bluuebunny/crossref_metadata_2025 huggingface dataset:
2853. Innate Immune Response in Serum and Cerebrospinal Fluid of Neonates and Infants Infected with Parechovirus-A3 and Enteroviruses
Authors: Habuka Rie , Aizawa Yuta , Izumita Ryohei , Domon Hisanori , Terao Yutaka , Saitoh Akihiko
Published: October 2019

Background

Parechovirus-A3 (PeV-A3) and enteroviruses (EVs) are the most common viral causes of neonatal and infantile sepsis. We previously reported that the clinical manifestations of PeV-A3 infection—e.g., high body temperature, tachycardia, and poor peripheral circulation, but not cerebrospinal fluid (CSF) pleocytosis—tend be more severe than those of EV infection. We tested the hypothesis that innate immune responses to PeV-A3 and EVs are distinct.

Methods

Using serum and CSF samples, we investigated immune responses of febrile neonates and infants <4 months in Niigata, Japan, from 2015 through 2018. PeV-A and EV infections were diagnosed with real-time PCR. PeV-A3 infection was diagnosed by sequence analysis of the VP1 region. The control was clinically well patients without serum and CSF findings suggestive of bacterial or viral etiology. The Milliplex MAP human cytokine/chemokine magnetic bead panel (Merck Millipore, Germany) was used to analyze 22 cytokines/chemokines related to innate immunity in serum and CSF.

Results

We evaluated 14 PeV-A3-infected and 15 EV-infected patients and 8 controls. Serum levels of proinflammatory cytokines/chemokines (fractalkine, interferon-α2, interleukin [IL]-1 receptor α, IL-6, IL-8, and IL-15) were significantly higher in PeV-A3-infected patients than in EV-infected patients (P < 0.005). Serum cytokine/chemokine profiles of EV-infected patients did not differ from those of controls. However, while most pro- and anti-inflammatory cytokines/chemokines in CSF were elevated in EV-infected patients, levels were low or undetectable in PeV-A3-infected patients and controls (P < 0.005).

Conclusion

PeV-A3-infected patients had high serum levels of proinflammatory cytokines/chemokines, which may explain why clinical manifestations were more severe in this patient group than in EV-infected patients. Conversely, the limited or nonexistent innate immune response in CSF from PeV-A3-infected patients might explain the absence of CSF pleocytosis. These findings improve our understanding of the differing pathophysiological characteristics of PeV-A3 and EV infection in neonates and young infants.

Disclosures

All Authors: No reported Disclosures.
2900. High Rates of Experienced and Witnessed Opioid Overdose in PWID Receiving HCV Treatment: Data From the ANCHOR Study
Authors: Rosenthal Elana S , Nussdorf Laura , D’Amore Aaron , Brokus Christopher , Silk Rachel , Eyasu Rahwa , Mathur Poonam , Bijole Phyllis , Jones Miriam , Kier Randy , Sternberg David , Masur Henry , Kottilil Shyam , Kattakuzhy Sarah
Published: October 2019

Background

People who inject drugs (PWID) have significant morbidity and mortality associated with hepatitis C (HCV); however, harms associated with ongoing injecting drug use (IDU)—such as opioid overdose—may pose a more imminent risk, and often are not addressed as part of HCV treatment. Naloxone distribution is a simple, evidenced-based strategy to reduce mortality associated with opioid overdose.

Methods

ANCHOR is a single-center study embedded in an urban harm-reduction program evaluating treatment of HCV in PWID with chronic HCV, opioid use disorder (OUD), and IDU. Participants received HCV treatment and were offered collocated buprenorphine. At each study visit, patients self-reported experienced and witnessed overdose and were offered naloxone.

Results

The 100 enrolled participants are predominantly male (75%), median 57 years, black (93%) and inject opioids at least daily (58%). At baseline, 65% had ever experienced overdose, 91% had ever witnessed an overdose, and 35% had ever administered naloxone. Between day 0 and week 48, 15 patients (15%) experienced overdose; of which, 4 (4%) were fatal. The rate of experienced overdose was 15 overdoses per 100 person-years. In addition, 59 (59%) patients witnessed at least one overdose between day 0 and week 48. Seventy-three patients were dispensed naloxone at least once, and of those who witnessed an overdose, 48 (81%) administered naloxone. Nineteen (40%) patients who administered naloxone had never used naloxone before starting HCV treatment.

Conclusion

PWID with HCV, OUD, and ongoing IDU have high rates of personal and witnessed overdose during and after HCV treatment. Dispensing naloxone at HCV-related visits is highly acceptable among PWID, and results in high rates of naloxone utilization. To reduce morbidity and mortality in patients and their communities, ID providers should complement treatment of infections by prescribing naloxone for patients with OUD, ideally as part of a comprehensive package of harm reduction and OUD treatment.

Disclosures

All Authors: No reported Disclosures.
2903. Post PCV13 Dynamics of NonVaccine Serotype (NVT): Disproportionate Increase of the Additional PCV20 Candidate Serotypes in Respiratory and Invasive Disease in Young Children
Authors: Ben-Shimol Shalom , Givon-Lavi Noga , Kotler Leore , Greenberg David , Dagan Ron
Published: October 2019

Background

PCV13 implementation in children resulted in a substantial decline in carriage of and disease by vaccine serotypes (VT13). However, disease caused by non-PCV13 serotypes (NVT) is still relatively prevalent and even increasing, leading to an effort to develop a 20-valent vaccine (PCV20), containing the additional 7 serotypes: 8, 10A, 11A, 12F, 15B/C, 22F, 33F (VT20-13). We assessed dynamics of VT13, VT20-13, and non-PCV20 (NVT20) in nasopharyngeal carriage, respiratory infections, and IPD in children < 2 years following PCV13 implementation.

