bluuebunny/crossref_metadata_2025 huggingface dataset:
144. Impact of Rapid Identification and Resistance Gene Detection using an Algorithm-Based Approach in Gram-Negative Bacteremia
Authors: Jawanda Jasanjeet , Clarke Lloyd , Creager Hannah M , Shields Ryan K
Published: November 2023

Background

Time to appropriate antimicrobial therapy is the most important predictor of survival among patients with sepsis due to Gram-negative bacteria (GNB). Infections due to multidrug-resistant (MDR) pathogens often result in inappropriate empiric treatment (tx). The GenMark ePlex identifies organisms and resistance markers within 1.5 hours from blood culture positivity compared to 48-72 hours by conventional methods.

Methods

We are conducting a single-center study to assess outcomes before and after ePlex implementation. The pre-intervention period included patients with GN bacteremia from January to June 2021. Patients were excluded if they received comfort-only care within 48 hours, had polymicrobial GN bacteremia, or were infected by an organism not on the ePlex panel. Primary outcome is time to in-vitro active therapy from blood culture collection.

Results

208 patients were identified during the pre-intervention period; 154 met inclusion criteria. Median age was 64 years, 49% were male, and 28% were immunocompromised. Median (IQR) Charlson Comorbidity index and Pitt Bacteremia scores were 6 (4-8) and 2 (1-8), respectively (Table 1). 16% of patients were infected by MDR GNB and 21% received inactive empiric tx. Overall median (IQR) time to in-vitro active tx was 3.9 (1–19) hours, but was 39.5 (13.6-71.9) hours among those who received inactive empiric tx. Median (IQR) time to first antibiotic modification was 2.7 (1.0-3.4) days. 38% of patients were transitioned to oral antibiotics at a median (IQR) of 4.2 (3.1-6.1) days. The median (IQR) duration of tx was 15 (10-17) days; 4.5% of patients were treated with ≤ 7 days. Median (IQR) length of hospitalization was 15.5 (7-36) days. 7.8% were re-admitted within 30 days (Table 2). In-hospital and 30-day mortality rates were numerically higher among patients who received inactive empiric therapy (27% and 21%, respectively) when compared to patients who received active empiric therapy (16.5% and 12%, respectively) (Figure 1).

Results Table 1: Patient demographics, underlying conditions and infection and treatment characteristics in the pre-intervention group

Results Table 2

Results Figure 1

Conclusion

Our pre-intervention data highlight opportunities to improve the management of GN bacteremia. Implementation of ePlex is likely to decrease the proportion of patients treated with inactive therapy, shorten time to optimal tx and reduce lengths of stay.

Disclosures

Ryan K. Shields, PharmD, MS, Allergan: Advisor/Consultant|Cidara: Advisor/Consultant|Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Menarini: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Roche: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Utility: Advisor/Consultant|Venatorx: Advisor/Consultant|Venatorx: Grant/Research Support
2562. Retrospective Analysis of Cefepime Intravenous Push versus Extended Infusion for the Treatment of Neutropenic Fever
Authors: Rust Thomas J , Krause Tracy M , Saw Stephen
Published: November 2023

Background

The outcomes associated with intravenous push (IVP) cefepime compared to extended infusion (EI) have not yet been studied. The objective of this study was to evaluate the effectiveness of IVP versus EI cefepime in patients with neutropenic fever.

Methods

This was a retrospective, single-center, cohort study evaluating hematopoietic stem cell transplant (HSCT) recipients who received IVP or EI cefepime for at least 48 hours for the treatment of neutropenic fever. Patients were excluded if they were admitted to an intensive care unit (ICU) at the time of cefepime initiation, required renal replacement therapy, received an IVP dose < 2 grams, or grew a cefepime-resistant organism from initial cultures. Patients were grouped 2:1 EI-to-IVP according to weight >100 kg and autologous or allogeneic HSCT. The primary outcome was defervescence at 72 hours. Secondary outcomes included 30-day in-hospital mortality, ICU transfer within 72 hours, ICU length of stay (LOS), hospital LOS, breakthrough infection, and escalation of gram-negative therapy within 72 hours. Data was analyzed using independent t-test or Wilcoxon Rank Sum test if continuous and chi-square test or Fisher’s Exact test if nominal.

Results

Of the 120 patients meeting eligibility criteria, 40 patients received IVP cefepime and 80 patients received EI cefepime. All baseline demographics were balanced between groups with the exception of time from cefepime order entry to first dose administration (Table 1). Concomitant medication administrations were also similar between groups apart from antipyretic administration (Table 2). Defervescence within 72 hours occurred in 28 (70%) patients treated with IVP and 51 (63.8%) patients treated with EI (p = 0.496). No patients experienced in-hospital mortality and median hospital LOS was not significantly impacted by IVP vs EI administration (18 vs 17.5 days, p = 0.158). None of the additional secondary outcomes studied were significantly different between groups (Table 3).

Conclusion

The current study showed no significant differences in clinical outcomes when administering cefepime as IVP or EI for the treatment of neutropenic fever. Larger studies and/or randomized controlled trials are necessary to confirm the findings of this study.

Disclosures

All Authors: No reported disclosures
2578. Trends in Pathogens and Antibiotic Treatment in Children with Cystic Fibrosis in 2018 and 2022: A Retrospective Multicenter Study
Authors: Stout Dayna , Fireizen Yaron , Vigers Timothy , Ahmed Mohamoud , Akong Kathryn , Ryu Julie , Hahn Andrea , Koumbourlis Anastassios , Tirakitsoontorn Pornchai , Arrieta Antonio C , Burgener Elizabeth , Towler Elinor , Keck Allison , Sagel Scott , Bradley John S
Published: November 2023

Background

The new Cystic Fibrosis (CF) transmembrane conductance regulator modulator therapy combination (elexacaftor/tezacaftor/ivacaftor, ETI) has significantly improved the quality of life of children with CF and decreased the rate of pulmonary exacerbations (PEx). The focus of our study was to examine the infection characteristics of PEx in children with CF before the availability of ETI (2018) and following ETI approval and during emergence from COVID-19 (2022).

