for inpatient cancer cases from 2020 of the University Hospital Cologne were identified by operating and procedure codes. The German diagnosis-related groups, extra fees, case mix index (CMI), length of stay (LOS), and average resource consumption of PC were evaluated from a micro-management perspective. The potential economic impact of implementing PI-treated PCs was modeled retrospectively. Results: In total, 951 inpatient cases were analyzed (CMI [median 4.7–9.9], LOS [median 26 days], number of cases in intensive care units [38%]). The median DRG fee was between EUR 13,800 and EUR 26,400. According to our model, the use of PI-PC compared to CONV-PC would result in savings between EUR 184 and EUR 306 per case. Conclusion: From a hospital management perspective, oncological cases requiring PC transfusion are associated with a high CMI (reimbursement per DRG flat fee) and moderate costs with sufficient add-on payment for PI on a case level. Investment and process costs for PI implementation can be analyzed for site-specific scenarios. [ABSTRACT FROM AUTHOR]

The prognosis of allogeneic stem cell transplant recipients admitted to the intensive care unit (ICU) has improved over the last decades. However, data focusing on patients treated in the ICU during the peri-transplant period are scarce. We therefore conducted an analysis comprising 70 patients who had allogeneic stem cell transplantation at the University Hospital Cologne between 2014 and 2020 and were admitted to the ICU between the initiation of conditioning therapy and day 30 after transplantation. The median age was 59 years (range: 18 − 72 years). 50% of patients were female. Sepsis was the most common cause for ICU admission (49%). Mechanical ventilation (MV) was required in 56% of patients, 27% had renal replacement therapy (RRT), and 64% needed vasopressors. The ICU, hospital, 90-day, and 1-year survival rates were 48.6%, 38.6%, 35.7%, and 16.2%, respectively. MV and/or RRT during the ICU stay were associated with an impaired survival (p < 0.0001). The same was true for the use of vasopressors (p < 0.0001). In contrast, baseline characteristics did not impact the outcome. Cardiopulmonary resuscitation (CPR) was performed in 17% of patients. None of the patients undergoing CPR was alive at 1 year. Among patients who died after discharge from the ICU (n = 23), sepsis and other infectious complications represented the major causes of death (48%). Taken together, the present analysis indicates unfavorable outcomes for allogeneic stem cell transplant recipients admitted to the ICU during the peri-transplant period. The data may help to make informed decisions with patients and their families. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing allogeneic stem cell transplantation (aSCT) are at high risk to develop an invasive fungal disease (IFD). Optimisation of antifungal prophylaxis strategies may improve patient outcomes and reduce treatment costs. Objectives: To analyse the clinical and economical impact of using continuous micafungin as antifungal prophylaxis. Patients/Methods: We performed a single‐centre evaluation comparing patients who received either oral posaconazole with micafungin as intravenous bridging as required (POS‐MIC) to patients who received only micafungin (MIC) as antifungal prophylaxis after aSCT. Epidemiological, clinical and direct treatment cost data extracted from the Cologne Cohort of Neutropenic Patients (CoCoNut) were analysed. Results: Three hundred and thirteen patients (97 and 216 patients in the POS‐MIC and MIC groups, respectively) were included into the analysis. In the POS‐MIC and MIC groups, median overall length of stay was 42 days (IQR: 35–52 days) vs 40 days (IQR: 35–49 days; p =.296), resulting in median overall costs of €42,964 (IQR: €35,040–€56,348) vs €43,291 (IQR: €37,281 vs €51,848; p =.993), respectively. Probable/proven IFD in the POS‐MIC and MIC groups occurred in 5 patients (5%) vs 3 patients (1%; p =.051), respectively. The Kaplan‐Meier analysis showed improved outcome of patients in the MIC group at day 100 (p =.037) and day 365 (p <.001) following aSCT. Conclusions: Our study results demonstrate improved outcomes in the MIC group compared with the POS‐MIC group, which can in part be explained by a tendency towards less probable/proven IFD. Higher drug acquisition costs of micafungin did not translate into higher overall costs. [ABSTRACT FROM AUTHOR]