Methods

Multiple prospective, population-based surveillance projects, conducted in Israel between 2009 and 2017 were used. We studied isolates from IPD; otitis media (OM); conjunctivitis; carriage in healthy children; carriage during lower respiratory tract infections with chest radiography examination (LRI); and carriage during non-LRI illnesses. We added data from healthy children in the community since 2011. Prevalence rate ratios were calculated, comparing VT13, VT20-13 and NVT20 rates in late-PCV13 (2015–2017) vs. early-PCV (2009–2011) periods.

Results

Overall, 9,089 episodes were recorded. VT13 declined significantly in all 6 groups by 75–86% (Figures 1 and 2). Proportions of VT20-13 significantly increased in all groups, excluding conjunctivitis. The highest increases were observed in IPD, OM, and carriage during LRI. In 2015–2017, VT20-13 consisted 24%, 23%, and 19% of carriage in healthy children, carriage in non-LRI illness, and conjunctivitis, respectively, vs. 51%, 33%, and 32% in IPD, OM, and carriage during LRI. VT20-13 rapidly became the leading fraction in IPD. NVT20 proportions increased in all groups.

Conclusion

(1) PCV13 implementation resulted in a substantial increase in NVT carriage and disease; (2) In IPD, VT20-13 became the dominant group; (3) The increases in the proportion of VT20-13 seen in OM and carriage during LRI was significantly higher than in conjunctivitis and in carriage without LRI.

Disclosures

All Authors: No reported Disclosures.
1138. Script for Pediatrics: Creating a Smartphone Application to Improve Antimicrobial Prescribing
Authors: Primhak Sarah , Pool Natasha , Humphrey Gayl , Voss Lesley , Webb Rachel H , Wilson Elizabeth M , Ritchie Stephen , Duffy Eamon , Best Emma
Published: October 2019

Background

When considering antimicrobial stewardship (AMS) interventions, pediatrics is an important and often overlooked group. By 5 years of age, 97% of New Zealand (NZ) children have received antibiotics (median 8 antibiotic courses/child). Prescribing is complex due to age and weight-based adjustments, unpalatable oral preparations and inappropriate allergy labeling. Our tertiary Children’s Hospital has >250 web-based nationally utilized guidelines, 15% including antimicrobials. A point prevalence audit showed only 63% guideline adherence for inpatient antimicrobial prescriptions. We designed an accessible app to bring antibiotic prescribing and antibiotic allergy decision-making to prescribers at point of care.

Methods

Using local hospital and community guidelines, the national formulary and in consultation with subspecialist teams, 31 algorithms were developed. Each algorithm asked questions including diagnosis, age, antibiotic allergy history and known colonization with-resistant organisms.

Results

The smartphone app (Script) uses the algorithms to advise on appropriate antimicrobial, dose, route and duration of treatment. Advice regarding IV-oral switch parameters and oral antibiotic choice is provided. If allergy is suspected symptom-based decision-making enables the user to choose an alternative agent or encourages allergy de-labeling. Further AMS occurs in some algorithms when advice is given not to prescribe antimicrobials.

Conclusion

Script for Pediatrics launched in NZ in March 2019 with >1000 users in the first 6 weeks. The most frequently accessed guidelines are otitis media, pneumonia and meningitis.

Smartphone applications with local relevance and the ability to update in real-time may prove important tools, by providing easily accessible and intuitive advice to help support antimicrobial stewardship activities. This intervention has been rapidly adopted by pediatric hospital prescribers. The impact on prescribing in concordance with guidelines, timely intravenous to oral antibiotic switch and allergy de-labeling will be assessed.

Disclosures

All authors: No reported disclosures.
1163. Minocycline EDTA Ethanol (MEDTA+EtOH) Lock Is Highly Efficacious in Rapidly Eradicating Candida auris Biofilm
Authors: Reitzel Ruth A , Rosenblatt Joel , Gerges Bahgat , Vargas-Cruz Nylev , Hachem Ray Y , Kontoyiannis Dimitrios P , Raad Issam I
Published: October 2019

Background

Bloodstream infections due to Candida auris are an emerging public health concern due to high prevalence of antifungal resistance and significant rates of patient mortality. C. auris is typically azole-resistant; however, several strains have been identified with elevated MICs to all major classes of antifungals. Previously we reported that a synergistic combination of MEDTA+EtOH was highly effective in a clinical trial that evaluated salvage of catheters in patients with bacterial CLABSI. We have also previously reported in vitro studies that demonstrated this combination was capable of eradicating ordinary yeast CLABSI pathogens. In this study we evaluated the ability MEDTA+EtOH lock to rapidly eradicate C. auris biofilms.

Methods

Biofilm eradication of C. auris was evaluated in 10 strains. Candida auris biofilm was grown on silicone discs for 24 hours. Discs were then washed to remove any nonadherent organisms and exposed for 60 minutes to 1 mg/mL Minocycline + 30 mg/mL EDTA + 25% Ethanol (MEDTA+EtOH) lock solution. 1.35% Taurolidine + 3.5% Citrate + 1000U Heparin (TCH) lock solution was used as a comparator. Discs were exposed to Muller–Hinton broth as a control. Subsequently discs were sonicated for 15 minutes in 5 mL of saline and quantitatively cultured onto sabouraud dextrose agar. Plates were incubated at 37°C for 48 hours and counted for growth. All testing was conducted with 6 replicates.