Methods

We conducted a multicenter (5 sites) retrospective review collecting data on children with CF over 12-month periods in 2018 and in 2022 who were hospitalized for PEx and treated with IV antibiotics. We analyzed the number of PEx, bacterial and fungal organisms identified by CF respiratory cultures and IV antibiotics used empirically at hospital admission.

Results

The number of hospitalizations for PEx decreased from 414 in 2018 to 163 in 2022. The most common organisms identified in all centers were Pseudomonas aeruginosa (Pa), Staphylococcus aureus (Sa) and Candida species, with no apparent overall difference in the relative percentages of pathogens isolated between 2018 and 2022 (figure 1), although fewer children were infected with methicillin-resistant S. aureus (MRSA) in 2022 (2.7%) than in 2018 (10%) (p=0.014). There was variability in the type of antipseudomonal agents and antistaphylococcal agents used empirically both within and between the different centers (figure 2).

Conclusion

Pathogens isolated from respiratory culture associated with PEx demonstrated similar rates of isolation of pathogens in the 2 time periods, consistent with historical CF pathogen isolation. The decreased number of PEx in 2022 compared to 2018 is consistent with the widespread use of ETI. The variability of usage antipseudomonal agents between centers and between years of data collection requires further investigation.

Disclosures

Andrea Hahn, MD, MS, TGV Dx: Advisor/Consultant Antonio C. Arrieta, MD, FIDSA, FPIDS, Astellas Pharma Global Development, Inc.: Advisor/Consultant|Astellas Pharma Global Development, Inc.: Grant/Research Support|Astellas Pharma Global Development, Inc.: Honoraria|Cumberland Pharmaceutical: Grant/Research Support|IDbyDNA: Advisor/Consultant|IDbyDNA: Grant/Research Support|Melinta: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Nabriva: Grant/Research Support|Paratek Pharmaceuticals: Grant/Research Support|Pfizer, Inc: Advisor/Consultant|Pfizer, Inc: Grant/Research Support|Roche/Genentech: Grant/Research Support|The Medicine Company: Grant/Research Support
2583. Antimicrobial Resistance Profile of Mycobacterium simiae and Treatment Trends from a Tertiary Care Center in Lebanon
Authors: Zakhour Johnny , Bitar Elio , Chalhoub Mariam , Wehbe Saliba , Harb Souad Bou , Kanj Souha S
Published: November 2023

Background

Mycobacterium simiae is a rare non-tuberculous mycobacterium (NTM) that is most identified in some Middle Eastern countries. It is unclear why this NTM is geographically restricted. The pathogen can either be a mere colonizer or cause significant morbidity. Patients with M. simiae infection require prolonged treatment with a combination of 3 antimicrobials. Drug resistance among M. simiae isolates can complicate the course of treatment. However, the correlation between in vitro resistance and clinical response is unknown. We aimed to report the susceptibility profile of M. simiae isolates from our institution and the prescribed treatments.

Methods

We conducted a retrospective study of M. simiae isolates from the American University of Beirut Medical Center (AUBMC) over 19 years. All isolates were cultured at AUBMC using the Lowenstein-Jensen media and the BacT/ALERT system then referred for speciation and susceptibility testing at Mayo Clinic, MN, USA.

Results

We included 72 isolates that underwent susceptibility testing from 59 patients. Most isolates were obtained from sputum samples (61.1%) and the rest from bronchoalveolar lavages (BAL). The highest rates of susceptibility were to clarithromycin (84.7%) and amikacin (73.6%). All isolates were resistant to ciprofloxacin, streptomycin, doxycycline, and minocycline (Graph 1). Median minimal inhibitory concentrations (MIC) for clarithromycin and amikacin for susceptible isolates were 8 and 16 mcg/mL respectively. Clofazimine susceptibility was performed on only 16 isolates, 10 of which had an MIC ≤ 0.06 mcg/mL and the highest was 0.25 mcg/mL. Empiric antimicrobial therapy was given to 30% of patients but was inappropriate in 80% of cases. Targeted therapy was given to 40.9% of patients. Most received triple therapy with clarithromycin (95.8%) and clofazimine (41.7%) being the most common agents. The median duration of treatment was 12 months with the longest duration being 11 years. Microbiologic cure was achieved in 73.9% of the 23 patients who underwent repeated testing.

Susceptibility of Mycobacterium simiae isolates according to the CLSI breakpoints.

TMP-SMX, trimethoprim-sulfamethoxazole. *Clofazimine was not included in this graph as there is no consensus on breakpoints for susceptibility for NTM. All our isolates had MICs ≤ 0.25 mcg/mL which is lower than breakpoints used in other studies.

Conclusion

M. simiae exhibits resistance to most available antimycobacterial agents. Further research is needed to understand resistance mechanisms of this organism and correlate in vitro and in vivo findings.