Background Due to severe immunosuppression, patients undergoing allogeneic hematopoietic stem cell transplantation (aSCT) are at increased risk of infection and especially bloodstream infections (BSI) remain a major cause of death. Knowledge of the specific epidemiology of pathogens and resistances is of utmost importance to optimize antimicrobial treatment strategies. Methods Based on the Cologne Cohort of Neutropenic Patients (CoCoNut) database, we conducted a retrospective analysis of blood cultures collected within 100 days following transplantation of patients undergoing aSCT between January 2009 and December 2018 at the University Hospital of Cologne, Germany. Contamination of coagulase-negative Staphylococci (CoNS) isolates (single positive isolate within 5 days) was considered within the analysis. Results In total, 843 aSCT patients were available for analysis (484/843 [57%] male). The median age was 53 (interquartile range [IQR] 43–62) years, predominant underlying diseases were acute myeloid leukemia (47%, 397/843), lymphoma (14%, 117/843), and acute lymphoblastic leukemia (11%, 89/843). Median inpatient stay was 39 (IQR 34–50) days, while 67/843 (8%) patients died. Antibacterial prophylaxis was administered in 289/843 (34%) and antifungal prophylaxis in 738/843 (88%) patients. BSI was diagnosed in 233/843 (28%) patients. In total, 5,489 pairs of blood cultures were taken (median 4 per patient, IQR 2–8), while a pathogen could only be detected in 922/5,489 (17%). Most frequent pathogens were CoNS (259/922, 28%), Enterococcus spp. (219/922, 24%), E. coli (132/922, 14%), Klebsiella spp. (44/922, 5%), P. aeruginosa (39/922, 4%), S. aureus (37/922, 4%), and Candida spp. (42/922, 5%). Polymicrobial infection was detected in 58/922 (6%) cases. Within Enterococci isolates, 24/219 (11%) were VRE. None of the Klebsiella , but 9/132 (7%) of E. coli isolates were ESBL positive. In 4/37 (11%) cases S. aureus isolates were MRSA. Conclusion Patients in the early phase after aSCT are at high risk of BSI with a predominantly gram-positive spectrum. Empirical antimicrobial treatment must consider pathogen epidemiology and resistance patterns while waiting for blood culture results. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Healthcare-associated infections (HAIs) are a leading cause for morbidity and mortality in neutropenic patients. Methods The Cologne Cohort of Neutropenic Patients (CoCoNut) is an ongoing, prospective, longitudinal cohort, collecting inpatient data for analysis of epidemiology, risk factors, and outcome of neutropenic patients (at least one day of absolute neutrophil count < 500/µL) at risk for HAIs. The CoCoNut contains comprehensive data, i.e. patient characteristics, medication, chemotherapy, clinical data (e.g. diarrhea, body temperature), as well as laboratory, microbiological, virologic, and radiological results. The purpose of this cohort is to improve the knowledge on HAIs and management of anti-infective prophylaxis and therapy. Results To date, the CoCoNut includes 8,176 inpatient stays from 3,354 neutropenic patients treated at the hematology/oncology department of the University Hospital of Cologne between January 2009 and December 2018. Hodgkin and Non-Hodgkin lymphoma (32%), acute leukemia (28%), and chronic leukemia (10%) were the predominant underlying diseases; comprising 843/8,176 (10%) inpatient stays with allogenic stem cell transplantation. The overall number of neutropenic days and fever days (body temperature ≥ 38 °C) was 56,824 and 25,347, respectively. Blood stream infections (occurrence of fever and positive blood culture) occurred in 1,283/8,176 (16%) inpatient stays, and the overall mortality rate was 9% (n = 716/8,176). By now, 17 peer-reviewed articles analyzing epidemiology, treatment, and outcome of HAIs were published based on data from the CoCoNut. Conclusion Data extracted from the CoCoNut underlines the important role of evaluating innovative treatment strategies. Considering the remaining high infection rate for HAIs of neutropenic patients, the growing development of antimicrobial drug resistance, and the existing powerful methods for data processing (e.g. artificial intelligence), we will continue to utilizing and expanding the CoCoNut in the future. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]