Results

Median and range of recovered viable colonies are presented below. MEDTA+EtOH was significantly more efficacious compared with control (P = 0.002 for all strains) in completely eradicating all replicates in all 10 strains of C. auris tested. MEDTA+EtOH was also superior compared with TCH lock solution (P = 0.002) for all strains.

Conclusion

MEDTA+EtOH is highly effective and was superior to TCH and positive control in the rapid in vitro eradication of all 10 strains of C. auris biofilms tested.

Disclosures

All authors: No reported disclosures.
1184. Making Pneumonia Surveillance Easy: Automation of Pneumonia Case Detection
Authors: Ding Dan , Stachel Anna , Iturrate Eduardo , Phillips Michael
Published: October 2019

Background

Pneumonia (PNU) is the second most common nosocomial infection in the United States and is associated with substantial morbidity and mortality. While definitions from CDC were developed to increase the reliability of surveillance data, reduce the burden of surveillance in healthcare facilities, and enhance the utility of surveillance data for improving patient safety - the algorithm is still laborious. We propose an implementation of a refined algorithm script which combines two CDC definitions with the use of natural language processing (NLP), a tool which relies on pattern matching to determine whether a condition of interest is reported as present or absent in a report, to automate PNU surveillance.

Methods

Using SAS v9.4 to write a query, we used a combination of National Healthcare Safety Network’s (NHSN) PNU and ventilator-associated event (VAE) definitions that use discrete fields found in electronic medical records (EMR) and trained an NLP tool to determine whether chest x-ray report was indicative of PNU (Fig1). To validate, we assessed sensitivity/specificity of NLP tool results compared with clinicians’ interpretations.

Results

The NLP tool was highly accurate in classifying the presence of PNU in chest x-rays. After training the NLP tool, there were only 4% discrepancies between NLP tool and clinicians interpretations of 223 x-ray reports - sensitivity 92.2% (81.1–97.8), specificity 97.1% (93.4–99.1), PPV 90.4% (79.0–96.8), NPV 97.7% (94.1–99.4). Combining the automated use of discrete EMR fields with NLP tool significantly reduces the time spent manually reviewing EMRs. A manual review for PNU without automation requires approximately 10 minutes each day per admission. With a monthly average of 2,350 adult admissions at our hospital and 16,170 patient-days for admissions with at least 2 days, the algorithm saves approximately 2,695 review hours.

Conclusion

The use of discrete EMR fields with an NLP tool proves to be a timelier, cost-effective yet accurate alternative to manual PNU surveillance review. By allowing an automated algorithm to review PNU, timely reports can be sent to units about individual cases. Compared with traditional CDC surveillance definitions, an automated tool allows real-time critical review for infection and prevention activities.

Disclosures

All authors: No reported disclosures.
1208. Preventing Transmission of Bloodborne Viruses from-Infected Healthcare Workers to Patients in Canadian Healthcare Settings: A National Guideline
Authors: Ogunremi Toju , Defalco Katherine , Lynn Johnston B , Boucoiran Isabelle , Cividino Maureen , Cleghorn Blaine , Ann Isinger Melody , Mark Joffe A , Mazzulli Tony , Robert Yves , Vearncombe Mary , Wong David K , Wong Jason , Dunn Kathy , Henry Bonnie
Published: October 2019

Background

Infectious agents, such as bloodborne viruses (BBVs), can potentially be transmitted from healthcare workers (HCWs) to patients. In an effort to reduce this risk to patients, this guideline, which provides a framework for policies on the management of HCWs infected with BBVs in Canada, was developed.

Methods

A total of six systematic reviews (1995–2016) were conducted to inform the risk of transmission of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) from infected HCWs to patients and the infectivity of each virus related to source serum viral load. Three environmental scans were conducted to inform sections on disclosure of HCW’s serologic status, Expert Review Panels, and lookback investigations. Government partners and key stakeholder organizations were consulted and a Task Group provided technical expertise.

Results

The risk of HCW-to-patient BBV transmission is negligible, except during exposure-prone procedures where there is a risk of HCW injury and possible exposure of a patient’s open tissues to the HCW’s blood. Transmission rates were lowest with HIV and highest with HBV (Table 1). Rates varied with several factors including source viral load, nature of potential exposure, infection prevention and control breaches, susceptibility of exposed patient, and use of post-exposure prophylaxis where relevant. The extent of reporting bias for exposure incidents where transmission did not occur is unknown. Current antiviral therapy informed guideline recommendations, with viral load thresholds provided to assist treating physician, Expert Review Panels and regulatory authorities in determining a HCW’s fitness for practice.

Conclusion

Routine Practices (or Standard Precautions) are critical to prevent HCW-to-patient transmission of infections; including BBVs. Recommendations provided in this guideline aim to further reduce the already minimal risk of HCW-to-patient transmission. The guideline provides a pan-Canadian approach for managing HCWs infected with a BBV, with recommendations directly impacting clinical practice related to preventing and controlling healthcare-associated infections.

Disclosures

All authors: No reported disclosures.
1212. Environmental Contamination Characterization of Two Outpatient Clinics
Authors: Warren Bobby G , Turner Nicholas A , Smith Becky A , Addison Rachel , Marden Samantha , Weber David J , Rutala William , Anderson Deverick J
Published: October 2019

Background

Environmental contamination in outpatient clinics is poorly understood.