Disclosures

Souha S Kanj, MD, Gilead: Advisor/Consultant|Menarini: Advisor/Consultant|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant
2587. Evaluating Seasonality & Demographic Risk Factors of Hospital Encounters in Patients with Community Acquired Pneumonia (CAP)
Authors: Lildar Taikchan , Shah Chineen , Khan Alvi , Sutaria Nishith , Miele Andrew , Chorzepa Aldona , Bozzo Thomas A , Robitsek Jonathan , Shakil Javeria , Cervellione Kelly L
Published: November 2023

Background

Community Acquired Pneumonia (CAP) is associated with increasing hospitalization rates and is a leading driver of morbidity and mortality. Seasonal differences associated with pathogen incidence in CAP-related hospital admissions have been found (Cilloniz et al., 2017). However, seasonal differences in CAP-related readmissions have not been studied.Table 1.Descriptive characteristics of the sample overall & by season. *percentages calculated as proportion of total pathogens identified, n=53 **calculated as proportion of total for each pathogen

Methods

This retrospective study examined 478 CAP-related admissions from 01/2017-03/2020 within an urban healthcare network in Queens, NY. The primary outcome was rates of readmission at 30 days. Predictors included demographics (e.g., age), clinical factors (e.g., Elixhauser comorbidity score), sputum culture bacteria present, and season of admission (Winter: 21 DEC-20 MAR, Spring: 21 MAR-20 JUN, Summer: 21 JUN-21 SEP, Fall: 22 SEP-20 DEC).

Results

Rates of hospital encounters due to CAP were highest in winter (33%) while rates of 30 day-readmission were highest in the spring (16%). Significant differences in total number of encounters were found by season (58% Winter, 25% Fall, 23% Spring, 19% Summer; p< 0.001) but not readmissions (p=0.29). Sputum culture data was available for 314 patients, with microbial etiology identified in 53 patients. Significant seasonal variations in Klebsiella pneumoniae incidence were found (53% summer, 23% fall & summer, 0% winter, p=0.02). Patients presenting in winter were significantly older than other seasons (avg.=71.5, p=0.01). Across seasons, patients readmitted within 30 days had significantly higher Elixhauser scores (median score=9 vs. median score=3, p=0.003). No significant differences were observed between seasons or readmission in terms of gender, race/ethnicity, smoking history, or Elixhauser score.

Conclusion

Seasonal differences in CAP-related encounters were observed, in line with previous studies. Descriptive differences in rates of readmission suggest that future research about risk factors is needed. This study is limited by its retrospective nature, low sputum culture rates, and unstandardized sputum culture collection methods. Data on viral pneumonia was not collected.

Disclosures

All Authors: No reported disclosures
2590. Efficacy of Doxycycline Versus Azithromycin in Community Acquired Pneumonia
Authors: Mei Julie , Blum Sharon , Bosco Michael , Akerman Meredith , Fleming Andrew
Published: November 2023

Background

Guideline-based CAP treatment has consisted of 2 preferred regimens: a beta lactam with a macrolide (azithromycin), or monotherapy with fluoroquinolone or beta lactam with doxycycline as an alternative regimen. While doxycycline may represent a more attractive option due to concerns for increased cardiovascular risks associated with azithromycin, individual trials assessing efficacy

Methods

Individuals over 18, admitted for greater than 48 hours at NYU Brooklyn, NYU Long Island, and NYU Tisch from January 1, 2019 to December 31, 2022 with clinical or radiographic evidence of pneumonia treated with ceftriaxone plus either azithromycin or doxycycline were included. Subjects were excluded if received alternative antibiotics for >24 hours, were hospitalization for >48 hours within the last 90 days, were pregnant or breastfeeding, had history of structural lung disease, active lung cancer, suspected tuberculosis, or bloodstream infections, immunocompromising condition, ventilated, or with non-infectious cause of pulmonary infiltrates.

Results

A total of 91 patients met inclusion criteria, 42 patients in the azithromycin group and 49 patients in the doxycycline group. Primary outcomes defined as treatment failure requiring broadening of antibiotics, all-cause inpatient mortality and time to clinical stability were similar between the groups. In the azithromycin group, 11.9% of patients required broadening antibiotics compared to 6.12% in the doxycycline group (p=0.46). Time to clinical stability was 3 in the azithromycin group versus 3.14 days (p=0.6) in the doxycycline group. Secondary outcomes including time to hospital discharge, time to stepdown to oral antibiotics and length of treatment had no difference between groups. There was no difference in safety outcomes between groups.

Conclusion

Azithromycin and doxycycline were comparable in terms of efficacy and safety when treating CAP. These findings can be added to the existing body of evidence supporting doxycycline as an attractive option for atypical CAP coverage.

Disclosures

All Authors: No reported disclosures
2616. Effect of Vitamin D on Clinical Outcomes in Patients Hospitalized with Influenza: A Retrospective Study
Authors: Chan-Colenbrander Suk Yin , Wang Qi
Published: November 2023

Background

Seasonal influenza infection causes significant morbidity and mortality worldwide. This study evaluates the effect of vitamin D on clinical outcomes in patients hospitalized with influenza infection.

Methods

We performed a retrospective chart review of patients (age 18 years and older) admitted between January 1, 2016, and December 31, 2019, to the University of Minnesota Medical Center, who were tested positive for influenza.

Data were summarized using median and interquartile range (IQR) for continuous variables, frequency and percentage for categorical variables. Groups were compared using two-sample Wilcoxon test for continuous variables and Chi-square test (or Fisher's exact test for sparse data) for categorical variables.

Results

Out of 320 patients tested positive for influenza, 180 were vaccinated against influenza. The median age of those tested positive in the vaccinated group was 64 (IQR 49-74) and the unvaccinated, 58 (IQR 35-71) p=0.0074. 97.8% of the vaccinated and 94.3% of the unvaccinated patients received oseltamivir. Significantly more unvaccinated patients were admitted to the intensive care unit (ICU) (p=0.0029) and required ventilatory support (p=0.0097) compared to those who were vaccinated.

55% of the vaccinated and 36.4% of the unvaccinated patients were on Vitamin D (p=0.001). Vitamin D median level was significantly higher in the vaccinated group, 35 (IQR 22-46) compared to 24 (IQR 15-36) in the unvaccinated group (p=0.0001).

Vitamin D levels did not significantly affect the length of hospital stay, ICU admission, respiratory or cardiovascular complications, hospital survival, survival at 1- and 3-years post hospitalization in both the vaccinated and unvaccinated groups.

Conclusion

Vitamin D levels did not significantly affect the clinical outcomes of patients hospitalized with influenza.

Disclosures

All Authors: No reported disclosures
2625. Characteristics and Outcomes of COVID-19 in Patients with a Left Ventricular Assist Device
Authors: Fleites Jorge , Natori Yoichiro , Simkins Jacques , Butrous Hoda , Bauerlein Jospeh , Phancao Anita , Loebe Matthias , Munagala Mrudula , Anjan Shweta
Published: November 2023

Background

Patients with left ventricular assist devices (LVAD) infected with SARS-CoV-2 may be at increased risk of complications and mortality. The purpose of the study was to analyze the characteristics and outcomes of LVAD patients with SARS-CoV-2 infection at our center.

Methods

A retrospective review of LVAD patients diagnosed with COVID-19 via PCR between March 1st, 2020, and March 1st, 2023, was conducted. Patient demographics, clinical, laboratory, and imaging data were collected. We performed descriptive statistical analysis on the data obtained.

Results

During the study period, we were actively following 130 LVAD patients, 34 (26.2%) developed COVID-19. Our cohort consisted of 27 males (79.4%) with a median age of 63.5 years and median BMI of 27.6 (Table 1). Eighteen and 12 self-identified as African American (52.9%) and Hispanic (35.3%), respectively. The common comorbidities included hypertension (94.1%), hyperlipidemia (79.4%), atrial fibrillation (67.4%), and chronic kidney disease (61.8%). The most common presenting symptoms were shortness of breath (41.2%), cough (35.3%), and fever (29.4%). Nine (26.5%) patients were asymptomatic. Twenty-eight (82.4%) and 16 (57.1%) were admitted to the hospital and ICU, respectively (Table 2). Ten (35.7%) and 2 (7.1%) patients required supplemental oxygen via nasal canula, and mechanical ventilation, respectively. Most of the hospitalized patients were managed with Remdesivir (71.4%) and systemic corticosteroids (42.9%). No complications of pump hemolysis or thrombosis, or systemic embolisms were noted. Two deaths were reported: one patient (2.9%) died while in the hospital from COVID-19, and another patient died 16 months later secondary to acute respiratory failure in the setting of post-COVID pulmonary fibrosis.

Conclusion

This is the largest single center study analyzing outcomes of COVID-19 in LVAD patients to date. Our cohort experienced a lower mortality rate from COVID-19 infection compared to prior studies. Larger studies are needed to guide management strategies and determine optimal timing for heart transplant after COVID-19.

Disclosures

All Authors: No reported disclosures
2643. Seasonality of infant respiratory syncytial virus associated bronchiolitis around the US since the onset of COVID-19: Results from four US health systems 2016-2023
Authors: Blatt Adam , Suh Mina , Wolf Zachary , Waddell Emory , Nelson Christopher B
Published: November 2023

Background

Respiratory syncytial virus (RSV) bronchiolitis (Br) is the leading cause of US infant hospitalizations and lower respiratory tract infections [1]. The historical seasonality of RSV in the US across all ages using passive laboratory surveillance has been described by the CDC (2014-17) [2] [3] and more recently by Staadegaard et al [4]. The objective of this analysis is to describe local variation in infant RSV-Br seasonality since the onset of COVID-19 in March 2020, across all facilities and all settings in four health systems across the US, and compare to trends from the recent pre-COVID-19 era.

Methods

From October 2015-April 2023 we conducted real-time surveillance across all facilities and all settings in the State University of New York (SUNY) Upstate Medical University Health System in Syracuse, NY; the Duke University Health System (DUHS) in Durham, NC; the University of South Florida Health and Tampa General Hospital (TGH) in Tampa, FL; and the Renown Regional Medical Center Health System (Renown) in Reno, NV. We assessed electronic health records (EHR) of infants (0-11 months) using ICD-10 codes for Br and RSV-Br and laboratory testing data to describe infant RSV-Br encounters. For additional methods see Movva N et al [5].

Results

During the recent pre-COVID-19 era, there was regional variation in seasonal onset and peak disease burden of infant RSV-Br (Figure 1). Onset and peak disease was earliest at TGH in the southeast and latest at Renown in the west. While occurring outside the historical seasonality timeframe, interseasonal 2021 and early seasonal 2022 infant RSV-Br was similar in duration and followed the same geographic pattern of onset to historical disease.

Conclusion

After the US onset of COVID-19 in March 2020, the geographic pattern of RSV-Br onset and peaks was preserved, despite the shift to interseasonal and early seasonal disease in 2021 and 2022, respectively. RSV surveillance is useful to determine whether RSV seasonality is returning to typical historic patterns. These results highlight the need for health system-level surveillance and can guide discussion regarding administration of candidate RSV vaccines and immunoprophylaxis and assessment of their impact.