Methods

We performed a microbiological analysis of surfaces in wound and pulmonary outpatient clinics at a tertiary care center. Cultures were obtained with pre-moistened cellulose sponges from three locations (Exam bed/chair, patient chair, physician area/chair) before and after clinic days. Sponges were combined with 1% Tween20-PBS and mixed in the Seward Stomacher. The homogenate was centrifuged and all but 5 mL of the supernatant was discarded. Samples were plated on Sheep’s blood agar and selective media for S. aureus, Enterococcus spp. and Gram-negative bacteria. CFU was determined by counting the number of colonies on each plate and using dilution calculations to calculate the CFU of the original ~5 mL homogenate. The total sample areas in the wound and pulmonary clinic were 12,735 cm2 and 16,400 cm2, respectively.

Results

A total of 300 samples were obtained over 90-days. Median total room CFU was 7,918 (IQR 2,939–18,855) (Figure 1). Median CFU for the examination area, patient area and physician areas were 2090 (537–10508), 1524 (573–4605) and 960 (371–2183), respectively (Figure 2). The proportions of samples positive for S. aureus, Enterococcus spp. and Gram-negative bacteria were 5.0, 3.3 and 7.7%, respectively (Table 1). In general, median total CFU increased during the clinic day (median CFU before the clinic day 6883 (2937–14983) vs. median after clinic day=10351 (3484–21263) (Figure 3). Environmental bioburden was higher in the wound clinic than the pulmonary clinic (median 18206 CFU [IQR 10048–25037) vs. 3764 [IQR 1452–6671], P < 0.001) (Figure 1). The average number of patients seen in the wound clinic per clinic day was greater than the pulmonary clinic (3.8 vs. 2.2, P < 0.001).

Conclusion

Outpatient clinic rooms were contaminated with clinically important pathogens. Contamination varied by environmental location and increased as the clinic day progressed. Higher contamination was seen in the wound clinic possibly due to higher patient volume vs. increased environmental contamination that occurs while giving wound care. Wound care clinics may need to focus on more detailed cleaning to reduce environmental contamination and the risk of pathogen transmission in at-risk patients.

Disclosures

All authors: No reported disclosures.
1216. A Novel Antimicrobial Surface Coating Demonstrates Persistent Reduction of both Microbial Burden and Healthcare-Associated Infections at Two High-acuity Hospitals
Authors: Elliott Sean P , Ellingson Katherine , Pogebra-Brown Kristen , Gerba Charles P
Published: October 2019

Background

Healthcare-Associated Infections (HAIs) pose substantial risks to patients and hospitals. Surface disinfection practices in hospitals have limited efficacy because surfaces are frequently and easily re-contaminated. A need for innovative technologies to address these challenges exists. One such innovation is a novel antimicrobial surface coating with potential to persistently reduce environmental bacterial load. Here, we use a multicenter, nonrandomized, controlled, pre-post study design to assess the impact of an antimicrobial surface coating on environmental bioburden and HAIs at two high acuity hospitals.

Methods

An antimicrobial surface coating was applied via electrostatic spray to patient rooms and common areas in three selected units at each hospital. Quantitative surface cultures were sent to an independent microbiology laboratory pre- and 11-weeks post-application to identify total bacterial colony-forming units (CFU). HAI outcomes from treatment and contemporaneous control units were assessed using National Healthcare Safety Network protocols for multidrug-resistant organism bloodstream infections (MDRO-BSI) and Clostridium difficile infections (CDI). We used Poisson regression models to compare HAI rates for treated and untreated units for 12-months before and after application of surface coating.

Results

Both hospitals showed statistically significant decreases in total bacterial CFU following application of the antimicrobial surface coating (64% and 75% decreases in Hospitals A and B, respectively, P < 0.0001). Across both hospitals, there was a 36% decline in pooled HAIs (hospital-onset MDRO-BSI + CDI) following application of surface coating in treated units (IRR = 0.64, 95% CI = 0.44–0.91), and no decline in HAIs over the same period in nontreated units (IRR = 1.20, 95% CI = 0.92–1.55).

Conclusion

Significant and persistent reductions in both microbial burden and associated HAIs occurred in units where surfaces were treated with antimicrobial surface coating, suggesting the potential for improved patient outcomes and reduced healthcare costs. Optimal implementation methods and long-term impact should be assessed with further study of this novel environmental control intervention.

Disclosures

All authors: No reported disclosures.
1228. Risk Factors for Contamination with Carbapenemase-Producing Enterobacteriales (CPE) in Exposed Hospital Drains in Ontario, Canada
Authors: Jamal Alainna , Brown Kevin A , Katz Kevin , Johnstone Jennie , Muller Matthew P , Allen Vanessa , Borgia Sergio , Boyd David A , Ciccotelli William , Delibasic Kornelija , Fisman David , Leis Jerome , Li Angel , Mataseje Laura , Mehta Mamta , Mulvey Michael , Ng Wil , Pantelidis Rajni , Paterson Aimee , McGeer Allison
Published: October 2019

Background

Hospital drains may be a source of CPE in patients. We determined prevalence of and risk factors for CPE contamination of hospital drains exposed to patients with CPE colonization/infection.

Methods

We cultured hand hygiene and patient use sink as well as tub/shower drains exposed to 310 inpatients colonized/infected with CPE in 10 Ontario hospitals. A multi-level logistic regression model was fitted to determine whether type of drain/room/unit was associated with CPE drain contamination. Drain and room occupant CPE isolates underwent Illumina whole-genome and MinION sequencing. Single nucleotide variant (SNV) phlogenomic analyses and plasmid characterization were performed.