Disclosures

Mina Suh, MPH, International Health, AstraZeneca: Grant/Research Support|Sanofi: Grant/Research Support|Sobi: Grant/Research Support ZACHARY Wolf, MBA, MS, AstraZeneca: Grant/Research Support|Sanofi: Grant/Research Support Emory Waddell, n/a, Sanofi: Research support Christopher B. Nelson, PhD MPH, Sanofi: employee|Sanofi: employee|Sanofi: Stocks/Bonds|Sanofi: Stocks/Bonds
2663. Comprehensive at-home Sexually Transmitted and Blood Borne Infection (STBBI) Testing Program: A Pilot Initiative
Authors: Christensen Brandon L , Shukalek Caley B , Kwon Grace (Juyoung) , Hill Nolan E , Church Deirdre L , Naugler Christopher T , Kim John , Somayaji Ranjani
Published: November 2023

Background

Sexually transmitted and blood borne infection (STBBIs) remain a growing concern in North America with rates increasing dramatically since 2000. Although self-testing has been demonstrated to be valid and acceptable, no fully remote STBBI testing programs are available in Canada. To evaluate feasibility and acceptability of at-home STBBI testing, we implemented a fully remote, web-based platform of risk-responsive, non-invasive STBBI diagnostics in a large Canadian health zone.

Methods

A web-based risk assessment and intake form was developed using RedCap software through a community-facing website (athomestitesting.ca) in partnership with a local sexual health centre. Demographic, sexual practices, and medical history were collected from interested participants through the platform. Diagnostic kits inclusive of testing for gonorrhea/chlamydia (urine and self-swabs of vagina/pharyngeal/rectal) and syphilis/HIV/Hepatitis C (dried blood spot) were mailed to participants based on their survey responses, along with instructions and supplies for collection and return. Outcomes to be assessed include feasibility and acceptability of the web-based platform, testing and positivity rates for STIs, and time to testing and treatment (for positive cases).

Results

In the first month to date with limited launch, eleven participants completed the intake survey and were mailed testing kits through the platform. Of the completed testing, no new STIs were identified. The median age of the cohort was 38 years old (IQR 32, 41) and six identified as men, four as women and one non-binary. Regarding gender identity, seven identified as gay/queer/bisexual and three as straight/heterosexual. In a follow-up survey, all participants to date stated reported satisfaction or extremely satisfaction with the online testing.

Conclusion

The platform model demonstrates feasibility in the early pilot phase with acceptability based on participant responses. Next steps include expanded launch of the platform and assessment of testing rates and feasibility of a web-based model for STI diagnostics.

Disclosures

Caley B. Shukalek, MD, MSc, MPH, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria|Merck Canada: Grant/Research Support|Merck Canada: Honoraria|PurposeMed Inc: Advisor/Consultant|PurposeMed Inc: Ownership Interest Ranjani Somayaji, M.D., CF Foundation: Grant/Research Support|CIHR: Grant/Research Support|Oncovir: Data and Safety Monitoring Board Fees|Vertex Pharmaceuticals: Advisor/Consultant|Vertex Pharmaceuticals: Grant/Research Support|Vertex Pharmaceuticals: Honoraria
2664. Patient Perspectives on Care Outcomes and Interactions with an Urban Emergency Department Health System for Mpox: A Quality Improvement Study
Authors: Dashler Gaby , Rudolph David , Brady Molly , Qiao Luxi , Jones Joyce , Hamill Matthew M , Gebo Kelly , Saheed Mustapha O , Heol Mun , Johnson Nyah , Rothman Richard E , Hsieh Yu-Hsiang , Hansoti Bhakti
Published: November 2023

Background

The Emergency Department (ED) is a safety net for vulnerable patients, and where almost 50% of patients with Mpox initially presented for care. We hypothesized that insufficient healthcare provider knowledge and expertise with Orthopoxvirus outbreaks, compounded by the social stigma experienced by patients at risk of acquiring Mpox, may impact the quality of care received by patients in this venue.

Methods

All patients who received Mpox care in Johns Hopkins Health System Emergency Departments (N=4) were invited to participate in a post-discharge telephonic interview approximately six months after their index visit. Study staff interviewed and coded patients using a semi-structured interview script with three overarching themes “system,” “clinical,” and “individual” level barriers and facilitators to care delivery.

Results

From July to November 2022, 47 patients received care for Mpox in the ED of which 13 agreed to participate; participants were mostly male (100%), living with concurrent HIV (54%) and identified as MSM (62%). Most patients were ultimately discharged from the ED (62%). The concern most often expressed by patients (n=7; 53%) was the lack of information regarding follow-up, isolation, and vaccine eligibility from the clinical staff, forcing patients to rely on the Internet and friends for information (n=5, 38%). Patients were also confused and frustrated about access to tecovirimat (n=4, 31%). Concerningly, experiences of stigma also played a significant role in patients' perception of access and quality of care from the ED (n=5, 38%).

Conclusion

Even though many patients with Mpox in the ED did not require hospitalization or treatment, the ED remained an important public health venue to help patients navigate this illness. Patients presenting to the ED often reported feeling stigmatized and uncertain about the next steps in their care post-diagnosis. Early, clear, concise public health messaging is critical to help improve provider and patient knowledge, as well as the patient experience. The ED is an important venue for risk communication and containment during an early outbreak response, especially for high-profile diseases that are under media scrutiny and where clinical uncertainty drive misinformation.

Disclosures

Matthew M. Hamill, MBChB, PhD, Roche diagnostics: Honoraria Kelly Gebo, MD, MPH, Pfizer: Advisor/Consultant|Spark HealthCare: Advisor/Consultant Richard E. Rothman, MD, PhD, CEPHEID: Advisor/Consultant|Cepheid: Grant/Research Support|Danaher: Grant/Research Support
2666. Rates of STI Testing and Diagnoses among Patients with Mpox in New York City, 2022
Authors: Gunaratne Shauna , Huang Simian , McLean Jacob , DeLaurentis Clare , Zucker Jason
Published: November 2023

Background

The 2022 global mpox outbreak occurred in the context of rising rates of sexually transmitted infections (STIs). We hypothesize that concurrent STI rates were underestimated due to inadequate testing during virtual visits and non-sexual health clinical settings.

Methods

We included data from all patients with confirmed mpox (through non-variola orthopoxviral PCR testing) from June 25 to October 17, 2022 at an urban tertiary academic center in New York. Manual chart review supplemented data extracted from the electronic medical record. We calculated descriptive statistics for HIV, syphilis, genitourinary, rectal, and pharyngeal gonorrhea/chlamydia (GC/CT) screening and diagnosis rates. We evaluated relationships between site-specific symptoms and extragenital testing.

Results

Of 228 individuals in the database, 98% were male at birth, the median age was 34 years. 40% were Hispanic and 27% Black. 50% were living with HIV. Only 41% were tested for other STIs in the two weeks prior to their mpox diagnosis.

At the time of their mpox visit, 62.7% of patients were tested for syphilis, with 45.5% showing evidence of active or previously treated syphilis. 67 persons without known HIV were tested for HIV, resulting in 3 new diagnoses within 2 weeks of mpox diagnosis. 57.5% of patients were screened with a genitourinary GC/CT nucleic acid amplification testing (NAAT), with 2.3% and 3.8% positive for gonorrhea and chlamydia, respectively. 46.5% were screened with a rectal GC/CT NAAT, with 16.0% and 6.6% positive for gonorrhea and chlamydia, respectively. 47.4% of individuals were screened with a pharyngeal GC/CT NAAT, with 7.4% and 0.9% positive for gonorrhea and chlamydia, respectively.

Site specific GC/CT NAATs were obtained from 52.2%, 55%, and 54% of patients with urinary, rectal and pharyngeal signs or symptoms, respectively. Without extragenital testing, 10 of 28 total gonorrhea cases (35.7%) and 3 of 13 total chlamydia cases (23.1%) would have been missed.

Conclusion

STI testing was insufficient in people with confirmed mpox, likely leading to under diagnosis of STIs. HIV testing was inadequate in at-risk individuals, and patients presenting with site-specific symptoms were too frequently not offered targeted testing.

Disclosures

All Authors: No reported disclosures
2681. National Outpatient Sexually Transmitted Infection Testing in Pregnant Patients in the United States, 2012 to 2019
Authors: Strey Kelsey , Mendoza Vidal M , Reveles Kelly
Published: November 2023

Background

Sexually transmitted infections (STI) continue to increase annually in the United States (US) with 2.5 million infections reported by the Centers for Disease Control and Prevention (CDC) in 2021. Pregnant patients are at risk for serious complications due to infection. It is recommended that pregnant women are screened early in pregnancy to avoid poor outcomes; however, few studies have used nationally representative data to assess STI testing in pregnancy in the US. This study aimed to estimate the utilization of preventative STI care on a national scale in pregnant patients.

Methods

This was a retrospective, cross-sectional study of outpatient visits in the CDC's National Ambulatory Medical Care Survey from 2012 to 2019. All patients reported as pregnant were included for analysis to assess STI testing (e.g., chlamydia, gonorrhea, hepatitis, HIV) overall. STI testing was described per 1000 total visits. Subgroup analyses were conducted by race, ethnicity and region. Multivariable logistic regression was used to identify predictors of receiving at least one STI test. Data weights were applied to analyses to generate national estimates.

Results

Over 232 million visits were included for analysis, of which 7.6% included an STI test. Overall, rates of receiving any STI test varied over the study period (39.6-136.0 per 1000 visits). Chlamydia testing was the most common, followed by gonorrhea, HIV, and hepatitis (48.5 v. 42.1 v. 39.5 v. 19.6 per 1000). Patients of non-Hispanic ethnicity, White race, and those in the West region had the lowest rates of STI testing (74.1 v. 55.8 v. 43.4 per 1000). Overall, Hispanic ethnicity (aOR 1.152, 95%CI 1.150-1.155), Black and more than one race (aOR 2.837, 95%CI 2.831-2.843 and aOR 3.06, 95%CI 3.04-3.09), government and private insurance (aOR 4.63, 95%CI 4.58-4.68 and aOR 4.71, 95%CI 4.66-4.76), metropolitan areas (aOR 1.865, 95%CI 1.859-1.871), and the Northeast region (aOR 2.449, 95%CI 2.442-2.455) were predictive of receiving any STI test.

Conclusion

STI testing in US outpatient physician offices varied over the study period and across test types, though was consistently low. Additionally, certain patient attributes, such as race, ethnicity, and payment source were predictive of testing.

Disclosures

Kelly Reveles, PharmD, PhD, Ferring Pharmaceuticals: Advisor/Consultant|Ferring Pharmaceuticals: Honoraria
2688. Characteristics of joint infections in solid organ transplant recipients
Authors: Abdow Victor P , Fraker John H , Kumar Rebecca , Beaulieu Ronald M
Published: November 2023

Background

There are sparse data surrounding joint infections in solid organ transplant (SOT) recipients, and this population is not specifically addressed in the Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines. We aim to provide microbiologic and treatment data to help inform future guidelines on managing joint infections in this unique patient population.

Methods

We retrospectively reviewed all adult SOT recipient admissions in our ten-hospital system for native or prosthetic joint infection between January 2015 and December 2021. Eighty-one patients were included based on ICD-9 or ICD-10 codes and were excluded if they were < 18 years old, did not have a SOT on immunosuppression, were transferred prior to treatment, or did not have a large joint infection (total n=33).