Results

53/ Of the 1,209 drains, 53 (4%) at 7 (70%) hospitals yielded CPE. Patient room shower drains were significantly more likely to yield CPE than hand hygiene sink (OR 3.35, 95% CI 1.61–6.97) and patient use sink (OR 10.89, 95% CI 3.62–32.80) drains. Hand hygiene sink drains were significantly more likely to yield CPE than patient use sink drains (OR 3.26, 95% CI 1.05–10.13). 8 (15%) drain isolates matched the room occupant CPE gene/species; 24 (44%) matched the gene but not species, and 23 (42%) matched neither gene nor species. Among 13 drain/11 room occupant pairs with molecular comparisons to date, only 1/13 (8%) drain isolates matched the respective room occupant carbapenemase allele and replicon harboring the carbapenemase gene (IncN replicon harboring blaKPC-3). In addition, one drain isolate had a plasmid highly related to plasmids of 2 isolates from a patient occupying a room in an adjacent unit (IncN3 replicons harboring blaKPC-2). At another hospital, all 6 drain isolates were located on one unit and had an IncHI2A/HI2/TrfA replicon harboring blaNDM-1; 5 of these were E. cloacae ST66, with 0–3 SNV differences observed between isolates.

Conclusion

Different drain types have different risks of CPE contamination. In our setting, most drain contamination was not caused by recognized room occupants. Further investigation is needed to understand the sources of hospital drain CPE contamination.

Disclosures

All authors: No reported disclosures.
1257. Mental Health, Quality of Life, and Accessibility to Care Among Virally Suppressed People Living with HIV in the United States
Authors: Evans Tammeka , Cutts Katelyn , Swinburn Paul , Lykopoulos Konstantinos , Ferrer Pedro A
Published: October 2019

Background

Life expectancy of people living with HIV (PLHIV) in the United States has improved dramatically in the last 25 years, and more than ever are virally suppressed (VS). However, HIV is a complex chronic condition associated with a myriad of concurrent conditions. The “Real-world Insights of PLHIV Shared through Electronic devices” (RISE) study was a cross-sectional survey designed to obtain an up-to-date understanding of the unmet needs in virally suppressed PLHIV.

Methods

Participants completed the survey on a mobile application downloaded directly to their device. The survey included a sociodemographic and clinical section, and seven validated patient-reported outcome measures. The current analysis was limited to Functional Assessment of HIV Infection (FAHI) total and domain scores as well as the Patient Satisfaction Questionnaire (PSQ-18) accessibility and convenience domain. A two-point difference in the FAHI domain scores and a five-point difference in the total score are generally considered clinically meaningful and were used as benchmarks for comparisons.

Results

Most of the sample (n = 1,226) were virally suppressed (VS) (92%), male (81%), White (53%), homosexual (77%), and reported some type of mental health condition (90%). On average participants were 46±11 years old and had been diagnosed with HIV 14.3±9.6 years ago. VS participants with a mental health condition reported significantly lower quality of life (QoL) than participants without a mental health condition, except on the FAHI social well-being and cognitive functioning scores (Table 1). VS participants with depression reported lower QoL even when controlling for key demographic variables (F= 278.3; P < 0.0001; R2=.77).

Conclusion

While treatment and care for PLHIV has improved in recent years, there remain significant unmet needs. Although achieving VS significantly improves the QoL of PLHIV, additional attention should be placed on the role of mental health and well-being, especially as individuals age while living with HIV. These results highlight the need to understand factors contributing to decreased HRQoL in PLHIV, and the importance of addressing these factors in clinical care.

Disclosures

All authors: No reported disclosures.
1280. A Pharmacist-led PrEP Program at the Epicenter of the HIV Epidemic in Atlanta; Our Experience
Authors: Smith Bradley L , Hester Allison M , Cantos Valeria D , James Tiffany R , Lora Meredith H
Published: October 2019

Background

Atlanta, GA ranks third in the nation for highest rates of new HIV diagnoses, disproportionally affecting Black men and women. Pre-exposure prophylaxis (PrEP) is underutilized in this population due to multiple barriers to uptake, including limited access to PrEP delivery programs. The advantages of a primary pharmacy-led PrEP program include: relatively low service fees, perform and assess point-of-care testing, and provide adherence counseling. Similar programs across the United States have been shown to effectively increase PrEP uptake and optimize retention in care. Grady Health System (GHS), the fifth largest public hospital system in the United States, is located at the epicenter of the HIV epidemic: downtown Atlanta. It encompasses 11 different primary care clinics, accounting for 850,000 outpatient visits per year. In August 2018, we launched a developmental pilot of a GHS pharmacy-based tele-PrEP program, aiming to optimize PrEP access for vulnerable populations who would otherwise not be able to obtain it. PrEP services are provided directly to the community and through a consultative support program for all clinical sites within the GHS system. The key pilot interventions included developing a user-friendly electronic medical record (EMR)-based PrEP order sets and brief provider education interventions in 6 GHS primary care clinics, to increase PrEP awareness among non-HIV clinicians.

Methods

We conducted a retrospective process evaluation of the pilot PrEP program based on the PrEP continuum of care.

Results

Over 9 months, 95 referrals were received from providers within the GHS clinics. Of the 95 patients referred, 56 (59%) started PrEP. Two patients were started on post-exposure prophylaxis prior to initiation of PrEP. Forty-five patients (81%) remain on PrEP as of April 2019. Six clients were diagnosed with 9 STIs on screening (4 syphilis, 2 gonorrhea, 2 chlamydia, 1 lymphogranuloma venereum). There have been no HIV seroconversions in patients on PrEP.