Results

There were 33 joint infections in 25 patients. The overall median time from transplant to joint infection was 3.7 years; heart and multivisceral occurred earlier (1.3 and 0.8 years, respectively). More than 77% of native joint infections required surgical intervention (n=17); 16 required washout. All 11 prosthetic joint infections required surgical intervention: two-stage revision was required in 7 of these cases, and debridement, antibiotics and implant retention (DAIR) procedure was performed only once. Just 15% of patients (n=5) had a resistant organism; the most common was methicillin-resistant Staphylococcus aureus (n=3). The median duration of antibiotics was 6.0 weeks. Only 42% of patients had resolution of the joint infection (n=14). Other outcomes included chronic suppression (n=7), recurrence (n=5), new infection (n=3), death (n=3), and amputation (n=1).

Conclusion

This study found that joint infections typically occur more than a year out from transplant. IDSA guidelines for surgical management of prosthetic joint infections advocates for DAIR or single-stage revision where feasible. However, most of our SOT patients required two-stage revision, suggesting a possible need for more aggressive intervention in this population. Additionally, most patients did not have multi-drug resistant organisms, indicating that multi-drug resistant coverage (i.e. carbapenems) is not necessarily needed in this population.

Disclosures

Rebecca Kumar, MD, Astra Zeneca: Grant/Research Support|Astra Zeneca: Honoraria|Regeneron: Grant/Research Support
2706. Effectiveness and Safety of Shingrix Vaccination in Solid Organ Transplant Recipients at a Large Urban Transplant Center
Authors: Halkett Megan , Ison Michael
Published: November 2023

Background

The varicella zoster virus (VZV) recombinant subunit vaccine, Shingrix, was found to be safe in solid organ transplant recipients (SOTR) and is now approved and recommended for all immunocompromised patients. Given limited efficacy data, we preferred a single center retrospective study to demonstrate safety and effectiveness of the Shingrix vaccine in solid organ transplant recipients.

Methods

After IRB approval, clinical data from all SOTR at Northwestern Memorial Hospital (NMH) who received the Shingrix vaccine after their transplant, between January 1, 2017 and March 1, 2022 was collected from our Enterprise Data Warehouse (EDW). Extracted data includes age, race, ethnicity, date of transplant, organ transplanted, and date(s) of vaccine administration(s). Clinical outcomes were assessed by diagnosis of acute allograft rejection and/or HZ made post-vaccine administration. Descriptive statistics were utilized. This project is supported by the IDSA G.E.R.M. program.

Results

309 of 338 eligible SOTR were included in the analysis of this study (characteristics and reasons for exclusion in Table 1). Only 1 (0.32%) patient experienced a new episode of acute allograft rejection within 3 months of Shingrix administration. 18/309 (5.8%) were diagnosed with HZ after vaccination with Shingrix. This represents a reduction in VZV reactivation events compared to the 9.1% incidence found in the 2021 meta-analysis of HZ in the general solid organ transplant population [Kwon, Transpl Infect Dis., 2021].Table 1.Characteristics of 338 solid organ transplant patients who received Shingrix vaccine.

Conclusion

The Shingrix vaccine, when administered to SOTR post-transplant, is safe and likely effective in reducing the rate of herpes zoster. This data supports the current recommendation to vaccinate all SOTR with Shingrix. Larger, multi-center data are needed to inform the true efficacy of the vaccine in SOTRs.

Disclosures

All Authors: No reported disclosures
2744. A 5-Year Single-Center Review of Strongyloides Seropositivity in Kidney Transplant Candidates in Rural Central Texas
Authors: Snellings Robin , Telchik Collin M , Padakanti Sowmya , Negron-Diaz Juan , Cahuayme-Zuniga Lizbeth
Published: November 2023

Background

The American Society of Transplantation recommends screening for Strongyloides stercoralis for people from or with extended travel to endemic areas including tropical regions of Southeast Asia and the Appalachian region of the United States. Asymptomatic carriers without risk factors can potentially be missed during screening assessments. Consequently, they can develop deadly hyperinfection and disseminated disease with immunosuppressive therapy. The aim of this study is to identify demographics and characteristics among our population of Strongyloides-infected kidney transplant candidates in rural Central Texas.

Methods

This study is a single-center, retrospective chart review of patients aged 18 or older who underwent evaluation for kidney transplant at our institution in rural Central Texas between January 1, 2018 and December 31, 2022 and tested equivocal or positive for serum Strongyloides IgG antibody.

Results

Out of the 1653 patients who underwent Strongyloides screening during their evaluation for kidney transplant within the study period, 182 (11.0%) returned as either equivocal or positive. Demographics of this Strongyloides-infected population are noted in table 1. 86.3% of these patients were born in the United States or Canada, 6.6% from Mexico, and 3.3% from Asia. 33.0% reported no international travel outside the United States (table 1). Comorbidities and symptoms of our population are listed in table 2. 83.5% were asymptomatic. Laboratory data and other risk factors for Strongyloides infection are noted in table 3. Only 6.0% had eosinophilia at time of diagnosis (considered as greater than 0.00 - 0.76 10*9/L). None of our population tested positive for human T-lymphotrophic virus (HTLV-1). Out of the 69 patients who were asked, 71.0% reported a history of walking outside barefoot.

Demographic information and international travel outside the United States

Patient comorbidities and symptoms

Laboratory data and other risk factors

Conclusion

Importantly, 11.0% of our population were found to have an equivocal or positive Strongyloides serology. Of those, 33.0% had no apparent risk factors for Strongyloides infection including international travel, suggesting local acquisition of the infection in rural Central Texas. More research is needed to identify unique risk factors for this population including environmental studies of this underserved population.