Conclusion

Utilizing a pharmacy-based PrEP program to train and support clinical providers in a large, hospital system can facilitate PrEP uptake and retention for patients in primary care.

Disclosures

All authors: No reported disclosures.
1325. Inpatient Initiation of ART Improves Short-Term Mortality in People Living with HIV
Authors: Campbell Jamie , Polk Christopher , Roshdy Danya , Leonard Michael
Published: October 2019

Background

Treatment of HIV is recommended as soon as possible and early initiation of combined antiretroviral therapy (cART) is associated with improved engagement in care; however, treatment with cART is often deferred in hospitalized patients despite being correlated with improved outcomes. We implemented an institutional intervention to ensure all people living with HIV (PLwH) were on cART during hospitalization to improve patient outcomes.

Methods

We prospectively identified all PLwH hospitalized at our institution and had ID physicians and pharmacists ensure they were on appropriate cART and linked to outpatient care. We retrospectively collected clinical and lab data to assess the impact of our intervention on inpatient mortality, 30-day mortality, 30-day readmission rate, and frequency of outpatient follow-up. Patients were excluded from analysis if they were admitted for hospice care.

Results

We identified 389 patient admissions in 275 unique patients, of which 304 admissions were already on cART at admission. After ID physician assessment, 37 of the 85 not on cART at admission were initiated on therapy. We assessed the impact of this intervention on short-term outcomes as listed in Table 1.

Despite the intervention group having similar immunologic and virologic baseline characteristics to those not initiated on cART, their inpatient and 30-day mortality was similar to those already on cART. Readmission rates also decreased in the intervention group. Thirteen of 24 patients in the intervention group who could be tracked for long-term follow-up within our system achieved virologic suppression by 90 days after hospital discharge.

Conclusion

Inpatient treatment with cART during hospitalization improves short-term mortality outcomes. This study also demonstrates the value of inpatient cART treatment as most patients achieved virologic suppression at subsequent outpatient follow-up.

Disclosures

All authors: No reported disclosures.
1328. Post-War and Post-Ebola HIV Care Continuum in a Liberian Academic Center: Fresh Insights and Trends Over 5-Year Period
Authors: Watchekwa Ian , Ogbuagu Onyema , Donato Sean , Nuta Cecilia , Barakat Lydia A
Published: October 2019

Background

Two-thirds of people living with HIV (PLWH) reside in sub-Saharan Africa. The UNAIDS 90-90-90 target to end the HIV epidemic is an aspirational but achievable goal. The Continuum of Care model allows evaluating the progress toward this goal as well as identifying gaps in diagnosis, linkage to care, HIV treatment. In Liberia, the estimated number of PLWH is 40,000 with only 26,000 (65%) diagnosed, 14,000 (53%) on combination ART (cART), and of those, 53% virally suppressed. After a devastating war and Ebola epidemic, the country has only one academic medical center, John F. Kennedy (JFK) Hospital in Monrovia, with the largest HIV clinic caring for a cohort of 3,000 PLWH. This study was designed to evaluate the HIV care continuum at this center over a 5-year period.

Methods

Data from 2014 to 2018 were collected from a database at JFK hospital HIV clinic. Data were extracted for all patients tested for HIV. The proportion of those tested positive, who were linked to care, retained in care, and subsequently initiated on cART was analyzed. Only a sample of PLWH received HIV viral load monitoring test. Utilizing the HIV care continuum model, data on each step of the care cascade were reported as simple percentages or proportions.

Results

Over the 5-year study period, a total of 41,343 individuals were screened for HIV and 4,066 tested positive (10%), much higher than the national rate of 3–5%. Linkage to care was inconsistent; 87% (592/678) in 2014, 98% (622/636) in 2015, 61% (644/1057) in 2016, 73% (570/786) in 2017, and 64% (584/909) in 2018 were enrolled in the clinic. ART initiation improved over time; of the PLWH enrolled in the clinic, 75%, 64%, 76%, 86%, and 84% for the years 2014, 2015, 2016, 2017, and 2018, respectively, were initiated on cART, also higher than the national rate estimated at 53%. Only a sample of 100 patients had HIV VL performed and of those 53% had viral suppression. From the total clinic cohort of 5,280 PLWH, 19–28% of HIV patients were lost to care with a 2–4% death rate annually.

Conclusion

Although the HIV Care Continuum rates at the largest academic center in Monrovia, Liberia were above national rates, they were suboptimal and fell below the 90-90-90 UNAIDS target. Current efforts are focused on understanding gaps in care and investigating opportunities to improve linkage to, and retention in care.

Disclosures

All authors: No reported disclosures.
1331. Interpretation and Application of Rapid Diagnostic Methodologies: The Positive Impact of Online, Curriculum-Based Learning
Authors: Thomas. Hurst Simi , Martorano James , Capparelli Catherine
Published: October 2019

Background

Antibiotic resistance has become one of the most serious public health threats today. Used appropriately, newer rapid diagnostic methodologies have the potential to positively impact care by informing a more targeted treatment approach that can reduce inappropriate antibiotic use, support antimicrobial stewardship, shorten hospital stays, and improve clinical outcomes.

Methods

To improve ID specialists’ knowledge and application of rapid diagnostic tests, a CME/ABIM MOC/ACCENT certified curriculum was developed. The curriculum comprised a series of 4 educational episodes, each with a video commentary from a clinical expert and each focused on a different site of infection: (a) Episode 1: CNS; (b) Episode 2: Gastrointestinal tract; (c) Episode 3: Respiratory tract; and (d) Episode 4: Bloodstream. The episodes in the curriculum were launched in serial fashion between October 30, 2018 and February 11, 2019, on a website dedicated to continuous professional development. Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design; each individual served as his/her own control. A chi-square test assessed changes pre- to post-assessment. P values of < 0.05 are statistically significant. Effect sizes were evaluated using Cramer’s V (<0.05 modest; 0.06–0.15 noticeable effect; 0.16–0.26 considerable effect; >0.26 extensive effect).

Results

15,092 HCPs, including 10,894 physicians have participated in the curriculum. This initial analysis comprises data from the subset of ID specialists from each episode who answered all pre-/post-assessment questions through March 18, 2019; data collection is ongoing. Following participation, significant improvements were observed overall (P ≤ 0.002 for each episode) and on the specific topics assessed in each episode (Graph). Additionally, 51%–55% of ID specialists indicated an intent to modify their diagnostic approach and 15%–29% had increased confidence in applying the rapid diagnostic results into patient care.

Conclusion

This educational curriculum significantly improved ID specialists’ knowledge of the strengths and limitations of different rapid diagnostic methodologies and improved the applications of test findings into clinical decision-making. These findings highlight the positive impact of well-designed online education.

Disclosures

All authors: No reported disclosures.
1342. Impact of HIV Infection on Treatment Outcome of New Tuberculosis Patients Attending Tuberculosis and Antiretroviral Treatment Services in the Community-Based Hospital, Thailand: A Retrospective Cohort Study
Authors: Pinsai Subencha
Published: October 2019

Background

Tuberculosis (TB) and HIV are one of the significant public health problems in Thailand, and an estimated 15,000 individuals have a dual infection. Both HIV and TB each disease speeds up the progression of each other. TB is the leading cause of death in HIV-infected individuals, and HIV coinfected TB patients have disease-specific, and treatment affected their treatment outcomes. There is insufficient evidence on issues of TB and HIV co-infection patients received treatment. This study aimed to assess the impact of HIV status on treatment outcome of TB patients.

Methods

We conducted a retrospective cohort study among TB patients who registered to service at Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand from October 1, 2017 to October 31, 2018. All patients’ demographic data, diagnosis, and treatment were retrieved. Clinical characteristics, treatment outcome, and factors associated with treatment outcome were analyzed.

Results

There were 49 (10.65%) HIV among 460 TB patients with a median (IQR) age of 44 (32–61) years old and 65.2% were males. Disseminated TB and extrapulmonary TB were higher in HIV coinfected group (P < 0.001). All pulmonary TB patients’ lower lobe involvement was higher in HIV coinfected group (62.50 vs. 36.00, P = 0.001). In HIV coinfected group median CD4 was 134 cell/mm3 (IQR 19–294), 66.67% were diagnosed HIV infection after TB diagnosis, the median time from TB diagnosed to antiretroviral was 29 days (IQR 21–48). The overall treatment success rate was 93.04%; the treatment success rate was similar in HIV coinfected TB patients (89.80%) and non- HIV-infected patients (93.43%) (P = 0.66).Adverse drug reactions were higher in HIV coinfected group (44.89% vs 12.41%) (P < 0.001). By multiple stepwise logistic regression, factors associated with anti-TB drug adverse reactions were having HIV infection (OR 7.99; 95% CI 3.73–17.10, P < 0.001), Age >60 years (OR 2.64; 95% CI 1.43–4.87, P = 0.002) and female sex (OR 1.97; 95% CI 1.11–3.52, P = 0.02).

Conclusion

There is a high TB treatment success rate among patients who have treated for TB, but adverse drug events in HIV co-infected TB patients is higher than that observed in non-HIV-infected patients.

Disclosures

All authors: No reported disclosures.
1355. Efficacy and Tolerability of Linezolid Adjunctive Treatment for Nontuberculous Mycobacterial Infection in Patients with Acquired Anti-Interferon-Gamma Autoantibody
Authors: Chavapradit Natthakit , Suputtamongkol Yupin , Angkasekwinai Nasikarn , Phoompoung Pakpoom , Chirapapisan Niphon , Foongladda Suporn
Published: October 2019

Background

Despite a long duration of combined oral antimycobacterial drugs, relapse/ reinfection of nontuberculous mycobacteria (NTM) is common among patients with anti-interferon gamma autoantibodies (anti-IFN-γ auto-Abs).

Methods

We reported here, an interim analysis of the prospective study of 25 patients with anti-IFN-γ auto-Abs, who received oral linezolid (LZD) adjunctive treatment for their NTM infections, at Siriraj Hospital, Bangkok, Thailand, between December 2017 and April 2019.

Results

8 patients (32%) were male, with a median age of 52.5 years. NTM identified among them included Mycobacterium abscessus (n = 19), M. avium complex (MAC) (n = 2), M. fortuitum (n = 2), M. kansasii (n = 1), and both M. abscessus and MAC (n = 1). The median duration of follow-up was 11 months (range 1.6–15 months). LZD 600 mg/day was given until clinical remission, then reduced to 300 mg/day for a total duration of at least 9 months. Other patient’s managements, including choice and duration of other antimycobacterial therapy were determined by the attending physician. Clinical remission was achieved, and LZD was discontinued at 9 months in 10 patients. NTM infection remained active and LZD was continued to 12 months in 4 patients. Two patients only completed 6 months of LZD. Culture proven relapse of M. abscessus occurred in 3 patients during LZD treatment, and 1 patient developed M. haemophilum infection after discontinuation of all drugs for 3 months. One patient was retreated with intravenous antimycobacterial drugs based on clinical suspicious of relapse NTM infection. LZD-related serious adverse events leading to discontinue of LZD occurred in 5 patients; severe myelosuppression (n = 1), peripheral neuropathy (n = 2), exfoliative dermatitis (n = 1), and idiopathic increased intracranial pressure (n = 1). Anemia occurred in 3 patients during the 600 mg LZD once-daily treatment period. No patient developed anemia after LZD was adjusted to 300 mg twice daily. The rate of peripheral neuropathy was similar throughout the study period.