Disclosures

All Authors: No reported disclosures
2753. Real-World Use of Cefiderocol Treating Non-COVID Patients with Confirmed Gram-Negative Infections in US Hospitals During January 2020-June 2022
Authors: Cai Bin , Zhou Yun , Slover Christine M , Copeland Jennifer D , Nguyen Sean T
Published: November 2023

Background

Cefiderocol (CFDC) has broad activity against Gram-negative (GN) pathogens. This study describes the CFDC usage in treating non-COVID patients with microbiology data in US hospitals from Jan 2020-Jun 2022.

Methods

This retrospective multicenter observational study included adult non-COVID hospitalized patients treated with CFDC consecutively for ≥3 days after laboratory confirmed GN infections between Jan 2020 to Jun 2022, as captured by Premier Healthcare data. This study describes the patient characteristics, microbiological profile, and overall, as well as 14-day and 28-days, in-hospital all-cause mortality (IHACM). Index culture was defined as the first clinical culture with GN pathogens. Index pathogens were all pathogens identified from the index culture.

Results

Patient characteristics of 275 hospitalized patients who received ≥3 days CFDC after the microbiological results are shown in Table 1. For index culture, 61.1% were taken ≤3 days of admission, 53.1% were taken during ICU stay, 45.8% involved respiratory culture, followed by urinary (19.6%), wound (18.2%) and blood (16.4%). Also 65.8% of patients had one index pathogen and 34.2% had ≥2 index pathogens. The most common index pathogens were Pseudomonas aeruginosa (48.7%), Acinetobacter baumannii (23.6%), Klebsiella pneumoniae (14.2%), and Stenotrophomonas maltophilia (13.1%). On the index culture day, 62.2% of patients had one pathogen from a single site and 37.8% had either one pathogen identified in multiple culture sites or multiple pathogens from ≥1 culture site.

CFDC was used as monotherapy in 92 (33%) patients, though 253 (92%) had used other GN antibiotics before starting CFDC. A total of 135 (49.1%) patients started CFDC ≤ 5 days of index culture, 108 (39.3%) patients between 6-20 days, and 32 (11.6%) patients > 20 days.

Crude overall IHACM was 16.4% (95%CI:12.0%-20.7%): 10.4% for those who started CFDC ≤ 5 days of index culture, 19.4% for 6-20 days, and 31.3% for > 20 days. Crude 14-day and 28-day IHACM from index culture or starting CFDC had the same trend and were lower than overall IHACM (see Table 2).

Conclusion

The study demonstrated that CFDC is effective in treating patients with GN infections. Patients receiving CFDC earlier had lower IHACM than those receiving CFDC later but need further investigation.

Disclosures

Bin Cai, MD, PhD, Shionogi Inc.: Shionogi employee Christine M. Slover, PharmD, Shionogi,INC: Employee Jennifer D. copeland, MS, Shionogi, Inc.: Employee (Medical/Micro) Sean T. Nguyen, PharmD, Shionogi: Employee|Shionogi, Inc: Employee
2774. Predictors of Treatment Outcomes in Bloodstream Infections Due to OXA-48-producing Klebsiella pneumoniae
Authors: Huang Po-Han , Chou Sheng-Hua , Chen Wen-Yin , Lin Yi-Tsung
Published: November 2023

Background

Klebsiella pneumoniae causes various infections and the rising prevalence of carbapenem-resistant K. pneumoniae (CRKP) constitutes a major public health threat. Carbapenemase production is the most common mechanism of carbapenem resistance in CRKP, and OXA-48-like-producing strains accounted for about one-fifth of carbapenemase-producing CRKP worldwide. Despite clinical evidence supporting the use of ceftazidime-avibactam (CZA) in treating carbapenem-resistant Enterobacterales (CRE) infections, studies regarding its effectiveness for OXA-48-producing CRKP is limited. OXA-48-producing CRKP may test susceptible to meropenem in vitro, but whether meropenem is effective when phenotypic-genotypic discordance exists is unknown.

Methods

In this retrospective cohort study, we evaluated patients with OXA-48-producing CRKP bacteremia at Taipei Veterans General Hospital from April 2017 through December 2022. Patients were categorized into five groups according to the treatment received: CZA, meropenem, colistin, colistin-meropenem combination, and other treatments. Clinical outcomes were compared according to the antibiotics received, and logistic regression was performed to evaluate risk factors associated with treatment failure.

Results

Forty-five patients were included, with 87% (39/45) having received at least one active antibiotic against the OXA-48-producing CRKP isolated from blood. Fourteen- and 30-day mortality rates were 31% and 38%, respectively. The clinical failure rate was 27% (4/15) for patients treated with CZA, 40% (4/10) with meropenem, 100% (8/8) with colistin, 75% (3/4) with meropenem-colistin-combination, and 38% (3/8) with other treatments (P = 0.010). The clinical failure rate for meropenem-treated patients dropped to 25% (2/8) if only CRKP strains with meropenem minimal inhibitory concentration (MIC) ≤ 4 mg/L were analyzed. In multivariate analysis, clinical failure was associated with Apache II Score (P = 0.022) and colistin use (P = 0.002).

Rates of clinical failure across treatment regimens

Rates of clinical failure at different meropenem MIC values in patients receiving meropenem treatment

MIC, minimum inhibitory concentration

Multivariable analysis of risk factors associated with clinical failure at 30 days

CI, conﬁdence interval

Conclusion

CZA is an important option in the treatment of OXA-48-producing CRKP bacteremia, and meropenem may remain a reasonable alternative if meropenem MIC was ≤ 4 mg/L. Use of colistin is an independent risk factor for treatment failure and should be avoided.

Disclosures

Po-Han Huang, MD, MSc, Pfizer: Honoraria