Conclusion

LZD might reduce the rate of relapsed/ reinfection of NTM infection in these patients. LZD 300 mg twice daily was less toxicity and more tolerable than 600 mg once daily. Long-term study with this modified regimen is now on-going.

Disclosures

All authors: No reported disclosures.
1358. A Novel Rapidly Growing Mycobacteria (RGM) Species Causing Soft Tissue and Orthopedic Hardware Infection After Trauma
Authors: Nguyen David C , Lisgaris Michelle , Vasireddy Sruthi , Wallace Richard J , Perez Federico , Rhoads Daniel D
Published: October 2019

Background

The widespread use of molecular techniques has resulted in increasing numbers of newly characterized rapidly growing mycobacteria (RGM). Many RGM cause soft tissue and orthopedic hardware infection, particularly after trauma. RGM species identification remains challenging with few genetic differences between species.

Methods

We describe a case involving RGM. We report results of matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry (Bruker Biotyper), sequencing of rpoB, erm(39), and 16S rRNA genes, and antibiotic susceptibility testing (AST). We review previous reports describing similar RGM infections.

Results

A 58-year-old male sustained multiple fractures and right thigh compartment syndrome after a motorcycle accident. He underwent fasciotomy and multi-stage surgical fixations. 3 months later, he had wound dehiscence, purulence and multiple fluid collections of his right leg and knee requiring surgical drainage and removal of orthopedic hardware. After 4 days, acid-fast bacilli grew on routine bacterial culture media. MALDI-TOF identified the isolate as Mycobacterium mageritense. In contrast, sequencing of 16S rRNA (100% identity) and erm(39) (> 99% identity) identified the isolate as Mycobacterium houstonense; erm(39) only had 80% similarity with Mycobacterium fortuitum. Sequencing of rpoB showed a 19 bp difference with the M. houstonense type strain, and showed similarity to M. fortuitum (97.64%) than M. houstonense (97.45%). AST demonstrated resistance to clarithromycin only. After initial treatment with imipenem, ciprofloxacin, and doxycycline, definite therapy with ciprofloxacin and doxycycline was successful. In the literature, we found one case each of M. mageritense and M. houstonense infection after trauma.

Conclusion

This case highlights the importance of RGM other than M. fortuitum as a cause of soft tissue and orthopedic hardware infections, and illustrates the difficulty of identifying them to the species level. Sequencing of erm(39) and 16S rRNA gene identified the isolate as M. houstonense, but the larger difference (>2.5%) in rpoB sequence suggests a novel species. Further characterization is underway. Efforts to determine RGM species and antibiotic susceptibility give important insight into diagnosis and management.

Disclosures

All authors: No reported disclosures.
1383. Everolimus is Associated with an Increased Risk of Tuberculosis in Solid-Organ Transplant Recipients
Authors: Sun Hsin-Yun , Cheng Aristine , Wang So-Meng , Tsai Meng-Kun , Chen Yih-Sharng , Wang Sheoi-Shen , Ho Cheng-Maw , Hu Rey-Heng , Hsu Hsao-Hsun , Fang Chi-Tai , Chen Yee-Chun , Chang Shan-Chwen
Published: October 2019

Background

Tuberculosis (TB) is an important post-transplant infection. Everolimus has been documented to reduce the risk of cytomegalovirus infection in transplant recipients, but its impact on other infections is less known. The present study aimed to assess immunosuppressive regimens on TB risk in solid-organ transplant (SOT) recipients via a matched case–control study.

Methods

From May 2005 to December 2018, SOT recipients with TB were retrospectively identified, and those without TB undergoing transplantation at the same university hospital were selected as controls. Controls and cases were matched by age (±5 years), transplant type and year (±5 years) at a ratio of 4:1. Conditional logistic regression was used to analyze the risk factors of TB.

Results

TB developed in 30 SOT recipients (13 kidney, 7 heart, 6 liver, and 4 lung) after a mean duration of 1,601 days after transplantation, with predominant lung involvement (87%). The diagnosis was made by culture in 70% and pathology in 17%. Rifamycins-based regimens were used in 27 cases, and 4 developed rejection without graft failure. A total of 106 controls were selected. At the time of TB diagnosis, cases were more likely to use everolimus than controls (27% vs. 11%, P < 0.05), but no significant differences were observed in the use of tacrolimus, cyclosporin, sirolimus, prednisolone, or mycophenolate mofetil. The median duration of everolimus use was 585 and 698 days in 8 cases and 12 controls, respectively. Multivariable analysis showed that everolimus use (adjust odds ratio [aOR] 22.3, 95% conference interval [CI] 2.5–203.0) and hemodialysis (aOR 19.6, 95% CI 1.3–287.1) were independently associated with TB.

Conclusion

TB is more likely to develop in SOT recipients on everolimus and hemodialysis. Further studies to confirm our findings are warranted, and TB risk assessment should be performed for those receiving everolimus and hemodialysis.

Disclosures

All authors: No reported disclosures.